scholarly journals ESKAPE Pathogens in Bloodstream Infections Are Associated With Higher Cost and Mortality but Can Be Predicted Using Diagnoses Upon Admission

2019 ◽  
Vol 6 (12) ◽  
Author(s):  
Joseph E Marturano ◽  
Thomas J Lowery
Keyword(s):  
Health Care ◽  
High Risk ◽  
Bloodstream Infections ◽  
Clinical Impact ◽  
Cost Of Care ◽  
Data Set ◽  
Absolute Increase ◽  
Word Group ◽  
Eskape Pathogens ◽  
Random Guessing

Abstract Background ESKAPE bacteria are thought to be especially resistant to antibiotics, and their resistance and prevalence in bloodstream infections are rising. Large studies are needed to better characterize the clinical impact of these bacteria and to develop algorithms that alert clinicians when patients are at high risk of an ESKAPE infection. Methods From a US data set of >1.1 M patient encounters, we evaluated if ESKAPE pathogens produced worse outcomes than non-ESKAPE pathogens and if an ESKAPE infection could be predicted using simple word group algorithms built from decision trees. Results We found that ESKAPE pathogens represented 42.2% of species isolated from bloodstream infections and, compared with non-ESKAPE pathogens, were associated with a 3.3-day increase in length of stay, a $5500 increase in cost of care, and a 2.1% absolute increase in mortality (P < 1e-99). ESKAPE pathogens were not universally more resistant to antibiotics, but only to select antibiotics (P < 5e-6), particularly against common empiric therapies. In addition, simple word group algorithms predicted ESKAPE pathogens with a positive predictive value of 7.9% to 56.2%, exceeding 4.8% by random guessing (P < 1e-99). Conclusions Taken together, these data highlight the pathogenicity of ESKAPE bacteria, potential mechanisms of their pathogenicity, and the potential to predict ESKAPE infections upon admission. Implementing word group algorithms could enable earlier and targeted therapies against ESKAPE bacteria and thus reduce their burden on the health care system.

scholarly journals Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States (Preprint)

2020 ◽  
Author(s):  
Jorn op den Buijs ◽  
Marten Pijl ◽  
Andreas Landgraf
Keyword(s):  
United States ◽  
Health Care ◽  
High Risk ◽  
Predictive Model ◽  
The United States ◽  
Data Set ◽  
Targeted Interventions ◽  
Emergency Hospital ◽  
The Us ◽  
Hospital Transport

BACKGROUND Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. OBJECTIVE The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. METHODS Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. RESULTS German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. CONCLUSIONS Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use.

scholarly journals EFEKTIFITAS MANDI CHLORHEXIDINE GLUCONATE TERHADAP PENURUNAN ANGKA KEJADIAN HAIs: LITERATURE REVIEW

2020 ◽  
Vol 4 (2) ◽  
pp. 1
Author(s):  
Tia Atnawanty ◽  
Sri Yona ◽  
Riri Maria
Keyword(s):  
Health Care ◽  
Literature Review ◽  
Bloodstream Infections ◽  
Chlorhexidine Gluconate ◽  
Cost Of Care ◽  
Healthcare Associated Infections ◽  
Chlorhexidine Bathing ◽  
Health Care Associated Infections ◽  
Healthcare Associated ◽  
The Cost

INTISARI : Latar Belakang: Insiden Health-care Associated Infections (HAIs) atau infeksi yang berhubungan dengan pelayanan kesehatan di dunia semakin meningkat sehingga menyebabkan morbiditas, mortalitas, dan biaya tinggi bagi rumah sakit. Klorheksidin glukonat sebagai antiseptik dengan aktivitas antimikroba spektrum luas telah ditunjukkan dalam beberapa penelitian sebagaiABSTRAKLatar belakang: Penyakit infeksi di fasilitas kesehatan atau disebut juga Healthcare Associated Infections (HAIs) menjadi masalah besar yang masuk ke rumah sakit karena dapat meningkatkan angka morbiditas (kesakitan), angka mortalitas (kematian) dan menambah biaya perawatan yang besar bagi rumah sakit. Chlorhexidine gluconate sebagai antiseptik dengan aktivitas antimikroba spektrum luas merupakan komponen penting dalam pencegahan infeksi. Rutinitas mandi harian di perawatan kritis dan intensif dan mandi sebelum operasi dengan sabun Chlorhexidine gluconatetelah menurunkan infeksi aliran darah, infeksi daerah operasi dan akuisi organisme patogen berbahaya dan resisten yang terdapat di rumah sakit. Namun karena belum konsistennya hasil penelitian terkait hal ini, akibatnya mandi Chlorhexidine belum dilakukan secara universal sebagai prosedur tetap dan masih menyisakan sampai sekarang. Kajian literatur ini bertujuan untuk menilai efektifitas mandi Chlorhexidine gluconate terhadap penurunan kejadian infeksi yang berkaitan dengan kesehatan dan mikroorganisme penyebabnya.Metode: Penulis melakukan pencarian literatur dengan mengumpulkan beberapa artikel terindeks yang berhubungan dengan topik yang diangkat menggunakan database seperti Clinical key, Elsevier, ProQuest , dan ScienceDirect dengan kata kunci chlorhexidine gluconate, chlorhexidine bathing, health care related infeksi .Hasil: Dari 3871 artikel umum, dilakukan penyaringan menjadi 269 artikel yang terkait, dikumpulkan sebanyak 16 artikel yang sesuai dengan topik dan 8 artikel yang sesuai kriteria sebagai bahan kajian literatur.Kesimpulan: Penulis menyimpulkan bahwa mandi dengan Chlorhexidine gluconate secara rutin penerapan “ bundles ” pencegahan dapat menurunkan prevalensi mikroorganisme berbahaya termasuk kuman patogen yang resisten terhadap antimikroba, namun efektifitas biaya, integritas kulit dan resistensi tetap harus. Kata kunci: chlorhexidine gluconate, mandi chlorhexidine, infeksi terkait perawatan kesehatan ABSTRAKLatar Belakang: Infectious diseases in health facilities also known as Healthcare Associated Infections (HAIs) are major problem facing hospitals because they can increase morbidity rates (pain), mortality rates (deaths) and increase the cost of care for hospitals. Chlorhexidine gluconate as an antiseptic with broad spectrum antimicrobial activity is an important component in infection prevention. Daily bathing routine in critical or intensive care and pre-surgery showers with Chlorhexidine soap have reduced bloodstream infections, surgical area infections and the acquisition of harmful and resistant pathogenic organisms found in hospitals. However, due to the inconsistency of research results related to this matter, as a result chlorhexidine bathing has not been done universally as a permanent procedure and still leaves debate until now. This literature review aims to assess the effectiveness of chlorhexidine gluconate baths in reducing the incidence of infections related to health services and their causative microorganisms. Metode: Penulis melakukan pencarian dengan mengumpulkan beberapa artikel terindeks yang berhubungan dengan topik yang diangkat dari beberapa database seperti Clinical keys, Elsevier, ProQuest dan ScienceDirect dengan kata kunci chlorhexidine gluconate, chlorhexidine bathing, perawatan kesehatan terkait infeksi .Hasil: Dari 3871 artikel umum yang disaring menjadi 269 artikel terkait, didapatkan sebanyak 16 artikel yang sesuai dengan topik dan 8 artikel yang memenuhi kriteria sebagai bahan studi literatur.Kesimpulan: Penulis menyimpulkan bahwa mandi dengan klorheksidin glukonat secara rutin dengan aplikasi “bundel” pencegahan infeksi dapat menurunkan prevalensi mikroorganisme berbahaya termasuk patogen resisten antimikroba, namun pertimbangan efektivitas biaya, integritas kulit, dan resistensi tetap harus diperhatikan. Kata kunci: klorheksidin glukonat, mandi klorheksidin, infeksi terkait perawatan kesehatankomponen tant dalam pencegahan infeksi di unit perawatan pasien. Salah satunya dengan rutinitas mandi sehari-hari di ruang perawatan kritis / intensif dan mandi sebelum operasi dengan sabun klorheksidin telah mengurangi infeksi aliran darah, infeksi area operasi dan didapatnya organisme patogen berbahaya dan resisten yang terdapat di rumah sakit. Namun karena ketidakkonsistenan hasil penelitian terkait hal tersebut, akibatnya mandi klorheksidin belum dilakukan secara universal sebagai prosedur permanen dan masih menyisakan perdebatan hingga saat ini. Tinjauan pustaka ini bertujuan untuk menilai keefektifan mandi klorheksidin glukonat dalam mengurangi kejadian infeksi yang berkaitan dengan layanan kesehatan dan mikroorganisme penyebabnya.Metode: Metode yang digunakan adalah penelusuran literatur baik nasional maupun internasional yang dilakukan dengan menggunakan database Clinical keys, Elsevier, ProQuest, dan lain-lain.Hasil: Dari hasil pencarian diperoleh sebanyak 22 artikel terkait yang dijadikan studi literatur.Kesimpulan: Penulis menyimpulkan bahwa mandi dengan klorheksidin glukonat secara rutin dengan aplikasi “bundel” pencegahan infeksi dapat menurunkan prevalensi mikroorganisme berbahaya termasuk patogen resisten antimikroba, namun pertimbangan efektivitas biaya, integritas kulit, dan resistensi tetap harus diperhatikan.

scholarly journals Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States

10.2196/25121 ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. e25121
Author(s):  
Jorn op den Buijs ◽  
Marten Pijl ◽  
Andreas Landgraf
Keyword(s):  
United States ◽  
Health Care ◽  
High Risk ◽  
Predictive Model ◽  
The United States ◽  
Data Set ◽  
Targeted Interventions ◽  
Emergency Hospital ◽  
The Us ◽  
Hospital Transport

Background Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. Objective The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. Methods Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. Results German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. Conclusions Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use.

scholarly journals 115. Evaluation of the Clinical Impact of the T2MR for the Diagnosis of Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S89-S89
Author(s):  
Tamara Seitz ◽  
Sebastian Baumgartner ◽  
Christoph Wenisch ◽  
Alexander Zoufaly
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Targeted Therapy ◽  
Blood Culture ◽  
Bloodstream Infections ◽  
Clinical Impact ◽  
Acinetobacter Baumanii ◽  
Eskape Pathogens ◽  
Positive Results

Abstract Background The EK-189 study evaluates the clinical impact of T2 magnetic resonance (T2MR) for rapid detection of bloodstream infections (BSI) caused by ESKAPE-pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Escherichia coli) compared with blood culture (BC). Here we present preliminary results from this ongoing study. Methods Patients newly admitted to an infectious diseases department with suspected blood stream infection with ESKAPE pathogens (based on predefined criteria) are included and randomized into BSI diagnosis with (a) T2MR and blood culture or (b) blood culture alone. Routine diagnostic workup including chest X-ray, complete laboratory workup (including blood count, C-reactive protein, interleukin-6) is performed in all patients. Antibiotic regimens are selected empirically based on suspected pathogens and are switched to targeted therapy at the discretion of the treating physician once a pathogen is detected. Outcome parameters include time to targeted (predefined) antibiotic therapy and time to discharge. Test characteristics of the T2MR compared with BC are also assessed. Results So far 44 patients were included (22 in each group). In 9/22 patients (41%) in the T2MR-group a pathogen was detected (4 Escherichia coli, 2 Klebsiella pneumoniae, 1 Staphylococcus aureus, 1 Pseudomonas aeruginosa and 1 Acinetobacter baumanii) and in 3/22 (14%) patients in the BC-group (all E. coli). The comparison of T2MR vs. BC is depicted in Table 1. Sensitivity and specificity of T2MR in comparison to BC were 100% and 64.7%. All positive results in T2MR were considered true positive results. The days until clinical improvement, the need for admission at ICU and the in-hospital mortality were similar in both groups. Conclusion The results from this preliminary analysis show that in patients with suspected BSI with ESKAPE pathogens, T2MR detects more pathogens than BC and potentially provides a quicker detection and shorter time to targeted therapy. Further analyses of this ongoing study with a larger sample size are needed to evaluate the impact of the use of T2MR on patient’s outcome Disclosures All authors: No reported disclosures.

Health-Care Associated Pneumonia (HCAP): Identification of Low and High-Risk Patients

2015 ◽  
Vol 11 (3) ◽  
pp. 241-246 ◽  
Author(s):  
John Abisheganaden ◽  
Yew Ding ◽  
Wai Chong ◽  
Bee Heng ◽  
Akash Verma ◽  
...  
Keyword(s):  
Health Care ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Health Care Associated Pneumonia

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

scholarly journals Women, Exercise, and Eating Disorder Recovery: The Normal and the Pathological

2021 ◽  
pp. 104973232199204
Author(s):  
Hester Hockin-Boyers ◽  
Megan Warin
Keyword(s):  
Health Care ◽  
Eating Disorder ◽  
Affect Regulation ◽  
Health Care Professionals ◽  
Value Systems ◽  
Structured Interviews ◽  
Data Set ◽  
The United Kingdom ◽  
Theoretical Frame ◽  
Intensity Of Exercise

The appropriate form, regularity, and intensity of exercise for individuals recovering from eating disorders is not agreed upon among health care professionals or researchers. When exercise is permitted, it is that which is mindful, embodied, and non-competitive that is considered normative. Using Canguilhem’s concepts of “the normal and the pathological” as a theoretical frame, we examine the gendered assumptions that shape medical understandings of “healthy” and “dysfunctional” exercise in the context of recovery. The data set for this article comes from longitudinal semi-structured interviews with 19 women in the United Kingdom who engaged in weightlifting during their eating disorder recovery. We argue that women in recovery navigate multiple and conflicting value systems regarding exercise. Faced with aspects of exercise that are pathologized within the eating disorder literature (such as structure/routine, body transformations, and affect regulation), women re-inscribe positive value to these experiences, thus establishing exercise practices that serve them.

Clinical impact of LncRNA XIST and LncRNA NEAT1 for diagnosis of high-risk group breast cancer patients

2021 ◽  
pp. 100709
Author(s):  
Menha Swellam ◽  
Hekmat M EL Magdoub ◽  
May A Shawki ◽  
Marwa Adel ◽  
Mona M Hefny ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Risk Group ◽  
High Risk Group ◽  
Clinical Impact ◽  
Breast Cancer Patients ◽  
Lncrna Xist ◽  
Lncrna Neat1

scholarly journals Hospital-Acquired Bloodstream Infections With MRSA and VRE: Standardized Admission Screening Did Not Impact Rates

2020 ◽  
Vol 41 (S1) ◽  
pp. s253-s254
Author(s):  
Jennifer Ellison ◽  
Blanda Chow ◽  
Andrea Howatt ◽  
Ted Pfister ◽  
Kathryn Bush
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
Cost Of Care ◽  
Early Initiation ◽  
Solid Organ ◽  
Screening Practices ◽  
Contact Precautions ◽  
Admission Screening ◽  
Hospital Acquired ◽  
Standardized Screening

Background: Bloodstream infections (BSIs) are an important cause of morbidity and mortality in severely ill patients, contributing to increased length of stay and a higher cost of care. Surveillance of hospital-acquired (HA) BSI is considered a measure of quality of care and has been performed provincially in Alberta since 2011. Prior to October 2015, a nonstandardized, risk-factor–based VRE screening process was used. Screening practices for antibiotic-resistant organisms (AROs) were aligned in October 2015 with a provincially standardized admission screening tool to allow for early initiation of contact precautions for patients colonized or infected with MRSA or VRE. In this data review, we sought to determine whether this admission screening change influenced ARO infections through review of HA-BSI rates. Methods: Prospectively, we reviewed reports of all patients admitted to Alberta Health Services/Covenant Health acute-care and acute-/tertiary-care rehabilitation facilities who met inclusion criteria: (1) positive blood culture identified with MRSA or VRE; (2) new episode for the patient; and (3) positive result occurred on or after calendar day 3 of admission. Data are presented as quarterly rates. Screening practices for MRSA and VRE were standardized provincially in October 2015 to include screening for MRSA on admission for patients who had an inpatient admission, received hemodialysis, or was an inmate in a correctional facility in the past 6 months. We also screened for VRE patients admitted to a solid-organ transplant unit or a hematology unit, regardless of risk factors. Results: We detected no changes in the quarterly rates of HA-BSI with MRSA or VRE after admission screening was standardized. Prior to standardized screening, MRSA BSI rates ranged from 0.12 to 0.25 per 10,000 patient days, with an overall rate of 0.18 per 10,000 patient days. After standardization, rates ranged from 0.09 to 0.30 per 10,000 patient days, with an overall rate of 0.17 per 10,000 patient days (P = .46). VRE BSI rates prior to standardization ranged from 0.03 to 0.13 per 10,000 patient days, with an overall rate of 0.08 per 10,000 patient days, which increased slightly to 0.09 per 10,000 patient days after standardized screening, ranging between 0.04 and 0.16 per 10,000 patient days (P = .61). Conclusions: Following the implementation of standardized admission screening and the early initiation of contact precautions, no significant changes were observed in rates of either HA-BSI with MRSA or VRE. Further investigation is required to identify the most effective strategies to reduce HA-BSIs caused by MRSA and VRE.Funding: NoneDisclosures: None

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