Supracondylar Fractures: A Retrospective Chart Review Comparing Infection Rate, Antibiotic Use, Surgical Time and Cost of Full Surgical Preparation and Draping vs “Semi-Sterile” Technique

Abstract Background: Semi-sterile and full preparation and draping techniques are commonly used in closed reduction percutaneous pinning (CRPP) of supracondylar fractures. Debate exists whether full preparation and draping is safer than semi-sterile technique in regards to infection risk and the utility of pre-operative antibiotics. This study is a comparison of infection rates, pre-operative antibiotic administration, cost and surgical time between techniques.Methods: A retrospective chart review of 336 pediatric patients with supracondylar fractures repaired with CRPP at our institution was completed between January 2014 and April 2018, 168 per technique. Infection rates, pre-operative antibiotic administration, preparation-to-incision time and cost in semi-sterile draping versus full preparation and draping techniques were compared. Results: Of the 336 patients, 1/168(0.1%) in the full preparation and draping group developed an infection compared to 0/168(0%) patients in the semi-sterile group. Pre-operative antibiotics (Cefazolin) were administered to 76/168(23%) patients in the full preparation and draping group and 0/168(0%) in the semi-sterile group. The infection found received pre-operative antibiotics. Mean preparation-to-incision time for the semi-sterile group was 2.4±2.0 minutes and the full preparation and draping group was 9.9 ±4.2 minutes(p <0.001). Surgical supply cost was $80.72 [CDN] and 108.24$ [CDN], respectively, for the semi-sterile and full preparation and draping groups. Conclusion: Risk of infection using a semi-sterile draping technique was safe and comparable to a full preparation and draping technique when used in CRPP of supracondylar fractures. The administration of pre-operative antibiotics does not appear to make a difference in infection rates. Semi-sterile operative technique is cost effective and has decreased preparation-to-incision time.

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Antibiotic use among twelve Canadian First Nations communities: a retrospective chart review of skin and soft tissue infections

BMC Infectious Diseases ◽

10.1186/s12879-020-4842-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Dahn Jeong ◽

Ha Nhan Thi Nguyen ◽

Mark Tyndall ◽

Yoko S. Schreiber

Keyword(s):

Soft Tissue ◽

First Nations ◽

Chart Review ◽

Retrospective Chart Review ◽

Antibiotic Use ◽

Soft Tissue Infections

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Infection and Antimicrobial Use in Laparoscopic Cholecystectomy

Infection Control and Hospital Epidemiology ◽

10.1086/501685 ◽

1999 ◽

Vol 20 (9) ◽

pp. 624-626 ◽

Cited By ~ 30

Author(s):

Maryanne McGuckin ◽

Judy A. Shea ◽

J. Sanford Schwartz

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Site Infection ◽

Infection Rate ◽

Chart Review ◽

Antimicrobial Prophylaxis ◽

Retrospective Chart Review ◽

Low Risk ◽

Antimicrobial Use ◽

Site Infection ◽

Surgical Site Infection Rate

AbstractRetrospective chart review of 1,702 patients undergoing laparoscopic cholecystectomy (LC) revealed an overall infection rate of 2.3% and a surgical-site infection rate of 0.4%. Preoperative antimicrobial prophylaxis was received by 79% of patients, but only 33% of these received the agent within 1 hour or less prior to surgery. These facts suggest that antimicrobial prophylaxis may not be necessary for low-risk LC patients.

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Antibiotic use among twelve Canadian First Nations communities: A retrospective chart review of skin and soft tissue infections

10.21203/rs.2.13137/v3 ◽

2020 ◽

Author(s):

Dahn Jeong ◽

Ha Nhan Thi Nguyen ◽

Mark Tyndall ◽

Yoko S Schreiber

Keyword(s):

Soft Tissue ◽

First Nations ◽

Chart Review ◽

Clinical Symptoms ◽

Community Setting ◽

Retrospective Chart Review ◽

Indigenous Communities ◽

Antibiotic Use ◽

Soft Tissue Infections ◽

Treatment And Prevention

Abstract Background Previous publications indicated an emerging issue with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), particularly skin and soft tissue infections (SSTIs), in Indigenous communities in Canada. The objectives of this analysis were to explore the prevalence of SSTIs due to CA-MRSA and patterns of antimicrobial use in the community setting. Methods A retrospective chart review was conducted as part of an environmental scan to assess antibiotic prescriptions in 12 First Nations communities across five provinces in Canada including Alberta, Saskatchewan, Manitoba, Ontario, and Québec. Charts were randomly selected from nursing stations and patients who had accessed care in the previous 12 months and were ≥18 years were included in the review. Data was collected from September to December, 2013 on antibiotic prescriptions, including SSTIs, clinical symptoms, diagnostic information including presence of CA-MRSA infection, and treatment. Results A total of 372 charts were reviewed, 60 from Alberta, 70 from Saskatchewan, 120 from Manitoba, 100 from Ontario, and 22 from Québec. Among 372 patients, 224 (60.2%) patients had at least one antibiotic prescription in the previous 12 months and 569 prescriptions were written in total. The prevalence of SSTIs was estimated at 36.8% (137 cases of SSTIs in 372 charts reviewed). In 137 cases of SSTIs, 34 (24.8%) were purulent infections, and 55 (40.2%) were due to CA-MRSA. Conclusions This study has identified a high prevalence of antibiotic use and SSTIs due to CA-MRSA in remote and isolated Indigenous communities across Canada. This population is currently hard to reach and under-represented in standard surveillance system and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment and prevention.

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The Low Fresh Gas Flow Anesthesia and Hypothermia in Neonates Undergoing Digestive Surgeries: A Retrospective Before-After Study

10.21203/rs.3.rs-28229/v1 ◽

2020 ◽

Author(s):

Yu Cui ◽

Yu Wang ◽

Rong Cao ◽

Gen Li ◽

Lingmei Deng ◽

...

Keyword(s):

Gas Flow ◽

Chart Review ◽

Retrospective Chart Review ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Surgical Time ◽

Eligibility Criteria ◽

Mean Body Temperature ◽

Digestive Surgery ◽

Intraoperative Hypothermia

Abstract Background Based on the previous investigation in our institution, the incidence of intraoperative hypothermia in neonates was high. Since September 1st, 2019, the recommendation had been launched to utilize ≤ 1 L/min fresh gas flow during the neonates’ surgical procedure. We therefore intended to evaluate the association between low fresh gas flow anesthesia and the occurrence of hypothermia in neonates undergoing digestive surgeries.Methods A retrospective chart review, before-after study was conducted for neonates who underwent digestive surgeries. The primary outcomes were the incidence of hypothermia. The secondary outcomes included hospital mortality, the value of lowest temperature, blood loss, mean body temperature during the surgery, the length of hypothermia during the surgery and postoperative hospital length-of- stay (PLOS).Results 249 neonates fulfilled the eligibility criteria. The overall incidence of intraoperative hypothermia was 81.9%. The low fresh gas flow anesthesia significantly reduced the odds of hypothermia [routine group: 149 (87.6%) versus low group: 55 (69.6); p ༜ 0.01]. Moreover, the low fresh gas flow anesthesia could reduce the length of hypothermia [routine group: 104 (50, 156) versus low group: 30 (0,100); p ༜ 0.01], as well as elevate the value of lowest temperature for neonates [routine group: 35.1 (34.5, 35.7) versus low group: 35.7(35.3, 36); p ༜ 0.01]. After adjustment for confounding, low fresh gas flow anesthesia and the length of surgical time were independently associated with intraoperative hypothermia.Conclusions Low fresh gas flow anesthesia is an effective way to alleviate hypothermia in neonates undergoing open digestive surgery.

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Adverse Events Releated to Antibiotic Use in Patients with Myasthenia Gravis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.815 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S342-S342 ◽

Cited By ~ 2

Author(s):

Kristen Zeitler ◽

Ripal Jariwala ◽

Jose Montero

Keyword(s):

Adverse Events ◽

Myasthenia Gravis ◽

Chart Review ◽

Adverse Reactions ◽

Antimicrobial Agents ◽

Medical Condition ◽

Retrospective Chart Review ◽

Antibiotic Use ◽

Disease Symptoms ◽

Antimicrobial Prescribing

Abstract Background Myasthenia gravis is a medical condition involving the neuromuscular junction, characterized by weakness and fatigue of voluntary muscles. While the understanding of myasthenia gravis has progressed over the years, questions remain regarding which antimicrobial agents can be administered safely to these patients. Traditionally, aminoglycosides and fluoroquinolones have been avoided in this patient population, while other antimicrobials may be prescribed with caution. With minimal literature to guide practice, our aim was to review antimicrobial prescribing in patients with myasthenia gravis at our institution. Methods We conducted a retrospective chart review of adult patients 18 years of age and older with a diagnosis of myasthenia gravis who were admitted from January 2012 through December 2015. Charts were reviewed for the receipt of any antimicrobial during the course of hospitalization and any adverse events related to receipt of antimicrobial agents. Results 205 patients with a diagnosis of myasthenia gravis were admitted to our institution during the study period. 132 (64.4 %) patients were female and ages ranged from 20 to 98 with a median age of 59 years. 159 (77.6 %) patients received at least 1 dose of an antimicrobial agent during their hospitalization. It was notable that 12.2 % and 11.7 % of patients received at least 1 dose of ciprofloxacin or levofloxacin, respectively. Additionally, 3.9 % of patients received at least 1 dose of an aminoglycoside (gentamicin or tobramycin). Five patients experienced a worsening of their myasthenia gravis symptoms with antibiotic use; 2 cases involved levofloxacin and 1 case each involved ciprofloxacin, cefazolin, or clindamycin. Of note, the average duration of therapy prior to symptoms being noted was 2.6 days. Conclusion This study highlights the wide variation in antimicrobial prescribing for patients with myasthenia gravis. Our chart review identified few adverse reactions exacerbating disease symptoms related to antimicrobial use. As it is still unclear the exact mechanism for the development of reactions in select patients with myasthenia gravis, further research may be needed to elucidate this information. Disclosures All authors: No reported disclosures.

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2100. A Retrospective Chart Review of Emergent Antibiotic Use

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1780 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S710-S710

Author(s):

Michelle Blyth ◽

James McNary ◽

Arnold Decano ◽

Audrey Renson ◽

Jeanne Carey

Keyword(s):

Emergency Department ◽

Antibiotic Stewardship ◽

Chart Review ◽

Vital Signs ◽

Retrospective Chart Review ◽

Antibiotic Use ◽

Academic Community ◽

Suspected Sepsis ◽

Empiric Antibiotics ◽

Data Points

Abstract Background The need for responsible antibiotic stewardship can be difficult to reconcile with the clinician’s task of quickly recognizing and treating sepsis. Empiric antibiotics are often given in patients with any suspicion of infection, yet antibiotics carry non-trivial risks including antibiotic resistance and susceptibility to other infections, such as Clostridium difficile. Methods This retrospective chart review includes 200 patients who were admitted to the hospital and administered antibiotics while in the Emergency Department (ED). From clinical documentation several clinical data points were gathered such as: changes to (including discontinuation of) antibiotics by the admitting team, final culture data, discharge diagnosis, vital signs and routine laboratory values. Results Our study finds that the majority of patients administered antibiotics in the ED of our academic community hospital were not diagnosed with sepsis (67%) and did not meet SIRS (62.5%) nor qSOFA (88%) criteria prior to administration of antibiotics. Vancomycin (39.7%) and piperacillin–tazobactam (22.2%) were the most frequent empiric antibiotics started. Antibiotics were stopped completely on admission by the admitting team in 22.2% of included patients. A wide variety of sources of infection were suspected, pneumonia (33%), cellulitis (15%), and cystitis (18%) being the most common. The overall mortality rate for this group during the admission was 4.5%, which was comparable to all-cause hospital mortality during the same time period. Infection was ruled out by discharge in 91 of the included 200 patients (45.5%). At least 37.5% of all included patients had received antibiotics within the last 3 months. Intriguingly, recent exposure was nearly twice as common (47.8%) among infected patients than in those without infections (24.7%), with a relative risk of 1.48 (CI 1.0993–2.0014). Conclusion These findings suggest that an opportunity exists for increased antibiotic stewardship in the emergency department in the management of suspected sepsis and/or infection. Stable patients in whom infection cannot be definitively ruled out may benefit more from prompt, thorough evaluation by an admitting team prior to the initiation of empiric antibiotics. Disclosures All authors: No reported disclosures.

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Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

Clinical Pediatrics ◽

10.1177/0009922818806312 ◽

2018 ◽

Vol 58 (1) ◽

pp. 60-65 ◽

Cited By ~ 4

Author(s):

David L. Brinker ◽

Erina L. MacGeorge ◽

Nicole Hackman

Keyword(s):

Physical Examination ◽

Otitis Media ◽

Chart Review ◽

Watchful Waiting ◽

Acute Otitis Media ◽

Retrospective Chart Review ◽

Antibiotic Use ◽

Central Pennsylvania ◽

Current Guidelines ◽

Prescription Behavior

Current guidelines recommend “watchful waiting” (WW) as an alternative to immediate antibiotic treatment. Continued high rates of antibiotic use suggest that WW may be underutilized. We conducted a retrospective chart review of 474 pediatric acute otitis media (AOM) cases at a clinic in central Pennsylvania. We assessed physical examination findings, diagnostic behavior, WW utilization, prescription writing, and filling in cases of pediatric AOM to evaluate the underutilization of WW. We evaluate diagnostic consistency with published guidelines and rates of antibiotic prescription resulting from misdiagnosis. We report WW instructions and compliance, and prescription filling behaviors. Fifty percent of AOM diagnoses in this sample were not supported by physical examination findings. The majority of these AOM diagnoses received antibiotic prescriptions, suggesting that unsupported diagnoses translated to injudicious prescribing. WW instructions corresponded to 57% fewer filled prescriptions and longer fill delay. We discuss the implications and recommendations to improve antibiotic stewardship.

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67. Transitioning from Permissive to Restrictive Urine Reflex Criteria: Compiling the Data

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.269 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S152-S152

Author(s):

Chad D Nix ◽

Angela H Villamagna

Keyword(s):

Chart Review ◽

White Blood Cells ◽

Retrospective Chart Review ◽

Clinical Decision ◽

Antibiotic Use ◽

Altered Mental Status ◽

Systematic Sampling ◽

Inclusion Criteria ◽

Adult Inpatient ◽

Urine Specimens

Abstract Background Reflex urine cultures (UCx) are a diagnostic stewardship practice that limit the progression of UCx to specimens that meet pre-defined urinalysis criteria, but there is no widely recommended threshold for culture. At our institution, urinalyses (UAs) are reflexed to UCx for positive nitrites, leukocyte esterase, presence of bacteria, or ≥5 white blood cells per high powered field (WBC/hpf). Our aim is to assess if a more restrictive criteria of >10 WBC/hpf would result in missed UTI diagnoses. Methods We performed a retrospective chart review of a systematic sampling of urine specimens collected from July 2018 to June 2019 in the emergency department and adult inpatient units. Inclusion criteria were UA with a WBC/hpf of 5-10 – samples that would not reflex to culture under our proposed criteria – and a UCx. We recorded signs, symptoms and antibiotic use via chart review. Positive UCxs were defined as ≥10e5 CFU/mL of bacterial growth (BG) and these cases were assessed using standardized CDC UTI definitions. Results 486 urine specimens with < 10e5 CFU/mL BG and 96 with ≥10e5 CFU/mL BG met inclusion criteria. Chart review was performed on 99 cases. 81 (82%) specimens had negative UCxs and 18 (18%) were positive. 45% had documented localizing UTI symptoms. 26% of all urine studies were sent for an indication of fever, 15% for altered mental status (AMS), and 8% for malaise. Among the 18 patients with positive UCxs, 11 (61%) met UTI criteria. Among the 81 patients with negative UCxs, 33/81 (41%) had a local symptom compatible with UTI. 7/81 (9%) patients had positive tests from other body sites; all 7 of these UCxs were sent for a new or worsening fever. Conclusion Of the 99 UCxs reviewed, less than half had a urinary symptom consistent with UTI, and almost half of studies were sent for non-specific indications such as fever, which suggests reflex UCxs are overutilized at our institution. However, our data demonstrate that a more restrictive UCx criteria may not be the solution, as at least 11 clinically significant UTIs would have been missed under the new criteria. We recommend improved clinical decision support tools and more data to validate restrictive reflex UCx criteria before their implementation. Disclosures All Authors: No reported disclosures

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Antibiotic use among twelve Canadian First Nations communities: A retrospective chart review of skin and soft tissue infections

10.21203/rs.2.13137/v2 ◽

2020 ◽

Author(s):

Dahn Jeong(Former Corresponding Author) ◽

Ha Nhan Thi Nguyen ◽

Mark Tyndall ◽

Yoko S Schreiber(New Corresponding Author)

Keyword(s):

Soft Tissue ◽

First Nations ◽

Chart Review ◽

Clinical Symptoms ◽

Retrospective Chart Review ◽

Indigenous Communities ◽

Antibiotic Use ◽

Soft Tissue Infections ◽

Treatment And Prevention ◽

High Prevalence

Abstract Background Previous publications indicated an emerging issue with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), particularly skin and soft tissue infections (SSTIs), in Indigenous communities in Canada. The objectives of this analysis were to explore the prevalence of SSTIs due to CA-MRSA and patterns of antimicrobial use in the community setting.Methods A retrospective chart review was conducted as part of an environmental scan to assess antibiotic prescriptions in 12 First Nations communities across five provinces in Canada including Alberta, Saskatchewan, Manitoba, Ontario, and Québec. Charts were randomly selected from nursing stations and patients who had accessed care in the previous 12 months and were ≥18 years were included in the review. Data was collected from September to December, 2013 on antibiotic prescriptions, including SSTIs, clinical symptoms, diagnostic information including presence of CA-MRSA infection, and treatment.Results A total of 372 charts were reviewed, 60 from Alberta, 70 from Saskatchewan, 120 from Manitoba, 100 from Ontario, and 22 from Québec. Among 372 patients, 224 (60.2%) patients had at least one antibiotic prescription in the previous 12 months and 569 prescriptions were written in total. The prevalence of SSTIs was estimated at 36.8% (137 cases of SSTIs in 372 charts reviewed). In 137 cases of SSTIs, 34 (24.8%) were purulent infections, and 55 (40.2%) were due to CA-MRSA.Conclusions This study has identified a high prevalence of antibiotic use and SSTIs due to CA-MRSA in remote and isolated Indigenous communities across Canada. This population is currently hard to reach and under-represented in standard surveillance system and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment and prevention.

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