Background: Cardiovascular implantable electronic device (CIED) infections without early diagnosis, treatment, and proper follow-up are associated with increased morbidity, mortality, and worse outcomes. Objective: This study aims to identify patients presenting for hospital admission with bacteremia and the presence of CIED by implementing a best practice advisory (BPA) notification in the electronic medical record to facilitate early consultation with the cardiac electrophysiology (EP) team and treatment.
Methods: A BPA was implemented into the electronic medical record (EMR) EPIC in 2022 and was generated for any patient that presented to our health system with bacteremia and the presence of a CIED. The BPA gave the provider an option for EP consultation. Data was collected from EPIC from 2021 to 2023 using the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD10-CM/PCS) codes to identify patients and comorbidities. A comparative analysis was conducted to determine the effectiveness of the BPA in increasing EP consults and cardiac device extraction procedures, as well as overall outcomes.
Results: A total of 447 patients were diagnosed with bacteremia and the presence of a CIED during the study period, with 178 before the BPA and 269 status post-BPA. The BPA resulted in a nonsignificant increase in EP consultations from 19.66% to 25.88% (p = 0.168) and device extractions from 9.55% to 13.75% (p = 0.182). EP consults were a significant predictor for device extractions (odds ratio (OR) = 9.4644, p < 0.0001). The mortality rate decreased from 17.42% to 14.13% (p = 0.419), and the 30-day readmission decreased from 14.37% to 12.41% (p = 0.652).
Conclusion: While the BPA did not show significant improvements, its implementation shows promise over time with positive trends in consults, extractions, and in-hospital mortality.
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http://dx.doi.org/10.7759/cureus.74012 | DOI Listing |
Clin Infect Dis
December 2024
Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden.
Background: Endocarditis occurs in approximately 10-15% of patients with Staphylococcus aureus bacteremia. Short time to positivity (TTP) in blood culture flasks has been linked to endocarditis in smaller studies. This study evaluated the association between TTP and endocarditis in S.
View Article and Find Full Text PDFJ Gen Intern Med
December 2024
Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.
Background: Detailed grading of chills is more useful for diagnosing bacteremia than simply classifying the presence or absence of chills. However, its value added to other clinical information has not been evaluated.
Objective: To evaluate the value of adding chills grading to other clinical information compared to simply noting the presence or absence of chills for predicting bacteremia in patients with suspected infection.
Background: Cardiovascular implantable electronic device (CIED) infections without early diagnosis, treatment, and proper follow-up are associated with increased morbidity, mortality, and worse outcomes. Objective: This study aims to identify patients presenting for hospital admission with bacteremia and the presence of CIED by implementing a best practice advisory (BPA) notification in the electronic medical record to facilitate early consultation with the cardiac electrophysiology (EP) team and treatment.
Methods: A BPA was implemented into the electronic medical record (EMR) EPIC in 2022 and was generated for any patient that presented to our health system with bacteremia and the presence of a CIED.
Pediatr Int
December 2024
Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
Background: Information on the etiology and prognosis for leukemoid reaction (LR) in children is still limited and little is known about the factors that distinguish LR from hematological malignancy (HM).
Methods: This was a single-center, case-control study. Pediatric patients (<18 years) with a white blood cell (WBC) count of 50,000/μL or more were included in the study.
Semin Dial
December 2024
Department of Critical Care Medicine, King George Medical University, Lucknow, India.
Background: Tunneled dialysis catheters (TDCs) are preferred over temporary noncuffed catheters for access in patients on maintenance hemodialysis. The removal of TDC after catheter-related blood stream infections (CRBSIs) is often not practiced even when indicated, and the adverse outcomes after such salvage are presently unclear.
Aims And Objectives: The study aimed to evaluate adverse outcomes after the first episode of definite or probable CRBSI.
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