MacLeod Ortega (beardelete4)

OBJECTIVES Increasing antimicrobial resistance has renewed interest in older, less used antimicrobials. Cotrimoxazole shows promise; however hyperkalaemia and acute kidney injury (AKI) are potential complications. Identifying risk factors for, and quantification of, these events is required for safe-use. This study aims to evaluate predictors of cotrimoxazole-associated AKI and hyperkalaemia in a clinical setting. METHOD Patients prescribed cotrimoxazole were identified using electronic-healthcare records over three years (01/04/2016-31/03/2019). Individual risk-factors were recognised. Serum creatinine and potassium trends were analysed over the subsequent 21-days. AKI and hyperkalaemic patients were classified using Kidney Disease Improving Global Outcomes (KDIGO) and laboratory criteria. Univariate and multiple logistic regression analyses were performed. RESULTS Among 214 patients prescribed co-trimoxazole, 42 (19.6%, 95%CI 14.6-25.7%) met AKI criteria and 33 (15.4%, 95%CI 11.0-21.1%) developed hyperkalaemia. Low baseline eGFR (0.6mmol/l, OR=2.47, 95%CI 1.14-5.27, p=0.0236). CONCLUSIONS Cotrimoxazole-associated AKI and hyperkalaemia is frequent and dose-dependent. Renal function, serum potassium and pre-existing cardiac disorders should be evaluated before prescribing cotrimoxazole. NSC697923 purchase Serum creatinine and potassium monitoring within first 2-4 days of treatment to identify susceptible patients is recommended, and the lowest effective dose prescribed. OBJECTIVES Bloodstream infection has a high mortality rate and it was not clear whether laboratory-based rapid identification of the organisms involved would improve outcome. METHODS The RAPIDO trial was an open parallel-group multi-centre randomised controlled trial. We tested all positive blood cultures from hospitalised adults by conventional methods of microbial identification and those from patients randomised (11) to rapid diagnosis, in addition, by matrix-assisted laser desorption/ionisation time of flight (MALDI-TOF) mass spectrometry directly on positive blood cultures. The only primary outcome was 28-day mortality. Clinical advice on patient management was provided in both groups by infection specialists. RESULTS First positive blood culture samples from 8,628 patients were randomised, 4,312 into rapid diagnosis, 4,136 into conventional. After pre-specified post-randomisation exclusions, 2,740 in the rapid diagnosis arm and 2,810 in the conventional were included in mortality analysis. There was no significant difference in 28-day survival (81·5% 2233/2740 rapid vs 82·3% 2313/2810 conventional; HR 1·05, 95% CI 0·93-1·19, p=0·42). Microbial identification was quicker in the rapid diagnosis group (median 38·5 vs 50·3 hours after blood sampling, IQR 26·7-50·3 vs 47·1-72·9, p less then 0·01) but times to effective antimicrobial therapy were no shorter (median 24 hours (IQR 2-78) vs 13 hours (IQR 2-69)). There were no significant differences in 7-day mortality or total antibiotic consumption; times to resolution of fever, discharge from hospital or de-escalation of broad spectrum therapy; or 28-day Clostridioides difficile incidence. CONCLUSIONS Rapid identification of bloodstream pathogens by MALDI-TOF in this trial did not reduce patient mortality despite delivering laboratory data to clinicians sooner. Intensive lifestyle interventions targeting diet and physical activity are recommended for reducing atherosclerotic cardiovascular disease (ASCVD) risk in adults. However, existing interventions often do not reach immigrant populations because of a mismatch between the social, cultural, and environmental context of immigrants and Western bio behavioral models which underpin evidence-based lifestyle interventions. The South Asian Healthy Lifestyle Intervention (SAHELI) study is a type 1 hybrid design randomized controlled trial aimed at reducing ASCVD risk in South Asian Americans, a group at higher ASCVD risk than whites and other