scholarly journals Generating Evidence for Chronic Obstructive Pulmonary Disease (COPD) Clinical Guidelines Using EHR Data

2019 ◽  
Author(s):  
Amber M. Johnson ◽  
Marvi Bikak ◽  
Paul M. Griffin ◽  
Mohammad Adibuzzaman
Keyword(s):  
Mortality Rate ◽  
Modeling And Simulation ◽  
Clinical Guidelines ◽  
Probabilistic Modeling ◽  
Optimal Time ◽  
Chronic Obstructive ◽  
Antibiotic Administration ◽  
Time Duration ◽  
Number Of Patients ◽  
Temporal Aspects

ABSTRACTObjectivesThe aim of this research was to develop data-driven models using electronic health records (EHRs) to conduct clinical studies for predicting clinical outcomes through probabilistic analysis that considers temporal aspects of clinical data. We assess the efficacy of antibiotics treatment and the optimal time of initiation for in-hospitalized diagnosed with acute exacerbation of COPD (AECOPD) as an application to probabilistic modeling.Materials and MethodsWe developed a semi-automatic Markov Chain Monte Carlo (MCMC) modeling and simulation approach that encodes clinical conditions as computable definitions of health states and exact time duration as input for parameter estimations using raw EHR data. We applied the MCMC approach to the MIMIC-III clinical database, where ICD-9 diagnosis codes (491.21, 491.22, and 494.1) were used to identify data for 697 AECOPD patients of which 25.9% were administered antibiotics.ResultsThe average time to antibiotic administration was 27 hours, and 32% of patients were administered vancomycin as the initial antibiotic. The model simulations showed a 50% decrease in mortality rate as the number of patients administered antibiotics increased. There was an estimated 5.5% mortality rate when antibiotics were initially administrated after 48 hours vs 1.8% when antibiotics were initially administrated between 24 and 48 hours.DiscussionOur findings suggest that there may be a mortality benefit in initiation of antibiotics early in patient with severe respiratory failure in settings of COPD exacerbations warranting an ICU admission.ConclusionProbabilistic modeling and simulation methods that considers temporal aspects of raw clinical patient data can be used to adequately generate evidence for clinical guidelines.

PREVALENCE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII (CRAB) IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS (ICUS) OF JPMC, KARACHI

2019 ◽  
Author(s):  
Rabia Arshad
Keyword(s):  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Acinetobacter Baumannii ◽  
Intensive Care Units ◽  
Carbapenem Resistance ◽  
Chronic Obstructive ◽  
Surgical Intensive Care ◽  
Carbapenem Resistant ◽  
Number Of Patients ◽  
Increased Risk

Background: Antimicrobial resistance is one of the research priorities of health organizations due to increased risk of morbidity and mortality. Outbreaks of nosocomial infections caused by carbapenem-resistant Acinetobacter Baumannii (CRAB) strains are at rise worldwide. Antimicrobial resistance to carbapenems reduces clinical therapeutic choices and frequently led to treatment failure. The aim of our study was to determine the prevalence of carbapenem resistance in A. baumannii isolated from patients in intensive care units (ICUs). Methods: This cross-sectional study was carried out in the Department of Microbiology, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Centre (JPMC), Karachi, from December 2016 to November 2017. Total 63 non-repetitive A. baumannii were collected from the patients’ specimens, admitted to medical and surgical ICUs and wards of JPMC, Karachi. The bacterial isolates were processed according to standard microbiological procedures to observe for carbapenem resistance. SPSS 21 was used for data analysis. Results: Out of the 63 patients, 40 (63.5%) were male. The age of the patient ranged from 15-85 year, with average of 43 year. 34.9% patients had been hospitalized for 3 days. Chronic obstructive pulmonary disease was present in highest number with average of 58.7% for morbidity. Number of patients on mechanical ventilation was highest (65.1%). All isolates were susceptible to colistin. The resistance to ampicillin-sulbactam, ceftazidime, ciprofloxacin, amikacin, piperacillin- tazobactam and meropenem was 82.5%, 81%, 100%, 87.3%, 82.5% and 82% respectively. Out of 82% CRAB, 77% were obtained from ICUs. Conclusion: This study has revealed the high rate of carbapenem resistance in A. baumannii isolates in ICUs thus leaving behind limited therapeutic options.

scholarly journals A multicenter randomized trial to assess the efficacy of CONvalescent plasma therapy in patients with Invasive COVID-19 and acute respiratory failure treated with mechanical ventilation: the CONFIDENT trial protocol

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Benoît Misset ◽  
Eric Hoste ◽  
Anne-Françoise Donneau ◽  
David Grimaldi ◽  
Geert Meyfroidt ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Neutralizing Antibodies ◽  
Ethical Issues ◽  
High Titer ◽  
Passive Immunization ◽  
University Hospital ◽  
Optimal Time ◽  
Relative Reduction ◽  
Number Of Patients

Abstract Background The COVID-19 pandemic reached Europe in early 2020. Convalescent plasma is used without a consistent evidence of efficacy. Our hypothesis is that passive immunization with plasma collected from patients having contracted COVID-19 and developed specific neutralizing antibodies may alleviate symptoms and reduce mortality in patients treated with mechanical ventilation for severe respiratory failure during the evolution of SARS-CoV-2 pneumonia. Methods We plan to include 500 adult patients, hospitalized in 16 Belgian intensive care units between September 2020 and 2022, diagnosed with SARS-CoV-2 pneumonia, under mechanical ventilation for less than 5 days and a clinical frailty scale less than 6. The study treatment will be compared to standard of care and allocated by randomization in a 1 to 1 ratio without blinding. The main endpoint will be mortality at day 28. We will perform an intention to treat analysis. The number of patients to include is based on an expected mortality rate at day 28 of 40 percent and an expected relative reduction with study intervention of 30 percent with α risk of 5 percent and β risk of 20 percent. Discussion This study will assess the efficacy of plasma in the population of mechanically ventilated patients. A stratification on the delay from mechanical ventilation and inclusion will allow to approach the optimal time use. Selecting convalescent plasmas with a high titer of neutralizing antibodies against SARS-CoV-2 will allow a homogeneous study treatment. The inclusion in the study is based on the consent of the patient or his/her legal representative, and the approval of the Investigational Review Board of the University hospital of Liège, Belgium. A data safety monitoring board (DSMB) has been implemented. Interim analyses have been planned at 100, 2002, 300 and 400 inclusions in order to decide whether the trail should be discontinued prematurely for ethical issues. We plan to publish our results in a peer-reviewed journal and to present them at national and international conferences. Funding and registration The trial is funded by the Belgian Health Care Knowledge Center KCE # COV201004 Trial registration Clinicaltrials.gov registration number NCT04558476. Registered 14 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04558476

Critical illness myopathy in intensive care setting

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mostafa K Fouad ◽  
Ashraf M Hazem ◽  
Kareem M Elnaghy
Keyword(s):  
Critical Illness ◽  
Mortality Rate ◽  
Usual Care ◽  
Usual Care Group ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Care Group ◽  
Fixed Effects Model ◽  
Analysis Study ◽  
Number Of Patients

Abstract Aim of the Work to provide cumulative data about the efficacy and safety of neuro-muscular electrical stimulation (NMES) combined with usual care (UC) versus usual care alone in ICU patients with Critical Illness Myopathy (CIM). Methodology The current systematic review was done on studies published between 2009 and 2019. The total number of patients in all the included studies was 1259 patients; 652 in NMES group, and 607 in UC group. Our data were divided into two groups: NMES (652 patients), and UC (607 patients). Metaanalysis study was done on 11 studies which described and compared the 2 different techniques for treatment of CIM; with overall number of patients (N = 1259). Results Regarding 1ry outcome measures, we found 8 studies reported critical Critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and the overlap, critical care setting   MRC scale for muscle strength, with total number of patients (N = 968). The random-effects model of the meta-analysis study showed non-significant difference in mean MRC scale in NMES group compared to usual care group (p > 0.05). We also found 11 studies reported ICU stay with total number of patients (N = 1259). The random-effects model of the meta-analysis study showed nonsignificant difference in mean ICU stay in NMES group compared to usual care group (p > 0.05). We also found only 2 studies reported SF-36 scale for quality of life, with total number of patients (N = 270). The fixed-effects model of the metaanalysis study showed highly significant decrease in mean SF-36 scale in NMES group compared to usual care group (p = 0.003). Regarding 2ry outcome measure, we found 3 studies reported CIM incidence with total number of patients (N = 394). The fixed-effects model of the meta-analysis study showed marked decrease in CIM incidence in NMES group compared to usual care group, but not reaching statistical significance (p > 0.05). We also found 9 studies reported mortality rate with total number of patients (N = 1044). The fixed-effects model of the meta-analysis study showed non-significant difference in mortality rate in NMES group compared to usual care. Our systematic review and meta-analysis showed that NMES combined with usual care was not associated with significant differences in global muscle strength, ICU stay, quality of life score, CIM incidence and mortality rate in comparison with usual care alone in critically ill patients. Conclusion NMES is not superior to usual care in management of CIM. Usual care remains the mainstay of management of CIM with significant better outcomes, in addition to preventive measures as early aggressive treatment of sepsis and MOF, blood glucose control, optimizing certain drugs use, early enteral nutrition, maintaining water, electrolyte and acidbase balance.

scholarly journals Long-Term Oxygen Therapy in COPD: evidences and open questions of current indications

2016 ◽  
Vol 73 (1) ◽  
Author(s):  
A. Corrado ◽  
T. Renda ◽  
S. Bertini
Keyword(s):  
Oxygen Therapy ◽  
Supplemental Oxygen ◽  
Future Research ◽  
Chronic Obstructive ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Copd Patients ◽  
Number Of Patients ◽  
Long Term Oxygen Therapy

Long term oxygen therapy (LTOT) has been shown to improve the survival rate in Chronic Obstructive Pulmonary Disease (COPD) patients with severe resting hypoxemia by NOTT and MRC studies, published more than 25 years ago. The improved survival was found in patients who received oxygen for more than 15 hours/day. The effectiveness of LTOT has been documented only in stable COPD patients with severe chronic hypoxemia at rest (PaO255%. In fact no evidence supports the use of LTOT in COPD patients with moderate hypoxemia (55<PaO2<65 mmHg), and in those with decreased oxygen saturation (SO2<90%) during exercise or sleep. Furthermore, it is generally accepted without evidence that LTOT in clinical practice is warranted in other forms of chronic respiratory failure not due to COPD when arterial blood gas criteria match those established for COPD patients. The prescription of oxygen in these circumstances, as for unstable patients, increases the number of patients receiving supplemental oxygen and the related costs. Comorbidities are likely to affect both prognosis and health outcomes in COPD patients, but at the moment we do not know if LTOT in these patients with complex chronic diseases and mild-moderate hypoxemia could be of any use. For these reasons a critical revision of the actual guide lines indications for LTOT in order to optimise effectiveness and costs, and future research in the areas that have not previously been addressed by NOTT and MRC studies, are mandatory.

scholarly journals Reduction in hospitalisation following pulmonary rehabilitation in patients with COPD

2008 ◽  
Vol 32 (3) ◽  
pp. 415 ◽  
Author(s):  
Nola Cecins ◽  
Elizabeth Geelhoed ◽  
Sue C Jenkins
Keyword(s):  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Hospital Admissions ◽  
Chronic Respiratory Disease ◽  
Health Care Utilisation ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Chronic Respiratory Disease Questionnaire ◽  
Number Of Patients ◽  
Bed Days

Objectives: Pulmonary rehabilitation (PR) improves exercise capacity and health-related quality of life (HRQoL), and reduces health care utilisation. This study quantified outcomes of a PR program over a 6-year period and determined the effects of PR on hospitalisation. Methods: Patients with chronic obstructive pulmonary disesae (COPD) who entered an 8-week outpatient PR program from 1998 to 2003 were included. Functional exercise capacity (6-minute walk distance [6MWD]) and HRQoL (Chronic Respiratory Disease Questionnaire) were measured before and following PR. The number of hospital admissions and total bed-days due to a COPD exacerbation in the 12 months before and following PR were recorded. Setting: Physiotherapy Department, Sir Charles Gairdner Hospital, Western Australia. Results: 187 (73%) of the 256 patients who entered PR completed the program. Improvements in 6MWD (404.2 �114.6 m to 439.6 �115.0m, P < 0.001) and HRQoL (4.1 �0.9 points per item to 4.9 �0.9 points per item, P < 0.001) occurred following PR. There was a 46% reduction in the number of patients admitted to hospital (71 to 38) with a COPD exacerbation and a 62% reduction in total bed-days (1131 to 432) following PR. Conclusion: Pulmonary rehabilitation provided in an Australian teaching hospital was associated with a reduction in COPD hospitalisation, and the resultant savings outweighed the costs of providing the program.

scholarly journals Trends in the incidence and outcome of sepsis using data from a Japanese nationwide medical claims database-the Japan Sepsis Alliance (JaSA) study group-

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Taro Imaeda ◽  
Taka-aki Nakada ◽  
Nozomi Takahashi ◽  
Yasuo Yamao ◽  
Satoshi Nakagawa ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Organ Dysfunction ◽  
Length Of Hospital Stay ◽  
Annual Incidence ◽  
Claim Database ◽  
Antibiotic Administration ◽  
Electronic Health Record Data ◽  
Acute Organ Dysfunction

Abstract Background Trends in the incidence and outcomes of sepsis using a Japanese nationwide database were investigated. Methods This was a retrospective cohort study. Adult patients, who had both presumed serious infections and acute organ dysfunction, between 2010 and 2017 were extracted using a combined method of administrative and electronic health record data from the Japanese nationwide medical claim database, which covered 71.5% of all acute care hospitals in 2017. Presumed serious infection was defined using blood culture test records and antibiotic administration. Acute organ dysfunction was defined using records of diagnosis according to the international statistical classification of diseases and related health problems, 10th revision, and records of organ support. The primary outcomes were the annual incidence of sepsis and death in sepsis per 1000 inpatients. The secondary outcomes were in-hospital mortality rate and length of hospital stay in patients with sepsis. Results The analyzed dataset included 50,490,128 adult inpatients admitted between 2010 and 2017. Of these, 2,043,073 (4.0%) patients had sepsis. During the 8-year period, the annual proportion of patients with sepsis across inpatients significantly increased (slope = + 0.30%/year, P < 0.0001), accounting for 4.9% of the total inpatients in 2017. The annual death rate of sepsis per 1000 inpatients significantly increased (slope = + 1.8/1000 inpatients year, P = 0.0001), accounting for 7.8 deaths per 1000 inpatients in 2017. The in-hospital mortality rate and median (interquartile range) length of hospital stay significantly decreased (P < 0.001) over the study period and were 18.3% and 27 (15–50) days in 2017, respectively. Conclusions The Japanese nationwide data indicate that the annual incidence of sepsis and death in inpatients with sepsis significantly increased; however, the annual mortality rates and length of hospital stay in patients with sepsis significantly decreased. The increasing incidence of sepsis and death in sepsis appear to be a significant and ongoing issue.

scholarly journals Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis

Pneumologia ◽  
2019 ◽  
Vol 68 (1) ◽  
pp. 31-36
Author(s):  
Ioana Cojocaru ◽  
Livia Luculescu ◽  
Daniela Negoescu ◽  
Irina Strâmbu
Keyword(s):  
Clostridium Difficile ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Respiratory Infections ◽  
Demographic Data ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Male Predominance ◽  
Number Of Patients ◽  
Lower Intestine

Abstract Clostridium difficile is an anaerobic bacterium than can colonise the lower intestine and cause enterocolitis in susceptible patients. Clostridium difficile infection (CDI) is typically a nosocomial infection, favoured by treatment with antibiotics (especially with broad-spectrum drugs), proton pump inhibitors, but also comorbidities, old age and prolonged hospitalisation. Based on the observation that in the past years, the frequency of nosocomial CDI has increased in the Institute of Pulmonology, Bucharest, this retrospective observational study aimed to analyse the characteristics of admitted patients who develop CDI, in order to identify possible particular features and risk factors. Accordingly, medical files from 80 patients admitted from January 2015 to August 2017 were analysed for demographic data, respiratory diagnosis, comorbidities, blood tests, treatments prescribed, time of CDI onset, evolution and outcome. The number of patients studied was 29 in 2015, 16 in 2016 and 35 in 2017, with slight male predominance. Totally, 54 patients (67.5%) had tuberculosis (pulmonary or pleural), 12 had lung cancer, five had respiratory infections, two had chronic obstructive pulmonary disease and seven had other diseases. All patients but nine were receiving antibiotics: tuberculosis drugs, cephalosporins, fluoroquinolones and beta-lactams. About half of the patients received proton pump inhibitors. Most patients had several comorbidities. Mean time since admittance to onset of diarrhoea was 20 days. CDI was treated with metronidazole or vancomycin. The evolution was favourable in 90% of patients, but eight patients (10%) died This study highlights a high frequency of CDI in patients treated for tuberculosis. Due to insufficient data, no epidemiological consideration could be made. Further studies are needed to assess the relationship among tuberculosis, tuberculosis treatment and CDI.

scholarly journals Abbreviated (8 hours) versus Traditional (24 hours) Postpartum MgSO4 Prophylaxis in Severe Preeclampsia: A Randomised Control Trial

2021 ◽  
Author(s):  
Shyamal Dasgupta ◽  
Anindya Das ◽  
Anurag Mallick ◽  
Chiranjit Ghosh
Keyword(s):  
Magnesium Sulphate ◽  
Total Duration ◽  
Severe Preeclampsia ◽  
Randomised Control Trial ◽  
Controlled Study ◽  
P Value ◽  
Time Duration ◽  
Traditional Group ◽  
Suitable Alternative ◽  
Number Of Patients

Introduction: Preeclampsia is a multisystem disorder affecting pregnancy after 20 weeks of gestation featured by hypertension and proteinuria. Magnesium Sulphate (MgSO4) has been used for 24 hours following delivery to prevent eclampsia in patients with severe preeclampsia. Aim: To determine the need to continue magnesium sulphate therapy 8 hours following delivery. Materials and Methods: The double blinded randomised controlled study was performed in the Department of Gynaecology and Obstetrics at R.G. Kar Medical College, Kolkata, West Bengal, India, from 1st July 2015 to 30th June 2016. Total 90 patients with severe preeclampsia were randomised in two group. In group A MgSO4 was discontinued 8 hours following delivery (abbreviated group) and in the group B it was continued for 24 hours following delivery (traditional group). The primary objective of study was to determine the need to continue MgSO4 therapy 8 hours following delivery. Secondary objectives were monitoring time by doctors, nursing care time, postpartum ambulation time, duration of urinary catheterisation, minor complication like urinary tract infection, duration and total dose of MgSO4 therapy. In order to calculate statistical significance of the different variables in between two groups, Student’s independent sample’s t-test was used for normally distributed numerical values and Chi-square test or Fischer’s-exact test was used for unpaired proportion data. Results: In abbreviated group, the number of patients (n=1) who did not need to continue MgSO4 therapy beyond 8 hours following delivery as safety measures were statistically significant (p-value <0.0001) in comparison to traditional group. Total duration and dose of MgSO4 therapy were significantly less (p-value <0.0001) in the abbreviated group. There was statistically significant reduction in time from delivery to postpartum ambulation and duration of indwelling urinary catheter in the abbreviated group. Conclusion: The abbreviated (8 hours) regime of postpartum MgSO4 for seizure prophylaxis is a suitable alternative to the traditional (24 hours) regime.

scholarly journals Mortality Rate and Characteristics of Deaths Following COVID-19 Vaccination

2021 ◽  
Vol 8 ◽  
Author(s):  
Gang Lv ◽  
Jing Yuan ◽  
Xiaomo Xiong ◽  
Minghui Li
Keyword(s):  
Mortality Rate ◽  
Long Term Care ◽  
Adverse Event Reporting System ◽  
Care Facility ◽  
Adverse Event Reporting ◽  
Chronic Obstructive ◽  
Term Care ◽  
Obstructive Pulmonary Disease ◽  
Long Term Care Facility

Background: The emergency use authorization for coronavirus disease 2019 (COVID-19) vaccines brought both hopes and concerns to the Americans and others. We aimed to estimate the mortality rate of COVID-19 vaccination and presented characteristics of deaths following COVID-19 vaccination.Methods: Data on deaths following COVID-19 vaccination were obtained from the Vaccine Adverse Event Reporting System (VAERS) from December 11, 2020 through January 8, 2021. The Centers for Disease Control and Prevention (CDC) COVID Data Tracker was used to identify the total number of people receiving COVID-19 vaccines during the same period to estimate the mortality rate. Stratified analysis was conducted by the location of vaccination.Results: As of January 8, 2021, 55 deaths were reported, and the mortality rate of COVID-19 vaccination was 8.2 per million population. A total of 37 deaths were reported among long-term care facility residents, and the mortality rate was 53.4 per million population. Top reported comorbidities associated with deaths included hypertension, dementia, chronic obstructive pulmonary disease (COPD), diabetes, and heart failure. In addition, dementia was more likely to be associated with deaths vaccinated at long-term care facilities than at other locations.Conclusion: The benefits of COVID-19 vaccines outweigh the potential risks in older frail populations, and our findings do not support actions to exclude older adults from being vaccinated. However, continued monitoring of COVID-19 vaccination is still warranted.

scholarly journals 189. Validating a Hospitalist-Specific Antibiotic Prescribing Metric across Four Acute Care Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S100-S101
Author(s):  
Jessica Howard-Anderson ◽  
Cara Nys ◽  
Julianne N Kubes ◽  
William C Dube ◽  
Benjamin Albrecht ◽  
...  
Keyword(s):  
Research Training ◽  
Antibiotic Use ◽  
Primary Diagnosis ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Antibiotic Administration ◽  
Obstructive Pulmonary Disease ◽  
Leadership Group ◽  
Immunocompromised Status ◽  
Hospital Stays

Abstract Background Peer comparison reduces unnecessary outpatient antibiotic prescribing, but no prescribing metric has been validated for inpatient comparison. We aimed to evaluate if an electronically derived antibiotic prescribing metric correlated with indicated antibiotic days in hospitalized patients. Methods We previously created a hospitalist-specific adjusted antibiotic use metric (observed:expected [O:E]) for National Healthcare Safety Network-defined broad-spectrum antibiotics. From May-Oct 2019 at four Emory Healthcare hospitals, we identified outlier hospitalists prescribing in the top (high O:E) and bottom (low O:E) 15th percentile. We randomly selected 10 days of antibiotic administration from each outlier and reviewed days with &gt; 2 days of consecutive days of antibiotics. For pneumonia, chronic obstructive pulmonary disease (COPD), or urinary tract infection (UTI) we determined if each day of antibiotics was indicated, assuming the diagnosis was accurate. We compared high vs. low O:E providers and used regression modeling to determine if the metric predicted indicated days of antibiotics. Results Among 997 days, 510 (51%) were from high and 487 (49%) from low O:E providers. High O:E providers had a greater proportion of days with &gt; 2 prior days of antibiotics (60%) compared to low O:E providers (54%, p = 0.03). In the subset of days with &gt; 2 prior days of antibiotics (n = 569), high O:E providers had more patient-days with longer hospital stays, diabetes and Charlson comorbidity index (CCI) &gt;3, and fewer days supervising (resident/advanced practice provider, Table 1). The primary diagnosis was pneumonia, COPD exacerbation or UTI in 260 (25%) days; 91% were indicated based on duration with no difference between high and low O:E providers (88% vs. 94%, p = 0.1). After controlling for days of hospitalization, CCI, immunocompromised status, and supervisory role, a high O:E was not associated with indicated antibiotic use (OR 0.5, 95% CI 0.2 – 1.3). Description of days with a patient on greater than two days of antibiotics, comparing high- versus low-metric providers Conclusion A high hospitalist antibiotic prescribing metric correlated with patients receiving &gt; 2 consecutive days of antibiotics on any given day but did not predict unindicated antibiotic use for a subset of diagnoses. Evaluating indicated use by validating diagnoses may improve metric performance. Disclosures Jessica Howard-Anderson, MD, Antibacterial Resistance Leadership Group (ARLG) (Other Financial or Material Support, The ARLG fellowship provides salary support for ID fellowship and mentored research training)

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