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10.1016/S1473-3099(20)30153-5 http://scihub22266oqcxt.onion/10.1016/S1473-3099(20)30153-5 32505231!7272178!32505231     free     free     free Deprecated: Implicit conversion from float 227.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 227.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 227.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 227.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 227.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 227.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 227.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534       Lancet+Infect+Dis 2020 ; 20 (10): 1172-1181 Nephropedia Template TP {{tp|p=32505231|t=2020. Needs assessment for novel Gram-negative antibiotics in US hospitals: a retrospective cohort study |pdf=|usr=}}{{32505231}} gab.com Text Needs assessment for novel Gram-negative antibiotics in US hospitals: a retrospective cohort study JO: Lancet Infect Dis http://www.kidney.de/pget.php?&tw=1&pmid=32505231 #FOAvip BACKGROUND: Evidence-based needs assessments for novel antibiotics against highly-resistant Gram-negative infections (GNIs) are scarce. We aimed to use real-world data from an electronic health record repository to identify treatment opportunities in US hospitals for GNIs resistant to all first-line drugs. METHODS: For this retrospective cohort study, population estimates with an unmet need for novel Gram-negative antibiotics were quantified using the Cerner Health Facts database (2009-15), aggregating episodes of infection in US hospitals with pathogens displaying difficult-to-treat resistance (DTR; resistance to carbapenems, other beta-lactams, and fluoroquinolones) and episodes involving empirical coverage with reserve drugs (colistin or polymyxin B and aminoglycosides). Episodes displaying extended-spectrum cephalosporin resistance (ECR) were also estimated. Episodes were multiplied by site-specific and fixed 14-day treatment durations for conservative and liberal days-of-therapy (DOT) estimates and stratified by site and taxon. Hospital type-specific DOT rates were reliability adjusted to account for random variation; cluster analyses quantified contribution from outbreaks. FINDINGS: Across 2 996 271 inpatient encounters and 134 hospitals, there were 1352 DTR-GNI episodes, 1765 episodes involving empirical therapy with colistin or polymyxin B, and 16 632 episodes involving aminoglycosides. Collectively, these yielded 39.0 (conservative estimate) to 138.2 (liberal estimate) DOT per 10 000 encounters for a novel DTR-GNI-targeted drug, whereas greater treatment opportunities were identified for ECR (six times greater) and beta-lactam susceptible GNIs (70 times greater). The most common DTR-GNI site and pathogen was lower respiratory (14.3 [43.3%] of 33 DOT per 10 000 encounters) and Pseudomonas aeruginosa (522 [38.1%] of 1371 episodes), whereas Enterobacteriaceae urinary-tract infections dominated the ECR or carbapenem-sparing niche (59.0% [5589 of 9535 episodes]) equating to 210.7 DOT per 10 000 encounters. DTR Stenotrophomonas maltophilia, Burkholderia spp, and Achromobacter spp represented less than 1 DOT per 10 000 encounters each. The estimated need for DTR-GNI-targeted antibiotics saw minor contributions by outbreaks and varied from 0.5 to 73.1 DOT per 10 000 encounters by hospital type. INTERPRETATION: Suspected or documented GNIs with no or suboptimal treatment options are relatively infrequent. Non-revenue-based strategies and innovative trial designs are probably essential to the development of antibiotics with improved effectiveness for these GNIs. FUNDING: Center for Drug Evaluation and Research, US Food and Drug Administration; Intramural Research Program, National Institutes of Health Clinical Center and the National Institute of Allergy and Infectious Diseases and the National Cancer Institute. Twit Text FOAVip Needs assessment for novel Gram-negative antibiotics in US hospitals: a retrospective cohort study ????Lancet Infect Dis http://www.kidney.de/pget.php?&tw=1&pmid=32505231 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=32505231 #FOAvip English Wikipedia <ref>{{Cite pmid|32505231}}</ref> Needs assessment for novel Gram-negative antibiotics in US hospitals: a retrospective cohort study #MMPMID32505231 Strich JR; Warner S; Lai YL; Demirkale CY; Powers JH 3rd; Danner RL; Kadri SS Lancet Infect Dis 2020[Oct]; 20 (10): 1172-1181 PMID32505231show ga BACKGROUND: Evidence-based needs assessments for novel antibiotics against highly-resistant Gram-negative infections (GNIs) are scarce. We aimed to use real-world data from an electronic health record repository to identify treatment opportunities in US hospitals for GNIs resistant to all first-line drugs. METHODS: For this retrospective cohort study, population estimates with an unmet need for novel Gram-negative antibiotics were quantified using the Cerner Health Facts database (2009-15), aggregating episodes of infection in US hospitals with pathogens displaying difficult-to-treat resistance (DTR; resistance to carbapenems, other beta-lactams, and fluoroquinolones) and episodes involving empirical coverage with reserve drugs (colistin or polymyxin B and aminoglycosides). Episodes displaying extended-spectrum cephalosporin resistance (ECR) were also estimated. Episodes were multiplied by site-specific and fixed 14-day treatment durations for conservative and liberal days-of-therapy (DOT) estimates and stratified by site and taxon. Hospital type-specific DOT rates were reliability adjusted to account for random variation; cluster analyses quantified contribution from outbreaks. FINDINGS: Across 2 996 271 inpatient encounters and 134 hospitals, there were 1352 DTR-GNI episodes, 1765 episodes involving empirical therapy with colistin or polymyxin B, and 16 632 episodes involving aminoglycosides. Collectively, these yielded 39.0 (conservative estimate) to 138.2 (liberal estimate) DOT per 10 000 encounters for a novel DTR-GNI-targeted drug, whereas greater treatment opportunities were identified for ECR (six times greater) and beta-lactam susceptible GNIs (70 times greater). The most common DTR-GNI site and pathogen was lower respiratory (14.3 [43.3%] of 33 DOT per 10 000 encounters) and Pseudomonas aeruginosa (522 [38.1%] of 1371 episodes), whereas Enterobacteriaceae urinary-tract infections dominated the ECR or carbapenem-sparing niche (59.0% [5589 of 9535 episodes]) equating to 210.7 DOT per 10 000 encounters. DTR Stenotrophomonas maltophilia, Burkholderia spp, and Achromobacter spp represented less than 1 DOT per 10 000 encounters each. The estimated need for DTR-GNI-targeted antibiotics saw minor contributions by outbreaks and varied from 0.5 to 73.1 DOT per 10 000 encounters by hospital type. INTERPRETATION: Suspected or documented GNIs with no or suboptimal treatment options are relatively infrequent. Non-revenue-based strategies and innovative trial designs are probably essential to the development of antibiotics with improved effectiveness for these GNIs. FUNDING: Center for Drug Evaluation and Research, US Food and Drug Administration; Intramural Research Program, National Institutes of Health Clinical Center and the National Institute of Allergy and Infectious Diseases and the National Cancer Institute. |Anti-Bacterial Agents/classification/*therapeutic use[MESH] |Cohort Studies[MESH] |Disease Outbreaks[MESH] |Gram-Negative Bacteria/*drug effects[MESH] |Gram-Negative Bacterial Infections/*drug therapy/epidemiology[MESH] |Hospitals[MESH] |Humans[MESH] |Inpatients[MESH] |Microbial Sensitivity Tests[MESH] |Needs Assessment[MESH] |Retrospective Studies[MESH]Needs assessment for novel Gram-negative antibiotics in US hospitals: (epmc).pdf DeepDyve Pubget Overpricing