P108: Cannabis hyperemesis syndrome within emergency department users in the Calgary health region: a retrospective analysis

Introduction: Cannabis hyperemesis syndrome (CHS) is associated with long-term, regular use of marijuana. CHS patients typically present to emergency departments (ED) during a hyper-emetic phase of paroxysmal nausea and vomiting. Despite extensive investigations as well as frequent ED presentations, CHS patients have a delayed time to diagnosis, and many are often missed. To date, there is a paucity of research examining CHS in emergency departments. Our objective was to identify CHS cases presenting to EDs within the Calgary health region, and to quantify the number of patients and frequency of ED visits for CHS. Methods: A retrospective chart review was performed on all patients who presented to any Calgary ED or urgent care center between January 1, 2015 and December 31, 2016 (ages 18 55 years) who had an ED discharge diagnosis of either nausea or vomiting alone, nausea with vomiting, or poisoning by cannabis, as identified in administrative data. Data abstraction from medical records was performed by trained personnel using standardized forms with comprehensive inclusion criteria for CHS. Results: The search strategy yielded a total of 320 ED visits from 156 individual patients. 55% of visits were by males, and 45% by females. The average age was 29.5 years. Of the 156 patients, 53% had cannabis use documented in the chart, with 51% reporting daily and/or regular cannabis use. Relief of symptoms from use of hot showers (a pathognomonic finding) was found in 17% of patients. 18% of patients (n=28) met criteria for CHS, and 28% (n=44) met partial criteria for CHS (having documented regular cannabis use, cyclic vomiting and abdominal pain) but no record of symptom resolution with cessation of cannabis use or from the use of hot showers. Patients meeting CHS criteria had an average of five repeat ED visits during the study period with 16% (n=12) of ED visits resulting in hospital admission. Conclusion: We identified a large cohort of patients with confirmed or suspected CHS. Given that nearly one third of the sample met partial criteria for CHS highlights the need for improved patient screening, as it is possible that this cohort may include missed cases. Further, many CHS patients are not responsive to first-line anti-emetics and accurate diagnosis is crucial for managing these patients effectively in the ED. This is of particular importance given the admission rate for CHS and resulting burden on the health system.

Molecular Characteristics of Travel-Related Extended-Spectrum-β-Lactamase-Producing Escherichia coli Isolates from the Calgary Health Region

ABSTRACT Extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli has recently emerged as a major risk factor for community-acquired, travel-related infections in the Calgary Health Region. Molecular characterization was done on isolates associated with infections in returning travelers using isoelectric focusing, PCR, and sequencing for bla CTX-Ms, bla TEMs, bla SHVs, bla OXAs, and plasmid-mediated quinolone resistance determinants. Genetic relatedness was determined with pulsed-field gel electrophoresis using XbaI and multilocus sequence typing (MLST). A total of 105 residents were identified; 6/105 (6%) presented with hospital-acquired infections, 9/105 (9%) with health care-associated community-onset infections, and 90/105 (86%) with community-acquired infections. Seventy-seven of 105 (73%) of the ESBL-producing E. coli isolates were positive for bla CTX-M genes; 55 (58%) produced CTX-M-15, 13 (14%) CTX-M-14, six (6%) CTX-M-24, one (1%) CTX-M-2, one (1%) CTX-M-3, and one (1%) CTX-M-27, while 10 (10%) produced TEM-52, three (3%) TEM-26, 11 (11%) SHV-2, and four (4%) produced SHV-12. Thirty-one (30%) of the ESBL-producing E. coli isolates were positive for aac(6′)-Ib-cr, and one (1%) was positive for qnrS. The majority of the ESBL-producing isolates (n = 95 [90%]) were recovered from urine samples, and 83 (87%) were resistant to ciprofloxacin. The isolation of CTX-M-15 producers belonging to clone ST131 was associated with travel to the Indian subcontinent (India, Pakistan), Africa, the Middle East, and Europe, while clonally unrelated strains of CTX-M-14 and -24 were associated with travel to Asia. Our study suggested that clone ST131 coproducing CTX-M-15, OXA-1, TEM-1, and AAC(6′)-Ib-cr and clonally unrelated CTX-M-14 producers have emerged as important causes of community-acquired, travel-related infections.