scholarly journals 227. Evaluation of Empiric Vancomycin Utilization at 72 Hours Post Admission: is De-escalation of Vancomycin Appropriate?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S114-S115
Author(s):  
Mandana Naderi ◽  
Kimberly Welker ◽  
Tina Pourshams-Manzouri ◽  
Vanthida Huang ◽  
Amy Buros
Keyword(s):  
Chart Review ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
White Blood Cells ◽  
Positive Culture ◽  
Retrospective Chart Review ◽  
P Value ◽  
Vancomycin Therapy ◽  
Clinical Criteria ◽  
Time Out ◽  
Days Of Therapy

Abstract Background At both of our institutions in 2018, the average vancomycin days of therapy per 1,000 patient days was 112. The purpose of this study was to examine a 72-hour time-out as an effective de-escalation tool by evaluating the indication and clinical appropriateness of the continuation of empiric vancomycin therapy. Methods A retrospective chart review was performed from January 2018 to October 2018 at two community hospitals. Patients > 18 years who received at least 3 days of empiric vancomycin therapy were included. Patients were excluded if immunocompromised, pregnant, on hemodialysis, received vancomycin for surgical prophylaxis, or expired within 72 hours of vancomycin initiation. Criteria for appropriate continuation of vancomycin at 3 days: positive culture for methicillin-resistant Staphylococcus aureus (MRSA), presence of infection with or without defined sources with systemic signs of infection (i.e. white blood cells >12,000 cells/L or < 5,000 cells/L and/or elevated temperature ≥ 37.5°C), or pending wound/sputum cultures after vancomycin initiation. Results A total of 160 adult patients initiated on vancomycin were analyzed; 118 of 160 (74%) met appropriate criteria. The most common indications for vancomycin were: skin and soft tissue infections (SSTI) 82 patients (51%); pneumonia 37 patients (23%); and positive blood culture 20 patients (13%). Risk factors for MRSA were similar between both groups. Forty-four (28%) patients had cultures pending and 23 patients (14%) had a known non-MRSA pathogen at time of assessment. American Indian race (OR 3.01 (1.21, 7.53) p-value= 0.0174) and SSTI indication (OR 2.87 (1.24, 6.80) p-value= 0.0147) were associated with not meeting appropriate criteria. Conclusion Approximately 25% of patients receiving empiric vancomycin therapy did not meet clinical criteria for continuation beyond 72 hours. The indication most commonly associated with continued vancomycin utilization was SSTI. These results identified indications in which empiric vancomycin prescribing can be optimized, and a 72-hour antibiotic time-out may be warranted as a stewardship intervention. Timely culture obtainment and intervention when another pathogen is identified are possible strategies to ensure success of 72-hour time-out. Disclosures All Authors: No reported disclosures

scholarly journals Clopidogrel, an ADP-P2Y12 Receptor Antagonist, Can Prevent Severe Postoperative Pain: A Retrospective Chart Review

Life ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 92
Author(s):  
Rikuhei Tsuchida ◽  
Masahiko Sumitani ◽  
Hiroaki Abe ◽  
Masae Ando ◽  
Kosuke Saita ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Chart Review ◽  
Stable State ◽  
Analgesic Efficacy ◽  
Retrospective Chart Review ◽  
Treated Group ◽  
P2y12 Receptor ◽  
Nociceptive Pain ◽  
P Value

The purinergic P2Y12 receptor regulates microglial activation, resulting in persistence and aggravation of pain in neuropathic and nociceptive pain models. We conducted a retrospective chart review to explore the analgesic potency of the P2Y12 receptor-specific antagonist, clopidogrel, for clinical management of postoperative pain in patients who underwent abdominal surgery. Twenty-seven patients with cardiovascular comorbidities, who underwent laparoscopic abdominal surgery and had ceased aspirin (ASP, n = 17) or clopidogrel (CLP, n = 10) for 14 days pre-operatively, were enrolled retrospectively. In both groups, the number of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) consumed for managing postoperative pain was compared using the chi-square test and Mann–Whitney test. Our results showed that from postoperative day (POD) 0 to POD 3, the average numerical rating reflecting the postoperative pain was comparable between the two groups (CLP: 4.0 ± 1.4 vs. ASP: 3.7 ± 0.8, P-value = 0.56). However, at POD 7, opioid consumption in the CLP-treated group (fentanyl-equivalent dose: 0.49 ± 0.56 mg) was significantly lower than that in the ASP-treated group (1.48 ± 1.35 mg, P-value = 0.037). After reaching a stable state by repeated systemic administration, clopidogrel sustained the analgesic efficacy for a certain period. In conclusion, microglial P2Y12 receptors may mediate signal transduction of postoperative nociceptive pain and enhance clinical opioid analgesia.

Evaluation of the Efficacy of Enoxaparin in the Neonatal Intensive Care Unit

2019 ◽  
Author(s):  
Diane Song ◽  
Jacqueline Magers ◽  
Mahmoud Abdel-Rasoul ◽  
Pavel Prusakov
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Cox Model ◽  
Factor Xa ◽  
Retrospective Chart Review ◽  
P Value ◽  
Bleeding Events ◽  
Days Of Therapy

Abstract Objective This article evaluates the efficacy of enoxaparin when targeting anti-factor Xa levels of 0.5 to 1 units per milliliter in the neonatal intensive care unit. Study Design This is a retrospective chart review of 45 neonates receiving enoxaparin for the treatment of venous thromboembolism. Enoxaparin dosing and corresponding anti-factor Xa levels were collected. Time to resolution of clot was confirmed by imaging and compared between clots in various locations. Results The median time to clot resolution was 76 days (interquartile range 40–91 days). Clot location, postnatal age, and sex at the clot onset were significantly associated with time to clot resolution in a multivariable Cox model (p-value: 0.03, 0.03, and < 0.01, respectively). Of the 54 patients analyzed for safety, 5 patients (9.3%) experienced bleeding events resulting in the discontinuation of enoxaparin. Conclusion Based on our findings, 50% of all patients evaluated, regardless of thrombus location, achieved resolution within the first 76 days of therapy. Clots located in the extremities tended to resolve sooner, hence earlier reimaging should be considered.

scholarly journals Recognition of Lynch Syndrome Amongst Newly Diagnosed Colorectal Cancers at St. Paul’s Hospital

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Steven Pi ◽  
Estello Nap-Hill ◽  
Jennifer Telford ◽  
Robert Enns
Keyword(s):  
Lynch Syndrome ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Inclusion Criteria ◽  
First Line ◽  
Clinical Criteria ◽  
Immunohistochemistry Staining ◽  
Age Of Diagnosis ◽  
History Of ◽  
Specific Malignancy

Background. Lynch Syndrome (LS) is the most common cause of inherited colorectal cancer (CRC). In British Columbia, most centres still use clinical criteria (Amsterdam II, Revised Bethesda, or the BC Cancer Agency’s criteria) to determine who should undergo further first-line testing in the form of microsatellite instability or immunohistochemistry staining. Given the limitations with this strategy, LS is thought to be underrecognized. Objective. To investigate whether LS is truly underrecognized when compared to the reported prevalence. Methods. A retrospective chart review of all CRC cases diagnosed at St. Paul’s Hospital from 2010 to 2013 was conducted. Results. 246 patients met inclusion criteria. 76% (83/109) with a family history of malignancy were unable to recall the specific malignancy or age of diagnosis. 18% (43/235) were only asked about a history of gastrointestinal related malignancy and 26% (65/246) met at least one of the three criteria but only 21% (13/63) received further investigation. Only 1.6% (4/246) had LS compared to the reported prevalence of 2–5% of all CRC cases. Conclusion. This data supports our hypothesis that LS is underrecognized. Issues at the patient, physician, and systems level need to be evaluated to determine where the limitations preventing appropriate testing are occurring.

Clinical Outcomes of Linezolid vs Vancomycin in Methicillin-Resistant Staphylococcus aureus Ventilator-Associated Pneumonia

2011 ◽  
Vol 26 (6) ◽  
pp. 385-391 ◽  
Author(s):  
Jeannie D. Chan ◽  
Tam N. Pham ◽  
Jenny Wong ◽  
Michelle Hessel ◽  
Joseph Cuschieri ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Cure ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Signs And Symptoms ◽  
Ventilator Associated Pneumonia ◽  
Vancomycin Therapy ◽  
Methicillin Resistant ◽  
Treatment Standard ◽  
Primary Endpoints ◽  
Days Of Therapy

Background: Vancomycin has been the treatment standard for methicillin-resistant Staphylococcus aureus (MRSA) infections, but clinical efficacy is limited. We report outcomes of a cohort with MRSA ventilator-associated pneumonia (VAP) treated with vancomycin vs linezolid. Methods: Retrospective analysis of 113 participants with MRSA VAP confirmed by bronchoscopy who have been initiated on therapy with either vancomycin or linezolid within 24 hours after bronchoscopy and completed ≥7 days of therapy during their hospitalization from July 2003 to June 2007. The primary endpoints were hospital survival and clinical cure, defined as resolution of signs and symptoms of VAP or microbiological eradication after completion of therapy along with clinical pulmonary infection score (CPIS) ≤6 at day 7 of therapy. Results: At hospital discharge, 23/27 (85.2%) of linezolid and 72/86 (83.7%) of vancomycin recipients had survived ( P = .672). In comparison to linezolid recipients, the adjusted odds ratio (OR) for survival was 0.72 (95% confidence interval [CI]: 0.16-3.27) with vancomycin therapy. Clinical cure was achieved in 24/27 (88.9%) of linezolid and 63/86 (73.3%) of vancomycin recipients ( P = .066). Compared to linezolid recipients, the adjusted OR for clinical cure was 0.24 (95% CI: 0.05-1.10) with vancomycin therapy. Survival and clinical cure did not differ significantly between vancomycin recipients with trough level ≥15 and <15 μg/mL, respectively. Conclusions: Our results suggested no survival benefit but a trend toward higher cure rate with linezolid therapy. The optimal treatment of MRSA VAP requires further study through randomized, controlled trials.

scholarly journals Surgical Outcomes of Myelomeningocele Repair: a 20-Year Experience from a Single Center in a Middle-Income Country

2021 ◽  
Author(s):  
Sina Zoghi ◽  
Maryam Feili ◽  
Mohammad Amin Mosayebi ◽  
Mohammad Amin Afifi ◽  
Afrooz Feili ◽  
...  
Keyword(s):  
Surgical Management ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
P Value ◽  
Fars Province ◽  
Middle Income ◽  
Middle Socioeconomic Status ◽  
Myelomeningocele Repair ◽  
Complications And Mortality

Abstract Objective Spina bifida primarily affects people of low and middle socioeconomic status. Herein, we describe the outcome of myelomeningocele surgical management in Iran and predictors of its postoperative complications and mortality. Methods This retrospective chart review studies the children who underwent surgical management for myelomeningocele in Shiraz, Fars province, Iran, from May 2001 to September 2020. To this end, we investigated mortality and 30-day complications and the factors that determined the operation's outcome. Results 256 patients were enrolled. The median age at the operation was roughly eight days (IQR: 7). The most common site of involvement of Myelomeningocele (MMC) was Lumbosacral (86%, n = 204). At the evaluation conducted prior to operation, CSF leaking was observed in 7% (n=16) of the patients. Postoperatively, 5.7% of the patients were expired in the 30 days following the operation (n = 14), while 24% needed readmission (n = 47). The most common complications leading to readmission included wound dehiscence (n = 10, 42%) and wound purulence (n = 6, 25%). No variable was significantly associated with postoperative complication except for the site of the lesion (p-value = 0.035) and the presence of the lipid content in the defect (p-value = 0.044). Conclusions Most patients born with MMC are referred for the neurosurgical evaluation following their birth; however, as results show there is much left to be desired compared with the 48h recommended by The Congress of Neurological Surgeons. Here, we concluded that presence of lipid compartment in the lesion and the site of the lesion are the two factor that were associated with the rate of mortality. However, further investigation into preoperative interventions and risk factors to mitigate risk of postoperational complications and mortality is highly encouraged. We highly advocate for the investigation and dissemination of the outcome of the conventional surgical management of MMC in financially restrained areas; because they can show the limitation these settings are confronted with (that are in a way unique to them and different from the resourceful settings) and provide a model for other similar areas with limited suitable care.

scholarly journals Empiric Vancomycin Use in Febrile Neutropenic Oncology Patients

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Jessica Libuit ◽  
Andrew Whitman ◽  
Rebecca Wolfe ◽  
Casey S. Washington
Keyword(s):  
Antibiotic Resistance ◽  
Febrile Neutropenia ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Empiric Therapy ◽  
Vancomycin Therapy ◽  
Oncology Patients ◽  
Teaching Institution ◽  
Large Community ◽  
Community Teaching

Abstract Vancomycin is commonly added as empiric therapy for febrile neutropenia. A retrospective chart review was conducted at a large community teaching institution to evaluate vancomycin use in oncology patients. The results revealed that a majority of empiric vancomycin therapy was inappropriate, raising concern for antibiotic resistance and prompting opportunities for improvement.

scholarly journals Microbiological profiles of tracheostomy patients: a single-center experience

2021 ◽  
Vol 16 ◽  
Author(s):  
Abdulaziz Alrabiah ◽  
Khaled Alhussinan ◽  
Mohammed Alyousef ◽  
Ahmed Alsayed ◽  
Abdullah Aljasser ◽  
...  
Keyword(s):  
Chart Review ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Strong Association ◽  
Retrospective Chart Review ◽  
Tracheal Aspirate ◽  
Positive Sample ◽  
Culture Result ◽  
Common Procedure ◽  
Single Center Experience ◽  
Antibiotic Dose

Background: This study compared the prevalence of common microorganisms in obstructed and non-obstructed cases across the four quarters on the first post-tracheostomy year.Methods: A retrospective chart review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between June 2015 and September 2019 at our hospital. Based on the tracheostomy indications, patients were allocated to obstructed or non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter.Results: Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5±16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated Pseudomonas aeruginosa, which showed significantly different proportions across the quarters (p=0.006). Among obstructed patients, P. aeruginosa was the most common (35%), followed by methicillin-resistant Staphylococcus aureus (MRSA; 23.5%).Conclusions: The most common post-tracheostomy microorganism was P. aeruginosa. MRSA showed a strong association with tracheostomy for obstructive indications.

scholarly journals 277. Low Rates of Bacterial Co-infection in Hospitalized Patients with COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S244-S244
Author(s):  
Stephanie Spivack ◽  
Geena Kludjian ◽  
Stefania Gallucci ◽  
Laurie Kilpatrick ◽  
Aaron D Mishkin ◽  
...  
Keyword(s):  
Chart Review ◽  
Additional Data ◽  
Positive Culture ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Antibiotic Usage ◽  
Research Support ◽  
Patient Demographics ◽  
Asymptomatic Carriage ◽  
True Infection

Abstract Background The rate of bacterial co-infection in inpatients with COVID-19 is unknown, however, patients who are hospitalized with COVID-19 often receive antibiotics for community-acquired bacterial pneumonia (CABP). Reducing unnecessary antibiotic usage in this population is important to prevent adverse effects and slow the development of antimicrobial resistance. Methods We performed a retrospective chart review on patients admitted to our health system between March and May 2020 with confirmed COVID-19 by nasopharyngeal PCR. We reviewed patients with positive cultures from urine, blood, sputum, and sterile sites. Positive cultures were reviewed to determine if they represented a true infection versus a contaminant or colonization. Patients with true infections were categorized as having a co-infection (CI) if the positive culture was collected within 48 hours of initial positive SARS-CoV-2 PCR test. Additional data was collected on patient demographics, types of infections, organisms grown, and antibiotic usage. Results 902 patients were admitted with positive SARS-CoV-2 tests during the study period. Of these, 47 patients (5.2%) had a bacterial CI. Some patients had more than one CI, with 53 total CIs identified. The median age of patients with CI was 66 years old (39 – 90). Tables 1 and 2 describe patient characteristics and infections. A subgroup analysis on types of bacteria was done on the 20 patients with a respiratory CI, who accounted for 2.2% of all COVID-positive patients admitted during the study period. In these infections, Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae were the most common organisms, accounting for 60%, 15%, and 10% infections, respectively. Table 1. Patient Characteristics Table 2. Co-infections Conclusion The overall rate of CIs in patients admitted with COVID-19 was low. Some of these CIs may represent an “incidentally positive” COVID-19 test if a patient presented with one infection and had asymptomatic carriage of SARS-CoV-2 when community prevalence was high. Further analysis is needed to evaluate specific risk factors for co-infection. Disclosures Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Astellas (Consultant, Speaker’s Bureau)Merck (Consultant, Grant/Research Support, Speaker’s Bureau)Qpex (Consultant)scPharmaceuticals (Consultant)Shionogi (Consultant) Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Astellas (Individual(s) Involved: Self): Speakers' bureau; Merck (Individual(s) Involved: Self): Consultant, Grant/Research Support; Nabriva: Consultant; Qpex (Individual(s) Involved: Self): Consultant; Shionogi (Individual(s) Involved: Self): Consultant

Unique microbiology of chronically unstable canal wall down tympanomastoid cavities: considerations for surgical revision

2013 ◽  
Vol 127 (5) ◽  
pp. 458-462 ◽  
Author(s):  
M B Gluth ◽  
B Y B Tan ◽  
P L Santa Maria ◽  
M D Atlas
Keyword(s):  
Antimicrobial Resistance ◽  
Chart Review ◽  
Positive Culture ◽  
Retrospective Chart Review ◽  
Surgical Revision ◽  
Chronic Instability ◽  
Specimen Processing ◽  
Canal Wall Down ◽  
Mastoid Surgery ◽  
Culture Specimen

AbstractObjective:To review the microbiology of open tympanomastoid cavities in patients who underwent revision surgery due to chronic instability.Methods:This paper describes a retrospective chart review of surgical revision cases of chronically unstable open mastoid cavities. Patient records from 2000 to 2010 were reviewed for the type of organism cultured, antimicrobial resistance and the presence of cholesteatoma.Results:In total, 121 revision surgical procedures were performed on 101 patients. Seventy-nine procedures involved culture specimen processing, 37 of which were positive. The most commonly cultured organism was Staphylococcus aureus, which was more than twice as common as any other pathogen. The presence of cholesteatoma had no impact on the likelihood of a positive culture or polymicrobial culture. Antimicrobial-resistant pathogens were uncommon.Conclusion:A positive culture was not an overwhelmingly common characteristic of unstable tympanomastoid cavities. Furthermore, antimicrobial resistance did not appear to play an essential role in leading patients towards revision open mastoid surgery.

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