scholarly journals Appropriateness of Anti-MRSA Therapy in Hospitalized Patients With Suspected Community-Onset Infections

2020 ◽  
Vol 41 (S1) ◽  
pp. s125-s126
Author(s):  
Sydney Springer ◽  
Muriel Burk ◽  
Kelly Echevarria ◽  
Makoto Jones ◽  
Matthew Goetz
Keyword(s):  
Risk Factors ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Empiric Therapy ◽  
Inappropriate Use ◽  
Medical Centers ◽  
Days Of Therapy ◽  
Mrsa Infection ◽  
Healthcare Associated ◽  
Manual Record

Background: Inappropriate use of MRSA-spectrum antibiotics is an important antimicrobial stewardship target. Contributors to inappropriate use include empiric treatment of patients who are determined to not be infected or who are infected but lack MRSA risk factors, and by excessive treatment duration when suspected MRSA infection is disproven. To characterize opportunities for improvement, we conducted a medical use evaluation (MUE) in 27 VA medical centers. The primary objectives were to assess the following proportions: (1) courses of unjustified empiric vancomycin therapy (patients in whom all antibacterials were halted within 2 days or without a principal or secondary discharge infection diagnosis); (2) courses of unjustified continuation of anti-MRSA therapy beyond day 4 (no MRSA risk factors or proven MRSA infection); and (3) excess anti-MRSA days of therapy (DOT), that is, DOT in unjustified empiric courses plus DOT after day 4 in unjustified continued courses. Methods: Clinical pharmacists performed retrospective, structured, manual record reviews of patients started on intravenous vancomycin on day 1 or 2 of hospitalization from June 2017 to May 2018. Exclusion criteria included surgical prophylaxis, recent MRSA infection, β-lactam allergy, renal insufficiency, severe immunosuppression, or infection that warranted anti-MRSA therapy other than vancomycin. Results: Of 2,493 evaluated patients, 1,320 met the inclusion criteria. Among them, 44% of courses were initiated in the emergency department, 37% of patients had ≥1 risk factor for healthcare-associated infections, and 50% of patients had ≥2 SIRS criteria or required vasopressor support. The most common admission diagnoses were skin and soft-tissue infection (SSTI, 40%; 68% nonpurulent) and pneumonia (27%; 46% without healthcare risk factors). Clinical cultures recovered MRSA from 8% of patients. Empiric therapy was not justified in 342 patients (26%; 57% were clinically stable). Continued therapy was unjustified in 46% of the 320 patients who received >4 days of anti-MRSA therapy. Of all days of anti-MRSA therapy, 23% were unjustified; 65% of these were due to unjustified empiric therapy. Site-specific variations in unjustified empiric therapy better correlated with the proportion of unjustified DOT than did unjustified continuation of therapy (Pearson correlation coefficients [PCC], 0.75 and 0.54, respectively) (Fig. 1). Facility-specific proportions of unjustified DOT modestly correlated with anti-MRSA DOT (PCC, 0.45; n = 27) (Fig. 2) but not the anti-MRSA standardized antimicrobial administration ratio (PCC, 0.15; n = 21). Conclusions: In this multicenter MUE, 26% of all days of anti-MRSA therapy lacked justification; this rate correlated with total facility-specific anti-MRSA DOT. Unnecessary empiric therapy, largely in the ED and for nonpurulent SSTIs and pneumonia without risk factors, was the principal contributor to unjustified DOT.Funding: NoneDisclosures: None

scholarly journals 1034. Automating Assessments of Vancomycin Appropriateness

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S364-S364
Author(s):  
Haley K Holmer ◽  
Caitlin M McCracken ◽  
Gregory B Tallman ◽  
Sara J Gore ◽  
Timothy Shan ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Empiric Therapy ◽  
Automated Classification ◽  
Electronic Health Record Data ◽  
Inappropriate Use ◽  
Days Of Therapy ◽  
Hospital Patients ◽  
Icd 10 ◽  
Procedure Codes

Abstract Background Assessing appropriateness of hospital antibiotic use is typically a labor-intensive task for antimicrobial stewardship teams and relies heavily on clinician judgement rather than a systematic process. Vancomycin is a frequently used agent that is a common stewardship target. We developed an algorithm to automatically classify the appropriateness of vancomycin days of therapy (DOTs) based upon electronic health record data. Methods We constructed a retrospective cohort of Oregon Health and Science University (OHSU) Hospital and Doernbecher Children’s Hospital patients admitted August 1, 2017 to July 31, 2018 receiving vancomycin. Data were collected on demographic, encounter, pharmacy, microbiology, and surgery data. An electronic algorithm was applied to classify vancomycin DOTs as appropriate, inappropriate, or indeterminate. Inappropriate use was defined as any case in which there was an opportunity for de-escalation as identified using microbiology data, ICD-10 codes, and procedure codes. Results We included 4,231 encounters; 493 (12%) were pediatric patients. Our algorithm automatically classified 59%, 3%, and 38% of encounters as having either appropriate, inappropriate, or indeterminate DOTs, respectively. Forty-four percent of all encounters received no more than a 24-hour course of vancomycin and were considered appropriate empiric therapy; half of these were attributed to surgical prophylaxis. Nine percent of all encounters had vancomycin administered within 3 days of a blood, sputum or tissue culture in which either a methicillin-resistant Staphylococcus species or an ampicillin-resistant, vancomycin-susceptible Enterococcus species was isolated and were classified as appropriate. Six percent of all encounters had cultures in which only Gram-negatives, fungi, or yeast were isolated and were therefore considered appropriate in the empiric period (≤48 hours) but inappropriate thereafter. Conclusion Automated assessments of antibiotic appropriateness could facilitate more informed antimicrobial stewardship initiatives and serve as a valuable stewardship metric. Characterization of indeterminate vancomycin use may inform increased automated classification. Further effort is needed to validate these assessments. Disclosures All authors: No reported disclosures.

scholarly journals 1027. Vancomycin Use in Community-Acquired Pneumonia: Assessing Inappropriate Therapy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S361-S362
Author(s):  
Timothy Shan ◽  
Sara J Gore ◽  
Caitlin M McCracken ◽  
Gregory B Tallman ◽  
Haley K Holmer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Positive Culture ◽  
Empiric Therapy ◽  
Community Acquired Pneumonia ◽  
University Hospital ◽  
Inappropriate Therapy ◽  
Definitive Therapy ◽  
Days Of Therapy ◽  
Risk Patients ◽  
The Impact

Abstract Background Current Infectious Disease Society of America guidelines recommend anti-methicillin-resistant Staphylococcus aureus(MRSA) agents for treatment of community-acquired pneumonia (CAP) only in specific high-risk patients. There are limited data on duration of vancomycin use that is appropriate in hospitalized patients with CAP. The objective of this study was to evaluate the use of vancomycin for CAP among inpatients. Methods We conducted a retrospective cohort study of inpatients at Oregon Health and Science University Hospital from August 1st, 2017 to July 31st, 2018 who received IV vancomycin and had a pneumonia encounter ICD-9 diagnosis code. Patients with hospital or ventilator-associated pneumonia were excluded. Appropriate therapy was defined as empiric therapy with known risk-factors, concordant therapy with no de-escalation option, or concurrent sepsis or febrile neutropenia. Vancomycin appropriateness was assessed based on medical history and microbiology for both empiric and definitive therapy. We characterized patients receiving inappropriate therapy and calculated the proportion of inappropriate days of therapy (DOT). Results We identified 52 patients with CAP who were treated with vancomycin for a median of 2 DOT (Interquartile Range (IQR): 1–3). Approximately 21% (11/52) of patients had risk factors warranting vancomycin empiric therapy and 42% (22/52) had concurrent sepsis. Nine CAP patients received inappropriate courses of vancomycin, median of 1 day (IQR: 1–2.25) of inappropriate therapy. The most common reason for classifying use as inappropriate was a positive culture for organisms other than MRSA. Patients receiving inappropriate therapy were more frequently transferred from another hospital (44% vs. 30%, P = 0.22). Overall, 16% (20/125) of vancomycin DOT were inappropriate. Conclusion In our study,CAP patients accounted for a small number of pneumonia patients who received vancomycin. The median inappropriate DOT was relatively short, possibly indicating that identification and de-escalation was performed quickly. Further work is required to determine the impact of these findings on patients. Disclosures All authors: No reported disclosures.

Risk Factors Associated with Methicillin Resistance amongStaphylococcus aureusInfections in Veterans

2010 ◽  
Vol 31 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Natalie L. McCarthy ◽  
Patrick S. Sullivan ◽  
Robert Gaynes ◽  
David Rimland
Keyword(s):  
Risk Factors ◽  
Methicillin Resistance ◽  
Medical Center ◽  
Care Facility ◽  
Prior History ◽  
Term Care ◽  
Factors Associated ◽  
The Past ◽  
Mrsa Infection ◽  
Healthcare Associated

Background.Methicillin-resistantStaphylococcus aureus(MRSA) is an emerging concern in infectious disease practice. Although MRSA infections occur in a wide variety of anatomic sites, the majority of studies considering the risk factors for methicillin resistance amongS. aureusinfections have focused on MRSA bacteremia.Objective.To describe risk factors associated with methicillin resistance amongS. aureusinfections at different anatomic sites.Methods.We collected information on the demographic and clinical characteristics of patients examined at the Atlanta Veterans Affairs Medical Center withS. aureusinfections during the period from June 2007 through May 2008. We used multivariate logistic regression to describe factors significantly associated with methicillin resistance.Results.There were 568 cases ofS. aureusinfection among 528 patients. We identified 352 cases (62%) of MRSA infection and 216 cases (38%) of methicillin-sensitiveS. aureusinfection. The adjusted odds of methicillin resistance were higher among infections that occurred among patients who had a prior history of MRSA infection (odds ratio [OR], 3.9 [95% confidence interval {CI}, 2.3–6.4]) or resided in a long-term care facility during the past 12 months (OR, 2.0 [95% CI, 1.0-4.0]) but were lower for infections that occurred among patients who had undergone a biopsy procedure during the past 12 months (OR, 0.7 [95% CI, 0.6-0.9]). Most cases of infection were community-onset infections (523 [92%] of 568 cases), and about one-half (278 [49%]) were not healthcare associated.Conclusions.Compared with previous studies of methicillin resistance among patients withS. aureusbacteremia, we found similar factors to be associated with methicillin resistance amongS. aureusisolates recovered from more diverse anatomic sites of infection. Of note, nearly one-half of our cases of MRSA infection were not healthcare associated.

scholarly journals Risk perception factors and their influence on road transportation

2014 ◽  
Vol 8 (2) ◽  
pp. 100-112 ◽  
Author(s):  
Aderinlewo Olufikayo ◽  
Ata Grace
Keyword(s):  
Risk Factors ◽  
Mobile Phone ◽  
Case Studies ◽  
Perceived Risk ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Drinking And Driving ◽  
Road Transportation ◽  
Number Of Factors ◽  
Pearson Correlation Analysis

This study assesses risk in road transportation in Ekiti State, Nigeria through a number of factors as well as the various ways by which these factors are perceived through Pearson correlation analysis. Six roads were identified as case studies from which information about how the users perceived risk was obtained mainly by administering questionnaires. The responses to the 23 questions which were developed based on the risk factors were analyzed statistically to obtain their relationships in terms of their correlation coefficients and R-squared values. The most dominant risk factors with respect to the roads considered as case studies were identified and the relationships between them were determined. The results showed that the most correlated risk factors are "drinking and driving (DAD)", "using a mobile phone (hands free) and driving (UMP(hf)AD)", "taking medicine and driving (TMAD)" and "using a mobile phone (hands free) and driving (UMP(hf)AD)" with Pearson correlation coefficient of 0.9772 and R-squared value of 0.9549.

scholarly journals Development of predictive nomograms for clinical use to quantify the risk of isolating resistance prone organisms in patients with infected foot ulcers

2019 ◽  
Vol 147 ◽  
Author(s):  
A. Farkas ◽  
F. Lin ◽  
K. Bui ◽  
F. Liu ◽  
G. L. An ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariable Analysis ◽  
Empiric Therapy ◽  
Foot Ulcers ◽  
Factors Associated ◽  
Predictive Algorithms ◽  
Infected Wounds ◽  
History Of ◽  
Mrsa Infection ◽  
Culture Positive

AbstractPseudomonas aeruginosaand methicillin-resistantStaphylococcus aureus(MRSA) have been considered prevalent pathogens in foot infections. However, whether empiric therapy directed against these organisms is necessary, and in whom to consider treatment, is rather unclear. The aim of this study was to develop predictive algorithms for forecasting the probability of isolating these organisms in the infected wounds of patients in a population where the prevalence of resistant pathogens is low. This was a retrospective study of regression model-based risk factor analysis that included 140 patients who presented with infected, culture positive foot ulcers to two urban hospitals. A total of 307 bacteria were identified, most frequently MRSA (11.1%).P. aeruginosaprevalence was 6.5%. In the multivariable analysis, amputation (odds ratio (OR) 5.75, 95% confidence interval (CI) 1.48–27.63), renal disease (OR 5.46, 95% CI 1.43–25.16) and gangrene (OR 2.78, 95% CI 0.82–9.59) were identified as risk factors associated with higher while diabetes (OR 0.07, 95% CI 0.01–0.34) and Infectious Diseases Society of America infection severity >3 (OR 0.18, 95% CI 0.03–0.65) were associated with lower odds ofP. aeruginosaisolation (Cstatistic 0.81). Similar analysis for MRSA showed that amputation was associated with significantly lower (OR 0.29, 95% CI 0.09–0.79) risk, while history of MRSA infection (OR 5.63, 95% CI 1.56–20.63) and osteomyelitis (OR 2.523, 95% CI 1.00–6.79) was associated with higher odds of isolation (Cstatistic 0.69). We developed two predictive nomograms with reasonable to strong ability to discriminate between patients who were likely of being infected withP. aeruginosaor MRSA and those who were not. These analyses confirm the association of some, but also question the significance of other frequently described risk factors in predicting the isolation of these organisms.

scholarly journals 2196. Impact of Rapid Discontinuation of Empiric Vancomycin in Patients with Hospital-Acquired or Healthcare-Associated Pneumonia and Absence of Adequate Respiratory Tract Culture Data

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S748-S748
Author(s):  
Alanna H Rufe ◽  
Linda S Johnson
Keyword(s):  
Antibiotic Therapy ◽  
Cohort Analysis ◽  
Empiric Therapy ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Antigen Tests ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
The Impact ◽  
Post Period

Abstract Background Vancomycin is a commonly utilized empiric therapy for patients with hospital-acquired and healthcare-associated pneumonia (HAP and HCAP). De-escalation is encouraged in the guidelines but not commonly performed in the absence of culture data. Studies have shown that in certain low-risk patients, vancomycin may not be necessary. A clinical criterion document was implemented in 2018 at CHI Memorial to facilitate rapid de-escalation of vancomycin. This study aims to assess the impact of early discontinuation of vancomycin in patients with HAP or HCAP and no respiratory culture. Methods A retrospective cohort analysis was conducted in adult inpatients who presented from September to December 2017 and 2018 with HAP or HCAP, no respiratory culture within 72 hours, and at most one risk factor for MRSA. Patients who did not meet criteria for de-escalation, were receiving antibiotics for an extrapulmonary infection, or had a pathogen identified from blood or urinary antigen tests were excluded. The primary endpoint was vancomycin days of therapy pre- vs. post-intervention. Secondary endpoints include vancomycin re-start, subsequent respiratory culture growing MRSA, intensive care unit (ICU) and total length of stay, total days of antibiotic therapy, total days of alternate anti-MRSA therapy and in-hospital mortality in de-escalated vs. non-de-escalated patients. Results A total of 66 patient were included; 25 in the pre- and 41 in the post-period. The median age was 83 in the pre- and 68 in the post-period, with 20% of patients being initiated in the ICU and one patient with HAP in each group. There was no difference in median days of vancomycin therapy in the pre- vs. post-intervention period (4 days [3–5] vs. 4 days [3–5]) P = 0.583. There were 37 patients not de-escalated and 29 patients rapidly de-escalated. Total days of inpatient antibiotic therapy was significantly lower in the de-escalated group (7 days [5–9] vs. 5 days [4–7]) P = 0.037. No other significant differences were noted (Table 2). Conclusion There was no difference in vancomycin days of therapy after the implementation of this pharmacist-led initiative. However, discontinuing vancomycin within 72 hours was safe in patients with HCAP and was associated with decreased days of inpatient antibiotic therapy. Disclosures All authors: No reported disclosures.

Reliability of the Minimum Masking Level as Outcome Variable in Tinnitus Clinical Research

2020 ◽  
Vol 29 (3) ◽  
pp. 429-435
Author(s):  
Patricia C. Mancini ◽  
Richard S. Tyler ◽  
Hyung Jin Jun ◽  
Tang-Chuan Wang ◽  
Helena Ji ◽  
...  
Keyword(s):  
Standard Deviation ◽  
High Frequency ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Outcome Variable ◽  
Reliable Estimate ◽  
Moderate Correlation ◽  
Trained Subjects ◽  
The Relationship ◽  
Minimum Intensity

Purpose The minimum masking level (MML) is the minimum intensity of a stimulus required to just totally mask the tinnitus. Treatments aimed at reducing the tinnitus itself should attempt to measure the magnitude of the tinnitus. The objective of this study was to evaluate the reliability of the MML. Method Sample consisted of 59 tinnitus patients who reported stable tinnitus. We obtained MML measures on two visits, separated by about 2–3 weeks. We used two noise types: speech-shaped noise and high-frequency emphasis noise. We also investigated the relationship between the MML and tinnitus loudness estimates and the Tinnitus Handicap Questionnaire (THQ). Results There were differences across the different noise types. The within-session standard deviation averaged across subjects varied between 1.3 and 1.8 dB. Across the two sessions, the Pearson correlation coefficients, range was r = .84. There was a weak relationship between the dB SL MML and loudness, and between the MML and the THQ. A moderate correlation ( r = .44) was found between the THQ and loudness estimates. Conclusions We conclude that the dB SL MML can be a reliable estimate of tinnitus magnitude, with expected standard deviations in trained subjects of about 1.5 dB. It appears that the dB SL MML and loudness estimates are not closely related.

Comparative Responses to Squats Completed with Free Weights and an Exoskeleton

2020 ◽  
Vol 4 (1) ◽  
pp. 51-63
Author(s):  
Peter Neuhaus ◽  
Chris Jumonville ◽  
Rachel A. Perry ◽  
Roman Edwards ◽  
Jake L. Martin ◽  
...  
Keyword(s):  
Data Collection ◽  
Female Athletes ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Actual Data ◽  
Limited Data ◽  
Comparative Similarity ◽  
Insufficient Amount ◽  
Force Data ◽  
Familiarization Session

AbstractTo assess the comparative similarity of squat data collected as they wore a robotic exoskeleton, female athletes (n=14) did two exercise bouts spaced 14 days apart. Data from their exoskeleton workout was compared to a session they did with free weights. Each squat workout entailed a four-set, four-repetition paradigm with 60-second rest periods. Sets for each workout involved progressively heavier (22.5, 34, 45.5, 57 kg) loads. The same physiological, perceptual, and exercise performance dependent variables were measured and collected from both workouts. Per dependent variable, Pearson correlation coefficients, t-tests, and Cohen's d effect size compared the degree of similarity between values obtained from the exoskeleton and free weight workouts. Results show peak O2, heart rate, and peak force data produced the least variability. In contrast, far more inter-workout variability was noted for peak velocity, peak power, and electromyography (EMG) values. Overall, an insufficient amount of comparative similarity exists for data collected from both workouts. Due to the limited data similarity, the exoskeleton does not exhibit an acceptable degree of validity. Likely the cause for the limited similarity was due to the brief amount of familiarization subjects had to the exoskeleton prior to actual data collection. A familiarization session that accustomed subjects to squats done with the exoskeleton prior to actual data collection may have considerably improved the validity of data obtained from that device.

Leader-Member Exchange (LMX) Impact on Work-Home Interference in a South African Commuter Transport Engineering Company

2019 ◽  
Vol 43 ◽  
Author(s):  
Jan Christoff Visagie ◽  
Michael M. Jones ◽  
Herman L. Linde
Keyword(s):  
South African ◽  
Structural Equation ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Leader Member Exchange ◽  
Negative Consequences ◽  
Dyadic Relationship ◽  
Cross Sectional ◽  
Engineering Company ◽  
Member Exchange

The South African workplace is confronted with many leadership challenges, specifically those relating to the employment relationship between subordinates and their supervisors. A high-quality relationship is essential, considering the work-family spillovers employees experience. Limited research has been conducted on the potential positive and negative consequences of the leader-member exchange (LMX) dyadic relationship. In this study, we used a cross-sectional research design, and drew an employee sample (N = 120) from a commuter transport engineering company. A five-point Likert scale was employed and statistical analyses were carried out using the SAS statistical program. We calculated Pearson correlation coefficients and used structural equation modelling to test the proposed conceptual model to indicate possible correlations between the different variables. The main finding of the study was that the nature of the LMX relationship quality in the relevant company appeared to be high and positively related to work-home enrichment but negatively related to work-home conflict and role overload. The article concludes by making a number of suggestions to respond to challenges.

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