Annuradha K. Persaud

Adults Hospitalized With Pneumonia in the United States: Incidence, Epidemiology, and Mortality

Background Understanding the burden of community-acquired pneumonia (CAP) is critical to allocate resources for prevention, management, and research. The objectives of this study were to define incidence, epidemiology, and mortality of adult patients hospitalized with CAP in the city of Louisville, and to estimate burden of CAP in the US adult population. Methods This was a prospective population-based cohort study of adult residents in Louisville, Kentucky, from 1 June 2014 to 31 May 2016. Consecutive hospitalized patients with CAP were enrolled at all adult hospitals in Louisville. The annual population-based CAP incidence was calculated. Geospatial epidemiology was used to define ecological associations among CAP and income level, race, and age. Mortality was evaluated during hospitalization and at 30 days, 6 months, and 1 year after hospitalization. Results During the 2-year study, from a Louisville population of 587499 adults, 186384 hospitalizations occurred. A total of 7449 unique patients hospitalized with CAP were documented. The annual age-adjusted incidence was 649 patients hospitalized with CAP per 100000 adults (95% confidence interval, 628.2-669.8), corresponding to 1591825 annual adult CAP hospitalizations in the United States. Clusters of CAP cases were found in areas with low-income and black/African American populations. Mortality during hospitalization was 6.5%, corresponding to 102821 annual deaths in the United States. Mortality at 30 days, 6 months, and 1 year was 13.0%, 23.4%, and 30.6%, respectively. Conclusions The estimated US burden of CAP is substantial, with >1.5 million unique adults being hospitalized annually, 100000 deaths occurring during hospitalization, and approximately 1 of 3 patients hospitalized with CAP dying within 1 year.

Enteral nutrition as stress ulcer prophylaxis in critically ill patients: A randomized controlled exploratory study

Purpose: We investigated whether early enteral nutrition alone may be sufficient prophylaxis against stress‐related gastrointestinal (GI) bleeding in mechanically ventilated patients. Materials and methods: Prospective, double blind, randomized, placebo‐controlled, exploratory study that included mechanically ventilated patients in medical ICUs of two academic hospitals. Intravenous pantoprazole and early enteral nutrition were compared to placebo and early enteral nutrition as stress‐ulcer prophylaxis. The incidences of clinically significant and overt GI bleeding were compared in the two groups. Results: 124 patients were enrolled in the study. After exclusion of 22 patients, 102 patients were included in analysis: 55 patients in the treatment group and 47 patients in the placebo group. Two patients (one from each group) showed signs of overt GI bleeding (overall incidence 1.96%), and both patients experienced a drop of >3 points in hematocrit in a 24‐hour period indicating a clinically significant GI bleed. There was no statistical significant difference in the incidence of overt or significant GI bleeding between groups (p = 0.99). Conclusion: We found no benefit when pantoprazole is added to early enteral nutrition in mechanically ventilated critically ill patients. The routine prescription of acid‐suppressive therapy in critically ill patients who tolerate early enteral nutrition warrants further evaluation. Highlights:GI bleeding has low incidence in the critically ill mechanically ventilated patients.Adding PPI to enteral nutrition may not offer an added prophylaxis against stress‐related GI bleeding.Our study supports the protective role of enteral nutrition in ICU.

Methods for computational disease surveillance in infection prevention and control: Statistical process control versus Twitter's anomaly and breakout detection algorithms

HighlightsWe compared traditional Statistical Process Control (SPC) charts with novel Anomaly/Breakout Detection (ABD) charts using Twitters Anomaly and Breakout detection algorithms for detecting out of control or anomalous HAI data.ABD charts appeared to work better than SPC charts in the context of seasonality and autocorrelation, two well‐known statistical issues with HAI data.These new charts may be useful for trending of HAI data and for other quality improvement data monitoring.An open‐access web application is provided for users to apply their own datasets to generate ABD and SPC charts. Background: Although not all health care‐associated infections (HAIs) are preventable, reducing HAIs through targeted intervention is key to a successful infection prevention program. To identify areas in need of targeted intervention, robust statistical methods must be used when analyzing surveillance data. The objective of this study was to compare and contrast statistical process control (SPC) charts with Twitters anomaly and breakout detection algorithms. Methods: SPC and anomaly/breakout detection (ABD) charts were created for vancomycin‐resistant Enterococcus, Acinetobacter baumannii, catheter‐associated urinary tract infection, and central line‐associated bloodstream infection data. Results: Both SPC and ABD charts detected similar data points as anomalous/out of control on most charts. The vancomycin‐resistant Enterococcus ABD chart detected an extra anomalous point that appeared to be higher than the same time period in prior years. Using a small subset of the central line‐associated bloodstream infection data, the ABD chart was able to detect anomalies where the SPC chart was not. Discussion: SPC charts and ABD charts both performed well, although ABD charts appeared to work better in the context of seasonal variation and autocorrelation. Conclusions: Because they account for common statistical issues in HAI data, ABD charts may be useful for practitioners for analysis of HAI surveillance data.

Antibiotic Timing and Outcomes in Sepsis 1 1Disclosures: No financial or other conflicts of interest to disclose.

Background: We evaluated the effect of time spent in the emergency department (ED) and process of care on mortality and length of hospital stay in patients with sepsis or septic shock. Methods: An observational cohort study was conducted on 117 patients who came through the University of Louisville Hospital ED and subsequently were directly admitted to the intensive care unit (ICU). Variables of interest were time in the ED from triage to physical transport to the ICU, from triage to antibiotic(s) ordered, and from triage to antibiotic(s) administered. Expected mortality was calculated according to the University Health System Consortium Database. Primary and secondary outcomes were in‐hospital death and hospital length of stay in days, respectively. Results: We found no significant association between time in the ED and mortality between survivors and nonsurvivors (5.5 versus 5.7 hours, P = 0.804). After adjusting for expected mortality, a 22% increase in mortality risk was found for each hour delay from triage to antibiotic(s) ordered; a 15% increase in mortality risk was observed for each hour from triage to antibiotic(s) given. Both time from triage to antibiotic(s) ordered (hazard ratio [HR] = 0.8, P = 0.044) and time from triage to antibiotic(s) delivery (HR = 0.79, P = 0.0092) were independently associated with an increased hospital stay (HR = 0.79, P = 0.0092). Conclusion: Though no significant association between mortality and ED time was demonstrated, we observed a significant increase in mortality in septic patients with both delays in antibiotic(s) order and administration. Delay in care also resulted in increased hospital stays both overall and in the ICU.