Bloodstream infections in hospitalized patients before and during the COVID-19 surge in a community hospital in the South Bronx

Abstract Background There is a paucity of data of bloodstream infections (BSI) before and during the COVID-19 pandemic. The aim of our study was to compare the incidence and characteristics of blood stream infections (BSI) in hospitalized patients before and during the surge of COVID-19 pandemic in a community hospital in South Bronx. Methods This is a retrospective observational comparative study of adult hospitalized patients with BSI admitted before (Jan 1-Feb 28, 2020) and during COVID-19 surge (Mar 1- May 1,2020). The incidence of BSI, patient demographics, clinical and microbiological characteristics of infections including treatment and outcomes were compared. Results Of the 155 patients with BSI, 64 were before COVID and 91 were during the COVID surge (Table 1). Incidence of BSI was 5.84 before COVID and 6.57 during surge (p = 0.004). Majority of patients during COVID period had ARDS (39.6%), required mechanical ventilation (57%), inotropic support (46.2%), therapeutic anticoagulation (24.2%), proning (22%), rectal tube (28.6%), Tocilizumab (9.9%), and steroids (30.8%) in comparison to pre-COVID (Table 2). Days of antibiotic therapy prior to BSI was 5 days before COVID and 7 during COVID. Mortality was higher among patients with BSI admitted during COVID surge (41.8% vs. 14.1% p < 0.0001). Of 185 BSI events, 71 were Pre-COVID and 114 during surge. Primary BSI were predominant (72%) before COVID contrary to secondary BSI (46%) (CLABSI) during COVID. Time from admission to positive culture was 2.5 days during COVID compared to 0.9 pre-COVID. Majority of BSI during COVID period were monomicrobial (93%) and hospital acquired (50%) (p=0.001). Enterococcus (20.2%), E.coli (13.2%), and MSSA (12.3%) were predominant microbes causing BSI during COVID vs. MRSA (15.5%), Streptococci (15.5%), and S. pneumoniae (14.1%) before COVID (Figure 1). In multivariate logistic regression, Enterococcal coinfection was associated with COVID positivity (OR 2.685, p = 0.038), mechanical ventilation (OR 8.739, p = 0.002), and presence of COPD/Asthma (OR 2.823, p = 0.035). Comparison of Microorganisms Isolated in the BSI X-axis represents the total number of BSI events whereas the number at the end of each bar represents the percentage Conclusion Higher incidence of secondary BSI (CLABSI) due to Enterococcus spp. was observed during the surge of COVID-19 infection in the South Bronx. Breakdown of infection control measures during the COVID-19 pandemic could have been contributory. Disclosures All Authors: No reported disclosures

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Impact of Residential Neighborhood and Race/Ethnicity on Outcomes of Hospitalized Patients with COVID-19 in the Bronx

10.1101/2021.01.09.21249515 ◽

2021 ◽

Author(s):

Dwayvania Miller ◽

Amara Sarwal ◽

Bo Yu ◽

Edgar Gomez ◽

Victor Perez-Gutierrez ◽

...

Keyword(s):

Severity Of Illness ◽

Hospitalized Patients ◽

The South ◽

South Bronx ◽

Disadvantaged Area ◽

Residential Neighborhood ◽

Major Disaster ◽

Comorbidity Burden ◽

Race Ethnicity ◽

The Impact

AbstractThe socially vulnerable have been most affected due to the COVID-19 pandemic, similar to the aftermath of any major disaster. Racial and social minorities are experiencing a disproportionate burden of morbidity and mortality.The aim of this study was to evaluate the impact of residential location/community and race/ethnicity on outcomes of COVID-19 infection among hospitalized patients within the Bronx. This was a single center retrospective observational cohort study that included SARS-CoV2 positive adult residents of the Bronx (stratified as residents of South Bronx vs Rest of Bronx) hospitalized between March-May 2020. Data extracted from hospital electronic medical records included residential addresses, race, comorbidities, and insurance details. Comorbidity burden other clinical and laboratory details were also assessed to determine their correlation to COVID-19 severity of illness and outcomes of mortality and length of stay.As expected, the COVID-19 pandemic differentially affected outcomes in those in the more socially disadvantaged area of the South Bronx versus the rest of the Bronx borough. Residents of the South Bronx had a significantly higher comorbidity burden and had public insurance to access medical care in comparison to the remainder of the Bronx. Interestingly, for the patient population studied there was no observed difference in 30-day mortality by race/ethnicity among those infected with COVID- 19 in spite of the increased disease burden observed.This adds an interesting perspective to the current literature, and highlights the need to address the social/economic factors contributing to health access disparity to reduce the adverse impact of COVID-19 in these communities.

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Bipolar Disorder and Comorbidity With Drug Use in Hospitalized Patients From a Mental Health Unit From the South of Spain

10.26226/morressier.5a7070e5ab9a5f002a4c695a ◽

2018 ◽

Author(s):

Olalla Santamaria

Keyword(s):

Mental Health ◽

Bipolar Disorder ◽

Drug Use ◽

Hospitalized Patients ◽

Health Unit ◽

The South ◽

Mental Health Unit

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Healthcare-Associated Laboratory-Confirmed Bloodstream Infections—Species Diversity and Resistance Mechanisms, a Four-Year Retrospective Laboratory-Based Study in the South of Poland

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052785 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2785

Author(s):

Agnieszka Chmielarczyk ◽

Monika Pomorska-Wesołowska ◽

Dorota Romaniszyn ◽

Jadwiga Wójkowska-Mach

Keyword(s):

Bloodstream Infections ◽

Diagnostic Techniques ◽

Resistance Mechanisms ◽

Infection Prevention And Control ◽

The South ◽

Coagulase Negative Staphylococci ◽

Aminoglycoside Resistance ◽

Gram Negative ◽

Maldi Tof ◽

Carbapenem Resistant

Introduction: Regardless of the country, advancements in medical care and infection prevention and control of bloodstream infections (BSIs) are an enormous burden of modern medicine. Objectives: The aim of our study was to describe the epidemiology and drug-resistance of laboratory-confirmed BSI (LC-BSIs) among adult patients of 16 hospitals in the south of Poland. Patients and methods: Data on 4218 LC-BSIs were collected between 2016–2019. The identification of the strains was performed using MALDI-TOF. Resistance mechanisms were investigated according to European Committee on Antimicrobial Susceptibility Testing, EUCAST recommendations. Results: Blood cultures were collected from 8899 patients, and LC-BSIs were confirmed in 47.4%. The prevalence of Gram-positive bacteria was 70.9%, Gram-negative 27.8% and yeast 1.4%. The most frequently isolated genus was Staphylococcus (50% of all LC-BSIs), with a domination of coagulase-negative staphylococci, while Escherichia coli (13.7%) was the most frequent Gram-negative bacterium. Over 4 years, 108 (2.6%) bacteria were isolated only once, including species from the human microbiota as well as environmental and zoonotic microorganisms. The highest methicillin resistant Staphylococcus aureus (MRSA) prevalence was in intensive care units (ICUs) (55.6%) but S. aureus with resistance to macrolides, lincosamides and streptogramins B (MLSB) in surgery was 66.7%. The highest prevalence of E. faecalis with a high-level aminoglycoside resistance (HLAR) mechanism was in ICUs, (84.6%), while E. faecium-HLAR in surgery was 83.3%. All cocci were fully glycopeptide-sensitive. Carbapenem-resistant Gram-negative bacilli were detected only in non-fermentative bacilli group, with prevalence 70% and more. Conclusions: The BSI microbiology in Polish hospitals was similar to those reported in other studies, but the prevalence of MRSA and enterococci-HLAR was higher than expected, as was the prevalence of carbapenem-resistant non-fermentative bacilli. Modern diagnostic techniques, such as MALDI-TOF, guarantee reliable diagnosis.

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1464. Adjuvant Systemic Steroid Therapy and Length of Hospital Stay in Pneumonia Patients: A Retrospective Cohort Study in a Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1645 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S733-S734

Author(s):

Rattanaporn Mahatanan

Keyword(s):

Hospital Stay ◽

Steroid Therapy ◽

Subgroup Analysis ◽

Community Hospital ◽

Length Of Hospital Stay ◽

Hospitalized Patients ◽

Systemic Steroid ◽

Inpatient Mortality ◽

Copd Patients ◽

Class Iv

Abstract Background Pneumonia is a leading cause of morbidity and mortality worldwide resulting in a substantial healthcare expenditure. Antimicrobial agents are the main treatment. Recent studies showed the benefits of steroid therapy as an adjuvant therapy for patients with pneumonia; however, the overall evidence is still controversial. Methods Electronic medical records of hospitalized patients (age >18) at a community hospital in a rural Maine with the discharge diagnosis of pneumonia in 2015 and 2016 were reviewed. Demographics, comorbidities, physical examination, initial laboratory, and Pneumonia Severity Index (PSI) were collected for each patient. The exposure was a systemic steroid administered by either oral or intravenous. The outcomes included length of hospital stay (LOS), inpatient mortality, and transfer to tertiary care center. Competing-risks regression was utilized to examine the association between steroid and LOS. Multivariable logistic regression analysis adjusted for propensity score was used for other outcomes. Results A total of 414 patients were included. 277(63%) patients received systemic steroids. Overall, steroid use was significantly associated with shorter LOS (HR 1.26, 95%CI 1.03-1.54, p=0.02) and decrease inpatient mortality (OR 0.11, 95%CI 0.03-0.45, p< 0.01). In subgroup analysis, steroid associated with shorter LOS only in patients with PSI class IV (HR 1.38, 95%CI 1.02-1.89, p=0.04) and PSI class V (HR 2.04, 95%CI 1.11-3.74, p=0.02). There was an association of steroid and shorter LOS in subgroup of COPD patients (HR 1.42, 95%CI 1.02-1.97, p=0.03). Table 1: The baseline characteristics of hospitalized patients with a diagnosis of pneumonia who received steroid vs non-steroid Figure 1: Subgroup analysis the effect of steroid and lenght of hospital stay (LOS) Conclusion Our study concluded that adjuvant steroid therapy associated with a decrease in length of hospital stay and improved inpatient mortality in hospitalized pneumonia patients. Steroid was most beneficial to those with severe pneumonia (PSI class IV-V) and COPD patients. Disclosures All Authors: No reported disclosures

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FALLS AS CHILDHOOD ACCIDENTS: AN INCREASING URBAN RISK

PEDIATRICS ◽

10.1542/peds.47.5.886 ◽

1971 ◽

Vol 47 (5) ◽

pp. 886-892

Author(s):

R. L. Sieben ◽

J. D. Leavitt ◽

J. H. French

Keyword(s):

New York ◽

Retrospective Study ◽

Health Hazard ◽

Hospitalized Patients ◽

Older Children ◽

South Bronx ◽

High Rise ◽

Childhood Accidents ◽

Urban Risk ◽

Hospital Affiliation

Falls from heights accounted for 20% of accidental deaths of children in New York City during 1966, and 67% of the children were under 5 years of age. A retrospective study of falls involving more than 10 feet during 1966 to 1968 at a single Bronx hospital affiliation disclosed that 55 children were hospitalized from this cause. Five of these hospitalized patients died, and two were found to have significant residua. This retrospective study of hospitalized patients indicates that falls from heights were a health hazard mainly for preschool males during the warmer summer months in the high rise slums of the south Bronx. Preschool children fell exclusively from windows and fire escapes, with little regard for height. Older children fell from dangerous play areas of lesser height. The need for routine installation of effective window guards is obvious.

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The Rebuilding of the South Bronx after the Fiscal Crisis

Journal of Urban History ◽

10.1177/0096144217714764 ◽

2017 ◽

Vol 43 (6) ◽

pp. 932-959

Author(s):

Themis Chronopoulos

Keyword(s):

New York ◽

Economic Policy ◽

Affordable Housing ◽

Low Income ◽

The United States ◽

City Government ◽

The South ◽

South Bronx ◽

Public Subsidies ◽

The One

This article explores the rebuilding of the South Bronx since 1977. This rebuilding represents an important public policy accomplishment, since the South Bronx was one of the most physically devastated areas in the United States. In terms of economic policy, the rebuilding of the South Bronx defies linear narratives. One the one hand, public–private partnerships, which represent some of the most important features of urban neoliberalism, were used heavily in the revitalization of the South Bronx. Community organizations that had been rebuilding areas in the South Bronx in the 1970s and the 1980s were required to conform to the requirements of the market, if they were to continue participating in urban development. On the other hand, the building of housing for low- and moderate-income people is not exactly a neoliberal economic policy, since these housing units were built with public subsidies and regulated by government agencies. In its insistence to rebuild the South Bronx as well as other physically devastated areas, the city government of New York became involved in creative financing by incorporating nongovernment organizations that were ran by accomplished businesspeople but remained nonprofit. And whatever the original intentions of city administrations in building and preserving affordable housing in the South Bronx may have been, the accommodation of so many low-income people performing low-paying but essential jobs has contributed to the making of a more vibrant urban economy, even if these same people are not necessarily the ones benefitting from New York’s economic dynamism.

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