Pub Date : 2023-10-06DOI: 10.1097/ipc.0000000000001301
Kristin E. Mondy, Rama Thyagarajan, H. Stephen Han, Brian Lee
Abstract Hemophagocytic lymphohistiocytosis (HLH) is characterized by uncontrolled activation of macrophages and phagocytosis of hematopoietic cells. Recognition and treatment are often delayed in infectious triggers of HLH because of lack of rapid and reliable diagnostic modalities, as well as the need for invasive tissue sampling. We report a rare case of Bartonella -induced HLH in a kidney transplant patient who presented with fever of unknown origin. The diagnosis was expedited with next-generation sequencing of microbial cell-free DNA. We also describe the successful treatment outcome with antibiotics alone and the promising utility of this newer diagnostic method.
{"title":"Rapid Diagnosis of Bartonella-Induced Hemophagocytic Lymphohistiocytosis Using Next-Generation Sequencing of Plasma","authors":"Kristin E. Mondy, Rama Thyagarajan, H. Stephen Han, Brian Lee","doi":"10.1097/ipc.0000000000001301","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001301","url":null,"abstract":"Abstract Hemophagocytic lymphohistiocytosis (HLH) is characterized by uncontrolled activation of macrophages and phagocytosis of hematopoietic cells. Recognition and treatment are often delayed in infectious triggers of HLH because of lack of rapid and reliable diagnostic modalities, as well as the need for invasive tissue sampling. We report a rare case of Bartonella -induced HLH in a kidney transplant patient who presented with fever of unknown origin. The diagnosis was expedited with next-generation sequencing of microbial cell-free DNA. We also describe the successful treatment outcome with antibiotics alone and the promising utility of this newer diagnostic method.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134945452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A 20-Day Course of Nirmatrelvir/r in a Young Man Newly Diagnosed With Acquired Immunodeficiency Syndrome Carrying Persistent Omicron BA.2 Infection","authors":"Giuseppe Bruno, Claudia Fabrizio, Marilina Tampoia, Maria Chironna, Giovanni Battista Buccoliero","doi":"10.1097/ipc.0000000000001291","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001291","url":null,"abstract":"Bruno, Giuseppe MD; Fabrizio, Claudia MD; Tampoia, Marilina MD; Chironna, Maria PhD; Buccoliero, Giovanni Battista MD Author Information","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134945315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.1097/ipc.0000000000001296
Adrián Sousa, Olalla Lima, Alexandre Pérez-González, Alejandro Araujo, Rebeca Longueira, Antón Otero, Marta Núñez, Cristina Ramos, Lucía Martínez-Lamas, Manuel Crespo-Casal, Martin Rubianes, María Teresa Pérez-Rodríguez
Introduction Corticosteroids have been thoroughly used in the treatment of COVID-19. The aim of the study was to analyze the impact of methylprednisolone pulse on in-hospital mortality of patients with acute respiratory distress syndrome (ARDS) due to COVID-19. Methods We conducted a retrospective, single-center observational study. We selected adult patients admitted to the hospital with the diagnosis of COVID-19 between March and June 2020. Cox regression was used to identify the factors associated with in-hospital mortality. Results A total of 306 patients were analyzed. In-hospital crude mortality rate was 17%. Diabetes mellitus (hazard ratio [HR], 5.5; 95% confidence interval [CI], 1.40–4.55), dementia (HR, 7.7; 95% CI, 4.25–13.87) and ARDS (HR, 4.2; 95% CI, 2.34–7.46) were associated with in-hospital mortality. In patients with ARDS diagnosis, the only in-hospital mortality risk factor was dementia (HR, 5.2; 95% CI, 2.44–11.07), whereas methylprednisolone pulse was a protective factor (HR, 0.2; 95% CI, 0.09–0.63). In the follow-up, 40% of patients had some symptom related to COVID-19. Conclusions Methylprednisolone pulse reduced the in-hospital mortality in patients with ARDS due to COVID-19. A high percentage of patients presented persistent symptoms in 90 days after the hospital discharge.
{"title":"Impact of Methylprednisolone Pulse on the Mortality of Patients With Acute Respiratory Distress Syndrome Secondary to COVID-19","authors":"Adrián Sousa, Olalla Lima, Alexandre Pérez-González, Alejandro Araujo, Rebeca Longueira, Antón Otero, Marta Núñez, Cristina Ramos, Lucía Martínez-Lamas, Manuel Crespo-Casal, Martin Rubianes, María Teresa Pérez-Rodríguez","doi":"10.1097/ipc.0000000000001296","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001296","url":null,"abstract":"Introduction Corticosteroids have been thoroughly used in the treatment of COVID-19. The aim of the study was to analyze the impact of methylprednisolone pulse on in-hospital mortality of patients with acute respiratory distress syndrome (ARDS) due to COVID-19. Methods We conducted a retrospective, single-center observational study. We selected adult patients admitted to the hospital with the diagnosis of COVID-19 between March and June 2020. Cox regression was used to identify the factors associated with in-hospital mortality. Results A total of 306 patients were analyzed. In-hospital crude mortality rate was 17%. Diabetes mellitus (hazard ratio [HR], 5.5; 95% confidence interval [CI], 1.40–4.55), dementia (HR, 7.7; 95% CI, 4.25–13.87) and ARDS (HR, 4.2; 95% CI, 2.34–7.46) were associated with in-hospital mortality. In patients with ARDS diagnosis, the only in-hospital mortality risk factor was dementia (HR, 5.2; 95% CI, 2.44–11.07), whereas methylprednisolone pulse was a protective factor (HR, 0.2; 95% CI, 0.09–0.63). In the follow-up, 40% of patients had some symptom related to COVID-19. Conclusions Methylprednisolone pulse reduced the in-hospital mortality in patients with ARDS due to COVID-19. A high percentage of patients presented persistent symptoms in 90 days after the hospital discharge.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135815491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.1097/ipc.0000000000001294
Nicole Hitchcock, Robin Trotman
Abstract Whipple disease (WD) is a rare condition caused by infection with Tropheryma whipplei , a ubiquitous bacterium whose detailed pathogenesis has yet to be elucidated. Its vague defining symptoms of polyarthralgia, weight loss, diarrhea, and abdominal pain do not lend themselves to a rapid diagnosis. The importance of considering WD in a differential diagnosis and recognizing the many manifestations of the condition must not be underestimated. Inadequate or delayed diagnosis can have a significant impact on morbidity and mortality. In this report, we describe 2 cases of classic WD, including representative imaging and histopathology, that were diagnosed almost simultaneously in 2 unrelated adult residents of Southwest Missouri.
{"title":"Whipple Disease in 2 Southwest Missouri Patients","authors":"Nicole Hitchcock, Robin Trotman","doi":"10.1097/ipc.0000000000001294","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001294","url":null,"abstract":"Abstract Whipple disease (WD) is a rare condition caused by infection with Tropheryma whipplei , a ubiquitous bacterium whose detailed pathogenesis has yet to be elucidated. Its vague defining symptoms of polyarthralgia, weight loss, diarrhea, and abdominal pain do not lend themselves to a rapid diagnosis. The importance of considering WD in a differential diagnosis and recognizing the many manifestations of the condition must not be underestimated. Inadequate or delayed diagnosis can have a significant impact on morbidity and mortality. In this report, we describe 2 cases of classic WD, including representative imaging and histopathology, that were diagnosed almost simultaneously in 2 unrelated adult residents of Southwest Missouri.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135858996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.1097/ipc.0000000000001292
Mohammed Ahmed Hamad, Zahra Taati Moghadam, Majid Taati Moghadam
Hamad, Mohammed Ahmed PharmD; Moghadam, Zahra Taati BSc; Moghadam, Majid Taati PhD Author Information
Hamad, Mohammed Ahmed PharmD; Moghadam, Zahra Taati BSc; Moghadam, Majid Taati PhD 作者信息
{"title":"Telemedicine, eHealth, and Telehealth Assistance for Patients With Immunodeficiency in the Waves of COVID-19 With New Variants of the Virus","authors":"Mohammed Ahmed Hamad, Zahra Taati Moghadam, Majid Taati Moghadam","doi":"10.1097/ipc.0000000000001292","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001292","url":null,"abstract":"Hamad, Mohammed Ahmed PharmD; Moghadam, Zahra Taati BSc; Moghadam, Majid Taati PhD Author Information","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135815499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.1097/ipc.0000000000001308
Charles M. Kopp, Nasim C. Sobhani, Barbara Baker, Kenneth Tapia, Rupali Jain, Jane Hitti, Alison C. Roxby
Abstract Women who are pregnant and living with human immunodeficiency virus (HIV) have traditionally been excluded from clinical trials regarding new pharmacotherapy. Immediate initiation of antiretroviral therapy is recommended for women who are pregnant and living with HIV. Integrase strand inhibitors (INSTIs) are first-line recommended agents because they lead to more rapid HIV viral load reduction. We conducted a retrospective study of women who are pregnant and living with HIV who received prenatal care at the University of Washington. Mothers were categorized by antiretroviral therapy class: INSTI, protease inhibitors, and nonnucleoside reverse transcriptase inhibitors. χ 2 and t tests were used for the analysis of baseline characteristics, and generalized estimating equations were used to adjust for HIV viral suppression between groups. There were a total of 234 mother-infant pairs whose pregnancies progressed beyond 20 weeks. The study demonstrated that women on INSTI regimens were more likely to have a shorter time to viral load suppression than women on nonnucleoside reverse transcriptase inhibitor regimens. In addition, 7 congenital anomalies were identified in this cohort, none of which were neural tube defects. There was no perinatal transmission of HIV to any of the infants. This small cohort of women provides high-quality data regarding the safety and efficacy of INSTI use for both mothers and infants in resource-rich settings.
{"title":"Antiretroviral Regimen and Pregnancy Outcomes of Women Living With Human Immunodeficiency Virus in a US Cohort","authors":"Charles M. Kopp, Nasim C. Sobhani, Barbara Baker, Kenneth Tapia, Rupali Jain, Jane Hitti, Alison C. Roxby","doi":"10.1097/ipc.0000000000001308","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001308","url":null,"abstract":"Abstract Women who are pregnant and living with human immunodeficiency virus (HIV) have traditionally been excluded from clinical trials regarding new pharmacotherapy. Immediate initiation of antiretroviral therapy is recommended for women who are pregnant and living with HIV. Integrase strand inhibitors (INSTIs) are first-line recommended agents because they lead to more rapid HIV viral load reduction. We conducted a retrospective study of women who are pregnant and living with HIV who received prenatal care at the University of Washington. Mothers were categorized by antiretroviral therapy class: INSTI, protease inhibitors, and nonnucleoside reverse transcriptase inhibitors. χ 2 and t tests were used for the analysis of baseline characteristics, and generalized estimating equations were used to adjust for HIV viral suppression between groups. There were a total of 234 mother-infant pairs whose pregnancies progressed beyond 20 weeks. The study demonstrated that women on INSTI regimens were more likely to have a shorter time to viral load suppression than women on nonnucleoside reverse transcriptase inhibitor regimens. In addition, 7 congenital anomalies were identified in this cohort, none of which were neural tube defects. There was no perinatal transmission of HIV to any of the infants. This small cohort of women provides high-quality data regarding the safety and efficacy of INSTI use for both mothers and infants in resource-rich settings.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135770029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/ipc.0000000000001311
Kritika Srinivasan Rajsri, Mana Rao
From the ∗Department of Molecular Pathobiology, New York University College of Dentistry †Department of Pathology, New York University School of Medicine, New York ‡Essen Medical Associates, Bronx §ArchCare, New York, NY. Correspondence to: Mana Rao, MD, ArchCare, 205 Lexington Ave, 3rd Floor, New York, NY 10016. E-mail: [email protected]. The authors have no funding or conflicts of interest to disclose.
来自纽约大学牙科学院*分子病理生物学系†纽约大学医学院病理学系Essen Medical Associates, Bronx§ArchCare, New York, NY。收信人:manarao, MD, ArchCare, 205 Lexington Ave, 3楼，New York, NY 10016。电子邮件:[email protected]。作者没有资金或利益冲突需要披露。
{"title":"Severe Disease Prevention Strategies of the Fukui Model Associated With Conventional and Alpha Variants of Severe Acute Respiratory Syndrome Coronavirus 2","authors":"Kritika Srinivasan Rajsri, Mana Rao","doi":"10.1097/ipc.0000000000001311","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001311","url":null,"abstract":"From the ∗Department of Molecular Pathobiology, New York University College of Dentistry †Department of Pathology, New York University School of Medicine, New York ‡Essen Medical Associates, Bronx §ArchCare, New York, NY. Correspondence to: Mana Rao, MD, ArchCare, 205 Lexington Ave, 3rd Floor, New York, NY 10016. E-mail: [email protected]. The authors have no funding or conflicts of interest to disclose.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/ipc.0000000000001285
Adam Hasse, Kimberly Korwek, Russell E. Poland
Background Use of the antiparasitic agent ivermectin as a potential treatment for early coronavirus disease 2019 (COVID-19) is not recommended, yet inpatient administration continues to be seen. Methods This was a retrospective analysis of more than 100,000 patients admitted to a large health system of community hospitals for COVID-19 to assess the association of ivermectin administration, either early in disease course or at higher severity, with mortality and disease progression (intensive care unit admission or use of mechanical ventilation). Propensity match analysis was used to account for covariates. Results Of the 122,002 patients hospitalized with COVID-19 included in this analysis, 1.1% (1380) received ivermectin while at mild to moderate severity (on room air or nasal cannula), and 0.2% (n = 293) received the drug while severe (noninvasive or mechanical ventilation). Among those who received it with mild to moderate severity, there was no effect on relative risk (RR) of mortality (RR, 1.01; 95% confidence interval [CI], 0.802–1.27), intensive care unit admission (RR, 0.984; 95% CI, 0.865–1.12), or use of mechanical ventilation (RR, 0.976; 95% CI, 0.777–1.23), but an increase in average length of stay (mean days, 8.0 vs 7.5; P < 0.001). Of those who received their first dose of ivermectin with more severe COVID-19, there was an increase in the RR of mortality (RR, 1.63; 95% CI, 1.34–1.99; P < 0.001). Conclusion Among hospitalized patients admitted with mild to moderate COVID-19, in-hospital administration of ivermectin provides no benefit in mortality or disease progression when administered early in the disease course, and may contribute to excess mortality when administered to patients at more severe disease states.
{"title":"In-Hospital Receipt of Ivermectin Is Associated With No Benefit in Mortality, Disease Progression, or Length of Stay for Patients With Mild to Moderate COVID-19","authors":"Adam Hasse, Kimberly Korwek, Russell E. Poland","doi":"10.1097/ipc.0000000000001285","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001285","url":null,"abstract":"Background Use of the antiparasitic agent ivermectin as a potential treatment for early coronavirus disease 2019 (COVID-19) is not recommended, yet inpatient administration continues to be seen. Methods This was a retrospective analysis of more than 100,000 patients admitted to a large health system of community hospitals for COVID-19 to assess the association of ivermectin administration, either early in disease course or at higher severity, with mortality and disease progression (intensive care unit admission or use of mechanical ventilation). Propensity match analysis was used to account for covariates. Results Of the 122,002 patients hospitalized with COVID-19 included in this analysis, 1.1% (1380) received ivermectin while at mild to moderate severity (on room air or nasal cannula), and 0.2% (n = 293) received the drug while severe (noninvasive or mechanical ventilation). Among those who received it with mild to moderate severity, there was no effect on relative risk (RR) of mortality (RR, 1.01; 95% confidence interval [CI], 0.802–1.27), intensive care unit admission (RR, 0.984; 95% CI, 0.865–1.12), or use of mechanical ventilation (RR, 0.976; 95% CI, 0.777–1.23), but an increase in average length of stay (mean days, 8.0 vs 7.5; P < 0.001). Of those who received their first dose of ivermectin with more severe COVID-19, there was an increase in the RR of mortality (RR, 1.63; 95% CI, 1.34–1.99; P < 0.001). Conclusion Among hospitalized patients admitted with mild to moderate COVID-19, in-hospital administration of ivermectin provides no benefit in mortality or disease progression when administered early in the disease course, and may contribute to excess mortality when administered to patients at more severe disease states.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/ipc.0000000000001289
Yamini Mandelia, Katherine Moravec, Kathleen Kinney Bryant, William A.B. Dalzell
Abstract COVID-19 pandemic has affected the pediatric and adult populations in different ways. Although adults experience more respiratory disease, pediatric population has been struck by multisystem inflammatory syndrome in children. There have been multiple case reports of Bell’s palsy associated with acute COVID-19 infection. We present the first known case of unilateral facial palsy after multisystem inflammatory syndrome in children in a pediatric patient.
{"title":"Facial Palsy After Multisystem Inflammatory Syndrome in Children","authors":"Yamini Mandelia, Katherine Moravec, Kathleen Kinney Bryant, William A.B. Dalzell","doi":"10.1097/ipc.0000000000001289","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001289","url":null,"abstract":"Abstract COVID-19 pandemic has affected the pediatric and adult populations in different ways. Although adults experience more respiratory disease, pediatric population has been struck by multisystem inflammatory syndrome in children. There have been multiple case reports of Bell’s palsy associated with acute COVID-19 infection. We present the first known case of unilateral facial palsy after multisystem inflammatory syndrome in children in a pediatric patient.","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-21DOI: 10.1097/ipc.0000000000001293
J. Cole
Inappropriate carbapenem prescribing leads to increased resistance, secondary infections, serious side effects, and wasted resources. A history of penicillin allergy has been identified as a potential trigger for inappropriate carbapenem prescribing. The PEN-FAST score is a validated tool that provides a high negative predictive value for allergic reaction with low scores. The objectives of this study were to determine the proportion of imipenem/cilastatin and meropenem prescriptions deemed appropriate according to published criteria and to evaluate the proportion of penicillin allergies with a low PEN-FAST score. A convenience sample of 100 carbapenem prescriptions (imipenem/cilastatin [n = 50] and meropenem [n = 50]) was evaluated with a retrospective chart review. Objective published criteria were used to assign a score of appropriate, suboptimal, or inappropriate. In patients with a history of penicillin allergy, a PEN-FAST score was retrospectively applied. Indications for use and risk factors for resistant infections were also recorded. Analysis was largely descriptive statistics, with a χ2 used to compare drug cohorts in R Studio. Prescribing was considered appropriate (25%), suboptimal (20%), and inappropriate (55%) in the combined cohort. Inappropriate prescribing was more common with imipenem/cilastatin (66% vs. 44%, P = 0.03). In 28 patients with a historical penicillin allergy, the PEN-FAST score was 0 (low risk for reaction) in the majority of cases (93%). Inappropriate carbapenem prescribing is common at the study facility and may benefit from directed antimicrobial stewardship measures. Implementing the PEN-FAST scoring method may be beneficial in a multifaceted intervention.
{"title":"Carbapenem Appropriateness in a Rural Facility","authors":"J. Cole","doi":"10.1097/ipc.0000000000001293","DOIUrl":"https://doi.org/10.1097/ipc.0000000000001293","url":null,"abstract":"\u0000 \u0000 Inappropriate carbapenem prescribing leads to increased resistance, secondary infections, serious side effects, and wasted resources. A history of penicillin allergy has been identified as a potential trigger for inappropriate carbapenem prescribing. The PEN-FAST score is a validated tool that provides a high negative predictive value for allergic reaction with low scores. The objectives of this study were to determine the proportion of imipenem/cilastatin and meropenem prescriptions deemed appropriate according to published criteria and to evaluate the proportion of penicillin allergies with a low PEN-FAST score.\u0000 \u0000 \u0000 \u0000 A convenience sample of 100 carbapenem prescriptions (imipenem/cilastatin [n = 50] and meropenem [n = 50]) was evaluated with a retrospective chart review. Objective published criteria were used to assign a score of appropriate, suboptimal, or inappropriate. In patients with a history of penicillin allergy, a PEN-FAST score was retrospectively applied. Indications for use and risk factors for resistant infections were also recorded. Analysis was largely descriptive statistics, with a χ2 used to compare drug cohorts in R Studio.\u0000 \u0000 \u0000 \u0000 Prescribing was considered appropriate (25%), suboptimal (20%), and inappropriate (55%) in the combined cohort. Inappropriate prescribing was more common with imipenem/cilastatin (66% vs. 44%, P = 0.03). In 28 patients with a historical penicillin allergy, the PEN-FAST score was 0 (low risk for reaction) in the majority of cases (93%).\u0000 \u0000 \u0000 \u0000 Inappropriate carbapenem prescribing is common at the study facility and may benefit from directed antimicrobial stewardship measures. Implementing the PEN-FAST scoring method may be beneficial in a multifaceted intervention.\u0000","PeriodicalId":13952,"journal":{"name":"Infectious Diseases in Clinical Practice","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44310498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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