Key PointsQuestionIs it possible to conduct operational surveillance using the clinical data routinely recorded in electronic health records to identify nonventilated adults with hospital-acquired pneumonia?FindingsIn this cohort study of 310 651 patients with 489 519 admissions, an electronic surveillance definition based on worsening oxygenation, at least 3 days of new antibiotics, fever or abnormal white blood cell count, and performance of chest imaging was successfully applied to all patients. This definition identified 0.6 event per 100 admissions and was associated with up to a 6-fold higher risk of hospital death compared with matched control patients.MeaningThis study suggests that electronic surveillance for nonventilator hospital-acquired pneumonia is feasible; this approach could inform the development and evaluation of pneumonia prevention programs in hospitals.
The Coral Triangle in the Indo-Pacific is a region renowned for exceptional marine biodiversity. The area could have acted as a ‘centre of origin’ where speciation has been prolific or a ‘centre of survival’ by providing refuge during major environmental shifts such as sea-level changes. The region could also have acted as a ‘centre of accumulation’ for species with origins outside of the Coral Triangle, owing to it being at a central position between the Indian and Pacific oceans. Here, we investigated support for these hypotheses using population-level DNA sequence-based reconstructions of the range evolution of 45 species (314 populations) of Indo-Pacific reef-associated organisms. Our results show that populations undergoing the most ancient establishment were significantly more likely to be closer to the centre of the Coral Triangle than to peripheral locations. The data are consistent with the Coral Triangle being a net source of coral-reef biodiversity for the Indo-Pacific region, suggesting that the region has acted primarily as a centre of survival, a centre of origin or both. These results provide evidence of how a key location can influence the large-scale distributions of biodiversity over evolutionary timescales.
Background Influential studies conclude that each hour until antibiotics increases mortality in sepsis. However, these analyses often 1) adjusted for limited covariates, 2) included patients with long delays until antibiotics, 3) combined sepsis and septic shock, and 4) used linear models presuming each hour delay has equal impact. We evaluated the effect of these analytic choices on associations between time-to-antibiotics and mortality. Methods We retrospectively identified 104,248 adults admitted to five hospitals from 2015–2022 with suspected infection (blood culture collection and intravenous antibiotics within 24 h of arrival), including 25,990 with suspected septic shock and 23,619 with sepsis without shock. We used multivariable regression to calculate associations between time-to-antibiotics and in-hospital mortality under successively broader confounding-adjustment, shorter maximum time-to-antibiotic intervals, stratification by illness severity, and removing assumptions of linear hourly associations. Results Changing covariates, maximum time-to-antibiotics, and severity stratification altered the magnitude, direction, and significance of observed associations between time-to-antibiotics and mortality. In a fully adjusted model of patients treated within 6 h, each hour associated with higher mortality for septic shock (aOR 1.07; 95% CI 1.04–1.11), but not sepsis without shock (aOR 1.03; 0.98–1.09) or suspected infection alone (aOR 0.99; 0.94–1.05). Modeling each hour separately confirmed that every hour delay was associated with increased mortality for septic shock, but only delays of >6 h were associated with higher mortality for sepsis without shock. Conclusions Associations between time-to-antibiotics and mortality in sepsis are highly sensitive to analytic choices. Failure to adequately address these issues can generate misleading conclusions.
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