Factors related to antibiotic-associated diarrhea in patients in the intensive care unit receiving antifungals: a single-center retrospective study

Sun, Jing; Zhang, Yanshu; Yu, Long-Chuan; Shi, Qiong; Xue, Wei; Zhang, Lei; Guo, Litao

doi:10.1177/0300060519836305

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…A recent retrospective study has revealed a higher incidence of antifungal-associated diarrhea (AAD) in patients within the intensive care unit who were treated with antifungals. This outcome is likely attributed to the fact that antifungals are commonly administered alongside other antibiotics, increasing the likelihood of inducing AAD [ 37 , 38 ]. In our study, amphotericin b and fluconazole were the existing antifungals in the antibiotics that met the inclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

Antibiotics and antibiotic-associated diarrhea: a real-world disproportionality study of the FDA adverse event reporting system from 2004 to 2022

Huang,

Li,

et al. 2023

BMC Pharmacol Toxicol

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Background Our study aimed to assess the risk signals of antibiotic-associated diarrhea (AAD) caused by various antibiotics using real-world data and provide references for safe clinical applications. Methods We analyzed data extracted from the FDA Adverse Event Reporting System (FAERS) database, covering the period from the first quarter of 2004 to the third quarter of 2022. We computed the reporting odds ratio (ROR) for each antibiotic or antibiotic class to compare the signal difference. Furthermore, we also examined the differences in the onset times and outcomes of AAD caused by various antibiotics. Results A total of 5,397 reports met the inclusion requirements. Almost all antibiotics, except tobramycin and minocycline (ROR 0.98; 95%CI: 0.64–1.51 and 0.42; 95%CI: 0.16–1.11, respectively), showed a significant correlation with AAD. The analysis of the correlation between different classes of antibiotics and AAD revealed that lincomycins (ROR 29.19; 95%CI: 27.06–31.50), third-generation cephalosporins (ROR 15.96; 95%CI: 14.58–17.47), and first/second generation cephalosporins (ROR 15.29; 95%CI: 13.74–17.01) ranked the top three. The ROR values for antibiotics from the same class of antibiotics also varied greatly, with the ROR values for third-generation cephalosporins ranging from 9.97 to 58.59. There were also differences in ROR values between β-lactamase inhibitors and their corresponding β-lactamase drugs, such as amoxicillin-clavulanate (ROR = 13.31; 95%CI: 12.09–14.65) and amoxicillin (ROR = 6.50; 95%CI: 5.69–7.44). 91.35% of antibiotics have an onset time of less than four weeks. Conclusions There is a significant correlation between almost all antibiotics and AAD, particularly lincomycins and β-lactam antibiotics, as well as a different correlation within the same class. These findings offer valuable evidence for selecting antibiotics appropriately.

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Section: Discussionmentioning

confidence: 99%

Antibiotics and antibiotic-associated diarrhea: a real-world disproportionality study of the FDA adverse event reporting system from 2004 to 2022

Huang,

Li,

et al. 2023

BMC Pharmacol Toxicol

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Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients

Cui,

Zhou,

Liu

et al. 2024

BMC Geriatr

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Background Antibiotic-associated diarrhea (AAD) can prolong hospitalization, increase medical costs, and even lead to higher mortality rates. Therefore, it is essential to predict the incidence of AAD in elderly intensive care unit(ICU) patients. The objective of this study was to create a prediction model that is both interpretable and generalizable for predicting the incidence of AAD in elderly ICU patients. Methods We retrospectively analyzed data from the First Medical Center of the People’s Liberation Army General Hospital (PLAGH) in China. We utilized the machine learning model Extreme Gradient Boosting (XGBoost) and Shapley’s additive interpretation method to predict the incidence of AAD in elderly ICU patients in an interpretable manner. Results A total of 848 adult ICU patients were eligible for this study. The XGBoost model predicted the incidence of AAD with an area under the receiver operating characteristic curve (ROC) of 0.917, sensitivity of 0.889, specificity of 0.806, accuracy of 0.870, and an F1 score of 0.780. The XGBoost model outperformed the other models, including logistic regression, support vector machine (AUC = 0.809), K-nearest neighbor algorithm (AUC = 0.872), and plain Bayes (AUC = 0.774). Conclusions While the XGBoost model may not excel in absolute performance, it demonstrates superior predictive capabilities compared to other models in forecasting the incidence of AAD in elderly ICU patients categorized based on their characteristics.

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Use of Express Tests in the Practice of Family Doctors and Pediatricians

Gospodarenko

Klets

Gnyloskurenko

et al. 2021

USMYJ

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Rapid diagnosis significantly reduces the patient's expectation of effective medical care. As a result, rapid or POC-tests are becoming increasingly important in the world. However, the frequency of their use, the availability of tests in medical facilities, the awareness of physicians about diagnostic capabilities and the need for them are currently unclear. The aim of our study was to determine the level of awareness of physicians about the use of rapid tests for influenza, RS-virus, ꞵ-hemolytic group A streptococcus and laboratory markers of inflammation in the form of POC-tests in daily practice. The study was conducted by interviewing 78 pediatricians and family physicians in Kyiv and Kyiv region who work at the primary and secondary levels of medical care. A questionnaire from EAPRASnetT (European Academy of Pediatric Research in the network of outpatient settings) was used for the survey. Our research has shown that hospital physicians are more informed about the use of rapid diagnostics and are more willing to use it in the treatment and diagnostic process. A rapid antigen test for influenza is available to the vast majority of inpatients (78%) and only half of outpatients (46.3%). Half of primary care physicians (56.1%) and the vast majority of secondary care professionals (73%) are willing to use this test in practice if it is available. The results of our study also showed a higher adherence to this rapid test of inpatients, as only 2.7% of them would like to confirm the results of POC-tests by laboratory tests (compared to 22% of outpatients). Most doctors in both outpatient clinics (61%) and inpatients (75.7%) are ready to use a rapid test for respiratory syncytial virus. Only 2.7% of hospital doctors would like to have a laboratory version, and outpatients would be completely satisfied with a quick test. However, due to the lack of trust in 14.6% of cases, they would like to confirm its results by laboratory testing. About a third of physicians (39%) use the rapid test for ꞵ-hemolytic group A streptococcus in the outpatient clinic, but half (51.2%) stated the need for this test and its unavailability. In the hospital, the data obtained were the opposite: half of doctors already use this test (59.5%), and another third would like to have it (35.1%). Rapid C-reactive protein testing is poorly used by physicians in both health care settings (12.2% in the outpatient setting and 29.7% in the inpatient setting) due to low security and lack of awareness. This is confirmed by the fact that 75.6% of primary and 64.9% of secondary care physicians stated that the test is not available, but they are ready to use this test if available. POC-test for C-reactive protein is used more in the hospital than in the outpatient clinic. At the outpatient stage, 12.2% of physicians do not consider it appropriate to use C-reactive protein in the diagnosis of diseases, in the hospital of such physicians 5%. About 10% of doctors in both groups expressed distrust in the rapid CRP-test, as they would like to use only the laboratory version. Doubts about the accuracy of almost twice as many outpatients, as more often would like to check it with a laboratory version (19.5% vs. 10.8% of inpatients). Therefore, one in five physicians in the outpatient clinic would use both the laboratory and POC versions. The rapid test for procalcitonin is used by every 5th doctor in the hospital and only 7% of the primary care, which can be attributed to the low availability of the test in medical practice, poor provision of medical institutions with POC-tests, as 62.2% and 78% of doctors the hospital and the clinic replied that they would use it if it was available. As for the complete general analysis of blood with leukocyte formula, only 17.1% and 35.5% of doctors of the polyclinic and hospital would like to use its POC version. Interviewed physicians would prefer a laboratory version of the test.It is necessary to raise awareness of physicians, especially primary care, about modern diagnostic methods, namely the practice of POC-tests and make them more accessible, which would significantly improve the diagnosis and treatment of patients, would have a positive impact on public health and significant economic effect.

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Factors related to antibiotic-associated diarrhea in patients in the intensive care unit receiving antifungals: a single-center retrospective study

Cited by 3 publications

References 26 publications

Antibiotics and antibiotic-associated diarrhea: a real-world disproportionality study of the FDA adverse event reporting system from 2004 to 2022

Antibiotics and antibiotic-associated diarrhea: a real-world disproportionality study of the FDA adverse event reporting system from 2004 to 2022

Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients

Use of Express Tests in the Practice of Family Doctors and Pediatricians

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