Prophylactic Acid-Suppressive Therapy in Hospitalized Adults: Indications, Benefits, and Infectious Complications

2017 ◽  
Vol 37 (3) ◽  
pp. 18-29 ◽  
Author(s):  
Andrew C. Faust ◽  
Kelly L. Echevarria ◽  
Rebecca L. Attridge ◽  
Lyndsay Sheperd ◽  
Marcos I. Restrepo
Keyword(s):  
Infectious Complications ◽  
Gastric Ph ◽  
Hospitalized Patients ◽  
Suppressive Therapy ◽  
Ulcer Bleeding ◽  
Risk Of Infection ◽  
Increased Risk ◽  
Risk Patients ◽  
Clinically Significant ◽  
Stress Ulcer Bleeding

Acid-suppressive therapy for prophylaxis of stress ulcer bleeding is commonly prescribed for hospitalized patients. Although its use in select, at-risk patients may reduce clinically significant gastrointestinal bleeding, the alteration in gastric pH and composition may place these patients at a higher risk of infection. Although any pharmacologic alteration of the gastric pH and composition is associated with an increased risk of infection, the risk appears to be highest with proton pump inhibitors, perhaps owing to the potency of this class of drugs in increasing the gastric pH. With the increased risk of infection, universal provision of pharmacologic acid suppression to all hospitalized patients, even all critically ill patients, is inappropriate and should be confined to patients meeting specific criteria. Nurses providing care in critical care areas may be instrumental in screening for appropriate use of acid-suppressive therapy and ensuring the drugs are discontinued upon transfer out of intensive care or when risk factors are no longer present.

Since blood transfusion is linked to the magnitude of the surgical procedure, comparing transfused patients to untransfused patients will always be confounded by infection risks due to factors related to the procedure. To control for these factors one must compare patients transfused with red cells from different sources or prepared in a manner which minimize infection risk. Patients transfused with homologous blood have infection rates several fold higher than recipients of equal values of autologous blood undergoing the same operative procedure (20-23). Homologous blood recipients have significantly longer hospital stays attributed to treating infections. The cost of a blood transfusion exceeds the cost of collection, storage and administration because of transfusion's association with length of stay. In this era of cost-containment the association with prolonged stay may ultimately curtail the use of blood. Homologous blood can be filtered to remove donor leukocytes which may be contributing to immune suppression and infection risk. A prospective randomized trial comparing the infection rates among colorectal cancer patients receiving filtered and unfiltered blood has been conducted (9). There were 17 infectious complications among the 56 recipients of whole blood and one infectious complication among the 48 recipients of filtered blood. Infections were prevented by the seemingly simplistic addition of a $25/filter to every bag of blood transfused. These clinical studies are very convincing: homologous blood transfusion is associated with increased risk of infection in every clinical situation examined. In multivariate analyses transfusion was a significant predictor of infection after consideration of other variables measured and in the majority of those studies transfusion was the single most significant factor. Patients receiving homologous blood exhibited an incidence of infectious complications that was approximately four times higher than patients receiving autologous blood. The association of transfusion with infection is found among patients undergoing surgery for cardiac, orthopedic and gastrointestinal disorders and for trauma as well as among unoperated patients transfused for bums and gastrointestinal bleeding. The observation that nosocomial infections are increased in these studies argues strongly that the association of transfusion with infection is not simply a reflection of transfusion as a marker of tissue destruction and contamination. Infections that develop in transfused patients away from the site of trauma or in the absence of trauma, cannot be attributed to the quantity of tissue destroyed or to the degree of bacterial contamination. Filtered blood can remove leukocytes and prevent postoperative infections. Since filtering blood can significantly reduce the incidence of infection among transfused patients, all transfused blood will be passing through filters in the very near future. EXPERIMENTAL STUDIES RELATING BLOOD TRANSFUSION TO INCREASED RISK OF INFECTION Patients are extremely heterogeneous and even in prospective randomized trials, factors which influence patients' participation affect the outcome despite double-blinding and randomization. In animal studies using syngeneic strains with identical housing, lighting, access to food and water, control over the extent of injury, use of antibiotics and exposure to other variables the influence of a single variable such as blood transfusion can be measured. Dr. Waymack's laboratory has intensively studied parameters which interact with transfusion in

1995 ◽  
pp. 296-296
Keyword(s):  
Blood Transfusion ◽  
Autologous Blood ◽  
Experimental Studies ◽  
Infection Risk ◽  
Infectious Complications ◽  
Risk Of Infection ◽  
Infection Rates ◽  
Homologous Blood ◽  
Increased Risk ◽  
The Cost

Reduced Rate of Infectious Complications Following Bloodless Autologous Peripheral Blood Stem Cell Transplants (APBSCT).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5453-5453 ◽  
Author(s):  
Patricia A. Ford ◽  
Barbara A. Matthews ◽  
Nicole M. Brown
Keyword(s):  
Breast Cancer ◽  
High Dose Chemotherapy ◽  
Infectious Complications ◽  
High Dose ◽  
Blood Transfusions ◽  
Risk Of Infection ◽  
Infection Rates ◽  
Autologous Transplants ◽  
Increased Risk ◽  
Risk Of Cancer

Abstract While blood transfusions can be life saving, the associated risk of transfusing allogeneic blood is significant. The most common patient fears are transfusion-transmitted diseases such as HIV, Hepatitis B and C and West Nile Virus; however, the known risk of transmitting these diseases is quite small. More common complications are due to immunosuppression which can cause an increased risk of cancer recurrence in the oncologic patient and a significantly increased risk of infection. In trauma patients, it has been shown that the risk of infection increases with each additional unit of blood transfused. Currently, about 2.2 units of platelets and 3.3 units of red blood cells are administered following high-dose chemotherapy and an APBSCT. At the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital, many procedures are now being completed without the use of blood products. We have previously reported the ability to perform bloodless APBSCT (Ballen, et al. J Clin Oncol2004;22:4087-4094). Knowing that blood transfusions can increase the risk of infection, we wanted to evaluate this transfusion-free population to determine if there was a correlation between infection rates and blood transfusions in the high risk transplant population. We performed a retrospective chart review of 46 patients with multiple myeloma (22), lymphoma (22) and breast cancer (2) who underwent a bloodless APBSCT in our center. Prior to transplantation, all patients recieved standard transplant doses of cyclophosphamide, carmustine and etoposide (BCV) or Melphalan. A PubMed search was performed and the closest data set in terms of patient demographics was a study by Pereira, et al. who report the rate of infectious complications in 75 patients with myeloma (30), lymphoma (30) and breast cancer (15) who were transfused liberally following high-dose chemotherapy and APBSCT (Pereira, et al. Eur J Haematol2006;76:102-108). In our bloodless patients, 37% of the patients had at least one infection, compared to Pereira and colleagues’ rate of 68% (see table). Our results are also reported in the average number of infections per patient. This comparison demonstrates a substantial reduction in the rate of infection in the bloodless population. While immunosuppression and the resulting increased infection rates have been correlated to blood transfusions in other patients populations, to the best of our knowledge this is the first report that suggests decreased infection rates in transfusion-free transplant patients. This data provides further evidence to support the practice of blood management strategies in order to reduce or eliminate blood transfusions. Patients with at least one infection All infections per person Bacterial per person Viral per person Fungal per person Unknown per person Autologous Transplants (Pereira, et al.) 68% .64 .53 .01 .07 .03 Bloodless Autologous Transplants 37% .41 .39 0 0 .02

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 De-labelling penicillin allergy in acutely hospitalized patients: a pilot study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Linde Steenvoorden ◽  
Erik Oeglaend Bjoernestad ◽  
Thor-Agne Kvesetmoen ◽  
Anne Kristine Gulsvik
Keyword(s):  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Low Risk ◽  
Penicillin Allergy ◽  
Environmental Benefit ◽  
Medical Department ◽  
Norwegian Population ◽  
Risk Patients ◽  
History Of ◽  
Clinically Significant

Abstract Background Penicillin allergy prevalence is internationally reported to be around 10%. However, the majority of patients who report a penicillin allergy do not have a clinically significant hypersensitivity. Few patients undergo evaluation, which leads to overuse of broad-spectrum antibiotics. The objective of this study was to monitor prevalence and implement screening and testing of hospitalized patients. Methods All patients admitted to the medical department in a local hospital in Oslo, Norway, with a self-reported penicillin allergy were screened using an interview algorithm to categorize the reported allergy as high-risk or low-risk. Patients with a history of low-risk allergy underwent a direct graded oral amoxicillin challenge to verify absence of a true IgE-type allergy. Results 257 of 5529 inpatients (4.6%) reported a penicillin allergy. 191 (74%) of these patients underwent screening, of which 86 (45%) had an allergy categorized as low-risk. 54 (63%) of the low-risk patients consented to an oral test. 98% of these did not have an immediate reaction to the amoxicillin challenge, and their penicillin allergy label could thus be removed. 42% of the patients under treatment with antibiotics during inclusion could switch to treatment with penicillins immediately after testing, in line with the national recommendations for antibiotic use. Conclusions The prevalence of self-reported penicillin allergy was lower in this Norwegian population, than reported in other studies. Screening and testing of hospitalized patients with self-reported penicillin allergy is a feasible and easy measure to de-label a large proportion of patients, resulting in immediate clinical and environmental benefit. Our findings suggest that non-allergist physicians can safely undertake clinically impactful allergy evaluations.

scholarly journals The SUP-ICU Trial: Does It Confirm or Condemn the Practice of Stress Ulcer Prophylaxis?

2019 ◽  
Vol 55 (2) ◽  
pp. 96-101 ◽  
Author(s):  
Jeffrey F. Barletta ◽  
Mitchell S. Buckley ◽  
Robert MacLaren
Keyword(s):  
Stress Ulcer ◽  
Controlled Trial ◽  
Infectious Complications ◽  
Stress Ulcer Prophylaxis ◽  
Suppressive Therapy ◽  
Secondary Outcome ◽  
Routine Practice ◽  
Risk Patients ◽  
Ulcer Prophylaxis ◽  
The Relationship

Purpose: Stress ulcer prophylaxis (SUP) is routinely administered to critically ill patients for the prevention of stress ulcer–induced, clinically important bleeding (CIB). Recently, the value of SUP has been questioned due to the perceived decline in CIB and the potential for infectious complications secondary to acid suppressive therapy. The SUP-ICU trial is a large, randomized controlled trial comparing intravenous pantoprazole with placebo for the indication of SUP. It is hoped that this trial would answer many of the questions pertaining to the overall value of SUP. This article will provide an in-depth assessment of the SUP-ICU trial in the context of the overall body of literature in this area. Furthermore, applications for clinical practice and recommendations on the provision of SUP are provided. Summary: The SUP-ICU trial revealed no difference in the primary outcome of 90-day mortality with pantoprazole but lower rates of CIB were noted (which was a secondary outcome). Overall, these data provide important insight into the value of SUP along with other questions related to the provision of SUP such as the relationship between CIB and mortality, infectious complications, and enteral nutrition. Conclusions: The SUP-ICU trial is a landmark trial describing the value of SUP in a modern-day setting of intensive care unit (ICU) practice. The provision of SUP should be continued in high-risk patients. Future studies are ongoing that will add further insight to this routine practice.

scholarly journals Correcting Hypokalemia in Hospitalized Patients Does Not Decrease Risk of Cardiac Arrhythmias

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Weston Harkness ◽  
Paula Watts ◽  
Michael Kopstein ◽  
Oliwier Dziadkowiec ◽  
Gregory Hicks ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrhythmias ◽  
Potassium Level ◽  
Hospitalized Patients ◽  
Retrospective Case ◽  
Exact Test ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
History Of ◽  
Clinically Significant

Background. It is currently standard practice to correct hypokalemia for the purpose of preventing cardiac arrhythmias in all hospitalized patients. However, the efficacy of this intervention has never been previously studied. Objective. The objective of our study was to evaluate whether patients without acute coronary syndrome or history of arrhythmias were at increased risk of clinically significant cardiac arrhythmias if their potassium level was not corrected to ≥3.5 mEq/L. Design. A retrospective case control study. Setting. A community hospital. Participants. We enrolled selected patients who had episodes of hypokalemia during their hospital stay and were monitored on telemetry. Patients were split into groups based on success of replacing serum potassium to ≥3.5 mEq/L after 24 hours. Measurements. The primary outcome was the development of an arrhythmia. Arrhythmias included supraventricular tachycardia, atrial fibrillation, atrial flutter, Mobitz type II second-degree or third-degree AV block, ventricular tachycardia, or ventricular fibrillation. A one-tailed Fisher’s exact test and logistic regression were used for analysis. Results. A total of 1338 hypokalemic patient days were recorded. Out of these days, 22 arrhythmia events (1.6% of patient days) were observed, 8 in the uncorrected group (1% patient days) and 14 in the corrected group (2.6% patient days). We found no statistically significant relationship between successfully correcting potassium to ≥3.5 mEq/L and number of arrhythmic events (p=0.037, OR = 2.38 (95% CI: 0.99, 6.03)). Logistic regression revealed that correction of potassium does not seem to be significantly related to arrhythmias (β = 0.869, p=0.0517). Conclusions. In the acute care setting, we found that patients with hypokalemia whose potassium level did not correct to ≥3.5 mEq/L were not at increased odds of having an arrhythmia. This study suggests that the common practice of checking and replacing potassium is likely inconsequential.

Anticoagulant management for pregnant women with coronavirus infection

2020 ◽  
Author(s):  
И.А. Лапина ◽  
Ю.Э. Доброхотова ◽  
В.В. Таранов ◽  
Т.Г. Чирвон
Keyword(s):  
Pregnant Women ◽  
Anticoagulant Therapy ◽  
Low Molecular Weight Heparin ◽  
Infectious Complications ◽  
Low Molecular Weight ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
Risk Patients ◽  
Thrombotic Complications ◽  
Coronavirus Infection

Введение. Частота распространения новой коронавирусной инфекции COVID-19 (НКИ COVID-19) среди беременных сравнима с общепопуляционными показателями, что требует особого внимания в связи с повышенным риском материнской смертности в результате осложнений инфекционного процесса. Учитывая наличие гиперкоагуляционного статуса во время физиологически протекающей беременности, инфицирование вирусом COVID-19 может способствовать еще большему усилению прокоагулянтных свой ств крови. Патогенетически обоснованным является применение антикоагулянтной терапии во время беременности при условии верифицированной коронавирусной инфекции с целью снижения риска развития тромботических осложнений. Материалы и методы. Представлены 2 клинических случая успешного применения антикоагулянтов (низкомолекулярного гепарина) у беременных с подтвержденным инфицированием COVID-19. Результаты. Ретроспективный анализ лабораторных и клинических данных продемонстрировал эффективность парнапарина натрия в качестве средства профилактики тромботических осложнений у беременных с НКИ COVID-19. Заключение. Применение антикоагулянтной терапии у беременных с НКИ COVID-19 позволяет снизить риск развития тромботических эпизодов и улучшить репродуктивные исходы беременности. Background. The COVID-19 frequency among pregnant women is comparable to general population but it requires specific approach due to increased risk of maternal mortality as a result of infectious complications. The hypercoagulation is during physiological pregnancy, and COVID-19 can enhance further a procoagulant conditions. In such cases the anticoagulant therapy is aimed to reduce the thrombotic risk. Patients / Methods. The article presents 2 clinical cases of successful use of anticoagulants (low molecular weight heparin) in pregnant women with confirmed COVID-19. Results. A retrospective analysis of laboratory and clinical data has demonstrated the effi cacy of parnaparin sodium as a means of preventing thrombotic complications in pregnant women with COVID-19. Conclusions. Anticoagulant therapy in pregnant women with COVID-19 allows to reduce the thrombotic risk and improve the reproductive outcomes of pregnancy.

scholarly journals Antibiotic Resistance in Nosocomial Bacteria Isolated from Infected Wounds of Hospitalized Patients in Czech Republic

Antibiotics ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 342
Author(s):  
Milan Kolar ◽  
Pavel Cermak ◽  
Lenka Hobzova ◽  
Katerina Bogdanova ◽  
Katerina Neradova ◽  
...  
Keyword(s):  
Czech Republic ◽  
Methicillin Resistance ◽  
Hospitalized Patients ◽  
Drug Resistant ◽  
Risk Of Infection ◽  
Increased Risk ◽  
Infected Wounds ◽  
Amoxicillin Clavulanic Acid ◽  
Etiological Agents ◽  
Staphyloccus Aureus

Hospitalized patients with wounds face an increased risk of infection with multi-drug-resistant nosocomial bacteria. In this study, samples from almost 10,000 patients from big hospitals in Czech Republic with infected wounds were analyzed for the presence of bacterial pathogens. In 7693 patients (78.8%), bacterial etiological agents were identified. Members of the Enterobacterales (37.1%) and Staphyloccus aureus (21.1%) were the most prevalent pathogens. Staphyloccus aureus showed methicillin resistance in 8.6%. Almost half of the Klebsiella pneumoniae isolates were ESBL-positive and 25.6% of the Enterobacter spp. isolates were AmpC-positive. The third most prevalent Pseudomonas aeruginosa showed resistance to 19–32% of the antipseudomonal antibiotics tested. Based on the results, amoxicillin/clavulanic acid, ampicillin/sulbactam or piperacillin/tazobactam combined with gentamicin can be recommended for antibiotic treatment of infected wounds. Once the etiological agent is identified, the therapy should be adjusted according to the species and its resistance.

Hyperglycemia during Neutropenia Was Associated with the Risk of Infection and Organ Dysfunction in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation (HSCT).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5308-5308 ◽  
Author(s):  
Shigeo Fuji ◽  
Sung-Won Kim ◽  
Shin-ichiro Mori ◽  
Shigemi Kamiya ◽  
Takahiro Fukuda ◽  
...  
Keyword(s):  
Stem Cell ◽  
Organ Dysfunction ◽  
Infectious Complications ◽  
Essential Difference ◽  
Infection Prophylaxis ◽  
Risk Of Infection ◽  
Hematopoietic Stem ◽  
Baseline Serum ◽  
Increased Risk ◽  
Mild Hyperglycemia

Abstract Background Recipients of allogeneic HSCT frequently require support with total parenteral nutrition (TPN), in expense of increased risk of infections associated with hyperglycemia, particularly in neutropenic period. Previously, van den Berghe et al. showed that intensive insulin therapy reduced the morbidity including infections and mortality in patients cared in the ICU. Here we assessed the clinical impact of hyperglycemia in patients undergoing myeloablative HSCT. Methods A retrospective cohort of consecutive 112 adults treated between January 2002 and June 2006 was reviewed, and 21 patients were excluded due to coexisting infectious diseases, preexisting neutropenia or graft failure. The remaining 91 patients with various hematological malignancies were categorized according to mean blood glucose (BG) level, which developed in neutropenic period, to 1) “normoglycemia” (BG≤110 mg/dl, n=28), 2) “mild hyperglycemia” (110<BG≤150 mg/dl, n=49) and 3) “moderate hyperglycemia” (150 mg/dl<BG, n=14). Conditioning regimens included BU/CY (n=45), CY/TBI (n=43) and CA/CY/TBI (n=3). GVHD prophylaxis included cyclosporine- (n=62) and tacrolimus-based regimen (n=29). Stem cell sources included bone marrow (n=46), peripheral blood (n=41) and cord blood cells (n=4). Infection prophylaxis was oral ciprofloxacin, acyclovir and fluconazole. The primary endpoint of this study was the occurrence of febrile neutropenia (FN) and infectious episodes including bacteremia, pneumonia and central venous catheter infection. The secondary endpoint was abnormal laboratory data as parameters for organ dysfunction, which were used in the study by van den Berghe, including elevation of serum creatinine ≥2.0 mg/dl or more than twice of the baseline, serum total bilirubin ≥2.0 mg/dl and serum C-reactive protein (CRP) ≥15 mg/dl. For statistical analysis, student T, chi-square, and Wilcoxon rank-sum tests were used. Results There was no essential difference between the 3 groups in the average caloric intake, occurrence of FN and infectious episodes. However, hyperglycemia was significantly associated with higher number of febrile days (normoglycemia 3.3±3.7 days; mild hyperglycemia 5.5±4.1days p=0.017; moderate hyperglycemia 7.4±5.0days: p=0.004), hypercreatininemia (normoglycemia 3.6 %; moderate hyperglycemia 28.6% OR 10.8, p=0.018), hyperbilirubinemia (normoglycemia 10.7 %; moderate hyperglycemia 42.9% OR 6.3, p=0.017), CRP ≥15 mg/dl (normoglycemia 14.3 %; moderate hyperglycemia 64.3% OR 10.8, p<0.001), longer hospital stay (normoglycemia 43.0±20.5 days; mild hyperglycemia 60.7±31.3 days: p=0.003, moderate hyperglycemia 77.8±51.3 days; p=0.004) and in-hospital mortality (normoglycemia 0%, mild hyperglycemia 10.2%; p=0.08, moderate hyperglycemia 21.4%; p<0.001). Conclusion Hyperglycemia during neutropenia was associated with increased risk of infection and organ dysfunction, which further lead to vicious cycle of infectious complications. The results may support the possibility that intensive glucose control reduces the morbidity including infectious complications and organ dysfunction after HSCT.

scholarly journals Deep Brain Electrode Externalization and Risk of Infection: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Alon Kashanian ◽  
Pratik Rohatgi ◽  
Srinivas Chivukula ◽  
Sameer A Sheth ◽  
Nader Pouratian
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Case Series ◽  
Infectious Complications ◽  
Control Group ◽  
Risk Of Infection ◽  
Relative Risks ◽  
Increased Risk ◽  
High Level ◽  
Deep Brain

Abstract BACKGROUND When evaluating deep brain stimulation (DBS) for newer indications, patients may benefit from trial stimulation prior to permanent implantation or for investigatory purposes. Although several case series have evaluated infectious complications among DBS patients who underwent trials with external hardware, outcomes have been inconsistent. OBJECTIVE To determine whether a period of lead externalization is associated with an increased risk of infection. METHODS We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses compliant systematic review of all studies that included rates of infection for patients who were externalized prior to DBS implantation. A meta-analysis of proportions was performed to estimate the pooled proportion of infection across studies, and a meta-analysis of relative risks was conducted on those studies that included a control group of nonexternalized patients. Heterogeneity across studies was assessed via I2 index. RESULTS Our search retrieved 23 articles, comprising 1354 patients who underwent lead externalization. The pooled proportion of infection was 6.9% (95% CI: 4.7%-9.5%), with a moderate to high level of heterogeneity between studies (I2 = 62.2%; 95% CI: 40.7-75.9; P &lt; .0001). A total of 3 studies, comprising 212 externalized patients, included a control group. Rate of infection in externalized patients was 5.2% as compared to 6.0% in nonexternalized patients. However, meta-analysis was inadequately powered to determine whether there was indeed no difference in infection rate between the groups. CONCLUSION The rate of infection in patients with electrode externalization is comparable to that reported in the literature for DBS implantation without a trial period. Future studies are needed before this information can be confidently used in the clinical setting.

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