Background Patients receiving carbapenems are clinically heterogeneous and have severe infections and multiple comorbidities. Evidence on factors associated with mortality and length of stay (LOS) in this treatment‐defined population remains limited. Methods This retrospective cohort study included adult hospital episodes involving at least one carbapenem dose at Hospital Shah Alam during 2025. Firth penalised logistic regression was used for in‐hospital mortality, and median regression with 2000 bootstrap resamples was used for right‐skewed LOS. Covariates were selected a priori. Carbapenem continuation beyond 72 h was treated as a postbaseline characteristic and was not included in outcome models. Results Among 112 eligible episodes involving 107 patients, 38 deaths occurred (33.9%); median LOS was 19.0 days (IQR: 10.8–28.0). Older age (adjusted OR: 1.41 per 10 years, 95% CI: 1.07–1.92) and definitive indication at carbapenem initiation (adjusted OR: 0.28, 95% CI: 0.10–0.70) were associated with in‐hospital mortality. Hospital‐acquired infection was associated with a longer adjusted median LOS (median difference 8.63 days, 95% bootstrap CI: 0.50–14.44). Definitive indication was not clearly associated with LOS after adjustment (median difference −5.54 days, 95% bootstrap CI: −12.00–4.62). Conclusions Older age and definitive indication at carbapenem initiation were associated with in‐hospital mortality, while hospital‐acquired infection was associated with longer median LOS. The treatment‐indication association should not be interpreted causally because residual confounding, particularly by acute illness severity and indication, remains likely.
Introduction Given the growing health impact of dengue fever in recent years, which primarily affects Latin American countries and Colombia in particular, interdisciplinary studies and scientific and technological advances to combat it, such as vaccines, mosquito genetic modification techniques, vector control using drones, and digital surveillance systems, among others, are becoming increasingly important. However, despite these achievements, little is known about the disease itself. The relationship between knowledge, sanitation conditions, and the preventive actions against dengue can be understood as part of the whole process of construction of community empowerment. Rather than acting solely as external factors, these dimensions constitute interrelated components that reflect the individuals and communities’ capacity to understand, confront, and actively participate in dengue prevention and control. Against this background, the main contribution of this study lies in addressing community empowerment in the face of dengue as a multidimensional construct comprised of dimensions of knowledge, sanitation, and preventive practices, allowing us to explore its internal structure and understand how these dimensions relate within a common analytical framework. Method A quantitative approach with an observational, cross‐sectional, and analytical design was used. A total of 352 people infected with dengue during 2019 in the department of Córdoba, Colombia, were surveyed. Each response was assigned a score using the Likert scale question technique. Subsequently, a composite empowerment index was constructed. This index was conceptualized as a multidimensional construct consisting of domains related to knowledge, sanitation, and preventive practices against dengue. Consequently, the analysis did not aim to evaluate external predictive relationships between these components and empowerment, but rather to explore the relative contribution of the dimensions that internally comprise the construct and its association with different levels of empowerment. Results The analysis revealed differences in the relative contribution of the components making up the empowerment construct. The higher index levels were associated with higher scores in the dimensions related to knowledge and preventive practices. In contrast, profiles characterized by favorable sanitation conditions, but lower levels of knowledge and preventive skills, tended to be located in lower categories of the empowerment index. This indicates that there is heterogeneity in the internal construct structure and reflects the relative importance of its constituent dimensions. Conclusion It is concluded that empowerment has to be understood not only as the result of an individual effort or purpose but also as a complex and multidimensional process whose levels of development reflect the individual, relational, and collective capacity to act together and achieve significant changes.
Introduction Antimicrobial resistance in uropathogenic Escherichia coli (UPEC) compromises urinary tract infection management, yet analytical evidence from northern Peru remains limited. This study evaluated demographic and clinical factors associated with resistance in UPEC isolates from a regional referral hospital. Methods A retrospective analytical cross‐sectional study included 350 patients with monomicrobial urine cultures positive for UPEC during 2024. Resistance was defined as resistance to at least one of 19 antimicrobials. Associations were estimated using modified Poisson regression with robust variance. Results Overall, 323 isolates (92.3%) showed resistance. The highest resistance proportions were observed for ciprofloxacin (70.9%), ceftriaxone (65.4%), ceftazidime (62.0%), and trimethoprim/sulfamethoxazole (46.3%). Age showed a significant nonlinear association with resistance ( p = 0.033). No statistically conclusive independent associations were observed for sex, prior antibiotic use, diabetes mellitus, hypertension, or obesity after adjustment. Conclusion UPEC resistance was highly frequent and concentrated in commonly used agents, supporting local surveillance and susceptibility‐guided empirical therapy.
Dengue poses a growing threat in endemic countries where industrial expansion intersects with Aedes vector-breeding habitats. Factories and manufacturing premises often generate a multitude of unmanaged water-holding containers-including water storage tanks, machinery components, landscaping features, and recyclable waste-that favor perennial reservoirs for Aedes aegypti vectors. Despite substantial public health burdens, occupational dengue prevention in the workplace remains largely reactive, fragmented, and insufficiently aligned with safety, health, and environment (SHE) management systems. This narrative review synthesizes evidence on dengue epidemiology in industrial contexts, larval source ecology in factory environments, workers' dengue risk perception, and the regulatory landscape governing occupational health in dengue-endemic countries. Drawing on these evidence domains, we propose the conceptual foundations of a proactive "Dengue-Free Factory Assessment Framework" (D-FAF) designed to prevent and reduce Ae. aegypti breeding and high dengue risk in workplaces in industrial areas, safeguard employee health, minimize work loss, and achieve a sustained reduction in dengue incidence. The framework integrates the "Plan-Do-Check-Act" (PDCA) logic of ISO 45001 and ISO 14001 into a scalable, standards-aligned tool applicable across diverse industrial sectors in dengue high-risk areas.
Meropenem is a broad-spectrum carbapenem antibiotic essential for treating serious infections including urinary tract infections, pneumonia, sepsis, and meningitis. This narrative review examines meropenem resistance trends and prescribing practices for severe infections in Pakistan highlighting how inappropriate use drives local antimicrobial resistance. Relevant literature was identified through a structured search of PubMed, Scopus, Web of Science, and Google Scholar using predefined keywords. Antimicrobial resistance (AMR) is a global health crisis that complicates treatment of infections caused by multidrug-resistant Gram-negative pathogens, including Acinetobacter baumannii, Klebsiella pneumoniae, and E. coli. Pharmacokinetic studies of meropenem show extensive tissue penetration, time-dependent bactericidal activity, and rapid renal clearance, which contribute to its effectiveness. In critically ill patients, specialized dosing strategies like continuous or extended infusions are recommended to maintain adequate drug levels. Emerging evidence also supports combination therapies (e.g., pairing meropenem with fosfomycin) to improve outcomes against carbapenem-resistant strains. In Pakistan, these concerns are especially acute: many key pathogens show high resistance rates due to widespread antibiotic overuse and misuse. Regional surveillance indicates that E. coli often remains relatively sensitive to meropenem, whereas Acinetobacter species exhibit alarmingly low susceptibility. Such resistance largely stems from the spread of extended-spectrum beta-lactamases (ESBLs) and carbapenemase-producing organisms, posing serious challenges to clinicians. This underscores the need for data-driven, context-specific strategies to guide therapy. Robust surveillance systems are needed to guide empirical therapy, and real-time resistance monitoring can help prevent treatment failures. The review emphasizes targeted antimicrobial strategies and judicious meropenem use. Ongoing education for healthcare providers and coordinated stewardship programs at local and national levels are also essential to preserve the antibiotic’s clinical utility. Ultimately, sustaining meropenem’s effectiveness in the face of rising AMR requires combined public health efforts, including tailored dosing protocols and localized resistance management, to keep meropenem a reliable option worldwide for treating life-threatening infections.
