32 research outputs found
Infectious disease physician characteristics and prescription of meropenem in the hospital
Abstract
Objective:
Physician characteristics may be correlated with medical treatment decisions and patient outcomes. This study examined the correlations between characteristics of infectious disease (ID) physicians and the use of the restricted antimicrobial meropenem.
Design:
This was a retrospective cohort study following 27 attending ID physicians for 5 years at a large academic medical center.
Methods:
All inpatient ID clinical encounters between 2013 and 2018 were assessed for physician and patient characteristics, including patient Charlson Comorbidity Index, patient sex, ID service seeing the patient, physician career stage, physician training location, and physician sex. Adjusted and unadjusted odds ratios were calculated for the receipt of meropenem on the same day as an ID clinical note.
Results:
Between 2013 and 2018, meropenem was administered on the same day as 9046 (11.1%) of 81,787 inpatient ID encounters. After adjustment for patient and practice-specific factors, physician career stage was associated with administration of meropenem. Patients seen by mid-career and late-career ID physicians were more likely to receive meropenem than those seen by early-career physicians (aOR 1.22 95% confidence interval [CI 1.13–1.31 and aOR 1.17 95% CI 1.10–1.25, respectively).
Conclusions:
ID provider characteristics may help target future antimicrobial stewardship program interventions
Imported Haycocknema perplexum Infection, United States
We report an imported case of myositis caused by a rare parasite, Haycocknema perplexum, in Australia in a 37-year-old man who had progressive facial, axial, and limb weakness, dysphagia, dysphonia, increased levels of creatine kinase and hepatic aminotransferases, and peripheral eosinophilia for 8 years. He was given extended, high-dose albendazole. © 2022 Centers for Disease Control and Prevention (CDC). All rights reserved
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
Body temperature and infection in critically ill patients on continuous kidney replacement therapy
Abstract Purpose Continuous kidney replacement therapy (CKRT) is an increasingly common intervention for critically ill patients with kidney failure. Because CKRT affects body temperature, detecting infections in patients on CKRT is challenging. Understanding the relation between CKRT and body temperature may facilitate earlier detection of infection. Methods We retrospectively reviewed adult patients (≥ 18 years) admitted to the intensive care unit at Mayo Clinic in Rochester, Minnesota, from December 1, 2006, through November 31, 2015, who required CKRT. We summarized central body temperatures for these patients according to the presence or absence of infection. Results We identified 587 patients who underwent CKRT during the study period, of whom 365 had infections, and 222 did not have infections. We observed no statistically significant differences in minimum (P = .70), maximum (P = .22), or mean (P = .55) central body temperature for patients on CKRT with infection vs. those without infection. While not on CKRT (before CKRT initiation and after cessation), all three body temperature measurements were significantly higher in patients with infection than in those without infection (all P < .02). Conclusion Body temperature is insufficient to indicate an infection in critically ill patients on CKRT. Clinicians should remain watchful for other signs, symptoms, and indications of infection in patients on CKRT because of expected high infection rates
Automating Quality Metrics in the Era of Electronic Medical Records: Digital Signatures for Ventilator Bundle Compliance
Ventilator-associated events (VAEs) are associated with
increased risk of poor outcomes, including
death. Bundle practices including
thromboembolism prophylaxis, stress ulcer
prophylaxis, oral care, and daily sedation
breaks and spontaneous breathing trials aim to
reduce rates of VAEs and are endorsed as quality
metrics in the intensive care units. We sought
to create electronic search algorithms (digital
signatures) to evaluate compliance with
ventilator bundle components as the first step
in a larger project evaluating the ventilator
bundle effect on VAE. We developed digital
signatures of bundle compliance using a
retrospective cohort of 542 ICU patients from
2010 for derivation and validation and testing
of signature accuracy from a cohort of random
100 patients from 2012. Accuracy was evaluated
against manual chart review. Overall, digital
signatures performed well, with median
sensitivity of 100% (range,
94.4%–100%) and median
specificity of 100% (range,
100%–99.8%). Automated ascertainment
from electronic medical records accurately
assesses ventilator bundle compliance and can be
used for quality reporting and research in
VAE