Quality and quantity of sample size is crucial in clinical studies to exclude association: antimicrobial exposure and the risk of delirium in critically ill patients
| Autor: | Sahish Kamat, Ahmed Elsousi, Rashid Nadeem, Zainab Ameer Obeida |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Letter medicine.drug_class Cefepime media_common.quotation_subject Critical Illness Antibiotics Encephalopathy Critical Care and Intensive Care Medicine Cohort Studies Anti-Infective Agents Neurotoxicity medicine Humans Quality (business) Intensive care medicine media_common Aged Retrospective Studies Critically ill business.industry Research lcsh:Medical emergencies. Critical care. Intensive care. First aid Delirium lcsh:RC86-88.9 Length of Stay Middle Aged Antimicrobial Critical care Intensive Care Units Cross-Sectional Studies Sample size determination Sample Size Multivariate Analysis Female medicine.symptom business medicine.drug |
| Zdroj: | Critical Care Critical Care, Vol 23, Iss 1, Pp 1-3 (2019) |
| ISSN: | 1466-609X 1364-8535 |
| Popis: | Background Prior retrospective cross-sectional work has associated antimicrobials with a non-specific phrase: encephalopathy without seizures. The purpose of this study is to determine whether different classes of antimicrobials have differential associations with the daily risk of delirium after critical illness is adjusted for. Methods Our study was a nested cohort that enrolled non-neurological critically ill adults from a medical or surgical intensive care unit (ICU) with daily follow-up to 30 days. Our independent variable was exposure to previous-day antimicrobial class: beta-lactams (subclasses: penicillins, first- to third-generation cephalosporins, fourth-generation cephalosporins, and carbapenems), macrolides, fluoroquinolones, and other. We adjusted for baseline covariates (age, comorbidities, cognition scores, sepsis, and mechanical ventilation), previous-day covariates (delirium, doses of analgesics/sedatives, and antipsychotic use), and same-day covariates (illness severity). Our primary outcome of delirium was measured by using the Confusion Assessment Method for the ICU. A daily delirium logistic regression model was used with an ICU time-restricted sensitivity analysis including daily adjustment for sepsis and mechanical ventilation. Results Of 418 ICU patients, delirium occurred in 308 (74%) with a median of 3 days (interquartile range 2–6) among those affected and 318 (76%) were exposed to antimicrobials. When covariates and ICU type were adjusted for, only first- to third-generation cephalosporins were associated with delirium (logistic regression model odds ratio (OR) = 2.2, 95% confidence interval (CI) 1.28–3.79, P = 0.004; sensitivity analysis OR = 2.13, 95% CI 1.10–4.10, P = 0.024). Conclusions First-, second-, and third-generation cephalosporins doubled the odds of delirium after baseline co-morbidities, ICU type, the course of critical care, and other competing antimicrobial and psychotropic medication risks were adjusted for. We did not find an association between delirium and cefepime, penicillins, carbapenems, fluoroquinolones, or macrolides. Electronic supplementary material The online version of this article (10.1186/s13054-018-2262-z) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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