1
|
Moon R, Tien A, Chung J, Pinnelas R, Lee R, Hwang J, Brasfield F, Sahota A. Safety and Efficacy of Intramuscular Tixagevimab-Cilgavimab in Prevention of COVID-19 in Patients Who Are Immunocompromised. Perm J 2023; 27:44-54. [PMID: 37718610 PMCID: PMC10723093 DOI: 10.7812/tpp/22.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Patients who are immunocompromised face an increased chance of severe COVID-19 infection compared with patients who are immunocompetent. However, vaccine efficacy for COVID-19 appears to be lower in patients who are immunocompromised. Tixagevimab-cilgavimab are monoclonal antibodies designed to enhance immune defense against COVID-19. Nevertheless, the safety and efficacy of tixagevimab-cilgavimab specifically in patients who are immunocompromised remains unknown. METHODS The authors conducted a retrospective case study of patients who were immunocompromised and received tixagevimab-cilgavimab between January 3, 2022 to July 31, 2022 at Kaiser Permanente Southern California. All patients were monitored for 180 days following tixagevimab-cilgavimab administration. Patients who were immunocompromised included those with solid tumors, hematologic malignancies, primary immunodeficiencies, recipients of solid organ or hematopoietic stem cell transplants, and patients undergoing treatment with immunosuppressive medications (eg, chemotherapy, high-dose corticosteroids, tumor necrosis factor blockers, and certain biologic agents). RESULTS A total of 2352 patients who were immunocompromised were included in the study. Among them, 101 patients (4.3%) tested positive for COVID-19, and 13 patients (0.6%) required COVID-19-related hospital admissions. Notably, no deaths were reported within 180 days following tixagevimab-cilgavimab administration. Additionally, 4 patients (0.17%) sought same-day medical care after receiving tixagevimab-cilgavimab. Within 30 days, there were 39 non-COVID-19-related hospital admissions (1.7%) and within 7 days, 11 hospital admissions (0.5%) occurred after tixagevimab-cilgavimab administration. DISCUSSION Tixagevimab-cilgavimab demonstrated a low incidence of COVID-19 and COVID-19-related hospital admissions in patients who were immunocompromised, with no reported mortality. Furthermore, there were no significant adverse effects associated with the use of these monoclonal antibodies. CONCLUSION Tixagevimab-cilgavimab exhibited a low incidence of COVID-19 and adverse effects in patients who were immunocompromised.
Collapse
Affiliation(s)
- Rebecca Moon
- Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Andy Tien
- Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Joanie Chung
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Rebecca Pinnelas
- Department of Cardiology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - Roland Lee
- Department of Nephrology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - Jennifer Hwang
- Department of Pulmonology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - Farah Brasfield
- Department of Hematology & Oncology, Anaheim Medical Center, Southern California Permanente Medical Group, Orange County, CA, USA
| | - Amandeep Sahota
- Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| |
Collapse
|
2
|
Slocker-Barrio M, López-Herce-Cid J, Bustinza-Arriortúa A, Fresán-Ruiz E, Jordán-García I, de Carlos-Vicente JC, Morteruel-Arizcuren E, García-Soler P, Nieto-Moro M, Schüffelmann C, Belda-Hofheinz S, Herrera-Castillo LX, Uriona-Tuma SM, Pinós-Tella L, Peña-López Y. Increase in Incidence Rates and Risk Factors for Multidrug Resistant Bacteria in Septic Children: A Nationwide Spanish Cohort Study (2013-2019). Antibiotics (Basel) 2023; 12:1626. [PMID: 37998828 PMCID: PMC10669462 DOI: 10.3390/antibiotics12111626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
The emergence of multidrug-resistant (MDR) bacteria in children is a growing concern, particularly among septic patients, given the need for first-right dosing. Our aim was to determine the incidence rates and factors associated with MDR-sepsis in the pediatric intensive care unit (PICU), using data from the Spanish ENVIN-HELICS PICU registry between 2013 and 2019. The rate of MDR bacteria among septic children ranged between 5.8 and 16.2% throughout this study period, with a significant increase since 2015 (p = 0.013). MDR-gram-negative bacteria (92%), particularly EBL-Enterobacterales (63.7%), were the most frequent causative microorganisms of MDR-sepsis. During this study period, sixteen MDR-sepsis (32.6%) corresponded to intrahospital infections, and 33 (67.4%) had community-onset sepsis, accounting for 10.5% of the overall community-onset sepsis. Independent risk factors associated with MDR-sepsis were antibiotics 48 h prior to PICU admission (OR 2.38) and PICU onset of sepsis (OR 2.58) in >1 year-old children, and previous malnourishment (OR 4.99) in <1 year-old children. Conclusions: There was an alarming increase in MDR among septic children in Spain, mainly by gram-negative (ESBL-Enterobacterales), mostly coming from the community setting. Malnourished infants and children on antibiotics 48 h prior to PICU are at increased risk and therefore require closer surveillance.
Collapse
Affiliation(s)
- María Slocker-Barrio
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (J.L.-H.-C.); (A.B.-A.); (L.X.H.-C.)
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0011, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Gregorio Marañón Biomedical Research Institute, 28009 Madrid, Spain
| | - Jesús López-Herce-Cid
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (J.L.-H.-C.); (A.B.-A.); (L.X.H.-C.)
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0011, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Gregorio Marañón Biomedical Research Institute, 28009 Madrid, Spain
- Mother and Child and Public Health Department, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Amaya Bustinza-Arriortúa
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (J.L.-H.-C.); (A.B.-A.); (L.X.H.-C.)
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0011, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Gregorio Marañón Biomedical Research Institute, 28009 Madrid, Spain
| | - Elena Fresán-Ruiz
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (E.F.-R.); (I.J.-G.)
| | - Iolanda Jordán-García
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (E.F.-R.); (I.J.-G.)
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain
- Consortium of Biomedical Research Network for Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | | | | | | | | | | | | | - Laura Ximena Herrera-Castillo
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (J.L.-H.-C.); (A.B.-A.); (L.X.H.-C.)
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0011, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Gregorio Marañón Biomedical Research Institute, 28009 Madrid, Spain
| | - Sonia María Uriona-Tuma
- Preventive Medicine and Public Health, ENVIN-HELICS Registry Administration, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (S.M.U.-T.); (L.P.-T.)
| | - Laia Pinós-Tella
- Preventive Medicine and Public Health, ENVIN-HELICS Registry Administration, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (S.M.U.-T.); (L.P.-T.)
| | - Yolanda Peña-López
- Pediatric Intensive Care Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
- Vall d’Hebron Institute of Research, 08035 Barcelona, Spain
- University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | | |
Collapse
|
3
|
Protus M, Uchytilova E, Indrova V, Lelito J, Viklicky O, Hruba P, Kieslichova E. Sepsis affects kidney graft function and one-year mortality of the recipients in contrast with systemic inflammatory response. Front Med (Lausanne) 2022; 9:923524. [PMID: 35966839 PMCID: PMC9372308 DOI: 10.3389/fmed.2022.923524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Infections remain a major cause of morbidity and mortality after kidney transplantation. The aim of our study was to determine the effect of sepsis on kidney graft function and recipient mortality. Methods A prospective, observational, single-center study was performed. Selected clinical and biochemical parameters were recorded and compared between an experimental group (with sepsis, n = 34) and a control group (with systemic inflammatory response syndrome, n = 31) comprising kidney allograft recipients. Results Sepsis worsened both patient (HR = 14.77, p = 0.007) and graft survival (HR = 15.07, p = 0.007). Overall one-year mortality was associated with age (HR = 1.08, p = 0.048), APACHE II score (HR = 1.13, p = 0.035), and combination immunosuppression therapy (HR = 0.1, p = 0.006), while graft survival was associated with APACHE II (HR = 1.25, p = 0.004) and immunosuppression. In sepsis patients, mortality correlated with the maximal dose of noradrenalin (HR = 100.96, p = 0.008), fungal infection (HR = 5.64, p = 0.024), SAPS II score (HR = 1.06, p = 0.033), and mechanical ventilation (HR = 5.97, p = 0.033), while graft survival was influenced by renal replacement therapy (HR = 21.16, p = 0.005), APACHE II (HR = 1.19, p = 0.035), and duration of mechanical ventilation (HR = 1.01, p = 0.015). Conclusion In contrast with systemic inflammatory response syndrome, septic kidney allograft injury is associated with early graft loss and may represent a significant risk of mortality.
Collapse
Affiliation(s)
- Marek Protus
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Eva Uchytilova
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Veronika Indrova
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Jan Lelito
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Ondrej Viklicky
- First Faculty of Medicine, Charles University, Prague, Czechia
- Department of Nephrology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Petra Hruba
- Transplantation Laboratory, Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Eva Kieslichova
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czechia
- First Faculty of Medicine, Charles University, Prague, Czechia
- *Correspondence: Eva Kieslichova,
| |
Collapse
|
4
|
Wagh H, Arif A, Reddy AJ, Tabaie E, Shekhar A, Min M, Nawathey N, Bachir M, Brahmbhatt H. Assessing the Efficacy of Alkylating Agent Regimens in the Treatment of Infantile Malignant Osteopetrosis: Cyclophosphamide, Busulfan, or Thiotepa. Cureus 2022; 14:e26600. [PMID: 35936184 PMCID: PMC9354912 DOI: 10.7759/cureus.26600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/25/2022] Open
Abstract
Infantile malignant osteopetrosis is a debilitating disease that requires total bone marrow irradiation and transplant procedures for patients to survive. The major complication of this procedure is graft vs host disease (GVHD), followed by infections and end organ toxicity. Therefore, current research efforts into treatment mainly aim to reduce GVHD while limiting infections and organ toxicity. Different regimens of alkylating agents have been used to try to reduce GVHD. The most common regimen is cyclophosphamide (Cy) with busulfan (Bu), followed by Cy with Bu and thiotepa (Thio). This meta-analysis aimed to evaluate the efficacy of different treatments by comparing mortality and morbidity causes and rates across groups. The mean one-year survival rate for the Cy, Bu, Thio regimen studies in the human leukocyte antigen (HLA) unmatched group (45.01%) was statistically lower than the one-year survival rate for the studies using just a Cy, Bu regimen (70.8%) in the HLA unmatched studies (p<0.00142). The one-year survival in the studies which had HLA-matched donors was 80.56%, which is statistically higher (p<0.001) than the one-year survival in the HLA-unmatched studies (53.96%), indicating a benefit of finding HLA-matched donors. It seems that price and availability could be a factor in the widespread use of Cy.
Collapse
|
5
|
Aliyu S, McGowan K, Hussain D, Kanawati L, Ruiz M, Yohannes S. Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital. J Intensive Care Med 2021; 37:565-571. [PMID: 33938320 DOI: 10.1177/08850666211014450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The prevalence of multi-drug resistant organism (MDRO) colonization in nursing home residents has been well documented, but little is known about the impact of MDRO bloodstream infections (BSIs). The aim of this study was to assess the prevalence, cost, and outcomes of MDRO-BSI vs. non-MDRO-BSI among nursing home residents. DESIGN Retrospective cohort study. SETTING 960 bed tertiary academic medical center. PATIENTS Persons ≥18 years old admitted to an acute care tertiary hospital from Skilled Nursing Facilities with a diagnosis of sepsis between 2015 and 2018. INTERVENTIONS Retrospective analysis of prevalence and outcomes. MEASUREMENTS AND MAIN RESULTS Among patients admitted to the study hospital with a diagnosis of sepsis during the study period, 7% were from nursing homes. The prevalence of MDRO-BSI was 47%. We identified 54 (50%) gram positive BSIs, 48 (45%) gram negative BSI and 5 (5%) fungal BSI. Thirty-one (57%) of the gram-positive infections and 14 (30%) of the gram-negative infections were with MDROs. The prevalence of BSI organisms were Staphylococcus aureus in 24%, Escherichia coli in 14%, Proteus mirabilis in 13%, Staphylococcus epidermidis in 8%, Enterococcus faecalis in 7%, and Klebsiella pneumoniae in 6%. We found that intensive care unit length of stay (7 days vs 5 days, P = .009), direct cost ($13,639 vs $9,922, P = .027), and total cost ($23,752 vs $17,900 P = .032) were significantly higher in patients with MDRO-BSI vs. non-MDRO-BSI. Patients with MDRO-BSI were twice as likely to receive inappropriate empiric antiinfective therapy (31% vs 16%, P = .006) and were more likely to die (49.1% vs 29.6%, P = .049). CONCLUSION Nursing home residents have a high prevalence of MDRO-BSI, which is associated with higher risk of receiving inappropriate initial anti-infective therapy, higher cost, higher ICU LOS, and higher mortality. Our research adds new information about the prevalence of fungemia in this population.
Collapse
Affiliation(s)
- Sainfer Aliyu
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Kevin McGowan
- Georgetown University School of Medicine, Washington, DC, USA
| | - Dilbi Hussain
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Lama Kanawati
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Maria Ruiz
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Seife Yohannes
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
6
|
A Multimodal Sepsis Quality-Improvement Initiative Including 24/7 Screening and a Dedicated Sepsis Response Team-Reduced Readmissions and Mortality. Crit Care Explor 2020; 2:e0251. [PMID: 33251514 PMCID: PMC7688252 DOI: 10.1097/cce.0000000000000251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives To evaluate if a hospitalwide sepsis performance improvement initiative improves compliance with the Centers for Medicare and Medicaid Services-mandated sepsis bundle interventions and patient outcomes. Study Design Retrospective analysis comparing 6 months before and 14 months after intervention. Setting Tertiary teaching hospital in Washington, DC. Subjects Patients admitted with a diagnosis of sepsis to a tertiary hospital. Interventions Implementation of a multimodal quality-improvement initiative. Measurements and Main Results A total of 4,102 patients were diagnosed with sepsis, severe sepsis, or septic shock during the study period, 861 patients (21%) were diagnosed during a 6-month preintervention period, and 3,241 (79%) were diagnosed in a 13-month postintervention period. Adjusted for patient case-mix, the prevalence of simple sepsis increased by 12%, but it decreased for severe sepsis and septic shock by 5.3% and 6.9%, respectively. Compliance with all sepsis bundle interventions increased by 31.1 percentage points (p < 0.01). All-cause hospital readmission and readmission due to infection were both reduced by 1.6% and 1.7 percentage points (p < 0.05). Death from any sepsis diagnosis was reduced 4.5% (p < 0.01). Death from severe sepsis and septic shock both was reduced by 5% (p < 0.01) and 6.5% (p < 0.01), respectively. Conclusions After the implementation of multimodal sepsis performance initiatives, we observed a higher prevalence of sepsis secondary to screening but a lower prevalence of severe sepsis and septic shock, an improvement in compliance with the sepsis bundle interventions bundle, as well as reduction in hospital readmission and all- cause mortality rate.
Collapse
|
7
|
Kabi A, Mohanty A, Kumar SK, Singh V, Jha MK, Gupta P. Clinical spectrum and risk factors for hospital-acquired septicemia in a tertiary care centre of North-East India. J Family Med Prim Care 2020; 9:3949-3954. [PMID: 33110792 PMCID: PMC7586596 DOI: 10.4103/jfmpc.jfmpc_469_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction: Although several studies have shown an increasing prevalence of sepsis due to multidrug-resistant organisms, specific data on hospital-acquired septicemia is lacking. Materials and Methods: An observational prospective study was carried out for a duration of 1 year in which patients developing hospital-acquired septicemia were included and their disease spectrum and associated risk factors were analyzed. Results: Among a total of 350 patients, 145 came out to be culture positive. Genitourinary infections were the most common infections encountered in this study, whereas the presence of invasive device came out to be the most prevalent risk factor. Conclusion: Septicemia is still a rising problem; hence, we should manage it carefully. Coagulase-negative Staphylococci can no longer be considered as contaminants and it should be treated as pathogens.
Collapse
Affiliation(s)
- Ankita Kabi
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Aroop Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shyam Kishor Kumar
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vanya Singh
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mithilesh Kumar Jha
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pratima Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
8
|
Salzberger B, Hitzenbichler F, Hanses F. [Treatment of infections in the critically ill under immunosuppression : What must be considered?]. Z Rheumatol 2019; 78:940-946. [PMID: 31538231 DOI: 10.1007/s00393-019-00706-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Patients under immunosuppressive treatment have a much higher risk for severe infections and sepsis. The morbidity and mortality of severe infections in critically ill patients are high but the prognosis is not different from immunocompetent patients if diagnosed early and treated adequately, especially in high volume centers. A high level of clinical alertness for infectious complications is essential for rapid and adequate diagnosis and treatment. The established principles for treatment of sepsis are also valid for immunocompromized patients, i.e. rapid initiation of antibiotic treatment, focal control and rapid supportive treatment according to the current guidelines on sepsis. In patients with the corresponding clinical signs and not responding to initial empirical treatment, opportunistic infections as rare causes of sepsis have to be taken into account. To prevent development or selection of resistance due to broad spectrum treatment, the empirical treatment should always focus on the specific pathogen detected.
Collapse
Affiliation(s)
- Bernd Salzberger
- Abt. Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Florian Hitzenbichler
- Abt. Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Frank Hanses
- Abt. Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.,Interdisziplinäre Notaufnahme, Universitätsklinikum Regensburg, Regensburg, Deutschland
| |
Collapse
|
9
|
Dalal RS, Vajravelu RK, Lewis JD, Lichtenstein GR. Hospitalization Outcomes for Inflammatory Bowel Disease in Teaching vs Nonteaching Hospitals. Inflamm Bowel Dis 2019; 25:1974-1982. [PMID: 31039244 DOI: 10.1093/ibd/izz089] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hospitalizations contribute significantly to the annual health care expenditure for inflammatory bowel disease (IBD), and reducing cost of care without compromising outcomes is a rising priority. Teaching hospitals (THs) have higher costs and utilize trainees in care to a greater extent than community hospitals, and it is unknown how hospital teaching status (HTS) affects outcomes. We therefore sought to investigate the impact of HTS on IBD hospitalization outcomes. METHODS We used the Vizient clinical database to identify patients hospitalized between October 1, 2014, and March 31, 2018, for IBD. Vizient hospitals were divided into major THs, minor THs, and non-THs. We used multivariable linear regression of aggregated discharge data to assess the association of HTS with mean length of stay (LOS), mean direct cost (DC), 30-day readmission rate (RR), and in-hospital mortality rate (MR), while adjusting for demographics and disease complexity. RESULTS Vizient included 29,863 discharges among 291 hospitals for ulcerative colitis (UC) and 62,698 discharges among 314 hospitals for Crohn's disease (CD) between October 1, 2014, and March 31, 2018. Unadjusted mean LOS, mean DC, and 30-day RR were greater among THs for both UC and CD. Unadjusted MR was greater among major THs for UC but not CD. After multivariable analysis, only 30-day RR for UC was increased in major THs relative to non-THs (1.98%; 95% confidence interval, 0.33%-3.61%). CONCLUSIONS Differences in metrics of cost-effective hospital care for patients with IBD appear to be driven by disease severity rather than HTS. Future research should attempt to better characterize factors driving resource utilization for IBD hospitalizations.
Collapse
Affiliation(s)
- Rahul S Dalal
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ravy K Vajravelu
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Lewis
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary R Lichtenstein
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
10
|
Immunosuppression and Heterogeneity in the Sepsis Volume-Outcome Relationship. Ann Am Thorac Soc 2019; 15:916-918. [PMID: 30067099 DOI: 10.1513/annalsats.201805-344ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
11
|
Douglas IS, Bednash JS, Fein DG, Mallampalli RK, Mansoori JN, Gershengorn HB. Update in Critical Care and Acute Respiratory Distress Syndrome 2018. Am J Respir Crit Care Med 2019; 199:1335-1343. [PMID: 30958975 DOI: 10.1164/rccm.201903-0550up] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Ivor S Douglas
- 1 Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado
| | - Joseph S Bednash
- 2 Acute Lung Injury Center of Excellence, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Rama K Mallampalli
- 4 Department of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Jason N Mansoori
- 1 Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado
| | - Hayley B Gershengorn
- 5 Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| |
Collapse
|
12
|
Kadan-Lottick N, Essau CA, Jayne D, Lyon S, Gulliford M. 55th ERA-EDTA Congress Copenhagen, Denmark, 24-27 May. Br J Hosp Med (Lond) 2018; 79:368-371. [PMID: 29995547 DOI: 10.12968/hmed.2018.79.7.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nina Kadan-Lottick
- Associate Professor of Pediatrics, Leader, Pediatric Oncology Clinical Trials, Section of Pediatric Hematology-Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Cecilia A Essau
- Professor of Developmental Psychopathology, Department of Psychology, Roehampton University, London
| | - David Jayne
- Professor of Clinical Autoimmunity, University of Cambridge, Cambridge
| | | | | |
Collapse
|