Three-year Retrospective Analysis Research Articles

Ongoing crisis across the HIV care continuum: high mortality among PWH admitted to the ICU in an urban safety-net hospital in the South

ABSTRACT We present a retrospective study of people with HIV (PWH) admitted to the medical intensive care unit (MICU) of an 862-bed academic, safety-net hospital. We aimed to determine the characteristics of ICU admissions among PWH, measure the mortality in this population and identify predictors of mortality. All patients ≥ 18 years old with a diagnosis of HIV infection admitted to the MICU between January 1, 2017 and December 31, 2019 were included. A total of 195 ICU admissions occurred during the study period. The mean age was 46.2 years, 77.4% were male and the majority were people of color. Overall, 125 (64.8%) patients had CD4<200 cells/mL and 12 (6.7%) were newly diagnosed with HIV. ICU mortality was 21.5% and hospital mortality was 24.6%. High APACHE score and CD4<200 were independent predictors of ICU mortality. Our three-year retrospective analysis of PWH admitted to the ICU in a large urban safety-net hospital in the US South during the recent modern ART era identified high ICU- and hospital mortality. We also identified a higher mortality risk at each step of the HIV care cascade, reinforcing the importance of proactive interventions including expanded HIV testing and implementation of strategies which improve engagement in care, ART adherence and virologic suppression.

P-1164. Prevalence of invasive Candidiasis and antifungal resistance in neonates: a multicenter three-year retrospective analysis from two large Mexican NICUs

Abstract Background Candida infections are increasingly recognized as clinically relevant pathogens in NICUs, particularly among preterm and low birth-weight infants (LBWI). Due to the emergence of Fluconazole-resistant Candida spp, current treatment guidelines of neonatal invasive Candidiasis (IC) suggest Amphotericin B as first line therapy, leaving Fluconazole as an alternative agent. Microbiological surveillance focused on fungal etiologies in Mexican NICUs is scarce, which may lead to inappropriate antifungal use. Methods Retrospective multicenter study conducted in the NICUs of the two pediatric reference hospitals in NL, Mexico. Clinical and microbiological data of all newborns ≤28 days diagnosed with blood culture-proven invasive Candidiasis from 2021-2023 were collected. LBWIs were defined as newborns &amp;lt; 2500 g at birth, and very LBWI (VLBWI) as &amp;lt; 1500 g. Descriptive statistical analyses were performed to determine the frequency of Candida spp and frequency of antifungal resistance. Results During the studied period, 928 positive blood cultures were included. Only 38 blood cultures (4%) were positive for Candida spp. No outbreaks occurred during the studied period. Twenty one patients (75%) were preterm. Mean gestational age was 29 weeks. Most patients (55%) were VLBWI (Table 1). All episodes were classified as late-onset sepsis. The most common isolated species were C. albicans (45%), followed by C. glabrata (29%), and C. parapsilosis (16%). No Fluconazole resistance was observed (Table 2). Caspofungin resistance was found in 5 C. glabrata isolates and 1 C. albicans. No cases of endophthalmitis or endocarditis were documented. Conclusion We report a low prevalence of blood culture-proven neonatal IC (4%) in two large Mexican NICUs during the studied period. Most patients were LBWI. This is consistent with international data. C. albicans was the most common isolated species. Based on the local epidemiology in two large NICUs of NL Mx, Fluconazole may be considered as a first line antifungal agent instead of Amphotericin B. Local microbial epidemiology and antifungal susceptibility patterns should be considered for the empirical treatment. Disclosures All Authors: No reported disclosures

P-1143. Etiology and resistance phenotypes of blood-culture proven neonatal sepsis from two large NICUs in Mexico: a multicenter three-year retrospective analysis

Abstract Background Neonatal sepsis is a significant cause of morbidity and mortality in newborns. Etiology depends on multiple factors, particularly regional epidemiology. Current international guidelines are based on data from developed countries, which may not reflect the situation of developing regions. Microbiological surveillance in Mexican NICUs is limited, which may lead to inappropriate antimicrobial use. Methods This is a retrospective multicenter study conducted in two NICUs from NL, Mexico (2021-2023). Clinical and microbiological data on ≤28-day newborns with blood culture-proven neonatal sepsis were collected. Neonatal sepsis was classified as early (≤3 days) and late onset ( &amp;gt;3 days). Descriptive statistical analyses were performed to assess microbiologic etiologies, as well as clinically-relevant resistance phenotypes (VITEK® 2). Results A total of 928 blood cultures from 775 patients were included. 49.0% were preterm. Mean gestational age was 35.2. Most episodes (66.9%) were classified as late-onset sepsis (Table 1). Staphylococcaceae were the most commonly identified family (48.6%). Coagulase-negative Staphylococci were the most common group (42.7%), being S. epidermidis the most common. Gram-negative bacilli were the second most common cause of neonatal sepsis (33.7 %), mostly due to K. pneumoniae (12.7%). Low prevalence of GBS was observed (3.0%). Fungal (4.1%) and enterococcal (5.2%) isolations were uncommon. The prevalence of ESBL-producing Enterobacterales were 39.4%; MRSA was 30.2% (Table 2). 4 cases (1.4%) of carbapenem-resistant Enterobacterales (CRE) and 2 cases (0.7%) of AmpC Enterobacterales were identified. Notably, 5 cases (10.4%) of vancomycin-resistant Enterococci (VRE) were identified. Conclusion The study reported clinical and microbiological data of blood culture-proven neonatal sepsis. In contrast with U.S. data, this study showed a lower prevalence of GBS and a significant presence of Gram-negative pathogens, alongside notable resistance profiles such as ESBL-producing Enterobacterales and VRE. Antimicrobial surveillance in developing regions is necessary in order to recognize the most common etiologies and develop treatment guidelines according to local epidemiology. VRE is a worldwide concern and should be closely monitored. Disclosures All Authors: No reported disclosures

An overview of healthcare-associated Candida auris outbreaks in Ministry of Health hospitals–Saudi Arabia 2020–2022; Retrospective multicentric study

Background Candida auris (C. auris) is an emerging fungus pathogen associated with nosocomial infections that is seen as a serious global health issue. Aim To describe the epidemiology and features of hospital-acquired Candida auris outbreaks in the Ministry of Health hospitals (MOH). Methods A three-year (2020–2022) retrospective analysis of Candida auris outbreaks in the Saudi MOH hospitals. A total of 45 hospitals were involved, with 511 cases of Candida auris. The data collected from the General Directorate of Infection Prevention and Control (GDIPC) platform comprises all patients’ data for C. auris instances, whether infected or colonized. Results Out of the 511 Candida auris recruited cases, 291 (56.9%) were infected, whereas 220 (43.1%) were colonized. 32.9% of cases were above the age of 65, and 68.9% were male. The majority of cases were admitted in the ICU unit (95.5%). Approximately 18.8% of cases were diabetes, and 18.5% were hypertensive. Central lines were discovered in 37.7% of the cases. Approximately 85.9% of cases had Foley catheters, 68.5% were on ventilators, and 53.8% had a tracheostomy. The crude mortality rate was particularly high (41.5%) among the study cases. It was non-significantly higher among infected individuals (44.7%) than colonized patients (37.3%) at (p value = 0.093). The prevalence of hypertension (p = 0.001), DM (p = 0.003), and peripheral line insertion (p = 0.004) was significantly higher among colonized patients. While the presence of COVID-19 (p = 0.001), and central line insertion (p = 0.001) was significantly higher among infected patients. Conclusion C. auris is a new pathogen that causes hospital outbreaks. Strict adherence to infection prevention and control criteria established by the Centre for Disease Control (CDC) and GDPIC has significantly contained and reduced the spread of these outbreaks. One-month retrospective surveillance before diagnosing the index case and a prospective surveillance strategy for at least three months is highly recommended.

HPR198 Evaluation of the Early Access Program Evolution: A Three-Year Retrospective Analysis

HPR198 Evaluation of the Early Access Program Evolution: A Three-Year Retrospective Analysis

FP7.12 - A Three-Year Retrospective Analysis of Variables and Their Relationships as Outcome Indicators Following Emergency Laparotomies in Octogenarians: Insights from a Single Institutional Experience

Abstract Aim This retrospective study aims to evaluate the morbidity and mortality outcomes associated with emergency laparotomies in individuals aged 80 years and above, referred to as octogenarians. Against the backdrop of the National Emergency Laparotomy Audit's data from the Eighth Year (2020–2021), which indicates a slight increase in overall in-hospital mortality rates across all age groups, the specific focus on octogenarians intends to provide insights into the unique challenges and outcomes experienced by this elderly population undergoing emergency laparotomies. Methods This retrospective analysis focused on emergency laparotomies in octogenarians between June 2020 and June 2023, comprising 62 cases out of 370. Using a standardized proforma, data was collected and statistical analysis was done with SPSS. Results In this study involving 62 elderly patients (mean age 84) undergoing emergency laparotomies, common diagnoses included Adhesional Small Bowel Obstruction and Large Bowel Obstruction due to Diverticular Disease. Despite the absence of geriatrician involvement, the overall mortality rate was 21%, emphasizing the potential impact of geriatrician reviews. While factors like sepsis and bowel resection did not significantly influence outcomes, the study identified associations between ASA Score, diagnosis type, and predicted mortality rate with patient survival. Complications and comorbidities, such as AKI and atrial fibrillation, were linked to increased mortality. Conclusion In summary, emergency major abdominal surgery poses significant risks, particularly for frail and elderly individuals with multiple co-morbidities. Recognizing frailty as an independent risk factor is crucial. While assessing frailty is complex, open discussions with patients and families about the substantial surgery-related risks are imperative. Establishing realistic expectations is vital for informed decision-making and patient-centered care.

A three-year retrospective analysis of variables and their relationships as outcome indicators following emergency laparotomies in octogenarians: insights from a single institutional experience

Background: This retrospective study aims to specifically assess the morbidity and mortality outcomes linked to emergency laparotomies in a subset of patients aged 80 years and above, referred to as octogenarians. The objective is to gain insights into the specific challenges and outcomes faced by this elderly population undergoing emergency laparotomies. Methods: This retrospective analysis focused on emergency laparotomies in octogenarians between June 2020 and June 2023, involving 62 cases out of 370 total emergency laparotomies conducted across various age groups. Using a standardized proforma, data was collected, and statistical analysis was performed with statistical package for the social sciences (SPSS). Results: In this study involving 62 elderly patients (mean age 84) undergoing emergency laparotomies, common diagnoses included adhesional small bowel obstruction (32.3%)and large bowel obstruction due to diverticular disease (21.0%). Approximately 22.6% of cases were malignant, emphasizing the diverse nature of the cohort. A significant portion (56.5%) underwent bowel resection, and 16.1% had a stoma. Notably, 100% of patients were not seen by geriatrics, indicating potential gaps in comprehensive assessment despite the absence of geriatrician involvement, the overall mortality rate was 21%, emphasizing the potential impact of geriatrician reviews. Conclusions: In summary, emergency major abdominal surgery poses significant risks, particularly for frail and elderly individuals with multiple co-morbidities. Recognizing frailty as an independent risk factor is crucial and highlights areas of potential improvement in this area with early involvement of geriatricians.

A Three-Year Retrospective Analysis: Do Nutritional and Immunological Indices Predict Postoperative Complications After Rectal Resection?

Background Nutritional and immunological indices, such as prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been used as predictors of outcomes and survival in a few cancers. However, the literature is unclear about their usefulness in predicting postoperative complications in rectal cancer resection operations. Additionally, the prescribed cut-off values as well as the timing of the tests for these indices vary among studies. We aimed to determine the role of PNI, NLR, and PLR in predicting postoperative complications in patients undergoing rectal resection. Methods This is a retrospective analysis from a colorectal unit of a tertiary care teaching hospital. All consecutive patients undergoing rectal resection for rectal cancer between April 2018 and March 2021 were included. PNI, NLR, and PLR were calculated from preoperative blood tests, and all morbidity and mortality within 30 days of operation were considered. Results A total of 202 patients were included. Three patients who did not have the necessary preoperative blood test reports were excluded. Of the remaining 199, 142 (71.4 %) were males. The mean age was 47.3 years. Of the patients,13.6% (n = 27) had major morbidity (Clavien-Dindo grade 3-5), including one mortality. The mean PNI, NLR, and PLR were 49.9, 4.3, and 230.5, respectively. The mean PNI between the groups (no complication vs. complication) was 49.6 vs. 50.1 (p = 0.46) and the mean NLR between the same groups was 4.7 vs. 3.8, (p = 0.06), and both were not significant. The mean PLR between the groups (256.3 vs. 203.4, p = 0.01) was found to be significant but significance was not elicited when only major complications were considered. Hence, none of the indices were a good predictor of postoperative complications in our study. Conclusion The role of nutritional and immunological indices (PNI, NLR, and PLR) is limited in predicting postoperative morbidity in rectal resection operations.

A Comprehensive Retrospective Institutional Study for Decoding Oral Squamous Cell Carcinoma.

Background Oral cancer is found to be the thirteenth most common cancer as stated by the WHO (World Health Organization 2023). Oral squamous cell carcinoma (OSCC) is associated with deleterious oral habits such as smoking, chewing tobacco and betel quid, alcohol consumption, low socioeconomic status, sharp teeth, and various causative factors. Materials and methods A three-year retrospective analysis (March 2020-September 2023) was carried out with the available patient records in the Dental Information Archival Software (DIAS) used in a private dental college in Chennai. The demographic data such as age, gender, and habit duration and clinicopathological data such as the anatomical site; tumor, node, and metastasis (TNM) staging; perineural invasion (PNI); lymphovascular invasion (LVI); and oral health-related quality of life were retrieved. Statistical analysis was done using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Results Males (78.35%) more commonly reported OSCC than females (21.62%), and the majority of them were in the age category of fifth to seventh decades of life. The most affected region was the buccal mucosa with 33.3%, followed by the lower alveolus with 30.63%. The duration of harmful habits varied from one year to more than 40 years, and the majority of the patients had T4a staging (40.54%), followed by T2 staging (29.73%) with a habit duration of morethan five years. Approximately 22.52% and 0.9% had PNI and LVI,respectively. The correlation between the two variables was evaluated using the Pearson correlation test and was found to be statistically significant (p < 0.05), i.e., habit to gender and staging with gender were p = 0.027 and p = 0.028, respectively. Conclusion The majority of cases reported were found to be at T4a tumor staging with a habitual duration of more than five years, and more than half of the study population had severe compromise in their quality of life. The presence ofperineural invasion and lymphovascular invasion has an impact on nodal metastasis, treatment choices, recurrence, and oral health-related quality of life. To address this challenge, oral health programs can implement comprehensive antitobacco counseling strategies, oral cancer public awareness programs to tackle the rising incidence of OSCC, and earlyoral precancer screening measures to enhance the prevention and overall quality of life of individuals with oral cancer.

COVID-19 Government policies in Portugal and Brazil: A three-year retrospective analysis

BackgroundCountries have adopted different COVID-19 policies to contain the transmission of the disease and to prepare for vaccination rollout. Countries’ political context, vaccine policy history, and health systems’ responses impacted COVID-19 health outcomes. ObjectiveThis study focused on synthesizing and examining COVID-19 non-pharmaceutical interventions in Brazil and Portugal, understanding the enablers and barriers to COVID-19 vaccination access and distribution, and health and non-health outcomes across three time-points: before vaccination, during mass vaccination, and after the declaration of endemicity. MethodsExtensive qualitative document analysis of secondary sources published in Portuguese and English over the past three years, and examination of primary publicly available epidemiological data since the beginning of the pandemic. ResultsIn the first year of the pandemic, the COVID-19 government response between the two countries was dissimilar; effective coordination, trust in the government response and political alignment in Portugal contrasted the political denial of the pandemic, lack of coordination between the various levels of government, at the same time the Brazilian population engaged in protective behaviours and distrusted the government. The COVID-19 vaccination had a good response from the public, associated with a primary care level network of distribution, low vaccine hesitancy, and strong childhood immunization programs before the pandemic in both countries. Vaccine manufacturing in Brazil and the strong support from the European Union to Portugal on vaccine acquisition have also aided these countries in achieving high COVID-19 vaccination coverage. ConclusionFuture policies to promote a well-functioning and resilient health system should consider medical and nursing workforce sustainability, equity in all policies, building public trust, strengthening health system governance, and improving preparedness and surveillance.

Three-Year Retrospective Theme Analysis on Impact of Co-curricular Activities in First-Year Pharmacy Students

Three-Year Retrospective Theme Analysis on Impact of Co-curricular Activities in First-Year Pharmacy Students

P24-066-23 Participation in Alcohol Free for 40 With Self-Tracking of Laboratory Values and Physical Metrics Improves Biometric Measures; A Three-Year Retrospective Analysis

P24-066-23 Participation in Alcohol Free for 40 With Self-Tracking of Laboratory Values and Physical Metrics Improves Biometric Measures; A Three-Year Retrospective Analysis

Resistance Profiles to Second-Line Anti-Tuberculosis Drugs and Their Treatment Outcomes: A Three-Year Retrospective Analysis from South India.

Background: Patients with first-line drug resistance (DR) to rifampicin (RIF) or isoniazid (INH) as a first-line (FL) line probe assay (LPA) were subjected to genotypic DST using second-line (SL) LPA to identify SL-DR (including pre-XDR) under the National TB Elimination Program (NTEP), India. SL-DR patients were initiated on different DR-TB treatment regimens and monitored for their outcomes. The objective of this retrospective analysis was to understand the mutation profile and treatment outcomes of SL-DR patients. Materials and Methods: A retrospective analysis of mutation profile, treatment regimen, and treatment outcome was performed for SL-DR patients who were tested at ICMR-NIRT, Supra-National Reference Laboratory, Chennai between the years 2018 and 2020. All information, including patient demographics and treatment outcomes, was extracted from the NTEP Ni-kshay database. Results: Between 2018 and 2020, 217 patients out of 2557 samples tested were identified with SL-DR by SL-LPA. Among them, 158/217 were FQ-resistant, 34/217 were SLID-resistant, and 25/217 were resistant to both. D94G (Mut3C) of gyrA and a1401g of rrs were the most predominant mutations in the FQ and SLID resistance types, respectively. Favorable (cured and treatment complete) and unfavorable outcomes (died, lost to follow up, treatment failed, and treatment regimen changed) were recorded in a total of 82/217 and 68/217 patients in the NTEP Ni-kshay database. Conclusions: As per the testing algorithm, SL- LPA is used for genotypic DST following identification of first-line resistance, for early detection of SL-DR in India. The fluoroquinolone resistance pattern seen in this study population corelates with the global trend. Early detection of fluoroquinolone resistance and monitoring of treatment outcome can help achieve better patient management.

Correlation between the increase in serum uric acid and the rapid decline in kidney function in adults with normal kidney function: a retrospective study in Urumqi, China

BackgroundTo examine the association between elevated serum uric acid (SUA) levels and the rapid decline in kidney function by conducting a retrospective cohort study on a physically healthy population in Urumqi, China.MethodsA cohort study of 2,802 physically healthy people with a normal estimated glomerular filtration rate (eGFR) was investigated from 2018 to 2021. The examination procedure included using questionnaires, taking physical measurements, and blood sampling. The rapid decline in kidney function was defined as eGFR > 5 mL·min–1 ·(1.73 m2 )–1 year. The relationship between elevated SUA levels and the rapid decline in kidney function was assessed.ResultsWhen performing the three-year retrospective analysis, 688 (28.55%) cases experienced a rapid decline in kidney function, and 52 (1.9%) cases developed chronic kidney disease (CKD). They were divided into the stable group and the rapidly declining kidney function group according to eGFR > 15 mL·min–1·(1.73 m2 )–1. The comparison revealed a greater increase in uric acid in the rapidly declining kidney function group [0.30 (-0.29, 0.82) mg/dL vs. − 0.07(-0.54, 0.37) mg/dL, Z = − 8.822, P < 0.001]. The participants were further divided into four groups according to their uric acid levels in 2018 and 2021, which included the normal to normal (N-N) group, the normal to hyperuricemia (HUA) (N-H) group, the HUA to normal (H-N) group, and the persistently HUA (H-H) group. The decrease in eGFR was significantly higher in the N-H group than in the other three groups (χ2 = 20.580, P < 0.001). The results of the multifactorial logistic regression analysis showed that elevated uric acid was a risk factor for the rapid decline in kidney function (OR = 1.640, P < 0.001).ConclusionElevated SUA levels were a risk factor for the rapid decline in kidney function in the Chinese health examination population. Higher SUA levels might predict the occurrence of progressive kidney impairment.

Expenditure and Utilization Patterns of Cancer Care in Kuwait

#Introduction Cancer is among the leading causes of morbidity and mortality worldwide. However. The trends in utilization of cancer services and related expenditures in Kuwait are poorly known. We aim to investigate the expenditure and utilization patterns of cancer care in Kuwait. Methods A three-year retrospective analysis study of expenditure and utilization pattern in KCCC was performed from 2015 to 2017 in MOH in Kuwait. Results We report a considerable variation of utilizations and expenditure levels over the three-year period. After adjusting the data, there was significant increase in utilization rates and expenditure in 2015-16 followed by significant decrease in year 2016-17. The expenditure was observed to increase by 1.1% in 2016 before it declined by 1.9% in 2017. Conclusions This study is the first of its kind in Kuwait. We report adequate utilization and expenditure of cancer care in Kuwait. However, we recommend heavy investments in precision medicine technology and patient outcomes research to improve overall financial and operational performance pertaining to cancer care in MOH in Kuwait.

Assessing the Malignancy Risk of a Meningioma by Its Location.

Meningiomas represent 30% of primary intracranial tumors. The current incidence is up to 4.5 cases per 100,000 habitants worldwide. Although there is no prognostic difference among benign histopathological subtypes, atypical meningiomas and malignant meningiomas (WHO grade II and III respectively) may extend to the adjacent brain parenchyma, dura mater, and osseous tissue with a recurrence score (21-49%). This manuscript analyzes the malignancy risk according to neoplastic localization through a logistic retrospective analysis from a total sample of 452 patients with grade I, II, and III (WHO) meningiomas. Detailed data collection through a three-year retrospective analysis (January 2008 to December 2011) was applied at Mexico's National Neurology and Neurosurgery Institute including patients with intracranial or spinal-cord meningioma, preoperative imaging study availability and post-surgical histopathological diagnosis. Formal written consent was not required with a waiver by the appropriate national research ethics committee in accordance with the provisions of the regulations of the general health law of Mexico. Convexity lesions displayed an increased risk of malignancy turning for non-benign meningiomas with an odds ratio of 3.1 (95% CI 1.6 to 5.7, p=0.0002) meanwhile skull-base meningiomas present an inverse risk with an odds ratio of 0.4 (95% CI 0.2 to 0.9, p=0.02), as well as spinal-cord meningiomas with an odds ratio of 0.3 (95% CI 0.1 to 0.9). Skull base and spinal cord meningiomas usually have benign behavior, meanwhile grade II or III meningiomas within this location are rare. The present work provides an additional criterion for decision making, according to the meningioma's location.

Evaluation of Toxoplasma gondii Molecular Test Results in Patients Admitted to Ankara City Hospital: Three-Year Retrospective Analysis

Aim: Toxoplasma gondii infects about 25-30% of the world population. Toxoplasmosis is generally asymptomatic in immunocompetent individuals, but the infection can be life threatening in congenitally infected children and immunocompromised individuals. In this study, it is aimed to analyse the molecular test results of patients suspected with toxoplasmosis, retrospectively. Material and Method: A total of 647 clinical samples investigated for T. gondii DNA with real-time PCR during the three-year period between 2019 and 2022 were evaluated retrospectively. For the qualitative detection of T. gondii, DNA isolation and DNA amplification were performed using commercial DNA extraction kit (Qiagen, Germany) and real time PCR kit (Sacace Biotechnologies, Italy), respectively. The data on the demographic and clinical parameters of the patients were obtained from the laboratory information management system. Results: Out of 647 patients investigated for T. gondii DNA with real-time PCR, 51.8% were female and the mean age of the patients was 37.03 years. Among all patients, five were positive for T. gondii DNA with real-time PCR and the frequency of a positive PCR result was found 0.8% of all samples analysed. The most frequently positive clinical sample was blood (80%). Among five patients with T. gondii DNA positivity, one was diagnosed with congenital toxoplasmosis, four were HIV-infection. Conclusion: Fast and accurate diagnosis of toxoplasmosis especially in immunosuppressed patients is crucial for rapid and specific treatment. Further studies are needed to understand the importance of molecular tests, in addition to the serological tests, in the diagnosis of toxoplasmosis.

Multidrug-resistant gram-negative bacterial infections the Tamale Teaching Hospital in Northern Ghana: a three-year retrospective analysis

Background: A variety of clinically important pathogens have developed multidrug resistance (MDR), which threatens global public health. This study aimed to determine the incidence, patterns, and trends of MDR of gram-negative bacterial isolates in clinical specimens in the Tamale Teaching Hospital, Ghana. Methods: This retrospective study analyzed gram-negative bacterial isolates and antimicrobial susceptibility test (AST) results of patients who visited the Tamale Teaching Hospital laboratory between 2017 and 2019. Results: A total of 2,779 gram-negative bacterial isolates and their phenotypic AST results were analyzed. From these, 1,297 gram-negative bacteria (46.7%) were isolated from urine samples, while the rest were isolated from sputum (20.9%), wound (14.3%), and swabs (11.7%) samples, etc. Escherichia coli (23.8%) was the most common gram-negative pathogen found predominantly in the urine samples (33.2%). All gram-negative bacteria isolated between 2017 and 2019 showed high MDR. Klebsiella pneumoniae gradually increased its MDR from 84.0% in 2017, 89.5% in 2018, to 95.1% in 2019. On the other hand, the MDR rates in Pseudomonas aeruginosa were approximately 65.8%, varying from 59.5% in 2017 to 78.7% in 2019. Among tested antimicrobials, amikacin was the most effective. Resistance to amikacin in Enterobacter spp., E. coli, and K. pneumoniae in vitro were 16.2%, 11.8%, and 17.7%, respectively. Conclusion: The study has shown that the high levels of MDR in gram-negative bacteria isolated may be associated with the infections recorded at the Tamale Teaching Hospital. The major gram-negative pathogens isolated have resistance to penicillins, cephalosporins, and fluoroquinolones. Aminoglycosides can offer high antibiotic activity to overcome gramnegative bacterial resistance. Further studies will be needed to decide policy direction on infection prevention and control, and antimicrobial stewardship programs.

Subtle oncological emergencies: Nature of illness, clinical characteristics, and outcomes

ObjectivesThe primary objective was to assess whether presentation severity at the emergency department (ED) can determine treatment and health outcomes among patients with oncological emergencies. MethodsWe conducted a three-year retrospective analysis of accessible records of adult cancer patients admitted with oncological emergencies. ResultsPatients with subtle presentations had longer wait times than patients with severe presentations in all ED timeliness indicators. On average, subtle presentations were significantly associated with 47.5 min increase in time to be seen, 33 min increase in time to be treated, 42 min increase in time to decide on admission and prolonged ED stay by 24 min (p < 0.05). Subtle presentations were also significantly associated with a four-fold increase in intensive care unit admissions and a three-fold increase in mortality odds. ConclusionThe severity of the clinical presentations significantly predicted oncological emergencies' treatment and health outcomes. This research raises the importance of emergency triage decision accuracy. Triage health workers should have a solid knowledge base regarding oncological emergencies to improve patients’ early recognition and prioritization. Oncological emergency presentations can be subtle, rendering patients vulnerable extensive delay and inferior outcomes. Therefore, triage nurses should be educated and trained on the multiple available severity scales sensitive to identifying the real urgency. Also, protocols and care pathways should be in place to enable immediate fast-tracking of patients and the provision of timely treatment.

387 Outcome Predictors of Interhospital Transferred Patients to Emergency General Surgery Service: Does Transfer Location Matter?

The regionalization of medicine further stresses emergency departments (ED) around the country. This paradigm shift that concentrates subspecialties to large academic institutions has increased the need to transfer patients from their initial, primary hospital. The interhospital-transferred (IHT) patients are associated with higher resource utilization and mortality. It is crucial to understand the differences that transferring IHT patients have on their outcome and identify specific clinical indicators that put them at increased risk of morbidity and mortality. We sought to understand the differences in predictors for outcomes between patients who were transferred from other hospitals’ EDs or inpatient units to a tertiary care center for surgical evaluation. We conducted a three-year retrospective analysis from 01/2014 to 12/2016. Adult patients who were transferred to our quaternary academic center’s emergency general surgery (EGS) service as the primary admitting service, were eligible. Our primary outcome was mortality and secondary outcomes were patients’ hospital dispositions and survivors’ hospital length of stay (HLOS). We used multivariable logistic and ordinal regressions to assess the associations of patients’ clinical factors at arrival to our medical center and their outcomes. We analyzed a total of 708 patients, 175 (25%) from the ED, 280 (39%) from the intensive care unit (ICU), and 253 (36%) from the ward. Compared to the ED patients, patients transferred from the ICU had a higher mean (SD) Sequential Organ Failure Assessment (SOFA) score [5.7 (4.5) vs. 2.39 (2), P<0.001], higher mortality, and longer HLOS. Transferring patients from the ICU (OR 2.95, 95% CI 1.36-6.41, P=0.006), requiring laparotomy (OR 1.96, 95% CI 1.04-3.70, P=0.039), and SOFA score (OR 1.22, 95% CI 1.13-1.32, P<0.001) were associated with higher mortality while gastrointestinal bleed was associated with lower mortality. Transfer from the ED was significantly associated with short HLOS (corr. coeff. 0.46, 95% CI 1.07-2.33, P=0.021) and favorable discharge disposition, discharge home (corr. coeff. 0.63, 95% CI 1.13-3.09, P=0.015). We found that ED patients are nested between ICU and intermediate care unit/floor originating transfers when comparing markers of decompensation (lactate, WBC count, SOFA score). At our academic center, patients who were transferred from other hospitals’ ED were less critically ill, had shorter HLOS, and lower mortality compared to patients from the ICU. We identified that SOFA score at admission was strongly associated with patients’ outcomes. It is important to not overlook the origin of a transfer when determining the needs of a patient. While awaiting future studies’ results, emergency physicians should use readily available scoring mechanisms like the SOFA score to further assess a patient’s risk of decompensation to facilitate earlier transfer to a higher-level care facility. Future research should analyze the contributing factors to patients’ decompensation and increased mortality following transfer to a higher care facility.