scholarly journals 248. Thirty-Day Mortality Among Patients with Candidemia Diagnosed by T2Candida Assay Alone: Influence of Risk Factors and Candida Species

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S140-S140
Author(s):  
Cameron White ◽  
Todd McCarty ◽  
Rachael A Lee ◽  
Sixto M Leal ◽  
Peter Pappas
Keyword(s):  
Risk Factors ◽  
Antifungal Therapy ◽  
Broad Spectrum ◽  
Candida Species ◽  
Limit Of Detection ◽  
Medical Center ◽  
Clinical Signs ◽  
Mortality Rates ◽  
Mortality Data ◽  
Broad Spectrum Antibiotics

Abstract Background Candidemia is a common cause of healthcare-associated bloodstream infection with high mortality rates despite antifungal therapy. Risk factors include prolonged ICU stay, immunosuppression, and exposure to broad-spectrum antibiotics. Blood cultures (BC) remain the gold standard for diagnosis but lack sensitivity and can take days to result. T2Candida (T2C) is a rapid diagnostic test utilizing PCR and magnetic resonance technology to detect five Candida species in whole blood in less than 6 hours. In this study we examined characteristics of patients with positive T2C assays in the absence of positive BC including risk factors and 30-day mortality rates. Methods We conducted a retrospective analysis of positive T2C cases at UAB Medical Center from 2016 to 2018 with either negative or no BC. For each patient we determined if clinical signs (e.g., hypotension, leukocytosis) and risk factors for candidemia were present at the time of collection. Our primary outcome of interest was 30-day mortality. Data were compared by multivariate analysis. Results A total of 173 patients with T2C positivity alone were included in the analysis. The most common risk factor was the use of broad-spectrum antibiotics followed by CVC (Table 1). The mean number of risk factors per patient was 3.6 (Figure 1). Overall 30-day mortality was 41%. Patients with a T2C result of C. albicans/C. tropicalis were almost 2.5 times more likely to die at 30 days (aOR 2.401, CI 1.159–4.974) compared with those with other positive results. Increasing number of risk factors (aOR 1.457, CI 1.126–1.886) and increasing age (aOR 1.052, CI 1.026–1.079) were significantly associated with increased odds of death at 30 days (Table 2). Conclusion In this study we demonstrate a significant association between increasing number of risk factors, older age, and A/T result with higher odds of 30-day mortality among patients with T2C positivity alone. While concern for false-positives exists when using T2C, our data suggest that this is an acutely ill population which warrants early and aggressive antifungal therapy. The lower limit of detection of T2C (1 cfu/mL) as compared with BC may explain lack of paired positive cultures in these patients despite clinical signs of and risk factors for candidemia. Disclosures All authors: No reported disclosures.

scholarly journals Clostridium difficile infection in an academic medical center in Saudi Arabia: prevalence and risk factors

2020 ◽  
Vol 40 (4) ◽  
pp. 305-309
Author(s):  
Mai Alalawi ◽  
Seba Aljahdali ◽  
Bashaer Alharbi ◽  
Lana Fagih ◽  
Raghad Fatani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Broad Spectrum ◽  
Medical Center ◽  
Academic Medical Center ◽  
Infection Prevalence ◽  
Healthcare Facilities ◽  
Broad Spectrum Antibiotics ◽  
Academic Medical ◽  
Significant Difference

ABSTRACT BACKGROUND: Clostridium difficile infection is one of the most common causes of diarrhea in healthcare facilities. More studies are needed to identify patients at high risk of C difficile infection in our community. OBJECTIVES: Estimate the prevalence of C difficile infection among adult patients and evaluate the risk factors associated with infection. DESIGN: Retrospective record review. SETTING: Tertiary academic medical center in Jeddah. PATIENTS AND METHODS: Eligible patients were adults (≥18 years old) with confirmed C difficile diagnosis between January 2013 and May 2018. MAIN OUTCOME MEASURES: Prevalence rate and types of risk factors. SAMPLE SIZE: Of 1886 records, 129 patients had positive lab results and met the inclusion criteria. RESULTS: The prevalence of C difficile infection in our center over five years was 6.8%. The mean (SD) age was 56 (18) years, and infection was more prevalent in men (53.5%) than in women (46.5%). The most common risk factors were use of proton-pump inhibitors (PPI) and broad-spectrum antibiotics. The overlapping exposure of both PPIs and broad-spectrum antibiotics was 56.6%. There was no statistically significant difference between the type of PPI ( P =.254) or antibiotic ( P =.789) and the onset of C difficile infection. CONCLUSION: The overall C difficile infection prevalence in our population was low compared to Western countries. The majority of the patients who developed C difficile infection were using PPIs and/or antibiotics. No differences were observed in the type of antibiotic or PPI and the onset of C difficile infection development. Appropriate prescribing protocols for PPIs and antibiotics in acute settings are needed. LIMITATIONS: Single center and retrospective design. CONFLICT OF INTEREST: None.

scholarly journals 1185. Impact of Utilizing Drug Resistance in Pneumonia (DRIP) Score on Management of Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S425-S425
Author(s):  
Avnish Sandhu ◽  
Erin Goldman ◽  
Jordan Polistico ◽  
Sarah Polistico ◽  
Ahmed Oudeif ◽  
...  
Keyword(s):  
Risk Factors ◽  
Drug Resistance ◽  
Broad Spectrum ◽  
Scoring System ◽  
Medical Center ◽  
Prescribing Patterns ◽  
Broad Spectrum Antibiotics ◽  
Morbidity Score ◽  
Co Morbidity ◽  
The Impact

Abstract Background Pneumonia is a leading cause of infection-related admissions and death. It is imperative that appropriate antibiotic therapy is selected. Traditional scoring systems for identifying at-risk persons for drug-resistant pathogens– i.e., Healthcare-associated pneumonia (HCAP), have been inaccurate and often lead to inappropriate antibiotic selection. A novel pneumonia scoring system –“Drug Resistance in Pneumonia (DRIP)” was implemented at the Detroit Medical Center (DMC) in January 2018. The objective of this study was to evaluate the effectiveness of the DRIP score in reducing the use of broad-spectrum antibiotics and the impact on key outcomes in patients treated for pneumonia. Methods A retrospective chart review of 89 patients admitted to the DMC for treatment of pneumonia was conducted—45 patients prior to and 44 patients post-implementation of the DRIP score. Basic demographics, signs and symptoms, antibiotics data, pneumonia severity score (CURB – 65), Charlson co-morbidity score, and outcome measures were compared. DRIP scores and HCAP risk factors were calculated for all patients. The definitions of broad-spectrum antibiotics (BSA) were consistent with DMC guidelines for the treatment of pneumonia (antibiotics targeting nosocomial Gram-negative organisms and/or methicillin-resistant Staphylococcus aureus). Results Demographics are shown in Table 1. 18 (40%) of the pre-implementation cohort had risk factors for resistance (HCAP risk factors) compared with 14 (32%) in the post. Conversely, 15 (33%) of the pre-implementation cohort had risk factors for resistance (DRIP ≥4) compared with 8 (18%) in the post-implementation period (Table 2). A difference in BSA prescribing was seen in patients previously characterized as having a high risk of resistance (HCAP) but with DRIP score <4 [5/7 (72%) vs.1/7 (16%) (Table 2)]. BSA use was 24 (53%) in the pre-implementation cohort and 12 (27%) in post-implementation cohort, P = 0.03. Durations of antibiotics were 8.3 days vs. 9.8 days respectively, P = 0.04. Readmission with pneumonia at 30 days was 3 (7.5%) for both groups. Conclusion The implementation of a novel DRIP scoring system resulted in improved prescribing patterns and a significant reduction of broad-spectrum antibiotics by 26% as compared with traditional HCAP score. Disclosures All authors: No reported disclosures.

scholarly journals 2193. Factors Impacting the Duration of Antimicrobial Therapy for Community-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S746-S747
Author(s):  
Avnish Sandhu ◽  
Erin Goldman ◽  
Jordan Polistico ◽  
Sarah Polistico ◽  
Ahmed Oudeif ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Clinical Signs ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Community Acquired Pneumonia ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Factors Associated ◽  
Specific Risk

Abstract Background Pneumonia is a common cause of infection associated with hospitalization. Treatment durations for community-acquired pneumonia (CAP) often exceed guideline recommended durations of 5–7 days without a clear explanation. The objective of this study was to determine factors that may lead to durations exceeding this recommendation. Methods A retrospective chart review of 89 patients admitted to the Detroit Medical Center (DMC) for the treatment of pneumonia was conducted. Demographics, clinical signs and symptoms, antibiotic data, pneumonia severity score (CURB 65), risk factors for resistance, microbiology results, and outcomes were recorded and analyzed for factors associated with increased durations of antibiotics. Average durations of antibiotics and durations of antibiotics greater that 7 days were assessed for each risk factor. Results Average durations of antibiotics was 9 days (SD 3.8) for the cohort, and 55 (61%) received durations of > 7 days. Average durations of antibiotics for risk factors are shown in Table 1. Factors associated with durations of antibiotics longer than 7 days are shown in Table 2. There was a trend toward longer average durations of antibiotics for persons with risk factors for resistance [Drug Resistance in Pneumonia (DRIP) score ≥ 4 (increased duration of antibiotics by 1.7 days, P = 0.07] and those with a positive legionella antigen [increased durations of antibiotics by 6.6 days, P = 0.07]. Conclusion Specific risk factors could not be associated with increased durations of antibiotics, although there was a trend toward longer durations for persons with markers for resistance and positive legionella testing. Efforts to reduce durations of antibiotics must target global clinician antibiotic prescribing patterns and not specific risk factors. Disclosures All authors: No reported disclosures.

scholarly journals Clinical Epidemiology and Risk Factors of Candida auris Bloodstream Infection in Trauma Patients

2020 ◽  
Vol 41 (S1) ◽  
pp. s168-s168
Author(s):  
Omika Katoch ◽  
Vijeta Bajpai ◽  
Surbhi Khurana ◽  
Sonal Katyal ◽  
Purva Mathur
Keyword(s):  
Risk Factors ◽  
Broad Spectrum ◽  
Clinical Epidemiology ◽  
Fungal Infections ◽  
Major Surgery ◽  
Trauma Patients ◽  
Candida Auris ◽  
Becton Dickinson ◽  
Broad Spectrum Antibiotics ◽  
Hospital Acquired

Background: Candidiasis caused by Candida auris is one of the most serious hospital-acquired infection. Initially, Candida auris was reported to cause local infections; later, invasive candidasis was also reported in which the bloodstream, the central nervous system, kidneys, liver eyes, etc, are invaded. In this study, we evaluated the clinical epidemiology and risk factors in patients hospitalized to trauma center. Methods: This study was conducted at JPN Apex Trauma Centre of All India Institute of Medical Sciences, New Delhi, which is a 169-bed hospital. All patients who were identified to have candidemia due to C. auris over a period of 5 years from January 2012 to December 2016 were included. Blood samples were collected in BAC-T-Alert bottles (Bio Merieux, Durham, NC) and isolates were identified up to the species level by the VITEK 2 (version 8.01, BioMerieux). Conventional identification was performed by observing color development on CHROMagar (Becton Dickinson, Franklin Lakes, NJ). The demographic and clinical data of patients were collected from the hospital information system. Results: Over a period of 5 years, 20 patients admitted to our trauma hospital developed candidemia due to Candida auris. Among them, men were predominant (95%), and the mean (SD) age of the patients was 33 (+15) years. Among these patients, 80% were in hospitalized and 20% were follow-up patients. The median of the total length of stay in the hospital was 34 days (range, 7–122). All of the patients were on mechanical ventilation; 65% patients were catheterized and 75% patients had central line placed. Head injury was the major cause of trauma followed by abdomen, chest, and spine. The overall mortality rate was 40%. Most of the patients (65%) who developed Candida auris infection were immunocompromised. The different comorbidities present were hypertension (35%), diabetes (15%), renal disease (10%), and hepatitis C (5%). Broad-spectrum antibiotics were given: amoxicillin-clavulanate was given to 65% of patients; cefoperazone sulbactam was given to 30% of patients; chloroamphenicol, amicillin-sulbactam, or clindamycin was given to 10% of patients. Antifungal agents like fluconazole or caspofungin were given to 5% of patients. Major surgeries like cranioplasty were performed in 58% of patients. Pancreatectomy, laparotomy, and endoscopic necrosectomy were performed in 42% of patients. Conclusions:Candida auris is one of the dreaded and most commonly spread hospital-acquired fungal infections, especially in immunocompromised patients. Broad-spectrum antibiotics use, major surgery, and invasive devices were the most common risk factors for acquiring Candida auris infection.Funding: NoneDisclosures: None

scholarly journals The Trends in the Distribution of Candida species Causing Candidemia at a Community Hospital in 2005 and 2014

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S87-S87
Author(s):  
Celestine Ishiekwene ◽  
Maxine Seales Kasangana ◽  
Monica Ghitan ◽  
Margaret Kuhn-Basti ◽  
Edward Chapnick ◽  
...  
Keyword(s):  
New York ◽  
Antifungal Therapy ◽  
Candida Species ◽  
Fungal Infections ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Common Species ◽  
Published Data ◽  
Candida Spp ◽  
Common Cause

Abstract Background Candida remains the most common cause of invasive fungal infections, with an attributable morality of 15–35%. Although five Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. glabrata, and C. krusei) account for 92% of cases of candidemia, Candida albicans remains the most common cause of candidemia. However, recent studies report that the frequency of non albicans species are increasing globally and the distribution of Candida spp. varies significantly among different geographic regions and hospitals units. Objective We determine the distribution of Candida species causing candidemia at an adult level 1 Trauma Center in Brooklyn, New York and compared the trends of Candida species between 2005 and 2014. The results were compared with trends of US data collected in 2004 and 2012. Knowledge of the frequency of causative species would facilitate appropriate selection of empiric antifungal therapy. Methods We performed a retrospective chart review of patients with candidemia who were admitted in 2005 and 2014. We determined the frequency of Candida species and compared 2005 data with those in 2014. Results In total, 226 and 109 patients with candidemia were admitted to our hospital in 2005 and 2014, respectively. Although, C. albicans was the most common species (43% of candidemia in 2005), its frequency decreased to 33% in 2014. The frequencies of C. glabrata and C. parapsilosis increased in 2014 compared with those in 2005 (24% vs. 16% and 33% vs. 26%, respectively). Figure 1 compared the proportion of Candida species in Maimonides Medical Center to National data. Conclusion Our finding of an increase in non-albicans spp. causing candidemia is consistent with published reports. We saw more cases of C. parapsilosis compared with published data. Our results may be used to inform empiric antifungal therapy. Disclosures All authors: No reported disclosures.

scholarly journals Fungal peritonitis in patients undergoing continuous ambulatory peritoneal dialysis in Qatar

2011 ◽  
Vol 5 (09) ◽  
pp. 646-651 ◽  
Author(s):  
Fahmi Yousef Khan ◽  
Mohammed Elsayed ◽  
Deshmukh Anand ◽  
Mohammed Abu Khattab ◽  
Doiphode Sanjay
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Broad Spectrum ◽  
Candida Species ◽  
Antibiotic Use ◽  
Fungal Species ◽  
Fungal Peritonitis ◽  
Bacterial Peritonitis ◽  
Broad Spectrum Antibiotics ◽  
Appropriate Therapy

Introduction: This study was conducted at Hamad General Hospital to determine the incidence of fungal peritonitis and to describe its clinical and microbiological findings in patients undergoing continuous ambulatory peritoneal dialysis in Qatar. Methodology: The medical records of these patients between 1 January 2005 and 31 December 2008 were retrospectively reviewed and the collected data were analysed. Results: During the study period, 141 episodes of peritonitis were observed among 294 patients. In 14 of these episodes (9.9%), fungal peritonitis was reported in 14 patients with a rate of 0.05 episodes per patient year, while the bacterial peritonitis rate was 0.63 per patient year. Thirteen (93%) patients had one or more previous episodes of bacterial peritonitis that was treated with multiple broad-spectrum antibiotics, 11 (85%) had received broad-spectrum antibiotics within the preceding month, 12 (92%) within three months, and 8 (62%) within six months. Candida species were the only fungal species isolated from the dialysate with predominance of non-albicans Candida species (especially Candida parapsilosis). Therapeutic approach was immediate catheter removal, followed by systemic antifungal therapy and temporary haemodialysis. Nine patients (64.3%) were continued on haemodialysis, whereas five patients (35.7%) died. Conclusions: Prior antibiotic use was an important risk factor predisposing patients to the development of fungal peritonitis. Early detection of fungal peritonitis would lead to early institution of appropriate therapy and prevention of complications.

scholarly journals Maternal Stroke

Circulation ◽  
2021 ◽  
Vol 143 (7) ◽  
pp. 727-738
Author(s):  
Islam Y. Elgendy ◽  
Syed Bukhari ◽  
Amr F. Barakat ◽  
Carl J. Pepine ◽  
Kathryn J. Lindley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Mortality ◽  
Maternal Age ◽  
The United States ◽  
Mortality Rates ◽  
Mortality Data ◽  
Postpartum Women ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Significant Burden

Maternal mortality rates have been steadily increasing in the United States, and cardiovascular mortality is the leading cause of death among pregnant and postpartum women. Maternal stroke accounts for a significant burden of cardiovascular mortality. Data suggest that rates of maternal stroke have been increasing in recent years. Advancing maternal age at the time of birth and the increasing prevalence of traditional cardiovascular risk factors, and other risk factors, as well, such as hypertensive disorders of pregnancy, migraine, and infections, may contribute to increased rates of maternal stroke. In this article, we provide an overview of the epidemiology of maternal stroke, explore mechanisms that may explain increasing rates of stroke among pregnant women, and identify key knowledge gaps for future investigation in this area.

scholarly journals 769. Risk Factors of Central Line-associated Bloodstream Infection in an Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S481-S482
Author(s):  
Zane Conrad ◽  
Minji Kang ◽  
Elizabeth Thomas ◽  
Doramarie Arocha ◽  
Julie B Trivedi
Keyword(s):  
Risk Factors ◽  
Candida Species ◽  
Medical Center ◽  
Academic Medical Center ◽  
Central Line ◽  
University Hospital ◽  
Icu Patients ◽  
Academic Medical ◽  
Significant Difference ◽  
Line Type

Abstract Background Central line-associated bloodstream infections (CLABSI) are one of the leading healthcare-acquired infections (HAI) with significant morbidity and mortality. We aimed to identify risk factors of CLABSI at an academic medical center to determine high-risk populations and target interventions. Methods This is an observational retrospective cohort study at William P. Clements Jr. University Hospital from January 1, 2017 to December 31, 2020. Retrospective chart review was conducted to identify demographics and co-morbidities of hospitalized patients diagnosed with CLABSI as defined by National Healthcare Safety Network (NHSN). Infections due to mucosal barrier injuries were excluded. Means were compared using independent-samples T-test and proportions were compared using chi-square. Results Ninety-three CLABSI events were identified with an increase in the standardized infection ratio from 0.38 in 2017 to 0.74 in 2020 (Figure 1). Bacterial organisms were identified in 71 (76%) cases while fungal organisms were identified in 22 (24%) (Table 2). There was no significant difference in the timing of CLABSI after line insertion (p=0.09) or organism identified (p=0.61) in PICC lines (n=33, 34%) vs all other central lines (n=60, 67%). When comparing immunocompromised patients with CLABSI (n=47, 51%) vs non-immunocompromised (n=46, 50%), there was a significant difference in the indication for line (chemotherapy), but no difference was seen in the number of line days prior to event (p=0.57), line type (p=0.17), or organism identified (p=0.94). Of all CLABSI, 46% (n=43) were in the intensive care unit (ICU) with significantly more Candida species (p=0.018) identified compared to non-ICU patients with CLABSI (n= 50, 54%). Figure 1. CLABSI Rate and SIR from 2017 to 2020 by Quarter Conclusion Candida species were more likely to be found in ICU patients with CLABSI as compared to non-ICU counterparts with further investigation in the ICU population revealing lack of flushing after administration of total parenteral nutrition. Otherwise, this observational cohort of CLABSI events did not identify any difference in immunosuppression status or line type. Given this information, infection prevention efforts will continue to be directed towards proper central line maintenance and removal when no longer indicated. Disclosures All Authors: No reported disclosures

scholarly journals Incidence, risk factors, phathophisiology and modern aspects of therapy of feline pyometra

2019 ◽  
pp. 54-60
Author(s):  
Georgy Petrovich Dyulger ◽  
Yuliya Gennadievna Sibileva ◽  
Maria Aleksandrovna Yakovleva Maria ◽  
Peter Georgievich Dyulger ◽  
Evgeniya Sergeevna Sedletskaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Early Detection ◽  
Inflammatory Response ◽  
Broad Spectrum ◽  
Clinical Manifestations ◽  
Systemic Inflammatory Response ◽  
Clinical Forms ◽  
Broad Spectrum Antibiotics ◽  
Incidence Risk

The article provides an overview of the frequency of distribution of pyometra in cats. Risk factors, clinical manifestations and clinical forms of the disease are analyzed. Current methods of pyometra diagnostics and clinical and laboratory criteria for early detection of signs of sepsis (systemic inflammatory response) in cats with pyometra are considered. The methods of pyometra therapy are analyzed. It was emphasized that the most effective and safest method of treating any form of pyometra is a total ovariohisterectomy in combination with broad-spectrum antibiotics. Encouraging results in the treatment of an open uncomplicated form of pyometers in cats were obtained using, along with antibiotics, preparations based on PgF2alfa and aglepristone.

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