scholarly journals 1306. Comparison of the Use of Extended and Intermittent Infusion Cefepime and Piperacillin/tazobactam in Non-critically Ill, Obese Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S667-S667
Author(s):  
Carolyn Marg ◽  
Zach DeLanoit ◽  
Kimberly D Boeser
Keyword(s):  
Clinical Success ◽  
Small Sample Size ◽  
Clinical Success Rate ◽  
Intermittent Infusion ◽  
Volume Of Distribution ◽  
Small Sample ◽  
Hospital Length Of Stay ◽  
Obese Patients ◽  
Target Time ◽  
All Cause Mortality

Abstract Background Obesity rates have dramatically increased over the last several decades, however, there is limited data to guide how antibiotics should be adjusted in obese patients. Physiologic differences including an increased volume of distribution and increased renal clearance may alter their pharmacokinetics and pharmacodynamics and subsequently, their efficacy. For beta-lactams like piperacillin/tazobactam (pip/tazo) and cefepime, extended infusion (EI) maximizes the time above the minimum inhibitory concentration (MIC) for optimal bactericidal activity. This dosing strategy may help decrease variability in achieving the target time above MIC in this patient population and lead to more favorable outcomes. Methods This single-center, retrospective, pre-/post- analysis included patients with a body mass index (BMI) > 30 that received EI (infused over 4 hours) or intermittent infusion (II) (infused over 30 minutes) pip/tazo or cefepime between 2/1/2020-4/30/2020 and 2/1/2019-4/30/2019, respectively. The primary outcome was in-hospital, all-cause mortality. Secondary outcomes included clinical success rate and hospital length of stay (LOS). Results During the evaluation periods, 98 patients met inclusion criteria (EI, N=53; II, N=45). Mean BMI was not statistically different between groups (EI, 36.0 kg/m2 [30.1-46.3]; II, 36.5 kg/m2 [30-48]). There were no cases of mortality in either group. The mean LOS in the II group was 13 days compared to 11.5 days in the EI group [95% CI -4.14-7.04; p=0.606]. After excluding one outlier of 104 days in the EI group, the average LOS was 9.5 days [95% CI: -0.87-7.33; p=0.121]. Markers of clinical success including time to resolution of fever (II: 47 hours; EI: 34 hours; p=0.216) and time to resolution of leukocytosis (II: 2 days; EI: 3.8 days; p=0.089) were not significantly different between groups. Conclusion The use of EI pip/tazo and cefepime was not associated with any differences in in-hospital, all-cause mortality, hospital LOS, or clinical success when compared to the use of II pip/tazo and cefepime. The lack of significant differences between groups may be attributable to the small sample size limiting the ability to detect a difference, especially regarding hospital LOS. Disclosures All Authors: No reported disclosures

scholarly journals Effect of Obesity on Clinical Failure of Patients Treated with Beta-Lactams

2021 ◽  
Author(s):  
Nathan A Pinner ◽  
Natalie G Tapley ◽  
Katie E Barber ◽  
Kayla R Stover ◽  
Jamie L Wagner
Keyword(s):  
Treatment Failure ◽  
Clinical Outcomes ◽  
Hospital Length Of Stay ◽  
Source Control ◽  
Definitive Treatment ◽  
Therapeutic Drug ◽  
Obese Patients ◽  
Definitive Therapy ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. This study assessed whether obese patients receiving a beta-lactam (BL) have worse clinical outcomes compared to non-obese patients and to identify if therapeutic drug monitoring (TDM) may be beneficial. Methods This multi-center, retrospective cohort included hospitalized adults admitted from July 2015-July 2017 treated with a BL as definitive monotherapy against a Gram-negative bacilli for ≥72 hours. Patients were excluded if there was lack of source control or if polymicrobial infections required >1 antibiotic for definitive therapy. Patients were classified based on body mass index (BMI): non-obese (BMI ≤29.9 kg/m 2) and obese (BMI ≥30.0 kg/m 2). The primary outcome was clinical treatment failure, and secondary were hospital length of stay (LOS), inpatient all-cause mortality, and 30-day all-cause readmission. Results There were 257 (43.6%) obese patients and 332 (56.4%) non-obese patients included. The most common infections were urinary (50.9%) and respiratory (31.4%). Definitive treatment was driven by 3 rd generation cephalosporins (46.9%) and cefepime (44.7%). Treatment failure occurred in 131 (51%) obese patients and 109 (32.8%) non-obese patients (p<0.001). Obesity and respiratory source were independently associated with increased likelihood of treatment failure. Obese patients were hospitalized longer than non-obese patients (p=0.002), but no differences were found for all-cause mortality (p=0.117) or infection-related readmission (0=0.112). Conclusions Obese patients treated with BLs have higher rates of treatment failure and longer hospitalization periods than non-obese patients. Future studies are needed to assess the impact of TDM and specific dosing recommendations for targeted infection types.

scholarly journals Endovascular treatment of aortic arch aneurysms

2008 ◽  
Vol 7 (2) ◽  
pp. 90-98 ◽  
Author(s):  
Roberto Chiesa ◽  
Germano Melissano ◽  
Yamume Tshomba ◽  
Efrem Civilini ◽  
Enrico Maria Marone ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Clinical Success ◽  
Small Sample Size ◽  
Small Sample ◽  
Neck Length ◽  
Proximal Neck ◽  
Open Conversion ◽  
Aortic Neck ◽  
Type Ia

BACKGROUND: Endovascular approach to the aortic arch is an appealing solution for selected patients. OBJECTIVE: To compare the technical and clinical success recorded in the different anatomical settings of endografting for aortic arch disease. METHODS: Between June 1999 and October 2006, among 178 patients treated at our institution for thoracic aorta disease with a stent-graft, the aortic arch was involved in 64 cases. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 14 cases, zone 1 in 12 cases and zone 2 in 38 cases. A hybrid surgical procedure of supra-aortic debranching and revascularization was performed in 37 cases. RESULTS: Zone 0. Proximal neck length: 44±6 mm. Initial clinical success was 78.6%: two deaths (stroke), one type Ia endoleak. At a mean follow-up of 16.4±11 months the midterm clinical success was 85.7%. Zone 1. Proximal neck length: 28±5 mm. Initial clinical success was 66.7%: 0 deaths, four type Ia endoleaks. At a mean follow-up of 16.9±17.2 months the midterm clinical success was 75.0%. Zone 2. Proximal neck length: 30±5 mm. Initial clinical success was 84.2%: two deaths (one cardiac arrest, one multiorgan embolization), three type Ia endoleaks, one case of open conversion. Two cases of delayed transitory paraparesis/paraplegia were observed. At a mean follow-up of 28.0±17.2 months the midterm clinical success was 89.5%. CONCLUSIONS: This study and a literature review demonstrated that hybrid procedure for aortic arch pathology is feasible in selected patients at high risk for conventional surgery. Our experience is still limited by the relatively small sample size. We propose to reserve zone 1 for patients unfit for sternotomy or in cases with aortic neck length > 30 mm following left common carotid artery debranching. We recommend to perform complete aortic rerouting of the aortic arch in cases with lesser comorbidities and shorter aortic neck.

scholarly journals Body Mass Index at Pediatric Leukemia Diagnosis and the Risks of Relapse and Mortality: Findings from a Single Institution and Meta-analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ashleigh M. Saenz ◽  
Stacie Stapleton ◽  
Raquel G. Hernandez ◽  
Greg A. Hale ◽  
Neil A. Goldenberg ◽  
...  
Keyword(s):  
Small Sample Size ◽  
Meta Analysis ◽  
Small Sample ◽  
Obese Patients ◽  
Single Institution ◽  
Pediatric Leukemia ◽  
Risk Of Mortality ◽  
Obesity Status ◽  
Increased Risk ◽  
Leukemia Diagnosis

High body mass index (BMI) is associated with relapse of certain adult cancers, but limited knowledge exists on its association with pediatric leukemia relapse. We evaluated the association between overweight/obesity (BMI ≥ 85th percentile) at pediatric leukemia diagnosis and relapse or mortality. A meta-analysis combining our findings with those of previous studies was also performed. The study included 181 pediatric leukemia patients. Sporadic missing data were multiply imputed, and hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated using Cox proportional hazard. Age- and sex-adjusted analysis for patients ≥10 years showed a trend towards increased risk of relapse for overweight/obese patients (HR = 2.89, 95% CI = 0.89–9.36, p=0.08) that was not evident among children<10 years (HR = 0.52, 95% CI = 0.08–3.54, p=0.49). We observed a statistically significant association between mortality and obesity status in unadjusted models (imputed: HR = 2.54, 95% CI = 1.15–5.60, p=0.021; complete set: HR = 2.72, 95% CI = 1.26–5.91, p=0.011) that was not statistically significant in both age- and sex-adjusted and multivariable adjusted analyses. The pooled estimate of our finding and previous studies showed an association between overweight/obese and increased risk of mortality for ALL (HR = 1.39, 95% CI = 1.16–1.46) and AML (HR = 1.64, 95% CI = 1.32–2.04). Although our study did not observe statistically significant associations due to a small sample size, the meta-analyses revealed an increased risk of mortality for overweight/obese patients. The findings of our study suggest an association of obesity status with relapse in children ≥10 years. However, our study was based on a small sample size from a single institution, and this association needs to be investigated in larger, multicenter studies.

scholarly journals 177. Clinical Outcomes of Daptomycin vs. Anti-Staphylococcal β-Lactams in Definitive Treatment of Methicillin-Susceptible Staphylococcus aureus (MSSA) Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S111-S111
Author(s):  
Sydney Agnello ◽  
Shandra R Day ◽  
Lynn Wardlow ◽  
Erica E Reed ◽  
Jessica M Smith ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Small Sample Size ◽  
Small Sample ◽  
Definitive Treatment ◽  
Clinical Failure ◽  
Primary Indication ◽  
Definitive Therapy ◽  
All Cause Mortality ◽  
Related Mortality

Abstract Background The preferred management of patients with MSSA bacteremia includes definitive therapy with intravenous anti-staphylococcal β-lactam antibiotics. In β-lactam allergic or intolerant patients, daptomycin has been targeted as a viable alternative. The objective of this study was to assess clinical outcomes of daptomycin compared with nafcillin or cefazolin for the treatment of MSSA bacteremia. Methods This was a retrospective cohort study of patients hospitalized from November 1, 2011 to October 31, 2018 at The Ohio State University Wexner Medical Center with MSSA bacteremia. Patients treated with nafcillin, cefazolin or daptomycin were included with 1:1:1 random selection. The primary outcome was a composite of clinical failure, defined as a change in therapy due to persistent/worsening signs and symptoms, bacteremia recurrence or persistence, or inpatient infection-related mortality. Secondary endpoints included 30-day infection-related mortality, duration of bacteremia, 30-day all-cause mortality and adverse events (AEs) necessitating a change in therapy. Results Among patients with MSSA bacteremia, 162 received at least one dose of daptomycin. Of those, 29 received at least 14 days of daptomycin and/or received daptomycin as definitive therapy and thus were included in the analysis. There was no difference in the primary outcome of composite clinical failure comparing daptomycin vs. nafcillin/cefazolin (P = 0.71). In addition, no difference was observed in 30-day infection-related mortality (P = 0.51), duration of MSSA bacteremia (P = 0.9), or 30-day all-cause mortality (P = 0.64). A higher number of AEs necessitating change in therapy were seen in the daptomycin group (P = 0.0002), reflecting initial β-lactam intolerance. Conclusion No difference in clinical failure was identified in patients treated with daptomycin vs. nafcillin/cefazolin suggesting that daptomycin may serve as a non-inferior alternative for treatment of MSSA bacteremia. A higher number of AEs occurred in the daptomycin group indicating β-lactam intolerance as a primary indication for daptomycin therapy. Given the small sample size, subsequent studies are needed to further evaluate the use of daptomycin in the treatment of MSSA bacteremia. Disclosures All authors: No reported disclosures.

scholarly journals The Outcome of Thoracentesis versus Chest Tube Placement for Hepatic Hydrothorax in Patients with Cirrhosis: A Nationwide Analysis of the National Inpatient Sample

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Ali Ridha ◽  
Yasir Al-Abboodi ◽  
Matthew Fasullo
Keyword(s):  
Length Of Stay ◽  
Chest Tube ◽  
Small Sample Size ◽  
Length Of Hospital Stay ◽  
Small Sample ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
National Inpatient Sample ◽  
Hepatic Hydrothorax ◽  
Chest Tube Placement

There are only a few studies with a small sample size of patients that have compared the risks of using chest tubes versus thoracentesis in hepatic hydrothorax. It has been shown that many complications may arise secondary to chest tube placement and is associated with increased morbidity and mortality. In this retrospective study, patients with cirrhosis were identified from the 2009 National Inpatient Sample by using ICD-9 codes; we evaluated the risk of chest tube versus thoracentesis in a largest population with hepatic hydrothorax to date to measure the mortality and the length of stay. A total of 140,573 patients with liver cirrhosis were identified. Of this, 1981 patients had a hepatic hydrothorax and ended up with either thoracentesis (1776) or chest tube (205). The mortality in those who received a chest tube was two times higher than that in thoracentesis group with a P value of ≤0.001 (CI 1.43–312). In addition, the length of hospital stay of the chest tube group was longer than that of the thoracentesis subset (7.2 days versus 3.8 days, resp.). We concluded that chest tube placement has two times higher mortality rate and longer hospital length of stay when compared to patients who underwent thoracentesis.

scholarly journals Multicenter Study of High-Dose Daptomycin for Treatment of Enterococcal Infections

2013 ◽  
Vol 57 (9) ◽  
pp. 4190-4196 ◽  
Author(s):  
Anthony M. Casapao ◽  
Ravina Kullar ◽  
Susan L. Davis ◽  
Donald P. Levine ◽  
Jing J. Zhao ◽  
...  
Keyword(s):  
Clinical Success ◽  
Clinical Success Rate ◽  
High Dose ◽  
Content Type ◽  
Hospital Acquired Infections ◽  
Median Dosage ◽  
All Cause Mortality ◽  
Vancomycin Resistant ◽  
Hospital Acquired ◽  
Enterococcal Infections

ABSTRACTEnterococci are among the leading pathogens isolated in hospital-acquired infections. Current antimicrobial options for vancomycin-resistant enterococci (VRE) are limited. Prior data suggest that daptomycin at >6 mg/kg of body weight/day may be used to treat enterococcal infections. We retrospectively evaluated the effectiveness and safety of high-dose daptomycin (HD-daptomycin) therapy (>6 mg/kg) in a multicenter cohort of adult patients with enterococcal infections to describe the characteristics and outcomes. Two hundred forty-five patients were evaluated.Enterococcus faeciumwas identified in 175 (71%), followed byEnterococcus faecalisin 49 (20%) andEnterococcusspp. in 21 (9%); overall, 204 (83%) isolates were VRE. Enterococcal infections included bacteremia (173, 71%) and intra-abdominal (35, 14%) and bone and joint (25, 10%) infections. The median dosage and duration of HD-daptomycin were 8.2 mg/kg/day (interquartile range [IQR], 7.7 to 9.7) and 10 days (IQR, 6 to 15), respectively. The overall clinical success rate was 89% (193/218), and microbiological eradication was observed in 93% (177/191) of patients. The median time to clearance of blood cultures on HD-daptomycin was 3 days (IQR, 2 to 5). The 30-day all-cause mortality rate was 27%, and 5 (2%) patients developed daptomycin-nonsusceptible enterococcal strains while on HD-daptomycin. Seven patients (3%) had creatine phosphokinase (CPK) elevation, yet no HD-daptomycin regimen was discontinued due to an elevated CPK and all patients were asymptomatic. Overall, there was a high frequency of clinical success and microbiological eradication in patients treated with HD-daptomycin for enterococcal infections, even in patients with complicated and difficult-to-treat infections. No adverse event-related discontinuation of HD-daptomycin was noted. HD-daptomycin may be an option for the treatment of enterococcal infections.

The association of malnutrition and sarcopenia with geriatric assessment impairment and outcomes in patients with bladder cancer undergoing cystectomy.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 423-423
Author(s):  
Megan Seema Gurjar ◽  
Chelsea K. Osterman ◽  
Kirsten A. Nyrop ◽  
Marc Bjurlin ◽  
Hung-Jui Tan ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Functional Status ◽  
Geriatric Assessment ◽  
Small Sample Size ◽  
Hospital Length ◽  
Small Sample ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Skeletal Muscle Index ◽  
Modifiable Factors

423 Background: Malnutrition and sarcopenia are linked to decreased functional status in older adults with malignancy, but their effect on geriatric assessment (GA) impairment in patients with bladder cancer (BC) undergoing radical cystectomy (RC) is unknown. We investigated the association between malnutrition and sarcopenia with GA impairment and postoperative outcomes. Methods: Patients with BC undergoing RC between 2012 – 2019 were enrolled in a prospective cohort study of GA before RC. Malnutrition was evaluated by a dietitian pre-RC per the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition diagnostic criteria. Sarcopenia, defined by a skeletal muscle index of < 52.4 cm2/m2 in males and < 38.5 cm2/m2 in females, was determined using SliceOmatic software to analyze pre-RC CT images at the L3 vertebra. Patients with vs without malnutrition and those with vs without sarcopenia were compared using Fisher’s exact and Wilcoxon rank sum tests. Results: Of 73 patients, 59 had GA + nutrition evaluation and 51 had GA + sarcopenia assessment (overall median age 68 [IQR 62-74], 76% male). The prevalence of malnutrition was 7% and sarcopenia was 63%. A numerically greater proportion of patients with malnutrition or sarcopenia were impaired on ≥ 1 GA measure compared to those without malnutrition (100% vs 78%, p=0.57) or sarcopenia (78% vs 68%, p=0.52), although this was not statistically significant (Table). Median hospital length of stay (LOS) was increased for patients with vs without sarcopenia (4 vs 5 days, p=0.005). Post-RC complication rate was similar for patients with vs without malnutrition (100% vs 75%, p=0.56) and patients with vs without sarcopenia (81% vs 74%, p=0.73), but malnourished patients were more likely to have Clavien-Dindo grade 3+ complications than those without malnutrition (100% vs 27%, p = 0.009). Conclusions: In our cohort of patients with BC undergoing RC, those with malnutrition or sarcopenia may have an increased rate of impairment on GA compared to those without malnutrition or sarcopenia. Sarcopenia was associated with increased LOS while malnutrition was associated with increased major complications. Our results are limited by small sample size, and future work is needed to elucidate whether addressing these modifiable factors improves functional status and postoperative outcomes. Research Sponsor: U.S. National Institutes of Health[Table: see text]

scholarly journals The Physical Function Intensive Care Test: Implementation in Survivors of Critical Illness

2014 ◽  
Vol 94 (10) ◽  
pp. 1499-1507 ◽  
Author(s):  
Amy Nordon-Craft ◽  
Margaret Schenkman ◽  
Lara Edbrooke ◽  
Daniel J. Malone ◽  
Marc Moss ◽  
...  
Keyword(s):  
Intensive Care ◽  
Physical Function ◽  
Grip Strength ◽  
Small Sample Size ◽  
The United States ◽  
Small Sample ◽  
Hospital Length Of Stay ◽  
Sum Score ◽  
Icu Discharge ◽  
Functional Components

Background Recent studies have demonstrated safety, feasibility, and decreased hospital length of stay for patients with weakness acquired in the intensive care unit (ICU) who receive early physical rehabilitation. The scored Physical Function in Intensive Care Test (PFIT-s) was specifically designed for this population and demonstrated excellent psychometrics in an Australian ICU population. Objective The purpose of this study was to determine the responsiveness and predictive capabilities of the PFIT-s in patients in the United States admitted to the ICU who required mechanical ventilation (MV) for 4 days or longer. Methods This nested study within a randomized trial administered the PFIT-s, Medical Research Council (MRC) sum score, and grip strength test at ICU recruitment and then weekly until hospital discharge, including at ICU discharge. Spearman rho was used to determine validity. The effect size index was used to calculate measurement responsiveness for the PFIT-s. The receiver operating characteristic curve was used in predicting participants' ability to perform functional components of the PFIT-s. Results From August 2009 to July 2012, 51 patients were recruited from 4 ICUs in the Denver, Colorado, metro area. At ICU discharge, PFIT-s scores were highly correlated to MRC sum scores (rho=.923) and grip strength (rho=.763) (P&lt;.0005). Using baseline test with ICU discharge (26 pairs), test responsiveness was large (1.14). At ICU discharge, an MRC sum score cut-point of 41.5 predicted participants' ability to perform the standing components of the PFIT-s. Limitations The small sample size was a limitation. However, the findings are consistent with those in a larger sample from Australia. Conclusions The PFIT-s is a feasible and valid measure of function for individuals who require MV for 4 days or longer and who are alert, able to follow commands, and have sufficient strength to participate.

scholarly journals Comparison of Anterior Approach and Posterior Circumspinal Decompression in the Treatment of Giant Thoracic Discs

2021 ◽  
pp. 219256822198996
Author(s):  
Lei Yuan ◽  
Zhongqiang Chen ◽  
Zhongjun Liu ◽  
Xiaoguang Liu ◽  
Weishi Li ◽  
...  
Keyword(s):  
Sample Size ◽  
Functional Status ◽  
Spinal Fusion ◽  
Complication Rate ◽  
Small Sample Size ◽  
Hospital Length ◽  
Small Sample ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Reliable Technique

Study Design: Retrospective cohort study. Objectives: The treatment of giant thoracic disc herniation (gTDH)remains challenging for surgeons worldwide because of its large volume and calcified or ossified nature and the limitations of the prior small-sample-size, single-center studies reporting comparative effectiveness. We aim to compare the anterior decompression and spinal fusion (ASF) and posterior circumspinal decompression and spinal fusion (PCDF) for patients with myelopathy due to gTDH in the largest study to date by sample size. Methods: Preoperative and postoperative functional status, surgical details, and complication rates were compared between the 2 groups. Results: A total of 186 patients were included: 63 (33.9%) ASF and 123(66.1%) PCDF. The PCDF group had significantly shorter operation duration (163.06 ± 53.49 min vs. 180.78 ± 52.06 min, P = 0.032) and a significant decrease in intraoperative blood loss(716.83 mL vs. 947.94 mL, P = 0.045), and also a shorter hospital length of stay (LOS) and postoperative LOS (6 vs. 7, P = 0.011). The perioperative complication rate (13.8% vs. 28.6%, P = 0.015) and surgery-associated complication rate(13.0% vs. 27.0%, P = 0.018) were significantly higher in the ASF group. A higher rate of complete decompression was achieved in the PCDF group. There were no observed significant differences in changes in functional status between the 2 groups. Conclusion: PCDF for central or paracentral gTDHs is a highly effective and reliable technique. It can be performed safely with a low complication rate. If either procedure can adequately excise a central or paracentral gTDH, a PCDF approach may be a better option.

scholarly journals Performance of the padit score in patients undergoing transvenous lead extraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P Dias Ferreira Reis ◽  
B Valente ◽  
V Ferreira ◽  
A Castelo ◽  
G Portugal ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Clinical Success ◽  
Univariate Analysis ◽  
Clinical Success Rate ◽  
Lead Extraction ◽  
Mortality Data ◽  
First Year ◽  
All Cause Mortality ◽  
Procedural Complications

Abstract Background The PADIT trial identified 5 independent predictors of cardiac implantable electronic device (CIED) infection (prior procedure, age, chronic kidney disease, immunosuppression and type of procedure) and developed a novel infection risk score. Aim To assess whether the PADIT score (PS) could predict CIED reinfection and adverse events in patients (pts) submitted to transvenous lead extraction (LE) using the Pisa Technique (PT) due to CIED infection. Methods We conducted a single-centre prospective study of consecutive procedures (P) of LE using the PT between February 2013 and October 2019. Demographic, clinical, microbiological, device/ procedure related variables, morbidity and mortality data were retrieved during follow-up (FUP). An univariate analysis was performed to evaluate the ability of the PS to predict CIED reinfection (Re), procedural complications (C), all-cause hospital mortality (M), all-cause mortality/ hospitalization during first year of follow-up (MH1) and cardiovascular mortality (CM). Results A total 171 Ps including 159 pts, of which 80.7% (130 pts)were due to CIED infection: 55.1% due to pocket site infection, 18.8% to occult bacteremia with probable CIED infection and 26.1% due to both pocket site and systemic infection, with 44% of pts presenting with valvular/ lead vegetation (mean age - 70.3Y, 77.7% male, mean LVEF of 49.6%). The Rs rate was 93.1% and the clinical success rate was 99.2%. There were no deaths related to the procedure. During a mean FUP of 33 months, 11 pts had to undergo a new P, 5 of them due to pocket reinfection. The mortality rate was 24.2% (37 pts), with 8 pts dying during hospital stay, and 19 pts during the first year post-P. The mean PS was 2.9±2.5 (min- 0, max- 10). A higher PS value was associated with Re (HR - 1,43, CI95% 1.09–1.87, p=0.011), CM (HR - 1,39, CI95% 1.06–1.85, p=0.018) and MH1 (OR - 1,19, CI95% 1.03–1.38, p=0.021). There was no association between the PS and the rate of clinical success of the procedure (2.9% vs 4.5%, p=0.395), procedural complications (2.9% vs 3.3%, p=0.656) and M (4.0% vs 2.8%, p=0.192). Interestingly, a higher PS was not associated with a higher use of an antibacterial envelope during device reimplantation (3.5% vs 2.9%, p=0.371). Conclusion The PADIT score revealed a high predictive power for reinfection, all-cause mortality/ hospitalization during first year of follow-up and cardiovascular mortality in pts submitted to LE using the PT for CIED infection. Funding Acknowledgement Type of funding source: None

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