Impact of the inpatient infectious disease consultations at a tertiary care university hospital

BACKGROUND: The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting. METHODS: This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit, whenever the antibiotic usage was switched to a mono or bi-therapy. RESULTS: The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6 % of cases and Quinolones discontinuation accounted for 22.7% of cases. CONCLUSION: Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients

COVID-19 in a Patient Treated for Granulomatosis with Polyangiitis: Persistent Viral Shedding with No Cytokine Storm

Introduction: The coronavirus disease COVID-19 is considered a pandemic disease that has developed rapidly all over the world. As of today, it is unclear whether immunosuppression confers an increased risk for pulmonary complications, or conversely, whether it can be a protective factor with respect to a cytokine storm. Case description: We report the case of a 55-year-old male patient with granulomatosis with polyangiitis treated with rituximab who was infected with COVID-19 pneumonia. To the best of our knowledge, only 1 case has been reported in the literature with similar characteristics. The patient had a non-classic evolution of clinical symptoms with persistent fever and viral shedding, in addition to a negative serology.Conclusion: This case emphasizes the management and immunity response to COVID-19 pneumonia in such patients. Data are still needed regarding patients who have prolonged B-cell depletion, which may put the patient at a higher risk for reinfection

Extended spectrum beta lactamase producing Escherichia coli tricuspid valve endocarditis

Escherichia coli is a rare cause of endocarditis. This article reports an 82-year-old male with a mechanical aortic valve replacement who was admitted for fever and fatigue. He was diagnosed with a tricuspid valve endocarditis caused by an extended spectrum beta lactamase producing Escherichia coli following positive blood cultures and echocardiography. He received six weeks of imipenem / cilastatin and subsequently improved and was discharged with ambulatory follow ups with his infectious disease specialist. Keywords: Tricuspid valve endocarditis, Infectious endocarditis, ESBL-producing E. coli, Case report, Imipene

Uncomplicated Streptococcal Bacteremia: The Era of Stepdown to Oral Antibiotic Therapy?

BACKGROUND: The purpose of this study was to compare the clinical outcomes of adults with uncomplicated streptococcal bacteremia who received either oral stepdown (PO) or continued intravenous (IV) therapy. METHODS: This was a retrospective, single-center, cohort study, including adults admitted with Streptococcal bloodstream infection between January 1, 2013, and December 31, 2020. Only patients with uncomplicated Streptococcal bloodstream infections were included. Patients transitioned to oral therapy within 5 days from bacteremia onset were compared to patients receiving continued IV therapy. The primary outcome was clinical failure, defined by either 90-day hospital readmission or mortality. Secondary outcomes included hospital length of stay (LOS) and antibiotic-related adverse events (AAEs). RESULTS: Of the 264 patients included, 42% were transitioned to oral step-down therapy. Group B Streptococcus (22.7%) was the most common isolate. The most common sources of infection were skin and soft tissue (35%) and pulmonary (25%). Intensive care unit stay was more common in the continued IV therapy group (22.2%) compared to the step-down PO group (5.4%). The frequency of clinical failure was similar in continued IV therapy and step-down PO (24.2% vs 18.0%, p= 0.23). The IV group had longer LOS (median, [IQR]) compared to the PO group (7 [5-13.5] vs 4 [3-5] days, p\u3c 0.001). AAEs were similar between the two groups (1.3% vs 1.8%, p=0.74). CONCLUSION: Stepdown to oral therapy may be appropriate for the treatment of uncomplicated Streptococcal bacteremia with consideration of factors such as patient comorbidities, type of infection, source control and clinical progress

Investigating infectious outcomes in adult patients undergoing solid organ transplantation: A retrospective single-center experience, Paris, France

OBJECTIVES: This study described the demographic characteristics, clinical presentation, treatment, and outcomes of solid organ transplant recipients who were admitted to our center for infection. It also determined factors associated with a poor outcome, and compares early and late period infections. METHODS: In this retrospective observational study, conducted at a tertiary care center in France between October 2017 and March 2019, infectious outcomes of patients with solid organ transplant where studied. RESULTS: A total of 104 patients were included with 158 hospitalizations for infection. Among these 104 patients, 71 (68%) were men. The median age was 59 years old. The most common symptoms on admission were fever (66%) and chills (31%). Lower respiratory tract infections were the most common diagnosis (71/158 hospitalizations). Urinary tract infections were frequently seen in kidney transplant recipients (25/60 hospitalizations). One or more infectious agents were isolated for 113 hospitalizations (72%): 70 bacteria, 36 viruses and 10 fungi, with predominance of gram-negative bacilli (53 cases) of which 13 were multidrug-resistant. The most frequently used antibiotics were third generation cephalosporins (40 cases), followed by piperacillin-tazobactam (26 cases). We note that 25 infections (16%) occurred during the first 6 months (early post-transplant period). Patients admitted during the early post-transplant period were more often on immunosuppressive treatment with prednisone (25/25 VS 106/133) (p = 0.01), mycophenolic acid (22/25 VS 86/133) (p = 0.03), presented for an urinary tract infection (10/25 VS 25/133) (p = 0.04) or a bacterial infection (17/25 VS 53/133) (p = 0.01). Patients with later infection had more comorbidities (57/83 VS 9/21) (p = 0.03), cancer (19/83 VS 0/21) (p = 0.04) or were on treatment with everolimus (46/133 VS 0/25) (p = 0.001). During 31 hospitalizations (20%), patients presented with a serious infection requiring intensive care (n = 26; 16%) or leading to death (n = 7; 4%). Bacteremia, pulmonary and cardiac complications were the main risk factors associated with poor outcome. CONCLUSION: Infections pose a significant challenge in the care of solid organ transplant patients, particularly those with comorbidities and intensive immunosuppression. This underscores the crucial importance of continuous surveillance and epidemiologic monitoring within this patient population

Univariate analysis of the association between the measured variables and death or ICU admission.

Univariate analysis of the association between the measured variables and death or ICU admission.</p