scholarly journals A Novel Program to Provide Drug Recovery Assistance and Outpatient Parenteral Antibiotic Therapy in People Who Inject Drugs

2021 ◽  
Author(s):  
Stephanie S Gelman ◽  
Eddie Stenehjem ◽  
Rachel A Foster ◽  
Nick Tinker ◽  
Nancy Grisel ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Therapy ◽  
Program Implementation ◽  
Bacterial Infections ◽  
People Who Inject Drugs ◽  
Control Period ◽  
Control Group ◽  
Readmission Rates ◽  
Parenteral Antibiotic ◽  
Implementation Period

Abstract Background Safe hospital discharge on parenteral antibiotic therapy is challenging for people who inject drugs (PWID) admitted with serious bacterial infections (SBI). We describe a Comprehensive Care of Drug Addiction and Infection (CCDAI) program involving a partnership between Intermountain Healthcare hospitals and a detoxification facility (DF) to provide simultaneous drug recovery assistance and parenteral antibiotic therapy (DRA-OPAT). Methods The CCDAI program was evaluated using a pre-post study design. We compared outcomes in PWID hospitalized with SBI during a 1-year post-implementation period (2018) with similar patients from a historical control period (2017), identified by propensity modeling and manual review. Results Eighty-seven patients were candidates for the CCDAI program in the implementation period. 35 participants (40.2%) enrolled in DRA-OPAT and discharged to the DF; 16 (45.7%) completed the full OPAT duration. Fifty-one patients with similar characteristics were identified as a pre-implementation control group. Median length of stay (LOS) was reduced from 22.9 days (IQI 9.8-42.7) to 10.6 days (IQI 6-17.4) after program implementation, p<0.0001. Total median cost decreased from $39,220.90 (IQI $23,300.71-$82,506.66) pre-implementation vs $27,592.39 (IQI $18,509.45-48,369.11) post-implementation, p<0.0001. 90-day readmission rates were similar (23.5% vs 24.1%), p=0.8. At 1-year follow-up, all-cause mortality was 7.1% in the pre-implementation group vs 1.2% post-implementation, p=0.06. Conclusion Partnerships between hospitals and community resources hold promise for providing resource efficient OPAT and drug recovery assistance. We observed significant reductions in length of stay and cost without increases in readmission rates; 1-year mortality may have been improved. Further study is needed to optimize benefits of the program.

scholarly journals Opioid Tolerance – A Predictor of Increased Length of Stay and Higher Readmission Rates

2014 ◽  
Vol 4;17 (4;7) ◽  
pp. E503-E507 ◽  
Author(s):  
Padma Gulur
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Health Care Providers ◽  
Massachusetts General Hospital ◽  
The United States ◽  
Opioid Tolerance ◽  
Control Group ◽  
Care Providers ◽  
Readmission Rates ◽  
Expected Length

The increasing use of opioids to manage pain in the United States over the last decade has resulted in a subset of our population developing opioid tolerance. While the management of opioid tolerant patients during acute episodes of care is well known to be a challenge amongst health care providers, there is little in the literature that has studied opioid tolerance as a predictor of outcomes. We conducted a review on all admissions to Massachusetts General Hospital over a period of 6 months, from January 2013 to June 2013, and identified opioid tolerant patients at admission using the FDA definition of opioid tolerance. To compare risk adjusted groups, we placed opioid tolerant patients and control patients into groups determined by expected length of stay of less than 2 days, 2 to 5 days, 5 to 10 days, and greater than 10 days. Opioid tolerant patients were then compared to the control for outcomes measures including observed length of stay and readmission rates. Our results show that all opioid tolerant patients have a significantly longer length of stay and a greater 30 day all cause readmission rate than the control group (P < 0.01). This trend was found in the first 3 risk adjusted groups, but not in the fourth group where expected length of stay was greater than 10 days. The opioid tolerant population is at risk given the poorer outcomes and higher health care costs associated with their care. It is imperative that we identify opportunities for improvement and delineate specific pathways for the care of these patients. Key words: Opioid tolerance, opioid tolerant patient population, opioid tolerant patients, readmission rates, length of stay

scholarly journals Low prevalence of bloodstream infection and high blood culture contamination rates in patients with COVID-19

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242533
Author(s):  
David Yu ◽  
Karolina Ininbergs ◽  
Karolina Hedman ◽  
Christian G. Giske ◽  
Kristoffer Strålin ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Bacterial Infections ◽  
Tertiary Care ◽  
Control Group ◽  
Contamination Rate ◽  
Empirical Antibiotic Therapy ◽  
Cohort Study Design ◽  
Low Prevalence ◽  
Tertiary Care Hospitals

Purpose In the management of COVID-19, knowledge is lacking on the frequency of secondary bacterial infections and on how empirical antibiotic therapy should be used. In the present study, we aimed to compare blood culture (BC) results of a COVID-19 patient cohort with two cohorts of patients without detected COVID-19. Methods Using a retrospective cohort study design of patients subjected to BC in six tertiary care hospitals, SARS-CoV-2 positive patients from March 1 to April 30 in 2020 (COVID-19 group) were compared to patients without confirmed SARS-CoV-2 during the same period (control group-2020) and with patients sampled March 1 to April 30 in 2019 (control group-2019). The outcomes studied were proportion of BC positivity, clinically relevant growth, and contaminant growth. Results In total 15,103 patients and 17,865 BC episodes were studied. Clinically relevant growth was detected in 197/3,027 (6.5%) BC episodes in the COVID-19 group compared to 717/6,663 (10.8%) in control group-2020 (p<0.0001) and 850/8,175 (10.4%) in control group-2019 (p<0.0001). Contamination was present in 255/3,027 (8.4%) BC episodes in the COVID-19 group compared to 330/6,663 (5.0%) in control group-2020 (p<0.0001) and 354/8,175 (4.3%) in control group-2019 (p<0.0001). Conclusion In COVID-19 patients, the prevalence of bloodstream bacterial infection is low and the contamination rate of BC is high. This knowledge should influence guidelines regarding blood culture sampling and empirical antibiotic therapy in COVID-19 patients.

scholarly journals 2148. Performance of the BioFire FilmArray Gastrointestinal Panel in a Clinical Setting of Infectious Diarrhea

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S728-S728
Author(s):  
Gloria Mayela Aguirre-García ◽  
Alejandra Moraila-Baez ◽  
Adrian Camacho-Ortiz
Keyword(s):  
Length Of Stay ◽  
Antibiotic Therapy ◽  
Acute Diarrhea ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Infectious Diarrhea ◽  
Conventional Methods ◽  
Therapy Modification ◽  
The Impact

Abstract Background Infectious diarrhea remains as one of the leading causes of morbidity and mortality worldwide among all age groups. Conventional methods for diagnosis are time consuming and expensive. The BioFire FilmArray gastrointestinal panel (FA-GIP) tests for 22 enteric pathogens, provides results in a few hours and improves healthcare costs. The impact on antibiotic stewardship is unknown. Methods We conducted a retrospective cohort, multi-center study to evaluate FA-GIP clinical performance in hospitalized patients with acute diarrhea. Patients from 3 hospitals from the Christus Muguerza health group were included between January 2017 and August 2018. The FA-GIP was ordered by the treating physician and was not influenced by the study. Duration of antibiotic therapy, length of hospital stay, and therapy modification were assessed. The comparison group consisted of patients with acute diarrhea in which no FA-GIP was ordered. Results Data from 130 patients with FA-GIP and 107 patients with conventional methods were collected. Pathogens were detected by FA-GIP in 72.3% of the cases. The median of duration of antibiotic therapy in FA-GIP group was 5 days (IQR 0–8) vs. 3 days (IQR 0–6) in conventional methods group, (P < 0.05). The mean length of stay was 3.3(SD ± 2.4) in FA-GIP group vs. 1.9 (SD ± 1.0) in the control group (P < 0.05). Patients in FA-GIP group had more days with diarrhea, lower hemoglobin levels, and higher creatinine levels at admission (Table 1). The most frequent pathogens detected were enteropathogenic Escherichia coli in 24.4%, norovirus in 19.1%, Clostridium difficile in 17.0% and Campylobacter jejuni in 15.9% (Table 2). Therapy modification after FA-GIP results was made in 51.1% of the patients with a detected pathogen, and in 42.8% of patients with no pathogen detected in FA-GIP the antibiotic was stopped. Conclusion Patients in the FA-GIP group had a more complex clinical scenario upon admission, they also had a longer duration of antibiotic therapies and longer length of stay. Although antibiotic therapy was positively influenced by the FA-GIP result, and no pathogen detection leads to withdrawal of unnecessary antibiotics. Disclosures All authors: No reported disclosures.

Procalcitonin-Guided Antibiotic Therapy Duration in Critically Ill Adults

2015 ◽  
Vol 26 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Caroline Walker
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Critically Ill ◽  
Bacterial Infections ◽  
Unit Length ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Control Group ◽  
Duration Of Treatment

Procalcitonin is a promising biomarker for antibiotic therapy because its levels rise and fall quickly with bacterial infections. A multi-database literature search was reviewed with 3 primary prospective randomized control trials used in further analysis. The results indicated that a procalcitonin-guided antibiotic protocol reduces the number of days a patient has to take antibiotics while having no effect on mortality when compared with control groups. Short-term studies did not show a difference in the intensive care unit length of stay, infection relapse rate, super-infection rate, or multidrug-resistant bacteria rate between the procalcitonin-protocol and control group. Because procalcitonin-guided antibiotic therapy has been shown to reduce the duration of treatment with antibiotics in critically ill patients without worsening the mortality rate or other outcomes, the implementation of a procalcitonin-guided antibiotic therapy should be considered for patients with proven or highly suspected bacterial infections in the intensive care unit.

scholarly journals Impact of Procalcitonin Monitoring on Duration of Antibiotics in Patients With Sepsis and/or Pneumonia in a Community Hospital Setting

2018 ◽  
Vol 34 (3) ◽  
pp. 109-116
Author(s):  
Elizabeth W. Covington ◽  
Stephen Eure ◽  
Doug Carroll ◽  
Christen Freeman
Keyword(s):  
Length Of Stay ◽  
Bacterial Infections ◽  
Community Hospital ◽  
Intervention Group ◽  
Hospital Setting ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Post Discharge ◽  
Average Hospital ◽  
Antibiotic Duration

Background: Procalcitonin (PCT) is a biomarker specific for bacterial infections versus viral or noninfectious causes. Utilizing PCT as a guide for antibiotic duration could have benefit in limiting antimicrobial overuse. Objective: The objective of this study was to analyze the effect of PCT monitoring on inpatient antibiotic duration for pneumonia and sepsis at a community hospital. Methods: This study utilized a prospective cohort design with a historical control group prior to the availability of PCT testing and a prospective intervention group after the availability of PCT testing at a community hospital. Results: A total of 102 patients (51 retrospective and 51 prospective) were included in the analysis. There was no difference in mean duration of inpatient antibiotics (6.1 ± 3.9 vs 5.4 ± 2.9 days, P = .50). Additionally, there was no difference in the average time to antibiotic de-escalation, average hospital length of stay, or intensive care unit length of stay. PCT monitoring resulted in a 41% reduction in discharge antibiotics (63% vs 37%, P = .0090) and a 2.2-day reduction in duration of overall inpatient and post-discharge antibiotics (9.5 ± 4.5 vs 7.3 ± 4.1 days, P = .013). There was no difference in mortality, relapse of infection, or 30-day readmission. Conclusion: PCT monitoring in patients with suspected pneumonia and/or sepsis in the community setting failed to show a reduction in duration of inpatient antibiotics after the introduction of PCT monitoring. However, PCT resulted in significantly fewer discharge antibiotics and overall inpatient plus post-discharge antibiotic duration, with no detrimental effect on mortality or readmission.

P-BN29 Laparoscopic cholecystectomy during the era of a Covid-19 pandemic; a cohort study

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Sian Davies ◽  
Nadar Ghassemi ◽  
Ning Yi Lo ◽  
Sneha Rathod ◽  
Alex Carney ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Acute Cholecystitis ◽  
Hospital Admissions ◽  
Surgical Intervention ◽  
Gallstone Disease ◽  
Good Practice ◽  
Control Group ◽  
Biliary Disease ◽  
Readmission Rates

Abstract Background The Covid-19 era has created a lot of uncertainty for management of common emergency and elective surgical conditions such as acute cholecystitis and other gallstone disease related emergency admissions. At our centre we continued to provide early operative intervention for patients presenting with biliary disease and acute cholecystitis throughout the Covid-19 era during both the 1st and the 2nd waves, despite a significant local surge in Covid-19 hospital admissions impacting on the available resources. Here we present the outcomes of our experience of managing such patients during the Covid-19 pandemic of 2020 of both 1st and 2nd waves. Methods A retrospective observational study was performed on all patients presenting with acute cholecystitis and biliary disease who underwent elective and emergency surgical intervention at UHNM (University Hospital of North Midlands) during the second wave of the Covid pandemic (2nd CW) between 14/10/2020 and 14/01/2021). These were then compared with patients who presented in the first Covid wave (1st CW) of 1/03/020 – 30/06/2020,) and a control group pre-covid (CG) 1/03/2019 – 30/06/2019, Patients were identified using ICD-10 codes K80 (Cholelithiasis) and K81 (Cholecystitis) and OPCS codes.J18.1 – J18.5. Primary endpoints were length of stay, 30 day readmission rates, mortality and morbidity. Results A total of 146 patients were identified who underwent laparoscopic cholecystectomy during the study time period (2ndCW). In comparison to 104 patients during the first covid wave cohort (1st CW) and the control group (CG) of 217 patients in the preceding non covid year. Length of stay (LOS) was significantly lower in the 2ndCW cohort in comparison to both the previous 1st CW cohort and the CG cohort (p &lt; 0.0001), with readmissions also being statistically lower (5% vs 15% and 12% respectively p = 0.027). There was no statistical difference in outcomes for post-operative complications as per Clavien-Dindo classification. Conclusions Overall our study demonstrates that the recommended good practice of early surgical intervention in both emergency and elective gallstone disease can continue during the pandemic periods without any significant impact on patient care & outcomes. Also during this period length of stay was significantly shorted and lower 30 day readmission rates which are likely to be multifactorial but where lessons could be potentially learnt.

Procalcitonin Testingreduce Unnecessary Antibiotic Use in Bacterial Infection

2019 ◽  
Vol 2 (1) ◽  
pp. 1-3
Author(s):  
Attabak Toofani Milani ◽  
Mahshid Mohammadian ◽  
Sadegh Rostaminasab ◽  
Roghayeh Paribananaem ◽  
Zohre Ahmadi ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Diagnostic Test ◽  
Bacterial Infections ◽  
Intervention Studies ◽  
Antibiotic Use ◽  
Clinical Suspicion ◽  
Diagnostic Biomarker ◽  
Clinical Routine ◽  
Initial Rise

Conventional diagnostic test have limitations to deferential diagnosis in clinical suspicion ofbacterial infection cases, that in some cases lead to inappropriate antibiotic therapy and increases antibiotic resistance. A new diagnostic insight is procalcitonin (PCT) test to improve diagnosis of bacterial infections and to guide antibiotic therapy. Serum PCT levels are of useful test as a biomarker in patients with bacterial infections for several reasons. Initial rise of PCT levels due to bacterial infection, subsequent sequential PCT levels can be used to assess the effectiveness and duration of antibiotic therapy. Based on clinical researches results, in bacterial infections, promising good results obtained when use of PCT used as differential diagnostic test. But further intervention studies are needed before use of PCT in clinical routine tests. The goal of this review is to study the PCT reliability as infections diagnostic biomarker.

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