Complication Of Pneumonia Research Articles

The role of Braden scores in predicting outcomes following revascularisation for chronic limb-threatening ischaemia and their association with frailty

Introduction: Chronic limb-threatening ischaemia (CLTI) is a substantial healthcare burden associated with high rates of amputation, morbidity and mortality. Frailty measures have proved to be an asset in risk prediction but are not routinely universally collated. This study aimed to identify the utility of Braden scores, an assessment tool for pressure ulceration, as a prognostic indicator for patients with CLTI undergoing revascularisation. Methods: This is a retrospective study of a prospectively maintained database of all patients with CLTI who underwent lower limb revascularisation bypass surgery between 2016 and 2018 in the Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK. Their Braden scores were obtained and their electronic Frailty Index (eFI) calculated. Patients were divided into subgroups for each scoring system and their post-revascularisation outcomes were compared. This allowed us to identify the ability of these scoring systems to predict outcomes. Results: Eighty-seven of 124 CLTI patients undergoing lower limb revascularisation bypass surgery had their Braden scores calculated. Nineteen patients (22%) had Braden scores <18 (high risk for ulceration) with a higher risk of baseline sarcopenia (32% vs 12%, p=0.04, OR 1.4, CI 0.48 to 4.53), major amputation (53% vs 28%, p=0.04, OR 1.2, CI 0.48 to 3.02), longer hospital stay (median 33 vs 14 days, p=0.04) and overall complications of pneumonia, myocardial ischaemia and wound infection (58% vs 31%, p=0.035, OR 1.8, CI 0.59 to 5.53) considered as composite factors. These patients also had worse overall survival according to Kaplan–Meier analysis (p<0.001), and the Braden scores were independently associated with death (hazard risk 1.157, CI 0.67 to 1.92; p=0.01). Braden scores were negatively correlated with an increasing eFI (p=0.016). Conclusion: Braden scores appear to be a promising prognostic indicator of adverse outcomes in patients with CLTI undergoing revascularisation surgery. Additionally, Braden scores may also be a surrogate marker of frailty. Further larger studies are required for the validation of Braden scores and their roles in improving outcomes of CLTI intervention.

Surgical treatment of pulmonary bullous diseases.

Sir, We read with interest, the article by Rastin et al. published in the September-October 2022 issue of Lung India on the results of the surgical treatment of pulmonary bleb and bullous disease.[1] We have also been interested in the treatment of bullous diseases.[2-5] After discussion of treatment options, we also performed surgical resection of two young patients with recurrently infected bullae. We paid attention to indications for resection and preoperative infection control but as a result there was no recurrence. One of them had an uneventful 6 years postoperatively, during which time she gave birth to three children. With this background, we ask the authors following the three questions. First, we would like to ask about indications for surgical resection in bulla patients with pneumonia. Especially in young patients, there is a concern that resection might reduce respiratory function. It is also necessary to pay attention to postoperative infection control. Should recurrent episodes of infection or hemoptysis be considered indications? Second, the authors reported multiple bullae in 19 (27.1%) patients and those with pneumonia complications in 24 (34.3%) patients. The authors emphasized the importance of intraoperative complete drainage if the fluid retention within the bulla. Please, let us know if there are any points that should be especially noted as preoperative measures for such patients. Third, it would be beneficial to know whether there were any patients with recurrent development of bullae after surgery. Please, let us know whether there were any patients in particular have recurrences of infected bullae. Declaration of patient consent The authors certify that appropriate patient consent was obtained. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Pulmonary function abnormality in patients recovered from Covid 19 pneumonia, in a tertiary care hospital in India.

One of the most dreaded complications of COVID pneumonia is post-COVID residual lung fibrosis and lung function impairment. To find out the extent and type of pulmonary function abnormality using spirometry, diffusion capacity, and 6-minute walk test and to co-relate with the clinical severity at the time of infection, in patients who have recovered from COVID19 pneumonia, in a tertiary care hospital in India. This is a prospective, cross-sectional study with a total 100 patients. Patients who have recovered from COVID pneumonia after one month of onset of symptoms and before 3 months who come for follow-up and have respiratory complaints undergo pulmonary function test will be recruited in the study. In our study, the most common lung function abnormality detected was restrictive pattern in 55% of the patients (N = 55) followed by mixed pattern in 9% of patients (N = 9), obstructive in 5% of patients (N = 5), and normal in 31% of patients (N = 31). In our study, total lung capacity was reduced in 62% of the patients and normal in 38% of the patients and diffusion capacity of lung was reduced in 52% of the patients recovered from 52% of the individuals. Also, a 6-minute walk test was reduced in 15% of the patients and normal in 85% of the patients. Pulmonary function test can serve as an important tool in both diagnosis and follow-up of post-COVID lung fibrosis and pulmonary sequalae.

Evaluation and outcome of parapneumonic effusion among children attending Assiut University Pediatric Hospital

BackgroundEmpyema is the most frequent suppurative complication of bacterial pneumonia in childhood. As parapneumonic effusion (PPE) progresses, fibrin and cellular debris accumulate, the purulent fluid becomes septated, and a thick peel forms over the pleura.AimTo describe and compare clinical, laboratory, microbiological findings in patients with PPE and to verify the prognostic accuracy of pleural fluid C-reactive protein in disease progression.Patients and methodsIn all, 25 children aged from 1 month to 16 years, with PPE and empyema were enrolled in this prospective study, which was carried out at Assiut University Children Hospital, from January 1, 2019 to June 30, 2019.ResultsFever and dyspnea occurred in 88 and 64% of patients, respectively. Right effusion occurred in 64% of patients. Hemoglobin was less than 10 g/dl in 72% of patients. Pleural fluid C-reactive protein after 1 week, decreased significantly (15.21 ± 9.45 vs. 50.70 ± 20.85 mg/dl). Blood culture showed no growth in 11 (44%) patients while six (24%) patients had Staphylococcus aureus. Pleural culture revealed no growth in 13 (52%) patients while S. aureus was found in seven (28%) patients.ConclusionS. aureus is the most common isolated organism in both blood and pleural fluid positive cultures. All children received the recommended antibiotics for the treatment of empyema and empyema drainage with an intercostal tube without using fibrinolytic therapy and only 12% of the children were advised for surgical treatment in the form of open thoracotomy with decortication.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

The effect of preoperative steroids for at least 10 days on complications following craniotomy for tumor resection: A database, retrospective cohort study

IntroductionThe effect of chronic steroid therapy on postoperative outcomes after craniotomy for tumor resection remains understudied. Research questionThis study aimed to fill this gap and to identify risk factors of postoperative morbidity and mortality among patients on chronic steroid use undergoing craniotomy for tumor resection. Materials and methodsData from the American College of Surgeons National Surgical Quality Improvement Program were used. Patients who underwent craniotomy for tumor resection between 2011 and 2019 were included. Perioperative characteristics and complications were compared among patients with and without chronic steroid therapy, defined as steroid use for at least 10 days. Multivariable regression analyses were conducted to assess the impact of steroid therapy on postoperative outcomes. Subgroup analyses involving patients on steroid therapy were conducted to explore risk factors of postoperative morbidity and mortality. ResultsOf 27,037 patients, 16.2% were on steroid therapy. On regression analyses, steroid use was significantly associated with any postoperative complication, infectious complication, urinary tract infection, septic shock, wound dehiscence, pneumonia, non-infectious, pulmonary, and thromboembolic complications, cardiac arrest, blood transfusion, unplanned reoperation, readmission, and mortality. On subgroup analysis, risk factors for postoperative morbidity and mortality among patients on steroid therapy included older age, higher American Society of Anesthesiology physical status, functional dependence, pulmonary and cardiovascular comorbidities, anemia, dirty/infected wounds, prolonged operative time, disseminated cancer, and a diagnosis of meningioma. Discussion and conclusionPreoperative brain tumor patients on steroids for 10 or more days are at a relatively high risk of postoperative complications. We recommend a judicious use of steroids in brain tumor patients, both in terms of dosage and duration of treatment.

Acute management of pneumonia in adult patients.

Acute management of pneumonia in adult patients.

Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Community Acquired Pneumonia in Children: A Cross-sectional Study

Introduction: Pneumonia is one of the most common causes of childhood morbidity and mortality, which warrants a proper diagnosis and adequate treatment. Early diagnosis of Community Acquired Pneumonia (CAP) is essential to reduce the total burden of this disease. Aim: To evaluate the diagnostic accuracy of Lung Ultrasound (LUS) in CAP in children as compared to Chest Radiograph (CXR). Materials and Methods: This was a cross-sectional study involving 91 subjects with clinically suspected pneumonia, who underwent US examination in the Department of Radiodiagnosis, Government Medical College, Thrissur, Kerala, India from December 2018 to December 2019. LUS was done to obtain information regarding different patterns of presentation of pneumonia. Although Computed Tomography (CT) is considered the gold standard imaging for pneumonia, it is used only for complicated pneumonia and is not routinely performed in the paediatric age group as radiation exposure will be more than that of the CXR. Hence, a CXR was taken as a reference standard in this study, and findings of LUS were compared. The data was managed using Microsoft Excel 2016 and statistical analysis was done with International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 27.0. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy were calculated. Results: Overall, LUS had a sensitivity of 95.83%, a specificity of 93.02%, a PPV of 93.88%, a NPV of 95.24%, and an accuracy of 94.5% (p<0.001) as compared to CXR which had a sensitivity of 93.8%, specificity of 95.23%, the PPV of 95.80%, the NPV of 93.0% and accuracy of 95%. Substantial agreement between LUS and a CXR was found, for diagnosing specific patterns of CAP with Cohen’s Kappa value of 0.74. Conclusion: LUS offers an important contribution to the diagnosis of pneumonia in children as compared with a CXR. With its high NPV, it can replace CXR in order to exclude lung consolidation in children, thus reducing radiation exposure in this population.

The Role of Computed Tomography in Diagnosing and Treating Community-Acquired Bacterial or Viral Pneumonia in Children

Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns.

Diagnostic Ability of Chest Ultrasound in Selective Paediatric Pneumonia Alternative to CT scan: A single-center Comparative Observational Study

Introduction: Chest CT is the gold standard method of the diagnostic evaluation of patients with pneumonia. Lung sonography has been lately explored as an alternative modality to decrease radiation hazards. This study aimed to evaluate the diagnostic ability of lung ultrasonography in detecting paediatric pneumonia at presentation and follow up and comparing findings with chest CT scan. Methods: A cross-sectional observational study was performed at a paediatric hospital from August 2019 to April 2021. We studied 106 children (ages from 45 days to 14 years) referred by the paediatrician with clinical data of pneumonia. All children underwent CT chest examination; 90 showed positive, while 16 showed no pneumonia. Ultrasonography was performed on all patients within 24 hours after CT examination. Results: We found that lung ultrasound showed 100% specificity, 82.2%, sensitivity in the diagnosis of paediatric pneumonia, accuracy was 84.9%, positive predictive value was 100% and negative predictive value was 50%. Their sensitivity and specificity are 100% in complicated pneumonia by parapneumonic effusion, empyema, and abscess formation. Conclusions: Chest ultrasound is a simple technique that can be performed in everyday practice, with high specificity and sensitivity compared to a chest CT scan in diagnosis and follow up of pneumonia in the pediatric age group.

Analysis of risk factors of fungal superinfections in viral pneumonia patients: A systematic review and meta-analysis.

Infections with fungi, such as Aspergillus species, have been found as common complications of viral pneumonia. This study aims to determine the risk factors of fungal superinfections in viral pneumonia patients using meta-analysis. This study aims to determine the risk factors of fungal infection s in viral pneumonia patients using meta-analysis. We reviewed primary literature about fungal infection in viral pneumonia patients published between January 1, 2010 and September 30, 2020, in the Chinese Biomedical Literature, Chinese National Knowledge Infrastructure, Wanfang (China), Cochrane Central Library, Embase, PubMed, and Web of Science databases. These studies were subjected to an array of statistical analyses, including risk of bias and sensitivity analyses. In this study, we found a statistically significant difference in the incidence of fungal infections in viral pneumonia patients that received corticosteroid treatment as compared to those without corticosteroid treatment (p < .00001). Additionally, regarding the severity of fungal infections, we observed significant higher incidence of invasive pulmonary aspergillosis (IPA) in patients with high Acute Physiology and Chronic Health Evaluation(APACHE) II scores (p < .001), tumors (p = .005), or immunocompromised patients (p < .0001). Our research shows that corticosteroid treatment was an important risk factor for the development of fungal infection in patients with viral pneumonia. High APACHE II scores, tumors, and immunocompromised condition are also important risk factors of developing IPA. The diagnosis of fungal infection in viral pneumonia patients can be facilitated by early serum galactomannan (GM) testing, bronchoalveolar lavage fluidAspergillus antigen testing, culture, and biopsy.

Burden of all-cause and organism-specific parapneumonic empyema hospitalization rates prior to the SARS-CoV-2 pandemic in the United States

Background and aimsParapneumonic empyema, a severe pneumonia complication, decreased shortly after 13-valent pneumococcal conjugate vaccine (PCV13) introduction in US children, though the long-term impact remains poorly described. It is also unclear whether PCV13 introduction in 2010 or the 2014 US recommendation for PCV13 use in older adults was associated with declines in empyema among adults. We examined overall and organism-specific parapneumonic empyema rates among US children and adults from 2006 to 2019, prior to the SARS-CoV-2 pandemic and the updated recommendations for PCV15 and PCV20 in the US. MethodsWe used the National Inpatient Sample and US Census Data to calculate national annual all-cause and pneumococcal empyema hospitalization rates by age group (2006–2019). We examined rates during the late-PCV13 era (October 2015–2019) after transition to ICD10 codes compared to rates in the late-PCV7 (2006–2009) and early-PCV13 era (2011–September 2015). We also examined the rate of empyema with thoracentesis-related procedures and according to the causative organism type. ResultsCompared to the late-PCV7 era, all-cause empyema hospitalization rates were lower among child age groups (<1, 1, 2–4 and 5–17 years) in the late-PCV13 era. In contrast, among most adult age groups (18–34, 50–64, 65+ years), all-cause empyema rates were higher in the late-PCV13 era compared to the late-PCV7 era. ConclusionEarly declines in all-cause empyema-related hospitalizations observed right after PCV13 introduction among children in 2010 were sustained through 2019, though rates did not decline among adults.

Feasibility of Modified Endobronchial Ultrasound-Guided Intranodal Forceps Biopsy: A Retrospective Analysis

Background: Endobronchial ultrasound (EBUS)-guided intranodal forceps biopsy (IFB), a diagnostic bronchoscopic technique for intrathoracic lymphadenopathy, is performed following EBUS-guided transbronchial needle aspiration (TBNA). The current EBUS-IFB technique is complex and provides small sample volumes. We modified this technique to allow the use of standard-sized forceps. Objectives: The aim of this study was to assess the feasibility of the modified EBUS-IFB technique, which combines standard-sized forceps with standard EBUS-TBNA equipment. Method: This retrospective analysis included consecutive patients scheduled for EBUS-TBNA with attempted additional IFB between July 2020 and March 2021. The feasibility indices of IFB, technical success rate, diagnostic accuracy, and major complications were retrospectively investigated. We performed semi-quantitative evaluation of the histological specimens and univariable analyses to identify factors associated with IFB failure. Results: During the study period, 295 patients underwent 307 EBUS-TBNAs; 195 cases were included in the analyses. Target lesions were mainly mediastinal lymph nodes (134 cases, 68.7%); the most frequent sites were #7 (61 cases) and #4R (50 cases). The median lesion size was 16.1 mm, the technical IFB success rate was 90.8%, and the diagnostic accuracy of the TBNA and IFB combination was 99.5%. One patient was lost to follow-up. Univariable analyses did not identify any factors involved in technical IFB failure. Major complications of pneumonia and pneumothorax occurred in 2 cases (1.0%). The median histological score was significantly higher in the IFB group than in the TBNA group (1.67 vs. 1.50, p = 0.032). Conclusions: Modified EBUS-IFB, combining standard-sized forceps with common EBUS-TBNA equipment, is feasible with few major complications.

Complications affecting the functional outcome after 1 year in older adults with severe head injury

Abstract Background This study explored possible significant complications, which affected the functional outcome after 1-year follow-up in older adults with severe head injury. Methods Retrospective secondary data were collected from the hospital medical information system. The patients who suffered from severe head injury (Injury Severity Score [ISS] ≧16) with the disease classification system were collected in the study. The survived patients were followed by telephone 1 year after discharge. Documented complications, Glasgow Outcome Scale, and Functional Independence Measure were used for comparisons. This study protocol was approved by the institutional review board of the hospital. Results Between January 2009 and September 2015, patients who were 65 years and older, diagnosed with ISS ≧16, were enrolled. There were 142 patients collected, and 60 patients survived reachable for more than 1 year for follow-up and analysis. The mean age of collected survival was 75.2 ± 6.1 years. Both complications of pneumonia and urinary tract infection had worsened the outcome of the older patients after 1-year follow-up (P &lt; 0.001). After 1 year, those who had complications with urinary tract infection but not pneumonia had a worse prognosis in the aspects of functional outcome in 1-year follow-up. Conclusions Older adults with severe head injuries often have high mortality. When they survived, independent life activities are critical for their quality of life. Urinary tract infections during admission have detrimental effects on the functional outcome in the older patients. Prevention of urinary tract infection is encouraged for better outcome in older patients with severe head injury.

462: PURULENT TEETH AND PURULENT PLEURAL SPACE

Introduction: Empyema is a rare but serious complication of pneumonia. Most common causative organisms include streptococcus species, staphylococcus, and anaerobes. We present a case of empyema secondary to Fusobacterium nucleatum and Porphyromonous gingivalis in a patient with periodontitis. Description: A 70-year-old male with a history of Cerebral Palsy presented with 2 weeks of generalized weakness. He was afebrile, heart rate of 160bpm, respiratory rate of 35/min, Oxygen saturation of 87% on room air, and a BP of 113/76. He was ill-appearing with decreased air entry on the right side of the chest on the exam. His labs showed a WBC of 11.2 k/ul, and high Lactic acid and procalcitonin. CXR showed subtotal opacification of the right hemithorax. CT Scan of the chest showed a large loculated right hydropneumothorax with adjacent atelectasis. Vancomycin, cefepime, and metronidazole were started. A chest tube was inserted for source control with immediate drainage of 120 ml of Purulent turbid fluid. Culture from the pleural fluid grew Fusobacterium nucleatum and Porphyromonous gingivalis. Repeat imaging showed multiple sites of undrained pleural effusion and incomplete expansion of the lung. TPA and DNase were instilled in the pleural cavity every 12 hours over a period of 72 hours to help with drainage and lysis of loculations. Follow-up chest CT showed trapped unexpanded lung with loculations, scarring, and pneumothorax around it. The patient underwent a right thoracotomy with complete visceral and parietal pleural decortication that resulted in the gradual expansion of the lungs and removal of his chest tube. Due to the organisms involved, a panorex xray was done and showed periodontitis. The patient underwent extraction of infected teeth to prevent recurrent empyema. He was discharged on ampicillin/ sulbactam for a total course of four weeks. Discussion: Fusobacterium nucleatum and Porphyromonous gingivalis are gram negative oral anaerobes that frequently cause periodontitis. Aspiration of oral and dental secretions containing these organisms resulted in pneumonia and empyema in our patient. Identifying those organisms allowed us to search and treat for the underlying conditions. Treatment strategies include appropriate antibiotic therapy along with pleural space drainage.

566. The Impact of a Clinical Practice Guideline and Educational Interventions on the Management of Children Hospitalized with Uncomplicated Community Acquired Pneumonia

Abstract Background The 2011 guidelines for management of pediatric uncomplicated community acquired pneumonia (CAP) recommend the use of ampicillin or penicillin first line. We sought to evaluate improvement in adherence to these guidelines through antimicrobial stewardship interventions at a single institution to minimize unnecessary broad antimicrobials. Methods A retrospective chart review was conducted of admitted patients aged 2 months - 21 years old with uncomplicated CAP. The pre-intervention phase was September 1, 2019-February 29, 2020 and the post-intervention phase included September 1-February 28 of 2021 and 2022. Antimicrobial stewardship interventions included the incorporation of clinical practice guidelines (CPG) into a new institutional CAP pathway (approved in June 2020) and subsequent education to ordering providers in the spring of 2020. Patients with complicated pneumonia or with comorbidities including sickle cell disease, chronic lung disease, neurologic conditions, congenital heart disease or patients who were immunocompromised were excluded. The prescribing patterns of specific physicians were recorded and adherence to CPG recommendations were assessed. The primary endpoint was to measure the reduction of broad spectrum antibiotics (vancomycin, clindamycin, ceftriaxone, levofloxacin and cefdinir) to narrow spectrum antibiotics (ampicillin, amoxicillin, and amoxicillin-clavulanate). Results A total of 114 patients were included in the study; 72 pre-intervention and 42 post-intervention. Mean age was 5.4 years pre- and 6.5 years post-intervention. A significant reduction in broad spectrum antibiotic use was noted in the ED (p=&amp;lt; 0.0001), during the first 24 hours of admission (p=0.0034) and for discharge antibiotics (p=0.0003) (Figures 1-3) between the pre- and post-intervention groups. Guideline adherence was 78.5%. No change in length of stay or treatment failure were observed. Antibiotic Prescriptions in the Emergency Department After the implementation of the CPG guideline there was a 17% reduction in the number of times a combination of antibiotics were used, a 7.2% reduction of broad spectrum antibiotics and a 24% increase in the utilization of narrow spectrum antibiotics, p-value= &amp;lt;0.0001. Antibiotic Utilization 24 hours After Hospital Admission After the implementation of the CPG guideline there was a 20% reduction in the number of times a broad spectrum antibiotic was prescribed, p-value =0.0034. Discharge Antibiotic Prescriptions After the implementation of the CPG guideline there was a 18% reduction of broad spectrum antibiotics and a 34% increase in the utilization of narrow spectrum antibiotics, p=0.0003. Conclusion The CPG and educational interventions had a positive impact on the antibiotic management of children hospitalized, with an overall 4.7% reduction of broad spectrum antibiotics and a 28% increase in the utilization of narrow spectrum antibiotics. Continued education may improve CPG adherence. Disclosures All Authors: No reported disclosures.

793. Procalcitonin-guided Antibiotic Stewardship Oversight Reduces Antibiotic Use and Adverse Outcomes for Patients Admitted with Pneumonia, Results from a Real-world Randomized Controlled Trial in US Hospitals

Abstract Background ProSAVE (NCT04158804) is the first prospective interventional RCT to address the effect of procalcitonin (PCT)-guidance in the setting of antimicrobial stewardship (ASP) oversight on clinical outcomes and antibiotics usage for patients admitted with pneumonia. Methods Analysis of the pilot cohort from a multicenter trial was conducted enrolling subjects admitted with pneumonia at three clinical sites (academic and community hospitals). Subjects meeting eligibility criteria were randomized 1:1 between the standard of care (SoC) versus PCT-guided ASP oversight (PCT arm); subjects were monitored daily by chart review for up to 30 days. An FDA-approved PCT algorithm was used to guide antimicrobial usage. 95 patients were enrolled as ITT of which 60 patients were assigned per-protocol who were adherent to the PCT algorithm (30 in SoC and 30 in the PCT arm). Primary study endpoints were antimicrobial usage and composite safety comprising readmission, death, intubation, septic shock, renal failure, and pneumonia complications such as empyema and abscess up to day 30. Results Baseline subject characteristics were similar between both arms; median age 73y (IQR: 62–86, heart disease (43% SoC vs. 40% PCT arm), and diabetes (23% SoC vs. 29% PCT arm). Early antimicrobial cessation by day 4 of hospitalization was achieved more often in the PCT arm as compared to SoC (ITT: SoC n=5, 11% vs. PCT arm n=14, 29%, p=0.045). In addition, antimicrobial prescription at discharge was lower in the intervention arm (ITT: SoC n=24, 51% vs. PCT arm n=15, 31%, p=0.08; similar and statistically significant efficacy for PP) (Fig 1, panel A). A substantial statistically significant improvement of safety was observed in the PCT arm compared to SoC (reduction by 18.3% (95%-CI: 2.3% – 36.3%) from 23.3% (11.9% – 41.1%, SoC) to 3.3% (0.8% – 16.7%, PCT arm) in PP, similar in ITT) (Fig 1, panel B). Readmission was the main driver for fewer safety events in the intervention arm (SoC 50% vs. PCT arm 33%). Conclusion In this pilot cohort of ProSAVE, the introduction of PCT-guided, ASP intervention to medical teams proved to be a successful aid for resourceful antibiotic management decisions resulting in shorter antibiotic durations and significantly lower adverse event rates. Disclosures Michael Mansour, MD, PhD, ThermoFisher Scientific: Grant/Research Support.

Survival in canine tetanus - retrospective analysis of 42 cases (2006-2020).

To define factors associated with survival in dogs with tetanus and to evaluate the prognostic significance of an established severity classification scheme. Medical records of dogs with the clinical diagnosis of tetanus were retrospectively reviewed with regard to signalment, clinical signs, clinicopathological findings on admission, wound characteristics, complications, therapeutic measures, and survival to discharge. Based on the extracted data, dogs were graded according to a previously published 4-class severity scheme. Non-parametric tests were applied for comparisons between survival categories. Forty-two dogs fulfilled inclusion criteria, of which 32 survived. Of 10 non-survivors, 4 died and 6 were euthanised. Non-survivors were more often younger than 2 years of age (6/10 vs. 7/32 dogs, p = 0.023), had shorter duration of specific signs of tetanus (time from onset of typical signs to presentation) (2 vs. 4 days, p = 0.016), were prescribed less often antibiotics prior to presentation (p = 0.006), had higher tetanus severity grade (10/12 dogs in Class III or IV died, p < 0.001), more often received acepromazine (p = 0.009) and atropine (p = 0.012), and more often had hyperthermia (p = 0.005) and respiratory complications (pneumonia, laryngeal spasm; p = 0.008). Wound characteristics, the use of tube feeding, metronidazole, methocarbamol, magnesium and antitoxin were not significantly different between non-survivors and survivors. Young dogs with a rapid course of severe generalized tetanus have a guarded prognosis. The previously described severity classification scheme proved valuable in predicting survival. Prospective multi-center studies are needed to clarify the prognostic significance of age, sedative usage and modified versions of an established classification scheme, including the presence of respiratory complications.

FETOMATERNAL OUTCOME OF PATIENTS WITH FEVER DURING TERM PREGNANCY

Introduction: Fever in pregnancy is a common clinical problem globally. The risk to the mother and fetus is signicantly increased in pregnancy complicated by infection and fever. Fever is one of the most frequent reasons for emergency consultation during pregnancy and may be associated with signicant adverse outcomes, these being maternal (sepsis, organ damages) obstetrical (miscarriage, preterm birth, chorioamnionitis) or fetal (malformations, fetal demise). However, only one study including mainly second and third trimester pregnant women, evaluated causes of acute undifferentiated fever and 25 % of women had no identied cause. A hospit Methodology: al based analytical cross sectional study was analysed the maternofetal outcome of 50 cases of fever during term pregnancy and the outcome of 50 cases without fever in term pregnancy and it was studied between 2020-2021 at Govt. Mohan Kumaramangalam medical college, Salem. During the study cases were selected with pregnant women at term gestation with or without fever admitted in Labour ward and Antenatal ward of Govt. Mohan Kumaramangalam medical college hospital. The patients recruited for the study underwent Clinical history, General examination, Obstretic examination, CTG and USG Obstretics, fever ivestigations. In the group 1, Patients of 37weeks completed mothers with fever for more than one day and in the group 2 healthy AN mothers of 37weeks completed gestation were included. Fetal outcome will be studied by t Results: aking variableslow birth weight, intrauterine growth retardation, preterm delivery, neonatal sepsis and perinatal death.Maternal complications –post operative wound infection, post-partum haemorrhage, pneumonia, septicemia, jaundice, hypoglycemia and other complications of specic fever will be studied. Most common cause of fever in pregnancy was respiratory tract infections. Urinary tract infection was the second common cause. Pregnant women with fever 24% had Hypotension and 56% had Tachycardia. Pregnant women with fever had almost half the delivery with meconium stained signicantly. Among 50 delivered fever mothers, 24% cases were Previous LSCS cases, 44% cases went into spontaneous labour, only 32% cases induced. Out of 32% cases induced, 50% cases were delivered vaginally and 50% Cases underwent caeserean sections. So, Fever did not signicantly affect labour onset and the mode of delivery. Signicantly NICU admission was required among the fever cohorts Fever during pregnancy is a common occurrence that can lead to a wide range of issues Conclusion: for both the mother and the foetus and newborn. Because the most prevalent causes of fever are preventable, there has to be a greater emphasis on the importance of being aware of how to avoid such illnesses in order to avoid life-threatening foetomaternal consequences.

Electric Systol In Acute Complicated Pneumonia Depending On Clinical Syndromes

In the structure of morbidity and especially mortality in young children, the leading place is occupied by acute pathology of the bronchopulmonary system. This problem is complicated by the fact that it is in young children that the highest incidence of pneumonia is noted, which are severe and often require intensive care. In the outcome of acute pneumonia, an important role is played by the reaction of various organs and systems, especially the cardiovascular system.