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

scholarly journals 296. Description of Super-infections in Hospitalized Patients with COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S255-S256
Author(s):  
Geena Kludjian ◽  
Stephanie Spivack ◽  
Stefania Gallucci ◽  
Laurie Kilpatrick ◽  
Aaron D Mishkin ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Positive Control ◽  
Patient Specific ◽  
Research Support ◽  
Patient Demographics ◽  
Secondary Infections ◽  
Specific Factors ◽  
True Infection

Abstract Background The rate of bacterial and fungal super-infections (SI) in inpatients with COVID-19 is unknown. In this study, we aimed to identify and describe patients that developed secondary infections while hospitalized with COVID-19. 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. Patients with positive cultures had cases reviewed to determine if they represented a true infection, defined by CDC criteria. SIs were defined as infections that occurred at least 48 hours or longer after the initial positive SARS-CoV-2 test. Additional data was collected on patient demographics, COVID-related therapies, types of infections, and outcomes. Results 902 patients were admitted with COVID-19 during our study period. Of these, 52 patients (5.8%) developed a total of 82 SIs. Tables 1 and 2 describe patient and infection characteristics. Patients identified as having a SI were admitted for a median of 30 days; 56% had mortality, and 39% of remaining patients were readmitted within 90 days. Table 1. Patient Characteristics Table 2. Super-infections Conclusion Overall, the rate of SIs in patients admitted with COVID-19 is low. These patients had a long length of stay, which may be either a cause of SI or an effect. Further analysis with matched COVID-positive control patients who do not develop SIs is needed to evaluate the risk of development of SIs in relation to presenting respiratory status, COVID-related therapies, and other patient-specific factors. 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

scholarly journals Impact of an Extended Infusion Β-lactam Strategy on Outcomes in Critically Ill Patients with Pseudomonas Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S299-S299
Author(s):  
Kenneth Klinker ◽  
Veena Venugopalan ◽  
Andrea Carnley ◽  
Stacy Voils ◽  
Jessica Cope ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Cure ◽  
Chart Review ◽  
Additional Data ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Drug Concentrations ◽  
Secondary Endpoints ◽  
Extended Infusion

Abstract Background Pseudomonas aeruginosa (PSA) is frequently associated with nosocomial infections resulting in significant morbidity and mortality. High MICs in MDR strains highlights the need to maximize antibiotic exposure with the goal of improving patient outcomes. For β-lactams, optimal efficacy is achieved when free drug concentrations are above the MIC for ~ 40–60% of the dosing interval. Unfortunately, due to significant pharmacokinetic variability in the critically ill, achieving this target with standard intermittent infusions (II) is challenging, resulting in preference for extended (EI) or continuous infusion strategies. Additional data in patients with PSA infections are needed to understand the association between infusion strategy and clinical outcome. Methods A single-center, retrospective chart review. Adult patients with positive respiratory or blood cultures for PSA treated with cefepime or piperacillin/tazobactam managed in an ICU from January 2012 to May 2016 were included. Primary endpoint was clinical cure (CC) at end of therapy (EOT) between patients receiving EI or II. Secondary endpoints included microbiologic eradication (ME), 28-day mortality, length of ICU and hospital stay, and effect of baseline kidney function on clinical cure. Results Eighty-three patients were included in the analysis. Patient characteristics were well matched except for a higher frequency of malignancy in the EI arm (P = 0.02). CC was achieved in an overwhelming majority of EI patients compared with II (89.2% vs. 69.6%, P = 0.031). Further, patients with normal renal function (CrCL ≥ 60; P = 0.02) or APACHE II ≥ 17 (P = 0.04) receiving II experienced higher failure rates. In multivariate analysis, use of II associated with 4-fold higher incidence of clinical failure (OR 4.5 [1.3–16.3]). For other secondary endpoints, ME was observed in 73% of EI vs. 65% of II (P = 0.44) and 28-day mortality was observed in 13% of patients in both arms (P = 0.94). No significant differences were observed with other secondary variables. Conclusion Use of an EI strategy in critically ill patients with PSA infections improves CC. Further, EI benefitted those patients with normal to augmented renal clearance suggesting that improved exposure may play a role in clinical outcomes. Disclosures K. Klinker, The Medicines Company: Scientific Advisor, Consulting fee.

scholarly journals 763. 30 Day Readmission Outcomes in Patients Over 80 Years of Age Enrolled in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S340
Author(s):  
Kathleen R Sheridan ◽  
Joshua Wingfield ◽  
Lauren McKibben ◽  
Natalie Clouse
Keyword(s):  
Readmission Rate ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Model Of Care ◽  
Readmission Rates ◽  
Parenteral Antibiotic ◽  
Patient Demographics

Abstract Background OPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics. Methods We conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562). Results Patient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams. Conclusion In general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.

Patient characteristics and outcomes of an interdisciplinary menopause clinic: a retrospective chart review

Maturitas ◽  
2015 ◽  
Vol 81 (1) ◽  
pp. 178-179
Author(s):  
Beate C. Sydora ◽  
Nicole Veltri ◽  
Christoph P. Sydora ◽  
Justin Marillier ◽  
Lori Battochio ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics

scholarly journals P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S81-S81
Author(s):  
R. Pinnell ◽  
P. Joo
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Urinary Symptoms ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Indwelling Catheter ◽  
Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

Surgical treatment for intramedullary spinal cord melanocytomas

2008 ◽  
Vol 9 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Eric M. Horn ◽  
Peter Nakaji ◽  
Stephen W. Coons ◽  
Curtis A. Dickman
Keyword(s):  
Spinal Cord ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Complete Resection ◽  
Intramedullary Spinal Cord ◽  
Local Infiltration ◽  
Patients Âgés ◽  
Patient Demographics

Spinal meningeal melanocytomas are rare lesions that are histologically benign and can behave aggressively, with local infiltration. The authors present their experience with intramedullary spinal cord melanocytomas consisting of 3 cases, which represents the second largest series in the literature. A retrospective chart review was performed following identification of all spinal melanocytomas treated at the author's institution, based on information obtained from a neuropathology database. The charts were reviewed for patient demographics, surgical procedure, clinical outcome, and long-term tumor progression. Three patients were identified in whom spinal melanocytoma had been diagnosed between 1989 and 2006. The patients' ages were 37, 37, and 48 years, and the location of their tumor was C1–3, T9–10, and T-12, respectively. All 3 had complete resection with no adjuvant radiotherapy during follow-up periods of 16, 38, and 185 months, respectively. One patient demonstrated a recurrence 29 months after resection and the other 2 patients have demonstrated asymptomatic recurrences on imaging studies obtained at 16 and 38 months following resection. With these cases added to the available literature, the evidence strongly suggests that complete resection is the treatment of choice for spinal melanocytomas. Even with complete resection, recurrences are common and close follow-up is needed for the long term in these patients. Radiation therapy should be reserved for those cases in which complete resection is not possible or in which there is recurrence.

Donor site morbidities resulting from conchal cartilage harvesting in rhinoplasty

2017 ◽  
Vol 131 (6) ◽  
pp. 529-533 ◽  
Author(s):  
M Y Lan ◽  
J P Park ◽  
Y J Jang
Keyword(s):  
Complication Rate ◽  
Chart Review ◽  
Donor Site ◽  
Retrospective Chart Review ◽  
Donor Site Morbidity ◽  
Conchal Cartilage ◽  
Patient Demographics ◽  
Morbidity Data

AbstractObjective:Conchal cartilage is frequently used in rhinoplasty, but donor site morbidity data are seldom reported. This study aimed to investigate the complications of conchal cartilage harvesting in rhinoplasty.Methods:A retrospective chart review of 372 patients who underwent conchal cartilage harvesting for rhinoplasty was conducted. Data regarding patient demographics, types of nasal deformities, graft usage and complications were analysed.Results:A total of 372 patients who underwent conchal cartilage harvesting for rhinoplasty were enrolled. The harvested conchal cartilage tissues were used in a variety of applications: tip graft, dorsal graft, septal reinforcement and correction of nostril asymmetry. Nine cases (2.4 per cent) with donor site morbidities were identified, including four cases (1.1 per cent) with keloids and five cases (1.3 per cent) with haematomas.Conclusion:Conchal cartilage harvesting is a safe and useful technique for rhinoplasty, with a low complication rate. However, patients should be informed about the possibility of donor site morbidities such as keloids and haematomas.

Factors Associated With Patient Nonattendance in Rhinology Clinics

2019 ◽  
Vol 33 (3) ◽  
pp. 317-322
Author(s):  
Benjamin N. Hunter ◽  
Brandon Cardon ◽  
Gretchen M. Oakley ◽  
Arun Sharma ◽  
Dana L. Crosby
Keyword(s):  
Chart Review ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Retrospective Chart Review ◽  
The United States ◽  
Patient Demographics ◽  
Medical Centers ◽  
Insurance Type ◽  
Academic Medical ◽  
Included Patient

Background Nonattendance to clinical appointments is a global problem appreciated by clinicians with an ambulatory presence. There are few reports of nonattendance in otolaryngology clinics, and no reports on nonattendance for a single otolaryngology subspecialty. Objective To describe the no-show population in rhinology clinics. Methods A retrospective chart review was performed involving rhinology clinics from 2 academic medical centers in the United States. All patients who either attended their clinic appointment(s) or did not attend without previously cancelling from June 2016 to May 2017 were included. Data collected included patient demographics, appointment status, season and time of visit, insurance status, type of visit (new vs established), and provider seen. Results There were 2791 clinical appointments evaluated over a 12-month period at 2 rhinology clinics involving 4 fellowship-trained rhinologists. Ninety-two percent of patients kept their appointments, while 8% did not. Sex, season of visit, time of visit (am vs pm), type of visit, provider sex, provider location, or provider’s experience (<10 years vs ≥10 years) were not associated with patient’s attendance status. Univariate analysis showed that patient’s age ≤50 ( P = .001) and primary insurance type ( P < .001) were associated with nonattendance. Medicaid as the primary insurance type was associated with clinic nonattendance. Multivariable analysis showed that age ≤ 50 years, odds ratio (OR) 1.62 (95% confidence interval [CI] 1.14–2.30), P = .007, and primary insurance type (Medicaid: OR 3.75 [95% CI 2.58–5.45], P < .001) remained significant predictors of nonattendance. Conclusion Patients younger than 50 years and patients with Medicaid as the primary insurance types are associated with risk of missing rhinology clinic appointments. As a subspecialty, delivery of timely care and clinical efficiency could be improved by interventions directed toward improving attendance among this population.

Hemoglobin Levels and Serum C-Reactive Protein in Patients With Moderate to Severe Hidradenitis Suppurativa

2019 ◽  
Vol 23 (5) ◽  
pp. 501-506 ◽  
Author(s):  
Christina M. Huang ◽  
Michelle A. Lowes ◽  
Christine Cserti ◽  
Afsaneh Alavi
Keyword(s):  
Disease Severity ◽  
Hidradenitis Suppurativa ◽  
Chart Review ◽  
Inflammatory Diseases ◽  
Retrospective Chart Review ◽  
C Reactive Protein ◽  
Patient Demographics ◽  
Reactive Protein ◽  
Anemia Of Chronic Inflammation ◽  
One Way Anova

Introduction: Anemia of chronic inflammation is associated with many inflammatory diseases. Little is known about anemia in hidradenitis suppurativa (HS). This study aimed to review the levels of hemoglobin (Hb) and investigate its relationship with serum C-reactive protein (CRP) and disease severity in HS patients. Methods: This was a retrospective chart review of all HS patients from 2015 to 2017 with Hb and CRP blood work. Patient demographics, disease severity, and laboratory results were extracted. Data were analyzed descriptively. A linear regression model was used for the association between Hb and CRP. Two-tailed t-tests and one-way ANOVA were used to compare differences between sexes and disease severities. Results: Of the 25 patients included, 14 (56%) were female. The median age and disease duration of all patients were 41 years (range, 19-56 years) and 10 years (range, 1-40 years), respectively. The overall median CRP level was 11.5 mg/dL (range, 1-86.7 mg/dL). The median Hb levels for women and men were and 123.5 g/L (range, 90-142 g/L) and 152.0 g/L (range, 109-166 g/L), respectively. Anemia was found in 42.9% (6/14) of women and 27.3% (3/11) of men. There was an inverse relationship between Hb and CRP levels in both sexes (men: r = ‒0.88; P = .0006; women r = ‒0.65; P = .012). Conclusions: Anemia was prevalent in the HS population, and Hb levels inversely correlated with CRP. Physicians should be aware that anemia is common in inflammatory states, and that CRP could be a biomarker in patients with HS.

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