The Mortality of Vancomycin-Resistant Enterococci Bloodstream Infections (VRE BSI)

Abstract Abstract 4928 Background VRE are nosocomial pathogens with resistance to most commonly used antimicrobial agents. VRE BSI occurs in as few as 4% of patients colonised with VRE[i]. A review of factors contributing to the development of VRE BSI was performed to improve patient safety at St George Hospital. Alarmingly, there were 9 new cases of VRE BSI detected amongst haematology inpatients in early 2010, as compared with only 2 in the previous 6 months. In high risk populations, the rate of VRE BSI amongst patients colonised with VRE can be as high as 29%[ii]. VRE BSI is associated with an increased length of hospital stay from 10.5 to 46 days[iii][iv]and an estimated increased cost of $27,190 per patient[v]. Annual net savings of $100,000-150,000 can be achieved by hospitals detecting 6–9 cases of VRE BSI per year by utilising enhanced infection control strategies[vi]. Methods Admission details for haematology in-patients and their microbiology results between 1/6/2009-30/11/2010 were reviewed. A subsequent case-controlled analysis was performed matching for patient age, disease and disease stage. Interventions to reduce the rate of VRE transmission were introduced in July 2010: improved hand hygiene education, additional staffing allocations, additional cleaning services, antimicrobial stewardship, improved patient education, increased staff awareness, monthly census screening of all patients on the 4 East Oncology/Haematology ward for VRE and contact tracing measures. Results 471 patients were admitted a total of 943 times. VRE was isolated in 61 patients. Average length of stay was significantly longer in patients with VRE than for patients without VRE [16.3±3.0 vs 8.4±1.0 days, p=0.01]. 16 patients had VRE BSI. After a median follow-up of 9.8 months, eight of these patients have died (50% mortality), mostly due to progressive disease. 45 patients had non-BSI VRE and were followed up for a median 8.4 months: 24 died (53% mortality), also mostly due to progressive disease. Case-controlled Analysis An age, case and stage of disease matched analysis compared 14 patients with VRE and 14 with no evidence of VRE. Median follow-up from presentation with disease was 16.3 months and from VRE detection was 8 months. Mortality rate was 64% vs 29%. Seven out of nine deaths in the VRE cohort were due to progressive disease. Conclusions The clinical significance of VRE BSI over other modes of detection remains uncertain for individual patients, however high rates may reflect uncontrolled VRE transmission. Case controlled analysis demonstrates an associated additional mortality risk for VRE positive patients. Disclosures: No relevant conflicts of interest to declare.

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Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽

10.1024/1023-9332.8.6.255 ◽

2002 ◽

Vol 8 (6) ◽

pp. 255-258 ◽

Cited By ~ 28

Author(s):

Perruchoud ◽

Vuilleumier ◽

Givel

Keyword(s):

Hospital Stay ◽

Pilonidal Sinus ◽

Primary Closure ◽

Average Length ◽

Length Of Hospital Stay ◽

Healing Time ◽

Incision And Drainage ◽

The Mean ◽

Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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Why do frail patients with chronic heart failure die and become hospitalised?

European Heart Journal ◽

10.1093/ehjci/ehaa946.1149 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Sze ◽

P Pellicori ◽

J Zhang ◽

J Weston ◽

A.L Clark

Keyword(s):

Heart Failure ◽

Cause Of Death ◽

Hospital Admissions ◽

Average Length ◽

Significant Proportion ◽

Length Of Hospital Stay ◽

Clinical Frailty Scale ◽

Frail Patients ◽

Increased Risk

Abstract Background Frailty is common in patients with heart failure (HF) and is associated with increased morbidity and mortality. A better understanding of the causes of hospitalisations and death in frail patients might help to tailor interventional strategies for these at-risk patients. Purpose We studied the cause of death and hospitalisations in ambulatory patients with HF and frailty. Methods We assessed frailty using the clinical frailty scale (CFS) in consecutive HF patients attending a routine follow-up visit. Those with CFS ≥5 were classified as frail. Mortality and hospitalisations were ascertained from medical records (updated systematically using an NHS electronic database), discharge letters, autopsy reports and death certificates. We studied the primary cause of death and hospitalisations within one year of enrolment. Results 467 patients (67% male, median (IQR) age 76 (69–82) years, median (IQR) NT-proBNP 1156 (469–2463) ng/L) were enrolled. 206 (44%) patients were frail. Frail patients were more likely to not receive or receive suboptimal doses of ACEi/ARB and Beta-blockers; while non-frail patients were more likely to be treated with optimal doses. At 1-year follow up, there were 56 deaths and 322 hospitalisations, of which 46 (82%) and 215 (67%) occurred in frail patients. Frailty was associated with an increased risk of all-cause mortality (HR (95% CI): 4.27 (2.60–7.01)) and combined mortality/ hospitalisation (HR (95% CI): 2.85 (2.14–3.80)), all p<0.001. 57% (n=26) of frail patients died of cardiovascular causes (of which 58% were due to HF progression); although deaths due to non-cardiovascular causes (43%, n=20), especially severe infections, were also common (26%, n=12). (Figure 1) The proportion of frail patients who had non-elective hospital admissions within 1 year was more than double that of non-frail patients (46% (n=96) vs 21% (n=54); p<0.001). Compared to non-frail patients, frail patients had more recurrent (≥2) hospitalisations (28% (n=59) vs 9% (n=24); p<0.001) but median (IQR) average length of hospital stay was not significantly different (frail: 6 (4–11) vs non-frail: 6 (2–12) days, p=0.50). A large proportion of hospitalisations (64%, n=137) in frail patients were due to non-cardiovascular causes (of which 34%, 30% and 20% were due to infections, falls and comorbidities respectively). Of cardiovascular hospitalisations (36%, n=78), the majority were due to decompensated HF (67%, n=46). (Figure 1) Conclusion Frailty is common in patients with HF and is associated with an increased risk of mortality and recurrent hospitalisations. A significant proportion suffered non-cardiovascular deaths and hospitalisations. This implies that interventions targeted at HF alone can only have limited impact on outcomes in frail patients. Figure 1 Funding Acknowledgement Type of funding source: None

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Doppler-Guided Hemorrhoidal Artery Ligation: Experience with 2 Years Follow-up

The American Surgeon ◽

10.1177/000313481207800345 ◽

2012 ◽

Vol 78 (3) ◽

pp. 344-348 ◽

Cited By ~ 1

Author(s):

İbrahim Yilmaz ◽

İlker Sücüllü ◽

Dursun Özgür Karakaş ◽

Yavuz Özdemİr ◽

Ergün Yücel ◽

...

Keyword(s):

Postoperative Pain ◽

Average Length ◽

Length Of Hospital Stay ◽

Artery Ligation ◽

Superior Rectal Artery ◽

Quick Recovery ◽

Doppler Probe ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery

Doppler-guided hemorrhoidal artery ligation (DGHAL) is a nonexcisional surgical technique for the treatment of hemorrhoidal disease, consisting of the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of hemorrhoidal plexus resulting in fibrosis. The aim of the study was to assess the efficacy and safety of DGHAL, define its indications, and identify its possible advantages and limitations for the treatment of second- and third-degree hemorrhoids. The procedure was performed using a specially designed proctoscope. The Doppler probe was used to locate all the terminal branches of hemorrhoidal arteries, which were then sutured. Patients were followed up for 2 years. From November 2006 to May 2009, 50 patients (29 female, mean age 38.2 years) underwent this procedure. The procedure was performed under local anesthesia. An average of five ligatures was placed. Average length of hospital stay was 2 hours and return to work was 2.5 days. The mean postoperative pain score was 1.72. There were no intra- or immediate postoperative major complications. In 44 patients (88%), surgery resolved the symptoms completely in a 2-year follow-up period. DGHAL is a safe and effective procedure. DGHAL can be the choice for second- and third-degree hemorrhoids with minimal postoperative pain and quick recovery.

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Involuntary out-patient commitment: 2-year follow-up

The Psychiatrist ◽

10.1192/pb.bp.112.040485 ◽

2013 ◽

Vol 37 (2) ◽

pp. 60-64 ◽

Cited By ~ 8

Author(s):

Laura Castells-Aulet ◽

Miguel Hernández-Viadel ◽

Pedro Asensio-Pascual ◽

Carlos Cañete-Nicolás ◽

Carmen Bellido-Rodríguez ◽

...

Keyword(s):

Mental Disorder ◽

Emergency Room ◽

Average Length ◽

Length Of Hospital Stay ◽

Delusional Disorder ◽

Emergency Room Visits ◽

Court Order ◽

Severe Mental Disorder ◽

The Impact

Aims and methodTo evaluate the impact of involuntary out-patient commitment (OPC) in patients with severe mental disorder who use hospital services. This is a retrospective–observational study in a population of 91 patients under OPC. The psychiatric diagnosis, sociodemographic variables, who requested the court order and for what motive were studied. The study also looked at the use of the available health services (emergency room visits, admissions, average length of hospital stay) for the period beginning 2 years before and ending 2 years after the initiation of the OPC.ResultsThe number of emergency room visits, admissions and the length of hospitalisation diminished in the 2 years following the initiation of the OPC. In terms of diagnosis, the OPC has the most impact on individuals with schizophrenia and delusional disorder.Clinical implicationsThe OPC can be useful for certain patients with severe mental disorder, particularly individuals with schizophrenia and delusional disorder.

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478. Outcomes of Extended-Spectrum β-Lactamase-Producing Escherichia coli Bloodstream Infection in Neutropenic Patients with Hematological Malignancies

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.551 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S233-S234

Author(s):

Sadaf Aslam ◽

James Denham ◽

John Greene

Keyword(s):

Hospital Stay ◽

Hematological Malignancies ◽

Average Length ◽

Length Of Hospital Stay ◽

Bloodstream Infections ◽

Cancer Center ◽

Mortality Data ◽

E Coli ◽

Extended Spectrum ◽

Neutropenic Patients

Abstract Background Infections with extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae is an emerging problem leading to poor clinical outcomes and increased mortality. The purpose of this study was to determine the prevalence, risk factors and outcomes of ESBL-producing E. coli (EC) in bloodstream infections (BSIs) of neutropenic patients with hematological malignancies and compare the difference with Non-ESBL producing EC. Methods Through an IRB approved protocol, a retrospective cohort study was conducted at the H. Lee Moffitt Cancer Center from January, 2007 till October, 2017. Of the 310 records, who had +ive blood cultures for E. Coli, a total of 63 neutropenic patients with hematological malignancies were identified based on the bloodstream infections with ESBL-EC and Non ESBL EC. Data included demographics, underlying malignancy, type of bone marrow transplant, duration of neutropenia, antibiotics use pre and post culture, length of hospital stay, severity of infection, ventilator use, and mortality data. Results A total of 310 cases with hematological malignancy and neutropenia were reviewed, 63 were identified as +ive blood culture for E. coli. Out of the 63 cases, 17 were ESBL-EC +ive and 46 were non-ESBL-EC. The prevalence of ESBL-EC was highest in the year 2015 (29.4%) and decreased in the subsequent years (Figure 1). The mean ages of the two groups were 53.59 ±12.4 and 60.82 ± 11.1, respectively. The average length of stay for the ESBL-EC group was 26.59 ± 11.2 days, longer than the non-ESBL EC group 21.96 ± 11.2. Days of neutropenia in non-ESBL vs. ESBL EC were 9 days ± 8.3, and 19 days ± 22.0, respectively, P < 0.01). No differences were observed in the 30–60 day mortality and other outcomes listed in Table 1. Conclusion The prevalence of ESBL-EC was observed to be higher in patients who were neutropenic for longer duration, were older and resulted in longer hospital stay. Early identification and empirical therapy in neutropenic patients suspected to have ESBL-EC infection is crucial. Also, the infection with ESBL-EC was higher in the year 2015 and decreased in the subsequent years. After higher rates, perhaps infection control, lab reporting changes, antibiotic stewardship and transmission-based precautions might have played a role. Disclosures All authors: No reported disclosures.

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PET -CT Adapted Therapy After 3 Cycles of ABVD for All Stages of Hodgkin Lymphoma. Preliminary Results in 193 Patients

Blood ◽

10.1182/blood.v118.21.1619.1619 ◽

2011 ◽

Vol 118 (21) ◽

pp. 1619-1619 ◽

Cited By ~ 1

Author(s):

Astrid Pavlovsky ◽

Isolda Fernandez ◽

Virginia Prates ◽

Miguel A Pavlovsky ◽

Lucia Zoppegno ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Progressive Disease ◽

Conflicts Of Interest ◽

Statistical Significance ◽

Cell Transplant ◽

Bulky Disease ◽

Radio Therapy ◽

Anatomic Reduction ◽

Pet Ct

Abstract Abstract 1619 Background: Positron emission tomography using 18F-fluoro-2-deoxy-d-glucose (FDG-PET-CT) is an important tool for treatment response assessment in Hodgkin Lymphoma (HL) treated with ABVD. It can predict response and overall outcome. The negative predictive value for PET-CT in patients (pts.) with HL is 90–94%. New recommendations define complete remission (CR) for HL as the lack of signs and symptoms of lymphoma with a negative PET-CT. OBJECTIVES: Reduce therapy in pts. who achieve early CR with negative PET-CT. Intensify treatment, only in pts. with positive PET-CT after 3 cycles of ABVD. Achieve CR, event free survival (EFS) and overall survival (OS), as good as in our historical control, when we used 3 or 6 cycles of ABVD plus involved field radio therapy (IFRT) in all pts.(LH-96) PATIENTS AND METHOD: Since October 2005, 200 newly diagnosed pts. with HL have been included in a prospective multicenter clinical trial (LH-05) All pts. received 3 cycles of ABVD and were then evaluated with a PET-CT (PET-CT +3) Pts. with a negative PET-CT+3 and absence of other signs or symptoms of lymphoma were considered in CR and received no further therapy. Pts with more than 50% of anatomic reduction of initial masses but persistent hyper metabolic lesions were considered in partial response (PR) and completed 6 cycles of ABVD and IFRT on PET-CT positive areas. Pts with less than PR received high doses of chemotherapy and an autologous stem cell transplant (ASCT). All pts were re-evaluated at the end of treatment with a new PET CT. One hundred and ninety three pts. have been evaluated. The median age at diagnosis was 29 years. One hundred and twenty five (65%) had localized stage (I-II) non bulky and 68 (35%) presented with advanced stage (III-IV), or bulky disease, 33 (17%) had bulky disease. RESULTS: One hundred and forty-eight (77%) achieved CR with negative PET-CT + 3. Forty-five (21%) were PET-CT+3 positive, 5 showed progressive disease. The other 40 pts. were in PR and completed a total of 6 ABVD + IFRT in PET-CT positive areas. Twenty eight achieved CR and 12 persisted with hypermetabolic lesions. Three died of progressive disease. After finishing planned treatment 178 pts. (92%) were in CR. With a median follow up of 39 months the EFS and OS at 36 months is 80% and 97% respectively. Patients with negative PET-CT +3 have an EFS of 86% compared to 61% for pts. with positive PET-CT+3 (P=0,001). We perform a multivariate analysis for EFS which included age, stage, IPS, bulky disease, extranodal areas and the result of the PET –CT+ 3. This last parameter together with age were the only ones with statistical significance (p=0.001 and 0.046 respectively). When comparing the results LH-05 with LH-96 there is no difference in EFS and OS at 36 months (83% vs. 85% and 97 vs. 96%) but in LH-05 only 23% received 6 cycles of ABVD and IFRT compared to 61% and 100% in LH-96. This reduces the exposure to chemo and radiotherapy. CONCLUSION: With PET-CT adapted therapy after 3 cycles of ABVD, 148 pts.(77%) received only 3 cycles of ABVD as initial therapy with an EFS and OS of 80% and 97% at 36 months. In the Cox regression model, PET-CT at completion of treatment was the most significant factor associated to EFS. In this interim analysis of PET-CT adapted therapy to all stages of HL, treatment with 3 cycles of ABVD can be adequate for pts. with negative PET-CT+3. Continuing with ABVD after a positive PET-CT +3 can be considered insufficient. A longer follow-up and a larger number of pts. are necessary to confirm these results. Disclosures: No relevant conflicts of interest to declare.

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Comparison of Lengths of Stay for Inpatients with Immune Thrombocytopenia Treated with Anti-Rh(D), Intravenous Immunoglobulin, and Steroids

Blood ◽

10.1182/blood.v120.21.4646.4646 ◽

2012 ◽

Vol 120 (21) ◽

pp. 4646-4646

Author(s):

Hrvoje Melinscak ◽

Ilan Shapira ◽

Mala Varma

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Intravenous Immunoglobulin ◽

Immune Thrombocytopenia ◽

Conflicts Of Interest ◽

Average Length ◽

Length Of Hospital Stay ◽

P Value ◽

Onset Of Action ◽

Lengths Of Stay

Abstract Abstract 4646 Rationale: Anti-Rh(D) is an effective treatment for acute immune thrombocytopenia [ITP]. It has a faster onset of action (1 day) vis a vis corticoids (3 days) and intravenous immunoglobulin [IVIG] (4 days). A direct comparison of length of stay for adult inpatients receiving these therapies has hitherto not been performed. We hypothesized that the length of stay would be shortest for patients treated with anti-Rh(D). Methods: A retrospective chart review was conducted to assess length of stay in relation to treatments proffered for ITP. The defining diagnosis of ITP [coded 287.31] was rendered from the computerised record at St. Luke's-Roosevelt Hospital Center and identified 303 patients, of which 147 received treatments for active ITP within a period spanning 01SEP2005 through 29FEB2012. Treatments consisted of prednisone alone, dexamethasone alone, anti-Rh(D) alone, IVIG alone, and combinations of corticoids and the latter two. An average length of stay was tabulated for each treatment regimen. Age and gender were also recorded. Results: A total of 147 hospitalisations for ITP were noted and the analysis of variance statistical calculation applied thus. The median age was 48 years and the male:female ratio was 1.1:1. Eleven groups were delineated and the means for length of hospital stay with confidence intervals derived. The groups were as follows: Prednisone, Dexamethasone, Methylprednisolone, Anti-Rh(D), IVIG, Prednisone and Anti-Rh(D), Dexamethasone and Anti-Rh(D), Prednisone and IVIG, Dexamethasone and IVIG, Methylprednisolone and IVIG, and Anti-Rh(D) and IVIG or Dexamethasone, Anti-Rh(D), and IVIG. The overall p-value for length of stay was 0.0016 (Table 1). The shortest stays were recorded for the corticoid alone groups; however, the mean stay for anti-Rh(D) was shorter than that of IVIG, both in sole and combined modality treatments. Conclusion: Anti-Rh(D) is favourable with respect to hospital stay duration. Although corticoids result in still shorter lengths of stay, anti-Rh(D) demonstrated a shorter length of stay compared with IVIG. Combined with its single dosing and relative cost savings, anti-Rh(D) is an excellent alternative to IVIG. Disclosures: No relevant conflicts of interest to declare.

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Carfilzomib-Pomalidomide-Dexamethasone (KPD) in Relapsed/Refractory Multiple Myeloma Patients - an Institutional Retrospective Analysis

Blood ◽

10.1182/blood-2019-131674 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5572-5572

Author(s):

Pallavi Mehta ◽

Neha Yadav ◽

Mohan Bhaarat ◽

Sumeet Prakash Mirgh ◽

Vishvdeep Khushoo ◽

...

Keyword(s):

Multiple Myeloma ◽

Maintenance Therapy ◽

Progressive Disease ◽

Conflicts Of Interest ◽

Haematological Toxicity ◽

Response Assessment ◽

Median Number ◽

Entire Cohort ◽

Response Status

Introduction Multiple myeloma has relished the emergence of various novel agents in last few decades. Unfortunately,relapses are still an inevitable part and at each relapse, treatment choice becomes a complex decision making process as these patients usually have exhausted conventional therapeutic regimens.Carfilzomib is a second-in class Proteosome Inhibitor (PI) and has been approved for patientsrefractory to minimum 2 lines of prior therapies. We are, hereby, presenting our initial experience with this novel combination (KPD)in RRMM patients at our centre. Methodology Retrospective study of RRMM patients who received KPD therapy from August 2017 till October 2018. Responses were assessed as per International Myeloma Working Group. Study was approved by Institutional Review Board. Results Total 39 patients were treated with KPD regimen during study period. Median age was 56 (32-74 years) with male ratio of 51.2% (n=20). At baseline presentation, bone disease {n=32 (82%)} was the most common presenting complaint followed by anemia {n=21 (53.8%)} and renal failure {n=16 (41%)}. Most common ISS staging was ISS-3 {n=18(46.1%)} and subtype was Light chain myeloma {n=15 (38.3%)} followed by IgG {n=13 (33.3%)}.Fluorescence In Situ Hybridization (FISH) was available in {n= 10 (25%)} and it was positive for del13q (n=1/10) and del17p (n=1/10) and t(11;14) (n=1/10). (Table-1) Median number of prior lines of chemotherapy was 3(1-15). Thirty-six (91%) patients were relapsed/refractory to both bortezomib and lenalidomide whereas n=3(9%) were relapsed/refractory to bortezomib only. Eleven (30.5%) patients underwent SCT pre KPD therapy including 2/11 patients received double SCT. Pre KPD 25 (64.1%) patients had progressive disease (PD), 10 (25%) had relapse and 4 (11.1%) patients had stable disease (SD). Median number of KPD cycles were 3(1-8). Median number of KPD cycles after which response assessment was donewas 3 (2-8). Median time to treatment response was 3 (2-7) months. ORR was 51.2% {CR-n=5 (12.8%); VGPR-n=5 (12.8%), PR-n=10 (25.6%)} whereas 2 (5.1%) patient had SD and 10 (25.6%) patients had PD at 2-8 cycles. Two (5.1%) patients are yet to be assessed. (Table-1) Common hematological toxicities seen were anemia (n=8), thrombocytopenia (n=13){grade-3/4=30.7%; n=4/13} and neutropenia(n=14){grade3/4=21.4%; n=3/14}.Non haematological toxicity such as cardiac toxicity was not observed in our patients. Pre KPD 2D-ECHO was available for 13 patients and which was normal in all patients. Post 2-4 cycles of KPD, 2D-ECHO was available for 7 patients and all patients had normal ECHO. Carfilzomib induced hypertension was seen in 20 patientsand could be well controlled with antihypertensives. Peripheral neuropathy (grade1/2) was seen in 10 patients. We also observedCarfilzomib induced hyponatremia in one patient.Febrile neutropenia(bacterial =6, viral=4, possible fungal=5) was seen in 14 patients.(Table-2) Twelve (20.5%) patients proceeded to either maintenance therapy or autologous stem cell transplantation (ASCT). Eight patients opted only for maintenance (carfilzomib=5, pomalidomide-dexamethasone=2 and pomalidomide =1). Remaining n=4/12(16%) patients received SCT. Pre SCT response status was VGPR n=2; PR n=1 and SD=1. Post SCT response status was VGPR (n=3) &PR (n=1). Post SCT, 3 patients were started on maintenance therapy as Bortezomib/pomalidomide=1, Pomalidomide/dexamethasone=2. One patient has been continued on KPD as a consolidation therapy. At a median follow-up of 10 months (1-14 months), relapse rate was 12.8% (n=5). Ten (25.6%) patients had PD.Mortality rate was 8.3% (n=3), commonest cause being progressive disease. The estimated mean PFS, OS and EFS of entire cohort was 11.9 months (95% C.I. 10.8- 13 months) (figure-1 a), 13 months (95% C.I. 11.9-14 months) (figure-1 b) and 7.9 months (95% C.I. 6.5-9.3 months) (figure - 1 c) respectively. Conclusion KPD is a well-tolerated regimen for patients with RRMM who have exhausted frontline myeloma regimen, however at the cost of significant side effects like infections and hypertension. It seems to be a convincing regimen as a bridge to ASCT but warrants further studies with longer follow-up to validate our results. Disclosures No relevant conflicts of interest to declare.

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Epidemiology and impact of hospital-acquired sepsis in Rajavithi Hospital, Bangkok, Thailand

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.701 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

K Kamnon ◽

S Supmontri

Keyword(s):

Average Length ◽

Delayed Diagnosis ◽

Length Of Hospital Stay ◽

Bloodstream Infections ◽

Health Indicators ◽

Global Public Health ◽

Medical Department ◽

Tract Infections ◽

The Cost ◽

Hospital Acquired

Abstract Background Sepsis is considered a major health burden, with high mortality and associated costs. Health indicators are essential to define strategies to improve the treatment of diseases and the epidemiology information of sepsis. Methods This study was a retrospective descriptive study. The purposes to determine distribution and impacts of hospital-acquired sepsis among patients, who were admitted in Rajavithi hospital. The Data was obtained from medical records of 6,673 sepsis from 2015 to 2019 (1st January 2015 - 31st December 2019), using hospital-acquired sepsis and impacts of hospital-acquired sepsis form developed by researcher. Data analysis was performed by using descriptive statistics. Results The major results of this study revealed that 51.1% of sepsis patients were women. The age range of sepsis patient was between 14-100 years old (mean 45.3±6.7 years). There were altogether 6,663 sepsis occurring among these patients. Forty-four point six percent of sepsis was urinary tract infections followed by pneumonia and bloodstream infections (31.2% and 13.7%). The causation of sepsis were related to gram negative bacteria (56.5%), gram positive bacteria (27.2%) and fungus (16.3%). Based on patient department, 57.3% of sepsis occurred in medical department. The length of hospital stay for patients with hospital-acquired sepsis ranged from 6 to 104 days. The average length of stay was 37.6 days. Overall mortality rate of hospital-acquired sepsis was 54.2%. The cost of treatment for hospital-associated sepsis was 9,376.94 USD per case. Sixty-five percent point eight percent of the cost was for antibiotic treatment, 19.6% for equipment, 9.4% for laboratory tests and 5.2% for other procedures. Conclusions Hospital-acquired sepsis among patients can have serious impacts on the patients and increase the economic burden of hospital. Hospital have to determine effective and sustainable hospital-acquired sepsis preventions. Key messages Sepsis is a serious condition that affects the patient. Sepsis are global public health problems. The factors related to mortality are delayed diagnosis, non-intensive care setting admission, delayed antibiotic and multi-organ failure.

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A 5-Year Experience of a Minimally Invasive Technique for Correction of Pectus Excavatum in Croatia

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2017.120 ◽

2006 ◽

Vol 49 (2) ◽

pp. 105-107 ◽

Cited By ~ 1

Author(s):

Mirko Žganjer ◽

Božidar Župančić ◽

Ljiljana Popović

Keyword(s):

Minimally Invasive ◽

Pectus Excavatum ◽

Average Length ◽

Length Of Hospital Stay ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Minimally Invasive Operation ◽

Steel Bar ◽

Normal Chest

The aim of this study was to assess the results of 5-year experience with minimally invasive operation without medial incision and resection cartilages for correction of pectum excavatum. From 2000 we made in our Hospital minimally invasive technique for the correction of pectus excavatum. 75 patients were treated by minimally invasive technique. A convex steel bar is inserted under the sternumtrough small bilateral Incisions. The steel bar is inserted with the convexity facing posteriorly, and when it is in position, the bar is turned over. After 2 years the bar is removed when permanent remolding has occurred. Initial excelent results were maintained in 54 patients (normal chest), good results in 16 (mild residual pectus) and poor in 5 (severe recurrence requiring further treatment). The mean follow-up since surgery were 3 months to 3 years. Average blood loss was 25 ml. Average length of hospital stay was 8 days. Patients returned to full activity after 2 month. Complications were pneumothorax in 12 patients, pneumonia in 6 patients and displacement of the steel barr requiring revision in 2 patients. Poor results occurred because steel bar was too soft in 3 patients, and soft sternum in 2 patients with Marfan’s syndrome. The minimally invesive technique is effective without cartilage incision and resection or sternal osteotomy.

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