scholarly journals The Case for Intermittent Carbapenem Dosing in Stable Haemodialysis Patients

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 815
Author(s):  
Vanda Ho ◽  
Felecia Tay ◽  
Jia En Wu ◽  
Lionel Lum ◽  
Paul Tambyah
Keyword(s):  
Randomised Controlled Trials ◽  
Clinical Utility ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Source Control ◽  
Readmission Rates ◽  
Duration Of Therapy ◽  
Iatrogenic Complications ◽  
Dosing Regimens ◽  
Randomised Controlled

Purpose: Antimicrobial resistant infections are common in patients on haemodialysis, often needing long courses of carbapenems. This results in a longer hospital stay and risk of iatrogenic complications. However, carbapenems can be given intermittently to allow for earlier discharge. We aim to describe the clinical outcomes of intermittent versus daily meropenem in stable, intermittently haemodialysed patients. Methods: In total, 103 records were examined retrospectively. Data collected include demographics, clinical interventions and outcomes such as hospital length of stay (LOS), 30-day readmission rates and adverse events. Findings: Mean age 61.6 ± 14.2 years, 57.3% male. Most common bacteria cultured were Klebsiella pneumoniae (16.5%). The most common indication was pneumonia (27.2%). Mean duration of therapy on meropenem was 12.4 ± 14.4 days; eight patients needed more than 30 days of meropenem. In total, 55.3% did not have intervention for source control; 86.4% received daily dosing of meropenem; 7.8% patients received intermittent dosing of meropenem only, and 5.8 patients received both types of dosing regimens. LOS of the index admission was shorter for the intermittent arm (15.5 ± 7.6 days versus daily: 30.2 ± 24.5 days), though 30-day readmission was higher (50% versus daily: 38.2%). Implications: We recommend further rigorous randomised controlled trials to investigate the clinical utility of intermittent meropenem dosing in patients on stable haemodialysis.

scholarly journals Intermittent versus daily dosing of meropenem in haemodialysis patients – A retrospective observational exploratory study

2020 ◽  
Author(s):  
Vanda Ho ◽  
Felecia Tay ◽  
Jia En Wu ◽  
Lionel Lum ◽  
Paul Tambyah
Keyword(s):  
Length Of Stay ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Source Control ◽  
Readmission Rates ◽  
Dosing Regimens ◽  
Randomised Controlled

Abstract BackgroundExtended microbial resistance is very common in patients on haemodialysis, often needing long courses of carbapenems. This results in increased length of stay in hospital and its complications. However, carbapenems can be given intermittently and avoid this problem.We aim to describe the clinical outcomes of intermittent versus daily meropenem in thrice weekly haemodialysed patients.Methods: 125 records were examined retrospectively. Data collected includes patient demographics, clinical interventions such as source control, meropenem dose and regime, and clinical outcomes such as length of hospital stay (LOS), 30-day readmission rates and adverse events.Results: Mean age was 62.6±1.3 years, 56% were male. 65.6% were on haemodialysis secondary to diabetic nephropathy, and 84% were on thrice-weekly regime. Most common bacteria cultured was Klebsiella pneumoniae (14.4%), the most common indication for meropenem was pneumonia (32%) and mainly used for cure (65%). Mean duration of therapy on meropenem was 11.5±1.2 days, 8 patients needed more than 30 days of meropenem. 59.2% did not have intervention for source control.87.2% received daily dosing of meropenem. 6.4% patients received intermittent dosing of meropenem only, 4.8% patients received both types of dosing regimens. Dosing was variable across both arms.LOS of the index admission was shorter for the intermittent arm, 15.5±2.7 days compared to daily arm, 34.7±2.7 days. Though 30-day readmission was higher (50% in the intermittent arm versus 33.1%), total LOS in the year was still lower (49±18.0 days in the intermittent arm versus 53.3±14.9 days). There were few adverse events in both arms.Conclusion: Our study suggests that intermittent dosing of meropenem may be helpful for reducing hospital length of stay. We suggest for randomised controlled trials to prove its safety and efficacy.

Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures

2018 ◽  
Vol 128 (5) ◽  
pp. 880-890 ◽  
Author(s):  
Atul Gupta ◽  
Junaid Nizamuddin ◽  
Dalia Elmofty ◽  
Sarah L. Nizamuddin ◽  
Avery Tung ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Operating Room ◽  
Healthcare Utilization ◽  
Cohort Analysis ◽  
Hospital Costs ◽  
Hospital Length ◽  
Opioid Abuse ◽  
Hospital Length Of Stay ◽  
Opioid Overdose ◽  
Readmission Rates

Abstract Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.

Does Travel Distance Affect Readmission Rates after Cardiac Surgery?

2017 ◽  
Vol 83 (10) ◽  
pp. 1170-1173
Author(s):  
Yen-yi Juo ◽  
Alexis Woods ◽  
Ryan Ou ◽  
Gianna Ramos ◽  
Richard Shemin ◽  
...  
Keyword(s):  
Medical Center ◽  
Surgical Care ◽  
Hospital Length ◽  
Travel Distance ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Logistic Regression Models ◽  
Caucasian Race ◽  
The Impact ◽  
The Relationship

With emphasis on value-based health care, empiric models are used to estimate expected read-mission rates for individual institutions. The aim of this study was to determine the relationship between distance traveled to seek surgical care and likelihood of readmission in adult patients undergoing cardiac operations at a single medical center. All adults undergoing major cardiac surgeries from 2008 to 2015 were included. Patients were stratified by travel distance into regional and distant travel groups. Multivariable logistic regression models were developed to assess the impact of distance traveled on odds of readmission. Of the 4232 patients analyzed, 29 per cent were in the regional group and 71 per cent in the distant. Baseline characteristics between the two groups were comparable except mean age (62 vs 61 years, P < 0.01) and Caucasian race (59 vs 73%, P < 0.01). Distant travel was associated with a significantly longer hospital length of stay (11.8 vs 10.5 days, P < 0.01) and lower risk of readmission (9.5 vs 13.4%, P < 0.01). Odds of readmission was inversely associated with logarithm of distance traveled (odds ratio 0.75). Travel distance in patients undergoing major cardiac surgeries was inversely associated with odds of readmission.

Should Benzodiazepine Sedation be Delivered by Infusion or Bolus?

2013 ◽  
Vol 14 (1) ◽  
pp. 24-27
Author(s):  
James Hutchinson ◽  
Georgina Harlow ◽  
David Sinton ◽  
Tony Whitehouse
Keyword(s):  
Mechanical Ventilation ◽  
Mode Of Delivery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Limited Data ◽  
Mechanically Ventilated ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Observational Cohort ◽  
Randomised Controlled

Benzodiazepine sedation for mechanically ventilated patients in intensive care (ICU) is common practice worldwide. We performed a literature review to investigate whether benzodiazepine sedation is best delivered by continuous infusion or intermittent bolus. PubMed, Ovid and Cochrane databases were searched. Only four studies, involving 481 patients, were found. Three were randomised controlled trials and one was an observational cohort study; all used different benzodiazepines, sometimes in conjunction with opiates. The studies measured different outcomes including mechanical ventilation duration, length of ICU and hospital stay, quality and complications of sedation and mortality. Use of intermittent sedation or opiate boluses alone reduced mechanical ventilation duration, ICU and hospital length of stay. However such limited data means that the optimal mode of delivery for benzodiazepine sedation remains unresolved.

Quality Effect of Early Discharge of Maternity Patients: Does Hospital Specialization Matter?

2008 ◽  
Vol 11 (2) ◽  
Author(s):  
Eugenia Amporfu
Keyword(s):  
Health Care Cost ◽  
Principal Component ◽  
Early Discharge ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Discharge Policy ◽  
Industrialized Nations ◽  
Hospital Specialization ◽  
The Impact

The quest to reduce health care cost has led many industrialized nations to reduce hospital length of stay. This paper uses instrumental variable estimation to estimate the effect of early discharge on readmission rates of maternity patients in British Columbia, Canada and investigates how the impact varied according to hospitals' degree of specialization. Principal component analysis was used to classify the hospitals according to their degree of specialization. The results show that the early discharge policy increased readmission rates, and this increase, varied according to the degree of specialization of the hospital. The increase in readmission rate is observed to be lowest in the very highly specialized hospitals and highest in the moderately specialized hospitals. The highly specialized hospitals are, however, capable of using resources most efficiently at least partly due to a reduction in the use of invasive procedures.

scholarly journals The Changing Landscape of Uncomplicated Gram-Negative Bacteremia: A Narrative Review to Guide Inpatient Management

2020 ◽  
Vol 15 (12) ◽  
pp. 746-753 ◽  
Author(s):  
Jeannie D Chan ◽  
Chloe Bryson-Cahn ◽  
Zahra Kassamali-Escobar ◽  
John B Lynch ◽  
Anneliese M Schleyer
Keyword(s):  
Cost Effective ◽  
Hospital Length ◽  
Antimicrobial Treatment ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Source Control ◽  
Gram Negative ◽  
Oral Agents ◽  
Gram Negative Bacteremia

Gram-negative bacteremia secondary to focal infection such as skin and soft-tissue infection, pneumonia, pyelonephritis, or urinary tract infection is commonly encountered in hospital care. Current practice guidelines lack sufficient detail to inform evidence-based practices. Specifically, antimicrobial duration, criteria to transition from intravenous to oral step-down therapy, choice of oral antimicrobials, and reassessment of follow-up blood cultures are not addressed. The presence of bacteremia is often used as a justification for a prolonged course of antimicrobial therapy regardless of infection source or clinical response. Antimicrobials are lifesaving but not benign. Prolonged antimicrobial exposure is associated with adverse effects, increased rates of Clostridioides difficile infection, antimicrobial resistance, and longer hospital length of stay. Emerging evidence supports shorter overall duration of antimicrobial treatment and earlier transition to oral agents among patients with uncomplicated Enterobacteriaceae bacteremia who have achieved adequate source control and demonstrated clinical stability and improvement. After appropriate initial treatment with an intravenous antimicrobial, transition to highly bioavailable oral agents should be considered for total treatment duration of 7 days. Routine follow-up blood cultures are not cost-effective and may result in unnecessary healthcare resource utilization and inappropriate use of antimicrobials. Clinicians should incorporate these principles into the management of gram-negative bacteremia in the hospital.

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