作者: Oo, Khin ; Lee, Monica ; Kim, Sun Moon ; Patel, Riddhi ; Letsen, James ; Samarneh, Mark ; Dhayaparan, Yarl ; Kaur, Bhawaninder ; Bouchekouk, Leila

Background The exponential increase in the incidence of Methicillin-resistant Staphylococcus aureus (MRSA) infections has imposed great burdens on hospital systems. Although there are vast antibiotic options for the treatment of MRSA, eradication is often tough. There are not many studies highlighting the post-discharge readmission rates for MRSA patients. Objective The primary aim of the study was to describe the 30-day readmission rate for patients hospitalized with a positive MRSA culture from a single center, with a secondary aim of analyzing 90-day readmission rates. Methods The authors conducted a retrospective study based on a chart review of patients' electronic medical records and the 3M billing platform to obtain information regarding patients treated for MRSA infections. Inclusion criteria were age above 18, admission to a single center in the United States, and positive microbial MRSA diagnoses between 2014 and 2024. Data regarding demographics, comorbidities, length of stay, and readmission diagnoses were collected and analyzed using Microsoft Excel Version 16.91. Results The retrospective analysis revealed a total of 127 patients who met the inclusion criteria. The demographics of the patient population were predominantly male and over the age of 65. Among the patients, 17.32% (22 out of 127 patients) had a readmission within 30 days of discharge after a MRSA infection. Of these 22 patients, 50% were male and 50% were female, with an average age of 65. These 22 patients accounted for 24 readmissions within 30 days of discharge. Of all the readmissions, 54.17% (13/24) were due to an infectious process, and 45.83% (11/24) were due to the exacerbation of comorbidities. Only 1 readmission was a result of recurrent MRSA bacteremia. The average readmission ratio within 30 days of MRSA infection was 1.09 per patient. Among the 127 patients included in the study, 27.56% (35/127) were readmitted at least once to the hospital within 90 days following discharge for the treatment of initial presentation with a positive MRSA culture. However, these 35 patients accounted for a total of 54 readmissions within 90 days of discharge. Of all the readmissions, 44.44% (24/54) were due to an infectious cause, while 44.44% (24/54) were due to the exacerbation of comorbidities. The average readmission ratio within 90 days of MRSA infection was 1.5 per patient. Conclusion The high readmission rates for patients with MRSA can be attributed to the increased morbidity associated with MRSA. Approximately half of the patients who were readmitted within 30 days were admitted due to an infectious process, whereas the other half were admitted due to the exacerbation of comorbidities.

2024-12-18·Cureus

Lambda Light Chain Cast Nephropathy Caused by Splenic Marginal Zone Lymphoma

Article

作者: Kohli, Jusnimrat ; Gu, Joyce H ; Samarneh, Mark ; Smothermon, Nicholas

We report an interesting case of an elderly male patient with splenic marginal zone lymphoma with a monoclonal cluster of differentiation (CD)5+ B cells. The patient developed signs of renal injury and was evaluated via serum protein electrophoresis and immunofixation electrophoresis, which revealed monoclonal gammopathy with elevated free lambda light chain. However, a bone biopsy ruled out a diagnosis of multiple myeloma. Upon renal biopsy, the patient was diagnosed with lambda light chain cast nephropathy. However, the patient's condition further deteriorated, and the patient eventually expired. This case highlights light chain cast nephropathy as a rare yet serious complication of lymphomas and, in particular, splenic marginal zone lymphoma.

2024-11-22·Cureus

Increasing Trends in the Pancreatitis Risk With Tumor Necrosis Factor Inhibitor Use

Article

作者: Gu, Joyce H ; Samarneh, Mark

Tumor necrosis factor (TNF) inhibitors are a class of pharmacologic agents used to treat a wide range of immunologic diseases. We present a systematic study of the pancreatitis risk with TNF inhibitor use through a retrospective case-control design disproportionality analysis of the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database, with data ranging from the fourth quarter of 2012 (2012 Q4) to the second quarter of 2024 (2024 Q2). Our analysis reveals an increasing trend in the pancreatitis risk with TNF inhibitors when stratified by year, with all of the TNF inhibitors studied exhibiting significant association with pancreatitis in the year 2023. Furthermore, these results hold even when controlling for sex, age, concurrent use of azathioprine, and the indication for treatment. Our findings flag the necessity for a careful investigation and monitoring of pancreatitis risk in patients undergoing TNF inhibitor therapy, especially in recent years.

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