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Antibiotic stewardship in small community hospital.

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Antibiotic stewardship in small community hospital.
Chest. 2014 Mar 1;145(3 Suppl):146A
Authors: Udeani G, Surani S
Abstract
SESSION TITLE: Respiratory Infections PostersSESSION TYPE: Poster …

Impact of Antimicrobial Stewardship Program (ASP) on Patients With Pneumonia.

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Impact of Antimicrobial Stewardship Program (ASP) on Patients With Pneumonia.

Chest. 2013 Oct 1;144(4_MeetingAbstracts):261A

Authors: Liew Y, Piotr C, Lee W, Tay D, Lee LW, Kwa AL

Abstract
SESSION TITLE: Respiratory Infections PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM – 02:30 PMPURPOSE: Pneumonia is one of the most common infectious diagnoses encountered in clinical practice and one of the leading causes of death. Adherence to antibiotic treatment guidelines is inconsistent and the erroneous diagnosis of pneumonia and misuse of antibiotics is common. We aim to evaluate if ASP can improve outcomes for hospitalized patients with pneumonia.METHODS: We conducted a retrospective review of the ASP database of all patients with pneumonia, and our ASP had recommended changes in antibiotic regimen from 1st September 2011 to 28th February 2013. We compared clinical outcomes between two groups of patients: patients whose physicians accepted and those whose physicians rejected ASP interventions.RESULTS: A total of 5296 patients were audited from 1st September 2011 to 28th February 2013. Of which 891 interventions were made to deescalate antibiotics based on cultures, narrowing of empirical choice of antibiotics, discontinuation of antibiotics and conversion of intravenous to oral antibiotics. Out of 251 patients in the rejected group, 45 (18%) died due to infection while 52 patients (8%) of 640 patients in the accepted group died due to infection in the accepted group. Mortality due to infection was statistically significantly lower in the accepted group when compared to rejected group (p<0.01). Out of the 733 patients who survived, 13 patients in the rejected group (n=185) were readmitted due to infection while 55 patients in the accepted group (n=548). Readmission due to infection was not statistically significant between the 2 groups (p=0.24). Two patients had 14-day re-infection in accepted group (n=29) while no patients in the rejected group had a 14 day re-infection. Mean duration of hospitalization was 10±21 days in the accepted group and 14±20 days in the rejected group. Duration of hospitalization was statistically significant shorter in the accepted vs rejected group (p=0.14).CONCLUSIONS: ASP has been demonstrated to be safe in reducing mortality and hospitalization stay in patients with pneumoniaCLINICAL IMPLICATIONS: ASP can be applied to the management of pneumonia to optimize management while maintaining or improving the quality of patient outcomes, benefiting both healthcare systems and patients.DISCLOSURE: The following authors have nothing to disclose: Yixin Liew, Chlebicki Piotr, Winnie Lee, Daniel Tay, Lai Wei Lee, Andrea Lay Hoon KwaNo Product/Research Disclosure Information.

PMID: 24153661 [PubMed – as supplied by publisher]

Chronic Pulmonary Thromboembolism.

Chronic Pulmonary Thromboembolism.

Chest. 2013 Oct 1;144(4_MeetingAbstracts):312A

Authors: Korapati S

Abstract
SESSION TITLE: Critical Care Global Case ReportsSESSION TYPE: Global Case ReportPRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM – 02:30 PMINTRODUCTION: Objectives of this case report are To recognize Chronic Pulmonary Thromboembolism To identify the underlying factors for its origin To understand the approach to its managementCASE PRESENTATION: 41 year old male presented to the ER with complaints of increasing lower extremity edema, that has now extended to involve his scrotum, abdominal wall and back. Patient has had bilateral lower extremity edema since 7 months. He was found to have bilateral DVTs and was treated for massive PE three months ago with TPA. He was sent home on anticoagulation and after IVC filter placement. Non resolution and instead increase in edema since discharge brought him back to the ER. Echocardiogram done showed elevated PA pressures at 105 mm of Hg, which is double of the last PA pressure reading, at the time of initial PE. Septal flattening was noted indicating right ventricular strain. CTA revealed interval increase in thrombus burden. INR at the time was noted to be 3.4. Patients oxygen saturations were 94 on room air, tachypnea and tachycardia were present. Polycythemia was recognized as new finding since his discharge which required phlebotomies during the admission. Work up revealed elevated erythropoietin and negative JAK mutation favoring a secondary cause like hypoxia secondary to chronic pulmonary embolism as a cause. CT abdomen was done to rule out malignancy involving the kidney or liver as a cause of the polycythemia. It came back within normal limits. Past medical history is significant for sarcoidosis on treatment with prednisone 15mg daily, methotrexate and bactrim prophylaxis since 1 year, history of exposure to beryllium with two negative blood lymphocyte proliferation tests and one negative BAL lymphocyte proliferation test, cavitary lung lesions with serology positive for aspergillosis on treatment with posaconazole. Social history is significant for traveling 1000 miles a week as part of his job as a salesman. No history of tobacco use. Family history reveals no bleeding or clotting disorders in the family. He is currently being evaluated for possible pulmonary endarterectomy or lung transplantation. Hypercoagulation panel pending.DISCUSSION: The natural history of acute pulmonary embolism is near-total resolution with minimal residual abnormalities; however, a minority of patients will develop chronic thromboembolic pulmonary hypertension. Several studies suggest that an underlying hypercoagulable state may be responsible in some patients. Diagnostic criteria are that Pulmonary hypertension must be present, defined as a mean pulmonary arterial pressure (PAP) ≥25 mmHg at rest in the absence of an elevated pulmonary capillary wedge pressure (ie, PCWP is ≤15 mmHg) and thromboembolic occlusion of the proximal or distal pulmonary vasculature must exist and be the presumed cause of the pulmonary hypertension. Surgery is the only definitive therapy for CTEPH.CONCLUSIONS: Chronic pulmonary thromboembolism occurs in about one percent of patients following acute PE. Recognize any underlying hyper coagulable state. Surgery is the only definitive therapy and it should not be delayed.Reference #1: Chronic thromboembolic pulmonary hypertension, Am J Respir Crit Care Med 2011 uptodateDISCLOSURE: The following authors have nothing to disclose: Sowmya KorapatiNo Product/Research Disclosure Information.

PMID: 24153718 [PubMed – as supplied by publisher]