scholarly journals 269. Clinical Characteristics and Outcomes of Persistent Staphylococcus aureus Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S135-S136
Author(s):  
Eunmi Yang ◽  
Hyemin Chung ◽  
Hyeonji Seo ◽  
Haein Kim ◽  
Jinyeong Kim ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Liver Cirrhosis ◽  
Confidence Interval ◽  
Charlson Comorbidity Index ◽  
Clinical Characteristics ◽  
Index Score ◽  
Charlson Comorbidity Index Score ◽  
Staphylococcus Aureus Bacteremia ◽  
Persistent Bacteremia ◽  
Comorbidity Index

Abstract Background Staphylococcus aureus bacteremia (SAB) is a leading cause of bacteremia and persistent SAB is associated with poor outcomes. We evaluated key clinical characteristics and outcomes associated with persistent SAB. Methods We reviewed patients enrolled in a prospective cohort of adult patients with S. aureus bacteremia at a tertiary hospital from August 2008 to December 2018. Clinical characteristics, outcomes, and microbiologic characteristics of patients with persistent bacteremia (≥ 3 d) were evaluated. Results Of the total 969 patients, 617 (63.7%) patients had persistent bacteremia. The median duration of bacteremia with persistent bacteremia was 5 days. The most common sources of persistent bacteremia were central venous catheter-related infection (33.4%) and bone and joint infection (14.9%). Methicillin resistant S. aureus (MRSA) isolates were analyzed in 372 (60.3%) patients and metastatic infections were 217 (35.2%) with persistent bacteremia. In the multivariate analysis, APACHE Ⅱ score (adjusted odds ratio [aOR], 1.07; 95% confidence interval [CI], 1.03–1.10), Charlson comorbidity index score (aOR, 1.14; 95% CI, 1.04–1.25), liver cirrhosis (aOR, 2.47; 95% CI, 1.44–4.23), and S. aureus pneumonia (aOR, 3.04; 95% CI, 1.29–7.18) were independently associated with 30-d mortality. In persistent MRSA bacteremia, ST5-SCCmecⅡ was 59.7% (222/372) and agr dysfunction was 64.8% (241/372). After adjusting for confounding factors, APACHE Ⅱ score (aOR, 1.08; 95% confidence interval [CI], 1.04–1.12), liver cirrhosis (aOR, 3.09; 95% CI, 1.56–6.14), and S. aureus pneumonia (aOR, 4.37; 95% CI, 1.40–13.67) were independently associated with 30-d mortality. Table 1. Demographic and Clinical characteristics of Patients With Persistent Bacteremia Table 2. Microbiologic Characteristics and Genotypes in MRSA Isolates Responsible for Persistent Bacteremia Fig 1. Duration of Staphylococcus aureus bacteremia Conclusion In persistent bacteremia, clinical factors, including APACHE Ⅱ score, Charlson comorbidity index score, liver cirrhosis, and S. aureus pneumonia contribute to 30-d mortality. Disclosures All Authors: No reported disclosures

scholarly journals FRI0514 USE OF OPIATE FOR HIP AND KNEE OSTEOARTHRITIS BEFORE AND AFTER JOINT REPLACEMENT SURGERY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 856.1-856
Author(s):  
C. Lao ◽  
D. Lees ◽  
D. White ◽  
R. Lawrenson
Keyword(s):  
New Zealand ◽  
Knee Osteoarthritis ◽  
Knee Replacement ◽  
Charlson Comorbidity Index ◽  
Hip Osteoarthritis ◽  
Index Score ◽  
Charlson Comorbidity Index Score ◽  
Joint Replacement Surgery ◽  
Before And After ◽  
Comorbidity Index

Background:Osteoarthritis of the hip and knee is one of the most common causes of reduced mobility. It also causes stiffness and pain. Opioids can offer pain relief but is usually used for severe acute pain caused by major trauma or surgery. The use of opioids for relief of chronic pain caused by arthritis has increased over the last few decades.[1]Objectives:This study aims to investigate the use of strong opiates for patients with hip and knee osteoarthritis before and after joint replacement surgery, over a 13 years period in New Zealand.Methods:This study included patients with osteoarthritis who underwent publicly funded primary hip and knee replacement surgeries in 2005-2017 in New Zealand. These records were identified from the National Minimum Dataset (NMD). They were cross referenced with the NZJR data to exclude the admissions not for primary hip or knee replacement surgeries. Patients without a diagnosis of osteoarthritis were excluded.The PHARMS dataset was linked to the NMD to identify the use of strong opiates before and after surgeries. The strong opiates available for community dispensing in New Zealand and included in this study are: dihydrocodeine, fentanyl, methadone, morphine, oxycodone and pethidine. Use of opiate within three months prior to surgery and within 12 months post-surgery were examined by gender, age group, ethnicity, Charlson Comorbidity Index score and year of surgery. Differences by subgroup was examined with Chi- square test. Logistic regression model was used to calculate the adjusted odds ratios of strong opiate use before and after surgery compared with no opiate use.Results:We identified 53,439 primary hip replacements and 50,072 primary knee replacements with a diagnosis of osteoarthritis. Of patients with hip osteoarthritis, 6,251 (11.7%) had strong opiate before hip replacement surgeries and 11,939 (22.3%) had opiate after surgeries. Of patients with knee osteoarthritis, 2,922 (5.8%) had strong opiate before knee replacement surgeries and 15,252 (30.5%) had opiate after surgeries.The probability of patients with hip and knee osteoarthritis having opiate decreased with age, increased with Charlson comorbidity index score, and increased over time both before and after surgeries. Male patients with hip and knee osteoarthritis were less likely to have opiate than female patients both before and after surgeries. New Zealand Europeans with hip and knee osteoarthritis were more likely to receive opiate than other ethnic groups prior to surgeries, but were less likely to have opiate than Asians post-surgeries.Patients who had opiate before surgeries were more likely to have opiate after surgeries than those who did not have opiate before surgeries. The odds ratio was 8.34 (95% confidence interval (CI): 7.87-8.84) for hip osteoarthritis and 11.94 (95% CI: 10.84-13.16) for knee osteoarthritis after adjustment for age, gender, ethnicity, year of surgery and Charlson comorbidity index score. Having opiate prior to surgeries also increased the probability of having opiate for 6 weeks or more after surgeries substantially. The adjusted odds ratio was 21.46 (95% CI: 19.74-23.31) for hip osteoarthritis and 27.22 (95% CI: 24.95-29.68) for knee osteoarthritis.Conclusion:Preoperative opiate holidays should be encouraged. Multiple strategies need to be used to develop analgesic plans that allow adequate rehabilitation, without precipitating a chronic opiate dependence. Clinicians would also benefit from clear guidelines for prescribing strong opiates.References:[1] Nguyen, L.C., D.C. Sing, and K.J. Bozic,Preoperative Reduction of Opioid Use Before Total Joint Arthroplasty.J Arthroplasty, 2016.31(9 Suppl): p. 282-7.Disclosure of Interests:None declared

scholarly journals Correction: Adjusted Age-Adjusted Charlson Comorbidity Index Score as a Risk Measure of Perioperative Mortality before Cancer Surgery

PLoS ONE ◽  
2016 ◽  
Vol 11 (6) ◽  
pp. e0157900 ◽  
Author(s):  
Chun-Ming Chang ◽  
Wen-Yao Yin ◽  
Chang-Kao Wei ◽  
Chin-Chia Wu ◽  
Yu-Chieh Su ◽  
...  
Keyword(s):  
Charlson Comorbidity Index ◽  
Risk Measure ◽  
Cancer Surgery ◽  
Index Score ◽  
Charlson Comorbidity Index Score ◽  
Perioperative Mortality ◽  
Comorbidity Index

scholarly journals Charlson Comorbidity Index Score and Risk of Severe Outcome and Death in Danish COVID-19 Patients

2020 ◽  
Vol 35 (9) ◽  
pp. 2801-2803 ◽  
Author(s):  
Daniel Mølager Christensen ◽  
Jarl Emanuel Strange ◽  
Gunnar Gislason ◽  
Christian Torp-Pedersen ◽  
Thomas Gerds ◽  
...  
Keyword(s):  
Charlson Comorbidity Index ◽  
Index Score ◽  
Charlson Comorbidity Index Score ◽  
Comorbidity Index

scholarly journals Adjusted Age-Adjusted Charlson Comorbidity Index Score as a Risk Measure of Perioperative Mortality before Cancer Surgery

PLoS ONE ◽  
2016 ◽  
Vol 11 (2) ◽  
pp. e0148076 ◽  
Author(s):  
Chun-Ming Chang ◽  
Wen-Yao Yin ◽  
Chang-Kao Wei ◽  
Chin-Chia Wu ◽  
Yu-Chieh Su ◽  
...  
Keyword(s):  
Charlson Comorbidity Index ◽  
Risk Measure ◽  
Cancer Surgery ◽  
Index Score ◽  
Charlson Comorbidity Index Score ◽  
Perioperative Mortality ◽  
Comorbidity Index

scholarly journals 109. Clinical Characteristics and Outcomes of Staphylococcus aureus Bacteremia From a Biliary Source

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S86-S86
Author(s):  
Eunmi Yang ◽  
Seongman Bae ◽  
Hyeonji Seo ◽  
Eunbeen Cho ◽  
Su-Jin Park ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Biliary Tract ◽  
Broad Spectrum ◽  
Solid Tumor ◽  
Charlson Comorbidity Index ◽  
Clinical Characteristics ◽  
Apache Ii Score ◽  
Metastatic Infection ◽  
Comorbidity Index ◽  
High Charlson Comorbidity Index

Abstract Background Staphylococcus aureus can cause various types of infection, but involvement of biliary tract is rare. There were only few case reports and no clinical studies. We assessed the clinical characteristics and outcomes of S. aureus bacteremia from a biliary source (biliary SAB) in a large cohort of SAB patients and compared the cases with those of catheter-related SAB. Methods We performed a matched case–control study within a prospective observational cohort of patients with SAB at a 2,700-bed tertiary hospital. All adult patients with SAB were observed for 12 weeks from July 2008 to July 2018. Biliary SAB was defined as the case of S.aureus isolated from blood culture with appropriate clinical biliary infection symptoms (fever, abdominal pain, or jaundice) and signs (abdominal tenderness or liver enzyme elevation with obstructive pattern). Biliary SAB cases were matched 1:3 to control patients with catheter-related SAB based on age, gender, ward, and case year. Results A total of 1,818 patients with SAB were enrolled in the entire cohort, and 42 (2%) were biliary SAB. Among patients with biliary SAB, 32 (76%) had solid tumor involving pancreaticobiliary tract or liver, 30 (71%) had biliary drainage stent, 14 (33%) were biliary procedure-related infection, and 24 (57%) had recent broad-spectrum antibiotics exposure (Table 1). When biliary SAB patients were compared with 126 patients with catheter-related SAB, they were significantly more likely to have community-onset SAB, solid tumor, and lower APACHE II score; and less likely to have metastatic infection (P = 0.03) (Table 2). Biliary SAB, solid tumor, and a high Charlson comorbidity index were associated with 12-week mortality. In multivariate analysis, biliary SAB (aOR, 5.5; 95% CI, 2.47–12.25) and a high Charlson comorbidity index (aOR, 1.32; 95% CI, 1.12–1.54) were independent risk factors for 12-week mortality. Conclusion Biliary SAB was relatively rare and developed mainly in pancreaticobiliary cancer patients and in recent broad-spectrum antibiotic users. High mortality was probably attributable to underlying cancers. When biliary tract infection caused by S. aureus is clinically suspected, early aggressive treatment for SAB should be considered. Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document