287. Characteristics and Outcomes of COVID-19 Patients with Candidemia at a Community Hospital in Chicago

Abstract Background 1,416 patients with acute COVID-19 infection were admitted to our hospital in 2020. During that year we noticed an alarming increase in cases of nosocomial Candidemia: 26 versus an average of 2.8 cases per year over the previous 5 years. 19 of the 26 episodes (73%) of Candidemia occurred in patients who were admitted with acute COVID-19 infection. Recent reports suggest that hospitalized patients with COVID-19 are at increased risk for developing Candidemia, however their clinical characteristics, risk factors and outcomes have not been well described. We evaluated the risk factors and mortality of hospitalized COVID-19 patients with Candidemia. Methods We performed a retrospective chart review of 19 patients with Candidemia and confirmed COVID-19 infection at a 292-bed community teaching hospital in Chicago, Illinois from January through December 2020. We report a descriptive analysis of the demographic characteristics, comorbidities, complications, and outcomes of these patients. Results The average age of our study population was 65 years; 68% were male. The average hospital length of stay (LOS) was 34 days. The mean time from admission to the development of Candidemia was 16 days. Associated co-morbidities included cardiovascular diseases (CVD) in 79%, diabetes mellitus (DM), in 68%, and obesity in 50%. Underlying kidney disease was present in 10%. Treatments for COVID-19 included convalescent plasma (53%), remdesivir (53%), steroids (52%) and tocilizumab (19%). All patients were managed in the intensive care unit (ICU) and 95% required multiple central line (CL) placements. Most of the patients (58%) required hemodialysis (HD); all patients were treated with multiple antibiotics. The average LOS in the ICU was 25 days. Despite anti-fungal treatment, 68% expired. The 28-day mortality was 50%. Conclusion The occurrence of Candidemia in our hospitalized patients with acute COVID-19 infection was associated with a history of CVD, DM, obesity, prolonged hospital LOS, requirement for multiple CL, HD, treatment with multiple antibiotics and a long stay in the ICU. The mortality of COVID-19 patients with Candidemia is high. The development of strategies to mitigate the occurrence of nosocomial Candidemia in this population of patients is urgently needed. Disclosures All Authors: No reported disclosures

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Preoperative Risk Factors for Complications in Elective Ankle and Hindfoot Reconstruction

Foot & Ankle Specialist ◽

10.1177/1938640017706155 ◽

2017 ◽

Vol 11 (1) ◽

pp. 54-60 ◽

Cited By ~ 10

Author(s):

Ryan P. Mulligan ◽

Kevin J. McCarthy ◽

Benjamin J. Grear ◽

David R. Richardson ◽

Susan N. Ishikawa ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Chart Review ◽

Reoperation Rate ◽

Deep Infection ◽

Foot And Ankle ◽

Psychological Variables ◽

Reconstruction Methods ◽

Increased Risk ◽

Retrospective Comparative Study ◽

Alcohol Users

Background. The purpose of this study was to examine medical, social, and psychological factors associated with complications and reoperation after foot and ankle reconstruction. Methods. A retrospective chart review was conducted of 132 patients (135 feet; 139 operative cases) who had elective foot and ankle reconstruction. Medical, social, and psychological variables were documented. Primary outcomes included complications and reoperations. Results. The overall complication rate was 28% (39/139), and the reoperation rate was 17% (24/139). Alcohol use (P = .03) and preoperative narcotic use (P = .02) were risk factors for complications, with delayed wound healing more frequent in alcohol users (P = .03) and deep infection (P = .045) and nonunion (P = .046) more frequent preoperative narcotic use. Deep infection also was more frequent in tobacco users (P < .01). Older patients were less likely to undergo reoperation (risk of reoperation increased with age). Other variables were not associated with increased complications. Conclusion. Patients who consumed alcohol or had been prescribed any amount of narcotic within 3 months preoperatively were at increased risk for complications. Patients who smoked were more likely to have a wound infection. Surgeons should be aware of these factors and counsel patients before surgery. Levels of Evidence: Level III: Retrospective comparative study

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Total Hip Replacement Provokes Endothelial Dysfunction

Angiology ◽

10.1177/0003319718774660 ◽

2018 ◽

Vol 69 (10) ◽

pp. 871-877 ◽

Cited By ~ 3

Author(s):

Peter Poredos ◽

Ana Mavric ◽

Lara Leben ◽

Pavel Poredos ◽

Mateja Kaja Jezovnik

Keyword(s):

Endothelial Dysfunction ◽

Endothelial Function ◽

Total Hip Replacement ◽

Postoperative Period ◽

Hip Replacement ◽

Hospital Length Of Stay ◽

Average Hospital ◽

Total Hip ◽

Increased Risk ◽

Cardiovascular Homeostasis

Surgery represents an increased risk of different perioperative complications. Endothelial function (EF) is a key mechanism responsible for cardiovascular homeostasis and is involved in thromboembolic complications. We aimed to follow changes of EF in an early postoperative period in patients undergoing total hip replacement (THR). Endothelial function was assessed noninvasively in 70 consecutive patients who underwent an elective THR under spinal anesthesia. Flow-mediated dilation (FMD) and low flow-mediated constriction capability of the brachial artery, which are indicators of EF were measured before the operation (baseline), 24 hours after the operative procedure, and 5 to 7 days postoperatively. Baseline FMD was 12.3% and decreased a day after surgery to 7.3% ( P < .001). After 5 to 7 days, it gradually increased to 9.2%. However, on average, it was lower than before surgery ( P < .001). The median duration of THR was 85.0 (65.0-100.0) minutes, the average hospital length of stay was 7 days. Total hip replacement is associated with an immediate decrease in FMD which remains significantly decreased 5 to 7 days after the surgery compared with the preoperative value. These results indicate that surgery provokes endothelial dysfunction and deteriorates cardiovascular homeostasis. This effect could be involved in cardiovascular complications in the postoperative period.

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Accuracy of Antiretroviral Prescribing in a Community Teaching Hospital: A Medication Use Evaluation

Journal of Pharmacy Practice ◽

10.1177/0897190019857842 ◽

2019 ◽

pp. 089719001985784

Author(s):

Jacob Lines ◽

Paul Lewis

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Medication Error ◽

Medication Errors ◽

Retrospective Chart Review ◽

The United States ◽

Error Rates ◽

Transitions Of Care ◽

Hiv Diagnosis ◽

Increased Risk

Background: Medication errors account for nearly 250 000 deaths in the United States annually, with approximately 60% of errors occurring during transitions of care. Previous studies demonstrated that almost 80% of participants with human immunodeficiency virus (HIV) have experienced a medication error related to their antiretroviral therapy (ART). Objective: This retrospective chart review examines propensity and type of ART-related errors and further seeks to identify risk factors associated with higher error rates. Methods: Participants were identified as hospitalized adults ≥18 years old with preexisting HIV diagnosis receiving home ART from July 2015 to June 2017. Medication error categories included delays in therapy, dosing errors, scheduling conflicts, and miscellaneous errors. Logistic regression was used to examine risk factors for medication errors. Results: Mean age was 49 years, 76.5% were men, and 72.1% used hospital-supplied medication. For the primary outcome, 60.3% (41/68) of participants had at least 1 error, with 31.3% attributed to delays in therapy. Logistic regression demonstrated multiple tablet regimens (odds ratio [OR]: 3.40, 95% confidence interval [CI]: 1.22-9.48, P = .019) and serum creatinine (SCr) ≥1.5 mg/dL (OR: 8.87, 95% CI: 1.07-73.45, P = .043) were predictive for risk of medication errors. Regimens with significant drug–drug interactions (eg, cobicistat-containing regimens) were not significantly associated with increased risk of medication errors. Conclusions and Relevance: ART-related medication error rates remain prevalent and exceeded 60%. Independent risk factors for medication errors include use of multiple tablet regimens and SCr ≥1.5 mg/dL.

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Mesh Exposure and Associated Risk Factors in Women Undergoing Transvaginal Prolapse Repair with Mesh

Obstetrics and Gynecology International ◽

10.1155/2013/926313 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Elizabeth A. Frankman ◽

Marianna Alperin ◽

Gary Sutkin ◽

Leslie Meyn ◽

Halina M. Zyczynski

Keyword(s):

Risk Factors ◽

Retrospective Chart Review ◽

Vaginal Wall ◽

Anterior Vaginal Wall ◽

Repair System ◽

Mesh Exposure ◽

Prolapse Repair ◽

Increased Risk ◽

Independent Risk Factors ◽

Associated Risk Factors

Objective. To determine frequency, rate, and risk factors associated with mesh exposure in women undergoing transvaginal prolapse repair with polypropylene mesh.Methods. Retrospective chart review was performed for all women who underwent Prolift Pelvic Floor Repair System (Gynecare, Somerville, NJ) between September 2005 and September 2008. Multivariable logistic regression was performed to identify risk factors for mesh exposure.Results. 201 women underwent Prolift. Mesh exposure occurred in 12% (24/201). Median time to mesh exposure was 62 days (range: 10–372). When mesh was placed in the anterior compartment, the frequency of mesh exposure was higher than that when mesh was placed in the posterior compartment (8.7% versus 2.9%,P=0.04). Independent risk factors for mesh exposure were diabetes (AOR = 7.7, 95% CI 1.6–37.6;P=0.01) and surgeon (AOR = 7.3, 95% CI 1.9–28.6;P=0.004).Conclusion. Women with diabetes have a 7-fold increased risk for mesh exposure after transvaginal prolapse repair using Prolift. The variable rate of mesh exposure amongst surgeons may be related to technique. The anterior vaginal wall may be at higher risk of mesh exposure as compared to the posterior vaginal wall.

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Routine Nasogastric Decompression in Small Bowel Obstruction: Is it Really Necessary?

The American Surgeon ◽

10.1177/000313481307900433 ◽

2013 ◽

Vol 79 (4) ◽

pp. 422-428 ◽

Cited By ~ 9

Author(s):

Annabelle L. Fonseca ◽

Kevin M. Schuster ◽

Adrian A. Maung ◽

Lewis J. Kaplan ◽

Kimberly A. Davis

Keyword(s):

Respiratory Failure ◽

Small Bowel ◽

Length Of Stay ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Retrospective Chart Review ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Increased Risk ◽

Nasogastric Decompression

Bowel rest, nasogastric (NG) decompression, and intravenous hydration are used to treat small bowel obstruction (SBO) conservatively; however, there are no data to support nasogastric tube (NGT) use in patients without active emesis. We aim to evaluate the use of nasogastric decompression in SBO and the safety of managing patients with SBO without the use of a NGT. A retrospective chart review was conducted of adult patients admitted to Yale New Haven Hospital over five years with the diagnosis of SBO. We compared patients who received NG decompression with those who did not. Outcome variables assessed were days to resolution, associated complications, hospital length of stay, and disposition. Of 290 patients who fit the criteria, 190 patients (65.52%) were managed conservatively. Fifty-five patients (18.97%) did not receive NGTs. Sixty-eight patients (23.45%) did not present with emesis; however, nearly 75 per cent of these patients received NGTs. Development of pneumonia and respiratory failure was significantly associated with NGT placement. Time to resolution and hospital length of stay were significantly higher in patients with NGTs. Patients with NG decompression had a significantly increased risk of pneumonia and respiratory failure as well as increased time to resolution and hospital length of stay.

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Warfarin-Induced Rapid Rise in INR Post–Cardiac Surgery Is Not Associated With Increased Bleeding Risk

Annals of Pharmacotherapy ◽

10.1177/1060028019858677 ◽

2019 ◽

Vol 53 (12) ◽

pp. 1184-1191 ◽

Cited By ~ 2

Author(s):

Logan M. Olson ◽

Andrea M. Nei ◽

Ross A. Dierkhising ◽

David L. Joyce ◽

Scott D. Nei

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Warfarin Dose ◽

Retrospective Chart Review ◽

Female Gender ◽

Bleeding Risk ◽

Hospital Length Of Stay ◽

Rapid Rise ◽

The Impact ◽

Post Cardiac Surgery

Background: Post–cardiac surgery bleeding can have devastating consequences, and it is unknown if warfarin-induced rapid international normalized ratio (INR) rise during the immediate postoperative period increases bleed risk. Objective: To determine the impact of warfarin-induced rapid-rise INR on post–cardiac surgery bleeding. Methods: This was a single-center, retrospective chart review of post–cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester. Patients were grouped based on occurrence or absence of rapid-rise INR (increase ≥1.0 within 24 hours). The primary outcome compared bleed events between groups. Secondary outcomes assessed hospital length of stay (LOS) and identified risk factors associated with bleed events and rapid rise in INR. Results: During the study period, 2342 patients were included, and 56 bleed events were evaluated. Bleed events were similar between rapid-rise (n = 752) and non–rapid-rise (n = 1590) groups in both univariate (hazard ratio [HR] = 1.22; P = 0.594) and multivariable models (HR = 1.24; P = 0.561). Those with rapid-rise INR had longer LOS after warfarin administration (discharge HR = 0.84; P = 0.0002). The most common warfarin dose immediately prior to rapid rise was 5 mg. Risk factors for rapid-rise INR were low body mass index, female gender, and cross-clamp time. Conclusion and Relevance: This represents the first report to assess warfarin-related rapid-rise INR in post–cardiac surgery patients and found correlation to hospital LOS but not bleed events. Conservative warfarin dosing may be warranted until further research can be conducted.

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Risk Factors for Temporomandibular Joint Arthritis in Children with Juvenile Idiopathic Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.111441 ◽

2012 ◽

Vol 39 (9) ◽

pp. 1880-1887 ◽

Cited By ~ 67

Author(s):

MATTHEW L. STOLL ◽

TYLER SHARPE ◽

TIMOTHY BEUKELMAN ◽

JENNIFER GOOD ◽

DANIEL YOUNG ◽

...

Keyword(s):

Risk Factors ◽

Juvenile Idiopathic Arthritis ◽

Temporomandibular Joint ◽

Strong Association ◽

Multivariable Analysis ◽

Mouth Opening ◽

Retrospective Chart Review ◽

Clinical Information ◽

Increased Risk ◽

Significant Difference

Objective.To determine the prevalence and features of temporomandibular joint (TMJ) arthritis by magnetic resonance imaging (MRI) among children with juvenile idiopathic arthritis (JIA), and to identify risk factors for TMJ arthritis.Methods.A retrospective chart review was performed on 187 patients with JIA who underwent a TMJ MRI at Children’s Hospital of Alabama between September 2007 and June 2010. Demographic and clinical information was abstracted from the charts. Univariate and multivariate analyses were performed to identify risk factors for TMJ arthritis identified by MRI.Results.MRI evidence of TMJ arthritis was detected in 43% of patients, with no significant difference among JIA categories. The number of joints with active arthritis (exclusive of the TMJ) and the use of systemic immunomodulatory therapies were not associated with TMJ arthritis. Multivariable analysis revealed a strong association between mouth-opening deviation and TMJ arthritis (OR 6.21, 95% CI 2.87–13.4). A smaller maximal incisal opening and shorter disease duration were also associated with an increased risk of TMJ arthritis.Conclusion.TMJ arthritis was identified in a substantial proportion of children with JIA (43%) and affects all JIA categories. TMJ arthritis was present in some patients despite limited or otherwise quiescent disease and in the presence of concurrent systemic immunomodulatory therapy. Routine evaluation for TMJ arthritis by MRI is warranted for all children with JIA.

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Rate of Antibiotic Use and Associated Risk Factors in COVID-19 Hospitalized Patients

10.1101/2020.10.21.20217117 ◽

2020 ◽

Author(s):

Alysa J. Martin ◽

Stephanie Shulder ◽

David Dobrzynski ◽

Katelyn Quartuccio ◽

Kelly E. Pillinger

Keyword(s):

Risk Factors ◽

Final Analysis ◽

Antibiotic Use ◽

Hospital Length ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Antibiotic Prescribing ◽

Factors Associated ◽

Secondary Endpoints ◽

Associated Risk Factors

AbstractBackgroundLiterature suggests that antibiotic prescribing in COVID-19 patients is high, despite low rates of confirmed bacterial infection. There are little data on what drives prescribing habits.ObjectiveThis study sought to determine antibiotic prescribing rates and risk factors for antibiotic prescribing in hospitalized patients. It was the first study to assess risk factors for receiving more than one course of antibiotics.MethodsThis was a retrospective, multi-center, observational study. Patients admitted from March 1, 2020 to May 31, 2020 and treated for PCR-confirmed COVID-19 were included. The primary endpoint was the rate of antibiotic use during hospitalization. Secondary endpoints included risk factors associated with antibiotic use, risk factors associated with receiving more than one antibiotic course, and rate of microbiologically confirmed infections.ResultsA total of 208 encounters (198 patients) were included in the final analysis. Eighty-three percent of patients received at least one course of antibiotics, despite low rates of microbiologically confirmed infection (12%). Almost one-third of patients (30%) received more than one course of antibiotics. Risk factors identified for both antibiotic prescribing and receiving more than one course of antibiotics were more serious illness, increased hospital length of stay, intensive care unit admission, mechanical ventilation, and acute respiratory distress syndrome.Conclusion and relevanceThere were high rates of antibiotic prescribing with low rates of bacterial co-infection. Many patients received more than one course of antibiotics during hospitalization. This study highlights the need for increased antibiotic stewardship practices in COVID-19 patients.

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Incidence and Outcomes of Acute Transfusion Reactions in Hospitalized Patients in the United States

Blood ◽

10.1182/blood-2020-138982 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 30-31

Author(s):

Rohit Kumar ◽

Sindhu Malapati ◽

Sunny R K Singh ◽

Bokhodir Mamedov ◽

Myra R Shah ◽

...

Keyword(s):

Risk Factors ◽

Conflicts Of Interest ◽

Multivariate Logistic Regression Analysis ◽

The United States ◽

Hospitalized Patients ◽

P Value ◽

Continuous Variables ◽

Blood Products ◽

Increased Risk ◽

Transfusion Reactions

Introduction Acute transfusion reactions (ATRs) have a broad spectrum of presentations ranging from benign to life-threatening. Due to the rarity of these reactions, there is a paucity of data regarding their incidence and clinical outcomes. The objectives of this study were to determine the incidence of ATRs, its risk factors, and associated mortality. Methods: We reviewed the National Inpatient Sample (NIS) database 2014 for admissions where the patient (>=18 years old) was transfused blood products. The NIS is a large publicly available all-payer inpatient healthcare database designed to produce U.S. regional and national estimates of inpatient utilization, access, charges, quality, and outcomes. ATRs were identified using ICD-9 CM codes for transfusion-associated circulatory overload (TACO), transfusion-related acute lung injury (TRALI), febrile non-hemolytic transfusion reactions (FNHTR), acute infections, anaphylaxis, and acute hemolytic reaction. Pearson's chi-square and student's t-test were used to compare categorical and continuous variables between hospitalizations with versus without ATRs, respectively. Multivariate logistic regression analysis was done to determine the risk factors for common ATRs (TACO, TRALI, and FNHTR). A multivariate cox proportional model was built to compare the mortality of two study groups. A 2-sided p-value ≤ 0.05 was considered significant. Results: A total of 2,134,691 hospitalizations were associated with the transfusion of blood products. ATRs were documented in 0.2% of the hospitalizations (TACO 0.08%, TRALI 0.06%, FNHTR 0.09%, others 0.003%). The group that had ATRs was slightly younger (median age 67 vs 68 years, p=0.002), had the same proportion of females (58.3% vs 55.3%, p=0.055), less comorbidity score (28.7% vs 31.7% had Charlson Comorbidity Index >3, p=0.042) and more critically ill (17.8% vs 10.5% on mechanical ventilation, p<0.001) compared to group without ATRs. Hospitalizations with ATRs had longer median length of stay (7 vs 6 days, p<0.001) and higher median hospital cost ($64,399 vs $53,912, p<0.001) compared to without ATRs. The risk factors for common ATRs (odds ratio, OR) are mentioned in the table. ATRs were not associated with increased risk of mortality (combined HR 0.89 95%CI 0.71-1.12, p=0.321). Conclusions: Nationally, the incidence of ATRs is low in hospitalized patients and it is not associated with increased mortality. This large database analysis gives insight into the risk factors associated with different ATRs. Disclosures No relevant conflicts of interest to declare.

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Risk factors for wound-related complications after surgical stabilization of spinal metastases with a special focus on the effect of postoperative radiation therapy

BMC Surgery ◽

10.1186/s12893-021-01431-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jan-Sven Jarvers ◽

Maximilian Lange ◽

Samuel Schiemann ◽

Jan Pfränger ◽

Christoph-Eckhard Heyde ◽

...

Keyword(s):

Risk Factors ◽

Body Weight ◽

Radiation Therapy ◽

Revision Surgery ◽

Spinal Metastases ◽

Retrospective Chart Review ◽

Wound Complications ◽

Special Focus ◽

Postoperative Radiation Therapy ◽

Increased Risk

Abstract Background Advancements in the field of oncological therapies during the last decades have led to a significantly prolonged survival of cancer patients. This has led to an increase in the incidence of spinal metastases. The purpose of this study was to assess risk factors for wound-related complications after surgical stabilization of spinal metastases with a special focus on the effect of postoperative RT and its timing. Methods Patients who had been treated for metastatic spine disease by surgical stabilization followed by radiotherapy between 01/2012 and 03/2019 were included and a retrospective chart review was performed. Results Of 604 patients who underwent stabilizing surgery for spinal metastases, 237 patients (mean age 66 years, SD 11) with a mean follow-up of 11 months (SD 7) were eligible for further analysis. Forty-one patients (17.3%) had wound-related complications, 32 of them before and 9 after beginning of the RT. Revision surgery was necessary in 26 patients (11.0%). Body weight (p = 0.021), obesity (p = 0.018), ASA > 2 (p = 0.001), and start of radiation therapy within 21 days after surgery (p = 0.047) were associated with an increased risk for wound complications. Patients with chemotherapy within 3 weeks of surgery (12%) were more likely to have a wound-related surgical revision (p = 0.031). Conclusion Body weight, obesity and ASA > 2 were associated with an increased risk for wound complications. Patients with chemotherapy within 3 weeks of the surgery were more likely to have a wound-related revision surgery. Patients who had begun radiation therapy within 21 days after surgery were more likely to have a wound complication compared to patients who waited longer.

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