scholarly journals 1709. Epidemiology of Invasive Fungal Infection (IFI) after Severe Influenza Requiring Intensive Care Unit (ICU) Admission: 10-Year Experience at a Tertiary Care Center in the United States

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S627-S627
Author(s):  
J Alex Viehman ◽  
Penny Sappington ◽  
Erin K McCreary ◽  
Rachel V Marini ◽  
Ryan K Shields ◽  
...  
Keyword(s):  
United States ◽  
Influenza A ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Fungal Colonization ◽  
Clinical Practices ◽  
Icu Admission ◽  
Severe Influenza ◽  
Colonization Rates

Abstract Background Despite increasing recognition of aspergillosis complicating severe influenza and its associated high fatality in Europe, incidence and features of the disease in the United States are unknown. Methods We reviewed all influenza cases requiring ICU admission from 2009 to 2019 at our center. Results 262 patients with influenza required ICU admission. 4% (10) developed IFI at median 2d after influenza diagnosis. 80% (8/10) of patients with IFI were infected with influenza A vs. 88% (221/252) without IFI. 20% were on steroids at the time of IFI diagnosis. 70% of IFI required mechanical ventilation. Types of IFI were pneumonia (70%, 6 Aspergillus and 1 Wangiella), endobronchial IFI (20%, 1 each with Aspergillus and Lictheimia), and Coccidioides fungemia (10%). 4% (10) of patients were fungal colonized, but did not have IFI (5 A. fumigatus, 1 A. terreus, 4 Penicillium). CT findings of IFI included nodules (4), cavitation (3), and ground-glass opacities (2). Serum galactomannan (GM) was positive in 3 (43%). Median time to antifungal therapy (AF) was 2 days. Triazoles were prescribed to all 7 patients with aspergillosis. Posaconazole and amphotericin B were AF for patients with Wangiellaand Lichteimia, respectively. Patients with C. immitis fungemia died before AF. Median duration of AF was 60 days among survivors. Patients with IFI required acute hemodialysis more frequently than colonized patients (60% vs. 0%, P = 0.01). 30-day mortality was 60% (6/10) and 20% 92/10) in patients with IFI and colonization, respectively (P = 0.2). Patients with IFI had significantly higher in-hospital and 60-day mortality than those without IFI (Fig 1, P = 0.009). Conclusion Our rate of post-influenza IFI (4%) was lower than reported in Europe (~15%), which might stem from a lack of systematic BAL GM testing at our center, over-reliance on GM to make diagnoses in Europe, and/or differences in pt populations and clinical practices in treating severe influenza. IFI and fungal colonization rates were similar at our center, highlighting the importance of using well-defined criteria to define disease. Given the high mortality of post-influenza IFI, priority should be given to defining risk factors that might identify patients for targeted AF prophylaxis. In using AF, it is important to recognize that Aspergillus is not the only cause of IFI. Disclosures All authors: No reported disclosures.

Dupilumab drug survival, treatment failures, and insurance approval at a tertiary care center in the United States

2020 ◽  
Vol 82 (4) ◽  
pp. 1023-1024 ◽  
Author(s):  
Hasan Khosravi ◽  
Sophia Zhang ◽  
Alyce M. Anderson ◽  
Laura K. Ferris ◽  
Sonal Choudhary ◽  
...  
Keyword(s):  
United States ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Tertiary Care Center ◽  
Drug Survival ◽  
Insurance Approval

Demographics and disease processes of patients seeking second medical hematology/oncology opinions at a tertiary care center in the United States

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16018-16018
Author(s):  
K. K. Curtis ◽  
D. W. Northfelt
Keyword(s):  
United States ◽  
Clinical Benefit ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
The United States ◽  
Lymphocytic Leukemia ◽  
Tertiary Care Center ◽  
Data Set ◽  
Related Information

16018 Background: Second opinions (SO) are common in medical practice. Aside from case series, little evidence exists to demonstrate a clinical benefit associated with SO. Lack of relevant data limits knowledge of numbers of patients, diseases, and motivations of SO seekers. Within the field of medical hematology/oncology (H/O), no specific demographic data are available to characterize patients seeking SO in the United States. Methods: To typify such patients at Mayo Clinic in Arizona (MCA), we recorded demographic and disease-related information for patients seeking these evaluations over a six month period from 1/1 through 6/30/05. Results: A total of 683 patients contacted MCA for medical H/O SO over the 6 month study period. A complete set of demographic and disease-related information was obtained from 655 patients; the remainder were excluded from the data set. Demographically, the majority of patients were female (53%), married (66%), and lived nearby (i.e., from Arizona-58%, or bordering state-22%). Average age was 62.3 years. Among oncologic diagnoses, the majority of patients (60% of 374 reported oncologic diagnoses) stated a diagnosis of breast, lung, colorectal, pancreatic or prostate cancer. Approximately 1/3 of patients had metastatic disease at the time they sought evaluation at MCA. There were 278 patients seeking evaluation for hematologic abnormalities, with the majority (160 patients, 58%) seeking evaluation for non-malignant conditions. Of those with malignancies, lymphoma (including Hodgkin and non-Hodgkin) was the most common (45%), followed by multiple myeloma (21%) and chronic lymphocytic leukemia (15%). Conclusions: This study provides insight into demographics and disease processes of patients seeking medical H/O SO at a tertiary care center in the United States. Although no definite conclusions can be drawn about motivations for seeking H/O SO, future research should examine patient motivation to better understand factors leading to this behavior. Given a lack of evidence for clinical benefit associated with SO seeking, and its potential costliness, better knowledge of demographic and motivational factors may allow for a more constructive approach to be taken toward the needs of SO seekers. No significant financial relationships to disclose.

scholarly journals Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United States

2009 ◽  
Vol 181 (3) ◽  
pp. 993-997 ◽  
Author(s):  
R. Houston Thompson ◽  
Matt Kaag ◽  
Andrew Vickers ◽  
Shilajit Kundu ◽  
Melanie Bernstein ◽  
...  
Keyword(s):  
United States ◽  
Partial Nephrectomy ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Tertiary Care Center

scholarly journals Prevalence of Carbapenem-Resistant Enterobacteriaceae (CRE) at a Tertiary-Care Center in the United States

2020 ◽  
Vol 41 (S1) ◽  
pp. s494-s495
Author(s):  
Diane Heipel ◽  
Yvette Major ◽  
Carli Viola-Luqa ◽  
Michelle Elizabeth Doll ◽  
Michael Stevens ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Infection Prevention ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Point Prevalence ◽  
Prevalence Survey ◽  
Icu Patients ◽  
Point Prevalence Survey

Background: Quantification of the magnitude of CRE both within a facility and regionally poses a challenge to healthcare institutions. Periodic point-prevalence surveys are recommended by the CDC CRE tool kit as a facility-level prevention strategy. A 2016 point-prevalence survey of 2 high-risk units at a tertiary-care center in the United States for CRE colonization found that all patients surveyed were negative for CRE. The infection prevention (IP) team repeated the study in 2019 to reassess the prevalence of CRE in the healthcare facility. Methods: A point-prevalence survey was performed in November 2019 on the same 2 high-risk units surveyed in 2016. A perirectal flocked swab was collected from all patients unless a patient refused and/or a contraindication to rectal swab was present. Swabs were inoculated onto HardyChrom TM CRE agar for incubation in ambient air at 35°C for 24 hours. Organism identification was performed using MALDI-TOF mass spectrometry on a MBT Smart by Bruker. Results: None of the patients on either high-risk unit was known to be colonized or infected with CRE at the time of the point-prevalence survey. Of 41 perirectal swabs collected, 4 (9.8%) were positive for CRE. None (0 of 20) were surgical ICU patients and 4 of 21 (19%) were medical ICU patients. All positive swabs revealed different organisms identified as follows: Escherichia coli, Enterobacter cloacae, Enterobacter kobai, and Enterobacter aerogenes. All 4 positive patients had had recent contact with multiple acute-care hospitals. Also, 2 had been transferred for liver transplant evaluation. None of these patients had received a carbapenem during their admission to the facility. Conclusion: CRE are increasingly identified in healthcare centers in the United States. Centers previously classified as low prevalence will need to maintain preventive strategies to limit transmission risks as colonized patients arrive in the facility for care. Adoption of a robust horizontal infection prevention program may be an effective strategy to avoid the spread of CRE.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

scholarly journals Correlation of coagulation parameters with clinical outcomes in Coronavirus-19 affected minorities in United States: Observational cohort

2020 ◽  
Author(s):  
Morayma Reyes Gil ◽  
Jesus D. Gonzalez-Lugo ◽  
Shafia Rahman ◽  
Mohammad Barouqa ◽  
James Szymanski ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Care Center ◽  
Tertiary Care ◽  
Laboratory Data ◽  
The United States ◽  
Illness Severity ◽  
Retrospective Case ◽  
Coagulation Parameters ◽  
D Dimer

ABSTRACTImportanceCOVID-19 has caused a worldwide illness and New York has become the epicenter of COVID-19 in the United States. Currently Bronx has the highest prevalence per capita in New York.ObjectiveTo investigate the coagulopathic presentation of COVID and its natural course and to investigate whether hematologic and coagulation parameters can be used to assess illness severity and death.DesignRetrospective case study of positive COVID inpatients between 3/20/2020-3/31/2020.SettingMontefiore Health System main hospital, Moses, a large tertiary care center in the Bronx.ParticipantsAdult inpatients with positive COVID tests hospitalized at MHS.Exposure (for observational studies)Datasets of participants were queried for physiological, demographic (age, sex, socioeconomic status and self-reported race and/or ethnicity) and laboratory data.Main Outcome and MeasuresRelationship and predictive value of measured parameters to mortality and illness severity.ResultsOf the 217 in this case review, 70 died during hospitalization while 147 were discharged home. Only the admission PT and first D-Dimer could very significantly differentiate those who were discharged alive and those who died. Logistic regression analysis shows increased odds ratio for mortality by first D-Dimer within 48 hrs. of admission. The optimal cut-point for the initial D-Dimer to predict mortality was found to be 1.65 μg/mLConclusionsWe describe here a comprehensive assessment of hematologic and coagulation parameters in COVID and examine the relationship of these to mortality. We demonstrate that both initial and maximum D-Dimer values are biomarkers that can be used for survival assessments.

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