Sasima Tongsai

The safety of early versus late ambulation in the management of patients after percutaneous coronary interventions: A meta-analysis

OBJECTIVE Early ambulation after percutaneous coronary intervention (PCI) could increase patient comfort, decrease length of hospital stay, and reduce the costs. However, this approach may increase the risk of vascular complications and has not been well assessed. This study was conducted to assess the safety of early ambulation versus late ambulation by combining the study results on safety in patients undergoing PCI. MATERIALS AND METHODS Studies were identified via five electronic databases, hand search and grey literature databases up to December 2011. We performed a meta-analysis of five randomized controlled trials to compare the safety of early versus late ambulation in the treatment of cardiac patients undergoing PCI. Of 1854 patients, 1083 were assigned to an early ambulation (range: 2-4 h of bed rest time) and 771 were assigned to late ambulation (range: 6-10 h of bed rest time). RESULTS There was no evidence that early ambulation was more harmful than late ambulation in terms of haematoma or bleeding event. The pooled relative risk (RR) of haematoma was 0.82 (95% CI, 0.53-1.28) and bleeding, 1.77 (95% CI, 0.87-3.59). A funnel plot showed minimal evidence of publication bias for haematoma event. CONCLUSIONS The results of this first meta-analysis indicated that early ambulation after PCI was not associated with an increased risk of haematoma or bleeding. This study also confirmed the findings of the included studies recommending reducing the bed rest time from 6-10 h to 2-4 h after removal of the arterial sheath, and supporting early mobilization.

Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease

Background Preoperative embolization (PE) may decrease intraoperative blood loss (IBL) in decompressive surgery of hypervascular spinal metastases. However, no consensus has been found in other metastases and no meta-analysis which reviewed the benefit of PE in spinal metastases has been conducted. Objective To assess IBL in spinal metastases surgery in a randomized controlled trial (RCT) and cohort studies comparing PE and a control group of non-embolized patients. Methods A systematic search of relevant publications in PubMed and EMBASE was undertaken. Inclusion criteria were RCTs and observational studies in patients with spinal metastases who underwent spine surgery and reported IBL. Meta-analysis was performed using standardized mean difference (SMD) and mean difference (MD) of IBL. Heterogeneity was assessed using the I2 statistic. Results A total of 265 abstracts (126 from PubMed and 139 from Embase) were identified through database searching. The reviewers selected six studies for qualitative synthesis and meta-analysis. The pooled SMD of the included studies was 0.58 (95% CI −0.10 to 1.25, p=0.09). Sensitivity analysis revealed that, if the study by Rehak et al was omitted, the pooled SMD was significantly changed to 0.88 (95% CI 0.39 to 1.36, p<0.001) and PE reduced the IBL significantly. The pooled MD was 708.3 mL (95% CI −224.4 to 1640.9 mL, p=0.14). If the results of the Rehak et al study were omitted, the pooled MD was significantly changed to 1226.9 mL (95% CI 345.8 to 2108.1 mL, p=0.006). Conclusions PE can be effective in reducing IBL in spinal metastases surgery in both renal cell carcinoma and mixed primary tumor groups.

Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia

Affi liations: From the Division of Clinical Science, St. George’s University of London. Financial/nonfi nancial disclosures: The author has reported to CHEST the following confl icts of interest: Dr Jones has received consulting fees and speakers honoraria from GlaxoSmithKline. Correspondence to: Paul W. Jones, PhD, Division of Clinical Science, St. George’s University of London, Cranmer Terr, London, SW17 0RE, England; e-mail: pjones@sgul.ac.uk

Epidemiology and risk factors of extensively drug-resistant Pseudomonas aeruginosa infections

Background The incidence of nosocomial infections from extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality. Methods We retrospectively studied a cohort of adult, hospitalized patients with P. aeruginosa (PA) infections between April and December 2014. Results Of the 255 patients with PA infections, 56 (22%) were due to XDR-PA, 32 (12.5%) to multidrug resistant Pseudomonas aeruginosa (MDR-PA), and 167 (65.5%) to non-MDR PA. Receiving total parenteral nutrition (adjusted OR [aOR] 6.21; 95% CI 1.05–36.70), prior carbapenem use (aOR 4.88; 95% CI 2.36–10.08), and prior fluoroquinolone use (aOR 3.38; 95% CI 1.44–7.97) were independently associated with the XDR-PA infections. All XDR-PA remained susceptible to colistin. Factors associated with mortality attributable to the infections were the presence of sepsis/septic shock (aOR 11.60; 95% CI 4.66–28.82), admission to a medical department (aOR 4.67; 95% CI 1.81–12.06), receiving a central venous catheter (aOR 3.78; 95% CI 1.50–9.57), and XDR-PA infection (aOR 2.73; 95% CI 1.05–7.08). Conclusion The prevalence of XDR-PA infections represented almost a quarter of Pseudomonas aeruginosa hospital-acquired infections and rendered a higher mortality. The prompt administration of an appropriate empirical antibiotic should be considered when an XDR-PA infection is suspected.

FT09. Factors Influencing Favorable Outcome and Persistent Infection of Endovascular Aneurysm Repair for Infected Abdominal Aortic Aneurysm

underwent in situ aortic reconstructions (48% abdominal aortic, 52% aortoiliac) using CAAs for infective aortic aneurysm (n 1⁄4 25 [66%]) and aortic prosthesis infection (n 1⁄4 13 [34%]). Among them, four (10.5%) patients presented with aortoenteric fistula. There were four (10.5%) early (<30 days) and seven (18%) late postoperative deaths during the follow-up period (median, 13.6 months; range, 1-72 months). Early mortality was attributed to CAA rupture, whereas late mortality was not related to an aorta-related cause. Four (10.5%) GRCs developed during the follow-up period; these included thrombotic iliac limb occlusion (n 1⁄4 1), aneurysmal dilation of CAA (n1⁄4 1), aortoenteric fistula (n 1⁄4 1) after fall down injury, and graft rupture (n 1⁄4 1). Patient survival and event-free survival rates at 3 years were 77% and 64%, respectively. Conclusions: In situ abdominal aortic reconstruction with CAA showed good results for patients with primary or secondary aortic infection even in immunocompromised patients. Although aorta-related mortality usually developed in the early postoperative period, postoperative surveillance of CAA is recommended to detect GRCs.

Prevalence and accuracy of screening test of asymptomatic bacteriuria during pregnancy in Siriraj Hospital

Abstract Background The early detection and treatment asymptomatic bacteriuria (ASB) during pregnancy prevents maternal and fetal complication. Thus the American College of OB-GYN recommends urine culture should be obtained at the first prenatal visit and the U.S. Preventive Services Task Force obtains urine culture during 12–16 weeks of gestation. The new antenatal care (ANC) model of Thai Ministry of Public Health uses screening at first ANC by urine dipstick. However, neither research nor routine ASB screen in Siriraj Hospital because there was low prevalence and all pregnancy been screened by the obstetricians. Methods Prospective cohort study was performed at the ANC clinic, OB-GYN department, Siriraj Hospital. Pregnancies of first antenatal care visit during January to December 2015 were enrolled. Urine culture (UC), Urine dipstick for nitrite (UDN), and Urine dipstick for leukocyte esterase (UDL), were performed. Subjects’ baseline characteristics until birth delivery were collected. Results Total 702 subjects were enrolled; median age, 28 yrs (range 16–45) and body mass index, 24.1 (range 14.0–44.3). The ASB prevalence was 2.3% (16 from 702) without significant difference between first, second, and thirdtrimester, P = 0.185. The most common organism was E. coli. Factors related to ASB were heart disease,
P < 0.001 and having sexual intercourse during pregnancy, P = 0.005. The sensitivity and specificity of UDN and UDL were 37.5% and 99.0% and 56.3% and 55.7%, respectively. Positive predictive value and negative predictive value of UDN and UDL were 46.2% and 2.9% and 98.5% and 98.2%, respectively. No abnormal maternal and fetal outcomes were reported. Conclusion According to very low prevalence of ASB in Siriraj hospital, routine urine culture may be unnecessary for all antenatal pregnancy. However, heart disease and sexual intercourse during pregnancy should be considered for screening and treatment. However, further evaluation of outcome, i.e. UTI, maternal and fetal complication of non-screening for ASB should be studied. Disclosures All authors: No reported disclosures.

Serological Response of Patients with Influenza A (H1N1) pdm09-Associated Pneumonia: An Observational Study

Background Little is known about the dynamics or magnitude of antibody response in patients with influenza A (H1N1) pdm09-associated pneumonia. We described and compared the antibody response to influenza A (H1N1) pdm09 in patients with and without pneumonia. Methods We collected serum samples and determined antibody titers by the hemagglutination inhibition (HI) and microneutralization (mNT) assays from patients with RT-PCR confirmed influenza A (H1N1) pdm09 virus at baseline, 1, 2 and 6 months after onset of illness. Results Fifty-nine patients were enrolled, 45 (76.3%) were between 15 and 60 years of age, 49 (83.1%) were hospitalized and 25 (42.4%) had complications with pneumonia. Ninety-four percent of patients had HI titers ≥ 1: 40 and 90% had mNT titers ≥ 1: 160 at 2 months after illness. Geometric mean titers (GMT) of HI and mNT increased significantly (p<0.001) between baseline and months 1 or 2, then declined significantly (p<0.001) at month 6 by the HI assay, but dropped to an insignificant level (p=0.24) by the mNT assay. The mNT-GMT was at least twice as high as corresponding HI antibodies over a 6 month period. The GMT of HI and mNT in those with pneumonia (1 mo) peaked earlier than that of those without pneumonia (2 mo). When adjusted by age and gender, those with pneumonia had a higher HI-GMT than those without pneumonia at 1 month (264 vs. 117, p=0.007), 2 months (212 vs. 159, p=0.013), and 6 months (160 vs. 82, p=0.018). Conclusions The patients recovered from influenza A (H1N1) pdm09-associated pneumonia, clearly developed an earlier and more robust antibody response until 6 months after onset of illness. The results in our study are useful to determine an appropriate donor and timing to obtain convalescent plasma for adjunctive treatment of seriously ill patients with pandemic H1N1 influenza.