Impact of Setting up an “Endocarditis Team” on the Management of Infective Endocarditis

Abstract Background Infective endocarditis (IE) remains a severe disease with a high mortality rate. Therefore, guidelines encourage the setup of a multidisciplinary group in reference centers. The present study evaluated the impact of this “Endocarditis Team” (ET). Methods We conducted a monocentric observational study at Strasbourg University Hospital, Strasbourg, France, between 2012 and 2017. The primary end point was in-hospital mortality. Secondary end points were 6-month and 1-year mortality, surgery rate, time to surgical procedure, duration of effective antibiotic therapy, length of in-hospital stay, and sequelae. We also assessed predictors of in-hospital mortality. Results We analyzed 391 episodes of IE. In the post-ET period, there was a nonsignificant decrease in in-hospital mortality (20.3% vs 14.7%, respectively; P = .27) and sequelae, along with a significant reduction in time to surgery (16.4 vs 10.3 days, respectively; P = .049), duration of antibiotic therapy (55.2 vs 47.2 days, respectively; P < .001), and length of in-hospital stay (40.6 vs 31.9 days, respectively; P < .01). In a multivariate analysis, the post-ET period was positively associated with survival (odds ratio, 0.45; 95% confidence interval, 0.20–0.96; P = .048). Conclusions This multidisciplinary approach exerted a positive impact on the management of IE and should be considered in all hospitals managing IE.

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Development of a predictive model for hospital mortality and re-admission in a cohort of infected patients that require hospitalization

Revista Española de Quimioterapia ◽

10.37201/req/063.2020 ◽

2020 ◽

Vol 33 (5) ◽

pp. 350-357

Author(s):

Julio Villanueva ◽

Lara Montes-Andujar ◽

Orville V Baez-Pravia ◽

Eric Jorge García-Lamberechts ◽

Juan González del Castillo ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Antibiotic Therapy ◽

Predictive Model ◽

Logistic Models ◽

Admission Rate ◽

Clinical Information ◽

University Hospital ◽

Causative Microorganism ◽

The Impact

Introduction. The aims of the study were: to develop a predictive model for hospital mortality and another for hospital re-admission, to identify the impact of antibiotic delay in the mortality rate and, to report the rate of inappropriate antibiotic therapy. Material and methods. A cohort and retrospective study was conducted at the HM Sanchinarro University Hospital during the period September 1st, 2012 to March 31th, 2013. The inclusion criteria were: age> 18 years, hospital admission from the ED with a diagnosis of bacterial infection. The exclusion criteria were: suspected viral infection, negative bacteriological cultures, life expectancy less than 6 months, lack of clinical information, assistance exclusively by the trauma emergency department. Two logistic models were made (hospital mortality and hospital re-admission). Results. A total of 517 patients were included. The final mortality model (30 deaths) include the following variables: respiratory rate (OR 1.12; IC95% 1.02; 1.22), oxygen saturation (OR 0.92; IC95% 0.87; 0.98), creatinine (OR 2.33; IC95% 1.62; 3.36), COPD (OR 3.02; IC95% 1.06; 8.21), cancer (OR 3.34; IC95% 1.07; 9.98) and chemotherapy in the last 3 months (OR 4.83; IC95% 1.54; 16.41). The final model for hospital re-admission (28 re-admissions) include the following variables: hepatopathy (OR 5.51; IC95% 1.57; 16.88), GPT (OR 1.005; IC95% 1.003; 1.008), history of stroke (OR 5.06; IC95% 1.04; 18.80) and arterial hypertension (OR 3.15; IC95% 1.38; 7.56). The antibiotic therapy delays not influenced the mortality or re-admission rate. In 24.3% the causative microorganism was identified and antibiotic treatment was inappropriate 19.6%. Conclusion. Hospital mortality rate was 5.8% and readmission rate was 5.7%. Variables associated with mortality differ from those associated with re-admission. The delay in the antibiotic initiation was not associated with a deleterious effect. Antibiotic therapy was inadequate in almost 20% of patients.

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Impact of antibiotic choice on readmission in adults experiencing an acute COPD exacerbation

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa317 ◽

2020 ◽

Author(s):

Jason W Lancaster ◽

Laura McAuliffe ◽

Elizabeth O’Gara ◽

Cyrille Cornelio ◽

Jennifer Hum ◽

...

Keyword(s):

Hospital Mortality ◽

Antibiotic Therapy ◽

Hospital Stay ◽

Academic Medical Center ◽

Hospital Length Of Stay ◽

Chronic Obstructive ◽

Copd Exacerbation ◽

Readmission Rates ◽

Copd Exacerbations ◽

The Impact

Abstract Purpose The impact of antibiotic therapy in managing acute chronic obstructive pulmonary disease (COPD) exacerbations requiring hospitalization remains unclear. We conducted a study to assess the impact of antibiotic therapy on the rate of 30-day readmission after discharge from a hospital stay for an acute COPD exacerbation. Additional study outcomes analyzed included the effects of antibiotic therapy on hospital length of stay, in-hospital mortality, 90-day and 12-month readmission rates, and time to next COPD exacerbation. Methods The study was an institutional review board–approved, retrospective, observational review of adult patients at a tertiary academic medical center. The medical records of patients 18 years of age or older who were hospitalized for an acute COPD exacerbation between January 2008 and December 2014 were evaluated. Included patients were stratified by receipt of guideline-appropriate, guideline-inappropriate, or no antibiotic therapy. Nonparametric data were analyzed using the Kruskal-Wallis test (nonparametric) and categorical data via χ 2 test, respectively. Results Three hundred twenty-five subjects were included; there were no significant differences in baseline characteristics in the 3 study groups. Sixty-eight percent of patients (n = 223) received antibiotics. The percentage of patients readmitted within 30 days did not differ between cohorts: 11.9% (appropriate therapy) vs 13.2% (nonappropriate therapy) vs 12.2% (no antibiotics) (P = 0.95 for all comparisons). Additionally, no detectable differences in 90-day or 12-month readmission rate, length of hospital day, or in-hospital mortality were found. However, a trend toward increased time to next COPD exacerbation was noted in those receiving antibiotics vs no antibiotics (352 days vs 192 days, P = 0.07). Conclusion Treatment of COPD exacerbations with antibiotics did not impact readmission rates, length of hospital stay, in-hospital mortality, or time to next exacerbation. More investigation is warranted to assess the effect of antibiotics on time to next exacerbation, as well as comparative effectiveness between antibiotic classes.

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In-hospital mortality in COVID-19 vs. pre-COVID-19 era in the Split-Dalmatia County, Croatia

European Journal of Public Health ◽

10.1093/eurpub/ckab165.068 ◽

2021 ◽

Vol 31 (Supplement_3) ◽

Author(s):

I Marasovic Šušnjara

Keyword(s):

Hospital Mortality ◽

Respiratory Diseases ◽

Score Test ◽

Additional Research ◽

University Hospital ◽

Complete Picture ◽

Cross Sectional ◽

Classification Of Diseases ◽

International Statistical Classification ◽

The Impact

Abstract Background The COVID-19 pandemic marked 2020 with numerous consequences for the health of the population. Therefore, this study aimed to explore whether the COVID-19 pandemic affected in-hospital mortality. Methods We employed a cross-sectional comparative study using two different time periods, pre-COVID-19 (2019 year) and COVID-19 era (2020 year) to explore possibilities of COVID-19 influences in-hospital mortality in Split-Dalmatia County, Croatia. The research used data from the national information system on hospitalizations from the Clinical Hospital Center Split, University Hospital Split. The indicators were statistically analyzed. The z-score test for two population proportions is used. Results In 2020, there was a significantly higher in-hospital mortality compared to 2019 (z = 9.0827; p < 0.00001), which was supported by a significant increase in mortality from respiratory diseases according to the comparison of disease categories of International Statistical Classification of Diseases and Related Health Problems (ICD-10) (z = 9.0427; p < 0.00001). Within hospital departments, significantly higher mortality was in the Intensive Care Unit (z = 5.2763; p < 0.00001) and the Infectious Diseases Department (z = 9.6982; p < 0.00001). Among deaths in 2020 with confirmed COVID-19, there were significantly more positive among deaths from respiratory diseases (z=-17.4462; p < 0.00001). There was no difference in mortality rates between 2020 and 2019 by age. Conclusions The results of the study indicate that COVID-19 has a contribution to hospital mortality. Given that the pandemic has not yet completed additional research, it will be necessary to obtain a more complete picture of the impact of COVID-19 on hospital mortality in Split-Dalmatia County, as well as in other regions and countries. Key messages The results of the study indicate that COVID-19 has a contribution to hospital mortality. Given that the pandemic has not yet completed additional research, it will be necessary to obtain a more complete picture of the impact of COVID-19 on hospital mortality.

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Are Invasive Procedures and a Longer Hospital Stay Increasing the Risk of Healthcare-Associated Infections among the Admitted Patients at Hiwot Fana Specialized University Hospital, Eastern Ethiopia?

Advances in Preventive Medicine ◽

10.1155/2020/6875463 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Moti Tolera ◽

Dadi Marami ◽

Degu Abate ◽

Merga Dheresa

Keyword(s):

Cigarette Smoking ◽

Hospital Stay ◽

University Hospital ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Invasive Procedures ◽

Healthcare Associated Infection ◽

Eastern Ethiopia ◽

Healthcare Associated ◽

The Impact

Background. Healthcare-associated infection is a major public health problem, in terms of mortality, morbidity, and costs. Majorities of the cause of these infections were preventable. Understanding the potential risk factors is important to reduce the impact of these avoidable infections. The study was aimed to identify factors associated with healthcare-associated infections among patients admitted at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. Methods. A cross-sectional study was carried out among 433 patients over a period of five months at Hiwot Fana Specialized University Hospital. Sociodemographic and clinical data were obtained from a patient admitted for 48 hours and above in the four wards (surgical, medical, obstetrics/gynecology, and pediatrics) using a structured questionnaire. A multivariate logistic regression model was applied to identify predictors of healthcare-associated infections. A p value <0.05 was considered statistically significant. Results. Fifty-four (13.7%) patients had a history of a previous admission. The median length of hospital stay was 6.1 days. Forty-six (11.7%) participants reported comorbid conditions. Ninety-six (24.4%) participants underwent surgical procedures. The overall prevalence of healthcare-associated infection was 29 (7.4%, 95% CI: 5.2–10.6). Cigarette smoking (AOR: 5.18, 95% CI: 2.15–20.47), staying in the hospital for more than 4 days (AOR: 4.29, 95% CI: 2.31–6.15), and undergoing invasive procedures (AOR: 3.58, 95% CI: 1.11–7.52) increase the odds of acquiring healthcare-associated infections. Conclusion. The cumulative prevalence of healthcare-associated infections in this study was comparable with similar studies conducted in developing countries. Cigarette smoking, staying in the hospital for more than 4 days, and undergoing invasive procedures increase the odds of healthcare-associated infections. These factors should be considered in the infection prevention and control program of the hospital.

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Epidemiology and Clinical Outcome of Patients Hospitalized With Pelvic Inflammatory Disease Complicated by Tubo-Ovarian Abscess

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s1064744995000470 ◽

1995 ◽

Vol 3 (4) ◽

pp. 135-139 ◽

Cited By ~ 7

Author(s):

Ying Chan ◽

Winsome Parchment ◽

Joan H. Skurnick ◽

Laura Goldsmith ◽

Joseph J. Apuzzio

Keyword(s):

Clinical Outcome ◽

Antibiotic Therapy ◽

Pelvic Inflammatory Disease ◽

Inflammatory Disease ◽

Surgical Intervention ◽

Severe Disease ◽

University Hospital ◽

Hospital Stays ◽

Wbc Count ◽

Ovarian Abscess

Objective: The purpose of this retrospective study was to compare the clinical outcome and characteristics of pelvic inflammatory disease (PID) complicated by tubo-ovarian abscess (TOA) with PID without TOA.Methods: Chart reviews were performed for all PID admissions to the University of Medicine and Dentistry of New Jersey-University Hospital, Newark, NJ, from January 1, 1992, to December 31, 1993.Results: The incidence in this study of TOA based on sonographic evidence of a complex adnexal mass was 18%. The major differences between the patients with and without TOAs were 1) history of hospitalization for PID: 68% (13/19) vs. 29% (25/85); 2) increased erythrocyte sedimentation rate: 82 vs. 41 mm/h; 3) increased WBC count on admission: 16,200 vs. 14,700/ml; 4) failure to respond to initial antibiotic therapy; and 5) longer hospital stay: 7.8 vs. 4.4 days, respectively. Surgical intervention was required in 3 patients: 2 patients who had TOAs and 1 patient who did not have a TOA by clinical examination or by ultrasound.Conclusions: Despite longer hospital stays and blood tests suggesting more severe disease processes, PID complicated by TOA is usually responsive to intravenous (IV) antibiotic therapy without the need for surgical intervention.

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Immediate tonsillectomy: indications for use as first-line surgical management of peritonsillar abscess (quinsy) and parapharyngeal abscess

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000903 ◽

2010 ◽

Vol 124 (10) ◽

pp. 1085-1090 ◽

Cited By ~ 11

Author(s):

C Page ◽

G Chassery ◽

P Boute ◽

R Obongo ◽

V Strunski

Keyword(s):

Antibiotic Therapy ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Complete Recovery ◽

Neck Surgery ◽

Peritonsillar Abscess ◽

University Hospital ◽

First Line ◽

Parapharyngeal Abscess ◽

Immediate Tonsillectomy

AbstractObjectives:This study was designed to evaluate the efficacy and morbidity of immediate tonsillectomy used to treat peritonsillar abscess (quinsy) and parapharyngeal abscess.Subjects and method:This four-year, retrospective study was based on 31 patients hospitalised in a university hospital ENT and head and neck surgery department for peritonsillar and/or parapharyngeal abscess. All patients underwent immediate, bilateral tonsillectomy. The length of hospital stay, duration of antibiotic therapy, microbiological findings, complications, and the time to complete recovery and oropharyngeal healing were recorded.Results:The patients' mean post-tonsillectomy hospital stay was 2.84 days (median: 3 days). No post-operative haemorrhage was observed. All patients were considered to be cured at the day 10 follow-up visit, and complete oropharyngeal healing was observed at the day 21 visit. The duration of antibiotic therapy ranged from 10 to 15 days (mean: 11.5 days; median: 10 days).Discussion and conclusion:Immediate tonsillectomy appears to be a safe and effective surgical technique for the management of peritonsillar and parapharyngeal abscess; in particular, it markedly reduces patients' hospital stay (when performed early in the course of the disease) and duration of antibiotic therapy. Immediate tonsillectomy has become the first-line treatment for parapharyngeal abscess and several types of peritonsillar abscess in our department.

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The impact of diabetes on outcomes, length of stay and costs in acute kidney injury patients: a cross-sectional multicenter study in China

10.21203/rs.3.rs-16071/v1 ◽

2020 ◽

Author(s):

Lishan Tan ◽

Li Chen ◽

Lingyan Li ◽

Jinwei Wang ◽

Xiaoyan Huang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Length Of Stay ◽

Hospital Mortality ◽

Hospital Stay ◽

Kidney Injury ◽

Renal Recovery ◽

Cross Sectional ◽

Patients With Diabetes ◽

The Impact ◽

Physician Diagnosis

Abstract Background : With the increasing worldwide prevalence and disease burden of diabetic mellitus, data on the impact of diabetes on acute kidney injury (AKI) patients in China are limited.Methods: A nationwide cross-sectional and retrospective study was conducted in China, which included 2,223,230 hospitalized adult patients and covered 82% of the country’s population. Diabetes was identified according to blood glucose, hemoglobin A1c levels, physician diagnosis and drug use. In total, 7604 AKI patients were identified, and 1404 and 6200 cases were defined as diabetic and non-diabetic respectively. Clinical characteristics, outcome, in-hospital stay, and costs of AKI patients with and without diabetes were compared. Multivariable logistic and linear regression analyses were conducted to evaluate the association of diabetes with mortality and renal recovery in the admitted AKI patients.Results: In this survey, AKI patients with diabetes were older, male-dominated (61.9%), with more comorbidities, and higher serum creatinine levels. Compared to patients without diabetes, a significant upswing in all-cause in-hospital mortality, hospital stay, and costs were found in those with diabetes ( p <0.05). After adjusted for relevant covariables, diabetes was independently associated with failed renal recovery (OR=1.13, p =0.04), rather than all-cause in-hospital mortality (OR=1.09, p =0.39). Also, diabetic status was positively associated with length of stay ( β =0.04, p =0.04) and costs ( β =0.09, p <0.01) in hospital after adjusted for possible confounders. Conclusions: Failed renal recovery, rather than all-cause in-hospital mortality, is independently associated with diabetes in hospitalized AKI patients. Moreover, diabetes is significantly correlated with in-hospital stay and expenditures in AKI.

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The Positive Impact of Pharmacist Interventions Using Educational Video Technology on Patient Knowledge of and Satisfaction with Warfarin Therapy

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i3.2351 ◽

2020 ◽

Vol 11 (3) ◽

pp. 2778-2789

Author(s):

Sireen A. R. Shilbayeh ◽

Abrar F. Al-Qarni ◽

Malak M. Al-Turki ◽

Meshael N. Al-Nuwisser ◽

Ohud A. Al-Nuwaysir ◽

...

Keyword(s):

Warfarin Therapy ◽

Positive Impact ◽

University Hospital ◽

Knowledge Assessment ◽

Patient Knowledge ◽

Educational Video ◽

Pharmacist Interventions ◽

Post Test ◽

The Impact

To assess the positive impact of pharmacist interventions via an educational video on patients’ knowledge of and satisfaction with warfarin therapy . This study used a prospective pre-test/post-test design that enrolled 91 patients from an anticoagulant clinic at King Khaled University Hospital in Riyadh, Saudi Arabia. All patients completed the Anticoagulation Knowledge Assessment (AKA) and Anti-Clot Treatment Satisfaction (ACTS) scales. Afterwards, the patients watched a 10-minute educational video containing basic information about warfarin and were given relevant informative booklets. The patients were reassessed after a mean follow-up period of approximately 52 days. In total, 85 patients completed the study. The impact of the intervention on patient knowledge was highly significant (mean difference=17.7%, 95% CI = 21.75-13.58, P.

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A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19

10.1101/2020.07.08.20148965 ◽

2020 ◽

Author(s):

Rosita Zakeri ◽

Rebecca Bendayan ◽

Mark Ashworth ◽

Daniel M Bean ◽

Hiten Dodhia ◽

...

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Hospital Admission ◽

Conditional Logistic Regression ◽

Severe Disease ◽

Case Control ◽

Ethnic Background ◽

Asian Ethnicity ◽

The Impact ◽

The Relationship

Background. People of minority ethnic background may be disproportionately affected by severe COVID-19 for reasons that are unclear. We sought to examine the relationship between ethnic background and (1) hospital admission for severe COVID-19; (2) in-hospital mortality. Methods. We conducted a case-control study of 872 inner city adult residents admitted to hospital with confirmed COVID-19 (cases) and 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people resident in the same region. To examine in-hospital mortality, we conducted a cohort study of 1827 adults consecutively admitted with COVID-19. Data collected included hospital admission for COVID-19, demographics, comorbidities, in-hospital mortality. The primary exposure variable was self-defined ethnicity. Results. The 872 cases comprised 48.1% Black, 33.7% White, 12.6% Mixed/Other and 5.6% Asian patients. In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3.12 [95% CI 2.63-3.71] and 2.97 [2.30- 3.85] respectively). Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2.28 [1.87-2.79] for Black, 2.66 [2.01-3.52] for Mixed/Other). Asian ethnicity was not associated with higher admission risk (OR 1.20 [0.86-1.66]). In the cohort study of 1827 patients, 455 (28.9%) died over a median (IQR) of 8 (4-16) days. Age and male sex, but not Black (adjusted HR 0.84 [0.63-1.11]) or Mixed/Other ethnicity (adjusted HR 0.69 [0.43-1.10]), were associated with in-hospital mortality. Asian ethnicity was associated with higher in-hospital mortality (adjusted HR 1.54 [0.98-2.41]). Conclusions. Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease. Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role. The impact of COVID-19 may be different in Asians.

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Obesity as a Risk Factor Among Hospitalized Patients with Infective Endocarditis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz390 ◽

2019 ◽

Vol 6 (10) ◽

Cited By ~ 1

Author(s):

Ché Matthew Harris ◽

Aiham Albaeni ◽

Scott Wright ◽

Keith C Norris

Keyword(s):

Regression Analysis ◽

Infective Endocarditis ◽

Hospital Mortality ◽

Multivariate Regression Analysis ◽

Hospitalized Patients ◽

Hospital Charges ◽

Total Hospital ◽

Charlson Comorbidity Score ◽

Hospital Resources ◽

The Impact

Abstract Objective Obesity contributes to diagnostic and management challenges for many hospitalized patients. The impact of obesity on in-hospital outcomes in patients with infective endocarditis has not been studied and was the focus of this investigation. Method We used the 2013 and 2014 Nationwide Inpatient Sample to identify adults ≥18 years of age with a principle diagnosis of endocarditis. We divided the sample into 2 groups based on presence of absence of obesity. Multivariate linear and logistic regression analysis was used to compare in-hospital mortality, valvular replacement, length of stay (LOS), and hospitalization charges. Results A total of 24 494 adults 18 years and older were hospitalized with infective endocarditis, of which 2625 were classified as obese. Patients with obesity were older (mean age, 57.8 ± 0.3 vs 54.3 ± 0.6 years; P < .01), more likely to be female (50.1% vs 36.1%; P < .01), and had more comorbidities (Charlson comorbidity score ≥ 3, 50.6% vs 28.8%; P < .01). Multivariate regression analysis found no differences between the 2 groups for mortality or repairs or replacements for any valve. On evaluation of resource utilization, patients with obesity had longer average LOS (13.9 days; confidence interval [CI], 12.7–15.1 vs 12.4 days; CI, 12.0–12.8; P = .016) and higher total hospital charges (US $160 789.90; CI, $140.922.40–$180 657.50 vs US $130 627.20; CI, $123 916.70–$137 337.70; P <.01). After adjustment for LOS for total hospital charges, there was no observed difference $11436.26 (CI, -$6649.07–$29521.6; P = .22). Conclusions . Obesity does not significantly impact in-hospital mortality or surgical valvular interventions among patients hospitalized with infective endocarditis, but obesity is associated with increased utilization of hospital resources.

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