scholarly journals Mortality in a Heterogeneous Population of Low-Risk Febrile Neutropenic Patients Treated Initially with Cefazolin and Tobramycin

2009 ◽  
Vol 20 (4) ◽  
pp. e145-e152 ◽  
Author(s):  
Francesca Le Piane ◽  
Sandra AN Walker ◽  
Scott E Walker ◽  
Nina Lathia ◽  
Carlo De Angelis ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Health Sciences ◽  
Primary Objective ◽  
Prospective Data ◽  
Sunnybrook Health ◽  
The Past ◽  
All Cause Mortality ◽  
Neutropenic Patients

BACKGROUND: At Sunnybrook Health Sciences Centre in Toronto, Ontario, the recommended empiric regimen for febrile neutropenia has been cefazolin and tobramycin for at least 25 years. However, we had no objective data to reassure us that patient mortality had not increased over the past five years.METHODS: A retrospective chart review of 48 episodes occurring in 44 patients admitted for the treatment of febrile neutropenia secondary to chemotherapy in 2002, and initially managed with cefazolin and tobramycin was conducted. Prospective data from 48 episodes in 2007 had previously been collected. Patients who developed febrile neutropenia while in hospital were excluded. The primary objective of the present study was to compare the all-cause mortality in 2007 with that from 2002.RESULTS: There were no statistically significant differences between the groups (P>0.05). All-cause mortality in 2007 was 8.3% (four of 48) compared with 10.4% (five of 48) in 2002 (P=1). All deaths occurred in patients considered to be at high risk according to the Talcott score.CONCLUSION: Mortality has not increased in the past five years with the use of empiric cefazolin and tobramycin for the treatment of patients admitted with febrile neutropenia at Sunnybrook Health Sciences Centre. Rates are comparable with those reported in the literature for similar patients. The results of the present study provide reassurance that the regimen continues to be effective for lower-risk febrile neutropenic patients.

Safety and tolerability of i.v. push piperacillin/tazobactam within an emergency department

2020 ◽  
Vol 77 (13) ◽  
pp. 1051-1053
Author(s):  
William Blake Hays ◽  
Tara Flack
Keyword(s):  
Emergency Department ◽  
Single Dose ◽  
Allergic Reaction ◽  
Broad Spectrum ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Drug Reactions ◽  
Broad Spectrum Antibiotic ◽  
Peripheral Site

Abstract Purpose Piperacillin/tazobactam is a broad-spectrum antibiotic that is widely used and commonly administered via the intravenous (i.v.) piggyback route over 0.5 to 4.0 hours. Recommendations for i.v. push (IVP) administration of piperacillin/tazobactam are lacking due to the high osmolality of the solution. The primary objective of this study was to retrospectively assess the safety and tolerability of piperacillin/tazobactam administered peripherally by IVP. Methods. A retrospective chart review was conducted to evaluate adverse drug reactions after administration of a single dose of IVP piperacillin/tazobactam through a peripheral line in an emergency department from August 2016 through November 2017. Results A total of 1,813 patients received 1 dose of IVP piperacillin/tazobactam during the study timeframe. Three hundred patients were randomly selected for assessment of safety and tolerability. Two hundred ninety-nine patients (99.7%) tolerated IVP piperacillin/tazobactam. One patient had an allergic reaction that included itching and hives. No infusion-related reactions were documented. Conclusion IVP administration of piperacillin/tazobactam through a peripheral site is safe and tolerable for adult patients.

Use of Pamidronate for Hypercalcemia of Malignancy in Renal Dysfunction

2019 ◽  
pp. 089719001988316 ◽  
Author(s):  
Sarah J. Norman ◽  
David J. Reeves ◽  
Lindsay M. Saum
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Chart Review ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Limited Impact ◽  
Hypercalcemia Of Malignancy ◽  
Baseline Renal Function ◽  
Community Teaching

Background: Few studies have been conducted investigating the use of bisphosphonates in hypercalcemia of malignancy (HCM) in the setting of renal dysfunction. Objective: The primary objective was to compare the incidence of acute kidney injury (AKI) within 7 days of receiving pamidronate for the treatment of HCM with pre-existing renal dysfunction versus normal renal function at the time of pamidronate administration. The secondary objectives explored the effects of pamidronate doses and infusion rates on the safety and efficacy in those with pre-existing renal dysfunction for the treatment of HCM. Methods: A retrospective chart review was conducted on patients who received pamidronate for the treatment of HCM at a community teaching hospital in Indianapolis, Indiana, from January 1, 2013, to May 31, 2017. Results: A total of 141 pamidronate administrations were included (116 patients had normal baseline renal function, and 25 patients had pre-existing renal dysfunction before pamidronate administration for the treatment of HCM). Two (8%) patients developed AKI in the pre-existing renal dysfunction group, compared with 4 (3.4%) patients in those without pre-existing renal dysfunction ( P = .288). For those with pre-existing renal dysfunction, the incidence of AKI did not differ based on the dosage of pamidronate given ( P = .762) or infusion rates ( P = .373). Conclusion: Pamidronate appears to have limited impact on renal function at doses up to 90 mg in the setting of pre-existing renal dysfunction for the treatment of HCM.

scholarly journals 2532. Identifying Educational Needs and Improving Provider Knowledge Regarding the Management of Febrile Neutropenia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S880-S880
Author(s):  
Amy Chang ◽  
Stan Deresinski ◽  
Aruna Subramanian ◽  
Bruno Medeiros ◽  
Emily Mui, PharmD ◽  
...  
Keyword(s):  
Medical Students ◽  
Febrile Neutropenia ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Empiric Therapy ◽  
Myelogenous Leukemia ◽  
Front Line ◽  
National Guidelines ◽  
Gram Positive ◽  
The Impact

Abstract Background In a retrospective chart review of 211 first episodes of febrile neutropenia (FN) in in-patients with acute myelogenous leukemia evaluating rates of appropriate vs. inappropriate management, we identified frequent noncompliance with national guidelines for the management of FN. We utilized these data to develop an educational intervention targeting front-line providers. Methods Based on findings from our chart review, we developed and implemented an interactive, case-based didactic session for advanced practice providers (APPs) and medical students/residents rotating on hematology, targeting inappropriate antibiotic use. Pretest questions were embedded into the lecture, preceding content related to each learning objective. Lecture material included content from national guidelines, literature addressing misconceptions (e.g., vancomycin usage for persistent fever), and data from our institutional antibiogram (Figure 1). A post-test was given directly after the lecture to evaluate knowledge gained. Results Five inappropriate behaviors were identified (Figure 2): (1) changing empiric therapy despite clinical stability, (2) misunderstanding piperacillin/tazobactam’s spectrum of activity, (3) inappropriate initiation of antibiotics active against resistant Gram-positive organisms; (4) failure to de-escalate therapy at 72 hours and (5) failure to add Gram-positive coverage when using aztreonam. Lectures were provided to 13 APPs and 17 medical students/residents over 6 sessions. An improvement in knowledge was noted for most learning objectives except for the third, for which misconceptions remained, especially regarding need for vancomycin in the setting of mucositis (Figures 3 and 4). Higher baseline knowledge was noted for medical students/residents than APPs. 93% of learners rated the lecture very/extremely helpful. Learners recommended future content focus on antifungal therapy. Conclusion We utilized local practice data to develop educational content for front-line providers. We will convert this lecture into a video-format to be incorporated into hematology rotations to reinforce key concepts. A prospective cohort study to evaluate the impact on prescribing behavior is underway. Disclosures All authors: No reported disclosures.

The risk of thrombotic events in patients with primary versus secondary hepatic malignancies who are undergoing surgical resection

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15178-15178
Author(s):  
T. J. Yates ◽  
M. Abouljoud ◽  
A. Lambing ◽  
P. Kuriakose
Keyword(s):  
Surgical Resection ◽  
Metastatic Disease ◽  
Chart Review ◽  
Malignant Disease ◽  
Retrospective Chart Review ◽  
Secondary Malignancies ◽  
The Past ◽  
Increased Risk ◽  
Thrombotic Complications ◽  
Hepatic Malignancies

15178 Background: The increased risk of thromboses is well documented in patients with malignancies, and those undergoing abdominal surgery. Furthermore, patients requiring hepatic resection for underlying malignant disease have been reported to be at increased risk for thrombotic complications. However, guidelines for thromboprophylaxis in this patient population are still under investigation. A cursory review performed at our institution determined the incidence of thrombotic events to be comparable to that reported in the literature. We, therefore, went further to study if there was a difference in the risk of thromboses between those undergoing resection for primary hepatic cancer, versus metastatic disease. Methods: We performed a retrospective chart review of patients undergoing surgical resection for hepatic malignancies. The primary end point was to determine whether there was a difference in the incidence of thrombotic events between primary and secondary malignancies. Results: A total of 99 patients at our institution underwent surgical resection for either primary or secondary hepatic malignancies in the past 5 years. There were 7 patients who developed thrombotic events within three months of their resection. Of these patients, all 7 underwent resection for secondary hepatic malignancies. Based on the nature of this study, and its lack of standardized thromboprophylaxis, statistical analysis was not performed. Conclusions: Patients undergoing surgical resection of hepatic malignancies appear to be at increased risk of thrombotic events, and may require more specific standardization of their thromboprophylaxis. Furthermore, based on our observation it appears those associated with metastatic disease may derive an even greater benefit from this. Future prospective studies will be required to evaluate this difference in thromboses, and to better define the guidelines for thromboprophylaxis. No significant financial relationships to disclose.

Prognostic Value of D-Dimer in Stable Patients with Pulmonary Embolism

2011 ◽  
Vol 17 (6) ◽  
pp. E183-E185 ◽  
Author(s):  
Paul D. Stein ◽  
Muhammad Janjua ◽  
Fadi Matta ◽  
Ahmed Alrifai ◽  
Fadel Jaweesh ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Hospital Mortality ◽  
High Mortality ◽  
Prognostic Value ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
All Cause Mortality ◽  
D Dimer

Prognosis of pulmonary embolism (PE) based on levels ofD-dimer has shown mixed results, and data on in-hospital prognosis of stable patients are sparse. We assessed in-hospital prognosis in 292 stable patients with PE based on retrospective chart review using an arbitrarily selected value ofD-dimer ≥5000 ng/mL as cut-off level. In-hospital mortality from PE was 0% (0 of 222) withD-dimer <5000 ng/mL compared with 2.9% (2 of 70) withD-dimer ≥5000 ng/mL ( P = .06). In-hospital all-cause mortality was 2.3% (5 of 222) withD-dimer <5000 ng/mL compared with 2.9% (2 of 70) withD-dimer ≥5000 ng/mL (NS). Markedly elevated levels ofD-dimer, therefore, did not indicate a high mortality from PE or all-cause mortality during hospitalization.

A Retrospective Chart Review of the Hematologic Consequences of Roux-en-y Gastric Bypass Surgery.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3772-3772
Author(s):  
Christina L. Costantino ◽  
Susan Kruse ◽  
David H. Henry
Keyword(s):  
Chart Review ◽  
Bypass Surgery ◽  
Reticulocyte Count ◽  
Gastric Bypass Surgery ◽  
Retrospective Chart Review ◽  
Duodenal Mucosa ◽  
The Past ◽  
B12 Deficiency ◽  
Post Menopausal

Abstract Roux-en-y gastric (RYGB) bypass surgery has become increasingly common as a procedure to control overweight/obesity. Due to the resulting bypass of significant amounts of gastric and duodenal mucosa, patients may develop anemia. We reviewed charts of 28 patients who had undergone RYGB surgery in the past 5 years who were referred to us for evaluation. Eighteen of these patients had no hematologic consequences as a result of the surgery. Five patients were anemic but were excluded because they had other causes for anemia than the bypass surgery: myeloma (1), pregnancy (1), breast cancer (1), and heavy menstruation (2). The remaining 5 patients however revealed hematologic abnormalities an average of approximately 23 months following RYGB surgery. In our retrospective chart review, we found anemia most commonly caused by iron deficiency although 1 patient had B12 deficiency, and we suggest periodic follow up of patients months to years after such surgery to screen for anemia from potential malabsorption of iron or B12 from this surgical alteration of gastrointestinal anatomy. Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Months since RYGB & first heme evaluation 24 months 28 months 39 months 11 months 11 months Pre/Post Menopausal pre pre pre pre pre Hemoglobin 8 12.9 9.8 6.7 9.9 B12 165 501 233 340 660 Ferritin 14 9 7 &lt;1 5 Folate 20.8 &gt;24.0 16.3 16.4 &gt;24.0 Creatinine 0.6 0.9 0.9 1.0 0.8 WBC 7.7 8.5 9 6.9 5.6 Platelets 364 300 473 378 462 Reticulocyte Count 1.00% 1.30% 1.20% 1.30% 1.30%

Impact of a cefepime shortage on dosing regimens and outcomes in hospitalized adults with febrile neutropenia

2020 ◽  
pp. 107815522091863
Author(s):  
Manuela Haiduc ◽  
Monank Patel ◽  
Thomas L Walsh ◽  
Matthew A Moffa ◽  
Derek N Bremmer
Keyword(s):  
Length Of Stay ◽  
Febrile Neutropenia ◽  
Severity Of Illness ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Objective ◽  
Hospitalized Patients ◽  
Dosing Regimen ◽  
United States Food ◽  
Dosing Regimens

Background Drug shortages may negatively impact outcomes in hospitalized patients. A cefepime dosing regimen of 1 gram every 6 hours (1 g q6h) has shown to provide similar exposures above target minimum inhibitory concentrations compared to the regimen of 2 g q8h approved by the United States Food and Drug Administration (FDA) for febrile neutropenia. Our objective was to determine if the dosing regimen of 1 g q6h amidst a cefepime shortage is an appropriate alternative for the treatment of febrile neutropenia. Methods A retrospective chart review of hospitalized patients who received cefepime for febrile neutropenia over a two-year period was performed. Patients were grouped based on cefepime dosing strategy: 2 g q8h vs. 1 g q6h. The primary objective was to compare time to defervescence after cefepime initiation. Secondary objectives included all-cause 30-day mortality, duration of antibiotic therapy, and inpatient length of stay. Results Seventy-five patients in each arm were included. There were no differences in baseline age or severity of illness between groups. There was no difference in the primary objective as median time to defervescence was similar between the 2 g q8h and 1 g q6h groups (69.0 vs. 65.3 h: p= 0.67). Additionally, no differences were found in the secondary objectives of all-cause 30-day mortality (10.7% vs. 9.3%: p = 0.79), duration of therapy (80.8 vs. 88.0 h: p = 0.34), or length of stay (9 vs. 7 days: p = 0.50). Conclusions Our study identified no differences in clinical outcomes with cefepime 1 g q6h compared to the traditional FDA-approved 2 g q8h regimen for the treatment of febrile neutropenia.

scholarly journals Empiric Vancomycin Use in Febrile Neutropenic Oncology Patients

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Jessica Libuit ◽  
Andrew Whitman ◽  
Rebecca Wolfe ◽  
Casey S. Washington
Keyword(s):  
Antibiotic Resistance ◽  
Febrile Neutropenia ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Empiric Therapy ◽  
Vancomycin Therapy ◽  
Oncology Patients ◽  
Teaching Institution ◽  
Large Community ◽  
Community Teaching

Abstract Vancomycin is commonly added as empiric therapy for febrile neutropenia. A retrospective chart review was conducted at a large community teaching institution to evaluate vancomycin use in oncology patients. The results revealed that a majority of empiric vancomycin therapy was inappropriate, raising concern for antibiotic resistance and prompting opportunities for improvement.

scholarly journals Five Years of Humanitarian Missions in São Tomé and Príncipe

2016 ◽  
Author(s):  
Cristina Caroça ◽  
João Paço
Keyword(s):  
Chart Review ◽  
Healthcare Access ◽  
Sensorineural Deafness ◽  
Retrospective Chart Review ◽  
Return To School ◽  
Governmental Organization ◽  
Private Healthcare ◽  
The Past ◽  
Sao Tome And Principe ◽  
Language Problems

INTRODUCTION: Since February 2011, a group of otolaryngologists from CUF Infante Santo Hospital, a private healthcare unit in Portugal, invited by a non-governmental organization to provide equipment and properly skilled professionals to help and treat otolaryngology diseases in São Tomé and Príncipe. These missions included surgical procedures, consultation and hearing evaluation. METHODS: This work is a retrospective chart review of all otolaryngology cases performed during these missions since 2011 to 2016, and what we done during mission. RESULTS: During these missions, we have found some common pathologies. Deafness is the most prevalent after which follows the lymphoid tissue of oropharynx pathology. On these 18 missions a total of 1057 otolaryngology assessments were conducted. The main surgery was oral cavity with adenoidectomy and tonsillectomy. The results of all audiological tests performed during these 18 missions, reveal an increase of sensorineural deafness. DISCUSSION: These missions’ purpose is to allow healthcare access to all, to identify people with hearing and language problems and to adapt prosthetics, if possible, mainly for children and young adults.We have witnessed a considerable improvement on the children to whom we have adapted prosthetics. Some of them return to school, have friends and became more social. As the result of this work, we conclude that all Humanitarian Missions must be adapted to each country’s needs as we have done over the past five years.

The effect of a scheduled regimen of acetaminophen and ibuprofen on opioid use following cesarean delivery

2020 ◽  
Vol 48 (2) ◽  
pp. 153-156
Author(s):  
Dijana Poljak ◽  
Joseph Chappelle
Keyword(s):  
Cesarean Delivery ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Time Intervals ◽  
Pain Scores ◽  
Pain Medications ◽  
Post Operative Pain

AbstractObjectiveThe primary objective was to evaluate if the administration of ibuprofen and acetaminophen at regularly scheduled intervals impacts pain scores and total opioid consumption, when compared to administration based on patient demand.MethodsA retrospective chart review was performed comparing scheduled vs. as-needed acetaminophen and ibuprofen regimens, with 100 women included in each arm. Demographics and delivery characteristics were collected in addition to pain scores and total ibuprofen, acetaminophen and oxycodone use at 24, 48 and 72 h postoperatively.ResultsThe scheduled dosing group was found to have a statistically significant decrease in pain scores at all time intervals. Acetaminophen and ibuprofen usage were also noted to be higher in this group while narcotic use was reduced by 64%.ConclusionScheduled dosing of non-narcotic pain medications can substantially decrease opioid usage after cesarean delivery and improve post-operative pain.

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