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Article ; Online: Antibiotic treatment durations for pyogenic liver abscesses: A systematic review.

Curran, Jennifer / Mulhall, Catherine / Pinto, Ruxandra / Bucheeri, Mohamed / Daneman, Nick

Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada

2023 Volume 8, Issue 3, Page(s) 224–235

Abstract: Background: We sought to systematically review the existing research on pyogenic liver abscesses to determine what data exist on antibiotic treatment durations.: Methods: We conducted a systematic review and meta-analysis of contemporary medical ... ...

Abstract	Background: We sought to systematically review the existing research on pyogenic liver abscesses to determine what data exist on antibiotic treatment durations. Methods: We conducted a systematic review and meta-analysis of contemporary medical literature from 2000 to 2020, searching for studies of pyogenic liver abscesses. The primary outcome of interest was mean antibiotic treatment duration, which we pooled by random-effects meta-analysis. Meta-regression was performed to examine characteristics influencing antibiotic durations. Results: Sixteen studies (of 3,933 patients) provided sufficient data on antibiotic durations for pooling in meta-analysis. Mean antibiotic durations were highly variable across studies, from 8.4 (SD 5.3) to 68.9 (SD 30.3) days. The pooled mean treatment duration was 32.7 days (95% CI 24.9 to 40.6), but heterogeneity was very high ( Conclusions: Among studies reporting on antibiotic durations for pyogenic liver abscess, treatment practices are highly variable. This variability does not seem to be explained by differences in patient, pathogen, abscess, or management characteristics. Future RCTs are needed to guide optimal treatment duration for patients with this complex infection.
Language	English
Publishing date	2023-11-29
Publishing country	Canada
Document type	Journal Article
ISSN	2371-0888
ISSN (online)	2371-0888
DOI	10.3138/jammi-2023-0004
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Article ; Online: Fixed versus individualized treatment for five common bacterial infectious syndromes: a survey of the perspectives and practices of clinicians.

Mponponsuo, Kwadwo / Pinto, Ruxandra / Fowler, Robert / Rogers, Ben / Daneman, Nick

JAC-antimicrobial resistance

2023 Volume 5, Issue 4, Page(s) dlad087

Abstract: Background: Traditionally, bacterial infections have been treated with fixed-duration antibiotic courses; however, some have advocated for individualized durations. It is not known which approach currently predominates.: Methods: We conducted a ... ...

Abstract	Background: Traditionally, bacterial infections have been treated with fixed-duration antibiotic courses; however, some have advocated for individualized durations. It is not known which approach currently predominates. Methods: We conducted a multinational clinical practice survey asking prescribers their approach to treating skin and soft tissue infection (SSTI), community-acquired pneumonia (CAP), pyelonephritis, cholangitis and bloodstream infection (BSI) of an unknown source. The primary outcome was self-reported treatment approach as being fully fixed duration, fixed minimum, fixed maximum, fixed minimum and maximum, or fully individualized durations. Secondary questions explored factors influencing duration of therapy. Multivariable logistic regression with generalized estimating equations was used to examine predictors of use of fully fixed durations. Results: Among 221 respondents, 170 (76.9%) completed the full survey; infectious diseases physicians accounted for 60.6%. Use of a fully fixed duration was least common for SSTI (8.5%) and more common for CAP (28.3%), BSI (29.9%), cholangitis (35.7%) and pyelonephritis (36.3%). Fully individualized therapy, with no fixed minimum or maximum, was used by only a minority: CAP (4.9%), pyelonephritis (5.0%), cholangitis (9.9%), BSI (13.6%) and SSTI (19.5%). In multivariable analyses, a fully fixed duration approach was more common among Canadian respondents [adjusted OR (aOR) 1.76 (95% CI 1.12-2.76)] and for CAP (aOR 4.25, 95% CI 2.53-7.13), cholangitis (aOR 6.01, 95% CI 3.49-10.36), pyelonephritis (aOR 6.08, 95% CI 3.56-10.39) and BSI (aOR 4.49, 95% CI 2.50-8.09) compared with SSTI. Conclusions: There is extensive practice heterogeneity in fixed versus individualized treatment; clinical trials would be helpful to compare these approaches.
Language	English
Publishing date	2023-08-01
Publishing country	England
Document type	Journal Article
ISSN	2632-1823
ISSN (online)	2632-1823
DOI	10.1093/jacamr/dlad087
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Article ; Online: Does this patient have Clostridioides difficile infection? A systematic review and meta-analysis.

Manzoor, Fizza / Manzoor, Saba / Pinto, Ruxandra / Brown, Kevin / Langford, Bradley J / Daneman, Nick

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

2023

Abstract: Background: The clinical features and predictors of Clostridioides difficile infection overlap with many conditions.: Objectives: We performed a systematic review to evaluate the diagnostic utility of clinical features (clinical examination, risk ... ...

Abstract	Background: The clinical features and predictors of Clostridioides difficile infection overlap with many conditions. Objectives: We performed a systematic review to evaluate the diagnostic utility of clinical features (clinical examination, risk factors, laboratory tests, and radiographic findings) associated with C. difficile. Methods: Systematic review and meta-analysis of diagnostic features for C. difficile. Data sources: MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched up to September 2021. Study eligibility criteria: Studies that reported clinical features of C. difficile, a valid reference standard test for confirming diagnosis of C. difficile, and a comparison among patients with a positive and negative test result. Participants: Adult and paediatric patients across diverse clinical settings. Outcomes: Sensitivity, specificity, likelihood ratios. Reference standard: Stool nucleic acid amplification tests, enzyme immunoassays, cell cytotoxicity assay, and stool toxigenic culture. Assessment of risk of bias: Rational Clinical Examination Series and Quality Assessment of Diagnostic Accuracy Studies-2. Methods of data synthesis: Univariate and bivariate analyses. Results: We screened 11 231 articles of which 40 were included, enabling the evaluation of 66 features for their diagnostic utility for C. difficile (10 clinical examination findings, 4 laboratory tests, 10 radiographic findings, prior exposure to 13 antibiotic types, and 29 clinical risk factors). Of the ten features identified on clinical examination, none were significantly clinically associated with increased likelihood of C. difficile infection. Some features that increased likelihood of C. difficile infection were stool leukocytes (LR+ 5.31, 95% CI 3.29-8.56) and hospital admission in the prior 3 months (LR+ 2.14, 95% CI 1.48-3.11). Several radiographic findings also strongly increased the likelihood of C. difficile infection like ascites (LR+ 2.91, 95% CI 1.89-4.49). Discussion: There is limited utility of bedside clinical examination alone in detecting C. difficile infection. Accurate diagnosis of C. difficile infection requires thoughtful clinical assessment for interpretation of microbiologic testing in all suspected cases.
Language	English
Publishing date	2023-06-14
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1328418-6
ISSN	1469-0691 ; 1470-9465 ; 1198-743X
ISSN (online)	1469-0691
ISSN	1470-9465 ; 1198-743X
DOI	10.1016/j.cmi.2023.06.010
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Zs.A 4541: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Candida colonization as a predictor of invasive candidiasis in non-neutropenic ICU patients with sepsis: A systematic review and meta-analysis.

Alenazy, Hameid / Alghamdi, Amenah / Pinto, Ruxandra / Daneman, Nick

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

2020 Volume 102, Page(s) 357–362

Abstract: Background: Candida colonization is a risk factor for the development of invasive candidiasis. This study sought to estimate the magnitude of this association, and determine if this information can be used to guide empirical antifungal therapy ... ...

Abstract	Background: Candida colonization is a risk factor for the development of invasive candidiasis. This study sought to estimate the magnitude of this association, and determine if this information can be used to guide empirical antifungal therapy initiation in critically ill septic patients. Methods: PubMed/MEDLINE and Embase were systematically reviewed for all published studies evaluating predictors of invasive candidiasis in ICU patients with sepsis. Meta-analysis was used to determine the pooled odds ratio for invasive candidiasis among colonized versus non-colonized patients. Sensitivity (SN), specificity (SP), positive and negative predictive values (PPV, NPV), and positive and negative likelihood ratios (+LR, -LR) were then calculated by considering the presence/absence of Candida colonization as the diagnostic test, and the presence/absence of invasive candidiasis as the disease of interest. Results: Out of 9825 patients in the 10 eligible studies, 3886 (40%) were colonized with Candida and 462 patients (4.7%) developed invasive candidiasis. Meta-analysis indicated that critically ill patients with sepsis who are colonized with candida are more likely to develop invasive candidiasis (odds ratio 3.32; 95% CI 1.68-6.58) compared with non-colonized patients. The pooled SN was 75.2% (95% CI 59.6-86.2%), while the pooled SP was 49.2% (95% CI 33.2-65.3%).The NPV of Candida colonization was high (96.9%; 95% CI 92.0-98.9%), but the PPV was low (9.1%; 95% CI 5.5-14.6%). Conclusion: Candida colonization is strongly associated with the likelihood of invasive candidiasis among ICU patients with sepsis. Available data argue against initiating empirical antifungal treatment in non-neutropenic septic patients without prior documented Candida colonization.
MeSH term(s)	Candida/growth & development ; Candidiasis, Invasive/complications ; Candidiasis, Invasive/epidemiology ; Candidiasis, Invasive/microbiology ; Critical Illness ; Humans ; Intensive Care Units ; Risk Factors ; Sepsis/complications ; Sepsis/epidemiology ; Sepsis/microbiology
Language	English
Publishing date	2020-11-03
Publishing country	Canada
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1331197-9
ISSN	1878-3511 ; 1201-9712
ISSN (online)	1878-3511
ISSN	1201-9712
DOI	10.1016/j.ijid.2020.10.092
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Zs.A 4516: Show issues

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Article ; Online: Remdesivir in Patients With Severe Kidney Dysfunction: A Secondary Analysis of the CATCO Randomized Trial.

Cheng, Matthew / Fowler, Rob / Murthy, Srinivas / Pinto, Ruxandra / Sheehan, Nancy L / Tseng, Alice

JAMA network open

2022 Volume 5, Issue 8, Page(s) e2229236

MeSH term(s)	Adenosine Monophosphate/analogs & derivatives ; Adenosine Monophosphate/therapeutic use ; Alanine/analogs & derivatives ; Alanine/therapeutic use ; Humans ; Kidney ; Kidney Diseases
Chemical Substances	remdesivir (3QKI37EEHE) ; Adenosine Monophosphate (415SHH325A) ; Alanine (OF5P57N2ZX)
Language	English
Publishing date	2022-08-01
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.29236
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Article ; Online: The authors reply.

Taran, Shaurya / Angriman, Federico / Pinto, Ruxandra / Ferreyro, Bruno / Amaral, Andre Carlos Kajdacsy-Balla

Critical care medicine

2022 Volume 50, Issue 6, Page(s) e590

Language	English
Publishing date	2022-05-19
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005511
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Zs.A 1261: Show issues

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Article ; Online: Measuring variability between clusters by subgroup: An extension of the median odds ratio.

Yarnell, Christopher / Pinto, Ruxandra / Fowler, Rob

Statistics in medicine

2019 Volume 38, Issue 22, Page(s) 4253–4263

Abstract: Investigating clustered data requires consideration of the variation across clusters, including consideration of the component of the total individual variance that is at the cluster level. The median odds ratio and analogues are useful intuitive ... ...

Abstract	Investigating clustered data requires consideration of the variation across clusters, including consideration of the component of the total individual variance that is at the cluster level. The median odds ratio and analogues are useful intuitive measures available to communicate variability in outcomes across clusters using the variance of random intercepts from a multilevel regression model. However, the median odds ratio cannot describe variability across clusters for different patient subgroups because the random intercepts do not vary by subgroup. To empower investigators interested in equity and other applications of this scenario, we describe an extension of the median odds ratio to multilevel regression models employing both random intercepts and random coefficients. By example, we conducted a retrospective cohort analysis of variation in care limitations (goals of care preferences) according to ethnicity in patients admitted to intensive care. Using mixed-effects logistic regression clustered by hospital, we demonstrated that patients of non-Caucasian ethnicity were less likely to have care limitations but experienced similar variability across hospitals. Limitations of the extended median odds ratio include the large sample sizes and computational power needed for models with random coefficients. This extension of the median odds ratio to multilevel regression models with random coefficients will provide insight into cluster-level variability for researchers interested in equity and other phenomena where variability by patient subgroup is important.
MeSH term(s)	Cluster Analysis ; Computer Simulation ; Humans ; Multilevel Analysis ; Odds Ratio ; Regression Analysis ; Retrospective Studies
Language	English
Publishing date	2019-07-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	843037-8
ISSN	1097-0258 ; 0277-6715
ISSN (online)	1097-0258
ISSN	0277-6715
DOI	10.1002/sim.8286
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Zs.A 1756: Show issues

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Article ; Online: Discordances Between Factors Associated With Withholding Extubation and Extubation Failure After a Successful Spontaneous Breathing Trial.

Taran, Shaurya / Angriman, Federico / Pinto, Ruxandra / Ferreyro, Bruno L / Amaral, Andre Carlos Kajdacsy-Balla

Critical care medicine

2021 Volume 49, Issue 12, Page(s) 2080–2089

Abstract: Objectives: To identify whether factors associated with withholding extubation in the ICU also predict the risk of extubation failure.: Design: Retrospective cohort study.: Setting: Eight medical-surgical ICUs in Toronto.: Patients: Adult ... ...

Abstract	Objectives: To identify whether factors associated with withholding extubation in the ICU also predict the risk of extubation failure. Design: Retrospective cohort study. Setting: Eight medical-surgical ICUs in Toronto. Patients: Adult patients receiving invasive mechanical ventilation, with a first successful spontaneous breathing trial within 28 days of initial ICU admission. Interventions: None. Measurements and main results: The primary end point had three mutually exclusive levels, including: 1) withholding extubation after a successful spontaneous breathing trial, 2) extubation failure within 48 hours, and 3) successful extubation. Among 9,910 patients, 38% of patients were not extubated within 24 hours of their first successful spontaneous breathing trial. A total of 12.9% of patients who were promptly extubated failed within the next 48 hours. Several discrepancies were evident in the association of factors with risk of withholding extubation and extubation failure. Specifically, both age and female sex were associated with withholding extubation (odds ratio, 1.07; 95% CI, 1.03-1.11; and odds ratio, 1.13; 95% CI, 1.02-1.26, respectively) but not a higher risk of failed extubation (odds ratio, 0.99; 95% CI, 0.93-1.05; and odds ratio, 0.93; 95% CI, 0.77-1.11, respectively). Conversely, both acute cardiovascular conditions and intubation for hypoxemic respiratory failure were associated with a higher risk of failed extubation (odds ratio, 1.32; 95% CI, 1.06-1.66; and odds ratio, 1.46; 95% CI, 1.16-1.82, respectively) but not a higher odds of a withheld extubation attempt (odds ratio, 0.79; 95% CI, 0.68-0.91; and odds ratio, 1.07; 95% CI, 0.93-1.23, respectively). Conclusions: Several factors showed discordance between the decision to withhold extubation and the risk of extubation failure. This discordance may lead to longer duration of mechanical ventilation or higher reintubation rates. Improving the decision-making behind extubation may help to reduce both exposure to invasive mechanical ventilation and extubation failure.
MeSH term(s)	Aged ; Airway Extubation/methods ; Airway Extubation/standards ; Airway Extubation/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Ontario/epidemiology ; Resuscitation Orders ; Retrospective Studies ; Time Factors ; Ventilator Weaning/methods ; Ventilator Weaning/standards ; Ventilator Weaning/statistics & numerical data
Language	English
Publishing date	2021-07-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005107
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Zs.A 1261: Show issues

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Article ; Online: Predictors of early mortality in critically ill patients with acute kidney injury necessitating renal replacement therapy: A cohort study.

Van Herreweghe, Imré / Texiwala, Sikander / Pinto, Ruxandra / Wald, Ron / Adhikari, Neill K J

Journal of critical care

2021 Volume 66, Page(s) 96–101

Abstract: Purpose: Reliable prediction of early mortality after initiation of renal replacement therapy (RRT) in critically ill patients may inform decision-making regarding this treatment. Our primary objective was to identify predictors of mortality within 2 ... ...

Abstract	Purpose: Reliable prediction of early mortality after initiation of renal replacement therapy (RRT) in critically ill patients may inform decision-making regarding this treatment. Our primary objective was to identify predictors of mortality within 2 days of starting RRT. Materials and methods: Patients with acute kidney injury (AKI), receiving RRT, and admitted to intensive care units of one hospital were included. Associations between baseline risk factors and mortality at 2 days and at hospital discharge were analyzed using logistic regression. Discrimination of both models was assessed. Results: We included 626 patients, treated initially with intermittent RRT (n = 300, 47.9%), continuous RRT (n = 211, 33.7%), or sustained low-efficiency dialysis (n = 115, 18.4%). Two-day mortality after starting RRT was 12.9% (n = 81), and hospital mortality was 50.5% (n = 316). Independent predictors of 2-day mortality included primary diagnostic category (p = 0.004) and sepsis-related organ failure assessment (SOFA) score (odds ratio [OR] 1.36 per point, 95% confidence interval [CI] 1.24-1.50). Independent predictors of hospital mortality included SOFA (1.29, 95%CI 1.21-1.37), Charlson score (1.20, 95%CI 1.18-1.43), and interhospital transfer (OR 0.55, 0.38-0.81). C-statistics were 0.81 (2-day mortality) and 0.80 (hospital mortality). Conclusions: Higher SOFA was associated with 2-day mortality after RRT initiation and with hospital mortality. Discrimination in both models was modest.
MeSH term(s)	Acute Kidney Injury/therapy ; Cohort Studies ; Critical Illness ; Humans ; Intensive Care Units ; Renal Replacement Therapy ; Retrospective Studies
Language	English
Publishing date	2021-09-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2021.08.011
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Zs.A 2152: Show issues

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Article ; Online: Prevalence and predictors of persistent post-COVID-19 symptoms.

Estrada-Codecido, Jose / Chan, Adrienne K / Andany, Nisha / Lam, Philip W / Nguyen, Melody / Pinto, Ruxandra / Simor, Andrew / Daneman, Nick

Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada

2022 Volume 7, Issue 3, Page(s) 208–219

Abstract: Background: The pandemic has affected hundreds of millions of people; early reports suggesting high rates of prolonged symptoms may be prone to selection bias.: Methods: In a program caring for all SARS-CoV-2 positive inpatients and outpatients ... ...

Abstract	Background: The pandemic has affected hundreds of millions of people; early reports suggesting high rates of prolonged symptoms may be prone to selection bias. Methods: In a program caring for all SARS-CoV-2 positive inpatients and outpatients between March to October 2020, and offering universal 90-day follow-up, we compared those who died prior to 90 days, not responding to follow-up, declining, or accepting follow-up. Among those seen or declining follow-up, we determined the prevalence and predictors of persistent symptoms. Results: Among 993 patients, 21 (2.1%) died prior to 90 days, 506 (50.9%) did not respond, 260 (26.1%) declined follow-up because they were well, and 206 (20.7%) were fully assessed. Of 466 who responded to follow-up inquiry, 133 (28.5%) reported ≥1 persistent symptom, including constitutional (15.5%), psychiatric (14.2%), rheumatologic (13.1%), neurologic (13.1%), cardiorespiratory (12.0%), and gastrointestinal (1.7%). Predictors differed for each symptom type. Any persistent symptom was more common in older patients (adjusted odds ratio [aOR] 1.11, 95% CI 1.04 to 1.18/5 years), those diagnosed in hospital (aOR 2.03, 95% CI 1.24 to 3.33) and those with initial constitutional and rheumatologic symptoms. Patients not responding to follow-up were younger and healthier at baseline. Conclusion: Persistent symptoms are common and diverse 3 months post-COVID-19 but are likely over-estimated by most reports.
Language	English
Publishing date	2022-09-27
Publishing country	Canada
Document type	Journal Article
ISSN	2371-0888
ISSN (online)	2371-0888
DOI	10.3138/jammi-2022-0013
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