scholarly journals Trends in Hospitalizations Related to Invasive Aspergillosis and Mucormycosis in the United States, 2000–2013

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Snigdha Vallabhaneni ◽  
Kaitlin Benedict ◽  
Gordana Derado ◽  
Rajal K. Mody
Keyword(s):  
United States ◽  
Invasive Aspergillosis ◽  
Census Data ◽  
Hematologic Malignancy ◽  
Weighted Least Squares ◽  
The United States ◽  
Solid Organ ◽  
Cell Transplant ◽  
United States Census ◽  
Hematopoietic Stem

Abstract Background Invasive aspergillosis (IA) and mucormycosis contribute to substantial mortality, especially among immunocompromised persons, including those with hematopoietic stem cell transplant (HSCT), hematologic malignancy (HM), and solid organ transplant (SOT). Methods Using International Classification of Diseases, Ninth Revision codes available in the National Inpatient Sample, a hospital discharge database, we estimated IA-related hospitalizations (IA-RH), mucormycosis-RH (M-RH), HSCT-RH, HM-RH, and SOT-RH during 2000–2013. United States census data were used to calculate overall M-RH and IA-RH rates and present trends; estimated annual numbers of HSCT-RH, HM-RH, and SOT-RH served as denominators to calculate M-RH and IA-RH rates occurring with these conditions. Weighted least-squares technique was used to test for linear trends and calculate average annual percentage change (APC). Results There were an estimated 169 110 IA-RH and 9966 M-RH during 2000–2013. Overall, IA-RH and M-RH rates per million persons rose from 32.8 to 46.0 (APC = +2.9; P < .001) and 1.7 to 3.4 (APC = +5.2%; P < .001), respectively, from 2000 to 2013. Among HSCT-RH, there was no significant change in M-RH rate, but a significant decline occurred in IA-RH rate (APC = −4.6%; P = .004). Among HM-RH, the rate of M-RH increased (APC = +7.0%; P < .001), but the IA-RH rate did not change significantly (APC = +1.2%; P = .073). Among SOT-RH, M-RH (APC = +6.3%; P = .038) and IA-RH rates (APC = +4.1%; P < .001) both increased. Conclusions Overall IA-RH and M-RH rates increased during 2000–2013, with a doubling of M-RH. Mucormycosis-related hospitalization occurring in conjunction with certain comorbidities increased, whereas IA-RH rates among patients with the comorbidities, decreased, remained stable, or increased to a lesser extent than M-RH.

scholarly journals 1132. Pneumocystis Infection in Children: National Trends and Characteristics in the United States, 1997–2012

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S339-S340
Author(s):  
Kengo Inagaki ◽  
Chad Blackshear ◽  
Charlotte V Hobbs
Keyword(s):  
United States ◽  
Primary Immunodeficiency ◽  
Hematologic Malignancy ◽  
Demographic Data ◽  
International Classification Of Diseases ◽  
The United States ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Pneumocystis Infection ◽  
Over Time

Abstract Background Although epidemiology of immunocompromising condition in children has evolved over time, updated epidemiology of pediatric pneumocystis infection in the United States is not available. Methods We performed a retrospective analysis using the Kids’ Inpatient Database, a nationally representative sample of US pediatric hospital discharges collected in 1997, 2000, 2003, 2006, 2009, and 2012. Pneumocystis cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification code 136.3 among children aged 0–18 years. Demographic data of cases with and without mortality were compared. Results We identified 1,902 (standard error, SE: 95) pneumocystis cases during the study period. The pneumocystis hospitalization rate decreased from 7.5 (SE: 0.91) to 2.7 (SE: 0.31) per a million US children from 1997 to 2012 (63.2% decrease). Cases with human immunodeficiency virus (HIV) infection decreased from 285 (SE: 56) cases in 1997 to 29 (SE: 7) cases in 2012, although non-HIV-associated cases remained relatively stable. After 2009, HIV was the third common underlying disorder after hematologic malignancy and primary immunodeficiency. All-cause in-hospital mortality was 11.7% (SE: 1.3%) and was particularly high among cases with hematopoietic stem cell transplant (HSCT) (32.4% [SE: 7.1%]) (P < 0.001). Conclusion Pneumocystis infection in children showed a marked decrease from 1997 to 2012 in the United States, largely driven by the reduction in HIV-associated cases. Non-HIV illnesses including hematologic malignancy and primary immunodeficiency became prominent underlying conditions over time. HSCT-associated cases had particularly high mortality. Non-HIV conditions should be the target for primary and secondary prevention in reducing the disease burden. Disclosures All authors: No reported disclosures.

scholarly journals High on Cannabis and Calcineurin Inhibitors: A Word of Warning in an Era of Legalized Marijuana

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Naomi Hauser ◽  
Tanmay Sahai ◽  
Rocco Richards ◽  
Todd Roberts
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
T Cell Activation ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
The United States ◽  
Solid Organ ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Cytochrome P 450

Tacrolimus, a potent immunosuppressant medication, acts by inhibiting calcineurin, which eventually leads to inhibition of T-cell activation. The drug is commonly used to prevent graft rejection in solid organ transplant and graft-versus-host disease in hematopoietic stem cell transplant patients. Tacrolimus has a narrow therapeutic index with variable oral bioavailability and metabolism via cytochrome P-450 3A enzyme. Toxicity can occur from overdosing or from drug-drug interactions with the simultaneous administration of cytochrome P-450 3A inhibitors and possibly P-glycoprotein inhibitors. Tacrolimus toxicity can be severe and may include multiorgan damage. We present a case of suspected tacrolimus toxicity in a postallogeneic hematopoietic stem cell transplant patient who was concurrently using oral marijuana. This case represents an important and growing clinical scenario with the increasing legalization and use of marijuana throughout the United States.

Pediatric Hand Burns Requiring Emergency Care in the United States

2021 ◽  
Author(s):  
Thomas J Sorenson ◽  
William J Mohr ◽  
Ashish Y Mahajan
Keyword(s):  
United States ◽  
Emergency Care ◽  
Census Data ◽  
The United States ◽  
Injury Incidence ◽  
United States Census ◽  
Injury Surveillance System ◽  
Cross Sectional ◽  
White Children ◽  
Epidemiological Characteristics

Abstract Purpose Hand and finger burns represent a relatively common occurrence in children, and serious injuries may require surgical intervention to prevent long-term disability. This study examines the epidemiological characteristics of pediatric patients presenting for emergency care of hand and finger burns within the United States (US). Methods We report a cross-sectional study of patients reported to the National Electronic Injury Surveillance System (NEISS) from January 1, 2010 to December 31, 2019. Patients were included in our study if they were younger than 18 years old and evaluated for an isolated hand or finger burn. United States census data from the same period were utilized for determining epidemiological estimates of injury incidence Results During the 10-year study period, an estimated 300,245 pediatric hand and finger burns were treated in 778,497,380 person-years: an incidence rate of 38.6 burns per 100,000 person years. Most treated burns occurred in the 1- to 2-year age group (28.3%) with an approximate 50% reduction in incidence for each 1-year age stratum until stabilizing at 6 years. Most burns occurred in white children (58%), but Black children had a higher incidence than white children when corrected for US population (45.15 burns versus 21.45 burns per 100,000 person-years). The most common etiology was a stove or oven (1595/10420; 15%). Conclusions Pediatric hand and finger burns occurred most frequently in young children from the oven and/or stove. We urge that parents be assertively counseled about potential burn risks to their young children’s hands and fingers, especially once they reach ambulatory age.

scholarly journals 144. Antifungal Use Trends in Hospitalized Adults in the United States, 2016-2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S184-S185
Author(s):  
Emily A Kaip ◽  
Ernie Shippey ◽  
Conan MacDougall
Keyword(s):  
United States ◽  
Fungal Infection ◽  
Negative Binomial ◽  
Hematologic Malignancy ◽  
Organ Transplant ◽  
The United States ◽  
Teaching Hospitals ◽  
Solid Organ ◽  
Days Of Therapy ◽  
Clinical Resource

Abstract Background Surveillance of antimicrobial use is a cornerstone of antimicrobial stewardship, though antifungal (AF) use is less frequently characterized. AFs are a major driver of inpatient costs and their use both reflects and drives changes in fungal susceptibility patterns. We report on trends in AF use in a large sample of United States hospitals over time including predictors of AF use. Methods We performed a retrospective analysis of adult inpatient visits between 2016 and 2020 at hospitals contributing data to the Vizient Clinical Database/Clinical Resource Manager (www.vizientinc.com). Inpatient use of systemically administered AFs was investigated as a function of study quarter, diagnosis code, and underlying immunosuppressive condition. Changes in AF use were modeled using logistic and negative binomial regression. Results We examined over 23 million admissions across 470 hospitals, 43% of which were classified as teaching hospitals and 54% of which performed solid organ transplants. During the study period, 4.03% (951,284/23,565,493) of admissions were billed for one or more of the study AFs. Among admissions receiving AFs, 86% received an azole, with the most frequently used agent being fluconazole, which accounted for for 46% of total AF days. Likelihood of AF receipt during admission increased by quarter (OR 1.012, p< 0.001), controlling for length of stay, presence of fungal infection, hematologic malignancy (HM), or solid organ transplant (SOT). Odds of any receipt and days of therapy (DOT) of fluconazole, isavuconazole, posaconazole, and echinocandins increased over the study period while those of voriconazole, itraconazole, and flucytosine decreased; odds of receipt of amphotericin products increased while DOT decreased; flucytosine receipt odds increased while DOT did not change. Only 30% of admissions with AF use were associated with a documented fungal infection, with 93% of these episodes documented as candidiasis. Admissions associated with SOT or HM represented 2% and 3% of all patient-days, but 11% and 25% of total AF days, respectively. Antifungal Utilization Conclusion AF use increased significantly over the study period, with changes across agents and classes. Most AF use occurred in the absence of administratively documented infection and was more common among SOT and HM patients. Disclosures All Authors: No reported disclosures

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