scholarly journals A Vignette-Based Survey to Assess Clinical Decision Making Regarding Antibiotic Use and Hospitalization of Patients with Probable Aseptic Meningitis

2012 ◽  
Vol 23 (3) ◽  
pp. 125-129
Author(s):  
Glenn Patriquin ◽  
Jill Hatchette ◽  
Kevin Forward
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Baseline Scenario ◽  
Blood Cell Count ◽  
Laboratory Findings

BACKGROUND: The many etiologies of meningitis influence disease severity – most viral causes are self-limiting, while bacterial etiologies require antibiotics and hospitalization. Aided by laboratory findings, the physician judges whether to admit and empirically treat the patient (presuming a bacterial cause), or to treat supportively as if it were viral.OBJECTIVE: To determine factors that lead infectious disease specialists to admit and treat in cases of suspected meningitis.METHODS: A clinical vignette describing a typical case of viral meningitis in the emergency department was presented to clinicians. They were asked to indicate on a Likert scale the likelihood of administering empirical antibiotics and admitting the patient from the vignette and for eight subsequent scenarios (with varied case features). The process was repeated in the context of an inpatient following initial observation and/or treatment.RESULTS: Participants were unlikely to admit or to administer antibiotics in the baseline scenario, but a low Glasgow Coma Score or a high cerebrospinal fluid (CSF) white blood cell count with a high neutrophil percentage led to empirical treatment and admission. These factors were less influential after a negative bacterial CSF culture. These same clinical variables led to maintaining treatment and hospitalization of the inpatient.CONCLUSIONS: Most participants chose not to admit or treat the patient in the baseline vignette. Confusion and CSF white blood cell count (and neutrophil predominance) were the main influences in determining treatment and hospitalization. A large range of response scores was likely due to differing regional practices or to different levels of experience.

scholarly journals 788. Evaluation of a Multiplex PCR Panel and Confirmatory Cytotoxin Testing on Clostridioides difficile at a Pediatric Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S438-S438
Author(s):  
Michael J Lauth ◽  
Greg Cook ◽  
Margarita Silio
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
Multiplex Pcr ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Antibiotic Use ◽  
P Value ◽  
Pediatric Hospital ◽  
Blood Cell Count ◽  
Clostridioides Difficile

Abstract Background With the introduction of gastrointestinal multiplex PCR (mPCR) tests, clinicians have received an increased number of positive tests for Clostridioides difficile. Patients who test positive via mPCR may not have a positive toxin assay indicative of true infection and may not need antibiotics. The goal of this study was to assess the symptoms of patients who test positive for C. difficile and determine the impact on antibiotic use at a pediatric hospital. Methods A single-center, retrospective review was completed from May 2018 to March 2020. Initial C. difficile screening tests were performed via an mPCR test or a mono-PCR test. Patients > 1 year of age had a reflex cytotoxin assay performed. The primary outcome was the difference in symptoms between cytotoxin positive and negative patients. Secondary outcomes included co-pathogen detection on mPCR and C. difficile antibiotic days of therapy. Results Four hundred and sixty-one patients were included in our chart review. 49% of patients had a positive mPCR for a GI pathogen (n=229), and 18% (n=82) were positive for C. difficile. Cytotoxin was positive for 45% of patients that had C. difficile on mPCR. 34% of patients that had C. difficile detected on mPCR also had co-pathogens detected. No significant differences were present in symptomatology between cytotoxin positive and negative patients and no significant differences between white blood cell count (Table 1). There was a significant difference in the number of patients treated for the C. difficile between the cytotoxin populations (p-value< 0.05). The average duration of treatment with a negative test was significantly less than for positive cytotoxin test patients (7.5 vs 11 days, p-value< 0.05). Table 1: Comparison of cytotoxin production in pediatric patients with Clostridioides difficile. Conclusion Our results show a significant amount of antibiotic use for patients with cytotoxin negative C. difficile and no differences in symptomatology or white blood cell count based on cytotoxin positivity. Diagnostic stewardship of mPCR tests may be needed to effectively impact this unneeded antibiotic use, specifically the duration. Disclosures All Authors: No reported disclosures

scholarly journals LIKELY BACTERIAL ACUTE CERVICAL LYMPHADENITIS IN CHILDREN: FACTORS PREDICTIVE OF FAVORABLE OUTCOME

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e40-e41
Author(s):  
Karina Deshaies-Poliquin ◽  
Laurence Arsenault-Blanchard ◽  
Alexandre Marceau ◽  
Richard Belanger ◽  
Simon Berthelot ◽  
...  
Keyword(s):  
Lymph Node ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Antibiotic Use ◽  
Favorable Outcome ◽  
Blood Cell Count ◽  
Cervical Lymphadenitis ◽  
Absolute White Blood Cell

Abstract BACKGROUND Cervical lymphadenitis is frequent in the paediatric population and usually the result of infectious agents. Management of likely bacterial acute cervical lymphadenitis (LBACL) mainly relies on expert advice and may vary widely from antibiotherapy to surgery as no official guidelines have been published over the last decade. OBJECTIVES To identify factors associated with favorable outcome in the management of LBACL in children in order to create a decision algorithm and its further evaluation. DESIGN/METHODS This retrospective observational study was based on the review of medical records of patient from 1 month to 18 years old who have consulted for LBACL between July 2010 and July 2015 at a tertiary care paediatric center. LBACL were identified using electronic record databases (hospitalization, emergency). Patients were included if they had acute (≤10 days) episode of unilateral cervical mass of which the final diagnosis was LBACL. Exclusion criteria were: mycobacterial adenitis, Kawasaki disease, Cat-scratch disease, bilateral cervical lymph node involvement, congenital malformation, immunodeficiency or underlying neoplasia. Favorable evolution was defined as outpatient treatment or hospital stay of 48 hours or less without surgical drainage. To identify factors at initial consultation predictive of a favorable outcome, we performed univariate logistic regression models with several potential independent covariates, including, among others, age (years), size of lymph node (mm), fever (38,5°C), an antibiotic use prior to consultation, fluctuation, absolute white blood cell count (x10^9/L), and purulent material at ultrasonography (yes/no). RESULTS Our final study cohort was composed of 166 patients with a mean age of 4,5 years (3,5SD) and 62% male. Ultrasound was obtained in 139(83,7%) patients and cervical tomodensitometry in 31(18,7%). Surgical drainage was performed in 35(21,1%). Overall, 68(41,0%) patients presented a favorable evolution from which 27(16,9%) were treated as outpatient (figure1). Factors associated with favorable outcome were (OR; 95%CI): age (1.17; 1.06–1.29; p=0.002), absolute white blood cell count (0.91; 0.87–0.96; p=0.001), no antibiotic use prior to consultation (0.26; 0.07–0.92; p=0.037) and absence of purulent material on ultrasound (0.07; 0.02–0.29; p<0.001). Size of lymph node (0.98; 0.96–1.00; p=0,057) or fluctuation (0.71; 0.21–2.39; p=0.57) did not achieved statistical significance. CONCLUSION Older patients without prior antibiotic use, those with lower absolute white blood cell count and no purulent material on ultrasound seem to better evolve than other children with likely bacterial acute cervical lymphadenitis. A decision algorithm to identify patients eligible for conservative management should include those predictive factors.

scholarly journals White Blood Cells and Severe COVID-19: A Mendelian Randomization Study

2021 ◽  
Vol 11 (3) ◽  
pp. 195
Author(s):  
Yitang Sun ◽  
Jingqi Zhou ◽  
Kaixiong Ye
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Blood Cells ◽  
Mendelian Randomization ◽  
Association Studies ◽  
White Blood Cells ◽  
Genome Wide Association Studies ◽  
Blood Cell Count

Increasing evidence shows that white blood cells are associated with the risk of coronavirus disease 2019 (COVID-19), but the direction and causality of this association are not clear. To evaluate the causal associations between various white blood cell traits and the COVID-19 susceptibility and severity, we conducted two-sample bidirectional Mendelian Randomization (MR) analyses with summary statistics from the largest and most recent genome-wide association studies. Our MR results indicated causal protective effects of higher basophil count, basophil percentage of white blood cells, and myeloid white blood cell count on severe COVID-19, with odds ratios (OR) per standard deviation increment of 0.75 (95% CI: 0.60–0.95), 0.70 (95% CI: 0.54–0.92), and 0.85 (95% CI: 0.73–0.98), respectively. Neither COVID-19 severity nor susceptibility was associated with white blood cell traits in our reverse MR results. Genetically predicted high basophil count, basophil percentage of white blood cells, and myeloid white blood cell count are associated with a lower risk of developing severe COVID-19. Individuals with a lower genetic capacity for basophils are likely at risk, while enhancing the production of basophils may be an effective therapeutic strategy.

Identifying Top Predictors of Change in Noncalcified Coronary Burden in Psoriasis by Machine Learning Over 1-Year

2021 ◽  
pp. 247553032110007
Author(s):  
Eric Munger ◽  
Amit K. Dey ◽  
Justin Rodante ◽  
Martin P. Playford ◽  
Alexander V. Sorokin ◽  
...  
Keyword(s):  
Machine Learning ◽  
Blood Pressure ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Severity Index ◽  
Blood Cell Count ◽  
Psoriasis Area Severity Index ◽  
Severity Index Score

Background: Psoriasis is associated with accelerated non-calcified coronary plaque burden (NCB) by coronary computed tomography angiography (CCTA). Machine learning (ML) algorithms have been shown to effectively identify cardiometabolic variables with NCB in cross-sectional analysis. Objective: To use ML methods to characterize important predictors of change in NCB by CCTA in psoriasis over 1-year of observation. Methods: The analysis included 182 consecutive patients with 80 available variables from the Psoriasis Atherosclerosis Cardiometabolic Initiative, a prospective, observational cohort study at baseline and 1-year using the random forest regression algorithm. NCB was assessed at baseline and 1-year from CCTA. Results: Using ML, we identified variables of high importance in the context of predicting changes in NCB. For the cohort that worsened NCB (n = 102), top baseline variables were cholesterol (total and HDL), white blood cell count, psoriasis area severity index score, and diastolic blood pressure. Top predictors of 1-year change were change in visceral adiposity, white blood cell count, total cholesterol, c-reactive protein, and absolute lymphocyte count. For the cohort that improved NCB (n = 80), the top baseline variables were HDL cholesterol related including apolipoprotein A1, basophil count, and psoriasis area severity index score, and top predictors of 1-year change were change in apoA, apoB, and systolic blood pressure. Conclusion: ML methods ranked predictors of progression and regression of NCB in psoriasis over 1 year providing strong evidence to focus on treating LDL, blood pressure, and obesity; as well as the importance of controlling cutaneous disease in psoriasis.

scholarly journals Enoxaparin-induced reactive thrombocytosis: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tao Xiang ◽  
Ming Cheng
Keyword(s):  
Molecular Weight ◽  
Platelet Count ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Hip Replacement ◽  
Low Molecular Weight ◽  
Blood Cell Count ◽  
Reactive Thrombocytosis

Abstract Background Enoxaparin is an anticoagulant that falls in the class of medications called low molecular weight heparins (LMWHs), and is used to prevent or treat patients with deep vein thrombosis (DVT) and pulmonary embolism. Enoxaparin is the most widely used LMWH for DVT prophylaxis following knee or hip replacement surgery. Common side effects of enoxaparin include bleeding, petechiae at the injection site, and thrombocytopenia. However, reactive thrombocytosis is a rarely reported adverse reaction. We managed a patient who developed enoxaparin-associated thrombocytosis, which was completely resolved after treatment cessation. Case presentation A 78-year-old female was hospitalized for post-hip replacement rehabilitation. Low molecular weight heparin 40 mg/day was administered subcutaneously to prevent deep venous thrombosis (DVT). At admission, her platelet count was normal (228 × 109/L) and her white blood cell count was slightly elevated (12.91 × 109/L). Seven days after admission, the patient developed thrombocytosis, which peaked on the 14th day (836 × 109/L), while her white blood cell count had returned to normal (8.86 × 109/L). Her therapeutic regimen was reviewed, and enoxaparin was identified as a potentially reversible cause of reactive thrombocytosis. Switching from enoxaparin to rivaroxaban lead to a gradual decrease in the patient’s platelet count, which eventually returned to normal levels 16 days after enoxaparin was discontinued. No complications secondary to thrombocytosis was observed, and no conclusion was reached on the use of small doses of aspirin for antithrombotic therapy under these circumstances. Conclusion Enoxaparin-induced reactive thrombocytosis should be suspected in patients with thrombocytosis following enoxaparin administration as an anticoagulant to prevent certain complications.

Elevated white blood cell count does not predict Clostridium difficile nucleic acid testing results

2021 ◽  
Author(s):  
Dustin E Bosch ◽  
Patrick C Mathias ◽  
Niklas Krumm ◽  
Andrew Bryan ◽  
Ferric C Fang ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Clostridium Difficile ◽  
Blood Cell ◽  
Cell Count ◽  
Prognostic Marker ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Inpatient Setting ◽  
Nucleic Acid Testing ◽  
Blood Cell Count

Abstract Background An elevated white blood cell count (&gt;15 thousand/μL) is an established prognostic marker in patients with Clostridium difficile infection (CDI). Small observational studies have suggested that a markedly elevated WBC should prompt consideration of CDI. However, there is limited evidence correlating WBC elevation with the results of C. difficile nucleic acid testing (NAAT). Methods Retrospective review of laboratory testing, outcomes, and treatment of 16,568 consecutive patients presenting to 4 hospitals over four years with NAAT and WBC testing on the same day. Results No significant relationship between C. difficile NAAT results and concurrent WBC in the inpatient setting was observed. Although an elevated WBC did predict NAAT results in the outpatient and emergency department populations (p&lt;0.001), accuracy was poor, with receiver-operator areas under the curve of 0.59 and 0.56. An elevated WBC (&gt;15 thousand/μL) in CDI was associated with a longer median hospital length of stay (15.5 vs. 11.0 days, p&lt;0.01), consistent with leukocytosis as a prognostic marker in CDI. NAAT-positive inpatients with elevated WBC were more likely to be treated with metronidazole and/or vancomycin (relative ratio 1.2, 95% confidence interval 1.1–1.3) and die in the hospital (relative ratio 2.9, 95% CI 2.0–4.3). Conclusions Although WBC is an important prognostic indicator in patients with CDI, an isolated WBC elevation has low sensitivity and specificity as a predictor of fecal C. difficile NAAT positivity in the inpatient setting. A high or rising WBC in isolation is not a sufficient indication for CDI testing.

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