scholarly journals 2786. The Role of Respiratory Panel PCR in Decreasing Antibiotic Exposure in Patients Diagnosed With a Respiratory Viral Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S984-S984
Author(s):  
Alexander Vostal ◽  
Michael Antonio Gonzalez ◽  
Nellie Darling ◽  
Christine Papastamelos ◽  
Madhuri Natarajan ◽  
...  
Keyword(s):  
Viral Infections ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Antibiotic Exposure ◽  
Duration Of Treatment ◽  
Bacterial Cultures ◽  
Antibiotic Duration ◽  
The Mean ◽  
Student’S T

Abstract Background Respiratory viral infections (RVI) are becoming increasingly recognized as an important cause of pneumonia. There is limited data regarding the role of rapid PCR testing for RVI and its effect on antibiotic duration and length of stay (LOS). Methods We performed a single-center, retrospective chart review in adult patients who were admitted and underwent evaluation with the FilmArray Multiplex Respiratory Panel (RP) (Biomerieux™) using a random sample from July 1, 2016 through April 1, 2018. Patient clinical and virologic characteristics, LOS, antibiotic use, and duration of treatment were collected. A Student’s t-test was performed for all comparisons. Results We identified 540 patients who were admitted and underwent RP testing. The mean age was 57.1 years (range 19–99), 50.2% were immunocompromised, 23.8% were transplant recipients, 70.4% had respiratory symptoms, and 35.7% had an admitting diagnosis of pneumonia. 55.6% required supplemental O2 and 24.6% had an ICU admission that required either noninvasive or mechanical ventilation. 22.6% (N = 122) of these patients were diagnosed with an RVI, of which 15 were co-infected with two or more respiratory viruses. There were 41 (34%) rhinovirus/enterovirus, 41 (34%) influenza (Types A/H1, A/H3, A/H1-2209, and B), 16 (13%) RSV, 15 (12%) coronavirus (Types NL63, OC43, 229E, and HKU1), 13 (11%) metapneumovirus, and 7 (5%) parainfluenza (Types 2, 3, and 4). 85.2% (104/122) of patients with an RVI received antibiotics. The mean LOS and antibiotic duration were 9.07 days and 7.31 days for patients with an RVI when compared with 11.5 days and 10.4 days for patients without an RVI (P = 0.098; P = 0.032), respectively. In patients with an RVI and negative bacterial cultures, the mean LOS was 8.4 days and mean antibiotic duration was 5.9 days when compared with 16.4 days and 15.5 days for all patients with positive bacterial cultures (P = 0.003; P < 0.0001), respectively. The mean time from available results of + RP to antibiotic discontinuation was 5.1 days in the setting of negative bacterial cultures. Conclusion Although antibiotic exposure and time to discontinuation still remained significant in patients diagnosed with an RVI, there was a marked reduction in LOS and antibiotic duration in the subset of patients with an RVI and negative bacterial cultures. Disclosures All authors: No reported disclosures.

scholarly journals Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

Geriatrics ◽  
2019 ◽  
Vol 4 (4) ◽  
pp. 61 ◽  
Author(s):  
Lai San Kong ◽  
Farida Islahudin ◽  
Leelavathi Muthupalaniappen ◽  
Wei Wen Chong
Keyword(s):  
Older Adults ◽  
Viral Infections ◽  
Antibiotic Use ◽  
The Body ◽  
Limited Information ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Validated Questionnaire

Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been noted. However, there is limited information about their knowledge and expectations for antibiotics. This study aimed to assess older adults’ knowledge of antibiotic use and resistance, their expectations for antibiotics and the relationship between knowledge, expectation and inappropriate practices related to antibiotic use. A cross-sectional survey involving respondents aged 60 years and above was conducted, using a validated questionnaire. A lack of knowledge about the role of antibiotics was observed, whereby more than half of the respondents incorrectly believed that antibiotics can treat viral infections (53.5%) and colds and coughs (53.7%). Also, 67.9% of respondents incorrectly believed that antibiotic resistance occurs when the body becomes resistant to antibiotics. Almost half of the respondents would expect antibiotics for symptoms of self-limiting viral infections. Respondents who answered correctly for the role of antibiotics in viral infections were more likely not to expect antibiotics for cold, flu and cough (p < 0.001). Respondents who answered correctly regarding the need to adhere to antibiotics were more likely to have completed their antibiotic course (p < 0.001). Future educational initiatives should provide key information on the role of antibiotics and the importance of complying with antibiotics in this population.

scholarly journals The Role of Antioxidants in the Treatment of Congenital CMV-Related Hearing: A Case-Control Study

OTO Open ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. 2473974X1984185 ◽  
Author(s):  
Hilary McCrary ◽  
Veronica del Calvo ◽  
Jeremy Purser ◽  
Geoff Casazza ◽  
Albert Park
Keyword(s):  
Hearing Loss ◽  
Case Control Study ◽  
Retrospective Chart Review ◽  
Case Control ◽  
Antioxidant Therapy ◽  
Hearing Thresholds ◽  
The Mean ◽  
The Right ◽  
Control Study

Objective Antioxidants have been used as a therapeutic measure for several causes of hearing loss, and this study aims to examine the use of antioxidants in children with congenital cytomegalovirus (cCMV)–related hearing loss. Study Design Case-control study. Setting Academic pediatric hospital. Subjects and Methods A retrospective chart review of pediatric patients with cCMV-related hearing loss treated with and without antioxidants (vitamins A, C, and E and magnesium, known as ACE-Mg) was completed. The primary end point was the mean change in hearing thresholds for the right and left ears after therapy. An evaluation of the mean change in thresholds was evaluated at the following frequencies: 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. A 2-sample t test and multiple linear regression were used to evaluate the data. Results A total of 78 children with cCMV-related hearing loss were included in the study, of whom 10 were treated with antioxidants. The average amount of time in which antioxidants were taken was 387 days. When comparing cases and controls, there was no differences in the mean change of hearing thresholds at each frequency for both the right and left ears ( P > .05). Length of antioxidant therapy and age at which therapy was initiated had no effect on hearing scores ( P > .05). Conclusions Oxidative stress plays a role in the pathogenesis of cCMV-related hearing loss. ACE-Mg is a safe adjuvant therapy for the treatment of hearing loss in children; however, this study demonstrates no hearing-related benefit from ACE-Mg antioxidant therapy.

Safety and Efficacy of Brivaracetam in Pediatric Refractory Epilepsy: A Single-Center Clinical Experience

2019 ◽  
Vol 35 (2) ◽  
pp. 102-105 ◽  
Author(s):  
Sara McGuire ◽  
Gustavo Silva ◽  
Darshan Lal ◽  
Divya S. Khurana ◽  
Agustin Legido ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Chart Review ◽  
Refractory Epilepsy ◽  
Focal Epilepsy ◽  
Retrospective Chart Review ◽  
Average Dose ◽  
Limited Data ◽  
Duration Of Treatment ◽  
Seizure Reduction ◽  
The Mean

Brivaracetam is a new antiepileptic drug with limited data in children. The objective of this study was to assess the efficacy/tolerability of brivaracetam. This is a retrospective chart review of children/adolescents with refractory epilepsy treated with brivaracetam from 2016 to 2018. The primary outcome was seizure reduction (decrease in seizure frequency >50%). Twenty-three patients were identified. Mean age at initiation was 12.5 years. Fourteen were females. Epilepsy was focal in 11, generalized in 6, and mixed in 3. Average dose was 3.9 mg/kg/d. The mean duration of treatment was 8.2 months. Eight had greater than 50% decrease in seizure frequency, of which 7 had focal epilepsy, and 1 had Lennox-Gastaut/mixed epilepsy. Two had drowsiness and 3 behavioral complaints. One experienced tingling and dizziness. Our retrospective review suggests that brivaracetam is an effective therapy for refractory focal epilepsy in children older than 4 years of age.

scholarly journals Demographic Factors Associated with Insertional and Noninsertional Achilles Tendinopathy

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0027
Author(s):  
Matt Levitsky ◽  
Justin Greisberg ◽  
J Turner Vosseller ◽  
Shirin Dey ◽  
Briana Hickey
Keyword(s):  
Physical Examination ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
Achilles Tendinopathy ◽  
Insertional Tendinopathy ◽  
Chi Squared ◽  
The Mean ◽  
Student’S T

Category: Sports Introduction/Purpose: Achilles tendinopathy is a common clinical entity encountered by orthopaedic surgeons, although the demographics of patients that suffer from this pathology are incompletely understood. It has been suggested that there may be differences in patients that get insertional (IAT) and noninsertional Achilles tendinopathy (NIAT), and our clinical experience has been that older, less active patients tend to get insertional tendinopathy. The goal of this study is to further investigate the features of patients in a single institution who presented with Achilles tendinopathy. Methods: We used ICD-9 and ICD-10 codes to find patients who presented with Achilles tendinopathy to two foot and ankle surgeons at one academic medical center from 2007-2018. We made note of patient characteristics such as age, gender, BMI, medical comorbidities, and level of activity. Physical examination, including the presence of a gastrocnemius equinus, was noted as well. Characteristics of insertional and non-insertional tendinopathy subgroups were compared using Student’s T-tests and chi- squared tests. Results: The characteristics of 948 consecutive patients were analyzed. The mean age was 55 years and 50.5% of the patients were male. Patients with IAT had significantly higher BMIs than did those with NIAT (30.5 compared to 28.0, p < .05). The mean age was 54.5 years in the IAT group compared to 55.8 years in the NIAT group (p>.05). Patients with NIAT self-identified as active a greater percentage of the time (63% vs 45%, p<0.5). 76% of the IAT group had a gastrocnemius equinus on physical examination, compared to 67% of the non-insertional group. Antecedent fluoroquinolone antibiotic use was only reported in 10% of patients, and all of these patients presented with NIAT. Conclusion: The age at which patients present with insertional and noninsertional Achilles tendinopathy is not significantly different, although patients with NIAT had a lower BMI and self-identified as active a greater percentage of the time. A gastrocnemius equinus was present in a high percentage of patients with both IAT and NIAT. Fluoroquinolone use was not involved in most cases, although, when it was, patients presented with NIAT.

scholarly journals 101. Diagnostic Utility of a Multiplex PCR Meningitis/Encephalitis Panel and Impact on Antibiotic Use

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S65-S65
Author(s):  
Aimen Vanood ◽  
Alexandra Hospodar ◽  
Christopher F Carpenter
Keyword(s):  
Length Of Stay ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Antibiotic Use ◽  
Traditional Methods ◽  
Csf Analysis ◽  
The Impact

Abstract Background The detection and identification of meningitis and encephalitis pathogens from CSF via traditional microbiologic methods may take several hours to days. The BioFire FilmArray Meningitis/Encephalitis Panel (BioFire), approved by the FDA in 2015, can detect 14 different pathogens within one hour, providing a faster time to diagnosis of a broad range of pathogens. The purpose of this study was to examine the impact of BioFire on length of hospital stay and duration of antibiotic use. Methods We conducted a retrospective chart review of patients diagnosed meningitis/encephalitis between 2015 and 2019 at 3 Beaumont Health (BH) hospitals. BioFire was adopted by BH midyear in 2017, allowing for analysis of cohorts over comparable periods before and after the introduction of the panel. Data collected and analyzed included biodemographics, comorbidities, presenting signs and symptoms, CSF analysis results, pathogens, days of antibiotic therapy, length of stay, and mortality. Results A total of 161 patients diagnosed with meningitis and/or encephalitis were reviewed, including 59 who underwent testing via BioFire. Of the 161 patients, 68 had a pathogen identified, 50 via traditional methods (6 bacterial and 44 viral) and 18 via BioFire (3 bacterial and 15 viral). West Nile Virus accounted for 17 of the viral infections diagnosed via traditional methods. The mean duration of antibiotic use after the assays resulted was not significantly different between patients with bacterial infections diagnosed by traditional methods or BioFire (11.2 vs 13.0 days, p=0.82) or for those with viral infections (0.1 vs 0 days, p=0.3). The median length of stay was also not significantly different between the two cohorts for patients with bacterial infections (21.7 vs 15.0 days, p = 0.36) or viral infections (6.2 vs. 10.0 days, p = 0.10). Conclusion While utilization of the BioFire panel yielded a faster diagnostic result, we have no evidence to demonstrate that it contributes to a significant reduction in duration of antibiotic use or length of stay. Disclosures All Authors: No reported disclosures

scholarly journals Role of Cathelicidin (Ll-37) and Human Β-Defensin In Atopic Dermatitis And Psoriasis

2020 ◽  
Vol 1 (1) ◽  
pp. 25-30
Author(s):  
Febrina Andarini ◽  
Nopriyati ◽  
Sarah Diba
Keyword(s):  
Atopic Dermatitis ◽  
Antimicrobial Peptide ◽  
Viral Infections ◽  
Low Frequency ◽  
Skin Barrier ◽  
Antibiotic Use ◽  
Atopic Skin ◽  
The Difference ◽  
Pathogen Colonization

The Human epithelium, including the epidermis produces antimicrobial peptide (AMP)as part of innate immunity. Cathelicidin and human β-defensins are the most AMPfound on the skin. This antimicrobial peptide has a role in the response of the naturalimmune system by becoming the front line of the defense system against infection. Thediscussion of this literature review will focus on cathelicidin and human β-defensin-1which are the main AMPs that affect atopic dermatitis and psoriasis. Antimicrobialpeptides are excessively produced in lesional psoriatic scales or rosacea in contrast tothe atopic skin that shows lower AMP levels when compared with psoriasis. Despitethe impaired skin barrier which facilitates potentially pathogenic microbes to colonizethe epidermis, patients with psoriasis surprisingly present a low frequency of skininfections, whereas patients with atopic dermatitis are predominantly susceptible toparticular cutaneous bacterial, fungal and viral infections. One possible explanation ofthe fact is the difference in the expression of AMPs. DA patients have fewer AMPexpression characteristics, especially cathelicidins LL-37 and HBD-2. Research onantimicrobial use can help reduce pathogen colonization so that clinical improvementof AD occurs. In the case of psoriasis, AMP expression increases, especially LL-37 andHBD-2, showing synergistic antimicrobial activity that is effective in eradicatingmicrobial colonization, so there is no strong evidence to support antibiotic use intreating psoriasis or in preventing disease.

Evaluation of Filgrastim Therapy in Kidney Transplant Recipients

2017 ◽  
Vol 27 (4) ◽  
pp. 360-364 ◽  
Author(s):  
Teresa Poon ◽  
Christina M. Guerra
Keyword(s):  
Kidney Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Duration Of Treatment ◽  
Adult Kidney ◽  
Serious Infections ◽  
The Mean ◽  
Short Courses

Context: Neutropenia is associated with a high risk of serious infections in kidney transplant recipients. There are no sufficient studies of using granulocyte colony-stimulating factors, such as filgrastim, in renal transplant recipients to establish a clear, specified role of this off-label indication. Using filgrastim in these patients may increase the risk of rejection by overstimulating the immune system. Objective: To evaluate the use of filgrastim in adult kidney transplant recipients presenting with neutropenia. Patients and Design: Data were obtained from a medication utilization report of filgrastim in kidney transplant recipients at our center from September 2012 to August 2015. Main Outcome Measure(s) and Results: There were 28 cases of neutropenia that were treated with a range of 1 to 5 doses of filgrastim 300 or 480 μg, with a mean of 1.79 doses. The mean total dose of filgrastim administered per episode of neutropenia was 632 μg (8.6 μg/kg). Overall, 87.5% of the cases achieved a white blood cell count of at least 3 × 109 cells/L within 7 days of hospital discharge. There were no cases of infection or acute rejection following treatment. Conclusions: The use of filgrastim in kidney transplant recipients demonstrated success in reversing neutropenia. Short courses of therapy were required with minimal adverse events. Patients who required readmission were successfully re-treated. Additional studies are required to determine the most effective dose and duration of treatment.

scholarly journals The Role of Oncofertility Clinics in Facilitating Access to Reproductive Specialists

2016 ◽  
Vol 3 (4) ◽  
pp. 131-136 ◽  
Author(s):  
Eduardo Hariton ◽  
Pietro Bortoletto ◽  
Eden R Cardozo ◽  
Ephraim P Hochberg ◽  
Mary E Sabatini
Keyword(s):  
Massachusetts General Hospital ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Cancer Center ◽  
The Mean ◽  
Reproductive Aged Women ◽  
The Impact ◽  
Patient Referrals ◽  
Mean Time

Purpose: To determine the impact of the establishment of a dedicated oncofertility clinic on the frequency of patient referrals for fertility preservation (FP) consultation and the time from patient referral to consultation. Methods: A retrospective chart review of all women aged 21 to 44 years with an active cancer diagnosis who were referred for FP consultation from 2011 to 2015. Results: A total of 6895 female patients eligible for FP were seen at the Massachusetts General Hospital (MGH) Cancer Center. Of those eligible, a total of 209 patients were referred for FP consultation with 150 included in the final analysis. Since the establishment of the oncofertility clinic, the mean time to nonemergent consultation with a reproductive endocrinologist decreased by 27%, from 10.4 to 7.6 days ( P = .03). Furthermore, the proportion of reproductive-aged females seen at the MGH Cancer Center referred for FP consultation increased from 1.7% to 3.0% ( P < .01). Conclusion: A dedicated oncofertility clinic increases physician referrals for FP and decreases the mean time to consultation, improving access to FP consultation for reproductive-aged women with cancer.

Reinfection rates following adherence to Infectious Diseases Society of America guideline recommendations in first cerebrospinal fluid shunt infection treatment

2019 ◽  
Vol 23 (5) ◽  
pp. 577-585
Author(s):  
Tamara D. Simon ◽  
Matthew P. Kronman ◽  
Kathryn B. Whitlock ◽  
Samuel R. Browd ◽  
Richard Holubkov ◽  
...  
Keyword(s):  
At Risk ◽  
Infectious Diseases ◽  
Antibiotic Use ◽  
Shunt Infection ◽  
Research Network ◽  
Csf Shunt ◽  
Duration Of Treatment ◽  
Infection Treatment ◽  
Antibiotic Duration ◽  
Csf Shunt Infection

OBJECTIVECSF shunt infection treatment requires both surgical and antibiotic decisions. Using the Hydrocephalus Clinical Research Network (HCRN) Registry and 2004 Infectious Diseases Society of America (IDSA) guidelines that were not proactively distributed to HCRN providers, the authors previously found high adherence to surgical recommendations but poor adherence to intravenous (IV) antibiotic duration recommendations. In general, IV antibiotic duration was longer than recommended. In March 2017, new IDSA guidelines expanded upon the 2004 guidelines by including recommendations for selection of specific antibiotics. The objective of this study was to describe adherence to both 2004 and 2017 IDSA guideline recommendations for CSF shunt infection treatment, and to report reinfection rates associated with adherence to guideline recommendations.METHODSThe authors investigated a prospective cohort of children younger than 18 years of age who underwent treatment for first CSF shunt infection at one of 7 hospitals from April 2008 to December 2012. CSF shunt infection was diagnosed by recovery of bacteria from CSF culture (CSF-positive infection). Adherence to 2004 and 2017 guideline recommendations was determined. Adherence to antibiotics was further classified as longer or shorter duration than guideline recommendations. Reinfection rates with 95% confidence intervals (CIs) were generated.RESULTSThere were 133 children with CSF-positive infections addressed by 2004 IDSA guideline recommendations, with 124 at risk for reinfection. Zero reinfections were observed among those whose treatment was fully adherent (0/14, 0% [95% CI 0%–20%]), and 15 reinfections were observed among those whose infection treatment was nonadherent (15/110, 14% [95% CI 8%–21%]). Among the 110 first infections whose infection treatment was nonadherent, 74 first infections were treated for a longer duration than guidelines recommended and 9 developed reinfection (9/74, 12% [95% CI 6%–22%]). There were 145 children with CSF-positive infections addressed by 2017 IDSA guideline recommendations, with 135 at risk for reinfection. No reinfections were observed among children whose treatment was fully adherent (0/3, 0% [95% CI 0%–64%]), and 18 reinfections were observed among those whose infection treatment was nonadherent (18/132, 14% [95% CI 8%–21%]).CONCLUSIONSThere is no clear evidence that either adherence to IDSA guidelines or duration of treatment longer than recommended is associated with reduction in reinfection rates. Because IDSA guidelines recommend shorter IV antibiotic durations than are typically used, improvement efforts to reduce IV antibiotic use in CSF shunt infection treatment can and should utilize IDSA guidelines.

scholarly journals 1340. Assessment of the impact of multiplex PCR panels in sepsis evaluations of young febrile infants

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S681-S682
Author(s):  
Hunter Ratliff ◽  
Tuan Tran ◽  
Natalie Williams-Bouyer ◽  
Diana Nguyen
Keyword(s):  
Multiplex Pcr ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Before And After ◽  
Antibiotic Duration ◽  
Controversial Topic ◽  
The Impact

Abstract Background The management of febrile infants under the age of 3 months has long been a controversial topic, often requiring them to be subject to a battery of tests, antibiotics, and hospitalization. Multiplex polymerase chain reaction (PCR) panels can provide a rapid diagnosis, but their role in managing these patients is still unknown. Our objective was to determine if multiplex respiratory and meningitis/encephalitis PCR panels decreased antibiotic duration of therapy (DOT) and hospital length of stay (LOS) when used in sepsis evaluations of febrile infants less than 90 days of age. Methods We performed a retrospective chart review of infants younger than 90 days old who were admitted to the pediatric ward for concerns of fever or sepsis from 1/1/2016 to 9/30/2019. Subjects with documented bacterial infections were excluded. Our primary outcomes were differences in DOT and LOS between patients admitted before and after PCR panels became available (Pre-PCR era and PCR era). Results 118 subjects were included in our analysis, with 52 (44.1%) coming from the Pre-PCR group. Descriptive statistics, stratified by era, are available in Table 1. The unadjusted mean LOS and DOT decreased by 8.4 (P = .003) and 32.8 (P &lt; .001) hours, respectively. Multivariate regression demonstrated that LOS was 1.16 times longer in the Pre-PCR era (95% CI: 1.10 - 1.22; P &lt; .001). Similarly, patients in the Pre-PCR era had DOT that was 1.95 times longer (95% CI: 1.55 - 2.46; P &lt; .001) when adjusting for covariates. Adjusted LOS and DOT by Era and Diagnosis PCR panel results by pathogen Conclusion We conclude that multiplex PCR panels can potentially influence the management of young febrile infants admitted for sepsis evaluations by rapidly diagnosing viral infections and thus decreasing DOT and LOS. In turn, that may improve patient outcomes and satisfaction, as well as possibly decrease costs. Multiplex PCR panels should be considered as part of routine sepsis evaluations in young febrile infants. Larger studies are needed, including in depth cost analysis. Table 1: Demographics Table 2: Results between Eras Disclosures All Authors: No reported disclosures

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