Impact of Penicillin Allergy Label on Length of Stay and Mortality in Hospitalized Patients through a Clinical Administrative National Dataset

2021 ◽  
pp. 1-9
Author(s):  
Montserrat Pérez-Encinas ◽  
Susana Lorenzo-Martínez ◽  
Juan Emilio Losa-García ◽  
Stefan Walter ◽  
Miguel Angel Tejedor-Alonso
Keyword(s):  
Infectious Diseases ◽  
Hospital Mortality ◽  
National Level ◽  
Length Of Hospital Stay ◽  
Hospitalized Patients ◽  
Adult Patients ◽  
Penicillin Allergy ◽  
Data Set ◽  
Hospital System ◽  
The Impact

<b><i>Background:</i></b> Penicillin allergy is a common problem in the management of infectious diseases. The aim of this study was to determine the impact of penicillin allergy on length of hospital stay (LOHS) among hospitalized adult patients and on in-hospital mortality at a national level. <b><i>Methods:</i></b> A retrospective cohort study of adult patients discharged from the Spanish Hospital System between 2006 and 2015 was conducted using the Minimum Basic Data Set (MBDS). We compared LOHS and in-hospital mortality of adult patients whose records contained penicillin allergy code V14.0 (International Classification of Diseases, Ninth Revision, Clinical Modification) as a secondary diagnosis, with a random sample without such a code. <b><i>Results:</i></b> We identified 981,291 admissions with code V14.0, which corresponded to 2.63% of all hospitalizations. Adults patients with a penicillin allergy label were significantly older than patients without such a label, with a median of 70 years (interquartile range [IQR]: 51–80) versus 63 years (IQR: 40–77). The proportion of women and the prevalence of infectious diseases were higher in the group with a penicillin allergy label (61.40% vs. 53.84%; 34.04% vs. 30.01%; respectively). We found a higher median Elixhauser-Van Walraven score in hospitalized patients with an allergy label. The median LOHS for hospitalizations with a penicillin allergy label (5 [IQR: 2–9]) was significantly longer than that in those without such a label (4 [IQR: 2–9]). Multivariate analysis showed an increase in LOHS due to the penicillin allergy label (odds ratio [OR] [95% confidence interval [CI]: 1.061 [1.057–1.065]) and a decrease in mortality in penicillin allergy records (OR [95% CI]: 0.834 [0.825–0.844]). <b><i>Conclusion:</i></b> In our study, the prevalence of a penicillin allergy label in hospitalized patients, using the MBDS, is low. Hospitalizations with an allergy label was associated with a longer LOHS. However, penicillin-allergic patients did not show higher mortality rates. Inaccurate reporting of penicillin allergies may have an impact on healthcare resources.

scholarly journals The high volume of patients admitted during the SARS-CoV-2 pandemic has an independent harmful impact on in-hospital mortality from COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0246170
Author(s):  
Alessandro Soria ◽  
Stefania Galimberti ◽  
Giuseppe Lapadula ◽  
Francesca Visco ◽  
Agata Ardini ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
High Volume ◽  
Hospitalized Patients ◽  
Urgent Care ◽  
Calendar Period ◽  
Cox Models ◽  
Hospital System ◽  
Risk Of Death ◽  
The Impact ◽  
Age And Sex

Background During the Coronavirus disease 2019 (COVID-19) pandemic, advanced health systems have come under pressure by the unprecedented high volume of patients needing urgent care. The impact on mortality of this “patients’ burden” has not been determined. Methods and findings Through retrieval of administrative data from a large referral hospital of Northern Italy, we determined Aalen-Johansen cumulative incidence curves to describe the in-hospital mortality, stratified by fixed covariates. Age- and sex-adjusted Cox models were used to quantify the effect on mortality of variables deemed to reflect the stress on the hospital system, namely the time-dependent number of daily admissions and of total hospitalized patients, and the calendar period. Of the 1225 subjects hospitalized for COVID-19 between February 20 and May 13, 283 died (30-day mortality rate 24%) after a median follow-up of 14 days (interquartile range 5–19). Hospitalizations increased progressively until a peak of 465 subjects on March 26, then declined. The risk of death, adjusted for age and sex, increased for a higher number of daily admissions (adjusted hazard ratio [AHR] per an incremental daily admission of 10 patients: 1.13, 95% Confidence Intervals [CI] 1.05–1.22, p = 0.0014), and for a higher total number of hospitalized patients (AHR per an increase of 50 patients in the total number of hospitalized subjects: 1.11, 95%CI 1.04–1.17, p = 0.0004), while was lower for the calendar period after the peak (AHR 0.56, 95%CI 0.43–0.72, p<0.0001). A validation was conducted on a dataset from another hospital where 500 subjects were hospitalized for COVID-19 in the same period. Figures were consistent in terms of impact of daily admissions, daily census, and calendar period on in-hospital mortality. Conclusions The pressure of a high volume of severely ill patients suffering from COVID-19 has a measurable independent impact on in-hospital mortality.

Impact of exchange rates on exports from India’s sub-national economies

2019 ◽  
Vol 8 (2) ◽  
pp. 166-184
Author(s):  
Khee Giap Tan ◽  
Sasidaran Gopalan ◽  
Jigyasa Sharma
Keyword(s):  
Exchange Rates ◽  
Export Performance ◽  
National Level ◽  
Skewed Distribution ◽  
Significant Finding ◽  
Data Set ◽  
Content Type ◽  
National Economies ◽  
The Impact ◽  
The Relationship

Purpose The purpose of this paper is to examine the impact of real effective exchange rates (REER), both in terms of levels and volatility, on the export performance of India’s sub-national economies, given the recent slowdown in India’s exports. Design/methodology/approach India’s export distribution is highly asymmetric, with 90 percent of India’s exports concentrated in 11 sub-national economies. Exploiting this concentration, this paper constructs a panel data set using available data between 2002 and 2014 to understand the relationship between REER and exports from the top exporting cluster. Moreover, the paper constructs a sub-national competitiveness index to capture the supply capacity of the states. Findings The empirical findings of this paper reveal that a higher REER volatility deters exports and movements in REER do not matter as much as volatility. The most significant finding of the paper is that state competitiveness is the most crucial factor affecting trade. Therefore, policy makers at the state level must lay more emphasis on the supply side such as addressing logistical bottlenecks to help revive exports growth. Originality/value This study makes a departure from the plethora of extant aggregate-level studies by examining the relationship between REER and exports at the sub-national level for India. Considering the highly skewed distribution of India’s exports, the study provides important insights into the exporting patterns and determinants that are at play at the sub-national level.

scholarly journals A Propensity Score Matched Study of the Positive Impact of Infectious Diseases Consultation on Antimicrobial Appropriateness in Hospitalized Patients with Antimicrobial Stewardship Oversight

2020 ◽  
Vol 64 (8) ◽  
Author(s):  
Jacqueline T. Bork ◽  
Kimberly C. Claeys ◽  
Emily L. Heil ◽  
Mary Banoub ◽  
Surbhi Leekha ◽  
...  
Keyword(s):  
Propensity Score ◽  
Infectious Diseases ◽  
Propensity Score Matching ◽  
Antimicrobial Stewardship ◽  
Positive Impact ◽  
Hospitalized Patients ◽  
Audit And Feedback ◽  
Medical Specialties ◽  
Infectious Diseases Consultation ◽  
The Impact

ABSTRACT Hospital-based antibiotic stewardship (AS) programs provide oversight and guidance for appropriate antimicrobial use in acute care settings. Infectious disease expertise is beneficial in the care of hospitalized patients with infections. The impact of infectious diseases consultation (IDC) on antimicrobial appropriateness in a large tertiary hospital with an established AS program was investigated. This was a cross-sectional study from October 2017 to March 2019 at a large academic hospital with an AS-directed prospective audit and feedback process and multiple IDC services. Antimicrobial appropriateness was adjudicated by an AS team member after antimicrobial start. Antimicrobial appropriateness was compared among antimicrobial orders with and without IDC using propensity score matching and multivariable logistic regression. Analyses were stratified by primary services caring for the patients. There were 10,508 antimicrobial orders from 6,165 unique patient encounters. Overall appropriateness was 92%, with higher appropriateness among patients with IDC versus without IDC (94% versus 84%; P < 0.0001). After propensity score matching and adjustment for certain antibiotics, organisms, syndromes, and locations, IDC was associated with a greater antimicrobial appropriateness odds ratio (OR) of 2.4 (95% confidence interval [CI], 1.9 to 3.0). Stratification by primary service showed an OR of 2.9 (95% CI, 2.1 to 3.8) for surgical specialties and an OR of 1.6 (95% CI, 1.1 to 2.2) for medical specialties. Even with a high overall antimicrobial appropriateness, patients with IDC had greater odds of antimicrobial appropriateness than those without IDC, and this impact was greater in surgical specialties. Infectious diseases consultation can be synergistic with antimicrobial stewardship programs.

Active haematological manifestations of systemic lupus erythematosus lupus are associated with a high rate of in-hospital mortality

Lupus ◽  
2016 ◽  
Vol 26 (6) ◽  
pp. 640-645 ◽  
Author(s):  
D Miranda-Hernández ◽  
C Cruz-Reyes ◽  
C Monsebaiz-Mora ◽  
E Gómez-Bañuelos ◽  
U Ángeles ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Hospital Mortality ◽  
Lupus Erythematosus ◽  
Hospitalized Patients ◽  
High Rate ◽  
Hospital Death ◽  
Control Group ◽  
Systemic Lupus ◽  
Medical Referral ◽  
The Impact

The aim of this study was to estimate the impact of the haematological manifestations of systemic lupus erythematosus (SLE) on mortality in hospitalized patients. For that purpose a case–control study of hospitalized patients in a medical referral centre from January 2009 to December 2014 was performed. For analysis, patients hospitalized for any haematological activity of SLE ( n = 103) were compared with patients hospitalized for other manifestations of SLE activity or complications of treatment ( n = 206). Taking as a variable outcome hospital death, an analysis of potential associated factors was performed. The most common haematological manifestation was thrombocytopenia (63.1%), followed by haemolytic anaemia (30%) and neutropenia (25.2%). In the group of haematological manifestations, 17 (16.5%) deaths were observed compared to 10 (4.8%) deaths in the control group ( P < 0.001). The causes of death were similar in both groups. In the analysis of the variables, it was found that only haematological manifestations were associated with intra-hospital death (odds ratio 3.87, 95% confidence interval 1.8–88, P < 0.001). Our study suggests that apparently any manifestation of haematological activity of SLE is associated with poor prognosis and contributes to increased hospital mortality.

scholarly journals Impact of Comorbidities on Length of Stay and Mortality in Hospitalized Patients with Cancer and Febrile Neutropenia

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2601-2601 ◽  
Author(s):  
Eva Culakova ◽  
Marek S. Poniewierski ◽  
Jeffrey Crawford ◽  
David C. Dale ◽  
Gary H. Lyman
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Research Funding ◽  
Infectious Complications ◽  
Hospitalized Patients ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Time Period ◽  
Increased Risk ◽  
The Impact

Background: Hematologic toxicities are common side effects of cancer chemotherapy. Despite advances in supportive care, febrile neutropenia (FN) continues to represent a serious adverse event often requiring hospitalization and is associated with an increased risk of mortality. The purpose of this analysis was to investigate the impact of comorbidities and infectious complications on in-patient length of stay (LOS) and mortality in hospitalized patients with cancer and neutropenia over the past decade. Methods: Hospitalization data from the University Health Consortium database inclusive of the years 2004-2012 from 239 US medical centers were analyzed. Cancer type, presence of neutropenia, comorbidities, and infection type were based on ICD-9-CM codes recorded during hospitalization. This analysis includes adult patients with malignant disease and neutropenia. Patients undergoing bone marrow or stem cell transplantation were excluded. For patients with multiple hospitalizations, the first admission during the time period studied was utilized. Primary study outcomes included hospital length of stay (LOS≥10 days) and in-hospital mortality. Multivariate logistic regression analysis was utilized to study the impact of major comorbidities on the primary outcomes. Major comorbidities under consideration included heart, liver, lung, renal, cerebrovascular, peripheral-vascular disease, diabetes and venous thromboembolism. Results: Among 135,309 patients with cancer hospitalized with neutropenic events, one-third were age 65 years or older and 51% were male. Approximately one-quarter (24.5%) of patients experienced more than one admission with FN. The mean (median) length of stay increased progressively from 11.1 (6) days in 2004 to 12.8 (7) days in 2012. Patients with leukemia, lymphoma and central nervous system (CNS) malignancies experienced the longest mean LOS (21.4, 10.5, 10.2 days, respectively). Overall, 50,846 (37.6%) had a LOS≥10 days and 10,261 (7.6%) patients died during the hospitalization with no difference seen over the time period of observation. (P=.30). Greater rates of mortality were observed in patients with lung (11.2%) or CNS (9.3%) malignancies, and leukemia (9.3%). Infectious complications were documented in 59.5% of patients and their presence was associated with greater LOS≥10 days (48.2% vs. 22.0%) and higher mortality (11.2% vs. 2.3%). Greater LOS≥10 days (51.6% vs. 37.1%) and increased mortality (9.8% vs. 7.5%) were also observed among obese patients with cancer. Likewise, patients with multiple comorbid conditions had more prolonged hospitalizations and a greater risk of in-hospital mortality. (Table) Abstract 2601. Table Solid tumors Lymphoma LeukemiaNo. of comorbiditiesNo. of patients% died% with LOS≥10 daysNo. of patients% died% with LOS≥10 daysNo. of patients% died% with LOS≥10 days017,8580.911.28,1890.617.010,3950.853.5118,1723.417.97,7512.626.611,3803.463.2214,2508.927.25,3868.141.08,6039.769.937,49918.038.42,86118.455.25,04022.877.742,70525.151.41,06033.670.52,00438.183.1≥ 560235.262.327839.980.657749.087.0All patients*61,0867.022.625,5256.632.237,9999.265.4 LOS – length of stay; * 10,699 patients with other type or multiple tumors not included in the table The trend toward longer LOS and greater mortality with increased number of comorbidities persisted in multivariate analyses after adjusting for cancer type, age, gender, ethnicity and type of infection (odds ratio (OR) per +1 comorbidity increase: [mortality: OR =1.89; 95% CI: 1.85-1.92; P<.0001], [LOS: OR=1.56; 95% CI: 1.54-1.58; P<.0001]). Conclusions: Major medical comorbidities are common among hospitalized patients with cancer and neutropenia. Importantly, such comorbidities are associated with prolonged hospitalization and increased risk of in-hospital mortality with significantly worse outcomes in patients with lymphoma or leukemia. Greater awareness of risk factors associated with poor prognosis in cancer patients hospitalized with neutropenic complications as well as validated risk tools to better identify low risk as well high risk patients may guide more personalized cancer care, potentially improving clinical outcomes and lowering the cost of care. Disclosures Crawford: Amgen: Consultancy. Dale:Amgen: Consultancy, Honoraria, Research Funding. Lyman:Amgen: Research Funding.

scholarly journals Extrapolating regional probability of drying of headwater streams using discrete observations and gauging networks

2017 ◽  
Author(s):  
Aurélien Beaufort ◽  
Nicolas Lamouroux ◽  
Hervé Pella ◽  
Thibault Datry ◽  
Eric Sauquet
Keyword(s):  
Headwater Streams ◽  
Regional Scale ◽  
National Level ◽  
Ephemeral Streams ◽  
Field Observations ◽  
Discrete Observations ◽  
Data Set ◽  
Intermittent Rivers ◽  
The Impact ◽  
Flow Intermittence

Abstract. Headwater streams represent a substantial proportion of river systems and have frequently flows intermittence due to their upstream position in the network. These intermittent rivers and ephemeral streams have recently seen a marked increase in interest, especially to assess the impact of drying on aquatic ecosystems. The objective of this paper is to quantify how discrete (in space and time) field observations of flow intermittence help to extrapolate the daily probability of drying at the regional scale. Two empirical models based on linear or logistic regressions have been developed to predict the daily probability of intermittence at the regional scale across France. Explanatory variables were derived from available daily discharge and groundwater level data of a dense gauging/piezometer network, and models were calibrated using discrete series of field observations of flow intermittence. The robustness of the models was tested using (1) an independent, dense regional data set of intermittence observations, (2) observations of the year 2017 excluded from the calibration. The resulting models were used to simulate the regional probability of drying in France: (i) over the period 2011–2017 to identify the regions most affected by flow intermittence; (ii) over the period 1989–2017, using a reduced input dataset, to analyze temporal variability of flow intermittence at the national level. The two regressions models performed equally well between 2011 and 2017. The accuracy of predictions depended on the number of continuous gauging/piezometer stations and intermittence observations available to calibrate the regressions. Regions with the highest performance were located in sedimentary plains, where the monitoring network was dense and where the regional probability of drying was the highest. Conversely, worst performances were obtained in mountainous regions. Finally, temporal projections (1989–2016) suggested highest probabilities of intermittence (> 35 %) in 1989–1991, 2003 and 2005. A high density of intermittence observations improved the information provided by gauging stations and piezometers to extrapolate the spatial distribution of intermittent rivers and ephemeral streams.

scholarly journals Obesity as a Risk Factor Among Hospitalized Patients with Infective Endocarditis

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Ché Matthew Harris ◽  
Aiham Albaeni ◽  
Scott Wright ◽  
Keith C Norris
Keyword(s):  
Regression Analysis ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Multivariate Regression Analysis ◽  
Hospitalized Patients ◽  
Hospital Charges ◽  
Total Hospital ◽  
Charlson Comorbidity Score ◽  
Hospital Resources ◽  
The Impact

Abstract Objective Obesity contributes to diagnostic and management challenges for many hospitalized patients. The impact of obesity on in-hospital outcomes in patients with infective endocarditis has not been studied and was the focus of this investigation. Method We used the 2013 and 2014 Nationwide Inpatient Sample to identify adults ≥18 years of age with a principle diagnosis of endocarditis. We divided the sample into 2 groups based on presence of absence of obesity. Multivariate linear and logistic regression analysis was used to compare in-hospital mortality, valvular replacement, length of stay (LOS), and hospitalization charges. Results A total of 24 494 adults 18 years and older were hospitalized with infective endocarditis, of which 2625 were classified as obese. Patients with obesity were older (mean age, 57.8 ± 0.3 vs 54.3 ± 0.6 years; P &lt; .01), more likely to be female (50.1% vs 36.1%; P &lt; .01), and had more comorbidities (Charlson comorbidity score ≥ 3, 50.6% vs 28.8%; P &lt; .01). Multivariate regression analysis found no differences between the 2 groups for mortality or repairs or replacements for any valve. On evaluation of resource utilization, patients with obesity had longer average LOS (13.9 days; confidence interval [CI], 12.7–15.1 vs 12.4 days; CI, 12.0–12.8; P = .016) and higher total hospital charges (US $160 789.90; CI, $140.922.40–$180 657.50 vs US $130 627.20; CI, $123 916.70–$137 337.70; P &lt;.01). After adjustment for LOS for total hospital charges, there was no observed difference $11436.26 (CI, -$6649.07–$29521.6; P = .22). Conclusions . Obesity does not significantly impact in-hospital mortality or surgical valvular interventions among patients hospitalized with infective endocarditis, but obesity is associated with increased utilization of hospital resources.

scholarly journals Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Theresa Madaline ◽  
Francis Wadskier Montagne ◽  
Ruth Eisenberg ◽  
Wenzhu Mowrey ◽  
Jaskiran Kaur ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
Rank Test ◽  
P Value ◽  
Analysis Model ◽  
Subdistribution Hazard ◽  
Significant Difference ◽  
The Impact

Abstract Objective Severe sepsis and septic shock (SS/SS) treatment bundles reduce mortality, and early infectious diseases (ID) consultation also improves patient outcomes. We retrospectively examined whether early ID consultation further improves outcomes in Emergency Department (ED) patients with SS/SS who complete the sepsis bundle. Method We included 248 adult ED patients with SS/SS who completed the 3-hour bundle. Patients with ID consultation within 12 hours of ED triage (n = 111; early ID) were compared with patients who received standard care (n = 137) for in-hospital mortality, 30-day readmission, length of hospital stay (LOS), and antibiotic management. A competing risk survival analysis model compared risks of in-hospital mortality and discharge alive between groups. Results In-hospital mortality was lower in the early ID group unadjusted (24.3% vs 38.0%, P = .02) and adjusted for covariates (odds ratio, 0.47; 95% confidence interval (CI), 0.25–0.89; P = .02). There was no significant difference in 30-day readmission (22.6% vs 23.5%, P = .89) or median LOS (10.2 vs 12.1 days, P = .15) among patients who survived. A trend toward shorter time to antibiotic de-escalation in the early ID group (log-rank test P = .07) was observed. Early ID consultation was protective of in-hospital mortality (adjusted subdistribution hazard ratio (asHR), 0.60; 95% CI 0.36–1.00, P = .0497) and predictive of discharge alive (asHR 1.58, 95% CI, 1.11–2.23; P-value .01) after adjustment. Conclusions Among patients receiving the SS/SS bundle, early ID consultation was associated with a 40% risk reduction for in-hospital mortality. The impact of team-based care and de-escalation on SS/SS outcomes warrants further study.

scholarly journals Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

2019 ◽  
Vol 8 (7) ◽  
pp. 981 ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
Ploypin Lertjitbanjong ◽  
Narothama Reddy Aeddula ◽  
Tarun Bathini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Incidence Rates ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
The Impact

Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%–72.4%) and 44.9% (95%CI: 40.8%–49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87–4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21–4.99). There was no publication bias as evaluated by the funnel plot and Egger’s regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.

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