1042. Stenotrophomans maltophilia Bacteremia, A 10-Year Tertiary Center Experience

Abstract Background Stenotrophomonas maltophilia is a hospital acquired infection that is associated with high morbidity and mortality. There has been a reported rise in S. maltophilia infections, presumed secondary to the increase in the population at risk. Methods We retrospectively reviewed all hospitalized adult patients in Mayo Clinic, MN with S. maltophilia bacteremia from January 2008 through January 2018. We analyzed patient population and described patients at risk, sources of infection, and changes in antimicrobial susceptibility profile. Results A total of 94 patients were analyzed, including 52 males, median age of 56 (46–65.75 IQR). The population included 60 infections in those with malignancies and 30 infections in transplant recipients. At presentation, 58 (61.7%) were febrile, while 54 (58.1%) presented with hemodynamic instability. Majority (70.2%) received broad-spectrum antimicrobials within 2 weeks of presentation. The most common source was catheter associated infection (n = 60), 15 cases were secondary to gastrointestinal, and 9 due to a pulmonary source. Almost half, 46 (48.9%) required ICU admission. Two patients were diagnosed with endocarditis. Most isolates, 61(64.9%), were resistant to ceftazidime, 2 (2.2%) resistant to TMP/SMX and 20 (21.5%) were resistant to levofloxacin. Exposure to a quinolone in the 30 days prior to presentation did not impact fluoroquinolone resistance. Five patients were exposed to Trimethoprim/Sulfamethoxazole (TMP/SMX) in the 30 days prior to presentation, which was associated with higher rate of TMP/SMX resistance compared with those without exposure (80% vs. 98.8%, P = 0.004). Treatment options commonly included combination therapy, and TMP/SMX was a primary agent used in the majority, 59 (62.8%). All-cause in-hospital mortality was 26.6%. All-cause mortality was lower for line associated infections (16.67%) vs. other sources (44.12%) with P = 0.0038. Conclusion S. maltophilia bacteremia should be considered in hospitalized patients with recent use of broad-spectrum antibiotics. Although TMP/SMX continues to have reliable activity, use of empiric ceftazidime pending susceptibility testing should be avoided as trend toward increasing resistance is noted. We noted a drop in TMP/SMX susceptibility in those with recent reported TMP/SMX use. Disclosures All authors: No reported disclosures.

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Stenotrophomonas Bacteremia Antibiotic Susceptibility and Prognostic Determinants: Mayo Clinic 10-Year Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa008 ◽

2020 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

Ahmed M Hamdi ◽

Madiha Fida ◽

Omar M Abu Saleh ◽

Elena Beam

Keyword(s):

At Risk ◽

Common Source ◽

High Morbidity ◽

Population At Risk ◽

The Past ◽

Source Of Infection ◽

Risk Sources ◽

Sources Of Infection ◽

Susceptibility Profiles ◽

Hospital Acquired

Abstract Background Stenotrophomonas maltophilia is a gram-negative, opportunistic infection that is usually hospital-acquired and associated with high morbidity and mortality. The reported increase in S. maltophilia infections is presumed to be due to an increase in the population at risk. Methods We retrospectively reviewed 10-year data for S. maltophilia bacteremia in hospitalized adults at our institution to determine the population at risk, sources of infection, common complications, antimicrobial susceptibility profiles, and clinical outcome trends over the past decade. Results Among the 98 patients analyzed, the most common source of infection was catheter-related (62, 63.3%). Most isolates (61, 65%) were resistant to ceftazidime; fewer were resistant to trimethoprim-sulfamethoxazole (TMP-SMX; 2, 2.1%) and levofloxacin (22, 23.4%). All-cause in-hospital mortality was 29.6% (29 patients). The highest mortality, 53.8%, was observed in pulmonary sources of bacteremia. Conclusions Although TMP-SMX continues to have reliable activity in our cohort, we noted resistance to TMP-SMX in patients with recent TMP-SMX exposure, including a case with developing resistance to TMP-SMX while on therapy.

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Surgical Management of Non-Malignant Esophageal Perforations: A Single-Center Analysis Over a 15-Year Period

Digestive Surgery ◽

10.1159/000504342 ◽

2019 ◽

Vol 37 (4) ◽

pp. 302-311

Author(s):

Karl-Frederick Karstens ◽

Eugen Bellon ◽

Michael Tachezy ◽

Jakob R. Izbicki ◽

Tarik Ghadban ◽

...

Keyword(s):

Surgical Management ◽

Treatment Options ◽

Multivariate Logistic Regression Analysis ◽

Critically Ill Patient ◽

High Morbidity ◽

Asa Score ◽

Septic Focus ◽

Tertiary Center ◽

Esophageal Perforations ◽

The Impact

Purpose: Esophageal perforations are associated with high morbidity and mortality. Different nonoperative and operative treatment options have been proposed. This study focuses on the impact of different surgical treatments in nonmalignant esophageal perforations and tries to identify predictors of mortality in a single tertiary center over a 15-year period. Methods: From 2002 to 2017, patients with surgically managed esophageal perforation were identified from our database. Patients with esophageal malignancies were excluded. Etiology, clinical data, treatment, and outcome were analyzed. A multivariate logistic regression analysis was performed to investigate the impact on mortality. Results: A total of 72 patients were identified. The majority of perforations were iatrogenic (54.2%) followed by Boerhaave’s syndrome (23.6%). Most ruptures were found in the distal third of the esophagus (59.7%) measuring <3 cm (61.1%). Patients were treated with exploration and drainage (8.3%), primary suture and patch reinforcement (36.1%), resection and restoration of continuity (25.0%), or resection without restoration of continuity (30.6%). Delayed therapy significantly correlated with sepsis (p < 0.0001) and mortality (p = 0.032). A correlation between an increasing perforation length with sepsis (p = 0.012) was observed. A higher Perforation Severity Score (PSS; OR 4.430; 95% CI 1.143–17.174; p = 0.031) and a higher American Society of Anesthesiologists (ASA) score (OR 2.923; 95% CI 1.011–8.448; p = 0.048) were associated with mortality in multivariate analysis. Conclusion: Esophageal perforations are associated with high mortality, and larger ruptures are associated with worse outcome. Rapid diagnosis and treatment are crucial for patient survival. Hence, PSS and ASA score help to identify high-risk patients. The advantage of surgical management lies in the rapid control of the septic focus in an already critically ill patient. Though, the kind of surgical technique needs to be adjusted to the individual situation.

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Patient and caregiver perspectives on a tool to identify undiagnosed dementia: A qualitative study

10.21203/rs.3.rs-513568/v1 ◽

2021 ◽

Author(s):

Lorella Palazzo ◽

Clarissa Hsu ◽

Deborah Barnes ◽

Marlaine Figueroa-Gray ◽

Mikael Anne Greenwood-Hickman ◽

...

Keyword(s):

At Risk ◽

Treatment Options ◽

Improve Patient Care ◽

Dementia Diagnosis ◽

Kaiser Permanente ◽

Team Members ◽

Dementia Risk ◽

Patients At Risk ◽

Improve Patient

Abstract BACKGROUND Early detection of dementia may improve patient care and quality of life, yet as many as half of patients are undiagnosed. Electronic health record (EHR) data could potentially be used to help to identify patients at risk of having undiagnosed dementia who could be targeted for outreach and assessment, but acceptability to patients and caregivers is unknown. METHOD We conducted five focus groups at Kaiser Permanente Washington, an integrated healthcare system in Washington State, to explore feelings about timing of dementia diagnosis, use of EHR-33 based tools to predict risk of undiagnosed dementia, and communication about risk. Two team members analyzed transcripts using inductive thematic coding. RESULTS Participant groups included: patients with dementia or mild cognitive impairment, patients with neither diagnosis, and caregivers. People who were non-white or Hispanic were oversampled. Forty patients and caregivers (63% women; 59% non-white/Hispanic) participated in focus 39 groups. Participants supported early diagnosis, describing benefits such as time to adjust to the disease, plan, involve caregivers, and identify resources. They also acknowledged the possible psychosocial toll of receiving the diagnosis. Participants also supported use of an EHR-based tool, but some worried about accuracy and privacy. Participants emphasized that information about dementia risk should be communicated thoughtfully by a trusted provider and should include advice about prognosis, treatment options and other resources. CONCLUSION Overall, patients and caregivers supported using EHR-based tools to help identify patients at risk of having undiagnosed dementia. Such tools must be implemented carefully to address concerns and ensure patients and caregivers are adequately supported.

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Renal protection in cardiovascular surgery

F1000Research ◽

10.12688/f1000research.7348.1 ◽

2016 ◽

Vol 5 ◽

pp. 331 ◽

Cited By ~ 3

Author(s):

Nora Di Tomasso ◽

Fabrizio Monaco ◽

Giovanni Landoni

Keyword(s):

At Risk ◽

Renal Damage ◽

Scientific Evidence ◽

Fluid Management ◽

Kidney Injury ◽

Hemodynamic Instability ◽

Major Surgery ◽

Renal Protection ◽

Patients At Risk ◽

Risk Patients

Acute kidney injury (AKI) is one of the most relevant complications after major surgery and is a predictor of mortality. In Western countries, patients at risk of developing AKI are mainly those undergoing cardiovascular surgical procedures. In this category of patients, AKI depends on a multifactorial etiology, including low ejection fraction, use of contrast media, hemodynamic instability, cardiopulmonary bypass, and bleeding. Despite a growing body of literature, the treatment of renal failure remains mainly supportive (e.g. hemodynamic stability, fluid management, and avoidance of further damage); therefore, the management of patients at risk of AKI should aim at prevention of renal damage. Thus, the present narrative review analyzes the pathophysiology underlying AKI (specifically in high-risk patients), the preoperative risk factors that predispose to renal damage, early biomarkers related to AKI, and the strategies employed for perioperative renal protection. The most recent scientific evidence has been considered, and whenever conflicting data were encountered possible suggestions are provided.

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COMPLICATIONS AFTER PARTIAL, TOTAL OR EXTENDED SACRECTOMY: A CASE SERIES

Coluna/Columna ◽

10.1590/s1808-185120212003235738 ◽

2021 ◽

Vol 20 (3) ◽

pp. 229-231

Author(s):

DANILO DE SOUZA FERRONATO ◽

MAURO COSTA MORAIS TAVARES JUNIOR ◽

DOUGLAS KENJI NARAZAKI ◽

CESAR SALGE GHILARDI ◽

WILLIAM GEMIO JACOBSEN TEIXEIRA ◽

...

Keyword(s):

Perioperative Complications ◽

Case Series ◽

Hemodynamic Instability ◽

Spinal Tumors ◽

Posterior Fixation ◽

High Morbidity ◽

Hospitalization Time ◽

Case Series Study ◽

Tertiary Center ◽

The Mean

ABSTRACT Objective The aim of this study was to conduct a survey of the different complications of partial, total or extended sacrectomy for the treatment of spinal tumors. Method This study is a descriptive analysis of medical records from a series of 18 patients who underwent sacrectomy between 2010 and 2019 at a tertiary center specializing in spinal tumor surgeries. The variables analyzed were sex, age, hospitalization time, oncologic diagnosis, posterior fixation pattern, rate of complications, and Frankel, ASA and ECOG scales. Results Of the 18 patients, 10 (55.5%) were male and 8 (44.5%) were female, and the mean age was 48 years. The mean hospitalization time was 23 days. Of the 18 patients, 8 (44.5%) contracted postoperative infections requiring surgery. Perioperative complications included liquoric fistula (22.25%), hemodynamic instability requiring vasoactive drugs in the immediate postoperative period (22.25%), wound dehiscence (11.1%), acute obstructive abdomen (11.1%), occlusion of the left external iliac artery (11.1%), immediate postoperative death due to acute myocardial infarction (11.1%), and intraoperative death due to hemodynamic instability (11.1%). Conclusions Partial, total or extended sacrectomy is a complex procedure with high morbidity and mortality, even in centers specializing in the treatment of spinal tumors. Level of evidence IV; case series study.

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Carbapenem-Resistant Enterobacteriaceae: Occult Threat in the Intensive Care Unit

Critical Care Nurse ◽

10.4037/ccn2014602 ◽

2014 ◽

Vol 34 (5) ◽

pp. 44-51 ◽

Cited By ~ 4

Author(s):

Ranae M. Zurawski

Keyword(s):

At Risk ◽

Intensive Care ◽

Control Measures ◽

Microbial Colonization ◽

Causative Organism ◽

High Morbidity ◽

Prevention Measures ◽

Carbapenem Resistant ◽

Patients At Risk ◽

Carbapenem Resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae are a group of virulent, drug-resistant gram-negative bacteria that are increasingly the cause of infection. Such infections are associated with a high morbidity and mortality and increased health care costs. Management of these infections requires recognition of patients at risk for multidrug-resistant microbial colonization and infections, identification of the causative organism, and rapid, appropriate treatment. Lack of awareness of proper isolation of patients harboring these organisms and delay in prescribing antibiotics such as tigecycline and polymyxins contribute to the spread of infection in intensive care units. Surveillance and infection control measures are paramount in preventing outbreaks of infection caused by carbapenem-resistant Enterobacteriaceae. Critical care nurses are in a vital position to monitor patients at risk for such infections and to promote infection prevention measures.

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Tumor Lysis Syndrome in Patients with Hematological Malignancies

Journal of Oncology ◽

10.1155/2017/9684909 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 15

Author(s):

Yohannes Belay ◽

Ketsela Yirdaw ◽

Bamlaku Enawgaw

Keyword(s):

At Risk ◽

Hematological Malignancies ◽

Treatment Options ◽

Tumor Lysis Syndrome ◽

Cochrane Library ◽

Risk Level ◽

Tumor Lysis ◽

Metabolic Complication ◽

Prevention And Treatment ◽

Patients At Risk

Tumor lysis syndrome is a metabolic complication that may follow the initiation of cancer therapy. It commonly occurs in hematological malignant patients particularly non-Hodgkin’s lymphoma and acute leukemia due to chemotherapy or spontaneously. It is characterized by a biochemical abnormality such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia and its clinical outcome is directly related to these biochemical abnormalities. Prevention and treatment of tumor lysis syndrome depend on immediate recognition of patients at risk. Therefore, identifying patients at risk and prophylactic measures are important to minimize the clinical consequences of tumor lysis syndrome. Patients with low risk should receive hydration and allopurinol. On the other hand patients with high risk should receive hydration and rasburicase in an inpatient setting. It is important to start therapy immediately, to correct all parameters before cancer treatment, to assess risk level of patients for TLS, and to select treatment options based on the risk level. In this review a comprehensive search of literatures was performed using MEDLINE/PubMed, Hinari, the Cochrane library, and Google Scholar to summarize diagnostic criteria, incidence, predicting factors, prevention, and treatment options for tumor lysis syndrome in patients with hematological malignancies.

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