The Impact of Reported Beta-Lactam Allergy in Hospitalized Patients With Hematologic Malignancies Requiring Antibiotics

Abstract Objective Reported penicillin allergies result in alternative antimicrobial use and are associated with worse outcomes and increased costs. Penicillin skin testing (PST) has recently been shown to be safe and effective in immunocompromised cancer patients, yet its impact on antimicrobial costs and aztreonam utilization has not been evaluated in this population. Method From September 2017 to January 2018, we screened all admitted patients receiving aztreonam. Those with a self-reported history of possible immunoglobulin E (IgE)-mediated reaction to penicillin were eligible for PST with oral challenge. Results A total of 129 patients were screened, and 49 patients were included and underwent testing. Sixteen patients (33%) had hematologic malignancies and 33 patients (67%) had solid tumors. After PST with oral challenge, 46 patients (94%) tested negative, 1 patient tested positive on oral challenge, and 2 patients had indeterminate results. The median time from admission to testing was 2 days (interquartile range, 1–4). After testing negative, 33 patients (72%) were switched to beta-lactam therapy, which resulted in a total of 390 days of beta-lactam therapy. For identical therapy durations, the direct total antibiotic cost was $15 138.89 for beta-lactams versus $78 331.50 for aztreonam, resulting in $63 192.61 in projected savings. A significant reduction in median days of aztreonam therapy per 1000 patient days (10.0 vs 8.0; P = .005) was found during the intervention period. Conclusions Use of PST in immunocompromised cancer patients receiving aztreonam resulted in improved aztreonam stewardship and significant cost savings. Our study demonstrates that PST with oral challenge should be considered in all cancer patients with reported penicillin allergies.

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228. Fluoroquinolone Prescribing for Diabetic Foot Infections following an FDA Drug Safety Communication for Aortic Aneurysm Risk

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.272 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S115-S116

Author(s):

Catherine Li ◽

Nicholas J Mercuro ◽

Ryan Chapin ◽

Howard Gold ◽

Christopher McCoy

Keyword(s):

Aortic Aneurysm ◽

Drug Safety ◽

Diabetic Foot ◽

Hospitalized Patients ◽

Transitions Of Care ◽

Antibiotic Prescribing ◽

Beta Lactam ◽

Chi Square ◽

Safety Communication ◽

The Impact

Abstract Background Fluoroquinolones were commonly prescribed for hospitalized patients with diabetic foot infection (DFI) at our institution, included in 69% of empiric antibiotic regimens from 2011–2014. On December 20, 2018, the U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication regarding the risk of aortic aneurysm with fluoroquinolones. The objective of this study was to assess the impact of the FDA Communication on antibiotic prescribing for DFI. Methods This was a single-center quasi-experimental study of hospitalized patients initiated on antibiotics for DFI before (February-December 2018) and after (February-December 2019) the 2018 FDA Communication. Patients with concomitant infections or documented beta-lactam or fluoroquinolone allergies were excluded. The primary outcome was inpatient days of fluoroquinolone therapy. Secondary outcomes included days of beta-lactam therapy and Outpatient Parenteral Antibiotic Therapy (OPAT) enrollment. Variables were compared using the Pearson’s chi square, Fisher’s exact, and Mann Whitney U tests, as appropriate. A logistic regression was performed to identify predictors for inpatient receipt of fluoroquinolones. Results A total of 198 patients were included. Baseline characteristics were similar between groups (Table 1). After the FDA Communication, the median duration of inpatient fluoroquinolones decreased from 3 [0–5.5] to 0 [0–1] days (p< 0.001). The duration of antipseudomonal beta-lactams increased from 0 [0–2] to 2 [0–6] days (p< 0.001). OPAT enrollment increased from 16.5% to 29.7% (p=0.028), with a corresponding increase in peripherally inserted central catheter placement (15.5% to 25.7%, p=0.074). There was no difference in outpatient fluoroquinolone prescribing over time. Incidence of re-infection, readmission for DFI, and antibiotic adverse events were similar between groups (Table 2). Table 1 Table 2 Conclusion Inpatient fluoroquinolone prescribing for DFI decreased significantly following the 2018 FDA Communication, followed by an increase in antipseudomonal beta-lactam use and OPAT enrollment. FDA statements can influence institutional antibiotic prescribing and transitions of care decisions, representing an opportunity for education by Antimicrobial Stewardship programs. Disclosures All Authors: No reported disclosures

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322 The impact of comorbidity identification on outcomes of pyoderma gangrenosum: A retrospective cohort study of previously hospitalized patients

Journal of Investigative Dermatology ◽

10.1016/j.jid.2021.02.344 ◽

2021 ◽

Vol 141 (5) ◽

pp. S57

Author(s):

M. Ravi ◽

J. Trinidad ◽

N. Spaccarelli ◽

B. Kaffenberger

Keyword(s):

Cohort Study ◽

Pyoderma Gangrenosum ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hospitalized Patients ◽

The Impact

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Impact of simple, specific, verbal instructions on the quality of bowel preparation in hospitalized patients undergoing colonoscopy: a multicenter randomized controlled trial

Endoscopy International Open ◽

10.1055/a-1339-0913 ◽

2021 ◽

Vol 09 (03) ◽

pp. E378-E387

Author(s):

Konstantinos Triantafyllou ◽

Paraskevas Gkolfakis ◽

Alexandros Skamnelos ◽

Georgia Diamantopoulou ◽

Athanasios Dagas ◽

...

Keyword(s):

Bowel Preparation ◽

Controlled Trial ◽

Statistical Significance ◽

Intervention Group ◽

Standard Of Care ◽

Hospitalized Patients ◽

Verbal Instructions ◽

Multicenter Randomized Controlled Trial ◽

The Impact

Abstract Background and study aims Bowel preparation for colonoscopy is frequently inadequate in hospitalized patients. We explored the impact of specific verbal instructions on the quality of inpatients bowel preparation and factors associated with preparation failure. Patients and methods Randomized (1:1), two strata (mobilized vs. bedridden; 3:2) trial of consecutive inpatients from four tertiary centers, who received either specific, verbal instructions or the standard of care (SOC) ward instructions about bowel preparation. The rate of adequate bowel preparation (Boston Bowel Preparation Score [BBPS] ≥ 6, no segment < 2) comprised the primary endpoint. Mean BBPS score, good (BBPS score ≥ 7, no segment score < 2) and excellent (BBPS = 9) were among secondary endpoints. Results We randomized 300 inpatients (180 mobile) aged 71.7 ± 15.1 years in the intervention (49.7 %) and SOC (50.3 %) groups, respectively. Overall, more patients in the intervention group achieved adequate bowel preparation, but this difference did not reach statistical significance neither in the intention-to-treat [90/149 (60.4 %) vs. 82/151 (54.3 %); P = 0.29] nor in the per-protocol analysis [90/129 (69.8 %) vs. 82/132 (62.1 %); P = 0.19]. Overall BBPS score did not differ statistical significantly in the two groups, but the provision of specific verbal instructions was associated with significant higher rates of good (58.1 % vs. 43.2 %; P = 0.02) and excellent (31.8 % vs. 16.7 %; P = 0.004) bowel preparation compared to the SOC group. Administration of same-day bowel preparation and patient American Society of Anesthesiologists score > 2 were identified as risk factors for inadequate bowel preparation. Conclusions Provision of specific verbal instructions did not increase the rate of adequate bowel preparation in a population of mobilized and bedridden hospitalized patients.

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Performance of the Wells score in predicting deep vein thrombosis in medical and surgical hospitalized patients with or without thromboprophylaxis: The R-WITT study

Vascular Medicine ◽

10.1177/1358863x21994672 ◽

2021 ◽

pp. 1358863X2199467

Author(s):

Jean-Eudes Trihan ◽

Michael Adam ◽

Sara Jidal ◽

Isabelle Aichoun ◽

Sarah Coudray ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Risk Stratification ◽

Hospitalized Patients ◽

Operating Characteristics ◽

Vein Thrombosis ◽

Ultrasound Study ◽

Wells Score ◽

Deep Vein ◽

The Impact ◽

Test Probability

The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score’s accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( p = 0.22) and 1.7%, 4.2% and 25.8% ( p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.

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Clinical Management of Hypertension, Inflammation and Thrombosis in Hospitalized COVID-19 Patients: Impact on Survival and Concerns

Journal of Clinical Medicine ◽

10.3390/jcm10051073 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1073

Author(s):

Patricia Martínez-Botía ◽

Ángel Bernardo ◽

Andrea Acebes-Huerta ◽

Alberto Caro ◽

Blanca Leoz ◽

...

Keyword(s):

Arterial Hypertension ◽

Clinical Management ◽

Cox Regression ◽

Angiotensin Receptor Blockers ◽

Treatment Options ◽

Clinical Manifestations ◽

Specific Treatment ◽

Hospitalized Patients ◽

Thrombosis Prophylaxis ◽

The Impact

The most severe clinical manifestations of the Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are due to an unbalanced immune response and a pro-thrombotic hemostatic disturbance, with arterial hypertension or diabetes as acknowledged risk factors. While waiting for a specific treatment, the clinical management of hospitalized patients is still a matter of debate, and the effectiveness of treatments to manage clinical manifestations and comorbidities has been questioned. In this study, we aim to assess the impact of the clinical management of arterial hypertension, inflammation and thrombosis on the survival of COVID-19 patients. The Spanish cohorts included in this observational retrospective study are from HM Hospitales (2035 patients) and from Hospital Universitario Central de Asturias (72 patients). Kaplan Meier survival curves, Cox regression and propensity score matching analyses were employed, considering demographic variables, comorbidities and treatment arms (when opportune) as covariates. The management of arterial hypertension with angiotensin-converting enzyme 2 (ACE2) inhibitors or angiotensin receptor blockers is not detrimental, as was initially reported, and neither was the use of non-steroidal anti-inflammatory drugs (NSAIDs). On the contrary, our analysis shows that the use on itself of corticosteroids is not beneficial. Importantly, the management of COVID-19 patients with low molecular weight heparin (LMWH) as an anticoagulant significantly improves the survival of hospitalized patients. These results delineate the current treatment options under debate, supporting the effectiveness of thrombosis prophylaxis on COVID-19 patients as a first-line treatment without the need for compromising the treatment of comorbidities, while suggesting cautiousness when administering corticosteroids.

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The Plasmair Decontamination System Is Protective Against Invasive Aspergillosis in Neutropenic Patients

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.81 ◽

2016 ◽

Vol 37 (7) ◽

pp. 845-851 ◽

Cited By ~ 2

Author(s):

Marie-Paule Fernandez-Gerlinger ◽

Anne-Sophie Jannot ◽

Sophie Rigaudeau ◽

Juliette Lambert ◽

Odile Eloy ◽

...

Keyword(s):

Invasive Aspergillosis ◽

Severe Infection ◽

Hematologic Malignancies ◽

Preventive Strategies ◽

European Organization ◽

Exact Test ◽

Eortc Criteria ◽

Neutropenic Patients ◽

Chemotherapy Induced Neutropenia ◽

The Impact

OBJECTIVEInvasive aspergillosis (IA) is a rare but severe infection caused by Aspergillus spp. that often develops in immunocompromised patients. Lethality remains high in this population. Therefore, preventive strategies are of key importance. The impact of a mobile air decontamination system (Plasmair, AirInSpace, Montigny-le-Bretonneux, France) on the incidence of IA in neutropenic patients was evaluated in this study.DESIGNRetrospective cohort studyMETHODSPatients with chemotherapy-induced neutropenia lasting 7 days or more were included over a 2-year period. Cases of IA were confirmed using the revised European Organization for Research and Treatment of Cancer (EORTC) criteria. We took advantage of a partial installation of Plasmair systems in the hematology intensive care unit during this period to compare patients treated in Plasmair-equipped versus non-equipped rooms. Patients were assigned to Plasmair-equipped or non-equipped rooms depending only on bed availability. Differences in IA incidence in both groups were compared using Fisher’s exact test, and a multivariate analysis was performed to take into account potential confounding factors.RESULTSData from 156 evaluable patients were available. Both groups were homogenous in terms of age, gender, hematological diagnosis, duration of neutropenia, and prophylaxis. A total of 11 cases of probable IA were diagnosed: 10 in patients in non-equipped rooms and only 1 patient in a Plasmair-equipped room. The odds of developing IA were much lower for patients hospitalized in Plasmair-equipped rooms than for patients in non-equipped rooms (P=.02; odds ratio [OR] =0.11; 95% confidence interval [CI], 0.00–0.84).CONCLUSIONIn this study, Plasmair demonstrated a major impact in reducing the incidence of IA in neutropenic patients with hematologic malignancies.Infect Control Hosp Epidemiol 2016;37:845–851

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Feasibility of telemedicine in the management strategy of patients with lymphoma amid the COVID-19 pandemic in Spain, a prospective study (Preprint)

10.2196/preprints.34128 ◽

2021 ◽

Author(s):

Raul Cordoba ◽

Alberto Lopez-Garcia ◽

Daniel Morillo ◽

Maria-Angeles Perez-Saenz ◽

Elham Askari ◽

...

Keyword(s):

Prospective Observational Study ◽

Digital Health ◽

Hematologic Malignancies ◽

Patient Portal ◽

Health Strategy ◽

Potential Risk Factors ◽

Hospital Visits ◽

A Prospective Study ◽

The Impact

BACKGROUND Recurrent hospital visits were potential risk factors for COVID-19 contagion. OBJECTIVE The aims of this prospective observational study was to analyze the consequences of COVID-19 pandemic in the health care of patients with lymphoma and the impact of telemedicine strategies such as the patient portal in their management. METHODS All data were obtained from the electronic medical record (EMR). Variables such as age, sex, matter of the visit, use of patient’s portal, changes in management, impact in clinical trials and suffering from COVID-19 contagion were recorded. RESULTS 290 patients were attended in the lymphoma clinic accomplishing 437 appointments. The median age was 66 years (range 18-94), and 157 (54.13%) were male. Of them, 109 out of 290 (37.58%) were aged older then 70 years. Regarding number of visits, 214 patients (73.79%) had only 1 visit to the hospital. Only 23 patients (7.93%) didn’t have access to patient’s portal. During the follow-up, only 7 patients (2.41%) suffered from COVID-19, with a median age of 66 years (51-80). CONCLUSIONS Telemedicine such as patient’s portal are feasible strategies in the management of patients with lymphoma during the COVID-19 pandemic, with a reduction of in-person visits to hospital and a very low contagion rate. This experience allowed us to continue with a new digital health strategy in the follow up of patients with hematologic malignancies. CLINICALTRIAL Not registered.

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Perception and Impact of Life Events in Medically Hospitalized Patients With Somatic Symptom and Related Disorders

Hospital Pediatrics ◽

10.1542/hpeds.2017-0197 ◽

2018 ◽

Vol 8 (11) ◽

pp. 699-705

Author(s):

Katherine K. Bedard-Thomas ◽

Simona Bujoreanu ◽

Christine H. Choi ◽

Patricia I. Ibeziako

Keyword(s):

Life Events ◽

Somatic Symptom ◽

Functional Disability ◽

De Novo ◽

Patient Characteristics ◽

Hospitalized Patients ◽

Health Care Use ◽

Life Event ◽

Academic Events ◽

The Impact

OBJECTIVES: We describe the prevalence and perceived impact of life events reported by medically hospitalized patients with somatic symptom and related disorders (SSRD) and highlight patient characteristics and outcomes associated with highly impactful life events. METHODS: Retrospective chart reviews were conducted of patients with SSRD at a tertiary pediatric hospital who were seen by the psychiatry consultation service and completed various instruments while medically admitted, including a de novo life events checklist. Descriptive statistics, correlations, χ2 tests, and internal consistency analyses were used. RESULTS: Charts of 70.2% of patients with SSRD who completed the life events checklist (N = 172; age range 8–25 years) were reviewed. Of those studied, 94% reported at least 1 life event in the last year, with academic events most prevalent, 81% reported life events across multiple domains, and 56% perceived the life event(s) as having a great impact on their lives. Patients who perceived more great impact life events were older, from households with lower median incomes, had higher self-reported somatization, greater functional disability, more comorbid psychiatric diagnoses, required more psychotropic medications, and had longer medical admissions. CONCLUSIONS: Findings reveal that although the majority of medically hospitalized patients with SSRD reported at least 1 relevant life event, it was the patients’ perception of the impact of the life event(s) that correlated with high levels of disability and health care use. An assessment of the perception of life events in patients with SSRD may help hospitalists and interdisciplinary providers identify high-risk patients for whom early psychiatry referrals can be made.

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