111 research outputs found
Accurate detection of sepsis at ED triage using machine learning with clinical natural language processing
Sepsis is a life-threatening condition with organ dysfunction and is a
leading cause of death and critical illness worldwide. Accurate detection of
sepsis during emergency department triage would allow early initiation of lab
analysis, antibiotic administration, and other sepsis treatment protocols. The
purpose of this study was to determine whether EHR data can be extracted and
synthesized with the latest machine learning algorithms (KATE Sepsis) and
clinical natural language processing to produce accurate sepsis models, and
compare KATE Sepsis performance with existing sepsis screening protocols, such
as SIRS and qSOFA. A machine learning model (KATE Sepsis) was developed using
patient encounters with triage data from 16 participating hospitals. KATE
Sepsis, SIRS, standard screening (SIRS with source of infection) and qSOFA were
tested in three settings. Cohort-A was a retrospective analysis on medical
records from a single Site 1. Cohort-B was a prospective analysis of Site 1.
Cohort-C was a retrospective analysis on Site 1 with 15 additional sites.
Across all cohorts, KATE Sepsis demonstrates an AUC of 0.94-0.963 with
73-74.87% TPR and 3.76-7.17% FPR. Standard screening demonstrates an AUC of
0.682-0.726 with 39.39-51.19% TPR and 2.9-6.02% FPR. The qSOFA protocol
demonstrates an AUC of 0.544-0.56, with 10.52-13.18% TPR and 1.22-1.68% FPR.
For severe sepsis, across all cohorts, KATE Sepsis demonstrates an AUC of
0.935-0.972 with 70-82.26% TPR and 4.64-8.62% FPR. For septic shock, across all
cohorts, KATE Sepsis demonstrates an AUC of 0.96-0.981 with 85.71-89.66% TPR
and 4.85-8.8% FPR. SIRS, standard screening, and qSOFA demonstrate low AUC and
TPR for severe sepsis and septic shock detection. KATE Sepsis provided
substantially better sepsis detection performance in triage than commonly used
screening protocols.Comment: 35 pages, 1 figure, 6 tables, 7 supplementary table
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C. difficile Screening for Colonization among Surgical Ward Admissions Is Feasible and Useful
Abstract Background: Identification of patients colonized with C. difficile (CDcol) upon admission and initiation of precautions has been shown to decrease hospital-acquired C. difficileinfection (HA-CDI) in a recent study. We implemented a quality improvement program screening new admissions to a surgical service and evaluated risk factors and outcomes associated with CDcol. Methods: Prospective cohort of all patients admitted to the surgical wards including ICU over a 6 month period 10/16â4/17. Upon admission, a perirectal swab was sent for C diff PCR. Patients with positive screens were placed on contact precautions. CDcol patients were not treated. Testing for CDI was done as usual practice only in patients with diarrhea. Main outcome was prevalence of CDcol and relationship to HA-CDI. Results: Of 708 surgical admissions, 585 (82.6%) patients were screened, 543 were eligible based on first admission; 19 (3.5%) were colonized. Recent surgical hospitalization (OR 13.2, 95% CI 3.4;52.1) and prior CDI (OR 19.5, 95% CI 2.9;127.7) were independent risk factors for CDcol. Antibiotic and PPI use were not associated. Of those with CDcol, 7 developed CDI (36.8%) compared with 5/524 (0.9%) screen negative patients (adj OR 60, 95% CI 12.6;286). CDcol combined with a prior h/o CDI allowed for detection of 8/12 (75%) cases of HA-CDI compared with 3/12 (25%) if only prior history was available. HA-CDI rates on surgical wards after one month post-implementation were 9.3/10,000 bed days of care compared with 12.2 in 2016 and 12.8 in 2015. No delays in bed flow were identified. Conclusion: Admission CDcol prevalence was low in our surgical VA population but was strongly associated with development of HA-CDI. Prior CDI was the strongest risk factor for CDcol and HA-CDI. Knowledge of prior CDI and CDcol status identified 75% of patients who developed CDI, 3 times more than knowledge of prior CDI alone. In certain settings, CDcol screening could improve detection and early isolation of potential CDiff spreaders. Implementation required significant support from administration, nursing and the laboratory, and was successful based on screening percentage without impact on bed flow. Impact on facility CDI rates remains to be fully demonstrated. Disclosures All authors: No reported disclosures
Clostridium difficile ribotype diversity at six health care institutions in the United States
Capillary-based PCR ribotyping was used to quantify the presence/absence and relative abundance of 98 Clostridium difficile ribotypes from clinical cases of disease at health care institutions in six states of the United States. Regionally important ribotypes were identified, and institutions in close proximity did not necessarily share more ribotype diversity than institutions that were farther apart
2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients
In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.Peer reviewe
Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)
Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs
The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey
Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe
WSES guidelines for management of Clostridium difficile infection in surgical patients
In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients
WSES guidelines for management of Clostridium difficile infection in surgical patients
In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.Peer reviewe
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