scholarly journals Rate of Antibiotic Use and Associated Risk Factors in COVID-19 Hospitalized Patients

2020 ◽  
Author(s):  
Alysa J. Martin ◽  
Stephanie Shulder ◽  
David Dobrzynski ◽  
Katelyn Quartuccio ◽  
Kelly E. Pillinger
Keyword(s):  
Risk Factors ◽  
Final Analysis ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Antibiotic Prescribing ◽  
Factors Associated ◽  
Secondary Endpoints ◽  
Associated Risk Factors

AbstractBackgroundLiterature suggests that antibiotic prescribing in COVID-19 patients is high, despite low rates of confirmed bacterial infection. There are little data on what drives prescribing habits.ObjectiveThis study sought to determine antibiotic prescribing rates and risk factors for antibiotic prescribing in hospitalized patients. It was the first study to assess risk factors for receiving more than one course of antibiotics.MethodsThis was a retrospective, multi-center, observational study. Patients admitted from March 1, 2020 to May 31, 2020 and treated for PCR-confirmed COVID-19 were included. The primary endpoint was the rate of antibiotic use during hospitalization. Secondary endpoints included risk factors associated with antibiotic use, risk factors associated with receiving more than one antibiotic course, and rate of microbiologically confirmed infections.ResultsA total of 208 encounters (198 patients) were included in the final analysis. Eighty-three percent of patients received at least one course of antibiotics, despite low rates of microbiologically confirmed infection (12%). Almost one-third of patients (30%) received more than one course of antibiotics. Risk factors identified for both antibiotic prescribing and receiving more than one course of antibiotics were more serious illness, increased hospital length of stay, intensive care unit admission, mechanical ventilation, and acute respiratory distress syndrome.Conclusion and relevanceThere were high rates of antibiotic prescribing with low rates of bacterial co-infection. Many patients received more than one course of antibiotics during hospitalization. This study highlights the need for increased antibiotic stewardship practices in COVID-19 patients.

scholarly journals Antibiotic Use and Associated Risk Factors for Antibiotic Prescribing in COVID-19 Hospitalized Patients

2021 ◽  
pp. 089719002110302
Author(s):  
Alysa J. Martin ◽  
Stephanie Shulder ◽  
David Dobrzynski ◽  
Katelyn Quartuccio ◽  
Kelly E. Pillinger
Keyword(s):  
Risk Factors ◽  
Final Analysis ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Factors Associated ◽  
Associated Risk Factors

Background: Literature suggests that antibiotic prescribing in COVID-19 patients is high. Currently, there are insufficient data on what drives antibiotic prescribing practices throughout the COVID-19 pandemic. Objective: This study sought to determine antibiotic use rates and identify risk factors for antibiotic prescribing in hospitalized patients. It was the first study to assess risk factors for receiving more than 1 course of antibiotics. Methods: This was a retrospective, multi-center, observational study. Patients admitted from March 1, 2020, to May 31, 2020, and treated for COVID-19 were included. The primary endpoint was the rate of antibiotic use during hospitalization. Secondary endpoints included risk factors associated with antibiotic use, risk factors associated with receiving more than 1 antibiotic course, and rate of microbiologically confirmed infections. Results: A total of 208 encounters (198 patients) were included in the final analysis. Eighty-three percent of patients received at least 1 course of antibiotics, despite low rates of microbiologically confirmed infection (12%). Almost one-third of patients (30%) received more than 1 course of antibiotics. Risk factors identified for both antibiotic prescribing and receiving more than 1 course of antibiotics included increased hospital length of stay (median 12 days), intensive care unit admission, and the necessity for mechanical ventilation. Conclusion and Relevance: There were high rates of antibiotic prescribing with low rates of microbiologically confirmed bacterial co-infection. Many patients received more than 1 course of antibiotics during hospitalization. This study highlights the importance and demand for appropriate antibiotic stewardship practices in COVID-19 patients.

scholarly journals Patterns of Oral Antibiotic Use and Excess Duration at Hospital Discharge

2020 ◽  
Vol 41 (S1) ◽  
pp. s522-s523
Author(s):  
Corey Medler ◽  
Nicholas Mercuro ◽  
Helina Misikir ◽  
Nancy MacDonald ◽  
Melinda Neuhauser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Guideline Recommendation ◽  
Resistant Organism ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Cross Sectional ◽  
Tract Infections

Background: Antimicrobial stewardship (AMS) interventions have predominantly involved inpatient antimicrobial therapy. However, for many hospitalized patients, most antibiotic use occurs after discharge, and unnecessarily prolonged courses of therapy are common. Patient transition from hospitalization to discharge represents an important opportunity for AMS intervention. We describe patterns of antibiotic use selection and duration of therapy (DOT) for common infections including discharge antibiotics. Methods: This retrospective cross-sectional analysis was derived from an IRB-approved, multihospital, quasi-experiment at a 5-hospital health system in southeastern Michigan. The study population included patients discharged from an inpatient general and specialty practice ward on oral antibiotics from November 2018 through April 2019. Patients were included with the following diagnoses: skin and soft-tissue infections (SSTIs), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), respiratory viral infections, acute exacerbation of chronic obstructive pulmonary disease (AECOPD), intra-abdominal infections (IAIs), and urinary tract infections (UTIs). Other diagnoses were excluded. Data were extracted from medical records including antibiotic indication, selection, and duration, as well as patient characteristics. Results: In total, 1,574 patients were screened and 800 patients were eligible for inclusion. The most common antibiotic indications were respiratory tract infections, with 487 (60.9%) patients. These included 165 AECOPD cases (20.6%) and 200 CAP cases (25%) with no multidrug resistant organism (MDRO) risk factors; 57 patients (7.1%) with MDRO risk factors; HAP in 7 patients (0.9%); and influenza in 58 patients (7.2%). Also, 205 (25.6%) patients were diagnosed with UTIs: 71 with cystitis (8.9%), 86 (10.8%) with complicated UTI (cUTI), and 48 (6%) with pyelonephritis. Furthermore, 125 patients (15.6%) were diagnosed with SSTI: 59 (7.4%) purulent and 66 (8.3%) nonpurulent. 31 (3.9%) patients had an IAI. The most commonly used antibiotics were cephalosporins in 536 patients (67%), azithromycin in 252 patients (31.5%), and fluroquinolones and tetracyclines in 231 patients (28.9%). Fluroquinolones were the most frequent antibiotic prescribed at discharge in 210 patients (26.3%). Figure 1 displays the average DOT relative to specific indications. The median duration of total antibiotic therapy exceeded institutional guideline recommendation for multiple conditions, including AECOPD (7 days vs recommended 5 days), CAP with COPD (8.3 vs 7 days ), CAP without COPD (7.7 vs 5 days), and pyelonephritis (11 vs 7–10 days). Also, 269 (33.6%) patients received unnecessary therapy; 218 (27.3%) of these were due to excess duration. Conclusions: Among a cross-section of hospitalized patients, the average DOT, including after discharge, exceeded the optimal therapy for many patients. Further understanding of patterns and influences of antibiotic prescribing is necessary to design effective AMS interventions for improvement.Funding: This work was completed under CDC contract number 200-2018-02928.Disclosures: None

scholarly journals Immunoglobulin Deficiency as an Indicator of Disease Severity in Patients with COVID-19

2020 ◽  
Author(s):  
Faeq Husain-Syed ◽  
István Vadász ◽  
Jochen Wilhelm ◽  
Hans-Dieter Walmrath ◽  
Werner Seeger ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disease Severity ◽  
Disease Onset ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Limited Information ◽  
Igg Deficiency ◽  
Associated Risk Factors ◽  
Lower Ratio

Despite the pandemic status of COVID-19, there is limited information about host risk factors and treatment beyond supportive care. Immunoglobulin G (IgG) could be a potential treatment target. Our aim was to determine the incidence of IgG deficiency and associated risk factors in a cohort of 62 critical ill COVID-19 patients admitted to two German ICUs (72.6% male, median age: 61 years). 13 (21.0%) of the patients displayed IgG deficiency (IgG <7 g/L) at baseline (predominant for the IgG1, IgG2, and IgG4 subclasses). IgG-deficient patients had worse measures of clinical disease severity than those with normal IgG levels (shorter duration from disease onset to ICU admission, lower ratio of PaO2 to FiO2, higher Sequential Organ Failure Assessment score, and higher levels of ferritin, neutrophil-to-lymphocyte ratio and serum creatinine). IgG-deficient patients were also more likely to have sustained lower levels of lymphocyte counts and higher levels of ferritin throughout the hospital stay. Furthermore, IgG-deficient patients compared to those with normal IgG levels displayed higher rates of acute kidney injury (76.9% vs. 26.5%; p=0.005) and death (46.2% vs. 14.3%; p=0.012), longer ICU (28 [6-48] vs. 12 [3-18] days; p=0.012) and hospital length of stay (30 [22-50] vs. 18 [9-24] days; p=0.004). Multivariable logistic regression showed increasing odds of 90-day overall mortality associated with IgG-deficiency (OR 12.8, 95% CI 1.5-108.4; p=0.019). IgG deficiency might be common in critically ill COVID-19 patients, and warrants investigation as both a marker of disease severity as well as a potential therapeutic target.

scholarly journals Risk factors for community-associated Clostridioides difficile infection in young children

2019 ◽  
Vol 147 ◽  
Author(s):  
M. K. Weng ◽  
S. H. Adkins ◽  
W. Bamberg ◽  
M. M. Farley ◽  
C. C. Espinosa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Children ◽  
Conditional Logistic Regression ◽  
Multivariable Analysis ◽  
Healthcare Facility ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Clostridioides Difficile ◽  
Associated Risk Factors ◽  
Few Data

AbstractThe majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case–control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014–February 2016. Case-patients were defined as children aged 1–5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18–17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.

scholarly journals Analysis of risk factors for unplanned reoperation following primary repair of gastrointestinal disorders in neonates

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu Cui ◽  
Rong Cao ◽  
Jia Li ◽  
Ling-mei Deng
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Length Of Stay ◽  
Operative Time ◽  
Primary Repair ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Gastrointestinal Disorders ◽  
Factors Associated ◽  
Link Type

Abstract Background The aim of our study was to identify the factors associated with unplanned reoperations among neonates who had undergone primary repair of gastrointestinal disorders. Methods A retrospective chart review was conducted for neonates who underwent primary gastrointestinal surgery between July 2018 and September 2020. The neonates were divided into two cohort, depending on whether they had an unplanned reoperation. The primary outcome was the occurrence of unplanned reoperation. The risk factors that associated the occurrence of unplanned reoperation were examined. Main results Two hundred ninety-six neonates fulfilled the eligibility criteria. The incidence of unplanned reoperation was 9.8%. Analyses of all patients with respect of developing unplanned reoperation showed that the length of operative time was an independent risk factor [Odds Ratio 1.02; 95% confidence interval 1.00, 1.04; p = 0.03]. Patients with unplanned reoperation had a longer postoperative hospital length-of-stay [19.9 ± 14.7 vs. 44.1 ± 32.1 days; p<0.01]. Conclusion The current study is the first analysis of risk factors associated with an unplanned reoperation in neonates undergoing primary repair of gastrointestinal disorders. The length of operative time is the only risk factor for an unplanned reoperation, and the unplanned reoperation can directly prolong the postoperative hospital length-of-stay. Trial registration This study was registered at http://www.chictr.org.cn/index.aspx with No. ChiCTR2000040260.

scholarly journals Incidence and Practice of Early Prone Positioning in Invasively Ventilated COVID-19 Patients—Insights from the PRoVENT-COVID Observational Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4783
Author(s):  
Willemke Stilma ◽  
David M. P. van Meenen ◽  
Christel M. A. Valk ◽  
Hendrik de Bruin ◽  
Frederique Paulus ◽  
...  
Keyword(s):  
Observational Study ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prone Positioning ◽  
Multicenter Observational Study ◽  
Factors Associated ◽  
Actual Use ◽  
Secondary Endpoints

We describe the incidence and practice of prone positioning and determined the association of use of prone positioning with outcomes in invasively ventilated patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) in a national, multicenter observational study, performed at 22 intensive care units in the Netherlands. Patients were categorized into 4 groups, based on indication for and actual use of prone positioning. The primary outcome was 28-day mortality. Secondary endpoints were 90-day mortality, and ICU and hospital length of stay. In 734 patients, prone positioning was indicated in 60%—the incidence of prone positioning was higher in patients with an indication than in patients without an indication for prone positioning (77 vs. 48%, p = 0.001). Patients were left in the prone position for median 15.0 (10.5–21.0) hours per full calendar day—the duration was longer in patients with an indication than in patients without an indication for prone positioning (16.0 (11.0–23.0) vs. 14.0 (10.0–19.0) hours, p < 0.001). Ventilator settings and ventilation parameters were not different between the four groups, except for FiO2 which was higher in patients having an indication for and actually receiving prone positioning. Our data showed no difference in mortality at day 28 between the 4 groups (HR no indication, no prone vs. no indication, prone vs. indication, no prone vs. indication, prone: 1.05 (0.76–1.45) vs. 0.88 (0.62–1.26) vs. 1.15 (0.80–1.54) vs. 0.96 (0.73–1.26) (p = 0.08)). Factors associated with the use of prone positioning were ARDS severity and FiO2. The findings of this study are that prone positioning is often used in COVID-19 patients, even in patients that have no indication for this intervention. Sessions of prone positioning lasted long. Use of prone positioning may affect outcomes.

Prevalence, Risk Factors, and Clinical Consequences of Recurrent Activation of a Rapid Response Team: A Multicenter Observational Study

2018 ◽  
Vol 34 (10) ◽  
pp. 782-789 ◽  
Author(s):  
Shannon M. Fernando ◽  
Peter M. Reardon ◽  
Damon C. Scales ◽  
Kyle Murphy ◽  
Peter Tanuseputro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Health Care Providers ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Rapid Response ◽  
Hospital Length Of Stay ◽  
Care Providers ◽  
Term Care ◽  
Home Setting

Introduction: Rapid response teams (RRTs) are groups of health-care providers, implemented by hospitals to respond to distressed hospitalized patients on the hospital wards. Patients assessed by the RRT for deterioration may be admitted to the intensive care unit (ICU) or may be triaged to remain on the wards, putting them at risk of recurrent deterioration and repeat RRT activation. Previous studies evaluating outcomes of patients with recurrent deterioration and multiple RRT activations have produced conflicting results. Methods: We used a prospectively collected multicenter registry from 2 hospitals within a single tertiary-level hospital system between 2012 and 2016. Comparisons were made between patients with a single RRT activation and those with multiple RRT activations over the course of their admission. Primary outcome was in-hospital mortality, which was analyzed using multivariable logistic regression. Results: A total of 5995 patients who had any RRT activation were analyzed. Of that, 1183 (19.7%) patients had recurrent deterioration and multiple RRT activations during their admission. Risk factors for recurrent deterioration included admission from a home setting (as opposed to a long-term care facility), RRT activation during nighttime hours, and delay (>1 hour) to RRT activation. Recurrent deterioration was associated with increased odds of mortality (adjusted odds ratio [OR]: 1.44 [1.28-1.64], P = <.001). Increasing number of RRT activations were associated with increasing risk of mortality. Patients with recurrent deterioration had prolonged median hospital length of stay (21.0 days vs 12.0 days, P < .001), while patients with only a single activation were more likely to be admitted to the ICU (adjusted OR: 2.30 [1.96-2.70], P < .001). Conclusions: Recurrent deteriorations leading to RRT activations among hospitalized patients are associated with increased odds of mortality and prolonged hospital length of stay. This work identifies a group of patients who warrant closer attention to help reduce adverse outcomes.

scholarly journals Bariatric Procedures in Older Adults in the United States: Analysis of a Multicenter Database

Geriatrics ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 32 ◽  
Author(s):  
Mendiratta ◽  
Dayama ◽  
Azhar ◽  
Prodhan ◽  
Wei
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Skilled Nursing Facility ◽  
The United States ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Factors Associated ◽  
Choice Of Procedure

Background: Bariatric procedures help reduce obesity-related comorbidities and thus improve survival. Clinical characteristics and outcomes after bariatric procedures in older adults were investigated. Methods: A multi-institutional Nationwide Inpatient Sample (NIS) database was queried from years 2005 through 2012. Older adults >60 years of age with procedure codes for bariatric procedures and a diagnosis of obesity/morbid obesity were selected to compare clinical characteristics/outcomes between those undergoing closed versus open procedures and identify risk factors associated with in-hospital mortality and increased hospital length of stay (LOS). Results: Over the study period, 79,122 bariatric procedures were performed. Those undergoing open procedures compared to closed procedures had a higher in-hospital mortality (0.8% vs. 0.2%) and a longer hospital LOS (4.8 days vs. 2.2 days). Risk factors significantly associated with in-hospital mortality were open procedures, the Western region, and the Elixhauser comorbidity index. Risk factors associated with increased LOS were Medicaid insurance type, an open procedure, a higher Elixhauser comorbidity score, a required skilled nursing facility (SNF) discharge, and died in hospital. Conclusion: Closed bariatric procedures are increasingly being preferred in older adults, with a four-fold lower mortality compared to open procedures. Besides choice of procedure, the presence of specific comorbidities is associated with increased mortality in older adults.

scholarly journals Epidemiological Risk Factors for Isolation of Ceftriaxone-Resistant versus -Susceptible Citrobacter freundii in Hospitalized Patients

2003 ◽  
Vol 47 (9) ◽  
pp. 2882-2887 ◽  
Author(s):  
Peter W. Kim ◽  
Anthony D. Harris ◽  
Mary-Claire Roghmann ◽  
J. Glenn Morris ◽  
Arjun Strinivasan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Case Group ◽  
Citrobacter Freundii ◽  
Icu Stay ◽  
Epidemiological Risk ◽  
Group 2 ◽  
Control Study

ABSTRACT Antimicrobial resistance is an emerging problem among nosocomial bacteria. Risk factors for the recovery of ceftriaxone-resistant (CRCF) or -susceptible (CSCF) Citrobacter freundii in clinical cultures from hospitalized patients were determined by using a case-case-control study design. CRCF was isolated from 43 patients (case group 1) and CSCF was isolated from 87 patients (case group 2) over a 3-year period. Risk factors for CRCF were exposure to imipenem (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.2 to 45.4), broad-spectrum cephalosporins (OR, 6.9; 95% CI, 1.8 to 26.7), vancomycin (OR, 3.0; 95% CI, 1.2 to 7.4), or piperacillin-tazobactam (OR, 2.6; 95% CI, 1.1 to 6.2), as well as hospital length of stay ≥1 week (OR, 3.6; 95% CI, 1.3 to 10.2) and intensive care unit (ICU) stay (OR, 2.6; 95% CI, 1.1 to 6.2). Risk factors for CSCF were peripheral vascular disease (OR, 23.2; 95% CI, 4.3 to 124.6), AIDS (OR, 9.5; 95% CI, 1.6 to 55.5), cerebrovascular disease (OR, 4.2; 95% CI, 1.6 to 10.8), and ICU stay (OR, 3.1; 95% CI, 1.8 to 5.4).

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