ID: 101: ROTHIA MUCILAGINOSA BACTEREMIA: 8 YEAR REVIEW OF A SINGLE INSTITUTION EXPERIENCE

2016 ◽  
Vol 64 (4) ◽  
pp. 953.1-953
Author(s):  
M Abidi ◽  
P Hari ◽  
A Banerjee ◽  
N Ledeboer
Keyword(s):  
Hematologic Malignancy ◽  
Descriptive Analysis ◽  
Marrow Transplant ◽  
Blood Cultures ◽  
Attributable Mortality ◽  
P Value ◽  
Morbidity Score ◽  
Co Morbidity ◽  
Significant Difference ◽  
Neutropenic Patients

BackgroundRothia spp. are gram positive bacteria which are known to cause infections in the immune compromised host. Literature is limited on the epidemiology and clinical significance of Rothia bacteremia.MethodsWe reviewed medical records of all patients with blood cultures positive from 2006–2014. Descriptive analysis was performed as well as comparative analysis of neutropenic patients (absolute neutrophil count ≤1000 /μL) at the time of bacteremia with non-neutropenic patients at the time of bacteremia. Fische's exact tests were used for comparisons of proportions and medians, respectively, with p-values <0.05 considered statistically significant.Results29 patients with Rothia bacteremia were identified. Median age was 58 years (range 27–73), with no significant gender difference (p=0.94). Charlson co-morbidity score of 4 or greater was found in 20 (69%) of patients; 20 (69%) patients had a hematologic malignancy or bone marrow transplant. While there were 14 deaths, only 1 was possibly attributed to Rothia infection. Neutropenia was observed in 21(72%) patients at the time of bacteremia. Neutropenic patients were less likely than non-neutropenic patients to have polymicrobial infection (24% vs. 63%, p=0.083); and were also more likely to have multiple positive blood cultures (76% vs. 0%; p value=0.0003). There was no difference between the two groups in need for ICU care, mortality or attributable mortality. Statistically significant difference was seen for steroid use (81% vs. 13%, p=0.0014), and fluroquinolone use (86% vs.13% p=<0.0001) preceding bacteremia in neutropenic patients. Presence of intra-vascular catheter was also more pre-dominant in the neutropenic group (86% vs. 50%, p=0.068) at the time of bacteremia.ConclusionsRothia bacteremia is seen in patients with medical co-morbidities, predominantly in patients with leukemia.A significant association was seen with prior use of steroid and fluroquinolone prophylaxis in neutropenic patients who developed Rothia bacteremia.Rothia bacteremia in neutropenic hosts was mostly monomicrobial and less likely thought to be a contaminant.

scholarly journals Prevalence and outcome of Covid-19 infection in cancer patients: a national VA study

2020 ◽  
Author(s):  
Nathanael R Fillmore ◽  
Jennifer La ◽  
Raphael E Szalat ◽  
David P Tuck ◽  
Vinh Nguyen ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Hematologic Malignancy ◽  
Current Smoker ◽  
Attributable Mortality ◽  
Veterans Administration ◽  
Cancer Type ◽  
Morbidity Score ◽  
Co Morbidity ◽  
The Us ◽  
Cancer Types

Background: Emerging data suggest variability in susceptibility and outcome to Covid-19 infection. Identifying the risk-factors associated with infection and outcomes in cancer patients is necessary to develop healthcare recommendations. Methods: We analyzed electronic health records of the US National Veterans Administration healthcare system and assessed the prevalence of Covid-19 infection in cancer patients. We evaluated the proportion of cancer patients tested for Covid-19 and their confirmed positivity, with clinical characteristics, and outcome, and stratified by demographics, comorbidities, cancer treatment and cancer type. Results: Of 22914 cancer patients tested for Covid-19, 1794 (7.8%) were positive. The prevalence of Covid-19 was similar across all ages. Higher prevalence was observed in African-American (AA) (15%) compared to white (5.5%; P<.001), in Hispanic vs non-Hispanic population and in patients with hematologic malignancy compared to those with solid tumors (10.9% vs 7.7%; P<.001). Conversely, prevalence was lower in current smoker patients, patients with other co-morbidities and having recently received cancer therapy (<6 months). The Covid-19 attributable mortality was 10.9%. Highest mortality rates were observed in older patients, those with renal dysfunction, higher Charlson co-morbidity score and with certain cancer types. Recent (<6 months) or past treatment did not influence mortality. Importantly, AA patients had 3.5-fold higher Covid-19 attributable hospitalization, however had similar mortality rate as white patients. Conclusion: Pre-existence of cancer affects both susceptibility to Covid-19 infection and eventual outcome. The overall Covid-19 attributable mortality in cancer patients is affected by age, co-morbidity and specific cancer types, however, race or recent treatment including immunotherapy does not impact outcome.

scholarly journals Fluoxetine enhances maximal electroshock seizure threshold in Albino rat model when compared to phenytoin

2017 ◽  
Vol 7 (1) ◽  
pp. 138 ◽  
Author(s):  
Tanmoy Gangopadhyay ◽  
Ananya Mandal ◽  
Uma Shanker Keshri
Keyword(s):  
Seizure Threshold ◽  
Albino Rats ◽  
P Value ◽  
Anticonvulsant Effect ◽  
Maximal Electroshock ◽  
Maximal Electroshock Seizure ◽  
Albino Rat ◽  
Co Morbidity ◽  
Significant Difference ◽  
Electroconvulsive Seizure

Background: Individuals with epilepsy have a higher incidence of psychiatric disorders than person without epilepsy. Epidemiological studies have shown that the co-morbidity of epilepsy and depression to be high as 50%. The conventional anti-depressants are believed to lower the seizure threshold making it difficult to treat the co-morbid depression, but animal studies have shown SSRIs, a common anti-depressant, to have anti-convulsant properties. So, we propose to study the anticonvulsant effects of fluoxetine, a SSRI, in albino rats against maximal electroshock seizure and to compare against a standard antiepileptic drug phenytoin.Methods: The anticonvulsant effect of fluoxetine was observed in model of maximal electroconvulsive seizure threshold in albino rats. The animals were divided into 3 groups having 6 animals each, receiving distilled water, fluoxetine and phenytoin respectively. The drugs were given orally, and the effect was observed on day 7, 14 and 21. Tonic hind-limb extension was taken as the parameter of electroshock seizure. The effects were compared against a standard anti-seizure drug phenytoin.Results: Fluoxetine showed significant elevation of the seizure threshold following 14 days of administration (P value 0.031). The effect was comparable to phenytoin with no significant difference after 7, 14 and 21 days of treatment (P-value 0.485, 0.699 and 0.818 respectively) though phenytoin showed significant anti-seizure effect since day 7 of treatment.Conclusions: Fluoxetine showed significant anti-seizure activity against electroconvulsive seizure in albino rats.

scholarly journals Perbedaan Fungsi Kognitif Mahasiswa Fakultas Kedokteran Unissula dengan IPK Kurang dari 3 dan IPK Lebih sama dengan 3 Yudisium Tahun 2018

2019 ◽  
Vol 2 (1) ◽  
pp. 293
Author(s):  
Ahmadi NH ◽  
Elly Noerhidajati ◽  
Siti Maesaroh
Keyword(s):  
Mini Mental State Examination ◽  
Descriptive Analysis ◽  
P Value ◽  
Test Results ◽  
Chi Square ◽  
Cross Sectional ◽  
Significant Difference ◽  
Chi Square Test ◽  
The One ◽  
State Examination

Cognitive function varies in each human being, from simple to complex, requiring attention, concentration, and coordination. Cognitive is related to a person's ability to think, solve problems, organize and also to communicate and interact with others and the environment. Methods: cross-sectional research, samples involve the students of medical faculty of Unissula-Semarang with GPA less than 3 and more than 3 graduated in 2018, instrument Mini-Mental State Examination (MMSE). Descriptive analysis and Chi-square test. Results and Discussion: samples are 56 students, the highest gender is men (51%), the range of age 18-21 years old (53.6%), the number of GPA is the same as the one below and above 3 there are 28 (50%). Test Chi Square gender difference with P value of 0.422 GPA gender does not have significant difference to the GPA, based on the age of the results of T-test p-value 0.000, showed age had significant difference to the GPA, where the age is getting younger GPA is getting better, based on the scores of MMSE test, it was obtained p 1.000, MMSE score has no significant difference with the GPA. Conclusion: Gender and MMSE value have no difference with GPA, there is difference between age and GPA, the younger the students the better GPA the students achieve.

Real-world practice patterns in treatment of metastatic breast cancer in Washington State.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13038-e13038
Author(s):  
Poorni Manohar ◽  
Hannah M. Linden ◽  
Joshua A. Roth ◽  
Vicky Wu ◽  
Catherine R. Fedorenko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Metastatic Breast ◽  
Washington State ◽  
Treatment Selection ◽  
P Value ◽  
First Line ◽  
Morbidity Score ◽  
Co Morbidity ◽  
To Receive

e13038 Background: Evidence-based, national guidelines for the management of metastatic breast cancer (MBC) recommend numerous treatment options that do not capture the nuances of real-world practice. Disparities may exist across Washington State with financial implications for patients and health systems. The objective of this study was to assess practice patterns around treatment of ER+/HER2- MBC in actual clinical practice. Methods: We collaborated with Hutchinson Institute for Cancer Outcomes Research (HICOR) to link enrollment and insurance claims records with Washington State cancer registries from 2008-2017. Our cohort comprised of women >18 years old with de novo ER+/HER2- MBC who met enrollment criteria in one of four payors (Premera, Regence, Medicare, or Medicaid). We identified receipt of first line treatment, categorized as CDK4/6 inhibitors plus endocrine therapy (CDKi+ET), chemotherapy (CT), or endocrine therapy alone (ET). We examined factors influencing treatment selection using Fisher's and Kruskal-Wallis tests. Total costs (defined as costs from inpatient and outpatient claims one year after diagnosis) was estimated for patients and payors. Results: We identified 140 patients with de novo ER+/HER2- MBC with median age of 64 (range 28-95). The majority of the cohort were Caucasian (90%) with the rest comprising of Asian, Black, American Indian, and Hispanic patients. Based on the Rural Urban Commuting Area (RUCA) classification, patients predominantly lived in metropolitan neighborhoods (96%). Over 20% of patients lived in areas of high deprivation (area of deprivation index, ADI, 8-10). Patients had either Commercial (40.7%), Medicaid/Medicare (43.6%) or multiple (15.7%) insurance. Our data show that 17 patients (12%) received first line therapy with CDKi + ET, 64 patients (46%) with CT, and 59 patients (42%) with ET alone. Factors influencing treatment selection include age, co-morbidity score, and payor type. Older patients (>65 years old) were more likely to receive ET alone compared to younger patients (56% vs 44%, p value <0.001). Patients with high co-morbidity score were more likely to receive ET (30%) compared to CT (5%) or CDKi + ET (23%), p value <0.001. Patients with commercial insurance made up over 50% of patients in our cohort who received CDKi +ET, while Medicare-insured patients were most likely to receive ET alone (p value <0.001). We estimated the mean cost of receiving first line therapy with CDKi +ET ($20,368 and $175,932), CT ($10,624 and $117,847) and ET alone ($13,292 and $60,338) for patients and payors, respectively (costs inflated to December 2019). Conclusions: Our study shows substantial variation across Washington state in treatment selection and costs for patients with metastatic breast cancer in the first-line setting. Our findings demonstrate the need for initiatives to standardize quality of care relative to clinical guidelines in metastatic breast cancer care.

ID: 97: MYCOBACTERIUM MUCOGENICUM IN HEMATOPOEITIC STEM CELL TRANSPLANT RECIPIENTS AND IN HIGH-RISK PATIENTS WITH HEMATOLOGIC MALIGNANCIES, 2008–2013

2016 ◽  
Vol 64 (4) ◽  
pp. 951.1-951
Author(s):  
M Abidi ◽  
A Banerjee ◽  
N Ledeboer ◽  
P Hari
Keyword(s):  
Stem Cell ◽  
Solid Tumors ◽  
Stem Cell Transplant ◽  
Hematologic Malignancy ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Survival Difference ◽  
Significant Difference ◽  
Neutropenic Patients ◽  
Mycobacterium Mucogenicum

BackgroundRapidly growing nontuberculous mycobacteria can cause variety of clinical syndromes including catheter related blood stream infections (BSI).MethodsWe reviewed medical records of patients with blood cultures positive for Mycobacterium mucogenicum (MM) from 2008–2013. We defined 4 at-risk groups: Stem cell transplant recipients (SCT); patients with hematologic malignancy; patients with solid tumors and other's (patient's on treatment with tumor necrotic factor inhibitors). Descriptive analysis was performed, as well as comparative analysis of neutropenic patients (absolute neutrophil count ≤1000 /μL) with non-neutropenic patients.Results39 patients with MM bacteremia were identified. There were 27 SCT recipients (24 Allogeneic; 3 Autologous). 4 patients had hematologic malignancy and 4 patients had solid tumors. Others included 4 patients. At time of diagnosis, 12 were neutropenic, and 27 were non-neutropenic. No significant difference was noted in age (p=0.41) or gender (p=1.00) or rates of pure vs. mixed mycobacterial BSI (p=1.00) or more than single blood culture positivity (p=1.00) between these two groups.The predominant clinical feature was fever with mean temperature of 38 degrees C (range 37.8–40.1). There was a significant difference in presence of fever at the time of bacteremia (92% vs. 42%; p=0.005) between the neutropenic and non-neutropenic group. Central venous catheter (CVC) was present at time of bacteremia in 33 cases (P=0.15); there was no significant difference for presence of CVC between these two groups (100% vs. 78%). Median duration of antibiotic treatment was 42 days (p=0.44). All patients were treated with >1 antibiotic. Most used regimen involved clarithomycin and amikacin (n=16).While there were 15 deaths; none were attributed to MM BSI. No significant survival difference was seen at 3 years between the neutropenic and non-neutropenic group (62% vs. 56%; p=0.75).ConclusionsMM is a rare cause of CVC-associated bacteremia. In our study MM BSI was seen in immune compromised patients, predominantly in SCT recipients. BSI resolved in all patients with CVC removal and combination antimicrobial treatment. None of the patients suffered a relapse.

scholarly journals STUDY TO EVALUATE THE SPECTRUM OF DIFFERENT CO-MORBIDITIES IN CHILDREN SUFFERING FROM SEVERE ACUTE MALNUTRITION WITH UNEXPECTED DYSELECTROLYTEMIA IN DIARRHEA

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Arunabh Kumar ◽  
Ashok Kumar ◽  
Manish Ranjan
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
P Value ◽  
Medical College ◽  
Institutional Ethics ◽  
Co Morbidity ◽  
Significant Difference ◽  
Study Population ◽  
Hiv 1 ◽  
Morbid Conditions

Aim: to evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea. Material and methods: The study was an observational study which was carried in the Department of pediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga Bihar, India for 2 years.  after taking the approval of the protocol review committee and institutional ethics committee. Total 200 Children below 5 year age were included in this study. Various co morbid conditions in study population were identified. All the laboratory examination was done with standard method. Results: Total 200 cases were included in study of which 96% were associated co-morbid conditions in SAM. Majority of children with SAM were having co-morbidity in the form of Anaemia (88%), Diarrhoea (60%) followed by pneumonia (32%), Rickets (31%), Tuberculosis (14%), Otitis    media    (12%),    UTI    (11%),    Celiac   (4%), Hypothyroidism (2%), & HIV (1%). Mean age (SD) of the diarrheal cases was 25(6) months (95% C.I. 24.1- 25.8) of which 70 were male (58.33%). Mean age (SD) of non-diarrheal cases was 19(6). (95% C.I. 16.6 – 19.4) of which 45 were male(75%). 120 (60%) SAM children presented with diarrhea of which 117 had dysnatremia in the form of Hyponatremia in 117 cases (58.5%) & Hypernatremia in 3 cases (1.5%) No statistically significant difference was found with hyponatremia in diarrheal or non-diarrheal cases of SAM (P value of 0.07). It was found that 20% SAM children were having hypokalemia. Hypokalemia was found in 15% of diarrheal cases & 5% in non- diarrheal cases. A statistically significant difference was found with hypokalemia in SAM (P value of 0.019) between Diarrheal & Non diarrheal cases. Conclusion: Dyselectrolytemia is high in complicated SAM and mainly sodium disturbances in form of hyponatremia are common in different co-morbid conditions. Keywords: Co-morbidities, Dyselectrolytemia, Potassium, Severe acute malnutrition, Sodium

scholarly journals Functional capacity and associated factors in community-dwelling and institutionalized elderly

2011 ◽  
Vol 5 (10) ◽  
pp. 2352
Author(s):  
Luciana Araújo dos Reis ◽  
Luana Araujo dos Reis ◽  
Gilson De Vasconcelos Torres ◽  
Claudio Henrique Meira Mascarenhas ◽  
Thaiza Teixeira Xavier Nobre
Keyword(s):  
Functional Capacity ◽  
Descriptive Analysis ◽  
Pain Scale ◽  
Community Dwelling ◽  
Personal Hygiene ◽  
P Value ◽  
State University ◽  
Chi Square ◽  
Institutionalized Elderly ◽  
Significant Difference

ABSTRACTObjective: to investigate the influence of sociodemographic and health factors on the functional capacity of community-dwelling and institutionalized elderly. Method: this is a descriptive exploratory study with a sample of 120 elderly men and women aged 60 years or older, residents of Jequié, Brazil, allocated to two groups of 60 elderly each. The first group was composed of community-dwelling elderly and the second of institutionalized elderly. The instrument consisted of four parts: 1) Sociodemographic and health characterization; 2) Pain-related aspects; 3) Numerical Pain Scale 4) Barthel’s Index. Statistical analyses were conducted using SPSS 13.0 software, while descriptive analysis was performed using the chi-square (x2) and Fischer Exact tests, with a p value≤0.05. This study was approved by the Ethics Committee of the State University of Southwest Bahia/UESB, opinion (No.224/08). Results: with respect to functional capacity, most of the community-dwelling elderly were classified as independent (86.7%) in all activities except personal hygiene, in which 86.7% were considered dependent. Most of the institutionalized elderly (70.0%) were classified as dependent as follows: transfer for personal hygiene (53.3%), bed-chair transfer (66.7%), walking (53.3%) and climbing stairs (60.0%). A statistically significant difference was found between functional capacity and pain (p

scholarly journals Use of leukocyte-depleted platelets and cytomegalovirus-seronegative red blood cells for prevention of primary cytomegalovirus infection after marrow transplant

Blood ◽  
1991 ◽  
Vol 78 (1) ◽  
pp. 246-250 ◽  
Author(s):  
RA Bowden ◽  
SJ Slichter ◽  
MH Sayers ◽  
M Mori ◽  
MJ Cays ◽  
...  
Keyword(s):  
Red Blood Cells ◽  
Blood Cells ◽  
Hematologic Malignancy ◽  
Controlled Trial ◽  
Marrow Transplant ◽  
Cmv Infection ◽  
Transplant Patients ◽  
Significant Difference ◽  
The Mean ◽  
Primary Cytomegalovirus Infection

Seventy-seven cytomegalovirus (CMV)-seronegative marrow transplant patients were randomized in a prospective controlled trial comparing the use of leukocyte-depleted platelets plus CMV-seronegative red blood cells with standard unscreened blood products for the prevention of primary CMV infection during the first 100 days after transplant. Eligible patients included CMV-seronegative patients undergoing autologous transplant or seronegative patients undergoing allogeneic transplant for aplastic anemia or non-hematologic malignancy who had seronegative marrow donors. Patients and marrow donors were serologically screened for CMV and randomized before conditioning for transplant and followed for CMV infection with weekly cultures of throat, urine, and blood and with weekly CMV serologies until day 100 after transplant. Leukocyte-depleted platelets were prepared by centrifugation, a procedure that removed greater than 99% of leukocytes. There were no CMV infections observed in 35 evaluable treatment patients compared with seven infections in 30 evaluable control patients (P = .0013). There was no statistically significant difference in the mean number of platelet concentrates in the treatment patients (164 concentrates) compared with the control patients (126 concentrates). Leukocyte-depleted platelets plus CMV-seronegative red blood cells are highly effective in preventing primary CMV infection after marrow transplant.

Overall Survival (OS) of Acute Myeloid Leukemia (AML) Treated at Academic Center (AC) Versus Non-Academic Center (NAC)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 533-533 ◽  
Author(s):  
Smith Giri ◽  
Valerie Shostrom ◽  
Krishna Gundabolu ◽  
KM Monirul Islam ◽  
Ranjan Pathak ◽  
...  
Keyword(s):  
Facility Location ◽  
Cox Regression ◽  
Rank Test ◽  
P Value ◽  
Income Status ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Academic Center ◽  
Morbidity Score ◽  
Co Morbidity

Abstract Introduction: Prior studies in cancer have suggested better OS of patients treated at AC as compared to NAC. This may be related to the availability of physicians with expertise in specific malignancies, better multidisciplinary care and access to more resources and clinical trials. Whether academic status of the facility affects OS of AML is unknown. Methods: We utilized the National Cancer Database Participant User File (NCDB PUF) to extract patient-level data of patients with AML reported between 1998 to 2011. Hospital facilities were classified as either AC (academic/research program) or NAC (community cancer program, comprehensive community cancer program, and other, per NCDB classification).We included only those patients, who had all of the first course treatment or a decision not to treat made at the reporting facility. Subjects with complete and known data for the variables sex, age, race, education, income, distance traveled for health care, hospital type, facility location, urban/rural location, insurance, Charlson co-morbidity score, chemotherapy use, time from diagnosis to treatment initiation, use of hematopoietic stem cell transplant, 30-day mortality, last contact, and vital status were included. These variables were analyzed in a univariate analysis. Kaplan Meier curves were drawn and compared using log rank test. Multivariate analysis was done using logistic regression for 30-day mortality and Cox regression with backward elimination approach for OS. Statistical analysis was done using PC SAS version 9.4. Results: A total of 7823 AML patients were studied, of which 4681 (60%) patients received treatment at AC. Patients treated at AC differed from NAC in the median age (62 vs. 67years; p <0.001), race (p <0.001), education (p=0.005), income (p <0.001), co-morbidity score (p=0.019), insurance (p<0.001), receipt of chemotherapy (p<0.001), transplant (p<0.001) and facility location (p<0.001). The median OS (12.6 vs. 7.0 months; p value <0.001) and 1-year OS (51% vs. 39%; p value <0.001) was better in AC as compared to NAC. In a multivariate analysis, the 30-day mortality was significantly worse in NAC as compared to AC (odds ratio, OR 1.52; 95% confidence interval, CI 1.33-1.74; p <0.001) (Table 1). Similarly, Cox regression showed that the OS was significantly worse in NAC as compared to AC (hazard ratio, HR 1.13; 95% CI 1.07-1.19; p <0.001) after adjusting for age, sex, Charlson co-morbidity score, receipt of chemotherapy, transplant, insurance and income status and facility location. Conclusion: Our population-based study suggests that the receipt of initial therapy at AC versus NAC is associated with lower 30-day mortality and higher 1-year OS. This may presumably be related to the provision of dedicated multidisciplinary leukemia teams, access to more resources and clinical trials in AC. The reasons behind such differences should be investigated in future studies, and necessary steps be taken to minimize this gap. Table 1. Multivariate logistic regression of 30-day mortality Variable Odds ratio 95% confidence interval P value Academic (ref) Non-Academic 1 1.52 1.33-1..74 <0.001 Age - <60 years (ref) - > 60 years 1 2.32 1.92-2.80 <0.001 Charlsonco-morbidity score -0 (ref) -1 - 2 or more 1 1.45 2.14 1.23-1.69 1.74-2.63 <0.001 <0.001 Chemotherapy - Yes (ref) - No 1 2.55 1.93-3.38 <0.001 Days until first treatment 0.87 0.86-0.89 <0.001 Income status - $ 46,000 + (ref) - < $ 30,000 - 30,000-34,999 - 35,000-45,999 1 1.31 1.31 1.21 1.06-1.62 1.09-1.58 1.03-1.43 0.011 0.004 0.023 Insurance Status - Private insurance/managed care (ref) - Not insured - Medicaid - Medicare - Other government 1 2.32 0.81 1.56 1.13 1.66-3.24 0.59-1.10 1.30-1.87 0.63-2.02 <0.001 0.178 <0.001 0.686 Figure 1. Kaplan Meier curve showing cumulative survival among AML patients treated at academic versus non-academic centers (p value of log rank test <0.001) Figure 1. Kaplan Meier curve showing cumulative survival among AML patients treated at academic versus non-academic centers (p value of log rank test <0.001) Disclosures No relevant conflicts of interest to declare.

scholarly journals 1079. Impact of Antimicrobial Stewardship Program (ASP) on Patients with Neurological Conditions

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S383-S383
Author(s):  
Lay Hoon Andrea Kwa ◽  
Li Wen Loo ◽  
Yixin Liew ◽  
Maciej Piotr Chlebicki
Keyword(s):  
Hospital Stay ◽  
Antimicrobial Stewardship ◽  
Length Of Hospital Stay ◽  
Duration Of Therapy ◽  
Stewardship Program ◽  
Morbidity Score ◽  
Co Morbidity ◽  
Significant Difference ◽  
Neurological Conditions ◽  
The Impact

Abstract Background Rising rates of antimicrobial resistance worldwide has dire consequences on patient care, as infections with resistant organisms impair patients’ recovery, resulting in protracted illness and hence prolonged hospital stay. Antimicrobial Stewardship Programs (ASPs) have shown to effectively reduce antibiotic resistance. Locally, we observed that patients with neurological conditions were often initiated on antibiotics for change in mental state or isolated fevers. Little is known whether these patients truly require antibiotics and hence, we aim to study the impact of ASP in these patients. Methods Retrospective review of ASP database between January 2014 and December 2017 was conducted, among all patients admitted to the neurology department in SGH and in whom the ASP team recommended discontinuation of empiric use of antibiotics. Demographics were collected. Clinical outcomes, duration of antibiotics therapy, length of hospital stay (LOS), infection-related readmissions and mortality, were compared between interventions accepted and rejected groups. Results The ASP team recommended 184 interventions [overall acceptance rate of 82.6% (152/184)]. There was no significant difference in underlying demographics, and Charlson Co-morbidity score between the 2 groups. However, the interventions-acceptance group had shorter duration of therapy by 1.67 days (4.99 ± 2.50 days vs. 6.66 ± 2.34 days; P < 0.01) and LOS by 2 days (22.5 ± 51.4 days vs. 24.5 ± 3.04 days; P = 0.83). There were no significant differences in 14-day mortality and readmission rates between the 2 groups. Conclusion In patients with neurological conditions, ASP interventions were safe, and associated with a significant reduction in the duration of therapy and LOS. Disclosures All authors: No reported disclosures.

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