scholarly journals 617. Long Acting Lipoglycopeptide Use in Veterans for Serious Gram-Positive Infections in the COVID Era

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S411-S412
Author(s):  
Carlos S Saldana ◽  
Tiffany Goolsby ◽  
Lauren H Epstein ◽  
Nora Oliver
Keyword(s):  
Hospital Stay ◽  
Clinical Information ◽  
Nursing Facilities ◽  
Gram Positive ◽  
Improvement Project ◽  
Median Hospital Stay ◽  
Joint Infections ◽  
Long Acting ◽  
Lost To Follow Up ◽  
Median Hospital

Abstract Background Dalbavancin and Oritavancin are semisynthetic lipoglycopeptides (LGP) that are FDA-approved for treatment of skin and soft tissue infections, but emerging data supports LGP use for other serious gram positive (GP) infections. We describe our experience with LGP during the COVID-19 pandemic. Methods We initiated a quality improvement project to assess the use of LGP for label and off-label indications at the Atlanta Veterans Affairs Health Care System. We define serious GP infections as infective endocarditis, osteomyelitis, joint infections, or bacteremia. Patients with serious GP infections that receivedLGP were selected at the treating physician's discretion. We reviewed medical records of all patients receiving at least one dose of long-acting LGP from March 1, 2020 - May 31, 2021. We described patient demographics, clinical information,and outcomes (90-day readmission). Results Nineteen patients with GP infections received LGP (table). Overall, the most common infection was cellulitis 7 (35%); 14 patients received LGPs for serious GP infections. All patients received at least one other non-LGP antibiotic for at least 2 days, majority vancomycin (60%) and cefazolin (30%). Overall, the median hospital stay among patients who received LGP was 8.5 days (range: 2-45 days), for those with serious GP infections the median hospital stay was 15 days (range: 4-45). 90% of patientswho received LGP were discharged home. Number of LGP doses ranged from 1 to 6 doses total, based on type of infection. Sixteen veterans (80%) followed up in outpatient clinicfollowing discharge within 2 weeks, two patients were discharged to home hospice due to complications of underlying malignancies and two patients were lost to follow up. Noadverse drug events were reported, and none with serious GP infections required rehospitalization at 90 days. Conclusion Our experience suggests that long-acting LGP may be valuable tools to treat serious gram-positive infections by optimizing theduration of hospitalization and preventing unnecessary admissions to acute care and nursing facilities for daily antibiotic infusions. These aspects of LGP use are especially important during the COVID-19 pandemic where nosocomial transmission has been documented. Disclosures All Authors: No reported disclosures

scholarly journals Is simultaneous surgery for nodes and primary in carcinoma penis safe?

2017 ◽  
Vol 03 (01) ◽  
pp. 050-053
Author(s):  
Senthil Chandrasekhar ◽  
Kathiresan Narayanswamy
Keyword(s):  
Hospital Stay ◽  
Median Hospital Stay ◽  
Staged Surgery ◽  
Surgery Group ◽  
Simultaneous Surgery ◽  
Simultaneous Group ◽  
The Mean ◽  
Carcinoma Penis ◽  
Median Hospital

Abstract Introduction: Historically, the combination of primary and nodal surgeries for carcinoma penis is thought to increase the morbidity and hospital stay. Despite the modifications in surgery including modified inguinal lymphadenectomies, morbidity of the procedure is high. Methods: A prospective, nonrandomized study to analyze a total of 56 consecutive patients from 2006 to 2009, who were evaluated and underwent surgery for primary and nodes for carcinoma penis at our center, was done. The median follow-up was 34 months (range from 12 to 48 months). The procedures included both prophylactic and therapeutic groin dissections. Various parameters were tested using SPSS version 17 statistics software. Results: Duration of drains, hospital stay, wound morbidity, and long-term complications were found to be similar in the simultaneous and staged surgery groups. The mean duration of drains for the simultaneous group of 18 patients was 12.56 days and the corresponding duration of drains for the staged surgery group of 36 patients was 12.83 days. The minor morbidity and major morbidity for the simultaneous group were 27.8% and 38.9% and the corresponding figures for the staged group were 22.2% and 44.4%, respectively. The mean and median hospital stay for the simultaneous surgery group were 21.5 and 27.5 days, respectively. The mean and median hospital stay for the staged surgery group were 17.5 and 21.36 days, respectively. The study revealed no statistically significant difference between the two groups with regard to all the above parameters. Conclusions: Simultaneous surgery for the primary and nodes in carcinoma penis is very much feasible. Simultaneous and early-staged lymphadenectomy have no difference in results with respect to drain duration, hospital stay, wound morbidity, and long-term complications. Simultaneous lymphadenectomy can be combined with penectomy both in the prophylactic and therapeutic settings.

scholarly journals Percutaneous or Transurethral Cystolithotomy for Bladder Lithiasis: Which is Safer?

2019 ◽  
Vol 36 (1-2) ◽  
pp. 17-22
Author(s):  
Joao Pimentel Torres ◽  
Vítor Fernandes ◽  
Nuno Morais ◽  
Sara Anacleto ◽  
Paulo Mota ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Prostate Hyperplasia ◽  
Median Hospital Stay ◽  
Urethral Strictures ◽  
Previous Diagnosis ◽  
Urethral Trauma ◽  
Significant Difference ◽  
Benign Prostate ◽  
Median Hospital

Introduction: Although the risk of urethral trauma while treating bladder stones is worrisome, evidence about the best treatment approach is scarce. The aim of this study is to compare the safety and efficacy of transurethral cystolithotomy and percutaneous suprapubic cystolithotomy in adults´ bladder lithiasis treatment. Methods: We retrospectively evaluated 120 patients (January 2012 to December 2017) who were surgically treated for bladder lithiasis with percutaneous suprapubic cystolithotomy (n= 20) and transurethral cystolithotomy (n= 100). Age, gender, calculi size, surgery duration, hospital stay, post-operative infections, haematuria, pain and urethral strictures were evaluated. Previous diagnosis of benign prostate hyperplasia and urethral strictures were also considered. Results: Both groups were homogeneous according to the pre-operative variables evaluated, including calculi dimensions and simultaneous diagnosis. Median surgery time in percutaneous suprapubic cystolithotomy and transurethral cystolithotomy were 65 and 58 minutes, respectively (p= 0.043). Pain and haematuria were similar in both groups. Median hospital stay was 2.0 days in both groups. Median follow-up time was 13 months. In the transurethral cystolithotomy, three patients (3%) developed urethral stricture while none of the patients treated with PSC developed urethral strictures during the follow-up (p= 0.435). Discussion: Percutaneous suprapubic cystolithotomy theoretically offers an advantage over transurethral cystolithotomy in terms of urethral trauma, although we did not observe a significant difference. However, it deserves to be considered, especially in patients with known urethral strictures that may hinder transurethral access. Further prospective studies with more patients may however confirm these theoretical advantages.

scholarly journals Enhanced Recoveryafter Colorectal Surgery. Results from Aprospective Observational Two-Centre Study

2009 ◽  
Vol 98 (3) ◽  
pp. 155-159 ◽  
Author(s):  
A. C. Miohn ◽  
S. V. Bernardshaw ◽  
S.-M. Ristesund ◽  
P. E. Hovde Hansen ◽  
O. Rœkke
Keyword(s):  
Colorectal Surgery ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Leisure Activities ◽  
University Hospital ◽  
Daily Activities ◽  
Median Hospital Stay ◽  
Surgical Department ◽  
Preparation Period ◽  
Median Hospital

Background and Aims: Enhanced recovery after surgery (ERAS) has reduced the median hospital stay from 8–10 days with traditional peri-operative routines to four days. The aim of the present study was to introduce the principles of ERAS in our hospital and measure the effect on hospital stay, complications and quality of life after discharge from hospital. Material and Methods: 94 consecutive patients, 40 males, 54 females, median age 66 years, were included in a prospective non-randomised observational study at Haukeland University Hospital and Haugesund Hospital from October 2000 until February 2003. After a three-month preparation period, the principles of ERAS were implemented. The results were evaluated with questionnaires and by follow-ups 8–10 and 30 days after surgery. The results were compared to the results of colorectal surgery before introduction of accelerated recovery. Results: 45 (48%) and 73 (78%) patients were discharged within three and five days after surgery with ERAS, compared to zero and seven (5%) patients with traditional recovery. The complication rate with ERAS was 31%, and the readmission rate was 15%. After one week, 57% had resumed their daily activities at home. After 30 days, 65% of the patients had resumed their normal and leisure activities. Conclusion: After a proper preparation period, ERAS principles may be implemented in surgical department, and is followed by a reduced median hospital stay and rapid return to normal daily activities for most patients after colorectal surgery.

scholarly journals The CHROME Study, a Real-world Experience of Single- and Multiple-Dose Oritavancin for Treatment of Gram-Positive Infections

2019 ◽  
Vol 6 (11) ◽  
Author(s):  
Mark Redell ◽  
Miguel Sierra-Hoffman ◽  
Maha Assi ◽  
Markian Bochan ◽  
David Chansolme ◽  
...  
Keyword(s):  
Real World ◽  
Multiple Dose ◽  
Clinical Success ◽  
Soft Tissue Infections ◽  
Gram Positive ◽  
Joint Infections ◽  
Medical Evaluation ◽  
Evaluable Population ◽  
Long Acting ◽  
Observational Program

Abstract Background Oritavancin (ORI) is a long-acting lipoglycopeptide indicated for the treatment of adult patients with acute bacterial skin and skin structure infections (ABSSSIs) caused or suspected to be caused by susceptible Gram-positive (GP) pathogens. Methods Data collected from a retrospective observational program (2014–2017), Clinical and Historic Registry and Orbactiv Medical Evaluation (CHROME), describe the utilization, outcomes, and adverse events (AEs) associated with ORI in 440 patients treated at 26 US sites for ABSSSI and other GP infections. Results Clinical success in evaluable patients receiving at least 1 dose of oritavancin was 88.1% (386/438). In a subgroup of patients who received ORI for skin and soft tissue infections (n = 401) and bacteremia (n = 7), clinical success was achieved in 89.0% and 100%, respectively. A cohort of 32 patients received 2–10 ORI doses separated by no more than 14 days for complicated GP infections. Clinical success was observed in 30 of 32 patients (93.8%), including 10 of 11 (90.9%) patients with bone and joint infections and 7 of 8 (87.5%) patients with osteomyelitis. In the safety evaluable population, the overall rate of AEs was 6.6%. Conclusions We describe results from a real-world program that includes the largest multicenter, retrospective, observational study in patients who received at least 1 dose of ORI for the treatment of GP infections. This study confirms that ORI is an effective, well-tolerated antibiotic used in single and multiple doses for the treatment of ABSSSIs and complicated GP infections.

scholarly journals An Algorithm for the Management of Bile Leak Following Laparoscopic Cholecystectomy

2007 ◽  
Vol 89 (1) ◽  
pp. 51-56 ◽  
Author(s):  
F Ahmad ◽  
RN Saunders ◽  
GM Lloyd ◽  
DM Lloyd ◽  
GSM Robertson
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Bile Leak ◽  
Median Hospital Stay ◽  
Management Protocol ◽  
The Impact ◽  
Median Hospital ◽  
Bile Leaks

INTRODUCTION The management of bile leaks following laparoscopic cholecystectomy has evolved with increased experience of ERCP and laparoscopy. The purpose of this study was to determine the impact of a minimally invasive management protocol. PATIENTS AND METHODS Twenty-four patients with a bile leak following laparoscopic cholecystectomy were recorded consecutively between 1993 and 2003. Between 1993–1998, 10 patients were managed on a case-by-case basis. Between 1998–2003, 14 patients were managed according to a minimally invasive protocol utilising ERC/biliary stenting and re-laparoscopy if indicated. RESULTS Bile leaks presented as bile in a drain left in situ post laparoscopic cholecystectomy (8/10 versus 10/14) or biliary peritonitis (2/10 versus 4/14). Prior to 1998, neither ERC nor laparoscopy were utilised routinely. During this period, 4/10 patients recovered with conservative management and 6/10 (60%) underwent laparotomy. There was one postoperative death and median hospital stay post laparoscopic cholecystectomy was 10 days (range, 5–30 days). In the protocol era, ERC ± stenting was performed in 11/14 (P = 0.01 versus pre-protocol) with the main indication being a persistent bile leak. Re-laparoscopy was necessary in 5/14 (P = 0.05 versus preprotocol). No laparotomies were performed (P < 0.01 versus pre-protocol) and there were no postoperative deaths. Median hospital stay was 11 days (range, 5–55 days). CONCLUSIONS The introduction of a minimally invasive protocol utilising ERC and re-laparoscopy offers an effective modern algorithm for the management of bile leaks after laparoscopic cholecystectomy.

scholarly journals Is COVID-19 that different in hemodialysis patients?: A single-center experience

2021 ◽  
Vol 35 (2) ◽  
Author(s):  
Marina Reis ◽  
◽  
Catarina Almeida ◽  
Ana Ventura ◽  
Catarina Ribeiro ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Troponin T ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Single Center ◽  
Median Hospital Stay ◽  
Single Center Experience ◽  
Median Hospital ◽  
Hospital Stay Duration ◽  
Bacterial Superinfection

Coronavirus disease 2019 (COVID-19) has affected millions worldwide, and in particular the care of patients on maintenance hemodialysis. These patients are thought to be at high risk of severe SARS-CoV-2 infection due to their older age and multiple comorbidities. The aim of this study was to compare hemodialysis and non-dialysis COVID-19 patients and find possible risk factors for mortality in hemodialysis patients. We developed a single-center retrospective cohort study, from March 1st to December 31st, 2020, that included maintenance hemodialysis patients hospitalized with laboratory confirmed SARS-CoV-2 infection, and age and sex propensity matched non-dialysis patients also hospitalized with a laboratory confirmed SARS-CoV-2 infection (1:1). A total of 34 hemodialysis patients were included, 70.6% male, mean age 76.5 years and on maintenance hemodialysis for 3.0 [0.5-23] years. At admission, 50.0% needed oxygen supply. Median hospital stay duration was 11.0 [5.8-17.0] days, and 38.2% developed bacterial superinfection. Maintenance hemodialysis patient mortality rate was 32.4%. When matched to the non-dialysis group, the hemodialysis group developed more often respiratory insufficiency (50.0% vs 8.8%, p<0.001) and had higher ferritin (1658.0 vs 623.5, p=0.004) and troponin T (130.0 vs 31.0, p<0.001) levels, whereas the non-dialysis group had higher transaminases levels. There was no statistical difference regarding hospitalization time, bacterial superinfection, or mortality between groups. When the logistic regression was performed, only bacterial superinfection was a predictor for mortality in hemodialysis COVID-19 patients (0.01 [0.00-0.26]). There was no difference in hospital stay nor in death rate between hemodialysis and non-dialysis COVID-19 patients. Despite these results, we must emphasize that mortality in the dialysis group was particularly high, with up to 32% of in-hospital mortality, and that bacterial superinfection has been shown to be an independent predictor of mortality. These results highlight the importance of interventions, such as full vaccination coverage, to mitigate the burden of COVID-19 in hemodialysis patients.

scholarly journals 200. Real-World Experience with Dalbavancin for Complicated Gram-Positive Infections: A Multicenter Evaluation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S118-S119
Author(s):  
Sara Alosaimy ◽  
Jeffrey Pearson ◽  
Michael Veve ◽  
Brandon Dionne ◽  
Muneerah Aleissa ◽  
...  
Keyword(s):  
Clinical Success ◽  
Signs And Symptoms ◽  
Apache Ii Score ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Persons Who Inject Drugs ◽  
Joint Infections ◽  
Fda Approval ◽  
Long Acting

Abstract Background Dalbavancin (DAL) received Food and Drug Administration (FDA) approval for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by Gram-positive organisms including Methicillin-resistant Staphylococcus aureus (MRSA). Due to its unique activity and dosing schedule, use in non-FDA approved indications has been increasing. We evaluated the clinical and safety outcomes of patients treated with DAL for various infections. Methods A multicenter, retrospective observational study was conducted from April 2017 to February 2019. We included adult patients who received 1 dose of DAL for any indication. The primary outcome was clinical success defined as 30-day survival from DAL initiation, resolution of signs and symptoms of infection, and absence of therapy escalation/change. Reasons for DAL therapy selection were also investigated. Results A total of 30 patients were included. The median age was 49 (35–58) years, 50% were female and 93.3% were Caucasian. Median APACHE II score was 9 (5–12). Persons who inject drugs (PWID) comprised 50%. Common DAL indications were bacteremia (53.3%), bone and joint infections (33.3%) and ABSSSI (26.7%). Pathogens were MRSA (43.3%), coagulase-negative Staphylococci (23.3%) and methicillin-susceptible S. aureus (MSSA) (13.3%). Previous antibiotics were administered in 93.3% of patients for a median of 9 (7–15) days and (13.3%) received combination antibiotic therapy with DAL. In a subgroup of patients with confirmed microbiological eradication (73.3%), DAL was initiated at a median of 8 days (4–14) after clearance. Clinical success was achieved in 80% of patients and 10% were de-escalated to oral therapy. Rash/pruritus and hypotension occurred in two and one patient, respectively. DAL was selected because of ease of administration (60%), inability to be discharged with a line (43.3%), poor candidacy for outpatient therapy (36.7%), and/or inadequate adherence (30%). Conclusion DAL appears to be well tolerated and results in high clinical success. Larger studies with longer follow would be valuable to more precisely define the role of DAL in complicated Gram-positive infections, particularly in comparison to other long-acting lipoglycopeptides. Disclosures All authors: No reported disclosures.

Choice of drainage procedure in paediatric pyopericardium: a 30-year experience

2005 ◽  
Vol 35 (4) ◽  
pp. 200-204 ◽  
Author(s):  
P V Hayavadana Rao ◽  
V Raveenthiran
Keyword(s):  
Observational Study ◽  
Hospital Stay ◽  
Drainage Procedure ◽  
Median Hospital Stay ◽  
Tube Drainage ◽  
Pericardial Drainage ◽  
Median Hospital

Although there is general agreement on the necessity of draining pyopericardium, debate continues as to the safe and effective method of drainage. Studies describing head-to-head comparison of various drainage procedures are very few and are disadvantaged by small numbers of cases. In this observational study, we review our 30-years experience with different techniques of pericardial drainage. Between 1972 and 2003, the authors have personally treated 39 children who suffered from pyopericardium. Among the 22 children who underwent early partial pericardiectomy, 20 were alive. In contrast to this,12 out of 15 children treated with repeated pericardiocentesis or sub-xiphoid tube drainage were dead. The median hospital stay for pericardiectomy group was 18 days (range 11-32) and that for the non-thoracotomy group was 34 days (range 18-55 days). With regard to immediate survival and early convalescence in the pyopericardium, partial pericardiectomy is superior to pericardiocentesis and sub-xiphoid tube drainage. Pericardiocentesis can be used for diagnostic or temporizing purposes, but not as the definitive drainage procedure. Partial pericardiectomy can be done even in small hospitals where heart-lung machines are not available.

Perioperative Outcomes for Laparotomy Compared to Robotic Surgical Staging of Endometrial Cancer in the Elderly: A Retrospective Cohort

2016 ◽  
Vol 26 (9) ◽  
pp. 1717-1721 ◽  
Author(s):  
Floor J. Backes ◽  
Adam C. ElNaggar ◽  
Michael Ryan Farrell ◽  
Lorna A. Brudie ◽  
Sarfraz Ahmad ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Elderly Patients ◽  
Hospital Stay ◽  
The Elderly ◽  
Pelvic Lymphadenectomy ◽  
Perioperative Outcomes ◽  
Median Hospital Stay ◽  
Improved Outcomes ◽  
Vaginal Cuff Dehiscence ◽  
Median Hospital

ObjectiveThis study aimed to compare outcomes of endometrial cancer (EMCA) staging in elderly patients performed either robotically or via laparotomy.MethodsA retrospective, multi-institutional chart review was conducted of all robotic and laparotomy staging surgeries for EMCA between 2003 and 2009. Charts were reviewed for intraoperative and postoperative complications and morbidities.ResultsSeven hundred forty-six women were identified who had undergone EMCA staging either robotically or via laparotomy; 89 and 93 patients 70 years or older underwent staging for EMCA via robotic and laparotomy, respectively. Both groups had similar age and body mass index. Among elderly patients being staged robotically, a higher incidence of pelvic lymphadenectomy, and decreased blood loss, incidence of blood transfusion, and overall complications were seen compared to laparotomy. Postoperatively, elderly patients staged robotically had a shorter median hospital stay (1 vs 4 days,P< 0.001), with no increase in readmission or return to the operating theater. No vessel, bowel, or genitourinary injuries occurred. Vaginal cuff dehiscence after robotic surgery was not significantly different, but wound and fascial complications were significantly increased in patients undergoing laparotomy. Thromboembolism rates were similar between both groups.ConclusionsElderly patients can safely undergo robotic EMCA staging with improved outcomes compared to laparotomy. The benefits of robotic staging include higher incidence of completion of lymphadenectomy, decreased hospital stay (without an increase in readmissions or reoperations), decreased transfusions, and decreased wound and fascial complications.

scholarly journals Efficacy of Integrative Chinese-Western Medicine Treatments for COVID-19 Patients in ICU in Yichang, Hubei, China

2020 ◽  
Author(s):  
Ziwen Yuan ◽  
Min Zhang ◽  
Jingcheng Li ◽  
Ting Peng ◽  
Chen Liang ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Western Medicine ◽  
Cost Effective ◽  
Assisted Ventilation ◽  
Efficacy And Safety ◽  
Median Hospital Stay ◽  
Median Hospital

Abstract BackgroundThe prognosis of severe COVID-19 patients is poor. Traditional Chinese Medicine had an advantage in keeping microenvironmental balance in treating SARS and COVID-19.MethodsThis prospective cohort study compared the efficacy and safety of integrative Chinese-Western medicine (ICWM) treatments with Western medicine (WM) treatments in severe or critically ill patients. The outcomes included: mortality, hospital stay in ICU, days with ventilator-assisted ventilation, etc.ResultsA total of 72 confirmed COVID-19 patients in ICU were included. The median age of patients was 66 years (IQR: 53-77.5), and there were 32 female patients (44.4%). There were no significant differences in laboratory tests and complications after treatments between groups. A total of 36 (50%) patients died during hospitalization, and the mortality in the ICWM group (28.6%) was significantly lower than that of the WM group (63.6%, adjusted P=0.011). And the time of assisted ventilation was shorter in the ICWM group (adjusted P=0.341). However, the median hospital stay was significantly longer in the ICWM group (18 vs. 14 days, adjusted P＜0.05).ConclusionsICWM treatments could significantly reduce mortality for severe or critically ill patients with COVID-19, and it was safe and cost-effective to add Chinese medicine.

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