scholarly journals Influence of Infectious Disease Physician Approval on Appropriateness of PICC Use and Outcomes

2020 ◽  
Vol 41 (S1) ◽  
pp. s485-s487
Author(s):  
Valerie M Vaughn ◽  
Megan O’Malley ◽  
Scott A. Flanders ◽  
Tejal N. Gandhi ◽  
Lindsay A. Petty ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antibiotic Therapy ◽  
Hospital Medicine ◽  
Severity Of Illness ◽  
Central Line ◽  
Medical Patients ◽  
Infectious Disease Physician ◽  
Single Lumen

Background:Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous (IV) antibiotic therapy after discharge from the hospital. Infectious disease (ID) physicians are often consulted prior to PICC placement, but whether their approval influences PICC appropriateness and complications is not known. Methods: Using data from the Michigan Hospital Medicine Safety Consortium (HMS) on PICCs placed in critically ill and hospitalized medical patients between January 1, 2015, and July 26, 2019, we examined the association between ID physician approval of PICC insertion for IV antibiotics and device appropriateness and outcomes. Appropriateness was defined according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) as a composite measure of (1) avoiding PICC use for durations ≤5 days; (2) using single-lumen instead of multilumen catheters; and (3) avoiding PICC use in patients with chronic kidney disease (eGFR>45 mL/min). The associations between ID approval of PICC use and odds of PICC-related complications (eg, deep vein thrombosis, central-line–associated bloodstream infection, and catheter occlusion) were also assessed. Multivariable models adjusting for patient severity of illness and hospital-level clustering were fit to both outcomes. Results were expressed as odds ratios (ORs) with corresponding 95% CIs. Results: Data from 36,594 patients who underwent PICC placement across 42 Michigan hospitals were included in the analysis. In total, 21,653 (55%) PICCs were placed for the indication of IV antibiotics; 14,935 (69%) of these had a documented ID consultation prior to placement, whereas 6,718 (31%) did not. Of the 14,935 PICCs with an ID consultation, 10,238 (69%) had ID approval documented prior to device placement (Fig. 1). Compared to no approval, PICCs approved by ID prior to insertion were more likely to be appropriate (OR, 3.51; 95% CI, 3.28–3.77; P < .001). Specifically, approval was associated with higher single-lumen use (OR, 5.13; 95% CI, 4.72–5.58; P < .001), less placement of PICCs with dwell times ≤ 5 days (OR, 0.29; 95% CI, 0.25–0.32; P < .001), and less frequent use in patients with chronic kidney disease (OR, 0.80; 95% CI, 0.73–0.87; P < .001). ID approval of PICCs prior to insertion was associated with a significantly lower odds of PICC-related complications (OR, 0.57; 95% CI, 0.51–0.64) (Table 1). Conclusions: ID approval of PICC use for IV antibiotic therapy in hospitalized patients was associated with greater appropriateness and fewer complications. Policies aimed at ensuring ID review prior to PICC use may help improve patient and device safety.Funding: NoneDisclosures:Valerie M. Vaughn reports contract research for Blue Cross and Blue Shield of Michigan, the Department of Veterans’ Affairs, the NIH, the SHEA, and the APIC. She also reports fees from the Gordon and Betty Moore Foundation Speaker’s Bureau, the CDC, the Pew Research Trust, Sepsis Alliance, and The Hospital and Health System Association of Pennsylvania.

Iron Localization and Infectious Disease in Chronic Kidney Disease Patients

2016 ◽  
Vol 43 (4) ◽  
pp. 237-244 ◽  
Author(s):  
Takeshi Nakanishi ◽  
Takahiro Kuragano ◽  
Masayoshi Nanami ◽  
Yukiko Hasuike
Keyword(s):  
Infectious Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Iron Metabolism ◽  
Innate Immune ◽  
Intracellular Growth ◽  
Iron Administration ◽  
Lower Infection ◽  
Lower Infection Rate

For patients on dialysis, infection is the second leading cause of mortality. Iron metabolism should be considered in the pathogenesis of infectious disease, as high local iron concentrations favor the growth of many microbes. This review is intended to provide information regarding iron metabolism and infection in chronic kidney disease (CKD) patients. There are 2 reasons these patients may be vulnerable to infection: (1) the excessive iron administered to treat renal anemia could be associated with impairments of the host's innate immune response, (2) CKD-associated inflammation could cause dysregulated iron metabolism. Pathogenic microorganisms can be categorized as extracellular or intracellular pathogens. The proliferation site may determine the degree of virulence. In cases of mainly extracellular microbial growth, the host's strategy of sequestering iron in cells may efficiently inhibit proliferation. However, the same strategy may favor the intracellular growth of microorganisms. The administration of excessive amounts of iron may modify iron localization by an increase in the hepcidin concentration. We conclude that there is a need for large multicenter randomized controlled trials to evaluate the long-term safety of different iron administration patterns that allow for a lower infection rate while still producing efficient erythropoiesis in CKD patients.

Hand Washing and Physicians: How to Get Them Together

2002 ◽  
Vol 23 (1) ◽  
pp. 32-35 ◽  
Author(s):  
Charles Salemi ◽  
M. Teresa Canola ◽  
Enid K. Eck
Keyword(s):  
Infectious Disease ◽  
Central Line ◽  
Hand Washing ◽  
Surgical Intensive Care Unit ◽  
Behavioral Factors ◽  
Infectious Disease Physician ◽  
Physician Compliance ◽  
Study Results ◽  
E Mail

AbstractObjective:To determine the motivating and behavioral factors responsible for improving compliance with hand washing among physicians.Design:Five unobtrusive, observational studies recording hand washing after direct patient contact, with study results reported to physicians.Setting:A 450-bed hospital in a health maintenance organization with an 18-bed medical-surgical intensive care unit (ICU) and a 12-bed cardiac care unit.Methods:An infectious disease physician met individually with participants to report study results and obtain a commitment to hand washing guidelines. Follow-up interviews were conducted to evaluate behavioral factors and educational programs. Hand washing study results were presented to all staff physicians by live and videotaped inservice presentations and electronic mail (e-mail) newsletters. The importance of influencing factors and the educational effectiveness of the hand washing program were evaluated.Results:Five observational hand washing studies were conducted in the ICU between April 1999 and September 2000. Rates of physician compliance with hand washing were 19%, 85%, 76%, 74%, and 68%, respectively. There were 71 initial encounters and 55 follow-up interviews with the same physicians. Physician interviews revealed that 73% remembered the initial encounter, 70% remembered the hand washing inservice presentations, and 18% remembered the e-mail newsletters. Personal commitment and meeting with an infectious disease physician had the most influence on hand washing behavior. Direct inservice presentations (either live or videotaped) had more influence than did e-mail information. Rates of ventilator-associated pneumonia did not significantly change before and during the study periods. A decrease in the rate of central-line–related bloodstream infections from 3.2 to 1.4 per 1,000 central-line days was found, but could not be solely attributed to improved physician compliance with hand washing.Conclusions:Physician compliance with hand washing can improve. Personal encounters, direct meetings with an infectious disease physician, and videotaped presentations had the greatest impact on physician compliance with hand washing at our medical center, compared with newsletters sent via e-mail. Local data on compliance with hand washing and physician involvement are factors to be considered for physician hand washing compliance programs in other medical centers.

scholarly journals Utilization Patterns of IV Iron and Erythropoiesis Stimulating Agents in Anemic Chronic Kidney Disease Patients: A Multihospital Study

Anemia ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Avani D. Joshi ◽  
David A. Holdford ◽  
Donald F. Brophy ◽  
Spencer E. Harpe ◽  
Darcy Mays ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Severity Of Illness ◽  
University Hospitals ◽  
Treatment Rate ◽  
Erythropoiesis Stimulating Agents ◽  
Treatment Practices ◽  
Admission Status ◽  
Utilization Patterns ◽  
Iv Iron

Intravenous (IV) iron and Erythropoiesis Stimulating Agents (ESAs) are recommended for anemia management in chronic kidney disease (CKD). This retrospective cohort study analyzed utilization patterns of IV iron and ESA in patients over 18 years of age admitted to University Health System Hospitals with a primary or secondary diagnosis of CKD between January 1, 2006 to December 31, 2008. A clustered binomial logistic regression using the GEE methodology was used to identify predictors of IV iron utilization. Only 8% (n= 6678) of CKD patients on ESA therapy received IV iron supplementation in university hospitals. Those receiving iron used significantly less amounts of ESAs. Patient demographics (age, race, primary payer), patient clinical conditions (admission status, severity of illness, dialysis status), and physician specialty were identified as predictors of IV iron use in CKD patients. Use of IV iron with ESAs was low despite recommendations from consensus guidelines. The low treatment rate of IV iron represents a gap in treatment practices and signals an opportunity for healthcare improvement in CKD anemic patients.

Incidence of bacterial infections in chronic kidney disease patients admitted in nephrology unit of Kathmandu Medical College Teaching Hospital

2018 ◽  
Vol 7 (1) ◽  
pp. 26-29
Author(s):  
Laxman Adhikari
Keyword(s):  
Infectious Disease ◽  
Chronic Kidney Disease ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Kidney Disease ◽  
Tract Infection ◽  
Infectious Diseases ◽  
Bacterial Infections ◽  
College Teaching ◽  
Medical College

Background: Infectious diseases are one of the leading causes of morbidity and mortality in chronic kidney disease patients, second only to cardiovascular causes. As the incidence of chronic kidney disease is increasing, the number of deaths due to infectious disease is also increasing. Infectious disease includes infection, bacteremia and sepsis in chronic kidney disease patients.Objective: To assess the incidence of bacterial infections in chronic kidney disease patients.Methodology: A prospective cross-sectional study was done among all chronic kidney disease patients admitted over 6 months in Nephrology Unit of Department of Medicine, Kathmandu Medical College Teaching Hospital.Results: 58 patients were admitted with infectious diseases, out of which 6 patients (10.34%) died during treatment while 1 patient (1.78%) left against medical advice. Infection in patients undergoing dialysis (5D) was much more compared to stage 4 or 5chronic kidney disease patients (58.62% vs. 13.79% vs. 17.24% respectively). 19 patients (32.76%) had pneumonia, 16 patients (27.56%) had Urinary Tract Infection while 12 patients (20.70%) had sepsis. Although sepsis was less prevalent compared to pneumonia/ Urinary Tract Infection, deaths due to sepsis was very high.Conclusion: The incidence of bacterial infections in chronic kidney disease patients is still high despite all the improvements in infection control and dialysis practices, and still lots is left to be done to reduce the morbidity and mortality caused by infections in chronic kidney disease patients.

scholarly journals A RARE CASE OF GENERALIZED LEGIONELLOSIS IN THE PRACTICE OF INFECTIOUS DISEASE PHYSICIAN

2012 ◽  
Vol 17 (5) ◽  
pp. 54-56
Author(s):  
M. V. Nagibina ◽  
O. A. Tishkevich ◽  
O. A Muravyov ◽  
V. A. Kadyshev ◽  
M. Z. Shakhmardanov ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antibiotic Therapy ◽  
Rare Case ◽  
Clinical Manifestations ◽  
Laboratory Diagnosis ◽  
Infectious Disease Physician

In legionellosis specific clinical manifestations and radiographic criteria are absent, so the identification of legionellosis is possible only with the widespread introduction of specific methods of laboratory diagnosis, that if necessary will allow to adjust quickly antibiotic therapy.

Acute kidney injury

2016 ◽  
Vol 9 (12) ◽  
pp. 732-740
Author(s):  
Kirsty Gillies ◽  
Thomas Blakeman ◽  
Daniel Lasserson
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
General Practice ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Severity Of Illness ◽  
Clinical Syndrome ◽  
Sick Patient

Acute kidney injury is a clinical syndrome that has become increasingly recognised as a marker of severity of illness in the acutely sick patient. It can lead to, or worsen, chronic kidney disease, and as a result, increase cardiovascular risk. This article sets out the relevance of acute kidney injury for general practice, detailing the identification, management, follow-up and strategies for prevention.

scholarly journals CHRONIC KIDNEY DISEASE AND VISCERAL CANDIDIASIS

2015 ◽  
pp. 61-64
Author(s):  
V. Moyseyenko ◽  
T. Nykula ◽  
I. Burzhynskaya
Keyword(s):  
Chronic Kidney Disease ◽  
Gastrointestinal Tract ◽  
Kidney Disease ◽  
Antibiotic Therapy ◽  
Immunosuppressive Therapy ◽  
Kidney Transplant ◽  
Oral Mucosa ◽  
Clinical Manifestations ◽  
Secondary Immunodeficiency ◽  
Other Substances

Kidneys play a significant role in metabolism, detoxification, biotransformation of dietary, medicinal and other substances. The mainstay of treatment of patients with chronic kidney disease, including pyelonephritis is antibiotic therapy; of glomerulonephritis - glucocorticoids, cytostatics. The presence of comorbidities, diabetes increases the total number of drugs used. Frequent prolonged use of drugs causes secondary immunodeficiency, gastrointestinal tract dysbiosis, clinical manifestations of which are oral mucosa candidiasis; the progression of kidney damage, kidney transplant may cause visceral candidiasis. Control of immunosuppressive therapy, parenteral infusion ofantifungal agents and timely diagnosis prevent candidiasis in patients with chronic kidney disease.    

Syphilis

2015 ◽  
Author(s):  
Emmanuel A. Burdmann
Keyword(s):  
Infectious Disease ◽  
Kidney Disease ◽  
Antibiotic Therapy ◽  
Renal Biopsy ◽  
Congenital Syphilis ◽  
Kidney Diseases ◽  
Transmission Route ◽  
Infected Blood ◽  
Clinical Presentations ◽  
Membranous Glomerulopathy

Syphilis is an infectious disease caused by the bacterium Treponema pallidum. The transmission route is usually sexual, but prenatal contamination (congenital syphilis) and transmission by infected blood can also occur. The most frequent presentation of syphilis nephropathy is proteinuria, and the most common form of associated glomerular disease is membranous glomerulopathy. Kidney disease usually reverts with antibiotic therapy. Syphilis must always be considered in proteinuric HIV-infected patients. Renal biopsy is necessary to differentiate between HIV-associated nephropathy and syphilis-induced glomerulopathies, since both kidney diseases have analogous clinical presentations, but syphilis-induced glomerulopathies may recover with syphilis successful treatment.

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