scholarly journals 700. Ampicillin-Ceftriaxone Versus Ampicillin-Gentamicin for Definitive Therapy of Enterococcus faecalis Infective Endocarditis: A Propensity Score-Matched,Retrospective Cohort Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S401-S401
Author(s):  
Niyati H Shah ◽  
Kathleen A Shutt ◽  
Yohei Doi ◽  
Yohei Doi
Keyword(s):  
Infective Endocarditis ◽  
Propensity Score ◽  
Adverse Events ◽  
Enterococcus Faecalis ◽  
Treated Patient ◽  
Cohort Analysis ◽  
Hospital Readmissions ◽  
The United States ◽  
Antibiotic Regimen ◽  
Definitive Therapy

Abstract Background The mortality rate for Enterococcus faecalis infective endocarditis (EIE) is high. Ampicillin-ceftriaxone (AC) has emerged as an alternative antibiotic regimen with lower toxicity compared to ampicillin-gentamicin (AG), but evidence regarding its success in reducing EIE-associated mortality in the United States is limited. We retrospectively compared mortality in EIE patients treated with AG versus AC. Methods We conducted a retrospective, propensity score-matched, cohort analysis of EIE patients treated with AG or AC from 2010 to 2017 at three hospitals in Pittsburgh, Pennsylvania. Patients were included in the analysis if they were treated for EIE with either AC or AG as the pathogen-directed antibiotic regimen for at least forty-eight hours. We assessed 90-day mortality as the primary outcome, and in-hospital mortality, length of hospital stay, hospital readmissions, adverse events, and relapse of bacteremia as the secondary outcomes. Results A total of 190 patients with EIE (100 treated with AC and 90 with AG) were included. Ninety-day mortality was significantly higher in the AC group than the AG group (21% vs 8%, p = 0.02). After propensity score-matching, 56 patients in each group remained for the outcomes analysis. We observed similar rates of 90-day mortality (6% vs 4%, p = 0.55), bacteremia relapse (0 patients in both cohorts), treatment failure (0% vs 1%, p = 0.50), and 90-day hospital readmission (24% vs 23%, p = 0.85) in the AC and AG-treated patient cohorts. Adverse events were more common in patients treated with AG, and more patients in the AG cohort switched antibiotic regimens than in the AC group. Conclusion EIE patients treated with AC have similar mortality rates as those treated with AG, while AG is associated with increased toxicity and adverse events. Larger, multi-center studies are still needed to compare the two antibiotic regimens. Disclosures All Authors: No reported disclosures

scholarly journals Ampicillin-Ceftriaxone vs Ampicillin-Gentamicin for Definitive Therapy of Enterococcus faecalis Infective Endocarditis: A Propensity Score–Matched, Retrospective Cohort Analysis

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Niyati H Shah ◽  
Kathleen A Shutt ◽  
Yohei Doi
Keyword(s):  
Infective Endocarditis ◽  
Propensity Score ◽  
Adverse Events ◽  
Cohort Analysis ◽  
Hospital Readmissions ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Aminoglycoside Resistance ◽  
Definitive Therapy ◽  
Significant Difference

Abstract Background Ampicillin-ceftriaxone (AC) has emerged as an alternative antibiotic regimen for enterococcal infective endocarditis (EIE) with reduced toxicity compared with ampicillin-gentamicin (AG), but evidence regarding its success in reducing EIE-associated death in the United States is limited. Methods We conducted a retrospective, propensity score–matched cohort analysis of EIE patients treated with AC or AG between 2010 and 2017 at 3 hospitals in Pittsburgh, Pennsylvania. We assessed all-cause 90-day mortality as the primary outcome and in-hospital mortality, length of hospital stay, hospital readmissions, adverse events, and relapse of bacteremia as the secondary outcomes. Results A total of 190 patients with EIE (100 treated with AC and 90 with AG) were included. Ninety-day mortality was significantly higher with AC than AG (21% vs 8%; P = .02). After propensity score matching, 56 patients in each group remained for the outcomes analysis. Documented aminoglycoside resistance, presence of annular or aortic abscess, and complete pacemaker removal were the significantly different variables between the 2 matched cohorts. We observed no statistically significant difference in 90-day mortality between the 2 treatment groups (11% vs 7%; P = .55). Adverse events were more common in patients treated with AG (25 vs 39; P = .0091), and more patients in the propensity score–matched AG cohort switched antibiotic regimens than in the AC group (10% vs 49%; P < .0001). Conclusions Patients treated with AC demonstrate no significant differences in mortality, treatment failure, or bacteremia relapse compared with AG in a propensity score–matched EIE cohort.

scholarly journals The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Guido Mazzinari ◽  
◽  
Ary Serpa Neto ◽  
Sabrine N. T. Hemmes ◽  
Goran Hedenstierna ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Abdominal Surgery ◽  
Las Vegas ◽  
Cohort Analysis ◽  
Risk Difference ◽  
Pulmonary Complications ◽  
Driving Pressure ◽  
Postoperative Pulmonary Complications ◽  
Open Abdominal Surgery

Abstract Background It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P <  0.001 versus 1.05 [95%CI 1.05 to 1.05], P <  0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P <  0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P <  0.001 versus 1.07 [95%CI 1.05 to 1.10], P <  0.001; risk difference 0.05 [95%CI 0.030.07], P <  0.001). Conclusions ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

scholarly journals Intraoperative Driving Pressure and Postoperative Pulmonary Complications After Abdominal Surgery – A Posthoc Propensity Score–Weighted Cohort Analysis of the LAS VEGAS Study Comparing Open to Closed Surgery

2020 ◽  
Author(s):  
Guido Mazzinari ◽  
Ary Serpa Neto ◽  
Sabrine Hemmes ◽  
Goran Hedenstierna ◽  
Samir Jaber ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Abdominal Surgery ◽  
Surgical Approach ◽  
Las Vegas ◽  
Cohort Analysis ◽  
Pulmonary Complications ◽  
Driving Pressure ◽  
Postoperative Pulmonary Complications ◽  
Open Abdominal Surgery

Abstract Background: It is uncertain whether associations between driving pressure (ΔP) during and occurrence of pulmonary complications after abdominal surgery depend on the surgical approach. Our primary objective was to test the time–weighted average ΔP (ΔPTW) association with postoperative pulmonary complications and our secondary objective was to test the association between ΔPTW and intraoperative Adverse Events. Methods: We realized a posthoc retrospective propensity score weighted cohort analysis of the ‘Local ASsessment of Ventilatory management during General Anesthesia for Surgery’ (LAS VEGAS) study including patients undergoing abdominal surgery from the study database including data from 146 hospitals across 29 countries. The primary endpoint was a composite of postoperative pulmonary complications. The secondary endpoint was the occurrence of intraoperative adverse events. Results: The analysis included 1,128 and 906 patients undergoing open or closed abdominal surgery repsectively. Absolute postoperative pulmonary complications rate was 5%. While driving pressure was lower in open abdominal surgery patients, time-weighted driving pressure was not different between groups. The association of ΔPTW with occurrence of postoperative pulmonary complications was significant in both groups, with a higher risk ratio in closed than in open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P<0.001 vs. 1.05 [95% CI 1.05 to 1.05; P<0.001; risk difference 0.05: [95%CI 0.04 to 0.06], P<0.001). ΔPTW marginal effect estimation showed increased probability of pulmonary complication in both groups with a steeper increase in closed surgery patients at ΔPTW above 20 cmH2O∙hour-1. The association of ΔPTW with occurrence of intraoperative adverse events was also significant in both groups, with higher odds ratio in closed surgery (1.13 [95%CI 1.12 to 1.14]; P<0.001 vs. 1.07 [95%CI 1.05 to 1.10]; P<0.001; difference 0.05 [95%CI 0.03 to 0.07]; p<0.001). Conclusions: Our results show how driving pressure represents a marker for pulmonary complications and adverse events in abdominal surgery regardless of surgical approach.Trial registration: LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

scholarly journals Comparative Toxicity and Effectiveness of Trastuzumab-Based Chemotherapy Regimens in Older Women With Early-Stage Breast Cancer

2017 ◽  
Vol 35 (29) ◽  
pp. 3298-3305 ◽  
Author(s):  
Katherine E. Reeder-Hayes ◽  
Anne Marie Meyer ◽  
Sharon Peacock Hinton ◽  
Ke Meng ◽  
Lisa A. Carey ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Propensity Score ◽  
Adverse Events ◽  
Older Patients ◽  
Early Stage ◽  
The United States ◽  
Health Care Use ◽  
Significant Shift ◽  
Serious Adverse Events ◽  
Adjuvant Trastuzumab

Purpose The combination of chemotherapy and trastuzumab is the standard of care for adjuvant treatment of human epidermal growth factor receptor 2–positive breast cancer. Two regimens have been widely adopted in the United States: doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab (ACTH) and docetaxel, carboplatin, and trastuzumab (TCH). No head-to-head comparison of these regimens has been conducted in a clinical trial, and existing trial data have limited generalizability to older patients. Methods We used SEER-Medicare data from 2005 to 2013 to compare outcomes of ACTH versus TCH among patients age older than 65 years. Propensity score matching was used to balance cohort characteristics between treatment arms. Outcomes included toxicity-related hospitalization, survival, and trastuzumab completion. Data from 1,077 patients receiving ACTH or TCH were analyzed, and the propensity-matched subsample included 416 women. Results There was a significant shift toward TCH over time, with 88% of patients receiving ACTH in 2005 compared with 15% by 2011. Among propensity score–matched patients, we found no difference between regimens in health care use overall or for chemotherapy-related adverse events (ACTH, 34% v TCH, 36.5%; P = .46). Patients receiving TCH were significantly more likely to complete trastuzumab (89% v 77%; P = .001). There was no difference in 5-year breast cancer–specific survival (ACTH, 92% v TCH, 96%; hazard ratio, 2.08; 95% CI, 0.90 to 4.82) or overall survival. Conclusion Among a matched sample of older patients, ACTH compared with TCH was not associated with a higher rate of serious adverse events or hospitalizations, but it was associated with less completion of adjuvant trastuzumab. We did not detect a difference in 5-year survival outcomes for ACTH compared with TCH. In the context of limited evidence in older patients, selection between these two regimens on the basis of concerns about differential toxicity or efficacy may not be appropriate.

Bi-microbial Healthcare-Associate Endocarditis caused by Enterococcus faecalis and Burkholderia cepacia: A Case Report and literature review

2020 ◽  
Vol 02 ◽  
Author(s):  
Masood Ghori ◽  
Nadya O. Al Matrooshi ◽  
Samir Al Jabbari ◽  
Ahmed Bafadel ◽  
Gopal Bhatnagar
Keyword(s):  
Case Report ◽  
Infective Endocarditis ◽  
Literature Review ◽  
Enterococcus Faecalis ◽  
Surgical Management ◽  
Burkholderia Cepacia ◽  
Clinical Presentation ◽  
Complicated Course ◽  
Healthcare Associated ◽  
Echocardiographic Findings

: Infective Endocarditis (IE), a known complication of hemodialysis (HD), has recently been categorized as Healthcare-Associated Infective Endocarditis (HAIE). Single pathogen bacteremia is common, polymicrobial endocardial infection is rare in this cohort of the patients. We report a case of endocarditis caused by Enterococcus faecalis (E. faecalis) and Burkholderia cepacia (B. cepacia), a first ever reported combination of a usual and an unusual organism, respectively, in a patient on HD. Clinical presentation of the patient, its complicated course ,medical and surgical management ,along with microbial and echocardiographic findings is presented herein. The authors believe that presentation of this case of HAIE may benefit and contribute positively to cardiac science owing to the rare encounter of this organism as a pathogen in infective endocarditis and the difficulties in treating it.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

2021 ◽  
Author(s):  
Rachel A Prusynski ◽  
Allison M Gustavson ◽  
Siddhi R Shrivastav ◽  
Tracy M Mroz
Keyword(s):  
United States ◽  
Systematic Review ◽  
Patient Outcomes ◽  
Hospital Readmissions ◽  
The United States ◽  
Skilled Nursing Facilities ◽  
Functional Improvement ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

scholarly journals Prognostic value of D-dimer for adverse outcomes in patients with infective endocarditis: an observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying-Wen Lin ◽  
Mei Jiang ◽  
Xue-biao Wei ◽  
Jie-leng Huang ◽  
Zedazhong Su ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Infective Endocarditis ◽  
Adverse Events ◽  
Prognostic Value ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Large Sample Size ◽  
Cox Regression Analysis ◽  
D Dimer

Abstract Background Increased D-dimer levels have been shown to correlate with adverse outcomes in various clinical conditions. However, few studies with a large sample size have been performed thus far to evaluate the prognostic value of D-dimer in patients with infective endocarditis (IE). Methods 613 patients with IE were included in the study and categorized into two groups according to the cut-off of D-dimer determined by receiver operating characteristic (ROC) curve analysis for in-hospital death: > 3.5 mg/L (n = 89) and ≤ 3.5 mg/L (n = 524). Multivariable regression analysis was used to determine the association of D-dimer with in-hospital adverse events and six-month death. Results In-hospital death (22.5% vs. 7.3%), embolism (33.7% vs 18.2%), and stroke (29.2% vs 15.8%) were significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L. Multivariable analysis showed that D-dimer was an independent risk factor for in-hospital adverse events (odds ratio = 1.11, 95% CI 1.03–1.19, P = 0.005). In addition, the Kaplan–Meier curve showed that the cumulative 6-month mortality was significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L (log-rank test = 39.19, P < 0.0001). Multivariable Cox regression analysis showed that D-dimer remained a significant predictor for six-month death (HR 1.11, 95% CI 1.05–1.18, P < 0.001). Conclusions D-dimer is a reliable prognostic biomarker that independently associated with in-hospital adverse events and six-month mortality in patients with IE.

scholarly journals Neurocognitive effects associated with proprotein convertase subtilisin-kexin type 9 inhibitor use: a narrative review

2021 ◽  
Vol 12 ◽  
pp. 204209862095927
Author(s):  
Wei C. Yuet ◽  
Didi Ebert ◽  
Michael Jann
Keyword(s):  
Cognitive Impairment ◽  
Adverse Events ◽  
The United States ◽  
Narrative Review ◽  
Lipid Lowering ◽  
Patient Specific ◽  
Proprotein Convertase ◽  
Pcsk9 Inhibitors ◽  
Pcsk9 Inhibitor ◽  
Receptor Modulation

Neurocognitive adverse events have been observed with the widespread use of 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors or “statins,” which reduce low-density lipoprotein cholesterol (LDL-C) levels and subsequently cardiovascular risk. The United States Food and Drug Association directed manufacturers of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors to monitor for neurocognitive adverse events due to their potent effects on LDL-C reduction, which is a proposed mechanism for neuronal cell dysfunction. Other proposed mechanisms for PCSK9 inhibitor-associated neurocognitive adverse events include N-methyl-d-aspartate receptor modulation, dysregulation of lipid and glucose metabolism, and patient-specific risk factors for cognitive impairment. The purpose of this narrative review article is to describe the proposed mechanisms, incidence of neurocognitive adverse events from phase II and III trials for PCSK9 inhibitors, neurocognitive assessments utilized in clinical trials, and clinical implications. Given the increasing prevalence of PCSK9 inhibitor use and the neurocognitive adverse events observed with prior lipid-lowering therapies, clinicians should be aware of the risks associated with PCSK9 inhibitors, especially when therapy is indicated for patients at high risk for cardiovascular events. Overall, the incidence of PCSK9 inhibitor-associated neurocognitive appears to be uncommon. However, additional prospective studies evaluating cognitive impairment may be beneficial to determine the long-term safety of these agents.

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