863. Outcomes of Healthcare-Associated Respiratory Viral Infections in a Pediatric Hospital: A Historical Cohort Study

Abstract Background Healthcare-associated respiratory viral infections (HARVI) occur frequently at pediatric hospitals. The spectrum and attributable outcomes of these infections are unknown. Methods Using a matched historical cohort design, HARVI cases identified between July 2013 and June 2018 at a large pediatric referral hospital in Dallas, Texas were defined as patients who tested positive for one of eight respiratory viruses during their hospitalization, had new respiratory symptoms develop during hospitalization, and had symptom onset on a hospitalization day that was greater than the maximum incubation period for the specific respiratory virus. Controls were matched 1:1 for index time, meaning that the control had a hospital length of stay that was at least as long as the length of stay in the matched case prior to viral testing. Controls were also matched for year and month of infection as well as hospital unit and/or age. The primary outcome was additional length of stay following infection or index time. Additional outcomes included transfer to intensive care, need for intubation, hospital charges, and all cause in-hospital mortality. Results Over the 5-year study period, 317 definite HARVI were identified (0.62 per 1,000 admitted patient days), and only 287 (91%) had a matched control to be included in analysis. Among these cases and matched controls, the median time to index time was 19 days (IQR 10-39 days). The most common causative viruses where rhinovirus/enterovirus (188, 65.5%), RSV (30, 10.5%), parainfluenza virus (28, 9.8%), and seasonal coronaviruses (27, 9.4%). Fewer cases than controls were in an intensive care unit at index time (101 [35.2%] vs. 156 [54.4%]) The mean additional length of stay following index time was shorter in cases than controls (35.2 days vs. 48.1 days, difference = -12.9 days, 95% CI -20.95 to -4.82 days). Conclusion Hospital length of stay for cases with HARVI was not longer than for those without HARVI. Possible explanations include confounding and selection bias. Further studies with carefully selected controls are needed. Disclosures All Authors: No reported disclosures

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Burden of illness in carbapenem-resistant Acinetobacter baumannii infections in US hospitals between 2014 and 2019

BMC Infectious Diseases ◽

10.1186/s12879-021-07024-4 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Jason M. Pogue ◽

Yun Zhou ◽

Hemanth Kanakamedala ◽

Bin Cai

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Acinetobacter Baumannii ◽

Burden Of Illness ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Hospital Charges ◽

Carbapenem Resistant

Abstract Background Carbapenem-resistant (CR) Acinetobacter baumannii is a concerning pathogen in the USA and worldwide. Methods To assess the comparative burden of CR vs carbapenem-susceptible (CS) A. baumannii, this retrospective cohort study analyzed data from adult patients in 250 US hospitals from the Premier HealthCare Database (2014–2019). The outcomes analyzed included hospital length of stay (LOS), intensive care unit (ICU) utilization, discharge status, in-hospital mortality, readmission rates and hospital charges. Logistic regression was used for univariate and multivariable assessment of the independent relationship between relevant covariates, with a focus on CR status, and in-hospital mortality. Results 2047 Patients with CR and 3476 patients with CS A. baumannii infections were included. CR A. baumannii was more commonly isolated in respiratory tract infections (CR 40.7% and CS 27.0%, P < 0.01), whereas CS A. baumannii was more frequently associated with bloodstream infections (CS 16.7% and CR 8.6%, P < 0.01). Patients with CR A. baumannii infections had higher in-hospital (CR 16.4% vs CS 10.0%; P < 0.01) and 30-day (CR 32.2% vs CS 21.6%; P < 0.01) mortality compared to those with CS infections. After adjusting for age, sex, admission source, infection site, comorbidities, and treatment with in vitro active antibiotics within 72 h, carbapenem resistance was independently associated with increased mortality (adjusted odds ratio 1.42 [95% confidence interval 1.15; 1.75], P < 0.01). CR infections were also associated with increases in hospital length of stay (CR 11 days vs CS 9 days; P < 0.01), rate of intensive care unit utilization (CR 62.3% vs CS 45.1%; P < 0.01), rate of readmission with A. baumannii infections (CR 17.8% vs CS 4.0%; P < 0.01) and hospital charges. Conclusions These data suggest that the burden of illness is significantly greater for patients with CR A. baumannii infections and are at higher risk of mortality compared with CS infections in US hospitals.

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Multicenter Validation of a Risk Index for Mortality, Intensive Care Unit Stay, and Overall Hospital Length of Stay After Cardiac Surgery

Circulation ◽

10.1161/01.cir.91.3.677 ◽

1995 ◽

Vol 91 (3) ◽

pp. 677-684 ◽

Cited By ~ 255

Author(s):

Jack V. Tu ◽

Susan B. Jaglal ◽

C. David Naylor

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Intensive Care Unit Stay ◽

Risk Index ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Multicenter Validation

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Patient-Specific Factors Drive Intensive Care Unit and Total Hospital Length of Stay in Operative Brain Tumor Patients

World Neurosurgery ◽

10.1016/j.wneu.2021.06.114 ◽

2021 ◽

Author(s):

Adrian E. Jimenez ◽

Pavan P. Shah ◽

Adham M. Khalafallah ◽

Sakibul Huq ◽

Jose L. Porras ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Brain Tumor ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Patient Specific ◽

Total Hospital ◽

Tumor Patients ◽

Specific Factors

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#87: Association Between Healthcare-Associated Respiratory Viral Infections and Length of Stay at a Pediatric Hospital

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.044 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S15-S15

Author(s):

Zachary Most ◽

Michael Sebert ◽

Patricia Jackson ◽

Trish M Perl

Keyword(s):

Length Of Stay ◽

Incubation Period ◽

Respiratory Infection ◽

Symptom Onset ◽

Viral Infections ◽

Pediatric Hospital ◽

Time Period ◽

Life Years ◽

Respiratory Viral Infections ◽

Healthcare Associated

Abstract Background Healthcare-associated infections (HAI) are major preventable causes of morbidity and mortality. While there are fewer overall HAI in children, there is a greater potential impact in disability-adjusted life years. Healthcare-associated respiratory viral infections (HARVI) are not frequently tracked within institutions, yet the risk for such infections in pediatric hospitals is very high. Recent data demonstrate large inter-hospital variability of HARVI incidence that may depend on various factors including the number of immunocompromised patients in the hospital and the presence of shared rooms. We hypothesize that the burden of healthcare-associated respiratory viral infections and their impact on the length of stay (LOS) is substantial at a large urban pediatric hospital. Methods A cohort of all children with any HARVI admitted to a large urban pediatric hospital between July 2017 and June 2018 were included after obtaining IRB approval. We defined a HARVI as a respiratory infection with an onset of symptoms while the patient was hospitalized meeting three criteria: A positive microbiologic test for one of 8 viruses, presence of symptoms of a respiratory infection, and onset of symptoms after admission beyond the minimum incubation period for each virus. Infections with symptom onset after admission beyond the maximum incubation period were considered definite hospital onset whereas others were considered possible hospital onset. The electronic medical record provided data on demographics, underlying medical conditions, hospital length of stay prior to infection and hospital unit of infection, and consequences and outcome of HARVI. The at-risk population for calculation of the incidence of HARVI was all admitted patient-days at the hospital over this time period. Results Between July 2017 and June 2018 the incidence of HARVI (definite or possible hospital onset) was 1.2 infections per 1,000 admitted patient-days (60% due to rhinovirus/enterovirus, 12% due to respiratory syncytial virus, and 9% due to influenza). Overall, 48% of patients were under 2 years of age, 18% were between 2 and 5 years of age, and 34% were over 5 years of age. Twenty-one percent were immunocompromised and 35% had underlying lung disease. The median length of stay prior to symptom onset was 11 days (IQR 5–36 days) and the median total length of stay was 30 days (IQR 15–82.5 days). Eight individuals had more than one HARVI over this time period. Nineteen percent were transferred to the intensive care unit and 7% died during their hospital admission Conclusion HARVI occurs frequently in a pediatric hospital and often in patients with underlying comorbidities. The risk for HARVI increases substantially with increased length of stay. Such data support the need for tracking HARVI in high-risk institutions.

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Hospital Length of Stay Among Patients Receiving Intermittent Versus Prolonged Piperacillin/Tazobactam Infusion in the Intensive Care Units

Journal of Intensive Care Medicine ◽

10.1177/0885066617708756 ◽

2017 ◽

Vol 33 (2) ◽

pp. 134-141 ◽

Cited By ~ 2

Author(s):

Jeannie D. Chan ◽

Timothy H. Dellit ◽

John B. Lynch

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Randomized Trials ◽

Average Duration ◽

Intermittent Infusion ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Inclusion Criteria ◽

Prolonged Infusion

Objectives: We sought to evaluate clinical outcomes of intensive care unit (ICU) patients following a hospital-wide initiative of prolonged piperacillin/tazobactam (PIP/TAZ) infusion. Methods: Retrospective observational study of patients >18 years old who was hospitalized in the ICU receiving PIP/TAZ for >72 hours during the preimplementation (June 1, 2010 to May 31, 2011) and postimplementation (July 7, 2011 to June 30, 2014) periods. Results: There were 124 and 429 patients who met inclusion criteria with average age of 54.3 and 56.9 years, and average duration of PIP/TAZ therapy was 6.1 ± 2.8 days and 5.9 ± 3.4 days in the pre- and postimplementation period, respectively. Intensive care unit and hospital length of stay (LOS) following initiation of PIP/TAZ were 8.0 ± 8.4 days versus 6.4 ± 6.8 days and 26.3 ± 22.8 days versus 20.4 ± 16.1 days among patients in the pre- and postimplementation periods, respectively. Compared to patients who received intermittent PIP/TAZ infusion, the adjusted difference in ICU and hospital LOS was 0.6 ± 0.8 days (95% confidence interval [CI]: −0.9 to 2.1 days) and 5.6 ± 2.1 days (95% CI: 1.4 - 9.7 days) shorter among patients who received prolonged PIP/TAZ infusion. At hospital discharge, 19 (15.3%) intermittent infusion and 74 (17.2%) prolonged infusion recipients had died. In comparison to intermittent infusion recipients, the adjusted odds ratio for mortality was 1.17 (95% CI: 0.65-2.1) with prolonged infusion. Conclusion: Our study demonstrated a reduction in hospital LOS with prolonged PIP/TAZ infusion among critically ill patients. Randomized trials are needed to further validate these findings.

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Change in alkaline phosphatase activity associated with intensive care unit and hospital length of stay in patients with septic acute kidney injury on continuous renal replacement therapy

BMC Nephrology ◽

10.1186/s12882-018-1028-9 ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Seung Don Baek ◽

Jae-Young Kang ◽

Hoon Yu ◽

Seulgi Shin ◽

Hyang-Sook Park ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Alkaline Phosphatase ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Length Of Stay ◽

Kidney Injury ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Septic Acute Kidney Injury

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Among Trauma Patients, Younger Men with Ventilator-Associated Pneumonia Have Worse Outcomes Compared to Older Men—An Exploratory Study

Healthcare ◽

10.3390/healthcare7020067 ◽

2019 ◽

Vol 7 (2) ◽

pp. 67

Author(s):

Duraid Younan ◽

Sarah Delozier ◽

Nathaniel McQuay ◽

John Adamski ◽

Aisha Violette ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Older Men ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Ventilator Associated Pneumonia ◽

Icu Stay ◽

Younger Men

Background: Ventilator-associated pneumonia is associated with significant morbidity. Although the association of gender with outcomes in trauma patients has been debated for years, recently, certain authors have demonstrated a difference. We sought to compare the outcomes of younger men and women to older men and women, among critically ill trauma patients with ventilator-associated pneumonia (VAP). Methods: We reviewed our trauma data base for trauma patients with ventilator-associated pneumonia admitted to our trauma intensive care unit between January 2016 and June 2018. Data collected included demographics, injury mechanism and severity (ISS), admission vital signs and laboratory data and outcome measures including hospital length of stay, ICU stay and survival. Patients were also divided into younger (<50) and older (≥50) to account for hormonal status. Linear regression and binary logistic regression models were performed to compare younger men to older men and younger women to older women, and to examine the association between gender and hospital length of stay (LOS), ICU stay (ICUS), and survival. Results: Forty-five trauma patients admitted to our trauma intensive care unit during the study period (January 2016 to August 2018) had ventilator-associated pneumonia. The average age was 58.9 ± 19.6 years with mean ISS of 18.2 ± 9.8. There were 32 (71.1%) men, 27 (60.0%) White, and 41 (91.1%) had blunt trauma. Mean ICU stay was 14.9 ± 11.4 days and mean total hospital length of stay (LOS) was 21.5 ± 14.6 days. Younger men with VAP had longer hospital LOS 28.6 ± 17.1 days compared to older men 16.7 ± 6.6 days, (p < 0.001) and longer intensive care unit stay 21.6 ± 15.6 days compared to older men 11.9 ± 7.3 days (p = 0.02), there was no significant difference in injury severity (ISS was 22.2 ± 8.4 vs. 17 ± 8, p = 0.09). Conclusions: Among trauma patients with VAP, younger men had longer hospital length of stay and a trend towards longer ICU stay. Further research should focus on the mechanisms behind this difference in outcome using a larger database.

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Use of hospital resources in the care of patients with intermediate risk pulmonary embolism

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620921601 ◽

2020 ◽

pp. 204887262092160

Author(s):

Alexander E Sullivan ◽

Tara Holder ◽

Tracy Truong ◽

Cynthia L Green ◽

Olamiji Sofela ◽

...

Keyword(s):

Intensive Care Unit ◽

Pulmonary Embolism ◽

Intensive Care ◽

High Risk ◽

Length Of Stay ◽

Intensive Care Unit Admission ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Intermediate Risk ◽

Risk Patients

Background Risk stratification and management of hemodynamically stable pulmonary embolism remains challenging. Professional societies have published stratification schemes, but little is known about the management of patients with intermediate risk pulmonary embolism. We describe the care of these patients at an academic health system. Methods Patient encounters from 1 January 2016 to 30 June 2017 were retrospectively identified utilizing a multihospital, electronic health record-based data warehouse. Using the 2019 European Society of Cardiology criteria, differences in hospital resource utilization, defined as intensive care unit admission, use of invasive therapies, and length of stay, were examined in patients with intermediate risk characteristics. Results A cohort of 322 intermediate risk patients, including 165 intermediate–low and 157 intermediate–high risk patients, was identified. Intermediate–high risk patients more often underwent catheter-directed therapy (14.0% vs. 1.8%; P<0.001) compared to intermediate–low risk patients and had a 50% higher rate of intensive care unit admission (relative risk 1.50; 95% confidence interval 1.06, 2.12; P=0.023). There was no difference in median intensive care unit length of stay (2.7 vs. 2.0 days; P=0.761) or hospital length of stay (5.0 vs. 5.0 days; P=0.775) between intermediate–high risk and intermediate–low risk patients. Patients that underwent invasive therapies had a 3.8-day shorter hospital length of stay (beta –3.75; 95% confidence interval –6.17, –1.32; P=0.002). Conclusion This study presents insights into the hospital resource utilization of patients with intermediate risk pulmonary embolism. The 2019 European Society of Cardiology risk stratification criteria are a clinically relevant scheme that identifies patients more often treated with intensive care unit admission and advanced therapies.

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