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Duong B, Zaidan M, Puebla Neira D, Polychronopoulou E, Sharma G, Duarte AG. Utilization of Pulmonary Rehabilitation Following Hospitalization for COVID-19. J Cardiopulm Rehabil Prev 2023; 43:E27-E29. [PMID: 37820273 DOI: 10.1097/hcr.0000000000000816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Brittany Duong
- Department of Internal Medicine, Division of Pulmonary Critical Care & Sleep Medicine (Drs Duong, Zaidan, Sharma, and Duarte) and Office of Biostatistics (Dr Polychronopoulou), The University of Texas Medical Branch, Galveston; and Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The University of Arizona, Phoenix (Dr Puebla Neira)
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Buckley MS, Kobic E, Yerondopoulos M, Sharif AS, Benanti GE, Meckel J, Puebla Neira D, Boettcher SR, Khan AA, McNierney DA, MacLaren R. Comparison of Methicillin-Resistant Staphylococcus aureus Nasal Screening Predictive Value in the Intensive Care Unit and General Ward. Ann Pharmacother 2023; 57:1036-1043. [PMID: 36575978 DOI: 10.1177/10600280221145152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening appears promising for antimicrobial stewardship programs. However, a paucity of data remains on the diagnostic performance of culture-based MRSA screen in the intensive care unit (ICU) for pneumonia and bacteremia. OBJECTIVE The objective of this study was to compare the predictive value of culture-based MRSA nasal screening for pneumonia and bacteremia in ICU and general ward patients. METHODS This multicenter, retrospective study was conducted over a 23-month period. Adult patients with MRSA nasal screening ≤48 hours of collecting a respiratory and/or blood culture with concurrent initiation of anti-MRSA therapy were included. The primary endpoint was to compare the negative predictive value (NPV) associated with culture-based MRSA nasal screening between ICU and general ward patients with suspected pneumonia. RESULTS A total of 5106 patients representing the ICU (n = 2515) and general ward (n = 2591) were evaluated. The NPV of the MRSA nares for suspected pneumonia was not significantly different between ICU and general ward patient populations (98.3% and 97.6%, respectively; P = 0.41). The MRSA nares screening tool also had a high NPV for suspected bacteremia in ICU (99.8%) and general ward groups (99.7%) (P = 0.56). The overall positive MRSA nares rates in the ICU and general ward patient populations were 9.1% and 8.2%, respectively (P = 0.283). Moreover, MRSA-positive respiratory and blood cultures among ICU patients were 5.8% and 0.8%, respectively. CONCLUSION AND RELEVANCE Our findings support the routine use of MRSA nasal screening using the culture-based method in ICU patients with pneumonia. Further research on the clinical performance for MRSA bacteremia in the ICU is warranted.
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Affiliation(s)
- Mitchell S Buckley
- Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Emir Kobic
- Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | | | - Atefeh S Sharif
- Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Grace E Benanti
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Jordan Meckel
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Daniel Puebla Neira
- Department of Pulmonary and Critical Care, The University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | - Abdul A Khan
- Department of Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Dakota A McNierney
- Department of Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Robert MacLaren
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
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Puebla Neira D, Zaidan M, Nishi S, Duarte A, Lau C, Parthasarathy S, Wang J, Kuo YF, Sharma G. Healthcare Utilization in Patients with Chronic Obstructive Pulmonary Disease Discharged from Coronavirus 2019 Hospitalization. Int J Chron Obstruct Pulmon Dis 2023; 18:1827-1835. [PMID: 37636902 PMCID: PMC10460173 DOI: 10.2147/copd.s415621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023] Open
Abstract
Rationale There is concern that patients with chronic obstructive pulmonary disease (COPD) are at greater risk of increased healthcare utilization (HCU) following Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV-2) infection. Objective To assess whether COPD is an independent risk factor for increased post-discharge HCU. Methods We conducted a retrospective cohort study of patients with COPD discharged home from a hospitalization due to Coronavirus Disease 2019 (COVID-19) between April 1, 2020, and March 31, 2021, using Optum's de-identified Clinformatics® Data Mart Database (CDM). COVID-19 was identified by an International Classification of Diseases, tenth revision, clinical modification (ICD-10-CM) diagnosis code of U07.1. The primary outcome was HCU (ie, emergency department (ED) visits, readmissions, rehabilitation/skilled nursing facility (SNF) visits, outpatient office visits, and telemedicine visits) nine months post-discharge after COVID-19 hospitalization (from here on "post-discharge") in patients with COPD compared to HCU of patients without COPD. Poisson regression modeling was used to calculate relative risk (RR) and confidence interval (CI) for COPD, adjusted for the other covariates. Results We identified a cohort of 160,913 patients hospitalized with COVID-19, with 57,756 discharged home and 14,622 (25.3%) diagnosed with COPD. Patients with COPD had a mean age of 75.48 years (±9.49); 55.5% were female and 70.9% were White. Patients with COPD had an increased risk of HCU in the nine months post-discharge after adjusting for the other covariates. Risk of ED visits, readmissions, length of stay during readmission, rehabilitation/SNF visits, outpatient office visits, and telemedicine visits were increased by 57% (RR 1.57; 95% CI 1.53-1.60), 50% (RR 1.50; 95% CI 1.46-1.54), 55% (RR 1.55; 95% CI 1.53-1.56), 18% (RR 1.18; 95% CI 1.14-1.22), 16% (RR 1.16; 95% CI 1.16-1.17), and 28% (RR 1.28; 95% CI 1.24-1.31), respectively. Younger patients (ages 18 to 65 years), women, and Hispanic patients with COPD showed an increased risk for post-discharge HCU. Conclusion Patients with COPD hospitalized with COVID-19 experienced increased HCU post-discharge compared to patients without COPD.
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Affiliation(s)
- Daniel Puebla Neira
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Mohammed Zaidan
- Division of Pulmonary Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Shawn Nishi
- Division of Pulmonary Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Alexander Duarte
- Division of Pulmonary Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Christopher Lau
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Sairam Parthasarathy
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Jiefei Wang
- Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, TX, USA
| | - Gulshan Sharma
- Division of Pulmonary Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Buckley MS, Benanti GE, Meckel J, Tekle LA, Gilbert B, Puebla Neira D, McNierney DA, Korkames G, Yerondopoulos M, Park A, O'Hea JA, MacLaren R. Correlation between partial thromboplastin time and thromboelastography in adult critically ill patients requiring bivalirudin for extracorporeal membrane oxygenation. Pharmacotherapy 2023; 43:196-204. [PMID: 36759323 DOI: 10.1002/phar.2776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023]
Abstract
STUDY OBJECTIVE Thromboelastography (TEG) offers a more dynamic assessment of hemostasis over activated partial thromboplastin time (aPTT). However, the clinical utility of TEG in monitoring bivalirudin during extracorporeal membrane oxygenation (ECMO) remains unknown. The purpose of this study was to evaluate the correlation between aPTT and TEG in adult ECMO patients anticoagulated with bivalirudin. DESIGN Multicenter, retrospective, cohort study conducted over a 2-year period. SETTING Two academic university medical centers (Banner University Medical Center) in Phoenix and Tucson, AZ. PATIENTS Adult patients requiring ECMO and bivalirudin therapy with ≥1 corresponding standard TEG and aPTT plasma samples drawn ≤4 h of each other were included. The primary endpoint was to determine the correlation coefficient between the standard TEG reaction (R) time and bivalirudin aPTT serum concentrations. MEASUREMENTS AND MAIN RESULTS A total of 104 patients consisting of 848 concurrent laboratory assessments of R time and aPTT were included. A moderate correlation between TEG R time and aPTT was demonstrated in the study population (r = 0.41; p < 0.001). Overall, 502 (59.2%) concurrent assessments of TEG R time and aPTT values showed agreement on whether they were sub-, supra-, or therapeutic according to the institution's classification for bivalirudin. The 42.2% (n = 271/642) discordant TEG R times among "therapeutic" aPTT were almost equally distributed between subtherapeutic and supratherapeutic categories. CONCLUSIONS Moderate correlation was found between TEG R time and aPTT associated with bivalirudin during ECMO in critically ill adults. Further research is warranted to address the optimal test to guide clinical decision-making for anticoagulation dosing in ECMO patients.
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Affiliation(s)
- Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Grace E Benanti
- Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jordan Meckel
- Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois, USA
| | - Luwam A Tekle
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Brian Gilbert
- Department of Pharmacy, Wesley Medical Center, Wichita, Kansas, USA
| | - Daniel Puebla Neira
- Department of Pulmonary and Critical Care, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Dakota A McNierney
- Department of Medicine, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Grace Korkames
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Melanie Yerondopoulos
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Andrew Park
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Jennifer A O'Hea
- Division of Pulmonary/Critical Care, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Robert MacLaren
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
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Neira DP, Seashore J. Letters to the Editor. AACN Adv Crit Care 2021; 32:152-153. [PMID: 33740812 DOI: 10.4037/aacnacc2021801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Daniel Puebla Neira
- Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX
| | - Justin Seashore
- Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX
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Puebla Neira D, Watts A, Seashore J, Polychronopoulou E, Kuo YF, Sharma G. Smoking and risk of COVID-19 hospitalization. Respir Med 2021; 182:106414. [PMID: 33915414 PMCID: PMC8052507 DOI: 10.1016/j.rmed.2021.106414] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 02/07/2023]
Abstract
Rationale The association between smoking status and severe Coronavirus Disease 2019 (COVID-19) remains controversial. Objective To assess the risk of hospitalization (as a marker of severe COVID-19) in patients by smoking status: former, current and never smokers, who tested positive for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2) at an academic medical center in the United States. Methods We conducted a retrospective cohort study in patients with SARS-COV2 between March-1-2020 and January-31-2021 to identify the risk of hospitalization due to COVID-19 by smoking status. Results We identified 10216 SARS-COV2-positive patients with complete documentation of smoking habits. Within 14 days of a SARS-COV2 positive test, 1150 (11.2%) patients were admitted and 188 (1.8%) died. Significantly more former smokers were hospitalized from COVID-19 than current or never smokers (21.2% former smokers; 7.3% current smokers; 10.4% never smokers, p<0.0001). In univariable analysis, former smokers had higher odds of hospitalization from COVID-19 than never smokers (OR 2.31; 95% CI 1.94-2.74). This association remained significant when analysis was adjusted for age, race and gender (OR 1.28; 95% CI 1.06-1.55), but became non-significant when analysis included Body Mass Index, previous hospitalization and number of comorbidities (OR 1.05; 95% CI 0.86-1.29). In contrast, current smokers were less likely than never smokers to be hospitalized due to COVID-19. Conclusions Significantly more former smokers were hospitalized and died from COVID-19 than current or never smokers. This effect is mediated via age and comorbidities in former smokers.
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Affiliation(s)
- Daniel Puebla Neira
- Division of Pulmonary and Critical Care Medicine. Department of Internal Medicine, University of Texas Medical Branch. Galveston, TX, USA.
| | - Abigail Watts
- Division of Pulmonary and Critical Care Medicine. Department of Internal Medicine, University of Texas Medical Branch. Galveston, TX, USA
| | - Justin Seashore
- Division of Pulmonary and Critical Care Medicine. Department of Internal Medicine, University of Texas Medical Branch. Galveston, TX, USA
| | | | - Yong-Fang Kuo
- Office of Biostatistics, University of Texas Medical Branch. Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch. Galveston, TX, USA
| | - Gulshan Sharma
- Division of Pulmonary and Critical Care Medicine. Department of Internal Medicine, University of Texas Medical Branch. Galveston, TX, USA
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Puebla Neira D, Tambra S, Bhasin V, Nawgiri R, Duarte AG. Discordant bilateral bronchoalveolar lavage findings in a patient with acute eosinophilic pneumonia associated with counterfeit tetrahydrocannabinol oil vaping. Respir Med Case Rep 2020; 29:101015. [PMID: 32071854 PMCID: PMC7013172 DOI: 10.1016/j.rmcr.2020.101015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 11/28/2022] Open
Abstract
Vaping has emerged as a popular alternative form of inhalation of nicotine and marihuana derivates (including Tetrahydrocannabinol, THC) in part due to the avoidance of combustion byproducts. Unfortunately, THC oil (especially that produced by unregulated individuals) may contain dilutants such as propylene glycol, vitamin E, and flavoring ingredients that can lead to adverse respiratory effects. Acute eosinophilic pneumonia (AEP) has been described in association with e-cigarette and vaping associated lung injury (EVALI) but the majority of bronchoalveolar lavage (BAL) samples reported in the literature do not show eosinophils as the predominant cell lineage. Only two other cases of AEP have been published, and here we present the first case reported in the literature of a patient with EVALI with AEP pattern associated with counterfeit tetrahydrocannabinol (THC) oil vaping and discordant bilateral BAL cell count differential.
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Affiliation(s)
- Daniel Puebla Neira
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sarah Tambra
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Vibha Bhasin
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Ranjana Nawgiri
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Alexander G. Duarte
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX, USA
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