scholarly journals Antibiotics for Aspiration Pneumonia in Neurologically Impaired Children

2019 ◽  
Vol 15 (7) ◽  
pp. 395-402 ◽  
Author(s):  
Joanna Thomson ◽  
Matt Hall ◽  
Lilliam Ambroggio ◽  
Jay G Berry ◽  
Bryan Stone ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Length Of Stay ◽  
Aspiration Pneumonia ◽  
Health Information System ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Empiric Antibiotic Therapy ◽  
Gram Negative ◽  
Empiric Antibiotic ◽  
Icu Transfer

OBJECTIVE: To compare hospital outcomes associated with commonly used antibiotic therapies for aspiration pneumonia in children with neurologic impairment (NI). DESIGN/METHODS: A retrospective study of children with NI hospitalized with aspiration pneumonia at 39 children’s hospitals in the Pediatric Health Information System database. Exposure was empiric antibiotic therapy classified by antimicrobial activity. Outcomes included acute respiratory failure, intensive care unit (ICU) transfer, and hospital length of stay (LOS). Multivariable regression evaluated associations between exposure and outcomes and adjusted for confounders, including medical complexity and acute illness severity. RESULTS: In the adjusted analysis, children receiving Gram-negative coverage alone had two-fold greater odds of respiratory failure (odds ratio [OR] 2.15; 95% CI: 1.41-3.27), greater odds of ICU transfer (OR 1.80; 95% CI: 1.03-3.14), and longer LOS [adjusted rate ratio (RR) 1.28; 95% CI: 1.16-1.41] than those receiving anaerobic coverage alone. Children receiving anaerobic and Gram-negative coverage had higher odds of respiratory failure (OR 1.65; 95% CI: 1.19-2.28) than those receiving anaerobic coverage alone, but ICU transfer (OR 1.15; 95% CI: 0.73-1.80) and length of stay (RR 1.07; 95% CI: 0.98-1.16) did not statistically differ. For children receiving anaerobic, Gram-negative, and P. aeruginosa coverage, LOS was shorter (RR 0.83; 95% CI: 0.76-0.90) than those receiving anaerobic coverage alone; odds of respiratory failure and ICU transfer rates did not significantly differ. CONCLUSIONS: Anaerobic therapy appears to be important in the treatment of aspiration pneumonia in children with NI. While Gram-negative coverage alone was associated with worse outcomes, its addition to anaerobic therapy may not yield improved outcomes.

scholarly journals Impact of a multiplex polymerase chain reaction panel on duration of empiric antibiotic therapy in suspected bacterial meningitis

2021 ◽  
Author(s):  
Justin J Choi ◽  
Lars F Westblade ◽  
Lee S Gottesdiener ◽  
Kyle Liang ◽  
Han A Li ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Multiplex Pcr ◽  
Hospital Length ◽  
Clinical Impact ◽  
Hospital Length Of Stay ◽  
Empiric Antibiotic Therapy ◽  
Chain Reaction ◽  
Empiric Antibiotic ◽  
Polymerase Chain

Abstract Background Multiplex polymerase chain reaction (PCR) panels allow for rapid detection or exclusion of pathogens causing meningitis and encephalitis (ME). The clinical impact of rapid multiplex PCR ME panel results on the duration of empiric antibiotic therapy is not well characterized. Methods We performed a retrospective pre-post study at our institution that evaluated the clinical impact of a multiplex PCR ME panel among adults with suspected bacterial meningitis who received empiric antibiotic therapy and underwent lumbar puncture in the emergency department. The primary outcome was the duration of empiric antibiotic therapy. Results The positive pathogen detection rates were similar between pre- and post-multiplex PCR ME panel periods (17.5%, 24 of 137, vs. 20.3%, 14 of 69, respectively). The median duration of empiric antibiotic therapy was significantly reduced in the post-multiplex PCR ME panel period compared to the pre-multiplex PCR ME panel period (34.7 h vs. 12.3 h, P=0.01). At any point in time, 46% more patients in the post-multiplex PCR ME panel period had empiric antibiotic therapy discontinued or de-escalated compared to the pre-multiplex PCR ME panel period (sex- and immunosuppressant use-adjusted HR 1.46, P=0.01). The median hospital length of stay was shorter in the post-multiplex PCR ME panel period (3 d vs. 4 d, P=0.03). Conclusions The implementation of the multiplex PCR ME panel for bacterial meningitis reduced the duration of empiric antibiotic therapy and possibly hospital length of stay compared to traditional microbiological testing methods.

Routine Nasogastric Decompression in Small Bowel Obstruction: Is it Really Necessary?

2013 ◽  
Vol 79 (4) ◽  
pp. 422-428 ◽  
Author(s):  
Annabelle L. Fonseca ◽  
Kevin M. Schuster ◽  
Adrian A. Maung ◽  
Lewis J. Kaplan ◽  
Kimberly A. Davis
Keyword(s):  
Respiratory Failure ◽  
Small Bowel ◽  
Length Of Stay ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Increased Risk ◽  
Nasogastric Decompression

Bowel rest, nasogastric (NG) decompression, and intravenous hydration are used to treat small bowel obstruction (SBO) conservatively; however, there are no data to support nasogastric tube (NGT) use in patients without active emesis. We aim to evaluate the use of nasogastric decompression in SBO and the safety of managing patients with SBO without the use of a NGT. A retrospective chart review was conducted of adult patients admitted to Yale New Haven Hospital over five years with the diagnosis of SBO. We compared patients who received NG decompression with those who did not. Outcome variables assessed were days to resolution, associated complications, hospital length of stay, and disposition. Of 290 patients who fit the criteria, 190 patients (65.52%) were managed conservatively. Fifty-five patients (18.97%) did not receive NGTs. Sixty-eight patients (23.45%) did not present with emesis; however, nearly 75 per cent of these patients received NGTs. Development of pneumonia and respiratory failure was significantly associated with NGT placement. Time to resolution and hospital length of stay were significantly higher in patients with NGTs. Patients with NG decompression had a significantly increased risk of pneumonia and respiratory failure as well as increased time to resolution and hospital length of stay.

scholarly journals 1043. Evaluation of Early Clinical Failure Criteria for Gram-Negative Bloodstream Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S311-S312
Author(s):  
Hana Rac ◽  
Alyssa Gould ◽  
P Brandon Bookstaver ◽  
Julie Ann Justo ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Bloodstream Infections ◽  
Failure Criteria ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Clinical Failure ◽  
Gram Negative ◽  
Additional Criterion ◽  
Prolonged Hospitalization

Abstract Background Early identification of patients at high risk of morbidity and mortality following Gram-negative bloodstream infections (GN-BSI) based on initial clinical course may prompt adjustments to optimize diagnostic and treatment plans. This retrospective cohort study aims to develop early clinical failure criteria (ECFC) to predict unfavorable outcomes in patients with GN-BSI. Methods Adults with community-onset GN-BSI who survived hospitalization for at least 96 hours at Palmetto Health hospitals in Columbia, SC, USA from January 1, 2010 to June 30, 2015 were identified. Multivariate logistic regression was used to examine association between clinical variables within 72–96 hours of BSI and unfavorable outcomes (28-day mortality or hospital length of stay >14 days). Results Among 766 patients with GN-BSI, 225 (29%) had unfavorable outcomes. After adjustments for Charlson Comorbidity Index and appropriateness of empirical antimicrobial therapy in multivariate model, predictors of unfavorable outcomes included systolic blood pressure <100 mmHg or vasopressor use (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1–2.5), heart rate >100/minute (aOR 1.7, 95% CI 1.1–2.5), respiratory rate ≥22/minute or mechanical ventilation (aOR 2.1, 95% CI 1.4–3.3), altered mental status (aOR 4.5, 95% CI 2.8–7.1), and peripheral WBC count >12 × 103/mm3 (aOR 2.7, 95% CI 1.8–4.1) at 72–96 hours from index BSI. Area under receiver operating characteristic curve of ECFC model in predicting unfavorable outcomes was 0.77 (0.84 and 0.71 in predicting 28-day mortality and prolonged hospitalization separately, respectively). Predicted 28-day mortality increased from 1% in patients with no ECFC to 3%, 7%, 16%, 32%, and 54% in presence of each additional criterion (P < 0.001). Predicted hospital length of stay was 7.5 days in patients without any ECFC and increased by 4.0 days (95% CI 3.1–4.9, P < 0.001) in presence of each additional criterion. Conclusion Risk of 28-day mortality or prolonged hospitalization can be estimated within 72–96 hours of GN-BSI using ECFC. These criteria may have utility in future clinical research in assessing response to antimicrobial therapy based on a standard evidence-based definition of early clinical failure. Disclosures P. B. Bookstaver, CutisPharma: Scientific Advisor, <$1,000. Melinta Therapeutics: Speaker’s Bureau, <$1,000.

Inappropriate antibiotic therapy in Gram-negative sepsis increases hospital length of stay*

2011 ◽  
Vol 39 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Andrew F. Shorr ◽  
Scott T. Micek ◽  
Emily C. Welch ◽  
Joshua A. Doherty ◽  
Richard M. Reichley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Therapy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Gram Negative

scholarly journals Standardized Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure

JAMA ◽  
2016 ◽  
Vol 315 (24) ◽  
pp. 2694 ◽  
Author(s):  
Peter E. Morris ◽  
Michael J. Berry ◽  
D. Clark Files ◽  
J. Clifton Thompson ◽  
Jordan Hauser ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Length Of Stay ◽  
Acute Respiratory Failure ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Multicentre, randomised trial to investigate early nasal high—flow therapy in paediatric acute hypoxaemic respiratory failure: a protocol for a randomised controlled trial—a Paediatric Acute respiratory Intervention Study (PARIS 2)

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030516
Author(s):  
Donna Franklin ◽  
Deborah Shellshear ◽  
Franz E Babl ◽  
Luregn J Schlapbach ◽  
Ed Oakley ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Oxygen Therapy ◽  
Randomised Trial ◽  
Hospital Length ◽  
High Flow ◽  
Hospital Length Of Stay ◽  
Oxygen Requirement ◽  
Tract Infections

IntroductionAcute hypoxaemic respiratory failure (AHRF) in children is the most frequent reason for non-elective hospital admission. During the initial phase, AHRF is a clinical syndrome defined for the purpose of this study by an oxygen requirement and caused by pneumonia, lower respiratory tract infections, asthma or bronchiolitis. Up to 20% of these children with AHRF can rapidly deteriorate requiring non-invasive or invasive ventilation. Nasal high-flow (NHF) therapy has been used by clinicians for oxygen therapy outside intensive care settings to prevent escalation of care. A recent randomised trial in infants with bronchiolitis has shown that NHF therapy reduces the need to escalate therapy. No similar data is available in the older children presenting with AHRF. In this study we aim to investigate in children aged 1 to 4 years presenting with AHRF if early NHF therapy compared with standard-oxygen therapy reduces hospital length of stay and if this is cost-effective compared with standard treatment.Methods and analysisThe study design is an open-labelled randomised multicentre trial comparing early NHF and standard-oxygen therapy and will be stratified by sites and into obstructive and non-obstructive groups. Children aged 1 to 4 years (n=1512) presenting with AHRF to one of the participating emergency departments will be randomly allocated to NHF or standard-oxygen therapy once the eligibility criteria have been met (oxygen requirement with transcutaneous saturation <92%/90% (dependant on hospital standard threshold), diagnosis of AHRF, admission to hospital and tachypnoea ≥35 breaths/min). Children in the standard-oxygen group can receive rescue NHF therapy if escalation is required. The primary outcome is hospital length of stay. Secondary outcomes will include length of oxygen therapy, proportion of intensive care admissions, healthcare resource utilisation and associated costs. Analyses will be conducted on an intention-to-treat basis.Ethics and disseminationEthics approval has been obtained in Australia (HREC/15/QRCH/159) and New Zealand (HDEC 17/NTA/135). The trial commenced recruitment in December 2017. The study findings will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. Authorship of all publications will be decided by mutual consensus of the research team.Trial registration numberACTRN12618000210279

scholarly journals 1471. Evaluation of Antibiotic De-escalation in Post Cardiac Arrest Patients with Culture-Negative versus Culture-Positive Aspiration Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S737-S737
Author(s):  
Natasha R Herzig ◽  
Tara L Harpenau ◽  
Kevin M Wohlfarth ◽  
Alicia M Hochanadel
Keyword(s):  
Cardiac Arrest ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Aspiration Pneumonia ◽  
Antimicrobial Therapy ◽  
Empiric Therapy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Culture Positive ◽  
Culture Negative

Abstract Background Cardiac arrest patients are often empirically treated for aspiration pneumonia with broad-spectrum antibiotics. Previous literature has shown no difference in clinical outcomes when discontinuing antimicrobial therapy for suspected aspiration pneumonia with negative respiratory cultures, but the application is limited in this population. This study aimed to assess antibiotic de-escalation practices for suspected aspiration pneumonia in post cardiac arrest patients with respiratory cultures and explore clinical outcomes. Methods This retrospective cohort conducted at a level 1 trauma center included adult out-of-hospital cardiac arrest patients who received antimicrobial therapy for suspected aspiration pneumonia. The primary endpoint was incidence of antibiotic de-escalation before day seven comparing culture-negative and culture-positive patients. De-escalation included discontinuation of methicillin-resistant Staphylococcus aureus (MRSA) coverage, Pseudomonas aeruginosa coverage, atypical coverage or all antibiotics when respective pathogens were not identified from microbiologic or serologic methods. Secondary endpoints included type of de-escalation and clinical outcomes. Results Eighty-six patients were included: 45 culture-negative and 41 culture-positive. Figure 1 depicts the breakdown of organisms isolated. Guideline-directed empiric therapy was used in 18.6% of patients, with the remainder receiving excessively broad empiric coverage. Antibiotic de-escalation before day seven occurred in 28 (80%) culture-negative patients and 32 (82%) culture-positive patients (p = 0.82), excluding patients who died before day seven. Providers frequently stopped unnecessary MRSA coverage in both groups. In-hospital mortality was higher in the group of patients without antibacterial de-escalation (62% vs. 33%, p=0.03), but hospital length of stay, ICU length of stay, and number of ventilator-free days were not different between groups. Figure 1: Epidemiology of Pathogens Isolated From Respiratory Cultures in Cardiac Arrest Patients Conclusion Culture results were not associated with antibiotic de-escalation in post cardiac arrest patients with suspected aspiration pneumonia. Opportunities exist for further de-escalation in this population, particularly patients with unnecessary pseudomonal coverage. Disclosures All Authors: No reported disclosures

Inappropriate Antibiotic Therapy In Gram-Negative Sepsis Increases Hospital Length Of Stay

2010 ◽  
Author(s):  
Andrew Shorr ◽  
Scott Micek ◽  
Emily Welch ◽  
Joshua Doherty ◽  
Richard Reichley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Therapy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Gram Negative
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