scholarly journals Influence of time to diagnosis of severe influenza on antibiotic use, length of stay, isolation precautions, and mortality: a retrospective study

2017 ◽  
Vol 11 (4) ◽  
pp. 337-344 ◽  
Author(s):  
Isabel E. Akers ◽  
Rainer Weber ◽  
Hugo Sax ◽  
Jürg Böni ◽  
Alexandra Trkola ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Antibiotic Use ◽  
Severe Influenza ◽  
Time To Diagnosis

scholarly journals Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

2021 ◽  
Vol 10 (1) ◽  
pp. e001120
Author(s):  
Brendan Joseph McMullan ◽  
Michelle Mahony ◽  
Lolita Java ◽  
Mona Mostaghim ◽  
Michael Plaister ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Audit And Feedback ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Intravenous Therapy ◽  
Paediatric Hospital ◽  
Inpatient Settings ◽  
Surgical Teams

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.

scholarly journals Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ines Gragueb-Chatti ◽  
Alexandre Lopez ◽  
Dany Hamidi ◽  
Christophe Guervilly ◽  
Anderson Loundou ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Length Of Stay ◽  
Critically Ill ◽  
Invasive Mechanical Ventilation ◽  
Blood Stream ◽  
Hospital Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Blood Stream Infections ◽  
Second Wave

Abstract Background Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality. Results Among the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups. Conclusions In this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients.

scholarly journals Rapid Multiplex Testing for Upper Respiratory Pathogens in the Emergency Department: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Larissa May ◽  
Grant Tatro ◽  
Eduard Poltavskiy ◽  
Benjamin Mooso ◽  
Simson Hon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Usual Care ◽  
Controlled Trial ◽  
Antibiotic Use ◽  
Respiratory Pathogens ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections ◽  
The Impact

Abstract Background Acute upper respiratory tract infections are a common cause of Emergency Department (ED) visits and often result in unnecessary antibiotic treatment.  Methods We conducted a randomized clinical trial to evaluate the impact of a rapid, multi-pathogen respiratory panel (RP) test versus usual care (control). Patients were eligible if they were ≥12 months old, had symptoms of upper respiratory infection or influenza like illness, and were not on antibiotics. The primary outcome was antibiotic prescription; secondary outcomes included antiviral prescription, disposition, and length of stay (ClinicalTrials.gov# NCT02957136). Results Of 191 patients enrolled, 93 (49%) received RP testing; 98 (51%) received usual care. Fifty-three (57%) RP and 7 (7%) control patients had a virus detected and reported during the ED visit (p=0.0001). Twenty (22%) RP patients and 33 (34%) usual care patients received antibiotics during the ED visit (-12% [95% CI -25%, 0.4%]; p=0.06/0.08); 9 RP patients received antibiotics despite having a virus detected. The magnitude of antibiotic reduction was greater in children (-19%) versus adults (-9%; post-hoc analysis). There was no difference in antiviral use, length of stay, or disposition. Conclusions Rapid RP testing was associated with a trend towards decreased antibiotic use, suggesting a potential benefit from more rapid viral tests in the ED. Future studies should determine if specific groups are more likely to benefit from testing and evaluate relative cost and effectiveness of broad testing, focused testing, and a combined diagnostic and antimicrobial stewardship approach.

Retrospective Study on Hospital Admissions due to Pyelonephritis in Type II Diabetic Patients

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Dilraj Dhillon ◽  
Thomas Randall ◽  
David Zezoff ◽  
Mouchumi Bhattacharyya
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Type Ii Diabetes Mellitus ◽  
Hospitalized Patients ◽  
Diabetic Patients ◽  
Clean Intermittent Catheterization ◽  
Type Ii ◽  
Indwelling Catheters ◽  
Significant Difference

Background: Pyelonephritis is a urinary tract infection that ascends to involve the kidneys. It can also occur as an infection secondary to bacteremia. Some pathogens that commonly cause pyelonephritis are E. coli, enterobacteriaceae, staphylococci, and pseudomonas. The initial patient presentation usually involves fever, chills, nausea, vomiting, costovertebral angle tenderness, and flank pain. Other cystitis symptoms such as dysuria, increased urinary frequency, malodorous urine, and hematuria may or may not be present. Symptoms of pyelonephritis with bacteriuria are sufficient for the diagnosis of pyelonephritis. Aim: The aim of this study was to investigate a potential link between Type II Diabetes Mellitus and pyelonephritis. Methods: In this retrospective study, hospitalized patients during the study period were reviewed. Variables examined were sex, age, and length of stay. Patients were excluded if they had known urogenital abnormalities, indwelling catheters (Foley, nephrostomy, suprapubic, or who regularly perform clean intermittent catheterization), were pregnant, or were on dialysis. Results: Of 333 patients analyzed, diabetics had a longer length of stay then non-diabetics (4.49 vs 3.67 days respectively; p=0.0041) and females were significantly younger than men in hospitalized patients for pyelonephritis were (50.0 vs 63.5 years; p=<0.0001). Further, it was found that diabetics were significantly older than nondiabetics were (60.4 vs 47.3; p=<0.0001) and more diabetics getting admitted with pyelonephritis were men vs women (59.32% vs 35.27%; p=0.0007). Conclusion: Results of the study were significant in showing that of all pyelonephritis-hospitalized patients on average the length of stay was longer for diabetics and it demonstrated that female patients with pyelonephritis are significantly younger than male patients hospitalized with pyelonephritis. Of note, there was no significant difference in the length of stay for diabetic patients based on their treatment modality (diet controlled vs. oral medications vs. insulin dependent vs. combined). The study also showed that diabetics getting admitted for pyelonephritis are more men and older in age compared to the nondiabetics.

The Association between Prolonged Antibiotic Use in Culture Negative Infants and Length of Hospital Stay and Total Hospital Costs

2021 ◽  
Author(s):  
Wesam Sourour ◽  
Valeria Sanchez ◽  
Michel Sourour ◽  
Jordan Burdine ◽  
Elizabeth Rodriguez Lien ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Multivariate Linear Regression Analysis ◽  
Negative Blood Culture ◽  
Total Cost

Objective This study aimed to determine if prolonged antibiotic use at birth in neonates with a negative blood culture increases the total cost of hospital stay. Study design This was a retrospective study performed at a 60-bed level IV neonatal intensive care unit. Neonates born <30 weeks of gestation or <1,500 g between 2016 and 2018 who received antibiotics were included. A multivariate linear regression analysis was conducted to determine if clinical factors contributed to increased hospital cost or length of stay. Results In total, 190 patients met inclusion criteria with 94 infants in the prolonged antibiotic group and 96 in the control group. Prolonged antibiotic use was associated with an increase length of hospital stay of approximately 31.87 days, resulting in a $69,946 increase in total cost of hospitalization. Conclusion Prolonged antibiotics in neonates with negative blood culture were associated with significantly longer hospital length of stay and increased total cost of hospitalization. Key Points

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