scholarly journals 1314. Descriptive Epidemiology of 30-day Readmissions among Survivors of Hospitalization with Bacterial Nosocomial Pneumonia in the US, 2012-2019

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S745-S745
Author(s):  
Marya Zilberberg ◽  
Brian Nathanson ◽  
Laura A Puzniak ◽  
Noah Zilberberg ◽  
Andrew F Shorr
Keyword(s):  
Nosocomial Pneumonia ◽  
Bacterial Pneumonia ◽  
Cleveland Clinic ◽  
Chronically Ill ◽  
Research Database ◽  
Principal Diagnosis ◽  
Research Support ◽  
Readmission Rates ◽  
Excess Morbidity ◽  
Hospital Acquired

Abstract Background Nosocomial pneumonia (NP) remains associated with excess morbidity and mortality. The effect of NP on other measures of outcome and quality, such as re-admission at 30 days, remains unclear. Moreover, differing types of NP may have varying impacts on re-admissions. Methods We conducted a multicenter retrospective cohort study within the Premier Research database, a source containing administrative, pharmacy, and microbiology data. The rate of rehospitalization at 30 days following the index discharge served as our primary endpoint. We compared NP patients readmitted with pneumonia (RaP) as the principal diagnosis to those readmitted for other reasons (RaO). We also compared readmission rates as function of the type of NP: ventilator-associated bacterial pneumonia (VABP), ventilated hospital-acquired bacterial pneumonia (vHABP), and non-ventilated HABP (nvHABP). Results Among 17,819 patients with NP, 14,123 (79.3%) survived to discharge, of whom 2,151 (15.2%) required an acute readmission within 30 days of index discharge. Of these, 106 (4.9%) were RaP, and the remainder were RaO. At index hospitalization, RaP patients were older (mean age (SD) 67.4 (13.9] vs. 63.0 (15.2) years), more likely medical (44.3% vs. 36.7%), and less chronically ill (median [IQR] Charlson scores (3 [2-5] vs. 4 [2-5]) than persons with RaO. Bacteremia (10.4% vs. 17.5%), need for vasopressors (15.1% vs. 20.0%), dialysis (9.4% vs. 16.5%), and/or sepsis (9.4% vs. 16.5%) or septic shock 14.2% vs. 17.1%) occurred less frequently in the RaP group. With respect to NP type, nvHABP was most common in RaP (47.2%) and VABP in RaO (38.1%). Conclusion One in seven survivors of a hospitalization complicated by NP requires an acute rehospitalization within 30 days. However, few of these readmissions had a principal diagnosis of pneumonia, irrespective of NP type. This suggests that short-term readmission does not capture the quality of care initially delivered to patients for their NP. Of the 5% of NP subjects with RaP, the plurality initially suffered from nvHABP. Disclosures Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee) Andrew F. Shorr, MD, MPH, MBA, Merck (Consultant)

scholarly journals 1322. Complications and Hospital Resource Utilization among Patients with Bacterial Nosocomial Pneumonia in the US, 2012-2019

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S749-S749
Author(s):  
Marya Zilberberg ◽  
Brian Nathanson ◽  
Laura A Puzniak ◽  
Noah Zilberberg ◽  
Andrew F Shorr
Keyword(s):  
Resource Utilization ◽  
Nosocomial Pneumonia ◽  
Post Infection ◽  
Hospital Costs ◽  
Cleveland Clinic ◽  
Extubation Failure ◽  
Research Database ◽  
Hospital Resource ◽  
Research Support ◽  
The Us

Abstract Background Nosocomial pneumonia (NP) remains a costly complication of hospitalization. Consisting of hospital-acquired ventilated (vHABP) and non-ventilated (nvHABP), and ventilator-associated (VABP) bacterial pneumonia, these conditions themselves are fraught with further complications. We examined hospital resource utilization (HRU) and the rates of important complications in these three groups in a large US database. Methods We conducted a multicenter retrospective cohort study within Premier Research database, a source containing administrative, pharmacy, and microbiology data. The three types of NP were identified based on a slightly modified, previously published ICD-9/10-CM algorithm,1 and compared with respect to hospital costs, length of stay (LOS) and development of C. difficile infection (CDI), extubation failure (EF), and reintubation (RT). CDI was identified by its treatment with metronidazole, vancomycin, or fidaxomicin. Marginal effects were derived from multivariable regression analyses. Results Among 17,819 patients who met the enrollment criteria, 26.5% had nvHABP, 25.6% vHAPB, and 47.9% VABP. Patients with nvHABP were oldest (mean 66.7+/-15.1 years) and those with VABP were youngest (59.7+/-16.6 years). vHABP was associated with the highest chronic disease burden (mean Charlson score 4.1+/-2.8) and VABP with lowest (3.2+/-2.5). Patients with nvHABP had lowest severity of acute illness (ICU 58.0%, vasopressors 7.7%), and those with vHABP were most likely to require vasopressors (38.8%). The adjusted EF and RT in vHABP and VABP, and CDI rates, and adjusted post-infection onset hospital LOS across all groups were similar. The adjusted marginal post-infection onset ICU LOS and total hospital costs relative to nvHABP were 5.9 (95% CI 5.4, 6.3) days and &6,814 (95% CI &3,637, &9,991) in vHABP, and 6.5 (95% CI 6.0, 6.9) days and &16,782 (95% CI &13,446, &20,118) in VABP. Conclusion Both HABP and VABP remain associated with significant morbidity and HRU in the US. VABP was associated with the longest post-infection ICU LOS and highest hospital costs. Reference 1. Zilberberg et al. Chest 2019;155:1119-30 Disclosures Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee) Andrew F. Shorr, MD, MPH, MBA, Merck (Consultant)

scholarly journals A Phase 3, Randomized, Double-Blind Study Comparing Tedizolid Phosphate and Linezolid for Treatment of Ventilated Gram-Positive Hospital-Acquired or Ventilator-Associated Bacterial Pneumonia

2021 ◽  
Author(s):  
Richard G Wunderink ◽  
Antoine Roquilly ◽  
Martin Croce ◽  
Daniel Rodriguez Gonzalez ◽  
Satoshi Fujimi ◽  
...  
Keyword(s):  
Clinical Response ◽  
Bacterial Pneumonia ◽  
Double Blind Study ◽  
Phase 3 ◽  
Gram Positive ◽  
Double Blind ◽  
Intention To Treat ◽  
The Difference ◽  
Hospital Acquired ◽  
Noninferiority Margin

Abstract Background Hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) are associated with high mortality rates. We evaluated the efficacy and safety of tedizolid (administered as tedizolid phosphate) for treatment of gram-positive ventilated HABP/VABP. Methods In this randomized, noninferiority, double-blind, double-dummy, global phase 3 trial, patients were randomized 1:1 to receive intravenous tedizolid phosphate 200 mg once daily for 7 days or intravenous linezolid 600 mg every 12 hours for 10 days. Treatment was 14 days in patients with concurrent gram-positive bacteremia. The primary efficacy end points were day 28 all-cause mortality (ACM; noninferiority margin, 10%) and investigator-assessed clinical response at test of cure (TOC; noninferiority margin, 12.5%) in the intention-to-treat population. Results Overall, 726 patients were randomized (tedizolid, n = 366; linezolid, n = 360). Baseline characteristics, including incidence of methicillin-resistant Staphylococcus aureus (31.3% overall), were well balanced. Tedizolid was noninferior to linezolid for day 28 ACM rate: 28.1% and 26.4%, respectively (difference, –1.8%; 95% confidence interval [CI]: –8.2 to 4.7). Noninferiority of tedizolid was not demonstrated for investigator-assessed clinical cure at TOC (tedizolid, 56.3% vs linezolid, 63.9%; difference, –7.6%; 97.5% CI: –15.7 to 0.5). In post hoc analyses, no single factor accounted for the difference in clinical response between treatment groups. Drug-related adverse events occurred in 8.1% and 11.9% of patients who received tedizolid and linezolid, respectively. Conclusions Tedizolid was noninferior to linezolid for day 28 ACM in the treatment of gram-positive ventilated HABP/VABP. Noninferiority of tedizolid for investigator-assessed clinical response at TOC was not demonstrated. Both drugs were well tolerated. Clinical Trials Registration NCT02019420.

Hospital-Acquired Pneumonia = Nosocomial Pneumonia

2012 ◽  
pp. 1152-1152
Author(s):  
Jeffrey N. Harr ◽  
Philip F. Stahel ◽  
Phillip D. Levy ◽  
Antoine Vieillard-Baron ◽  
Yang Xue ◽  
...  
Keyword(s):  
Nosocomial Pneumonia ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract WMP94: Readmission Within 30 days After Acute Ischemic Stroke, United States 2013

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Xin Tong ◽  
Mary G George ◽  
Sallyann M Coleman King ◽  
Cathleen Gillespie ◽  
Robert Merritt
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
The United States ◽  
Artery Occlusion ◽  
Principal Diagnosis ◽  
Readmission Rates ◽  
The Cost

Introduction: Hospital readmissions contribute significantly to the cost of medical care and reflect the burden of disease. Limited data have been reported on national hospital readmission after acute ischemic stroke. Methods: Among 2013 adult hospitalizations from the National Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD), we identified acute ischemic stroke (AIS) hospitalizations using principal diagnosis ICD-9-CM codes. We provided national estimates of AIS non-elective readmission rates within 30 days. Results: In 2013, there were a total of 489,813 adult index AIS admissions in the United States. The readmission rate within 30 days for a new AIS as the principal diagnosis was 2.1% of index AIS admissions, and was 10.2% of all readmissions. The readmission rate for all non-elective reasons increased with age, with the lowest readmission rate (8.9%) among ages 18-44, and the highest (11.7%).among ages 85+. The readmission rate was higher among patients with public insurance (11.1%) as compared to private (7.4%) or others (7.9%). Recurrent AIS (20.2%) was the most common reason for readmission, including unspecified cerebral artery occlusion with infarction (ICD9-CM=434.91, 13.0%) and cerebral embolism with infarction (ICD9-CM=434.11, 3.1%). In addition, infections were among the most common causes (Septicemia 5.7%, UTI 2.7%, and pneumonia 2.2%) and TIA (2.4%). Conclusions: The findings have important implications for identifying groups and conditions at high-risk for readmission. The large number of recurrent AIS within 30 days of index AIS highlights the need for improved patient follow-up and secondary prevention treatment.

scholarly journals Clinical Correlation of a Clostridium difficile Testing Algorithm Reflexing PCR Positive Specimens to Toxin Enzyme Immunoassay (EIA)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S395-S396 ◽  
Author(s):  
Maria Bueno Rios ◽  
James Karichu ◽  
Abhishek Deshpande ◽  
Thomas Fraser ◽  
Carlos Isada ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Cleveland Clinic ◽  
Nucleic Acid Amplification Test ◽  
Nucleic Acid Amplification ◽  
Microbiology Laboratory ◽  
Research Support ◽  
The United Kingdom ◽  
Stool Specimens ◽  
Testing Algorithm ◽  
Positive Results

Abstract Background An algorithm promoted in the United Kingdom reflexes specimens positive for C. difficile by a nucleic acid amplification test (NAAT) to toxin EIA. Samples positive by NAAT and negative by toxin EIA are reported as “C. difficile could be present (ie, potential C. difficile excretor).” We explored the potential utility of this algorithm to distinguish C. difficile infection (CDI) from colonization compared with retrospective clinical assessment. Methods Liquid stool specimens (n = 300) from inpatients (or the Emergency Department) submitted to the Cleveland Clinic Microbiology laboratory for C. difficile PCR testing (Cepheid Xpert C. difficile/Epi) with positive results were included in the study. The CDIFF QUICK CHEK COMPLETE GDH/toxin EIA assay (Alere) was performed according to manufacturer’s instructions. The charts of all patients were reviewed by Infectious Diseases physicians blinded to the EIA results. Using the American College of Gastroenterology (ACG) classification system, CDI status was determined to be mild, moderate, severe, or complicated. Patients without significant diarrhea (<3 unformed stools / 24 hours) were considered colonized. Those without documentation of stools were classified as indeterminate. Correlation of clinical assessment with EIA results was assessed. Results Most of the PCR positive specimens (75%) were toxin EIA negative. Correlation of clinical assessment with toxin EIA is summarized in the table below. Among patients colonized vs. those with CDI, the percentages with negative toxin EIA results were 80% and 73%, respectively. GDH antigen results were negative for 25 specimens—17 were from patients considered to have CDI. Conclusion Toxin EIA performed on samples positive for C. difficile by PCR does not reliably identify patients considered to have CDI with ACG criteria applied. GDH as an initial screen would not have detected 6.8% of patients with CDI. Disclosures S. S. Richter, bioMerieux: Investigator, Research support; BD Diagnostics: Investigator, Research support; Roche: Investigator, Research support; BioFire: Investigator, Research support; OpGen: Investigator, Research support

scholarly journals A Randomized, Double-blind, Multicenter Trial Comparing Efficacy and Safety of Imipenem/Cilastatin/Relebactam Versus Piperacillin/Tazobactam in Adults With Hospital-acquired or Ventilator-associated Bacterial Pneumonia (RESTORE-IMI 2 Study)

2020 ◽  
Author(s):  
Ivan Titov ◽  
Richard G Wunderink ◽  
Antoine Roquilly ◽  
Daniel Rodríguez Gonzalez ◽  
Aileen David-Wang ◽  
...  
Keyword(s):  
Clinical Response ◽  
Bacterial Pneumonia ◽  
Severe Renal Impairment ◽  
Apache Ii Score ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Gram Negative ◽  
Mitt Population ◽  
All Cause Mortality ◽  
Hospital Acquired

Abstract Background Imipenem combined with the β-lactamase inhibitor relebactam has broad antibacterial activity, including against carbapenem-resistant gram-negative pathogens. We evaluated efficacy and safety of imipenem/cilastatin/relebactam in treating hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP). Methods This was a randomized, controlled, double-blind phase 3 trial. Adults with HABP/VABP were randomized 1:1 to imipenem/cilastatin/relebactam 500 mg/500 mg/250 mg or piperacillin/tazobactam 4 g/500 mg, intravenously every 6 hours for 7–14 days. The primary endpoint was day 28 all-cause mortality in the modified intent-to-treat (MITT) population (patients who received study therapy, excluding those with only gram-positive cocci at baseline). The key secondary endpoint was clinical response 7–14 days after completing therapy in the MITT population. Results Of 537 randomized patients (from 113 hospitals in 27 countries), the MITT population comprised 264 imipenem/cilastatin/relebactam and 267 piperacillin/tazobactam patients; 48.6% had ventilated HABP/VABP, 47.5% APACHE II score ≥15, 24.7% moderate/severe renal impairment, 42.9% were ≥65 years old, and 66.1% were in the intensive care unit. The most common baseline pathogens were Klebsiella pneumoniae (25.6%) and Pseudomonas aeruginosa (18.9%). Imipenem/cilastatin/relebactam was noninferior (P < .001) to piperacillin/tazobactam for both endpoints: day 28 all-cause mortality was 15.9% with imipenem/cilastatin/relebactam and 21.3% with piperacillin/tazobactam (difference, −5.3% [95% confidence interval {CI}, −11.9% to 1.2%]), and favorable clinical response at early follow-up was 61.0% and 55.8%, respectively (difference, 5.0% [95% CI, −3.2% to 13.2%]). Serious adverse events (AEs) occurred in 26.7% of imipenem/cilastatin/relebactam and 32.0% of piperacillin/tazobactam patients; AEs leading to treatment discontinuation in 5.6% and 8.2%, respectively; and drug-related AEs (none fatal) in 11.7% and 9.7%, respectively. Conclusions Imipenem/cilastatin/relebactam is an appropriate treatment option for gram-negative HABP/VABP, including in critically ill, high-risk patients. Clinical Trials Registration NCT02493764.

Pneumonia

2018 ◽  
Author(s):  
Pippa Newton
Keyword(s):  
Nosocomial Pneumonia ◽  
Acute Infection ◽  
Healthcare Setting ◽  
Community Acquired Pneumonia ◽  
Hospital Acquired Pneumonia ◽  
Pulmonary Parenchyma ◽  
Post Intubation ◽  
Hospital Acquired ◽  
Symptoms And Signs

Pneumonia is defined as acute infection of the pulmonary parenchyma, presenting with consistent symptoms and signs and associated with new radiographic shadowing. It may be acute or chronic in onset and involve either one area of a lung (e.g. lobar pneumonia) or be multifocal in nature. It may be community acquired or hospital acquired. Community- acquired pneumonia is defined as pneumonia occurring in an individual with no recent contact with a healthcare setting, or in a patient admitted to hospital with development of symptoms and/or signs of pneumonia within 48 hours of admission. Hospital-acquired pneumonia or nosocomial pneumonia occurs when a patient develops symptoms or signs of pneumonia after 48 hours of admission to a healthcare setting or in the context of a long-term nursing home resident. A subtype of nosocomial pneumonia is ventilator-associated pneumonia, defined as pneumonia occurring at least 48–72 hours post intubation.

Expanding Education Technology to Meet the Needs of Patients, Families, and Clinicians

2009 ◽  
Vol 10 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Jodi DeMarco ◽  
Meg Schuster Nystrom
Keyword(s):  
Health Education ◽  
Cleveland Clinic ◽  
Length Of Hospital Stay ◽  
Care Process ◽  
Successful Implementation ◽  
Health Educators ◽  
Consumer Health ◽  
Readmission Rates ◽  
Television System ◽  
Internal Resources

With the patient length of hospital stay continuously decreasing, health educators and nurses are continually challenged to adequately educate patients prior to discharge. Health education is recognized as a key component for reducing readmission rates by increasing patient compliance, yet health education resources must be readily accessible to patients throughout the entire hospital experience in order to achieve fulfillment. The Center for Consumer Health Information at Cleveland Clinic examined the existing in-hospital delivery systems in order to identify a means to reach patients at all access points in the health care process. This article demonstrates how a closed circuit television system may be utilized to deliver health education content to individuals in both in-patient and out-patient settings. The evaluation of vendors and identification of internal resources is imperative to the successful implementation of an in-patient education system.

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