101. Diagnostic Utility of a Multiplex PCR Meningitis/Encephalitis Panel and Impact on Antibiotic Use

Abstract Background The detection and identification of meningitis and encephalitis pathogens from CSF via traditional microbiologic methods may take several hours to days. The BioFire FilmArray Meningitis/Encephalitis Panel (BioFire), approved by the FDA in 2015, can detect 14 different pathogens within one hour, providing a faster time to diagnosis of a broad range of pathogens. The purpose of this study was to examine the impact of BioFire on length of hospital stay and duration of antibiotic use. Methods We conducted a retrospective chart review of patients diagnosed meningitis/encephalitis between 2015 and 2019 at 3 Beaumont Health (BH) hospitals. BioFire was adopted by BH midyear in 2017, allowing for analysis of cohorts over comparable periods before and after the introduction of the panel. Data collected and analyzed included biodemographics, comorbidities, presenting signs and symptoms, CSF analysis results, pathogens, days of antibiotic therapy, length of stay, and mortality. Results A total of 161 patients diagnosed with meningitis and/or encephalitis were reviewed, including 59 who underwent testing via BioFire. Of the 161 patients, 68 had a pathogen identified, 50 via traditional methods (6 bacterial and 44 viral) and 18 via BioFire (3 bacterial and 15 viral). West Nile Virus accounted for 17 of the viral infections diagnosed via traditional methods. The mean duration of antibiotic use after the assays resulted was not significantly different between patients with bacterial infections diagnosed by traditional methods or BioFire (11.2 vs 13.0 days, p=0.82) or for those with viral infections (0.1 vs 0 days, p=0.3). The median length of stay was also not significantly different between the two cohorts for patients with bacterial infections (21.7 vs 15.0 days, p = 0.36) or viral infections (6.2 vs. 10.0 days, p = 0.10). Conclusion While utilization of the BioFire panel yielded a faster diagnostic result, we have no evidence to demonstrate that it contributes to a significant reduction in duration of antibiotic use or length of stay. Disclosures All Authors: No reported disclosures

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1340. Assessment of the impact of multiplex PCR panels in sepsis evaluations of young febrile infants

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1522 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S681-S682

Author(s):

Hunter Ratliff ◽

Tuan Tran ◽

Natalie Williams-Bouyer ◽

Diana Nguyen

Keyword(s):

Multiplex Pcr ◽

Bacterial Infections ◽

Viral Infections ◽

Retrospective Chart Review ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Before And After ◽

Antibiotic Duration ◽

Controversial Topic ◽

The Impact

Abstract Background The management of febrile infants under the age of 3 months has long been a controversial topic, often requiring them to be subject to a battery of tests, antibiotics, and hospitalization. Multiplex polymerase chain reaction (PCR) panels can provide a rapid diagnosis, but their role in managing these patients is still unknown. Our objective was to determine if multiplex respiratory and meningitis/encephalitis PCR panels decreased antibiotic duration of therapy (DOT) and hospital length of stay (LOS) when used in sepsis evaluations of febrile infants less than 90 days of age. Methods We performed a retrospective chart review of infants younger than 90 days old who were admitted to the pediatric ward for concerns of fever or sepsis from 1/1/2016 to 9/30/2019. Subjects with documented bacterial infections were excluded. Our primary outcomes were differences in DOT and LOS between patients admitted before and after PCR panels became available (Pre-PCR era and PCR era). Results 118 subjects were included in our analysis, with 52 (44.1%) coming from the Pre-PCR group. Descriptive statistics, stratified by era, are available in Table 1. The unadjusted mean LOS and DOT decreased by 8.4 (P = .003) and 32.8 (P < .001) hours, respectively. Multivariate regression demonstrated that LOS was 1.16 times longer in the Pre-PCR era (95% CI: 1.10 - 1.22; P < .001). Similarly, patients in the Pre-PCR era had DOT that was 1.95 times longer (95% CI: 1.55 - 2.46; P < .001) when adjusting for covariates. Adjusted LOS and DOT by Era and Diagnosis PCR panel results by pathogen Conclusion We conclude that multiplex PCR panels can potentially influence the management of young febrile infants admitted for sepsis evaluations by rapidly diagnosing viral infections and thus decreasing DOT and LOS. In turn, that may improve patient outcomes and satisfaction, as well as possibly decrease costs. Multiplex PCR panels should be considered as part of routine sepsis evaluations in young febrile infants. Larger studies are needed, including in depth cost analysis. Table 1: Demographics Table 2: Results between Eras Disclosures All Authors: No reported disclosures

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Misuse of Antibiotic during COVID 19 Outbreaks

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v11i6-s.5102 ◽

2021 ◽

Vol 11 (6-S) ◽

pp. 181-187

Author(s):

Rajendran Vinoth ◽

R Sambath Kumar ◽

N. Venkateswaramurthy

Keyword(s):

Antibiotic Resistance ◽

Bacterial Infections ◽

Viral Infections ◽

Antibiotic Use ◽

Self Administration ◽

Medical Institutions ◽

Wide Range ◽

Patients At Risk ◽

Almost All ◽

The Impact

The COVID-19 outbreak, caused by the severe acute respiratory syndrome coronavirus 2, has been detected in December 2019 in Wuhan, China, and is accompanied by significant degrees of morbidity and mortality. Antibiotic resistance (AMR) threatens to wreak havoc on healthcare system and the impact of globalization, and COVID-19 is intended to keep it at bay for the time being. During the COVID-19 crisis, a wide range of antimicrobial medicines were promoted as viable treatments. While both industrialized and industrializing nations have seen a rise in antimicrobial medication usage, use and abuse have been significantly more prevalent in developing countries. Antibiotic resistance is still a concern since microorganisms that cause resistant infections develop in hospitals and medical institutions, placing all patients at risk, complicating the care of COVID-19. Improper prescriptions, a lack of care management policies and needless self-administration by the general population are examples of these. Antibiotics seem to be more motivated to abuse and misusing antibiotics than to keep them safe and take them only when prescribed. Almost all of the substantial antibiotic usage in COVID-19 patients is inevitable. Patients having lung viral infections are more likely to develop subsequent bacterial infections, which lead to higher disease severity and death. Immediately crucial components of any AMR mitigation approach are increased spending in education and increased public knowledge of AMR. More studies are needed to better understand the health risks and rate of co-infection in COVID-19 patients in order to promote a decrease in any unnecessary antimicrobial prescribing. Keywords: COVID-19; Antibiotic use and misuse; Antimicrobial Resistance.

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565 POST-OPERATIVE WEIGHT LOSS AND OUTCOMES FOLLOWING ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doaa087.148 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

R Khaw ◽

S Munro ◽

J Sturrock ◽

H Jaretzke ◽

S Kamarajah ◽

...

Keyword(s):

Weight Loss ◽

Length Of Stay ◽

Hospital Stay ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Failure To Thrive ◽

Post Discharge ◽

Postoperative Weight Loss ◽

Poor Outcomes ◽

The Impact

Abstract Oesophageal cancer is the 11th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed have looked to tackle this. This study investigates the impact of these on mortality, length of hospital stay and postoperative weight loss. Methods Patients undergoing oesophagectomy between January 1st 2012—December 2014 and 28th October 2015–December 31st 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Pre-operative body weight was measured at elective admission, and further weights were identified from a prospectively maintained database, during further clinic appointments. Other data was collected through patient notes. Results 594 patients were included. Mean age at diagnosis was 65.9 years (13–65). Majority of cases were adenocarcinoma (63.3%), with varying stages of disease (TX-4, NX-3). Benign pathology accounted for 8.75% of cases. Mean weight loss post-oesophagectomy exceeded 10% at 6 months (SD 14.49). Majority (60.1%) of patients were discharged with feeding jejunostomy, and 5.22% of these required this feed to be restarted post-discharge. Length of stay was mean 16.5 days (SD 22.3). Complications occurred in 68.9% of patients, of which 13.8% were infection driven. Mortality occurred in 26.6% of patients, with 1.83% during hospital admission. 30-day mortality rate was 1.39%. Conclusion Failure to thrive and prolonged weight-loss following oesophagectomy can contribute to poor recovery, with associated complications and poor outcomes, including increased length of stay and mortality. Further analysis of data to investigate association between weight loss and poor outcomes for oesophagectomy patients will allow for personalised treatment of high-risk patients, in conjunction with members of the multidisciplinary team, including dieticians.

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Rapid Multiplex Testing for Upper Respiratory Pathogens in the Emergency Department: A Randomized Controlled Trial

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz481 ◽

2019 ◽

Cited By ~ 3

Author(s):

Larissa May ◽

Grant Tatro ◽

Eduard Poltavskiy ◽

Benjamin Mooso ◽

Simson Hon ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Usual Care ◽

Controlled Trial ◽

Antibiotic Use ◽

Respiratory Pathogens ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections ◽

The Impact

Abstract Background Acute upper respiratory tract infections are a common cause of Emergency Department (ED) visits and often result in unnecessary antibiotic treatment. Methods We conducted a randomized clinical trial to evaluate the impact of a rapid, multi-pathogen respiratory panel (RP) test versus usual care (control). Patients were eligible if they were ≥12 months old, had symptoms of upper respiratory infection or influenza like illness, and were not on antibiotics. The primary outcome was antibiotic prescription; secondary outcomes included antiviral prescription, disposition, and length of stay (ClinicalTrials.gov# NCT02957136). Results Of 191 patients enrolled, 93 (49%) received RP testing; 98 (51%) received usual care. Fifty-three (57%) RP and 7 (7%) control patients had a virus detected and reported during the ED visit (p=0.0001). Twenty (22%) RP patients and 33 (34%) usual care patients received antibiotics during the ED visit (-12% [95% CI -25%, 0.4%]; p=0.06/0.08); 9 RP patients received antibiotics despite having a virus detected. The magnitude of antibiotic reduction was greater in children (-19%) versus adults (-9%; post-hoc analysis). There was no difference in antiviral use, length of stay, or disposition. Conclusions Rapid RP testing was associated with a trend towards decreased antibiotic use, suggesting a potential benefit from more rapid viral tests in the ED. Future studies should determine if specific groups are more likely to benefit from testing and evaluate relative cost and effectiveness of broad testing, focused testing, and a combined diagnostic and antimicrobial stewardship approach.

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The Association between Prolonged Antibiotic Use in Culture Negative Infants and Length of Hospital Stay and Total Hospital Costs

American Journal of Perinatology ◽

10.1055/s-0041-1729560 ◽

2021 ◽

Author(s):

Wesam Sourour ◽

Valeria Sanchez ◽

Michel Sourour ◽

Jordan Burdine ◽

Elizabeth Rodriguez Lien ◽

...

Keyword(s):

Length Of Stay ◽

Blood Culture ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Antibiotic Use ◽

Hospital Length Of Stay ◽

Control Group ◽

Multivariate Linear Regression Analysis ◽

Negative Blood Culture ◽

Total Cost

Objective This study aimed to determine if prolonged antibiotic use at birth in neonates with a negative blood culture increases the total cost of hospital stay. Study design This was a retrospective study performed at a 60-bed level IV neonatal intensive care unit. Neonates born <30 weeks of gestation or <1,500 g between 2016 and 2018 who received antibiotics were included. A multivariate linear regression analysis was conducted to determine if clinical factors contributed to increased hospital cost or length of stay. Results In total, 190 patients met inclusion criteria with 94 infants in the prolonged antibiotic group and 96 in the control group. Prolonged antibiotic use was associated with an increase length of hospital stay of approximately 31.87 days, resulting in a $69,946 increase in total cost of hospitalization. Conclusion Prolonged antibiotics in neonates with negative blood culture were associated with significantly longer hospital length of stay and increased total cost of hospitalization. Key Points

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Human Neutrophil Lipocalin as a Superior Diagnostic Means To Distinguish between Acute Bacterial and Viral Infections

Clinical and Vaccine Immunology ◽

10.1128/cvi.00347-15 ◽

2015 ◽

Vol 22 (9) ◽

pp. 1025-1032 ◽

Cited By ~ 17

Author(s):

Per Venge ◽

Lena Douhan-Håkansson ◽

Daniel Garwicz ◽

Christer Peterson ◽

Shengyuan Xu ◽

...

Keyword(s):

Whole Blood ◽

Human Neutrophil ◽

Bacterial Infections ◽

Viral Infections ◽

Response Times ◽

Clinical Performance ◽

Point Of Care ◽

Signs And Symptoms ◽

Healthy Controls ◽

Acute Infections

ABSTRACTThe distinction between causes of acute infections is a major clinical challenge. Current biomarkers, however, are not sufficiently accurate. Human neutrophil lipocalin (HNL) concentrations in serum or whole blood activated by formyl-methionine-leucine-phenylalanine (fMLP) were shown to distinguish acute infections of bacterial or viral cause with high accuracy. The aim was therefore to compare the clinical performance of HNL with currently used biomarkers. Seven hundred twenty-five subjects (144 healthy controls and 581 patients with signs and symptoms of acute infections) were included in the study. C-reactive protein (CRP), the expression of CD64 on neutrophils, procalcitonin (PCT), and blood neutrophil counts were measured by established techniques, and HNL concentrations were measured in whole-blood samples after activation with fMLP. All tested biomarkers were elevated in bacterial as opposed to viral infections (P< 0.001). CRP, PCT, and CD64 expression in neutrophils was elevated in viral infections compared to healthy controls (P< 0.001). In the distinction between healthy controls and patients with bacterial infections, the areas under the receiver operating characteristic (ROC) curves were >0.85 for all biomarkers, whereas for the distinction between bacterial and viral infections, only HNL concentration in fMLP-activated whole blood showed an area under the ROC curve (AUROC) of >0.90 and superior clinical performance. The clinical performance of HNL in fMLP-activated whole blood was superior to current biomarkers and similar to previous results of HNL in serum. The procedure can be adopted for point-of-care testing with response times of <15 min.

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Impact of postoperative haemoglobin on length of stay post fractured hip repair in patients with standardised perioperative management

Hip International ◽

10.1177/1120700018773428 ◽

2018 ◽

Vol 29 (2) ◽

pp. 172-176

Author(s):

Siu-Wai Choi ◽

Frankie K L Leung ◽

Tak-Wing Lau ◽

Gordon T C Wong

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Postoperative Recovery ◽

Medical Complications ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Total Length ◽

The Impact ◽

Postoperative Haemoglobin

Introduction: Perioperative blood transfusion is not without risk and effort should be made to limit patients’ exposure to allogeneic blood. However, there is conflicting data regarding the impact of anaemia on postoperative recovery in patients with repaired hip fractures. It is hypothesised that for a given baseline functional status and fracture type, lower postoperative haemoglobin will increase rehabilitation time and prolong total length of hospital stay. Methods: This is a retrospective study on data collected prospectively on patients entered into the Clinical Pathway aged >65 years admitted to Queen Mary Hospital (QMH) with a fractured neck of femur during 2011–2013. Potential predictor variables were analysed with linear regression with respect to total length of stay and those that reached a significance level of 0.05 were included in further analysis. Results: 1092 patients were admitted to QMH with a suspected fractured neck of femur; data from 747 patients were analysed. The fracture sites were neck of femur (50%), intertrochanteric (48%) and subtrochanteric fracture (2%). Approximately 30% of patients received blood transfusions. Of these only the development of postoperative medical complications statistically prolonged hospital stay. No relationship was seen with haemoglobin levels cut-off above and below 10 g/dl with the result remaining non-significant down to a cut-off of above and below 8 g/dl. Discussion: This study revealed that post-surgical haemoglobin level of between 8 g/dl and 10 g/dL did not have an impact on the total length of hospital stay. The development of postoperative medical complications was the only factor that prolonged the total length of stay.

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A UK-based survey of cat owners’ perceptions and experiences of antibiotic usage

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x19826353 ◽

2019 ◽

Vol 22 (2) ◽

pp. 69-76 ◽

Cited By ~ 1

Author(s):

Jennifer Stallwood ◽

Alex Shirlow ◽

Angie Hibbert

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Stewardship ◽

Diagnostic Tests ◽

Bacterial Infections ◽

Viral Infections ◽

Diagnostic Testing ◽

Antibiotic Use ◽

Good Communication ◽

Long Acting ◽

Veterinary Antibiotic

Objectives The aim of this study was to explore owners’ knowledge of antibiotics, experience of antibiotic use in their cats and involvement in decision-making regarding antibiotic prescriptions. Methods Cat owners were recruited via social media and veterinary practices to complete a survey designed to evaluate general knowledge of antibiotics, attitudes to antibiotic stewardship and experiences of antibiotic use in their own cat between November 2017 and March 2018. Data were analysed descriptively. Results A total of 1436 surveys were completed; 247 respondents (17.2%) had a veterinary background. The majority of the remaining respondents correctly identified that antibiotics treat bacterial infections (84.0%; n = 999) but do not treat viral infections (72.8%; n = 865). A minority (n = 338; 28.4%) agreed that antibiotic resistance was a problem in cats in the UK; 92.3% (n = 1097) identified that resistance was a problem in human medicine. Seventy percent (n = 832) of the respondents’ cats had received antibiotics; 29.6% (n = 246) received a long-acting injectable antibiotic (14 days’ duration). Diagnostic tests were performed before antibiotic prescription in 38.7% (n = 322) of cats; 1.4% (n = 7) of respondents reported declining suggested tests and 65.8% (n = 778) indicated that they would be happy to pay for diagnostic tests to allow selection of the most appropriate antibiotic. Most respondents (95.8%; n = 792) indicated that they were happy to follow their veterinarian’s advice and recommendations; however, 49.2% (n = 405) had expected antibiotics to be prescribed. Conclusions and relevance Cat owners demonstrated good knowledge of antibiotic action; however, greater owner education regarding the potential for veterinary antibiotic resistance, requirement for diagnostic testing and training in the administration of oral medication with first-line antibiotics, as well as the use of veterinary antibiotic guidelines, will improve antibiotic stewardship. Good communication between veterinarians and owners is necessary for rational antibiotic use.

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2786. The Role of Respiratory Panel PCR in Decreasing Antibiotic Exposure in Patients Diagnosed With a Respiratory Viral Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2463 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S984-S984

Author(s):

Alexander Vostal ◽

Michael Antonio Gonzalez ◽

Nellie Darling ◽

Christine Papastamelos ◽

Madhuri Natarajan ◽

...

Keyword(s):

Viral Infections ◽

Retrospective Chart Review ◽

Antibiotic Use ◽

Antibiotic Exposure ◽

Duration Of Treatment ◽

Bacterial Cultures ◽

Antibiotic Duration ◽

The Mean ◽

Student’S T

Abstract Background Respiratory viral infections (RVI) are becoming increasingly recognized as an important cause of pneumonia. There is limited data regarding the role of rapid PCR testing for RVI and its effect on antibiotic duration and length of stay (LOS). Methods We performed a single-center, retrospective chart review in adult patients who were admitted and underwent evaluation with the FilmArray Multiplex Respiratory Panel (RP) (Biomerieux™) using a random sample from July 1, 2016 through April 1, 2018. Patient clinical and virologic characteristics, LOS, antibiotic use, and duration of treatment were collected. A Student’s t-test was performed for all comparisons. Results We identified 540 patients who were admitted and underwent RP testing. The mean age was 57.1 years (range 19–99), 50.2% were immunocompromised, 23.8% were transplant recipients, 70.4% had respiratory symptoms, and 35.7% had an admitting diagnosis of pneumonia. 55.6% required supplemental O2 and 24.6% had an ICU admission that required either noninvasive or mechanical ventilation. 22.6% (N = 122) of these patients were diagnosed with an RVI, of which 15 were co-infected with two or more respiratory viruses. There were 41 (34%) rhinovirus/enterovirus, 41 (34%) influenza (Types A/H1, A/H3, A/H1-2209, and B), 16 (13%) RSV, 15 (12%) coronavirus (Types NL63, OC43, 229E, and HKU1), 13 (11%) metapneumovirus, and 7 (5%) parainfluenza (Types 2, 3, and 4). 85.2% (104/122) of patients with an RVI received antibiotics. The mean LOS and antibiotic duration were 9.07 days and 7.31 days for patients with an RVI when compared with 11.5 days and 10.4 days for patients without an RVI (P = 0.098; P = 0.032), respectively. In patients with an RVI and negative bacterial cultures, the mean LOS was 8.4 days and mean antibiotic duration was 5.9 days when compared with 16.4 days and 15.5 days for all patients with positive bacterial cultures (P = 0.003; P < 0.0001), respectively. The mean time from available results of + RP to antibiotic discontinuation was 5.1 days in the setting of negative bacterial cultures. Conclusion Although antibiotic exposure and time to discontinuation still remained significant in patients diagnosed with an RVI, there was a marked reduction in LOS and antibiotic duration in the subset of patients with an RVI and negative bacterial cultures. Disclosures All authors: No reported disclosures.

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Antibiotics in hives and their effects on honey bee physiology and behavioral development

Biology Open ◽

10.1242/bio.053884 ◽

2020 ◽

Vol 9 (11) ◽

pp. bio053884 ◽

Cited By ~ 1

Author(s):

Yarira Ortiz-Alvarado ◽

David R. Clark ◽

Carlos J. Vega-Melendez ◽

Zomary Flores-Cruz ◽

Maria G. Domingez-Bello ◽

...

Keyword(s):

Honey Bee ◽

Bacterial Infections ◽

Fat Body ◽

Age Of Onset ◽

Antibiotic Use ◽

Behavioral Development ◽

Human Interventions ◽

And Behavior ◽

The Impact

ABSTRACTRecurrent honeybee losses make it critical to understand the impact of human interventions, such as antibiotic use in apiculture. Antibiotics are used to prevent or treat bacterial infections in colonies. However, little is known about their effects on honeybee development. We studied the effect of two commercial beekeeping antibiotics on the bee physiology and behavior throughout development. Our results show that antibiotic treatments have an effect on amount of lipids and rate of behavioral development. Lipid amount in treated bees was higher than those not treated. Also, the timing of antibiotic treatment had distinct effects for the age of onset of behaviors, starting with cleaning, then nursing and lastly foraging. Bees treated during larva-pupa stages demonstrated an accelerated behavioral development and loss of lipids, while bees treated from larva to adulthood had a delay in behavioral development and loss of lipids. The effects were shared across the two antibiotics tested, TerramycinR (oxytetracycline) and TylanR (tylosin tartrate). These effects of antibiotic treatments suggest a role of microbiota in the interaction between the fat body and brain that is important for honeybee behavioral development.This paper has an associated First Person interview with the first author of the article.

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