scholarly journals 109. Impact of Accelerate PhenoTM System on Time to De-escalation of Antimicrobial Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S69-S69
Author(s):  
Caroline Powers ◽  
Ryan P Moenster ◽  
Travis W Linneman
Keyword(s):  
Blood Culture ◽  
Hospital Stay ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Multivariate Regression ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
P Value ◽  
Gram Positive ◽  
Quasi Experimental

Abstract Background The Accelerate PhenoTM system yields identification (ID) and antimicrobial susceptibility testing (AST) within 7 hours of growth in blood culture. The objective of this study was to determine its impact on time to de-escalation of antimicrobial therapy. Methods This retrospective quasi-experimental, observational cohort study included patients hospitalized at the St. Louis VA who received intravenous antibiotics for a positive blood culture. Patients with blood cultures positive for polymicrobial growth or fungi or those requiring antibiotics for other infections were excluded. The primary endpoint was time to de-escalation of antimicrobial therapy from before and after implementation of Accelerate PhenoTM (September 2017 to August 2018 and September 2018 to August 2019, respectively). Secondary outcomes included time to ID and AST, length of hospital stay, and days of antimicrobial therapy. The variables of gram-positive infections, use of Accelerate PhenoTM, and presence of infectious diseases consult and/or pharmacist antimicrobial stewardship note were included in a univariate analysis. Variables with a p-value< 0.2 were included in a multivariate regression. Results 168 patients were included, with 92 patients in the pre-implementation and 76 in the post-implementation group. Overall, mean age was 67 years and 162 (96%) were men. Staphylococcus spp. and Escherichia coli were the most common causative organisms. Time to de-escalation did not differ significantly between the post-implementation and pre-implementation groups (65 vs. 61 hours, p=0.47). Time to organism ID was decreased by 16 hours using Accelerate PhenoTM (50 vs. 66 hours, p=0.016). However, no difference was found in time to AST or length of hospital stay. Days of antimicrobial therapy while hospitalized was also similar between groups (6.8 vs. 5.9 days, p=0.256). Only gram-positive infections and presence of antimicrobial stewardship notes were included in the multivariate regression. Neither were independently associated with de-escalation within 48 hours. Conclusion Accelerate PhenoTM system did not impact time to de-escalation of antimicrobial therapy. Disclosures All Authors: No reported disclosures

scholarly journals Comparative outcomes and predictive assessment of trifecta in open, laparoscopic, and robotic-assisted partial nephrectomy cases with renal cell carcinoma: a 10-year experience at Ramathibodi Hospital

2021 ◽  
Author(s):  
Chaichant Soisrithong ◽  
Wit Viseshsindh ◽  
Wisoot Kongchareonsombat ◽  
Charoen Leenanupunth ◽  
Wachira Kochakarn ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Predictive Factors ◽  
Operative Time ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Laparoscopic Partial Nephrectomy ◽  
P Value ◽  
Open Partial Nephrectomy ◽  
Robotic Assisted

Abstract Purpose: To compare perioperative and trifecta outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robotic assisted laparoscopic partial nephrectomy (RPN) in patients with small renal mass at Ramathibodi Hospital, and to determine predictive factors in connection with trifecta. Methods: We retrospectively reviewed 141 patients who underwent partial nephrectomy by eight experienced surgeons from January 2009 to December 2018. Baseline preoperative characteristics, postoperative and trifecta outcomes of the three treatment modalities were compared and analyzed. Univariate analysis was performed to determine predictive factors for trifecta achievement. Results: A total of 70 patients had complete data available. 18 OPN, 11 LPN and 41 RPN cases were identified and reviewed. All preoperative and perioperative parameters were similar, except for operative time, which was significantly shorter in the OPN group compared with those undergoing LPN and RPN (135 vs 189 and 225 min, respectively; p-value = 0.001). Of these 70 patients, 59 were deemed eligible for and included in trifecta analysis, which revealed similar trifecta outcomes (64.29.%, 45.45%, and 64.71% in the OPN, LPN, and RPN groups, respectively; p-value = 0.388). Univariate analysis showed that length of hospital stay was a negative associated factor for trifecta achievement (p-value = 0.007, 95% CI =0.619 (0.44-0.88)).Conclusion: Although OPN displayed the shortest operative time, the trifecta achievement rate was not significantly different among the three groups. The sole parameter, which was negatively associated with trifecta outcome achievement, was the length of hospital stay.

Impact of rapid diagnostics with antimicrobial stewardship support for children with positive blood cultures: A quasi-experimental study with time trend analysis

2020 ◽  
Vol 41 (8) ◽  
pp. 883-890
Author(s):  
Alison C. Tribble ◽  
Jeffrey S. Gerber ◽  
Warren B. Bilker ◽  
Ebbing Lautenbach
Keyword(s):  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Positive Blood Culture ◽  
Interrupted Time Series ◽  
Blood Cultures ◽  
Hospitalized Children ◽  
Gram Positive ◽  
Gram Negative ◽  
Definitive Therapy ◽  
Quasi Experimental

AbstractObjective:Evaluate the clinical impact of the implementation of VERIGENE gram-positive blood culture testing (BC-GP) coupled with antimicrobial stewardship result notification for children with positive blood cultures.Design:Quasi-experimental study.Setting:Quaternary children’s hospital.Patients:Hospitalized children aged 0–21 years with positive blood culture events 1 year before and 1 year after implementation of BC-GP testing.Methods:The primary outcome was time to optimal antibiotic therapy for positive blood cultures, defined as receiving definitive therapy without unnecessary antibiotics (pathogens) or no antibiotics (contaminants). Secondary outcomes were time to effective therapy, time to definitive therapy, and time to stopping vancomycin, length of stay, and 30-day mortality. Time-to-therapy outcomes before and after the intervention were compared using Cox regression models and interrupted time series analyses, adjusting for patient characteristics and trends over time. Gram-negative events were included as a nonequivalent dependent variable.Results:We included 264 preintervention events (191 gram-positive, 73 gram-negative) and 257 postintervention events (168 gram-positive, 89 gram-negative). The median age was 2.9 years (interquartile range, 0.3–10.1), and 418 pediatric patients (80.2%) had ≥1 complex chronic condition. For gram-positive isolates, implementation of BC-GP testing was associated with an immediate reduction in time to optimal therapy and time to stopping vancomycin for both analyses. BC-GP testing was associated with decreased time to definitive therapy in interrupted time series analysis but not Cox modeling. No such changes were observed for gram-negative isolates. No changes in time to effective therapy, length of stay, or mortality were associated with BC-GP.Conclusions:The implementation of BC-GP testing coupled with antimicrobial stewardship result notification was associated with decreased time to optimal therapy and time to stopping vancomycin for hospitalized children with gram-positive blood culture isolates.

scholarly journals 48. Association of Rapid Pathogen Identification and Pharmacist Intervention on Time to Optimal Antimicrobial Therapy for Bloodstream Infections at Two Community Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S47-S47
Author(s):  
Bryant M Froberg ◽  
Nicholas Torney
Keyword(s):  
Blood Culture ◽  
Hospital Mortality ◽  
Positive Blood Culture ◽  
Antimicrobial Therapy ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Pharmacist Intervention ◽  
Pathogen Identification ◽  
Community Hospitals ◽  
Significant Difference

Abstract Background As many as 1 in 3 patients with bloodstream infections at community hospitals receive inappropriate empiric antimicrobial therapy. Studies have shown that the coupling of real-time intervention with rapid pathogen identification improves patient outcomes and decreases health-system costs at large, tertiary academic centers. The aim of this study was to assess if similar outcomes could be obtained with the implementation of real-time pharmacist intervention to rapid pathogen identification at two smaller, rural community hospitals. Methods This was a pre-post implementation study that occurred from September of 2019 to March 2020. This study included patients ≥18 years of age admitted with one positive blood culture. Patients were excluded if they were pregnant, had a polymicrobial blood culture, known culture prior to admission, hospice consulted prior to admission, expired prior to positive blood culture, or transferred to another hospital within 24 hours of a positive blood culture. Endpoints of patients prior to intervention were compared to patients post-implementation. The primary endpoint was time to optimal antimicrobial therapy. Secondary endpoints included time to effective antimicrobial therapy, in-hospital mortality, length of hospital stay, and overall cost of hospitalization. Results Of 212 patients screened, 88 patients were included with 44 patients in each group. Both groups were similar in terms of comorbidities, infection source, and causative microbial. No significant difference was seen in the mean time to optimal antimicrobial therapy (27.3±35.5 hr vs 19.4± 30 hr, p=0.265). Patients in the post-implementation group had a significantly higher mean hospitalization cost ($24,638.87± $11,080.91 vs $32,722.07±$13,076.73, p=0.013). There was no significant difference in time to effective antimicrobial therapy, in-hospital mortality, or length of hospital stay. Conclusion There were no between-group differences in the primary outcome of time to optimal therapy, with a higher mean hospitalization cost after implementation. These results suggest further antimicrobial stewardship interventions are needed, along with larger studies conducted in the community hospital settings. Disclosures All Authors: No reported disclosures

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

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

scholarly journals Comparative Analysis of Dalbavancin versus Other Antimicrobial Options for Gram-Positive cocci Infections: Effectiveness, Hospital Stay and Mortality

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1296
Author(s):  
Mar de Pablo-Miró ◽  
Sergi Pujol-Ruiz ◽  
Simona Iftimie ◽  
María del Mar Arenas-Miras ◽  
Inmaculada López-Montesinos ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Multidrug Resistant ◽  
Ambulatory Setting ◽  
Bivariate Analysis ◽  
Gram Positive ◽  
Healthcare Associated ◽  
Remarkable Reduction ◽  
Gram Positive Cocci ◽  
Control Study

Dalbavancin is a new antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococci, and offers the possibility of administering intravenous therapy once weekly in an ambulatory setting. We conducted a multicenter observational case-control study, comparing all patients who received dalbavancin (cases) with hospitalized patients who were treated instead with daptomycin, linezolid or vancomycin (controls), based on clinical diagnosis, main microorganism involved, and age. The primary outcome was the length of hospital stay after starting the study antimicrobial. Secondary outcomes were 7-day and 30-day efficacy, 30-day mortality, 90-day recurrence, 90-day and 6-month hospitalization, presence of adverse events and healthcare-associated infections; 161 patients (44 cases and 117 controls) were included. Bivariate analysis showed that dalbavancin reduced the total length of hospital stay (p < 0.001), with fewer 90-day recurrences (p = 0.005), 6-month hospitalizations related to the same infection (p = 0.004) and non-related hospitalizations (p = 0.035). Multivariate analyses showed that length of hospital stay was significantly shorter in patients treated with dalbavancin (−12.05 days 95% CI [−17.00, −7.11], p < 0.001), and 30-day efficacy was higher in the dalbavancin group (OR 2.62 95% CI [1.07, 6.37], p = 0.034). Although sample size of the study may be a limitation, we can conclude that Dalbavancin is a useful antimicrobial drug against Gram-positive infections, including multidrug-resistant pathogens, and allows for a remarkable reduction in length of hospital stay with greater 30-day efficacy.

Reduced length of hospital stay through a point of care placed automated blood culture instrument

2016 ◽  
Vol 36 (4) ◽  
pp. 619-623 ◽  
Author(s):  
M. J. Bruins ◽  
M. J. Egbers ◽  
T. M. Israel ◽  
S. H. A. Diepeveen ◽  
M. J. H. M. Wolfhagen
Keyword(s):  
Blood Culture ◽  
Hospital Stay ◽  
Point Of Care ◽  
Length Of Hospital Stay

P175 TRANSLATION OF MINIMALLY INVASIVE ESOPHAGECTOMY FROM RANDOMIZED CONTROLLED TRIAL SETTING (TIME) TO NATIONAL PRACTICE (DUCA) IN NETHERLANDS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Markar Sheraz ◽  
Ni Melody ◽  
Gisbertz Suzanne ◽  
Straatman Jennifer ◽  
van der Peet Donald ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Time Trial ◽  
Reoperation Rate ◽  
Invasive Esophagectomy

Abstract Aims The TIME trial showed reduced pulmonary complications from minimally invasive esophagectomy (MIE) over an open approach, and led to widespread adoption of MIE in the Netherlands. The aim of this study was to compare clinical outcomes from minimally invasive esophagectomy in the DUCA (national dataset) and the TIME trial (RCT) for transthoracic esophagectomy1. Methods Original patient data from the TIME trial1 was extracted along-with data from the Dutch National Cancer Audit (DUCA) (2011-2017). Initially univariate analysis was used to compare patient and tumor demographics and clinical and pathological outcomes from patients receiving MIE in the TIME trial and in the DUCA-dataset. Secondly multivariate analysis, with adjustment patient and tumor factors, was performed for the effect of MIE vs. Open esophagectomy on clinical outcomes in both datasets. Thirdly the datasets were combined and multivariate analysis, was performed for the effect of patient inclusion in TIME trial or DUCA-dataset. Results 115 patients from TIME (59 MIE vs. 56 open) and 4605 patients from the DUCA-dataset (2652 MIE vs. 1953 open) were included. Univariate analysis showed, in TIME trial, MIE reduced postoperative complications and length of hospital stay. However in the DUCA-dataset, MIE increased postoperative complications, re-intervention rate and length of hospital stay, however pathological benefits included increased proportion of R0 margin and lymph nodes harvested. Multivariate analysis confirmed the TIME data showed MIE reduced postoperative complications (OR=0.38, 95%CI 0.16–0.90). In the DUCA-dataset, MIE was associated with increased postoperative complications (OR=1.37, 95%CI 1.20–1.55), re-intervention (OR=1.84, 95%CI 1.57–2.14), and length of hospital stay (Coeff=1.57, 95%CI 0.06–3.08). Pathological benefits to MIE in the DUCA-dataset included a reduction in proportion of R1 margin, and increased lymph node harvest. Multivariate analysis of the combined dataset, showed inclusion in the TIME trial was associated with a reduction in postoperative complications (OR=0.23, 95%CI 0.15–0.36) and reoperation rate (OR=0.34, 95%CI 0.17–0.66). Conclusions MIE when adopted nationally outside the TIME-trial, was associated with an increase in postoperative complications and reoperation rate, which may reflect surgeons on a national level going through their proficiency-gain curve in the technique and outside of expert MIE centers.

scholarly journals Culturing Periprosthetic Tissues in BacT/Alert® Virtuo Blood Culture Bottles for a Short Duration of Post-operative Empirical Antibiotic Therapy

2020 ◽  
Vol 5 (3) ◽  
pp. 145-150
Author(s):  
Claire Duployez ◽  
Frédéric Wallet ◽  
Henri Migaud ◽  
Eric Senneville ◽  
Caroline Loiez
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Joint Infection ◽  
Length Of Hospital Stay ◽  
Empirical Antibiotic Therapy ◽  
Gram Positive ◽  
Gram Negative ◽  
Surgical Interventions ◽  
Joint Infections ◽  
Gram Positive Cocci

Abstract. Introduction: A post-operative empirical antibiotic therapy (PEAT) is required in periprosthetic joint infections. It commonly uses broad-spectrum antibiotics to cover most Gram-positive cocci and Gram-negative bacilli. It is currently continued until first microbiological results are available, no less than five days later.Methods: We performed a retrospective study in order to evaluate duration of incubation required for surgical samples using the BacT/Alert® Virtuo blood culture bottles system.Results: Among 216 surgical interventions and 199 clinical strains (53.8% staphylococci, 22,1% streptococci and enterococci, 14,6% Gram-negative bacilli, 5,5% anaerobes), 90.5% of the strains were detected between day 0 and day 2; 15 infective strains are cultured from day 3 including 8 Cutibacterium sp., 4 staphylococci, 2 streptococci and 1 Enterococcus.Conclusions: We suggest that the duration of PEAT in patients operated for a periprosthetic joint infection may be shortened to three days as Gram-negative rods are unlikely to grow after three days of culture by using BacT/Alert® Virtuo blood culture bottles. This is likely to shorten the overall length of hospital stay, to diminish the occurrence of adverse side effects, and the emergence of antimicrobial resistance. However, coverage of Gram-positive cocci should be maintained for 14 days until the definite culture results are available.

scholarly journals Implementation of Minimally Invasive Esophagectomy From a Randomized Controlled Trial Setting to National Practice

2020 ◽  
Vol 38 (19) ◽  
pp. 2130-2139 ◽  
Author(s):  
Sheraz R. Markar ◽  
Melody Ni ◽  
Suzanne S. Gisbertz ◽  
Leonie van der Werf ◽  
Jennifer Straatman ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Time Trial ◽  
Pulmonary Complications ◽  
Invasive Technique ◽  
Invasive Esophagectomy

PURPOSE The aim of this study was to examine the external validity of the randomized TIME trial, when minimally invasive esophagectomy (MIE) was implemented nationally in the Netherlands, using data from the Dutch Upper GI Cancer Audit (DUCA) for transthoracic esophagectomy. METHODS Original patient data from the TIME trial were extracted along with data from the DUCA dataset (2011-2017). Multivariate analysis, with adjustment for patient factors, tumor factors, and year of surgery, was performed for the effect of MIE versus open esophagectomy on clinical outcomes. RESULTS One hundred fifteen patients from the TIME trial (59 MIE v 56 open) and 4,605 patients from the DUCA dataset (2,652 MIE v 1,953 open) were included. In the TIME trial, univariate analysis showed that MIE reduced pulmonary complications and length of hospital stay. On the contrary, in the DUCA dataset, MIE was associated with increased total and pulmonary complications and reoperations; however, benefits included increased proportion of R0 margin and lymph nodes harvested, and reduced 30-day mortality. Multivariate analysis from the TIME trial showed that MIE reduced pulmonary complications (odds ratio [OR], 0.19; 95% CI, 0.06 to 0.61). In the DUCA dataset, MIE was associated with increased total complications (OR, 1.36; 95% CI, 1.19 to 1.57), pulmonary complications (OR, 1.50; 95% CI, 1.29 to 1.74), reoperations (OR, 1.74; 95% CI, 1.42 to 2.14), and length of hospital stay. Multivariate analysis of the combined and MIE datasets showed that inclusion in the TIME trial was associated with a reduction in reoperations, Clavien-Dindo grade > 1 complications, and length of hospital stay. CONCLUSION When adopted nationally outside the TIME trial, MIE was associated with an increase in total and pulmonary complications and reoperation rate. This may reflect nonexpert surgeons outside of high-volume centers performing this minimally invasive technique in a nonstandardized fashion outside of a controlled environment.

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