Adam R Aluisio1, Shiromi M Perera2, Derrick Yam3, Stephanie Garbern1, Jillian L Peters4, Logan Abel4, Daniel K Cho4, Dayan Woldemichael2, Stephen B Kennedy5, Moses Massaquoi5, Foday Sahr6, Tao Liu3, Adam C Levine1. 1. Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. 2. International Medical Corps, Washington, DC, USA. 3. Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA. 4. Warren Alpert Medical School of Brown University, Providence, RI, USA. 5. Ministry of Health, Monrovia, Liberia. 6. College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
Abstract
OBJECTIVE: To evaluate the association between oral third-generation cephalosporin antibiotic treatment and mortality in Ebola virus disease (EVD). METHODS: This retrospective cohort studied EVD-infected patients admitted to five Ebola Treatment Units in Sierra Leone and Liberia during 2014-15. Empiric treatment with cefixime 400 mg once daily for five days was the clinical protocol; however, due to resource variability, only a subset of patients received treatment. Data on sociodemographics, clinical characteristics, malaria status and Ebola viral loads were collected. The primary outcome was mortality compared between cases treated with cefixime within 48 h of admission to those not treated within 48 h. Propensity scores were derived using clinical covariates. Mortality between treated and untreated cases was compared using propensity-matched conditional logistic regression and bootstrapped log-linear regression analyses to calculate an odds ratio (OR) and relative risk (RR), respectively, with associated 95% confidence intervals (CI). RESULTS: Of 424 cases analysed, 360 (84.9%) met the cefixime treatment definition. The mean age was 30.5 years and 40.3% were male. Median cefixime treatment duration was 4 days (IQR: 3, 5). Among cefixime-treated patients, mortality was 54.7% (95% CI: 49.6-59.8%) vs. 73.4% (95% CI: 61.5-82.7%) in untreated patients. In conditional logistic regression, mortality likelihood was significantly lower among cases receiving cefixime (OR = 0.48, 95% CI: 0.32-0.71; P = 0.01). In the bootstrap analysis, a non-significant risk reduction was found with cefixime treatment (RR = 0.82, 95% CI: 0.64-1.16, P = 0.11). CONCLUSION: Early oral cefixime may be associated with reduced mortality in EVD and warrants further investigation.
OBJECTIVE: To evaluate the association between oral third-generation cephalosporin antibiotic treatment and mortality in Ebola virus disease (EVD). METHODS: This retrospective cohort studied EVD-infectedpatients admitted to five Ebola Treatment Units in Sierra Leone and Liberia during 2014-15. Empiric treatment with cefixime 400 mg once daily for five days was the clinical protocol; however, due to resource variability, only a subset of patients received treatment. Data on sociodemographics, clinical characteristics, malaria status and Ebola viral loads were collected. The primary outcome was mortality compared between cases treated with cefixime within 48 h of admission to those not treated within 48 h. Propensity scores were derived using clinical covariates. Mortality between treated and untreated cases was compared using propensity-matched conditional logistic regression and bootstrapped log-linear regression analyses to calculate an odds ratio (OR) and relative risk (RR), respectively, with associated 95% confidence intervals (CI). RESULTS: Of 424 cases analysed, 360 (84.9%) met the cefixime treatment definition. The mean age was 30.5 years and 40.3% were male. Median cefixime treatment duration was 4 days (IQR: 3, 5). Among cefixime-treated patients, mortality was 54.7% (95% CI: 49.6-59.8%) vs. 73.4% (95% CI: 61.5-82.7%) in untreated patients. In conditional logistic regression, mortality likelihood was significantly lower among cases receiving cefixime (OR = 0.48, 95% CI: 0.32-0.71; P = 0.01). In the bootstrap analysis, a non-significant risk reduction was found with cefixime treatment (RR = 0.82, 95% CI: 0.64-1.16, P = 0.11). CONCLUSION: Early oral cefixime may be associated with reduced mortality in EVD and warrants further investigation.
Authors: Adam R Aluisio; Shiromi M Perera; Derrick Yam; Stephanie Garbern; Jillian L Peters; Logan Abel; Daniel K Cho; Stephen B Kennedy; Moses Massaquoi; Foday Sahr; Suzanne Brinkmann; Lindsey Locks; Tao Liu; Adam C Levine Journal: J Nutr Date: 2019-10-01 Impact factor: 4.798
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Authors: Logan Abel; Shiromi M Perera; Derrick Yam; Stephanie Garbern; Stephen B Kennedy; Moses Massaquoi; Foday Sahr; Dayan Woldemichael; Tao Liu; Adam C Levine; Adam R Aluisio Journal: BMC Infect Dis Date: 2022-01-20 Impact factor: 3.090