Heart failure disease has been one of the major chronic cardiovascular diseases that cause morbidity, mortality, and hospitalization of all cardiac patients. Heart failure has a significantly increased lifetime risk of development is about 20%. Symptomatic predictions are usually non-specific and hardly can discriminate the occurrence of heart failure from other diseases. It represents a challenging problem because of its economical and medical burden on the health care system. However, the management and presentation of a patient with heart failure remain in the fields of doubt. This review will highlight the importance of diagnosing and managing Congestive heart failure patients for primary health care physicians. This review was collected and classified from eligible published English written documents, articles, clinical trials. This electronic research engine was included: PubMed. This review discussed the diagnosis and management of Congestive heart failure and the details regarding this topic including definitions classifications, were included in this review. The primary care physician approach is often concerned with traditional palliative therapies before worsening the condition and plans to assess different reports regarding heart failure patients throughout their follow-up schedules.
Purpose
Antibiotic de-escalation (ADE) in critically ill patients is controversial. Previous studies mainly focused on mortality; however, data are lacking about superinfection. Therefore, we aimed to identify the impact of ADE versus continuation of therapy on superinfections rate and other outcomes in critically ill patients.
Methods
This was a two-center retrospective cohort study of adults initiated on broad-spectrum antibiotics in the intensive care unit (ICU) for ≥ 48 h. The primary outcome was the superinfection rate. Secondary outcomes included 30-day infection recurrence, ICU and hospital length of stay, and mortality.
Results
250 patients were included, 125 in each group (ADE group and continuation group). Broad spectrum antibiotic discontinuation occurred at a mean of 7.2 ± 5.2 days in the ADE arm vs. 10.3 ± 7.7 in the continuation arm (P value = 0.001). Superinfection was numerically lower in the ADE group (6.4% vs. 10.4%; P = 0.254), but the difference was not significant. Additionally, the ADE group had shorter days to infection recurrence (P = 0.045) but a longer hospital stay (26 (14–46) vs. 21 (10–36) days; P = 0.016) and a longer ICU stay (14 (6–23) vs. 8 (4–16) days; P = 0.002).
Conclusion
No significant differences were found in superinfection rates among ICU patients whose broad-spectrum antibiotics were de-escalated versus patients whose antibiotics were continued. Future research into the association between rapid diagnostics with antibiotic de-escalation in the setting of high resistance is warranted.
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