scholarly journals Validation of a Community Acquired Pneumonia Score to Improve Empiric Antibiotic Selection at an Academic Medical Center

2020 ◽  
Author(s):  
Meredith B. Oliver ◽  
Karen Fong ◽  
Laura Certain ◽  
Emily S. Spivak ◽  
Tristan T. Timbrook
Keyword(s):  
Risk Factors ◽  
Prediction Models ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Signs ◽  
Community Acquired Pneumonia ◽  
Drug Resistant ◽  
Clinical Prediction ◽  
Local Risk ◽  
Prior Infection

The 2019 American Thoracic Society and the Infectious Diseases Society of America Community-Acquired Pneumonia (CAP) Guidelines recommend drug resistant pathogens (DRP) be empirically covered if locally validated risk factors are present. This retrospective case-control validation study evaluated the performance of the Drug-Resistance in Pneumonia (DRIP) clinical prediction score. Two hundred 17 adult patients with ICD-10 pneumonia diagnosis, positive confirmed microbiologic data, and clinical signs and symptoms were included. A DRIP score of ≥ 4 was used to assess model performance. Logistic regression was used to select for significant predictors and create a modified DRIP score, which was evaluated to define clinical application. The DRIP score predicted pneumonia due to a DRP with a sensitivity of 67% and specificity of 73%. The AUROC curve was 0.76 (95% CI, 0.69-0.82). From regression analysis, prior infection with a DRP and antibiotics in the last 60 days, yielding score of 2 and 1 points respectively, remained local risk factors in predicting drug-resistant pneumonia. Sensitivity (47%) and specificity (94%) were maximized at a threshold of ≥ 2 in the modified DRIP model. Therefore, prior infection with a DRP remained the only clinically relevant predictor for drug-resistant pneumonia. The original DRIP score demonstrates a decreased performance in our patient population and behaves similar to other clinical prediction models. Empiric CAP therapy without anti-MRSA and anti-pseudomonal coverage should be considered for non-critically ill patients without a drug resistant pathogen infection in the past year. Our data support the necessity of local validation to authenticate clinical risk predictors for drug-resistant pneumonia.

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 1317. Prevalence of Pseudomonas aeruginosa as the Causative Organism for Community Acquired Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S747-S747
Author(s):  
Adam D Haviland ◽  
Wendy Szymczak ◽  
Gregory Weston
Keyword(s):  
Risk Factors ◽  
Influenza A ◽  
Medical Center ◽  
Academic Medical Center ◽  
Community Acquired Pneumonia ◽  
Causative Organism ◽  
Inclusion Criteria ◽  
Term Care ◽  
Empiric Antibiotic ◽  
Antigen Tests

Abstract Background IDSA/ATS guidelines regarding pneumonia diagnosis and treatment changed in 2019. Guidelines recommend determining local prevalence of MRSA and P. aeruginosa to help guide empiric antibiotic coverage. The aim of our study was to determine the prevalence of P. aeruginosa as the causative organism for adult patients admitted to a large urban academic medical center with community acquired pneumonia (CAP). Methods A report of urine streptococcus antigen tests collected January 1st-December 31st in 2019 was generated. Six hundred charts were reviewed and two hundred subjects met inclusion criteria (figure 1). Inclusion criteria were age >18, hospital admission, and documented suspicion of pneumonia by a physician. Results The average age was 70 and half of the cases were women. The causative organism was identified in 60/200 cases (table 1). No cases of P. aeruginosa were identified. The most commonly isolated organisms were Influenza A and pneumococcus. 66% of cases had age >65yo, 25% were from long term care facilities, 34% had structural lung disease, 20% had dementia, 15% were hospitalized in the prior 90 days and received IV antibiotics, and 30% of cases met severe CAP criteria (table 2). Figure 1. Workflow Table 1. Organisms Identified Table 2. Risk Factors Conclusion Limitations include a low prevalence of renal failure in the study population, and lack of a standardized respiratory infection evaluation. Our results suggest that empiric coverage for P. aeruginosa may not be needed at our center in this cohort of older patients with clinical characteristics sometimes thought to be risk factors for P. aeruginosa. Disclosures Wendy Szymczak, PhD, Premier, Inc (Consultant)Qiagen (Consultant, Scientific Research Study Investigator) Gregory Weston, MD MSCR, Allergan (Grant/Research Support)

scholarly journals Risk factors associated with physician trainee concern over missed educational opportunities during the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sunny S. Lou ◽  
Charles W. Goss ◽  
Bradley A. Evanoff ◽  
Jennifer G. Duncan ◽  
Thomas Kannampallil
Keyword(s):  
Risk Factors ◽  
Clinical Education ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Clinical Work ◽  
Educational Opportunities ◽  
Missed Opportunities ◽  
Physician Trainee ◽  
At Home

Abstract Background The COVID-19 pandemic resulted in a transformation of clinical care practices to protect both patients and providers. These changes led to a decrease in patient volume, impacting physician trainee education due to lost clinical and didactic opportunities. We measured the prevalence of trainee concern over missed educational opportunities and investigated the risk factors leading to such concerns. Methods All residents and fellows at a large academic medical center were invited to participate in a web-based survey in May of 2020. Participants responded to questions regarding demographic characteristics, specialty, primary assigned responsibility during the previous 2 weeks (clinical, education, or research), perceived concern over missed educational opportunities, and burnout. Multivariable logistic regression was used to assess the relationship between missed educational opportunities and the measured variables. Results 22% (301 of 1375) of the trainees completed the survey. 47% of the participants were concerned about missed educational opportunities. Trainees assigned to education at home had 2.85 [95%CI 1.33–6.45] greater odds of being concerned over missed educational opportunities as compared with trainees performing clinical work. Trainees performing research were not similarly affected [aOR = 0.96, 95%CI (0.47–1.93)]. Trainees in pathology or radiology had 2.51 [95%CI 1.16–5.68] greater odds of concern for missed educational opportunities as compared with medicine. Trainees with greater concern over missed opportunities were more likely to be experiencing burnout (p = 0.038). Conclusions Trainees in radiology or pathology and those assigned to education at home were more likely to be concerned about their missed educational opportunities. Residency programs should consider providing trainees with research or at home clinical opportunities as an alternative to self-study should future need for reduced clinical hours arise.

scholarly journals Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

2021 ◽  
Vol 18 (2) ◽  
pp. 486
Author(s):  
Pavani Rangachari ◽  
Jie Chen ◽  
Nishtha Ahuja ◽  
Anjeli Patel ◽  
Renuka Mehta
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Childhood Asthma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Research ◽  
Ed Visits ◽  
The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

scholarly journals History of Depression and Increased Risk of Sternal Wound Infection After Cardiothoracic Surgery: A Novel and Potentially Modifiable Risk Factor

2019 ◽  
Vol 6 (3) ◽  
Author(s):  
Deborah A Theodore ◽  
Renee D Goodwin ◽  
Yuan (Vivian) Zhang ◽  
Nancy Schneider ◽  
Rachel J Gordon
Keyword(s):  
Risk Factors ◽  
Wound Infection ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cardiothoracic Surgery ◽  
Sternal Wound Infection ◽  
Composite Variable ◽  
Increased Risk ◽  
History Of ◽  
History Of Depression

Abstract Background Sternal wound infection (SWI) is a leading cause of postoperative disease and death; the risk factors for SWI remain incompletely understood. The goal of the current study was to investigate the relationship between a preoperative history of depression and the risk of SWI after cardiothoracic surgery. Methods Among patients undergoing cardiothoracic surgery in a major academic medical center between 2007 and 2012, those in whom SWI developed (n = 129) were matched, by date of surgery, with those in whom it did not (n = 258). Multivariable logistic regression was used to examine the strength of relationships between risk factors and development of infection. History of depression was defined as a composite variable to increase the sensitivity of detection. Results History of depression as defined by our composite variable was associated with increased risk of SWI (adjusted odds ratio, 2.4; 95% confidence interval, 1.2–4.7; P = .01). Staphylococcus aureus was the most common organism isolated. Conclusions History of depression was associated with increased risk of SWI. Future prospective studies are warranted to further investigate this relationship. Depression is highly treatable, and increased efforts to identify and treat depression preoperatively may be a critical step toward preventing infection-related disease and death.

Risk factors for acute kidney injury associated with the treatment of bacterial endocarditis at a tertiary academic medical center

2017 ◽  
Vol 29 (5) ◽  
pp. 292-298 ◽  
Author(s):  
Brianne M. Ritchie ◽  
Beth A. Hirning ◽  
Craig A. Stevens ◽  
Steven A. Cohen ◽  
Jeremy R. DeGrado
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Medical Center ◽  
Academic Medical Center ◽  
Kidney Injury ◽  
Bacterial Endocarditis ◽  
Academic Medical

Epidemiology and risk factors for carbapenem-resistant Enterobacteriaceae colonisation and infections: case-controlled study from an academic medical center in a southern area of China

2019 ◽  
Vol 77 (4) ◽  
Author(s):  
Lili Fang ◽  
Xiaohui Lu ◽  
Heping Xu ◽  
Xiaobo Ma ◽  
Yilan Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Academic Medical Center ◽  
Pulmonary Diseases ◽  
Controlled Study ◽  
Global Public Health ◽  
Detection Rates ◽  
Carbapenem Resistant ◽  
Associated Risk Factors ◽  
Carbapenem Resistant Enterobacteriaceae

ABSTRACT OBJECTIVE While the emergence and spread of carbapenem-resistant Enterobacteriaceae (CRE) and related infections pose serious threats to global public health, the epidemiology and associated risk factors remain poorly understood and vary by geography. METHODS In a case-controlled retrospective study, we examined the prevalence, patient background and risk factors for CRE colonisation and infections, and all patient-derived CRE from January 2015 to January 2017. Isolated carbapenem-susceptible Enterobacteriaceae (CSE) from 2875 enrolled patients were randomly selected during the study. RESULTS CRE colonisation and infections detection rates were 47/2875 (1.6%). Respiratory tract specimens were most frequently seen in 20/47 (42.6%) cases. Klebsiella pneumoniae was the main isolate in 35/47 (74.5%) CRE. As for carbapenemase, KPC-2-producing bacteria was most frequently detected in 38/47 (80.9%) Enterobacteriaceae. No underlying conditions (P = 0.004), pulmonary diseases (P = 0.018) and no antibiotics used prior to culture within 30 days (P < 0.001) were statistically significant between the CRE and CSE groups. CONCLUSION Klebsiellapneumoniae was the main isolate of CRE. The blaKPC-2 was the predominant CRE gene. Underlying conditions especially pulmonary diseases and antibiotics used prior to culture within 30 days represented key risk factors for acquisition of CRE.

Clinical Predictors for Laboratory-Confirmed Influenza Infections: Exploring Case Definitions for Influenza-Like Illness

2015 ◽  
Vol 36 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Shital C. Shah ◽  
Dino P. Rumoro ◽  
Marilyn M. Hallock ◽  
Gordon M. Trenholme ◽  
Gillian S. Gibbs ◽  
...  
Keyword(s):  
Influenza A ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Signs ◽  
Case Definition ◽  
Chief Complaint ◽  
Nasopharyngeal Swab ◽  
Clinical Predictors ◽  
Case Definitions ◽  
Influenza Like Illness

OBJECTIVETo identify clinical signs and symptoms (ie, “terms”) that accurately predict laboratory-confirmed influenza cases and thereafter generate and evaluate various influenza-like illness (ILI) case definitions for detecting influenza. A secondary objective explored whether surveillance of data beyond the chief complaint improves the accuracy of predicting influenza.DESIGNRetrospective, cross-sectional study.SETTINGLarge urban academic medical center hospital.PARTICIPANTSA total of 1,581 emergency department (ED) patients who received a nasopharyngeal swab followed by rRT-PCR testing between August 30, 2009, and January 2, 2010, and between November 28, 2010, and March 26, 2011.METHODSAn electronic surveillance system (GUARDIAN) scanned the entire electronic medical record (EMR) and identified cases containing 29 clinical terms relevant to influenza. Analyses were conducted using logistic regressions, diagnostic odds ratio (DOR), sensitivity, and specificity.RESULTSThe best predictive model for identifying influenza for all ages consisted of cough (DOR=5.87), fever (DOR=4.49), rhinorrhea (DOR=1.98), and myalgias (DOR=1.44). The 3 best case definitions that included combinations of some or all of these 4 symptoms had comparable performance (ie, sensitivity=89%–92% and specificity=38%–44%). For children <5 years of age, the addition of rhinorrhea to the fever and cough case definition achieved a better balance between sensitivity (85%) and specificity (47%). For the fever and cough ILI case definition, using the entire EMR, GUARDIAN identified 37.1% more influenza cases than it did using only the chief complaint data.CONCLUSIONSA simplified case definition of fever and cough may be suitable for implementation for all ages, while inclusion of rhinorrhea may further improve influenza detection for the 0–4-year-old age group. Finally, ILI surveillance based on the entire EMR is recommended.Infect Control Hosp Epidemiol 2015;00(0): 1–8

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