2411. One Dose Vancomycin Prophylaxis for In-Hospital Clostridioides difficile - Associated Disease

Abstract Background Clostridioides difficile - associated disease (CDAD) is the most common cause of healthcare-associated diarrhea with increasing prevalence and mortality rates. Recent reports suggest that prophylactic administration of vancomycin or fidaxomicin might reduce in-hospital CDAD incidence. The aims of this study were to examine whether primary oral vancomycin prophylaxis (OVP) reduces the in-hospital incidence of CDAD in elderly patients treated with systemic antibiotics and its impact on 90-day readmission rate. Methods This single-center, retrospective cohort study included 484 patients ≥ 65 years who received antimicrobial therapy for ≥ 24 hours and were hospitalized for ≥ 72 hours during a 24-month period. Patients diagnosed with CDAD within the first 48 hours of hospitalization were excluded. OVP group received ≥ 1 dose of vancomycin 125 mg once per day. Results Patients within OVP group (122; 25.2%) had higher age adjusted Charlson comorbidity index (CCI) (8; IQR 6–10 vs. 6; 5–8), were more often hospitalized within 3 months (62; 50.8% vs. 121; 33.4%), more commonly received piperacillin/tazobactam (60; 49.2% vs. 81; 22.4%) and carbapenems (27; 22.1% vs. 43; 11.9%) with longer duration of antibiotic therapy (14; 10–20 vs 10; 10–14 days). CDAD was diagnosed in 3 (2.5%) patients in OVP, compared with 45 patients (12.4%, p = 0.0011) in control group. In logistic regression analysis CCI > 6 (OR 3.54; 95% CI 1.79–6.87), OVP (0.19; 0.06–0.57), nursing home residency (4.10; 2.40–7.02), carbapenems (3.14; 1.60–6.15) and piperacillin/tazobactam (5.43; 2.87–10.14) were associated with CDAD. In this cohort, 28 (23.7%) patients from OVP and 69 (21.7%) patients from control group had 90-day readmission. 6 patients in OVP (4 new episodes) and 21 (14 new episodes) in control group were admitted for CDAD. Only CDAD during index hospitalization was associated with 90-day readmission (HR 4.60; 95% CI 1.93–10.96). Conclusion Primary OVP was highly effective in reducing the risk of in-hospital CDAD in elderly patients treated with systemic antimicrobial therapy. Prospective studies with follow-up are needed to define long-term efficacy and potential risks of this strategy. Disclosures All authors: No reported disclosures.

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Age Dependendent Efficacy of Ace Inhibitors Among Chinese Cardiovascular Patients During Hospitalization Phase

Asian Journal of Medical Sciences ◽

10.3126/ajms.v1i2.2947 ◽

2011 ◽

Vol 1 (2) ◽

pp. 59-63

Author(s):

Tabish Hussain ◽

Li Yu Shu ◽

A Seid Adji ◽

Tumenjavkhlan Sosorburam

Keyword(s):

Myocardial Infarction ◽

Elderly Patients ◽

Ace Inhibitors ◽

Ace Inhibitor ◽

Recovery Period ◽

Control Group ◽

Study Group ◽

Significant Finding ◽

Cardiovascular Patients

Objective: Cardiac failure is a global burden among cardiovascular diseases, and major cause of morbidity and mortality especially among elderly age group. Angiotensin Converting Enzyme(ACE) inhibitors, remained the choice of treatment as they inhibit the renin angiotensin aldosterone system along with reduction in levels of pro-inflammatory cytokines, both of them are key factors in progression and complications of heart failure. The aim of this study was to rule out the effect of aging and efficacy of ACE inhibitor, Captopril, among Chinese cardiovascular patients with acute myocardial infarction (MI) during the hospitalization phase of therapy. Material & Methods: Randomized control trial at hospital of Tongji Medical College Wuhan, China over a period of more than 1 year from April 2009 till July 2010 recruiting patients in two stages. A total of 260 patients with mean age 65±8 years were recruited. All suffered from first time myocardial infarction and arrived in Cardiac emergency within 72 hours of the event. The participants were then randomly divided in study and control groups which were then further classified in sub-groups depending upon their age. Study group received ACE inhibitor Captopril in addition to standardized therapy while control group just received the conventional therapy for the event. Statistical analyses were done to formulate the corre-lation between multi-variables. Results: Participants were divided in Study group (N=150) (A and C, Young and Old) and the control group (N=110) (B and D, Young and Old). Survival rate was better among elderly on captopril in comparison to younger ones during the hospitalization. The Systolic blood pressure among study group was significantly lower than control group (132.9±16.3mmHg/84.7 ±9.1mmHg vs. 147.1±17.4mmHg/85.1 ±10.9mmHg, P<0.05).Patient’s survival was statistically significant with respect to age (P<0.001). Conclusion: Treatment with Captopril is definitely associated with improved short as well as long term cardiac prognosis and markedly. Captopril therapy is associated with improved long term prognosis and reduced cardiac mortality during the hospitalization phase of the therapy and recovery period. But the most significant finding is that the increased survival after taking Captopril was higher in elderly patients than in younger patients. ACE inhibitors like Captopril in proper dosage play a real vital beneficial role among elderly patients as compared to the younger ones, but still there is need to recruit a large cohort in different ethnic groups with different genetic makeup. Key Words: Myocardial infarction (MI); Ace-inhibitor; Aging DOI: 10.3126/ajms.v1i2.2947Asian Journal of Medical Sciences 1 (2010) 59-63

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SURGICAL TREATMENT OF ATRIAL FIBRILLATION IN ELDERLY PATIENTS UNDERGOING HIGH RISK CARDIAC SURGERY

10.22541/au.162214407.72009074/v1 ◽

2021 ◽

Author(s):

Mohsin Uzzaman ◽

Imthiaz Manoly ◽

Mohini Panikkar ◽

Maciej Matuszewski ◽

Nicolas Nikolaidis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Surgical Treatment ◽

High Risk ◽

Elderly Patients ◽

Control Group ◽

Surgical Ablation ◽

Af Ablation

BACKGROUND/AIM To evaluate outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery. MEHODS We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation 2. No-Surgical AF treatment. Patients requiring redo procedures or those who had isolated PVI or LAAO were excluded. Heart rhythm assessed from Holter reports or 12-lead ECG. Follow-up data collected through telephone consultations and medical records. RESULTS There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p=0.001). One (1.4%) patient in Cox maze group with 30-day mortality compared to 14 (8.2%) the control group (p=0.05). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - significantly better than No-Surgical AF treatment groups (P<0.001). 160 patients (66.9%) were alive at long-term follow-up with better survival curves in Cox Maze group compared to No-Surgical treatment group (p=0.02). There was significantly higher proportion of patients in NYHA 1 status in Cox-Maze group (p=0.009). No differences observed in freedom from stroke (p=0.80) or permanent pacemaker (p=0.33). CONCLUSIONS. Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic/prognostic benefits. Therefore, surgical risk need not be reason to deny benefits of concomitant AF-ablation.

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Risk of Hospital-Onset C. difficile Infection Increases With Prior Inpatient and Outpatient Visits

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.569 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s78-s79

Author(s):

Aaron Miller ◽

Alberto Segre ◽

Daniel Sewell ◽

Sriram Pemmaraju ◽

Philip Polgreen

Keyword(s):

Substance Abuse ◽

Nursing Home ◽

Long Term Care ◽

Prior Exposure ◽

Term Care ◽

Healthcare Settings ◽

Clostridioides Difficile ◽

Increased Risk ◽

Healthcare Associated

Background:Clostridioides difficile is a leading cause of healthcare-associated infections, and greater healthcare exposure is a primary risk factor for Clostridioides difficile infection (CDI). Longer hospital stays and greater CDI pressure, both at the hospital level and the level, have been linked to greater risk. In addition, symptoms associated with healthcare-associated CDI often do not present until a patient has been discharged. Our study objective was to estimate the extent to which exposure to different types of healthcare settings (eg, prior hospitalization, emergency department [ED], outpatient or long-term care) increase risk for hospital-onset CDI. Methods: We conducted a case-control study using the Truven Marketscan Commerical Claims and Medicare Supplemental databases from 2001 to 2017. Case patients were selected as all inpatient visits with a secondary diagnosis of CDI and no previous CDI diagnosis in the prior 90 days. Controls were selected from all inpatient admissions without any CDI diagnosis during the current admission or prior 90 days. A logistic regression model was used to estimate risk associated with prior healthcare exposure. Indicators were created for prior exposure to different healthcare settings: separate indicators were used to indicate transfer, exposure to that setting in the prior 1–30 days, 31–60 days and 61–90 days. Separate indicators were created for prior hospitalization, ED, outpatient clinic, nursing home or long-term care facilities (LTCFs), psychiatric or substance-abuse facility or other outpatient facility. We also included an indicator for prior exposure to a family member with CDI and prior outpatient antibiotics. Results: Estimates for selected variables (odds ratios) are presented in Table 1. Prior hospitalization, ED visits, outpatient clinics, nursing home and LTCFs were all associated with increased risk of secondary diagnosed CDI. Prior hospitalization and nursing home/LTCF conveyed the greatest risk. In addition, a ‘dose-–response’ relationship occurred for each of these exposure settings, with exposure nearest the admission date having the largest risk. Prior exposure to psychiatric , substance abuse, or other outpatient facilities were not risk factors for CDI. Having a family member with prior CDI and both low-risk and high-risk outpatient antibiotics were associated with increased risk. These factors also exhibited a ‘dose–response’ pattern. Conclusions: Exposure to various healthcare settings significantly increased risk for secondary CDI. Prior healthcare exposures occurring nearest to the point of admission conveyed the greatest risk. These results suggest that many hospital-associated CDI cases attributed to a current hospital stay may actually be acquired from prior healthcare settings.Funding: CDC Modeling Infectious Diseases (MInD) in Healthcare NetworkDisclosures: None

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NCOG-09. PREDICTIVE GERIATRIC FACTORS IN ELDERLY PATIENTS TREATED FOR IDH-MUTANT HIGH-GRADE GLIOMAS: A FRENCH POLA NETWORK STUDY

Neuro-Oncology ◽

10.1093/neuonc/noab196.600 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi153-vi153

Author(s):

Coline Montégut ◽

Jean-Sébastien Guillamo ◽

François Ducray ◽

Caroline Dehais ◽

Cohen-Jonathan Moyal Elisabeth ◽

...

Keyword(s):

Body Mass Index ◽

Elderly Patients ◽

Body Mass ◽

The Elderly ◽

High Grade ◽

Neuropsychological Disorders ◽

Comorbidity Index ◽

High Grade Gliomas ◽

And Biological Markers

Abstract We aimed to describe the characteristics, patterns of care and predictive geriatric factors of elderly patients with IDH-mutant (IDHm) high-grade gliomas (HGG) included in the French POLA network, dedicated to HGG (including 68% of IDHm HGG). For IDHm HGG patients over the age of 70 years, geriatric features were collected: G8 score items (appetite, weight loss, mobility, neuropsychological disorders, body mass index, medications, self-rated health, age), Activities and Instrumental Activities of Daily Living (ADL, IADL) scores, Charlson’s comorbidity Index (CCI) and biological markers. Out of the 1433 HGG patients included in the POLA Network, 119 (8.3%) occurred in patients ≥ 70 years. Among them, 39 presented with IDHm HGG. Of these 39 patients, estimated G8 score was ≤ 14/17 for 16 patients (64%), ADL score was < 6 for 33.3%, IADL score was < 4 for 47% and CCI was ≥ 5 for 72%. Regarding treatment feasibility, 6 of the 19 patients treated by temozolomide prematurely discontinued chemotherapy including 2 for toxicity and 4 for progression. Five of the 10 patients treated by PCV prematurely discontinued chemotherapy, all for toxicity. In multivariate analysis, loss of mobility (p=0.018; p=0.008), severe neuropsychological disorders (p=0.005; p=0.047), body mass index < 21 kg/m2 (p=0.002; p=0.006) and ADL score < 6 (p=0.002; p=0.01) were significantly predictive of poor PFS and OS. Then we generated a specific brain geriatric score including these four items with a sensibility, specificity and AUC for long term survivor (≥ 48 months) of 100%, 83% and 0.948 respectively. Using a cutoff of < 10/13, this score was significantly correlated to PFS and OS (p< 0.001 both). In conclusion, geriatric predictive factors may contribute to the elderly management improvement: the brain geriatric score must now be validated in a prospective independent cohort including IDHm and IDHwt elderly patients.

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Achalasia is associated with a higher incidence of depression in outpatients in Germany

PLoS ONE ◽

10.1371/journal.pone.0250503 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250503

Author(s):

Sven H. Loosen ◽

Jennis Kandler ◽

Tom Luedde ◽

Karel Kostev ◽

Christoph Roderburg

Keyword(s):

Mood Disorders ◽

Life Quality ◽

Control Group ◽

Comorbidity Index ◽

Esophageal Sphincter ◽

One Year ◽

The Impact ◽

Work Up

Background and aim Achalasia represents a chronic motility disorder of the esophagus featuring an impaired lower esophageal sphincter relaxation and loss of esophageal peristalsis. By causing dysphagia, regurgitation, aspiration and chest pain, achalasia might tremendously affect life quality of patients. However, the impact of achalasia on the development of mood disorders including depression has largely remained unclear. The aim of this study was to evaluate the incidence of depression in achalasia patients. Methods We analyzed a large primary care cohort database in Germany capturing data from 7.49 million patients. Results A total of n = 1,057 patients with achalasia diagnosed between January 2005 and December 2018 were matched to a cohort of n = 3,171 patients without achalasia controlling for age, sex, physician, index year, and the Charlson comorbidity index. Interestingly, while the frequency of depression prior to the diagnosis of achalasia was comparable in both groups, new diagnoses of depression were significantly higher within one year after the diagnosis of achalasia compared to the control group, suggesting a direct and previously unrecognized association between achalasia and depression. Conclusion Our data suggest that the clinical management of patients with achalasia should include a careful and structured work-up for mood disorders in order to improve long-term quality of life in these patients.

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PS01.181: ESOPHAGECTOMY FOR ESOPHAGEAL CARCINOMA TO ELDERLY PATIENTS OVER 75 YEARS OLD

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.181 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 100-101

Author(s):

Naoto Ujiie ◽

Yusuke Taniyama ◽

Tadashi Sakurai ◽

Takahiro Heishi ◽

Chiaki Sato ◽

...

Keyword(s):

Surgical Treatment ◽

Survival Rate ◽

Elderly Patients ◽

Esophageal Carcinoma ◽

Operation Time ◽

The Elderly ◽

Elderly Group ◽

Control Group ◽

And Control

Abstract Background Recently, operation cases of elderly patients are increasing in esophageal carcinoma. Because elderly patients often have pre-existing disease and may easily cause postoperative complications, it is necessary to consider whether surgical treatment is appropriate for those elderly patients. The aim of this study is to investigate the safety of esophagectomy for elderly patients with esophageal carcinoma. Methods All 483 patients who underwent esophagectomy for esophageal carcinoma between April 2007 and March 2015 were included in this study. Patients were divided into two groups: elderly group (over 75 years old: n = 72) and control group (under 75 years old: n = 411). The short and long-term outcomes were retrospectively examined to those groups. Results In the elderly group, their median age was 77 [75–85] and all of their performance status was 0 or 1, except 4 patients. 66 cases of the elderly group had some comorbidity, which was significantly higher than that of the control group (93.0 vs. 80.2%, P = 0.007). Pre-surgical treatment was performed to 38.9% of the elderly group, whereas 58.9% in the control group (P = 0.002). No significant differences were demonstrated in clinical stage, occupation site, histological type and pathological stage between these groups. The operation time was relatively shorter in the elderly group compare to the control group (549 vs. 585min, P = 0.018). The number of dissected lymph node was also smaller in elderly group (31 vs. 35, P = 0.048). The postoperative complications such as pneumonia, recurrent laryngeal nerve paralysis did not show any difference between these groups. The 5-year overall survival rate (OS) and the 5-year disease specific survival rate (DSS) also did not show statistical differences between the elderly and control group (OS: 53.0 vs. 57.0%, P = 0.765; DSS: 64.6 vs. 62.7%, P = 0.605). Conclusion Between elderly and control group, there was no difference in postoperative complication and long-term survival. This study confirmed the safety of esophagectomy for elderly patients with esophageal carcinoma by reducing treatment stress such as neoadjuvant therapy, extended operation time and extensive lymphadenectomy. Disclosure All authors have declared no conflicts of interest.

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Clinical experience with piribedil in chronic cerebrovascular disease with cognitive impairment

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2019-4-100-103 ◽

2019 ◽

Vol 11 (4) ◽

pp. 100-103

Author(s):

E. V. Moroz ◽

T. A. Zakharycheva ◽

M. V. Antonyuk

Keyword(s):

Cognitive Impairment ◽

Elderly Patients ◽

Cerebrovascular Disease ◽

Cognitive Functions ◽

Combined Therapy ◽

Lipid Lowering ◽

Control Group ◽

Good Tolerability ◽

Before And After

Objective: to evaluate the effect of piribedil on cognitive functions in elderly patients with chronic cerebrovascular disease (CCVD) and cognitive impairment (CI). Patients and methods. A total of 67 patients aged 60-75 years with CCVD and CI were examined. A control group included 32 patients who had received basic therapy with antihypertensive and, if indicated, lipid-lowering and antithrombotic drugs. A study group consisted of 35 patients who additionally took piribedil 50 mg after evening meals for 3 months. Neuropsychological examination was made before and after a treatment cycle. Results and discussion. After 3 months, only the piribedil group showed a significant neuropsychological improvement (p<0.05-0.001). There were statistically significant differences in the measures of short-term (5.9±0.5 and 4.27±0.5 words; p<0.05) and long-term (6.4±0.8 and 4.16±0.5 words; p<0.05) memories, correction task (38.4±0.8 and 49.1±0.1 errors; p<0.001), attentiveness (421.0±0.9 and 406.0±0.6 sec; p<0.001), and work efficiency (16.3±0.9 and 12.3±1.2 sec; p<0.05). The investigation revealed that the drug had a good tolerability, neither adverse events nor drug-drug interactions. Conclusion. When used in CCVD and CI, piribedil 50 mg once daily for 3 months is able to improve cognitive functions in elderly patients, which indicates that it is feasible to use the drug in combined therapy with essential (antihypertensive, lipid-lowering, antithrombotic) medicines.

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2421. Efficacy of Secondary Prophylaxis with Oral Vancomycin in Preventing Recurrent Clostridioides difficile Infections in Patients Receiving Systemic Antibiotics

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2099 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S836-S836

Author(s):

Kelly E Pillinger ◽

Jason K Lew ◽

Kelly M Conn ◽

Stephanie Shulder

Keyword(s):

Risk Factors ◽

Medical Center ◽

Secondary Prophylaxis ◽

Hospital Length Of Stay ◽

Control Group ◽

Oral Vancomycin ◽

Clostridioides Difficile ◽

Significant Difference ◽

Systemic Antibiotics ◽

The Impact

Abstract Background One of the major challenges in Clostridioides difficile infection (CDI) is preventing recurrence, particularly in the setting of risk factors, such as systemic antibiotics that impact the gut microbiome. There are little data to demonstrate the impact of secondary prophylaxis with oral vancomycin and due to the lack of evidence, the IDSA guidelines do not make a recommendation. Methods This was a multi-site, retrospective cohort study of adult inpatients within the University of Rochester Medical Center who received either a high- or medium-risk systemic antibiotic between July 1, 2013 and September 30, 2018 and had a positive C. difficile test within one year prior to admission. The primary endpoint was incidence of recurrent CDI within 90 days from the start of antibiotics in patients who received oral vancomycin prophylaxis (OVP) vs. those who did not receive prophylaxis (control). Results Of 425 patients screened, 153 patients were included in the control and 78 patients in the OVP group. The OVP group was more likely to be immunosuppressed (P < 0.001), have increased hospital length of stay (P < 0.001), receive a proton pump inhibitor (P = 0.049), have a prior episode of CDI within the previous 90 days (P < 0.001), and have > 1 prior episode of CDI (P = 0.038). The control group was more likely to have received metronidazole for the most recent CDI episode (P < 0.001), likely reflecting mild-moderate severity. Recurrent CDI within 90 days was 10.3% in the OVP group compared with 17.6% in the control (P = 0.175). A subgroup analysis of the patients with recurrent CDI found the time to recurrence from initiation of systemic antibiotics was similar in the OVP group compared with control (43 vs 30 days, P = 0.223). Conclusion While there was not a statistically significant difference in recurrent CDI within 90 days, the OVP group had numerous risk factors that made these patients at higher risk for recurrence compared with the control group. This may be clinically important and certain risk factors, such as timing of previous CDI episode, could be used to guide which patients should receive OVP. Prospective studies are needed to better elucidate the role of OVP and better define the patients that may benefit the most. Disclosures All authors: No reported disclosures.

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