scholarly journals Clinical Outcomes of Antipseudomonal vs. Non-Antipseudomonal Therapy in Patients with Osteomyelitis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S97-S97
Author(s):  
Jeffrey W Jansen ◽  
Ryan P Moenster
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Cohort Analysis ◽  
Anatomical Site ◽  
Clinical Failure ◽  
Primary Analysis ◽  
Exclusion Criteria ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Retrospective Cohort Analysis ◽  
Culture Negative

Abstract Background Osteomyelitis (OM) in diabetics is frequently a polymicrobial infection that rarely involves Pseudomonas (4–5% of cases). Bone cultures have a low-positive yield of 34–50% and, as a result, many patients receive antimicrobial regimens which include antipseudomonal (AP) therapy. Methods A retrospective cohort analysis of adult Veterans with OM treated with AP compared with non-antipseudomonal (NAP) therapy was conducted. Patients managed by the VA St. Louis outpatient parenteral antimicrobial therapy (OPAT) service from 1/1/2009 to 7/31/2015 were identified and screened for inclusion. Patients with culture negative (CN) or non-pseudomonal superficial swab cultures (SCx) were included. Figure 1 presents the study profile and exclusion criteria. The primary outcome was clinical failure, defined as a composite of: (1) extension of antibiotics beyond 1 week of the planned duration, (2) recurrence of OM at the same anatomical site within 12 months, or (3) any unplanned surgery or amputation at the anatomical site within 12 months of ABx completion. Results Overall, 104 patients with 109 OM encounters were included; there were 29 CN encounters and 80 SCx encounters. Table 1 presents baseline demographics. The overall failure rate was 55/109 (50.5%). The results of the analysis are shown in Table 2. While not included in the primary analysis, Pseudomonas was isolated from 8/88 (9.1%) swab cultures and 5/33 (15%) deep cultures. Conclusion Empiric AP therapy did not improve clinical outcomes in patients with either CN or SCx OM. Disclosures All authors: No reported disclosures.

scholarly journals 850. Outcomes of Patients Discharged on Parenteral Ceftriaxone Compared with Oxacillin or Cefazolin in Methicillin-susceptible Staphylococcal aureus (MSSA) Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S16-S17
Author(s):  
Lee Erik Connor ◽  
Yasir Hamad ◽  
Ige George
Keyword(s):  
Primary Outcome ◽  
Bloodstream Infections ◽  
Standard Of Care ◽  
Outcome Data ◽  
Blood Cultures ◽  
Clinical Failure ◽  
Median Length ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Group 5 ◽  
Staphylococcal Aureus

Abstract Background MSSA is a leading cause of bloodstream infection (BSI) and its incidence is on the rise. Standard of care (SOC) is prolonged parenteral therapy with nafcillin, oxacillin, or cefazolin. Ceftriaxone is active against MSSA and can be given conveniently as a daily infusion. Methods We conducted a retrospective analysis of hospitalized adults with MSSA BSI from December 2014 to May 2018, defined as ≥1 blood cultures positive for MSSA and discharged on outpatient parenteral antimicrobial therapy (OPAT) on either ceftriaxone, cefazolin, or oxacillin. We excluded patients with ESRD and polymicrobial infections. We collected demographics, comorbidities, outcome data, and treatment-related adverse events. The primary outcome was 90-day mortality with secondary outcomes of clinical failure and microbiologic failure. Clinical failure was defined as readmission for any infection within 90 days of discharge or a change in antibiotics from the planned course of therapy after discharge. Microbiologic failure was defined as reinfection with MSSA within 90 days of discharge from any site. Results In total, 167 patients had a BSI with MSSA. Of those patients, 66 (39.5%) were discharged on SOC and 101 (60.5%) on ceftriaxone. The two groups were similar in terms of their demographics (Table 1). The SOC group had more cases of endocarditis with 34 (51.5%) than ceftriaxone with 25 (24.8%) (P = 0.001). LOS for the SOC group had a median of 14.05 days whereas the ceftriaxone group had a median length of stay of 7.88 (P = 0.004). In the SOC group, 5 (7.6%) patients died compared with 8 (7.9%) patients in the ceftriaxone group within 90 days of the onset of bacteremia which was not statistically significant (P = 0.94) (Figure 1). There were 4 (6.1%) cases of microbiologic failure in SOC and 7 (6.9%) cases in the ceftriaxone group (P = 0.83). For clinical failures, the SOC had 6 (9.1%) cases compared with the 19 (18.8%) cases in the ceftriaxone group (P = 0.13). Conclusion Ceftriaxone was not statistically different when compared with SOC in terms of mortality, microbiologic failure, or clinical failure. Though clinical failures numerically were more frequent in the ceftriaxone group. Ceftriaxone maybe a reasonable and convenient option to SOC for patients with uncomplicated MSSA BSI discharged on OPAT, but further studies are needed. Disclosures All Authors: No reported Disclosures.

Initiation of hemodialysis at one month following fistulogram in patients with advanced kidney disease

Vascular ◽  
2022 ◽  
pp. 170853812110682
Author(s):  
Eelin Wilson ◽  
Yoni Sacknovitz ◽  
Varun Dalmia ◽  
Omar Sanon ◽  
Ayesha Hatch ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Primary Outcome ◽  
Cohort Analysis ◽  
Stage Iv ◽  
Low Contrast ◽  
Factors Associated ◽  
Iodinated Contrast ◽  
Retrospective Cohort Analysis ◽  
Contrast Volume ◽  
Ckd Stage

Objective Previous studies have demonstrated that low contrast volume used in access-related interventions had limited effects on the progression of chronic kidney disease (CKD) after fistulography, but studies are limited and heterogeneous. We sought to evaluate the rate of and factors associated with progression to dialysis (HD) within 1 month after fistulography for patients with advanced CKD. Methods A single-institution retrospective cohort analysis of patients with CKD stage IV and V, not yet on HD, undergoing fistulography from 1 January 2014 to 31 December 2018 was performed. The primary outcome was progression to HD within 1 month. Additional variables and the association with the primary outcome such as medical comorbidities, contrast type or volume were assessed. Results A total of 34 patients underwent 41 fistulograms prior to HD initiation. Progression to HD within 1 month of fistulogram occurred in seven patients (all CKD V). The mean time between fistulogram and HD was 271 days for 31 of 34 patients who ultimately progressed to HD. Those with CKD IV began HD in 549 days on average, while those with CKD V began HD in 190 days on average. Three patients had not initiated HD at a mean of 539 days of follow-up. The only factors associated with progression to HD within 1 month included use of isovue ( p = .005) and elevated contrast volume, with a mean of 40 mL ( p = .027). Conclusion Although none of the patients with CKD IV required HD within 1 month after fistulogram, the use of larger iodinated contrast volume was associated with progression to HD within 1 month of fistulography for patients with CKD V. Further studies should investigate the safety of iodinated and alternative (e.g., carbon dioxide) contrast media in fistulography or duplex-based HD access procedures for CKD patients, especially CKD V, not yet on HD.

scholarly journals 177. Clinical Outcomes of Daptomycin vs. Anti-Staphylococcal β-Lactams in Definitive Treatment of Methicillin-Susceptible Staphylococcus aureus (MSSA) Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S111-S111
Author(s):  
Sydney Agnello ◽  
Shandra R Day ◽  
Lynn Wardlow ◽  
Erica E Reed ◽  
Jessica M Smith ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Small Sample Size ◽  
Small Sample ◽  
Definitive Treatment ◽  
Clinical Failure ◽  
Primary Indication ◽  
Definitive Therapy ◽  
All Cause Mortality ◽  
Related Mortality

Abstract Background The preferred management of patients with MSSA bacteremia includes definitive therapy with intravenous anti-staphylococcal β-lactam antibiotics. In β-lactam allergic or intolerant patients, daptomycin has been targeted as a viable alternative. The objective of this study was to assess clinical outcomes of daptomycin compared with nafcillin or cefazolin for the treatment of MSSA bacteremia. Methods This was a retrospective cohort study of patients hospitalized from November 1, 2011 to October 31, 2018 at The Ohio State University Wexner Medical Center with MSSA bacteremia. Patients treated with nafcillin, cefazolin or daptomycin were included with 1:1:1 random selection. The primary outcome was a composite of clinical failure, defined as a change in therapy due to persistent/worsening signs and symptoms, bacteremia recurrence or persistence, or inpatient infection-related mortality. Secondary endpoints included 30-day infection-related mortality, duration of bacteremia, 30-day all-cause mortality and adverse events (AEs) necessitating a change in therapy. Results Among patients with MSSA bacteremia, 162 received at least one dose of daptomycin. Of those, 29 received at least 14 days of daptomycin and/or received daptomycin as definitive therapy and thus were included in the analysis. There was no difference in the primary outcome of composite clinical failure comparing daptomycin vs. nafcillin/cefazolin (P = 0.71). In addition, no difference was observed in 30-day infection-related mortality (P = 0.51), duration of MSSA bacteremia (P = 0.9), or 30-day all-cause mortality (P = 0.64). A higher number of AEs necessitating change in therapy were seen in the daptomycin group (P = 0.0002), reflecting initial β-lactam intolerance. Conclusion No difference in clinical failure was identified in patients treated with daptomycin vs. nafcillin/cefazolin suggesting that daptomycin may serve as a non-inferior alternative for treatment of MSSA bacteremia. A higher number of AEs occurred in the daptomycin group indicating β-lactam intolerance as a primary indication for daptomycin therapy. Given the small sample size, subsequent studies are needed to further evaluate the use of daptomycin in the treatment of MSSA bacteremia. Disclosures All authors: No reported disclosures.

scholarly journals Comparison of Postoperative Bleeding in Total Hip and Knee Arthroplasty Patients Receiving Rivaroxaban, Enoxaparin, or Aspirin for Thromboprophylaxis

2018 ◽  
Vol 24 (8) ◽  
pp. 1315-1321 ◽  
Author(s):  
Desirae E. Lindquist ◽  
David W. Stewart ◽  
Aaryn Brewster ◽  
Caitlin Waldroup ◽  
Brian L. Odle ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Primary Outcome ◽  
Cohort Analysis ◽  
Postoperative Bleeding ◽  
Total Hip ◽  
Retrospective Cohort Analysis ◽  
Hip And Knee Arthroplasty ◽  
Total Knee ◽  
Pharmacologic Agents ◽  
Specific Agent

Background: Guidelines recommend the use of multiple pharmacologic agents and/or mechanical compressive devices for prevention of venous thromboembolism, but preference for any specific agent is no longer given in regard to safety or efficacy. Objective: To compare postoperative bleeding rates in patients receiving enoxaparin, rivaroxaban, or aspirin for thromboprophylaxis after undergoing elective total hip arthroplasty or total knee arthroplasty. Methods: This retrospective cohort analysis evaluated patients who received thromboprophylaxis with either enoxaparin, rivaroxaban, or aspirin. All data were collected from the electronic medical record. The primary outcome was any postoperative bleeding. Results: A total of 1244 patients were included with 366 in the aspirin, 438 in the enoxaparin, and 440 in the rivaroxaban arms. Those who received aspirin or enoxaparin were less likely to experience any bleeding compared to those patients who received rivaroxaban ( P < .05). There was also a lower rate of major bleeding in these groups, but the differences were not significant. Conclusions: Aspirin and enoxaparin conferred similar bleeding risks, and both exhibited less bleeding than patients who received rivaroxaban.

Clinical Outcomes of Patients with Type 2 Diabetes Treated with Multiple Daily Injection (MDI) of Insulin—A Retrospective Cohort Analysis

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 2273-PUB
Author(s):  
THOMAS LUDDEN ◽  
ANASTASIA ERMAKOVA ◽  
YAN XIONG ◽  
RAY SIERADZAN ◽  
NAOMI C. SACKS ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Outcomes ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Daily Injection ◽  
Multiple Daily Injection ◽  
Retrospective Cohort Analysis

scholarly journals Fluoroquinolone Versus Nonfluoroquinolone Treatment of Bloodstream Infections Caused by Chromosomally Mediated AmpC-Producing Enterobacteriaceae

Antibiotics ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 331
Author(s):  
Sarah Grace Gunter ◽  
Katie E. Barber ◽  
Jamie L. Wagner ◽  
Kayla R. Stover
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Clinical Failure ◽  
Beta Lactam ◽  
Definitive Therapy ◽  
Effective Option ◽  
Secondary Endpoints ◽  
Microbiological Cure

Objectives: Chromosomally mediated AmpC-producing Enterobacteriaceae (CAE) display high susceptibility to fluoroquinolones; minimal clinical data exist supporting comparative clinical outcomes. The objective of this study was to compare treatment outcomes between fluoroquinolone and nonfluoroquinolone definitive therapy of bloodstream infections caused by CAE. Methods: This retrospective cohort assessed adult patients with positive blood cultures for CAE that received inpatient treatment for ≥48 h. The primary outcome was difference in clinical failure between patients who received fluoroquinolone (FQ) versus non-FQ treatment. Secondary endpoints included microbiological cure, infection-related length of stay, 90-day readmission, and all-cause inpatient mortality. Results: 56 patients were included in the study (31 (55%) received a FQ as definitive therapy; 25 (45%) received non-FQ). All non-FQ patients received a beta-lactam (BL). Clinical failure occurred in 10 (18%) patients, with 4 (13%) in the FQ group and 6 (24%) in the BL group (p = 0.315). Microbiological cure occurred in 55 (98%) patients. Median infection-related length of stay was 10 (6–20) days, with a significantly longer stay occurring in the BL group (p = 0.002). There was no statistical difference in 90-day readmissions between groups (7% FQ vs. 17% BL; p = 0.387); one patient expired. Conclusion: These results suggest that fluoroquinolones do not adversely impact clinical outcomes in patients with CAE. When alternatives to beta-lactam therapy are needed, fluoroquinolones may provide an effective option.

scholarly journals 769. Comparison of Vancomycin Continuous and Intermittent Infusion Dosing Strategies Among Patients in an Outpatient Antimicrobial Therapy Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S342-S343
Author(s):  
Pegah Shakeraneh ◽  
Tarvinder S Gilotra ◽  
Dongliang Wang ◽  
Tasaduq Fazili ◽  
Jeffrey Steele ◽  
...  
Keyword(s):  
Propensity Score ◽  
Antimicrobial Therapy ◽  
Intermittent Infusion ◽  
Primary Objective ◽  
Unplanned Readmission ◽  
Clinical Failure ◽  
Exclusion Criteria ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Therapy Program ◽  
Significant Difference

Abstract Background Vancomycin may be administered via intermittent infusion (I-I) or continuous infusion (C-I). C-I vancomycin has advantages including the potential for less nephrotoxicity; however, available data are inconsistent and varies based on inpatient and outpatient settings. Thus, the primary objective of this study was to compare rates of nephrotoxicity in patients who received C-I or I-I vancomycin in an outpatient parenteral antimicrobial therapy (OPAT) program. Secondary objectives included time to onset of nephrotoxicity and clinical failure. Methods This was a single-center, propensity score-matched, retrospective cohort study of patients who received C-I or I-I vancomycin for at least one week in the OPAT program between October 1, 2017 and March 31, 2019. Exclusion criteria included patients lost to follow-up, age less than 18 years old, and those requiring renal replacement therapy. Nephrotoxicity was defined as a serum creatinine (Scr) increase of >0.5 mg/dL or >50% from baseline for two consecutive measurements. Clinical failure was defined as unplanned readmission, extension of planned therapy, or change in antibiotic therapy. Results Three hundred patients were identified who received C-I or I-I vancomycin. After propensity score matching and exclusion criteria were applied, 74 patients were included in each cohort. Demographic information was similar between cohorts including baseline Scr, age, gender, comorbidities, concurrent nephrotoxins, indication, and vancomycin duration. C-I was associated with a 3.22-fold decrease in nephrotoxicity risk when compared with I-I [C-I: 6.8% vs. I-I 18.9%; OR (95% CI): 3.22 (1.10–9.46), P =0.027]. C-I was associated with a significantly slower onset to nephrotoxicity compared with I-I (P = 0.035; Figure 1). A significant difference in clinical failure was not observed between C-I and I-I (10/74, 13.7% vs. 17/74, 23.0%; P = 0.147). Conclusion C-I vancomycin was associated with a lower nephrotoxicity risk and slower onset to nephrotoxicity, but no difference in clinical failure rates when compared with I-I. Disclosures All authors: No reported disclosures.

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