Effect of COVID-19 Infection on HeartCare, Data from the SHORE Multicenter Registry

Purpose

Transplant patients represent a cohort in which COVID-19 (C19) may stimulate an unpredictable clinical course. The aim of this study was to evaluate the impact of C19 infection on AlloMap gene expression profiling (AM) and AlloSure donor derived cell free DNA (AS) results in patients post heart transplant.

Methods

The Surveillance Using HeartCare Outcomes Registry (SHORE) is a multicenter study for post heart transplant patients followed with AM/AS for 5 years. Patients enrolled were analyzed based on C19 . AM/AS were evaluated before, at the time and following infection. Both individual trends and the differences between the median AS and AS levels were studied. Nonparametric tests were used to assess categorical and longitudinal variables.

Results

21 patients developed C19 infection; 16 (76%) were males, median age 50 years. There was no significant difference in AM or AS in stable patients (no rejection, CAV, graft dysfunction, dnDSA) compared to the first AM/AS profile in the C19+ patients, Figure 1. Event rates in C19+ patients are described in Table 1. 12 C19+ patients had 28 biopsies, 2 of which were within 30 days of C19. 1 patient had ACR 2R and another AMR 1; all other biopsies were <ACR 2R/AMR1. Additionally, 5 patients developed dnDSA and 7 patients developed subsequent CMV viremia, a median of 67 and 158 days after C19 diagnosis, respectively. No CAV, graft dysfunction, or deaths were reported in this small group of C19+ patients.

Conclusion

The presence of C19 infection is not associated with a significant increase in AS or AM scores, suggesting AS and AM are not confounded by C19 and can be used safely as non-invasive surveillance in this population.

Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity

OBJECTIVE

The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates.

METHODS

Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees.

RESULTS

Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation.

CONCLUSION

Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.

Incidence of healthcare-associated infections with invasive devices and surgical procedures in Nepal

SETTING

Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal.

OBJECTIVES

1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures.

DESIGN

This was a cohort study using secondary data (December 2017 to April 2018).

RESULTS

Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9-6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, P = 0.02). The most common HAI bacteria (n = 70) were Escherichia coli (44.3%), Enterococcus spp. (22.9%) and Klebsiella spp. (11.4%). Of 98 CAIs with 41 isolates, E. coli (36.6%), Staphylococcus aureus (22.0%) and methicillin-resistant S. aureus (14.6%) were common.

CONCLUSION

We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.

1592 An Audit on Prophylactic Prescribing for Third Molar Surgery

Introduction

Over-prescription of antibiotics gives rise to problems including increased risk of adverse antimicrobial reaction and antimicrobial resistance. Despite this, the ‘routine’ prescription of prophylactic antibiotics following lower third molar removal (LTMR) remains common practice. The current body of evidence shows minimal to no statistically significant difference in the incidence of postoperative infection between prescribing and withholding prophylactic antibiotics for LTMR in healthy individuals. There is currently no published guidance on appropriate antibiotic usage following LTMR.

Method

A single centred, retrospective review of 100 successive patients undergoing LTMR. In the absence of current guidance, standards of specific criteria to justify antibiotic prophylaxis were formed. Primary outcome measures included appropriate prescription of prophylactic antibiotics, and record of clinical indication for antibiotic prescription. Following dissemination of results and implementation of suggested improvements, a 2nd audit cycle has commenced.

Results

Cycle 1 (n = 100) (Nov 2019 - April 2020) 52% of patients received prophylactic antibiotics following LTMR. Only 9% had a clear appropriate justification for use. 27% of antibiotics were not prescribed in accordance with BNF or SDCEP guidance. There were 0 postoperative infections within this cohort.

Conclusions

Over-prescription of antibiotic prophylaxis with inadequate documented justification for use is clear. All clinicians have a duty to consider the rising incidence of antimicrobial resistance and reflect this in their practice. The use of prophylactic systemic antibiotics in LTMR should be limited to cases where it may be deemed to show clinical benefit in patient best interest on both an individual and community scale.

Corrigendum to: Canadian Paediatric Society 92nd Annual Conference: Abstracts-79: Withholding Feeds During Blood Transfusion and Risk of Transfusion Associated Necrotizing Enterocolitis (TANEC)

[This corrects the article DOI: 10.1093/pch/20.5.e62a.].

Trends in maternal mortality in India over two decades in nationally representative surveys

OBJECTIVE

To assess national and regional trends and causes-specific distribution of maternal mortality in India.

DESIGN

Nationally representative cross-sectional surveys.

SETTING

All of India from 1997 to 2020.

SAMPLE

About 10 000 maternal deaths among 4.3 million live births over two decades.

METHODS

We analysed trends in the maternal mortality ratio (MMR) from 1997 through 2020, estimated absolute maternal deaths and examined the causes of maternal death using nationally representative data sources. We partitioned female deaths (aged 15-49 years) and live birth totals, based on the 2001-2014 Million Death Study to United Nations (UN) demographic totals for the country.

MAIN OUTCOME MEASURES

Maternal mortality burden and distribution of causes.

RESULTS

The MMR declined in India by about 70% from 398/100 000 live births (95% CI 378-417) in 1997-98 to 99/100 000 (90-108) in 2020. About 1.30 million (95% CI 1.26-1.35 million) maternal deaths occurred between 1997 and 2020, with about 23 800 (95% CI 21 700-26 000) in 2020, with most occurring in poorer states (63%) and among women aged 20-29 years (58%). The MMRs for Assam (215), Uttar Pradesh/Uttarakhand (192) and Madhya Pradesh/Chhattisgarh (170) were highest, surpassing India's 2016-2018 estimate of 113 (95% CI 103-123). After adjustment for education and other variables, the risks of maternal death were highest in rural and tribal areas of north-eastern and northern states. The leading causes of maternal death were obstetric haemorrhage (47%; higher in poorer states), pregnancy-related infection (12%) and hypertensive disorders of pregnancy (7%).

CONCLUSIONS

India could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not.

TWEETABLE ABSTRACT

We estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind.