AbstractBackgroundThe Enterobacterales order is among the most common group of bacteria relevant in clinical practice. Among them are inducible AmpC-producing Enterobacterales (AE). This unique group of bacteria may produce AmpC enzymes if induced in the setting of certain beta-lactam antibiotics, limiting the number of effective treatment options. Previous data have suggested that inappropriate antibiotics used empirically for AE increase the risk of treatment failure, but limited data are available to describe the risk factors associated with community-onset (CA) AE to help guide empiric therapy.MethodsThis was a retrospective case-control study of patients admitted to University Hospital from 2021 to 2023 with a CA Enterobacter cloacae, Klebsiella aerogenes, or Citrobacter freundii clinical isolate. The first clinical isolate was included for each patient. Patients were matched at a rate of 1:1 to a patient with a CA Enterobacterales organism without 3rd generation cephalosporin resistance. Patients were matched according to infection, age (+/- 5 years), and sex at birth. The primary outcome was to evaluate risk factors associated with CA AE infections.ResultsA total of 176 patients were included in this study, 88 in each group. In a univariate analysis, prior hospitalization (OR, 3.3 [95% CI, 1.72-6.4]), surgical intervention (OR, 5.8 [95% CI, 1.62-20.9]), exposure to any antibiotic (OR, 2.2 [95% CI, 1.15-4.14]), exposure to 1st generation cephalosporins (OR, 2.8 [95% CI, 1.09-7.07]), and exposure to cefepime (OR, 3.3 [95% CI, 1.03-10.72]) within 3 months were associated with an increased risk of a CA AE. Being Hispanic or Latino was associated with a decreased risk of having a CA AE in a univariate analysis and was the only variable statistically significant in a multivariable analysis (OR, 0.34 [95% CI, 0.15-0.74]).ConclusionOur findings suggest that patients with prior hospitalization, surgical intervention, exposure to any antibiotic, to 1st generation cephalosporins, and to cefepime within 3 months may be associated with an increased risk of a CA AE in a univariate analysis, although no association was seen in a multivariable analysis. In contrast, Hispanic or Latino patients may be at a decreased risk for CA AE. A larger sample size may be warranted to validate these findings.DisclosuresAll Authors: No reported disclosures

2023-11-27·Open Forum Infectious Diseases

2528. Cefepime Induced Neurotoxicity in Patients With or Without a History of Seizures

作者: Baalbaki, Nadeem ; Salim, Tanzila ; Mohsen, Mahinaz ; Hoge, Christopher ; Sackey, Joachim ; Dar, Aleena

AbstractBackgroundCefepime is a commonly utilized antimicrobial for the treatment of nosocomial infections and serves as a carbapenem sparing agent for the treatment of ampC inducible bacteria. Although generally tolerated, cefepime induced neurotoxicity (CIN) is a well-documented adverse effect that has been observed most significantly in patients with renal dysfunction and elevated serum troughs. Data describing the incidence of CIN in patients with a history of seizures is currently limited.MethodsThis was a retrospective matched cohort study of patients admitted to University Hospital from May 2020 to May 2022 who were treated with cefepime for > 48 hours with or without a baseline history of seizures. Patients with seizures were identified using ICD-10 codes. Patients were matched at a rate of 1:1 by age (+/- 5), sex at birth, and month of admission (+/- 1). The primary outcome was the rate of CIN in patients with a history of seizures versus patients without a history of seizures. The secondary outcome was identification of risk factors associated with CIN.ResultsA total of 102 patients were included in this study (51 in each group). There was no statistically significant difference in the rate of CIN in patients with a history of seizures versus patients without a history of seizures (11.8% vs 5.9%, P = 0.487). In a univariate analysis, patients with acute kidney injury (OR, 13.1 [95% CI, 2.3-74.8]) and an intensive care unit (ICU) stay (OR, 5.3 [95% CI, 1.04-36.4]) were associated with an increased risk of CIN. In a multivariate analysis, duration of cefepime administration was the only risk factor associated with CIN that was statistically significant (OR, 1.94 [95% CI 1-3.8]).ConclusionThere was no statistically significant difference in the rate of CIN in patients with a history of seizures compared to patients without a history of seizures, although there were twice as many patients with CIN in the seizure group. Patients with acute kidney injury and an ICU stay were more likely to experience CIN in a univariate analysis, however confidence intervals were wide requiring caution with interpretation. There was a 1.94 times increase in the odds of CIN with every additional day of cefepime administration. Further investigations with larger sample sizes are warranted to confirm these findings.DisclosuresAll Authors: No reported disclosures

2021-11-01·Spine2区 · 医学

Scoliosis Surgery Normalizes Cardiac Function in Adolescent Idiopathic Scoliosis Patients

2区 · 医学

Article

作者: Hasan, Sayyida ; Sarwahi, Vishal ; Galina, Jesse ; Gecelter, Rachel ; Lo, Yungtai ; Amaral, Terry D. ; Maguire, Kathleen ; Kalantre, Sarika ; Atlas, Aaron

Study Design.Single-center retrospective chart review with minimum 2-year follow up.Objective.To determine incidence of pulmonary hypertension in adolescent idiopathic scoliosis patients and to determine the effect of scoliosis surgery on pulmonary hypertension.Summary of Background Data.Spinal deformity in adolescent idiopathic scoliosis can increase right atrial and ventricular pressures secondary to restrictive lung disease. Pulmonary hypertension leading to cor pulmonale is the most feared outcome, however mild pulmonary hypertension in adolescent idiopathic scoliosis (AIS) patients has been reported. No study has previously examined changes in the improvement of right heart function following scoliosis surgery.Methods.Cobb angle, 2D-echo signs of structural heart disease, aortic root dimensions, tricuspid regurgitant jet velocity (TRV), pulmonary function tests (PFTs), arterial blood gas (ABG), and patient demographics reviewed. Right ventricular systolic pressure (RVSP) estimated using Bernoulli equation (4[TRV]2) and right atrial pressure. RVSP ≥36 mmHg is a surrogate marker for pulmonary hypertension. All echocardiograms were read by board certified Pediatric Cardiologists. Logistic regression used to assess for differences in TRV between groups.Results.Mean preoperative RVSP was significantly elevated in AIS patients (26.9 ± 0.49; P < 0.001) compared with controls (17.25 + 0.88). Only 47 (21%) Group 1 patients had elevated preoperative TRV (≥2.8 m/s) versus none in Group 2 (P < 0.001). Additionally, logistic regression showed AIS patients have odds ratio of 3.29 for elevated TRV (P = 0.007)—an indirect measure of pulmonary hypertension. In all Group 3 patients, the cardiac function normalized postoperatively (mean TRV = 2.09 + 0.23; P < 0.001). No association found between Cobb angle, aortic root parameters, or pulmonary function tests.Conclusion.This study found 13.9% of patients with adolescent idiopathic scoliosis had elevated TRV while controls had no TRV abnormalities. Additionally, RVSP measurements demonstrated mild pulmonary hypertension in AIS patients. These abnormal values normalized postoperatively, indicating the benefits of scoliosis surgery on cardiac function in adolescent idiopathic scoliosis.Level of Evidence: 3

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