Risk factors and outcomes of postoperative meningitis

Giriş: Bu çalışma, cerrahi sonrası gelişen menenjitlerde risk faktörlerini ve sonuçlarını belirlemek amacıyla gerçekleştirilmiştir. Hastalar ve Metod: Çalışmaya Ocak 2004-Aralık 2009 tarihleri arasında beyin cerrahisi operasyonu sonrasında izlemde menenjit gelişen 163 hasta ile menenjit gelişmeyen 152 hasta dahil edilmiştir. Her bir hastanın demografik, klinik ve tedavi karakteristikleri tıbbi kayıtlarından elde edilmiştir. Bulgular: Hastaların izlendiği altı yıl içerisinde yapılan 4203 nöroşirürjik cerrahinin 163 (%3.9)'ünde nozokomiyal menenjit geliştiği belirlenmiştir. Hastaların yaş ortalaması 45.6 ± 17.2 yıl, kontrol grubunun yaş ortalaması ise 45.0 ± 17.1 yıl olarak bulunmuştur. Hastaların klinik örneklerinde [beyin omurilik sıvısı (BOS) ve/veya kan] toplam 132 mikroorganizma izole edilmiştir. En sık gram-negatif patojenler (%51.5) etken olarak belirlenmiştir. Hastalar ve kontrol grubu risk faktörlerine göre karşılaştırıldığında, ventrikülo-peritoneal şant varlığı, eksternal drenaj uygulaması, BOS kaçağı, operasyon sonrası mekanik ventilasyon uygulaması, postoperatif dönemde steroid tedavisi ve santral venöz kateter uygulaması, hasta grubunda kontrol grubuna göre istatistiksel olarak anlamlı şekilde yüksek bulunmuştur. Kontrol grubunda mortalite oranı %4.6 iken, menenjit grubunda %26.3'tür. Beyin cerrahisi operasyonu geçiren hastalarda; mekanik ventilasyon (OR: 7.97, %95 GA: 4.11-15.47), ileri yaş (OR: 3.21, %95 GA: 1.47-6.96), santral venöz kateter kullanımı (OR: 5.15, %95 GA: 2.52-10.51), BOS kaçağı (OR: 2.16, %95 GA: 1.12-4.18) ve menenjit tanısı (OR: 7.42, %95 GA: 3.43-17.06) mortalite için risk faktörleri olarak saptanmıştır. Menenjit grubunda ise multivaryate lojistik regresyon analiz sonucuna göre postoperatif steroid kullanımı (OR: 6.54, %95 GA: 1.02-41.89) ve mikroorganizma türü (gram-negatif olması) (OR: 3.48, %95 GA: 1.09-11.11) mortaliteyi etkileyen bağımsız faktörler olarak saptanmıştır. Sonuç: Cerrahi sonrası gelişen menenjitler, hem morbidite ve mortalite hem de sıklık açısından önemini korumaktadır. Eksternal ve internal drenaj sistemleri ve BOS kaçağı, hem infeksiyon gelişimi hem de mortalite için önemli risk faktörleri iken, ileri yaş ve gram-negatif menenjit ile postoperatif steroid kullanımı menenjitte mortaliteyi artıran önemli risk faktörleri olarak belirlenmiştir.Introduction: This study was planned to detect the risk factors and outcome of meningitis developed after surgery. Patients and Methods: In the follow up of patients after neurosurgery, 163 meningitis and 152 control patients were included to the study, between January 2004 and December 2009. Demographic, clinical and laboratory data were obtained from patient files. Results: In the six-year follow up of 4203 neurosurgical procedures, nosocomial infection rate was found to be 3.9%. The mean age was 45.6 ± 17.2 years and 45.0 ± 17.1 years for the meningitis and control patients, respectively. One hundred and thirty two microorganisms were isolated in cultures of clinical specimens [cerebrospinal fluid (CSF) and/or blood]. Gram-negative bacteria were found to be the most frequent pathogen (51.5%). When patient and control groups were compared according to the risk factors, presence of ventriculo-peritoneal shunt, external drainage, CSF leakage, mechanical ventilation after operation, postoperative steroid treatment and central venous catheterization were found to be higher in the patient group and the differences were statistically significantly. While mortality rate was 4.6% in control group, it was 26.3% in meningitis patient groups. Mechanical ventilation (OR: 7.97, 95% CI 4.11-15.47), older age groups (OR: 3.21, 95% CI: 1.47-6.96), central venous catheterization (OR: 5.15, 95% CI: 2.52-10.51), CSF leakage (OR: 2.16, 95% CI: 1.12-4.18) and diagnosis of meningitis (OR: 7.42, 95% CI: 3.43-17.06) found to be the risk factors for mortality for patients who had neurosurgery. According to multivariate logistic regression analysis, age, postoperative steroid usage (OR: 6.54, 95% CI: 1.02-41.89) and type of microorganism (gram-negative) (OR: 3.48, 95% CI: 1.09-11.11) were found to be the independent risk factors for mortality in meningitis group. Conclusion: As a result, meningitis developing after surgery is still important because of its morbidity, mortality and high rate. External and internal drainage systems and CSF leakage are important risk factors in the development of infection and mortality. And also, advance age, gram-negative etiology and postoperative steroid usage were found to be related with mortality in meningitis patient

Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study

Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction ?40%). Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019. Results: The study included 1462 outpatients (male: 70.1%, mean age: 67±11 years, mean LVEF: 30%±6%) with chronic HFrEF. Renin–angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter–defibrillator (ICD) and cardiac resynchronization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279). Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy. (Anatol J Cardiol 2020; 24: 32-40) Keywords: adherence, chronic heart failure, device therapy, guidelines, pharmacological treatment, outpatient

Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: the ATA study

Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess ad-herence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction ?40%).Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019.Results: The study included 1462 outpatients (male: 70.1%, mean age: 67±11 years, mean LVEF: 30%±6%) with chronic HFrEF. Renin–angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter–defibrillator (ICD) and cardiac resynchro-nization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279).Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy. (Anatol J Cardiol 2020; 24: 32-40