Bloodstream infection (BSI) is a common complication in patients with solid tumor malignancies but available information on risk factors associated with BSI among these patients is scarce. To determine the associated risk factors and clinical outcomes of antibiotic treatment in BSI solid tumor malignancies. This was a retrospective case-control study performed in the National Care Centre. Adult patients with solid tumor malignancy and positive for blood culture bacteria growth (n=130) as well as adult patients with solid tumor malignancy and negative for blood culture bacteria growth were included (n=130). The most common form of solid malignancy (n=260) are those associated with digestive organs (n=72, 27.7%) and breast tumors (n=57, 21.9%). From 130 patients that were positive for BSI, gram-negative infection occurred in 71.5% (n=93) of the cases, mainly due to Klebsiella pneumoniae (n=31, 21.5%), Escherichia coli (n=24, 16.7%), and Pseudomonas aeruginosa (n=17, 11.8%). 98.2% (n=128) of BSI patients received empirical antimicrobial therapy while 58.5% (n=76) received adequate empirical antibiotic coverage. Elevated CRP levels (Adjusted OR=1.009; 95%CI=1.003-1.015; p=0.002) and total lymphocyte counts of <0.8x109/L (Adjusted OR=3.980; 95%CI=1.567-10.108; p=0.004) were found to be independent risk factors of BSI in solid tumor malignancy. There was no significant association between adequacy of empirical antibiotic coverage with the length of hospital stay (p=0.149), 48-hours all-cause mortality (p=0.255), and 28-days all-cause mortality (p=0.676). Close monitoring of the CRP elevation and presence of total lymphocyte counts <0.8x109/L may be used to determine the high risk for BSI in solid tumor malignancy patients.
Introduction: Although pharmacists’ role in the care of human immunodeficiency virus (HIV)-infected and acquired immunodeficiency syndrome (AIDS) patients is well established, studies had reported pharmacists’ negative attitudes towards people living with HIV/AIDS (PLWHA), with negative impact on HIV management. This study aimed to explore pharmacists’ knowledge of HIV/AIDS, perception towards the changing of treatment regimens of HIV/AIDS, attitudes towards PLWHA, and to identify factors affecting the pharmacists’ attitudes towards PLWHA in the state of Kelantan, which reportedly have the third highest number of HIV/AIDS patients in Malaysia. Materials and method: A validated online 43-item questionnaire was distributed to 400 pharmacists in Kelantan. Multivariate logistic regression was performed to identify factors associated with pharmacists’ negative attitude towards PLWHA. Results: A total of 170 respondents (response rate 42%) completed the questionnaire. Respondents had knowledge on the potential causes of HIV infection [median(IQR) score=13.00(1); maximum score=14.00], and preventive measures of HIV/AIDS transmission [median(IQR) score=12.00(1); maximum score=12.00]. On decision in changing regimens, the respondents agreed on the need to change treatment regimen for HIV/AIDS when required [median(IQR) score=7.00(2); maximum score=8.00]. Up to 40.6% of respondents thought that the treatment regimen should not be switched based on cost. Two-thirds of the respondents had negative attitudes towards PLWHA (67.1%). Respondents who worked in community pharmacy reported positive attitudes towards PLWHA (Adj OR=0.125; 95%CI=0.025-0.623; p=0.011). Conclusion: Pharmacists in Kelantan had several misconceptions towards the causes of HIV/AIDS, preventive measures of HIV/AIDS transmission, and necessity in changing treatment regimen when required. Despite good disease related knowledge, most pharmacists had negative attitudes towards PLWHA, while pharmacists working in community settings presented more positive attitudes towards PLWHA.
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