scholarly journals 1471. Evaluation of Antibiotic De-escalation in Post Cardiac Arrest Patients with Culture-Negative versus Culture-Positive Aspiration Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S737-S737
Author(s):  
Natasha R Herzig ◽  
Tara L Harpenau ◽  
Kevin M Wohlfarth ◽  
Alicia M Hochanadel
Keyword(s):  
Cardiac Arrest ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Aspiration Pneumonia ◽  
Antimicrobial Therapy ◽  
Empiric Therapy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Culture Positive ◽  
Culture Negative

Abstract Background Cardiac arrest patients are often empirically treated for aspiration pneumonia with broad-spectrum antibiotics. Previous literature has shown no difference in clinical outcomes when discontinuing antimicrobial therapy for suspected aspiration pneumonia with negative respiratory cultures, but the application is limited in this population. This study aimed to assess antibiotic de-escalation practices for suspected aspiration pneumonia in post cardiac arrest patients with respiratory cultures and explore clinical outcomes. Methods This retrospective cohort conducted at a level 1 trauma center included adult out-of-hospital cardiac arrest patients who received antimicrobial therapy for suspected aspiration pneumonia. The primary endpoint was incidence of antibiotic de-escalation before day seven comparing culture-negative and culture-positive patients. De-escalation included discontinuation of methicillin-resistant Staphylococcus aureus (MRSA) coverage, Pseudomonas aeruginosa coverage, atypical coverage or all antibiotics when respective pathogens were not identified from microbiologic or serologic methods. Secondary endpoints included type of de-escalation and clinical outcomes. Results Eighty-six patients were included: 45 culture-negative and 41 culture-positive. Figure 1 depicts the breakdown of organisms isolated. Guideline-directed empiric therapy was used in 18.6% of patients, with the remainder receiving excessively broad empiric coverage. Antibiotic de-escalation before day seven occurred in 28 (80%) culture-negative patients and 32 (82%) culture-positive patients (p = 0.82), excluding patients who died before day seven. Providers frequently stopped unnecessary MRSA coverage in both groups. In-hospital mortality was higher in the group of patients without antibacterial de-escalation (62% vs. 33%, p=0.03), but hospital length of stay, ICU length of stay, and number of ventilator-free days were not different between groups. Figure 1: Epidemiology of Pathogens Isolated From Respiratory Cultures in Cardiac Arrest Patients Conclusion Culture results were not associated with antibiotic de-escalation in post cardiac arrest patients with suspected aspiration pneumonia. Opportunities exist for further de-escalation in this population, particularly patients with unnecessary pseudomonal coverage. Disclosures All Authors: No reported disclosures

scholarly journals Comparison of culture-negative and culture-positive sepsis or septic shock: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Yuting Li ◽  
Jianxing Guo ◽  
Hongmei Yang ◽  
Hongxiang Li ◽  
Yangyang Shen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
Mechanical Ventilation Duration ◽  
Culture Positive ◽  
Culture Negative

Abstract Background Mortality and other clinical outcomes between culture-negative and culture-positive septic patients have been documented inconsistently and are very controversial. A systematic review and meta-analysis was performed to compare the clinical outcomes of culture-negative and culture-positive sepsis or septic shock. Methods We searched the PubMed, Cochrane and Embase databases for studies from inception to the 1st of January 2021. We included studies involving patients with sepsis or septic shock. All authors reported our primary outcome of all-cause mortality and clearly compared culture-negative versus culture-positive patients with clinically relevant secondary outcomes (ICU length of stay, hospital length of stay, mechanical ventilation requirements, mechanical ventilation duration and renal replacement requirements). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). Results Seven studies including 22,655 patients were included. The primary outcome of this meta-analysis showed that there was no statistically significant difference in the all-cause mortality between two groups (OR = 0.95; 95% CI, 0.88 to 1.01; P = 0.12; Chi-2 = 30.71; I2 = 80%). Secondary outcomes demonstrated that there was no statistically significant difference in the ICU length of stay (MD = − 0.19;95% CI, − 0.42 to 0.04; P = 0.10;Chi-2 = 5.73; I2 = 48%), mechanical ventilation requirements (OR = 1.02; 95% CI, 0.94 to 1.11; P = 0.61; Chi2 = 6.32; I2 = 53%) and renal replacement requirements (OR = 0.82; 95% CI, 0.67 to 1.01; P = 0.06; Chi-2 = 1.21; I2 = 0%) between two groups. The hospital length of stay of culture-positive group was longer than that of the culture-negative group (MD = − 3.48;95% CI, − 4.34 to − 2.63; P < 0.00001;Chi-2 = 1.03; I2 = 0%). The mechanical ventilation duration of culture-positive group was longer than that of the culture-negative group (MD = − 0.64;95% CI, − 0.88 to − 0.4; P < 0.00001;Chi-2 = 4.86; I2 = 38%). Conclusions Culture positivity or negativity was not associated with mortality of sepsis or septic shock patients. Furthermore, culture-positive septic patients had similar ICU length of stay, mechanical ventilation requirements and renal replacement requirements as those culture-negative patients. The hospital length of stay and mechanical ventilation duration of culture-positive septic patients were both longer than that of the culture-negative patients. Further large-scale studies are still required to confirm these results.

scholarly journals Comparison of Culture-Negative and Culture-Positive Sepsis or Septic Shock: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Yuting Li ◽  
Jianxing Guo ◽  
Hongmei Yang ◽  
Hongxiang Li ◽  
Yangyang Shen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
Mechanical Ventilation Duration ◽  
Culture Positive ◽  
Culture Negative

Abstract Background: Mortality and other clinical outcomes between culture-negative and culture-positive septic patients have been documented inconsistently and are very controversial. A systematic review and meta-analysis was performed to compare the clinical outcomes of culture-negative and culture-positive sepsis or septic shock.Methods: We searched the PubMed, Cochrane, and Embase databases for studies from inception to the 1st of January 2021. We included studies involving patients with sepsis or septic shock. All authors reported our primary outcome of all-cause mortality and clearly comparing culture-negative versus culture-positive patients with clinically relevant secondary outcomes (ICU length of stay, hospital length of stay, mechanical ventilation requirements, mechanical ventilation duration and renal replacement requirements). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results: Seven studies including 22655 patients were included. The primary outcome of this meta-analysis showed that there was no statistically significant difference in the all-cause mortality between two groups (OR=0.95; 95% CI, 0.88 to 1.01; P=0.12; Chi2=30.71; I2=80%) . Secondary outcomes demonstrated that there was no statistically significant difference in the ICU length of stay(MD=-0.19;95% CI, -0.42 to 0.04; P=0.10;Chi2=5.73; I2=48%), mechanical ventilation requirements(OR=1.05; 95% CI, 0.93 to 1.18; P=0.41; Chi2=5.89; I2=66%) and renal replacement requirements(OR=0.82; 95% CI, 0.67 to 1.01; P=0.06; Chi2=1.21; I2=0%) between two groups. The hospital length of stay of culture-positive group was longer than that of the culture-negative group(MD=-3.48;95% CI, -4.34 to -2.63; P<0.00001;Chi2=1.03; I2=0%). The mechanical ventilation duration of culture-positive group was longer than that of the culture-negative group(MD=-0.64;95% CI, -0.88 to -0.4; P<0.00001;Chi2=4.86; I2=38%).Conclusions: Culture positivity or negativity was not associated with mortality of sepsis or septic shock patients. Furthermore, culture-positive septic patients had similar ICU length of stay, mechanical ventilation requirements and renal replacement requirements as those culture-negative patients. The hospital length of stay and mechanical ventilation duration of culture-positive septic patients were both longer than that of the culture-negative patients. Further large-scale studies are still required to confirm these results.

Medical Comorbidity in Psychiatric Inpatients: Relation to Clinical Outcomes and Hospital Length of Stay

2002 ◽  
Vol 43 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Constantine G. Lyketsos ◽  
Gary Dunn ◽  
Michael J. Kaminsky ◽  
William R. Breakey
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Psychiatric Inpatients ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Medical Comorbidity

scholarly journals No associations between physical activity and clinical outcomes among hospitalized patients with severe COVID-19

2020 ◽  
Author(s):  
Ana J. Pinto ◽  
Karla F. Goessler ◽  
Alan L. Fernandes ◽  
Igor H. Murai ◽  
Lucas P. Sales ◽  
...  
Keyword(s):  
Physical Activity ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Hospital Length ◽  
Sao Paulo ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Activity Levels ◽  
Physical Activity Levels

AbstractPurposeThis small-scale, prospective cohort study nested within a randomized controlled trial aimed to investigate the possible associations between physical activity levels and clinical outcomes among hospitalized patients with severe COVID-19.MethodsHospitalized patients with severe COVID-19 were recruited from Clinical Hospital of the School of Medicine of the University of Sao Paulo (a quaternary referral teaching hospital), and from Ibirapuera Field Hospital, both located in Sao Paulo, Brazil. Physical activity levels were assessed by Baecke Questionnaire of Habitual Physical Activity. The primary outcome was hospital length of stay. The secondary outcomes were: mortality, admission to the intensive care unit (ICU), and mechanical ventilation requirement.ResultsMean hospital length of stay was 8.5 ± 7.1 days; 3.3% of patients died, 13.8% were admitted to ICU, and 8.6% required mechanical ventilation. Linear regression models showed that physical activity indexes were not associated with hospital length of stay (work index: β=-0.57 [95%CI: −1.80 to 0.65], p=0.355; sport index: β=0.43 [95%CI: −0.94 to 1.80], p=0.536; leisure-time index: β=1.18 [95%CI: −0.22 to 2.59], p=0.099; total activity index: β=0.20 [95%CI: −0.48 to 0.87], p=0.563. Physical activity indexes were not associated with mortality, admission to ICU and mechanical ventilation requirement (all p>0.05).ConclusionsAmong hospitalized patients with COVID-19, physical activity did not associate with hospital length of stay or any other clinically-relevant outcomes. These findings suggest that previous physical activity levels may not change the prognosis of severe COVID-19.

scholarly journals Functional Impairment, Symptom Burden, and Clinical Outcomes Among Hospitalized Patients With Advanced Cancer

2020 ◽  
Vol 18 (6) ◽  
pp. 747-754 ◽  
Author(s):  
Daniel E. Lage ◽  
Areej El-Jawahri ◽  
Charn-Xin Fuh ◽  
Richard A. Newcomb ◽  
Vicki A. Jackson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Functional Status ◽  
Clinical Outcomes ◽  
Advanced Cancer ◽  
Functional Impairment ◽  
Symptom Burden ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Assessment System ◽  
Hospital Length Of Stay

Background: National guidelines recommend regular measurement of functional status among patients with cancer, particularly those who are elderly or high-risk, but little is known about how functional status relates to clinical outcomes among hospitalized patients with advanced cancer. The goal of this study was to investigate how functional impairment is associated with symptom burden and healthcare utilization and clinical outcomes. Patients and Methods: We conducted a prospective observational study of patients with advanced cancer with unplanned hospitalizations at Massachusetts General Hospital from September 2014 through March 2016. Upon admission, nurses assessed patients’ activities of daily living (ADLs; mobility, feeding, bathing, dressing, and grooming). Patients with any ADL impairment on admission were classified as having functional impairment. We used the revised Edmonton Symptom Assessment System (ESAS-r) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, respectively. Multivariable regression models were used to assess the relationships between functional impairment, hospital length of stay, and survival. Results: Among 971 patients, 390 (40.2%) had functional impairment. Those with functional impairment were older (mean age, 67.18 vs 60.81 years; P<.001) and had a higher physical symptom burden (mean ESAS physical score, 35.29 vs 30.85; P<.001) compared with those with no functional impairment. They were also more likely to report moderate-to-severe pain (74.9% vs 63.1%; P<.001) and symptoms of depression (38.3% vs 23.6%; P<.001) and anxiety (35.9% vs 22.4%; P<.001). Functional impairment was associated with longer hospital length of stay (β = 1.29; P<.001) and worse survival (hazard ratio, 1.73; P<.001). Conclusions: Hospitalized patients with advanced cancer who had functional impairment experienced a significantly higher symptom burden and worse clinical outcomes compared with those without functional impairment. These findings provide evidence supporting the routine assessment of functional status on hospital admission and using this to inform discharge planning, discussions about prognosis, and the development of interventions addressing patients’ symptoms and physical function.

scholarly journals Effect of a sepsis prediction algorithm on patient mortality, length of stay and readmission: a prospective multicentre clinical outcomes evaluation of real-world patient data from US hospitals

2020 ◽  
Vol 27 (1) ◽  
pp. e100109 ◽  
Author(s):  
Hoyt Burdick ◽  
Eduardo Pino ◽  
Denise Gabel-Comeau ◽  
Andrea McCoy ◽  
Carol Gu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Real World ◽  
Learning Algorithm ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Machine Learning Algorithm

BackgroundSevere sepsis and septic shock are among the leading causes of death in the USA. While early prediction of severe sepsis can reduce adverse patient outcomes, sepsis remains one of the most expensive conditions to diagnose and treat.ObjectiveThe purpose of this study was to evaluate the effect of a machine learning algorithm for severe sepsis prediction on in-hospital mortality, hospital length of stay and 30-day readmission.DesignProspective clinical outcomes evaluation.SettingEvaluation was performed on a multiyear, multicentre clinical data set of real-world data containing 75 147 patient encounters from nine hospitals across the continental USA, ranging from community hospitals to large academic medical centres.ParticipantsAnalyses were performed for 17 758 adult patients who met two or more systemic inflammatory response syndrome criteria at any point during their stay (‘sepsis-related’ patients).InterventionsMachine learning algorithm for severe sepsis prediction.Outcome measuresIn-hospital mortality, length of stay and 30-day readmission rates.ResultsHospitals saw an average 39.5% reduction of in-hospital mortality, a 32.3% reduction in hospital length of stay and a 22.7% reduction in 30-day readmission rate for sepsis-related patient stays when using the machine learning algorithm in clinical outcomes analysis.ConclusionsReductions of in-hospital mortality, hospital length of stay and 30-day readmissions were observed in real-world clinical use of the machine learning-based algorithm. The predictive algorithm may be successfully used to improve sepsis-related outcomes in live clinical settings.Trial registration numberNCT03960203

scholarly journals 1043. Evaluation of Early Clinical Failure Criteria for Gram-Negative Bloodstream Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S311-S312
Author(s):  
Hana Rac ◽  
Alyssa Gould ◽  
P Brandon Bookstaver ◽  
Julie Ann Justo ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Bloodstream Infections ◽  
Failure Criteria ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Clinical Failure ◽  
Gram Negative ◽  
Additional Criterion ◽  
Prolonged Hospitalization

Abstract Background Early identification of patients at high risk of morbidity and mortality following Gram-negative bloodstream infections (GN-BSI) based on initial clinical course may prompt adjustments to optimize diagnostic and treatment plans. This retrospective cohort study aims to develop early clinical failure criteria (ECFC) to predict unfavorable outcomes in patients with GN-BSI. Methods Adults with community-onset GN-BSI who survived hospitalization for at least 96 hours at Palmetto Health hospitals in Columbia, SC, USA from January 1, 2010 to June 30, 2015 were identified. Multivariate logistic regression was used to examine association between clinical variables within 72–96 hours of BSI and unfavorable outcomes (28-day mortality or hospital length of stay &gt;14 days). Results Among 766 patients with GN-BSI, 225 (29%) had unfavorable outcomes. After adjustments for Charlson Comorbidity Index and appropriateness of empirical antimicrobial therapy in multivariate model, predictors of unfavorable outcomes included systolic blood pressure &lt;100 mmHg or vasopressor use (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1–2.5), heart rate &gt;100/minute (aOR 1.7, 95% CI 1.1–2.5), respiratory rate ≥22/minute or mechanical ventilation (aOR 2.1, 95% CI 1.4–3.3), altered mental status (aOR 4.5, 95% CI 2.8–7.1), and peripheral WBC count &gt;12 × 103/mm3 (aOR 2.7, 95% CI 1.8–4.1) at 72–96 hours from index BSI. Area under receiver operating characteristic curve of ECFC model in predicting unfavorable outcomes was 0.77 (0.84 and 0.71 in predicting 28-day mortality and prolonged hospitalization separately, respectively). Predicted 28-day mortality increased from 1% in patients with no ECFC to 3%, 7%, 16%, 32%, and 54% in presence of each additional criterion (P &lt; 0.001). Predicted hospital length of stay was 7.5 days in patients without any ECFC and increased by 4.0 days (95% CI 3.1–4.9, P &lt; 0.001) in presence of each additional criterion. Conclusion Risk of 28-day mortality or prolonged hospitalization can be estimated within 72–96 hours of GN-BSI using ECFC. These criteria may have utility in future clinical research in assessing response to antimicrobial therapy based on a standard evidence-based definition of early clinical failure. Disclosures P. B. Bookstaver, CutisPharma: Scientific Advisor, &lt;$1,000. Melinta Therapeutics: Speaker’s Bureau, &lt;$1,000.

scholarly journals 1951. Extended Infusions of Β-lactam Antibiotics are Feasible and May Improve Mortality in the Pediatric Population

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S59-S60
Author(s):  
Rachael L Schortemeyer ◽  
Tracy N Zembles ◽  
Glenn Bushee ◽  
Evelyn Kuhn ◽  
Michelle L Mitchell
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Interim Analysis ◽  
Pediatric Population ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Drug Concentrations ◽  
All Cause Mortality

Abstract Background Infections due to multi-drug-resistant organisms (MDRO) are associated with poor clinical outcomes. Due to limited treatment options for MDROs, it is essential to improve the delivery of available antibiotics. Optimal efficacy of β-lactam antibiotics can be achieved when free drug concentrations exceed the minimum inhibitory concentration of the organism for at least 50% of the dosing interval. This is more feasible when extending the duration of infusion. Adult literature supporting the use of extended infusion β-lactams (EIBL) is robust; however, pediatric data are limited. Furthermore, extended infusions (EI) may be more difficult to achieve in pediatric patients due to limited intravenous line access. The purpose of this study was to determine the feasibility of EIBLs as the standard of care and compare clinical outcomes between standard infusions (SI) and extended infusions (EI). Methods This retrospective chart analysis included hospitalized patients less than 18 years old between October 1, 2017 and March 31, 2019 who received at least 72 hours of cefepime, piperacillin/tazobactam, or meropenem. Patients weighing less than 3.5 kg or requiring continuous renal replacement therapy were excluded. EI were defined as antibiotic delivery over 3–4 hours, while SI were delivered over 30 minutes. The percent of patients completing therapy utilizing EI was measured. Clinical outcomes compared hospital length of stay; time to blood culture clearance, defervescence, inflammatory marker normalization; 30-day readmission rates; and 30-day all-cause mortality between the SI and EI groups. Results A total of 560 patients were included in the interim analysis. Over 90% of patients were able to complete therapy utilizing EI (Figure 1). The EI group had lower readmission rates, but the interim analysis has not yet controlled for planned admissions. A sub-analysis of critically ill patients requiring vasopressors identified a lower mortality rate (5.1% vs. 23.1%, P = 0.023) and decreased the length of stay (554 vs. 1,055 hours, P = 0.035) in the EI compared with SI group (Table 1). Conclusion EIBLs are feasible in the pediatric population and may lead to improved outcomes including decreased all-cause mortality and hospital length of stay, especially in critically ill children. Disclosures All Authors: No reported Disclosures.

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