General Surgery

SAN DIEGO – Less than a third of hospitals reprocessed duodenoscopes adequately to prevent potential transmission of carbapenem-resistant Enterobacteriaceae (CRE) and other pathogens, investigators reported at an annual scientific meeting on infectious diseases.

Moreover, only a third of facilities had conducted active surveillance for multidrug-resistant infections related to use of their duodenoscopes in the past year, reported Susan Beekmann of the Emerging Infections Network of the Infectious Diseases Society of America. “These findings suggest that endemic bacterial transmission associated with duodenoscopy may occur and may go unrecognized,” said Ms. Beekmann, program coordinator for EIN at the University of Iowa Carver College of Medicine in Iowa City.

©CDC/James Archer

Duodenoscopes, which are used in endoscopic retrograde cholangiopancreatography (ERCP), became a hot topic earlier this year after causing outbreaks of fatal CRE infections in Los Angeles County. The Food and Drug Administration has acknowledged that the “complex design of the devices makes it difficult to remove contaminants compared to other types of endoscopes,” and both the CDC and the FDA have recommended specific reprocessing and surveillance steps to reduce the chances that the scopes transmit serious infections.

To understand how hospitals were actually reprocessing and culturing the scopes at the time CDC released its guidance, Ms. Beekmann and her colleagues electronically surveyed 740 hospital epidemiologists through IDSA-EIN. They received responses from 378 physicians (52%), of which half said their facilities used duodenoscopes, Ms. Beekmann reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Only 55 (29%) of these respondents said their facilities reprocessed duodenoscopes to an extent that the IDSA researchers defined as adequate – that is, manual reprocessing with high-level disinfection, either alone or in combination with other options, Ms. Beekmann said. Furthermore, only a third of facilities had cultured their duodenoscopes or done any other surveillance for bacterial transmission after duodenoscopy in the past year, even though most said they reviewed their reprocessing policies and procedures more often than once a year.

Respondents also described widely varying methodologies for sampling and culturing, Ms. Beekmann said. “Although we did not ask about them, ten respondents mentioned ATP bioluminescence assays,” she added. Based on the findings, better reprocessing technologies and consistent, real-time strategies to monitor the effectiveness of scope reprocessing are “urgent patient safety needs,” she and her colleagues concluded.

Ms. Beekmann and her associates reported no relevant financial disclosures.

SAN DIEGO – Less than a third of hospitals reprocessed duodenoscopes adequately to prevent potential transmission of carbapenem-resistant Enterobacteriaceae (CRE) and other pathogens, investigators reported at an annual scientific meeting on infectious diseases.

Moreover, only a third of facilities had conducted active surveillance for multidrug-resistant infections related to use of their duodenoscopes in the past year, reported Susan Beekmann of the Emerging Infections Network of the Infectious Diseases Society of America. “These findings suggest that endemic bacterial transmission associated with duodenoscopy may occur and may go unrecognized,” said Ms. Beekmann, program coordinator for EIN at the University of Iowa Carver College of Medicine in Iowa City.

©CDC/James Archer

Duodenoscopes, which are used in endoscopic retrograde cholangiopancreatography (ERCP), became a hot topic earlier this year after causing outbreaks of fatal CRE infections in Los Angeles County. The Food and Drug Administration has acknowledged that the “complex design of the devices makes it difficult to remove contaminants compared to other types of endoscopes,” and both the CDC and the FDA have recommended specific reprocessing and surveillance steps to reduce the chances that the scopes transmit serious infections.

To understand how hospitals were actually reprocessing and culturing the scopes at the time CDC released its guidance, Ms. Beekmann and her colleagues electronically surveyed 740 hospital epidemiologists through IDSA-EIN. They received responses from 378 physicians (52%), of which half said their facilities used duodenoscopes, Ms. Beekmann reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Only 55 (29%) of these respondents said their facilities reprocessed duodenoscopes to an extent that the IDSA researchers defined as adequate – that is, manual reprocessing with high-level disinfection, either alone or in combination with other options, Ms. Beekmann said. Furthermore, only a third of facilities had cultured their duodenoscopes or done any other surveillance for bacterial transmission after duodenoscopy in the past year, even though most said they reviewed their reprocessing policies and procedures more often than once a year.

Respondents also described widely varying methodologies for sampling and culturing, Ms. Beekmann said. “Although we did not ask about them, ten respondents mentioned ATP bioluminescence assays,” she added. Based on the findings, better reprocessing technologies and consistent, real-time strategies to monitor the effectiveness of scope reprocessing are “urgent patient safety needs,” she and her colleagues concluded.

Ms. Beekmann and her associates reported no relevant financial disclosures.

SAN DIEGO – Less than a third of hospitals reprocessed duodenoscopes adequately to prevent potential transmission of carbapenem-resistant Enterobacteriaceae (CRE) and other pathogens, investigators reported at an annual scientific meeting on infectious diseases.

Moreover, only a third of facilities had conducted active surveillance for multidrug-resistant infections related to use of their duodenoscopes in the past year, reported Susan Beekmann of the Emerging Infections Network of the Infectious Diseases Society of America. “These findings suggest that endemic bacterial transmission associated with duodenoscopy may occur and may go unrecognized,” said Ms. Beekmann, program coordinator for EIN at the University of Iowa Carver College of Medicine in Iowa City.

©CDC/James Archer

Duodenoscopes, which are used in endoscopic retrograde cholangiopancreatography (ERCP), became a hot topic earlier this year after causing outbreaks of fatal CRE infections in Los Angeles County. The Food and Drug Administration has acknowledged that the “complex design of the devices makes it difficult to remove contaminants compared to other types of endoscopes,” and both the CDC and the FDA have recommended specific reprocessing and surveillance steps to reduce the chances that the scopes transmit serious infections.

To understand how hospitals were actually reprocessing and culturing the scopes at the time CDC released its guidance, Ms. Beekmann and her colleagues electronically surveyed 740 hospital epidemiologists through IDSA-EIN. They received responses from 378 physicians (52%), of which half said their facilities used duodenoscopes, Ms. Beekmann reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Only 55 (29%) of these respondents said their facilities reprocessed duodenoscopes to an extent that the IDSA researchers defined as adequate – that is, manual reprocessing with high-level disinfection, either alone or in combination with other options, Ms. Beekmann said. Furthermore, only a third of facilities had cultured their duodenoscopes or done any other surveillance for bacterial transmission after duodenoscopy in the past year, even though most said they reviewed their reprocessing policies and procedures more often than once a year.

Respondents also described widely varying methodologies for sampling and culturing, Ms. Beekmann said. “Although we did not ask about them, ten respondents mentioned ATP bioluminescence assays,” she added. Based on the findings, better reprocessing technologies and consistent, real-time strategies to monitor the effectiveness of scope reprocessing are “urgent patient safety needs,” she and her colleagues concluded.

Ms. Beekmann and her associates reported no relevant financial disclosures.

CHICAGO – Gram-negative bacteria are the new frontier of antimicrobial resistance.

Resistant Escherichia coli, Klebsiella, and other organisms are increasingly common in Asia, South America, and southern Europe, but haven’t quite established themselves yet in the United States.

In an interview at the annual clinical congress of the American College of Surgeons, Dr. John Mazuski, a professor of surgery at Washington University in St. Louis, explained what’s known so far, and the steps to take now to keep the organisms in check.

[email protected]

CHICAGO – Gram-negative bacteria are the new frontier of antimicrobial resistance.

Resistant Escherichia coli, Klebsiella, and other organisms are increasingly common in Asia, South America, and southern Europe, but haven’t quite established themselves yet in the United States.

In an interview at the annual clinical congress of the American College of Surgeons, Dr. John Mazuski, a professor of surgery at Washington University in St. Louis, explained what’s known so far, and the steps to take now to keep the organisms in check.

[email protected]

CHICAGO – Gram-negative bacteria are the new frontier of antimicrobial resistance.

Resistant Escherichia coli, Klebsiella, and other organisms are increasingly common in Asia, South America, and southern Europe, but haven’t quite established themselves yet in the United States.

In an interview at the annual clinical congress of the American College of Surgeons, Dr. John Mazuski, a professor of surgery at Washington University in St. Louis, explained what’s known so far, and the steps to take now to keep the organisms in check.

[email protected]

The number of self-harm emergencies increases by 50% after bariatric surgery, according to a report published online Oct. 7 in JAMA Surgery.

Mental health problems are common among both morbidly obese adults and patients undergoing bariatric surgery, and a recent meta-analysis of 30 studies found that suicide risk was four times higher among patients undergoing bariatric surgery than in the general population. To examine this association, researchers performed a population-based longitudinal cohort study comparing self-harm behaviors during the 3 years before bariatric surgery with those during the 3 years after bariatric surgery in all 8,815 adults who underwent gastric bypass, intestinal bypass, and sleeve gastrectomy in Ontario during a 5-year period.

KatarzynaBialasiewicz/Thinkstock.com

This cohort reflects the practice of approximately 200 surgeons. Self-harm behaviors were categorized as medication overdose, alcohol-related, poisoning by toxic chemicals, or physical trauma. Approximately 64% of the study population had a history of anxiety disorders, 7.8% had general mental health disorders, and 0.6% reported alcohol misuse before undergoing bariatric surgery, wrote Junaid A. Bhatti, Ph.D., of the department of evaluative clinical sciences, Sunnybrook Research Institute, Toronto, and the department of surgery, University of Toronto.

There were 62 self-harm events during the preoperative interval and 96 during the postoperative interval. The mean incidence of self harm was 2.33 events per 1,000 patients during the 3 years before surgery and 3.63 per 1,000 during the 3 years after surgery, for a rate ratio of 1.54. This represents an increase of approximately 50% after bariatric surgery. The postoperative self-harm rate also was three times as high as that in the general Ontario population (1.2 per 1,000 people) during the same period.

Most of these incidents (73%) were medication overdoses. These were considered serious suicide attempts posing significant risk to the patients; they required ambulance transport and hospital admission. Physical trauma such as self-hanging accounted for another 21%. Almost all of the patients with postoperative self-harm behaviors had a known history of mental health problems, chiefly major depression. These findings suggest the need for increased screening and monitoring for excessive drug or alcohol use, as well as activating a reliable support network to mitigate the stress that follows profound changes in diet and lifestyle, Dr. Bhatti and his associates said (JAMA Surg. 2015 Oct 7. doi: 10.1001/jamasurg.2015.3414).

The reason for this rise in self-harm behaviors is not yet known. Some experts contend that changes in alcohol metabolism following bariatric surgery raise the likelihood of intoxication or alcohol-related disinhibition, both of which can escalate impulsivity. Others argue that morbid obesity arises from a food addiction, and after the procedure patients may turn from overeating to alcohol/substance abuse. Most agree that the surgery and the lifestyle changes it requires increase the patient’s stress and anxiety, which can exacerbate preexisting mental health problems. Finally, bariatric surgery itself alters neurohormone levels, which could in turn predispose patients to depression or suicidal behaviors, the investigators said.

This study was limited in that the data didn’t allow the researchers to account for some important surgery-related factors, including patients’ failure to lose a significant amount of weight. In addition, the study focused on self-harm behaviors that led to emergency-department visits; since completed suicides generally don’t include ED visits, some cases of self-harm that ended in death could not be included.

The Canadian Institutes of Health Research, the Canada Research Chair in Medical Decision Sciences, and the Da Souza Chair in Trauma Research funded the study. Dr. Bhatti and his associates reported having no relevant financial disclosures.

The number of self-harm emergencies increases by 50% after bariatric surgery, according to a report published online Oct. 7 in JAMA Surgery.

Mental health problems are common among both morbidly obese adults and patients undergoing bariatric surgery, and a recent meta-analysis of 30 studies found that suicide risk was four times higher among patients undergoing bariatric surgery than in the general population. To examine this association, researchers performed a population-based longitudinal cohort study comparing self-harm behaviors during the 3 years before bariatric surgery with those during the 3 years after bariatric surgery in all 8,815 adults who underwent gastric bypass, intestinal bypass, and sleeve gastrectomy in Ontario during a 5-year period.

KatarzynaBialasiewicz/Thinkstock.com

This cohort reflects the practice of approximately 200 surgeons. Self-harm behaviors were categorized as medication overdose, alcohol-related, poisoning by toxic chemicals, or physical trauma. Approximately 64% of the study population had a history of anxiety disorders, 7.8% had general mental health disorders, and 0.6% reported alcohol misuse before undergoing bariatric surgery, wrote Junaid A. Bhatti, Ph.D., of the department of evaluative clinical sciences, Sunnybrook Research Institute, Toronto, and the department of surgery, University of Toronto.

There were 62 self-harm events during the preoperative interval and 96 during the postoperative interval. The mean incidence of self harm was 2.33 events per 1,000 patients during the 3 years before surgery and 3.63 per 1,000 during the 3 years after surgery, for a rate ratio of 1.54. This represents an increase of approximately 50% after bariatric surgery. The postoperative self-harm rate also was three times as high as that in the general Ontario population (1.2 per 1,000 people) during the same period.

Most of these incidents (73%) were medication overdoses. These were considered serious suicide attempts posing significant risk to the patients; they required ambulance transport and hospital admission. Physical trauma such as self-hanging accounted for another 21%. Almost all of the patients with postoperative self-harm behaviors had a known history of mental health problems, chiefly major depression. These findings suggest the need for increased screening and monitoring for excessive drug or alcohol use, as well as activating a reliable support network to mitigate the stress that follows profound changes in diet and lifestyle, Dr. Bhatti and his associates said (JAMA Surg. 2015 Oct 7. doi: 10.1001/jamasurg.2015.3414).

The reason for this rise in self-harm behaviors is not yet known. Some experts contend that changes in alcohol metabolism following bariatric surgery raise the likelihood of intoxication or alcohol-related disinhibition, both of which can escalate impulsivity. Others argue that morbid obesity arises from a food addiction, and after the procedure patients may turn from overeating to alcohol/substance abuse. Most agree that the surgery and the lifestyle changes it requires increase the patient’s stress and anxiety, which can exacerbate preexisting mental health problems. Finally, bariatric surgery itself alters neurohormone levels, which could in turn predispose patients to depression or suicidal behaviors, the investigators said.

This study was limited in that the data didn’t allow the researchers to account for some important surgery-related factors, including patients’ failure to lose a significant amount of weight. In addition, the study focused on self-harm behaviors that led to emergency-department visits; since completed suicides generally don’t include ED visits, some cases of self-harm that ended in death could not be included.

The Canadian Institutes of Health Research, the Canada Research Chair in Medical Decision Sciences, and the Da Souza Chair in Trauma Research funded the study. Dr. Bhatti and his associates reported having no relevant financial disclosures.

The number of self-harm emergencies increases by 50% after bariatric surgery, according to a report published online Oct. 7 in JAMA Surgery.

Mental health problems are common among both morbidly obese adults and patients undergoing bariatric surgery, and a recent meta-analysis of 30 studies found that suicide risk was four times higher among patients undergoing bariatric surgery than in the general population. To examine this association, researchers performed a population-based longitudinal cohort study comparing self-harm behaviors during the 3 years before bariatric surgery with those during the 3 years after bariatric surgery in all 8,815 adults who underwent gastric bypass, intestinal bypass, and sleeve gastrectomy in Ontario during a 5-year period.

KatarzynaBialasiewicz/Thinkstock.com

This cohort reflects the practice of approximately 200 surgeons. Self-harm behaviors were categorized as medication overdose, alcohol-related, poisoning by toxic chemicals, or physical trauma. Approximately 64% of the study population had a history of anxiety disorders, 7.8% had general mental health disorders, and 0.6% reported alcohol misuse before undergoing bariatric surgery, wrote Junaid A. Bhatti, Ph.D., of the department of evaluative clinical sciences, Sunnybrook Research Institute, Toronto, and the department of surgery, University of Toronto.

There were 62 self-harm events during the preoperative interval and 96 during the postoperative interval. The mean incidence of self harm was 2.33 events per 1,000 patients during the 3 years before surgery and 3.63 per 1,000 during the 3 years after surgery, for a rate ratio of 1.54. This represents an increase of approximately 50% after bariatric surgery. The postoperative self-harm rate also was three times as high as that in the general Ontario population (1.2 per 1,000 people) during the same period.

Most of these incidents (73%) were medication overdoses. These were considered serious suicide attempts posing significant risk to the patients; they required ambulance transport and hospital admission. Physical trauma such as self-hanging accounted for another 21%. Almost all of the patients with postoperative self-harm behaviors had a known history of mental health problems, chiefly major depression. These findings suggest the need for increased screening and monitoring for excessive drug or alcohol use, as well as activating a reliable support network to mitigate the stress that follows profound changes in diet and lifestyle, Dr. Bhatti and his associates said (JAMA Surg. 2015 Oct 7. doi: 10.1001/jamasurg.2015.3414).

The reason for this rise in self-harm behaviors is not yet known. Some experts contend that changes in alcohol metabolism following bariatric surgery raise the likelihood of intoxication or alcohol-related disinhibition, both of which can escalate impulsivity. Others argue that morbid obesity arises from a food addiction, and after the procedure patients may turn from overeating to alcohol/substance abuse. Most agree that the surgery and the lifestyle changes it requires increase the patient’s stress and anxiety, which can exacerbate preexisting mental health problems. Finally, bariatric surgery itself alters neurohormone levels, which could in turn predispose patients to depression or suicidal behaviors, the investigators said.

This study was limited in that the data didn’t allow the researchers to account for some important surgery-related factors, including patients’ failure to lose a significant amount of weight. In addition, the study focused on self-harm behaviors that led to emergency-department visits; since completed suicides generally don’t include ED visits, some cases of self-harm that ended in death could not be included.

The Canadian Institutes of Health Research, the Canada Research Chair in Medical Decision Sciences, and the Da Souza Chair in Trauma Research funded the study. Dr. Bhatti and his associates reported having no relevant financial disclosures.

SAN DIEGO – Canadian hospitals are making progress in reducing the rates of methicillin-resistant Staphylococcus aureus, but the rates of antimicrobial resistance in Canadian hospitals increased significantly for extended-spectrum beta-lactamase–producing Escherichia coli and Klebsiella pneumoniae, as well as vancomycin-resistant enterococci.

Those are among the key findings from a large national analysis known as CANWARD that were presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. “What it’s telling us is that some of the things that we’re doing on the antimicrobial resistance side are working,” lead study author George G. Zhanel, Pharm.D., professor of microbiology and infectious diseases at the University of Manitoba, Winnipeg, said in an interview. “But it also tells us that some of these pathogens like [vancomycin-resistant enterococci] and [extended-spectrum beta-lactamase]–producing E. coli continue to go up. So there is some good news and some bad news, but it tells us that it’s not all just doom and gloom. Some progress has been made, but there’s still a long way to go.”

Frontline Medical News

Conducted annually, CANWARD is a national health surveillance study that assesses pathogens causing infections in Canadian hospitals and their patterns of antimicrobial resistance. For the current analysis, Dr. Zhanel and his associates collected 36,607 isolates from patients in tertiary care hospitals in Canada from January 2007 to December 2014. They used Clinical and Laboratory Standards Institute broth microdilution methods to perform antimicrobial susceptibility testing on more than 45 marketed and investigational agents.

Slightly more than half of the patients (55%) were male, and 87% were over age 18. The most common pathogens were E. coli (19.7%), methicillin-susceptible Staphylococcus aureus (MSSA; 16.4%), Pseudomonas aeruginosa (8.7%), S. pneumoniae (6.5%), K. pneumoniae (6.1%), methicillin-resistant S. aureus (MRSA; 4.7%), Enterococcus species (4.0%), and Hemophilus influenzae (4.0%). Susceptibility rates for E. coli were 99.9% for meropenem and tigecycline, 99.7% for ertapenem, 97.7% for piperacillin/tazobactam, 92.5% for ceftriaxone, 90.4% for gentamicin, 77.2% for ciprofloxacin, and 73.0% for trimethoprim and sulfamethoxazole. Susceptibility rates for P. aeruginosa were 94.2% for colistin, 84.3% for piperacillin/tazobactam, 83.3% for ceftazidime, 81.2% for meropenem, 77.6% for gentamicin, and 74.1% for ciprofloxacin. Susceptibility rates for MRSA were 100% for linezolid and telavancin, 99.9% for daptomycin, 99.4% for tigecycline, 99.1% for vancomycin, and 93.3% for trimethoprim and sulfamethoxazole. The rates of resistant organisms between 2007 and 2014 increased significantly for extended-spectrum beta-lactamase–producing E. coli (from 3.4% to 11.6%) and K. pneumoniae (from 1.5% to 6.5%), as well as vancomycin-resistant enterococci (from 1.8% to 7.0%), while rates of MRSA significantly declined (from 26.1% to 20.2%).

“The biggest surprise to me is that the hospital-acquired genotype of MRSA is going down,” Dr. Zhanel commented. “The community-acquired genotype is still going up, but the hospital-acquired [genotype] has plummeted in hospitals.”

He noted that CANWARD data suggest that antimicrobial resistance “is not confined to one part of the hospital. We have resistance happening in medical wards, ICUs, and hospital emergency rooms. We consistently find that resistance is highest in the ICU and by far the lowest in the ER. With clinics we find that it’s a variable scenario.”

The study was supported in part by Abbott, Achaogen, Affinium, Astellas, Astra Zeneca, Bayer, Cerexa/Forest, Cubist, Galderma Laboratories, Merck, Paladin Labs, Pfizer/Wyeth, Sunovion, and the Medicines Co. The researchers reported having no relevant financial disclosures.

[email protected]

SAN DIEGO – Canadian hospitals are making progress in reducing the rates of methicillin-resistant Staphylococcus aureus, but the rates of antimicrobial resistance in Canadian hospitals increased significantly for extended-spectrum beta-lactamase–producing Escherichia coli and Klebsiella pneumoniae, as well as vancomycin-resistant enterococci.

Those are among the key findings from a large national analysis known as CANWARD that were presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. “What it’s telling us is that some of the things that we’re doing on the antimicrobial resistance side are working,” lead study author George G. Zhanel, Pharm.D., professor of microbiology and infectious diseases at the University of Manitoba, Winnipeg, said in an interview. “But it also tells us that some of these pathogens like [vancomycin-resistant enterococci] and [extended-spectrum beta-lactamase]–producing E. coli continue to go up. So there is some good news and some bad news, but it tells us that it’s not all just doom and gloom. Some progress has been made, but there’s still a long way to go.”

Frontline Medical News

Conducted annually, CANWARD is a national health surveillance study that assesses pathogens causing infections in Canadian hospitals and their patterns of antimicrobial resistance. For the current analysis, Dr. Zhanel and his associates collected 36,607 isolates from patients in tertiary care hospitals in Canada from January 2007 to December 2014. They used Clinical and Laboratory Standards Institute broth microdilution methods to perform antimicrobial susceptibility testing on more than 45 marketed and investigational agents.

Slightly more than half of the patients (55%) were male, and 87% were over age 18. The most common pathogens were E. coli (19.7%), methicillin-susceptible Staphylococcus aureus (MSSA; 16.4%), Pseudomonas aeruginosa (8.7%), S. pneumoniae (6.5%), K. pneumoniae (6.1%), methicillin-resistant S. aureus (MRSA; 4.7%), Enterococcus species (4.0%), and Hemophilus influenzae (4.0%). Susceptibility rates for E. coli were 99.9% for meropenem and tigecycline, 99.7% for ertapenem, 97.7% for piperacillin/tazobactam, 92.5% for ceftriaxone, 90.4% for gentamicin, 77.2% for ciprofloxacin, and 73.0% for trimethoprim and sulfamethoxazole. Susceptibility rates for P. aeruginosa were 94.2% for colistin, 84.3% for piperacillin/tazobactam, 83.3% for ceftazidime, 81.2% for meropenem, 77.6% for gentamicin, and 74.1% for ciprofloxacin. Susceptibility rates for MRSA were 100% for linezolid and telavancin, 99.9% for daptomycin, 99.4% for tigecycline, 99.1% for vancomycin, and 93.3% for trimethoprim and sulfamethoxazole. The rates of resistant organisms between 2007 and 2014 increased significantly for extended-spectrum beta-lactamase–producing E. coli (from 3.4% to 11.6%) and K. pneumoniae (from 1.5% to 6.5%), as well as vancomycin-resistant enterococci (from 1.8% to 7.0%), while rates of MRSA significantly declined (from 26.1% to 20.2%).

“The biggest surprise to me is that the hospital-acquired genotype of MRSA is going down,” Dr. Zhanel commented. “The community-acquired genotype is still going up, but the hospital-acquired [genotype] has plummeted in hospitals.”

He noted that CANWARD data suggest that antimicrobial resistance “is not confined to one part of the hospital. We have resistance happening in medical wards, ICUs, and hospital emergency rooms. We consistently find that resistance is highest in the ICU and by far the lowest in the ER. With clinics we find that it’s a variable scenario.”

The study was supported in part by Abbott, Achaogen, Affinium, Astellas, Astra Zeneca, Bayer, Cerexa/Forest, Cubist, Galderma Laboratories, Merck, Paladin Labs, Pfizer/Wyeth, Sunovion, and the Medicines Co. The researchers reported having no relevant financial disclosures.

[email protected]

SAN DIEGO – Canadian hospitals are making progress in reducing the rates of methicillin-resistant Staphylococcus aureus, but the rates of antimicrobial resistance in Canadian hospitals increased significantly for extended-spectrum beta-lactamase–producing Escherichia coli and Klebsiella pneumoniae, as well as vancomycin-resistant enterococci.

Those are among the key findings from a large national analysis known as CANWARD that were presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. “What it’s telling us is that some of the things that we’re doing on the antimicrobial resistance side are working,” lead study author George G. Zhanel, Pharm.D., professor of microbiology and infectious diseases at the University of Manitoba, Winnipeg, said in an interview. “But it also tells us that some of these pathogens like [vancomycin-resistant enterococci] and [extended-spectrum beta-lactamase]–producing E. coli continue to go up. So there is some good news and some bad news, but it tells us that it’s not all just doom and gloom. Some progress has been made, but there’s still a long way to go.”

Frontline Medical News

Conducted annually, CANWARD is a national health surveillance study that assesses pathogens causing infections in Canadian hospitals and their patterns of antimicrobial resistance. For the current analysis, Dr. Zhanel and his associates collected 36,607 isolates from patients in tertiary care hospitals in Canada from January 2007 to December 2014. They used Clinical and Laboratory Standards Institute broth microdilution methods to perform antimicrobial susceptibility testing on more than 45 marketed and investigational agents.

Slightly more than half of the patients (55%) were male, and 87% were over age 18. The most common pathogens were E. coli (19.7%), methicillin-susceptible Staphylococcus aureus (MSSA; 16.4%), Pseudomonas aeruginosa (8.7%), S. pneumoniae (6.5%), K. pneumoniae (6.1%), methicillin-resistant S. aureus (MRSA; 4.7%), Enterococcus species (4.0%), and Hemophilus influenzae (4.0%). Susceptibility rates for E. coli were 99.9% for meropenem and tigecycline, 99.7% for ertapenem, 97.7% for piperacillin/tazobactam, 92.5% for ceftriaxone, 90.4% for gentamicin, 77.2% for ciprofloxacin, and 73.0% for trimethoprim and sulfamethoxazole. Susceptibility rates for P. aeruginosa were 94.2% for colistin, 84.3% for piperacillin/tazobactam, 83.3% for ceftazidime, 81.2% for meropenem, 77.6% for gentamicin, and 74.1% for ciprofloxacin. Susceptibility rates for MRSA were 100% for linezolid and telavancin, 99.9% for daptomycin, 99.4% for tigecycline, 99.1% for vancomycin, and 93.3% for trimethoprim and sulfamethoxazole. The rates of resistant organisms between 2007 and 2014 increased significantly for extended-spectrum beta-lactamase–producing E. coli (from 3.4% to 11.6%) and K. pneumoniae (from 1.5% to 6.5%), as well as vancomycin-resistant enterococci (from 1.8% to 7.0%), while rates of MRSA significantly declined (from 26.1% to 20.2%).

“The biggest surprise to me is that the hospital-acquired genotype of MRSA is going down,” Dr. Zhanel commented. “The community-acquired genotype is still going up, but the hospital-acquired [genotype] has plummeted in hospitals.”

He noted that CANWARD data suggest that antimicrobial resistance “is not confined to one part of the hospital. We have resistance happening in medical wards, ICUs, and hospital emergency rooms. We consistently find that resistance is highest in the ICU and by far the lowest in the ER. With clinics we find that it’s a variable scenario.”

The study was supported in part by Abbott, Achaogen, Affinium, Astellas, Astra Zeneca, Bayer, Cerexa/Forest, Cubist, Galderma Laboratories, Merck, Paladin Labs, Pfizer/Wyeth, Sunovion, and the Medicines Co. The researchers reported having no relevant financial disclosures.

[email protected]

CHICAGO – Many traditional and novel biochemical cardiac risk markers show dramatic and stable improvements following sleeve gastrectomy, a prospective, observational study shows.

C-reactive protein (CRP) levels were elevated in 78% of patients preoperatively, but they fell early in the preoperative course at 3 months (median 6.6 mg/L vs. 4.5 mg/L; P less than .0001) and continued to decline throughout the 12-month follow-up (median 5.8 mg/L vs. 2.4 mg/L; P less than .0001).

“This gradual improvement and normalization of this inflammatory marker may reflect the slower resolution of the chronic inflammatory burden that obesity brings along with it,” Ms. Tara Mokhtari said at the American College of Surgeons  Clinical Congress.

Though prior studies have shown that gastric bypass and adjustable gastric banding improved biochemical cardiac risk factors (BCRFs), this is the first prospective study to detail such improvements following sleeve gastrectomy.

The study evaluated 10 BCRFs (total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides (TG), TC/HDL ratio, hemoglobin A_1c, TG/HDL ratio, homocysteine, lipoprotein A, and CRP) in 334 morbidly obese patients undergoing laparoscopic sleeve gastrectomy during 2006-2015. Their mean age was 45 years, 76.4% were women, 55% were hypertensive, 29.4% had diabetes, 9.6% had known coronary artery disease, and 26.4% were on a lipid-lowering medication.

Many patients had abnormal cardiac risk factors prior to surgery, the most striking being the 78% of patients with elevated CRP levels (at least 3 mg/L), according to Ms. Mokhtari of Stanford (Calif.) University.

One-third also had abnormal HDL levels, total cholesterol, and triglyceride/HDL ratio and 20% had LDL levels above the 130 mg/dL threshold. Statin use was discontinued in all patients following surgery, per hospital protocol.

After sleeve gastrectomy, body mass index declined from 43.5 preoperatively to 36.6 at 3 months, 34.3 at 6 months, and 33.1 at 12 months, according to the study authors, led by Dr. John M. Morton, also of Stanford.

Similar to the early changes observed in CRP, there were significant changes from baseline at 3 months in triglycerides (116.5 mg/dL vs. 98.5 mg/dL; P less than .0001) and HbA_1c (5.8% vs. 5.5%; P less than .0001).

Six months after sleeve gastrectomy, significant improvements were seen in these same risk factors as well as HDL cholesterol (47 mg/dL vs. 51 mg/dL; P less than .0001), TG/HDL ratio, a surrogate marker for metabolic syndrome (2.5 vs. 1.9; P less than .0001), and lipoprotein A (8.9 mg/dL vs. 5.4 mg/dL; P = .016), Ms. Mokhtari said.

By 12 months, all cardiac risk factors except LDL cholesterol (median preop 101.5 mg/dL vs. 102.5 mg/dL; P = .062) were significantly improved. Notably, HDL increased to a median of 54 mg/dL, triglycerides continued to decline to 93 mg/dL, and HgA_1c held steady at 5.5%.

“Triglycerides fell dramatically and remained stable, which in combination with the increase in HDL, reflects a much healthier overall lipid profile for our post-sleeve patients,” Ms. Mokhtari said. “It’s important to recall that all of these improvements were seen without the use of a statin drug.”

Improvement in these cardiac biomarkers may further represent improvements in other obesity-related diseases, as evidenced by improvements in the markers for type II diabetes and metabolic syndrome, she said.

“Such risk factors are useful in determining baseline risk for our sleeve patients and also can be followed very easily in the postoperative period,” Ms. Mokhtari added.

Discussant Dr. Aurora D. Pryor of State University of New York at Stony Brook, congratulated the authors on their research and asked how sleeve gastrectomy stacks up to gastric bypass or banding as a procedure for metabolic disease and whether the biomarker improvements will translate into improved mortality.

There are several published reports on cardiac risk factors and gastric banding and Roux-en-Y gastric bypass, but many do not include the newer biomarkers of lipoprotein A, homocysteine, or CRP, Ms. Mokhtari observed. A 2006 study by the Stanford investigators, however, suggests that “overall, Roux-en-Y allowed for a more significant improvement in these risk factors compared to sleeve,” she said.

Ms. Mokhtari went on to say that the SOS study reported a decrease in cardiovascular events after Roux-en-Y bypass, but that no such solid evidence exists for sleeve gastrectomy. However, studies have shown comparable improvements in Framingham risk scores at 1 year between sleeve and Roux-en-Y.

[email protected]

CHICAGO – Many traditional and novel biochemical cardiac risk markers show dramatic and stable improvements following sleeve gastrectomy, a prospective, observational study shows.

C-reactive protein (CRP) levels were elevated in 78% of patients preoperatively, but they fell early in the preoperative course at 3 months (median 6.6 mg/L vs. 4.5 mg/L; P less than .0001) and continued to decline throughout the 12-month follow-up (median 5.8 mg/L vs. 2.4 mg/L; P less than .0001).

“This gradual improvement and normalization of this inflammatory marker may reflect the slower resolution of the chronic inflammatory burden that obesity brings along with it,” Ms. Tara Mokhtari said at the American College of Surgeons  Clinical Congress.

Though prior studies have shown that gastric bypass and adjustable gastric banding improved biochemical cardiac risk factors (BCRFs), this is the first prospective study to detail such improvements following sleeve gastrectomy.

The study evaluated 10 BCRFs (total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides (TG), TC/HDL ratio, hemoglobin A_1c, TG/HDL ratio, homocysteine, lipoprotein A, and CRP) in 334 morbidly obese patients undergoing laparoscopic sleeve gastrectomy during 2006-2015. Their mean age was 45 years, 76.4% were women, 55% were hypertensive, 29.4% had diabetes, 9.6% had known coronary artery disease, and 26.4% were on a lipid-lowering medication.

Many patients had abnormal cardiac risk factors prior to surgery, the most striking being the 78% of patients with elevated CRP levels (at least 3 mg/L), according to Ms. Mokhtari of Stanford (Calif.) University.

One-third also had abnormal HDL levels, total cholesterol, and triglyceride/HDL ratio and 20% had LDL levels above the 130 mg/dL threshold. Statin use was discontinued in all patients following surgery, per hospital protocol.

After sleeve gastrectomy, body mass index declined from 43.5 preoperatively to 36.6 at 3 months, 34.3 at 6 months, and 33.1 at 12 months, according to the study authors, led by Dr. John M. Morton, also of Stanford.

Similar to the early changes observed in CRP, there were significant changes from baseline at 3 months in triglycerides (116.5 mg/dL vs. 98.5 mg/dL; P less than .0001) and HbA_1c (5.8% vs. 5.5%; P less than .0001).

Six months after sleeve gastrectomy, significant improvements were seen in these same risk factors as well as HDL cholesterol (47 mg/dL vs. 51 mg/dL; P less than .0001), TG/HDL ratio, a surrogate marker for metabolic syndrome (2.5 vs. 1.9; P less than .0001), and lipoprotein A (8.9 mg/dL vs. 5.4 mg/dL; P = .016), Ms. Mokhtari said.

By 12 months, all cardiac risk factors except LDL cholesterol (median preop 101.5 mg/dL vs. 102.5 mg/dL; P = .062) were significantly improved. Notably, HDL increased to a median of 54 mg/dL, triglycerides continued to decline to 93 mg/dL, and HgA_1c held steady at 5.5%.

“Triglycerides fell dramatically and remained stable, which in combination with the increase in HDL, reflects a much healthier overall lipid profile for our post-sleeve patients,” Ms. Mokhtari said. “It’s important to recall that all of these improvements were seen without the use of a statin drug.”

Improvement in these cardiac biomarkers may further represent improvements in other obesity-related diseases, as evidenced by improvements in the markers for type II diabetes and metabolic syndrome, she said.

“Such risk factors are useful in determining baseline risk for our sleeve patients and also can be followed very easily in the postoperative period,” Ms. Mokhtari added.

Discussant Dr. Aurora D. Pryor of State University of New York at Stony Brook, congratulated the authors on their research and asked how sleeve gastrectomy stacks up to gastric bypass or banding as a procedure for metabolic disease and whether the biomarker improvements will translate into improved mortality.

There are several published reports on cardiac risk factors and gastric banding and Roux-en-Y gastric bypass, but many do not include the newer biomarkers of lipoprotein A, homocysteine, or CRP, Ms. Mokhtari observed. A 2006 study by the Stanford investigators, however, suggests that “overall, Roux-en-Y allowed for a more significant improvement in these risk factors compared to sleeve,” she said.

Ms. Mokhtari went on to say that the SOS study reported a decrease in cardiovascular events after Roux-en-Y bypass, but that no such solid evidence exists for sleeve gastrectomy. However, studies have shown comparable improvements in Framingham risk scores at 1 year between sleeve and Roux-en-Y.

[email protected]

CHICAGO – Many traditional and novel biochemical cardiac risk markers show dramatic and stable improvements following sleeve gastrectomy, a prospective, observational study shows.

C-reactive protein (CRP) levels were elevated in 78% of patients preoperatively, but they fell early in the preoperative course at 3 months (median 6.6 mg/L vs. 4.5 mg/L; P less than .0001) and continued to decline throughout the 12-month follow-up (median 5.8 mg/L vs. 2.4 mg/L; P less than .0001).

“This gradual improvement and normalization of this inflammatory marker may reflect the slower resolution of the chronic inflammatory burden that obesity brings along with it,” Ms. Tara Mokhtari said at the American College of Surgeons  Clinical Congress.

Though prior studies have shown that gastric bypass and adjustable gastric banding improved biochemical cardiac risk factors (BCRFs), this is the first prospective study to detail such improvements following sleeve gastrectomy.

The study evaluated 10 BCRFs (total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides (TG), TC/HDL ratio, hemoglobin A_1c, TG/HDL ratio, homocysteine, lipoprotein A, and CRP) in 334 morbidly obese patients undergoing laparoscopic sleeve gastrectomy during 2006-2015. Their mean age was 45 years, 76.4% were women, 55% were hypertensive, 29.4% had diabetes, 9.6% had known coronary artery disease, and 26.4% were on a lipid-lowering medication.

Many patients had abnormal cardiac risk factors prior to surgery, the most striking being the 78% of patients with elevated CRP levels (at least 3 mg/L), according to Ms. Mokhtari of Stanford (Calif.) University.

One-third also had abnormal HDL levels, total cholesterol, and triglyceride/HDL ratio and 20% had LDL levels above the 130 mg/dL threshold. Statin use was discontinued in all patients following surgery, per hospital protocol.

After sleeve gastrectomy, body mass index declined from 43.5 preoperatively to 36.6 at 3 months, 34.3 at 6 months, and 33.1 at 12 months, according to the study authors, led by Dr. John M. Morton, also of Stanford.

Similar to the early changes observed in CRP, there were significant changes from baseline at 3 months in triglycerides (116.5 mg/dL vs. 98.5 mg/dL; P less than .0001) and HbA_1c (5.8% vs. 5.5%; P less than .0001).

Six months after sleeve gastrectomy, significant improvements were seen in these same risk factors as well as HDL cholesterol (47 mg/dL vs. 51 mg/dL; P less than .0001), TG/HDL ratio, a surrogate marker for metabolic syndrome (2.5 vs. 1.9; P less than .0001), and lipoprotein A (8.9 mg/dL vs. 5.4 mg/dL; P = .016), Ms. Mokhtari said.

By 12 months, all cardiac risk factors except LDL cholesterol (median preop 101.5 mg/dL vs. 102.5 mg/dL; P = .062) were significantly improved. Notably, HDL increased to a median of 54 mg/dL, triglycerides continued to decline to 93 mg/dL, and HgA_1c held steady at 5.5%.

“Triglycerides fell dramatically and remained stable, which in combination with the increase in HDL, reflects a much healthier overall lipid profile for our post-sleeve patients,” Ms. Mokhtari said. “It’s important to recall that all of these improvements were seen without the use of a statin drug.”

Improvement in these cardiac biomarkers may further represent improvements in other obesity-related diseases, as evidenced by improvements in the markers for type II diabetes and metabolic syndrome, she said.

“Such risk factors are useful in determining baseline risk for our sleeve patients and also can be followed very easily in the postoperative period,” Ms. Mokhtari added.

Discussant Dr. Aurora D. Pryor of State University of New York at Stony Brook, congratulated the authors on their research and asked how sleeve gastrectomy stacks up to gastric bypass or banding as a procedure for metabolic disease and whether the biomarker improvements will translate into improved mortality.

There are several published reports on cardiac risk factors and gastric banding and Roux-en-Y gastric bypass, but many do not include the newer biomarkers of lipoprotein A, homocysteine, or CRP, Ms. Mokhtari observed. A 2006 study by the Stanford investigators, however, suggests that “overall, Roux-en-Y allowed for a more significant improvement in these risk factors compared to sleeve,” she said.

Ms. Mokhtari went on to say that the SOS study reported a decrease in cardiovascular events after Roux-en-Y bypass, but that no such solid evidence exists for sleeve gastrectomy. However, studies have shown comparable improvements in Framingham risk scores at 1 year between sleeve and Roux-en-Y.

[email protected]

The September issue of ACS Surgery News is available online -- use the mobile app to download or view as a pdf.

This month's issue features news about intragastric balloons now approved by the FDA, commentary by Dr. Mark Weissler on the rich variety of learning and networking opportunities at the upcoming Clinical Congress, and an update on the implications of a recent court ruling on the number of lawsuits brought against doctors.

The September issue of ACS Surgery News is available online -- use the mobile app to download or view as a pdf.

This month's issue features news about intragastric balloons now approved by the FDA, commentary by Dr. Mark Weissler on the rich variety of learning and networking opportunities at the upcoming Clinical Congress, and an update on the implications of a recent court ruling on the number of lawsuits brought against doctors.

The September issue of ACS Surgery News is available online -- use the mobile app to download or view as a pdf.

This month's issue features news about intragastric balloons now approved by the FDA, commentary by Dr. Mark Weissler on the rich variety of learning and networking opportunities at the upcoming Clinical Congress, and an update on the implications of a recent court ruling on the number of lawsuits brought against doctors.

LAS VEGAS – More than one in 10 patients with Clostridium difficile infection at the time of hospital discharge are readmitted for C. difficile infection within 90 days, according to findings from a review of Medicare data from 2009 to 2011.

Of a random sample of nearly 900,000 Part A inpatients and Part D prescription drug claimants during the study period, about 8,500 were hospitalized with a primary or secondary diagnosis of C. difficile infection, and of 7,042 of those who were discharged alive and who were eligible for the study, 945 (13.4%) were readmitted within 90 days, Dr. Charles M. Psoinos reported at the annual meeting of the American Association for the Surgery of Trauma.

CDC/D. Holdeman

Compared with 1,900 patients not readmitted for any reason, those who were readmitted had more baseline comorbidities (average Elixhauser index, 5.9 vs. 4.7), and a significantly shorter length of stay during the index hospitalization (9.2 vs. 11.8 days), and those older than 95 years were twice as likely as those aged 65-70 years to be readmitted, as were those with an emergent vs. nonemergent index hospitalization, said Dr. Psoinos of the University of Massachusetts, Worcester.

Further, the readmission rate was lower in the 39% of patients discharged on oral metronidazole (19%), and in the 12% discharged on oral vancomycin (28%), than among the 38% discharged with no ongoing treatment (48%), while those discharged on both oral metronidazole and vancomycin were at increased risk for readmission (odds ratio, 1.29), he said.

The 90-day all cause mortality rate was nearly doubled in those who were readmitted, compared with those who were not (17.8% vs. 8.9%; OR, 1.77), he said.

Patients who were and were not readmitted did not differ significantly with respect to age (mean of about 80 years) and race distribution, and the outcomes were adjusted for the differences in baseline comorbidities and other confounding factors.

The findings could have important implications for reducing readmissions among Medicare beneficiaries, Dr. Psoinos said.

The incidence of C. difficile infections has increased nearly eightfold in the elderly population over the last several decades, and the elderly now account for more than 70% of hospitalized patients with such infections. Recurrence rates range from 5% to 31% after cessation of therapy, and readmission rates are similar, he explained, noting that treatment recommendations for C. difficile infections are commonly based on symptoms and their severity, with oral metronidazole recommended for mild and moderate disease, vancomycin only for severe disease, and dual therapy for complicated severe disease.

Though limited by the retrospective design of the study, the findings suggest that C. difficile patients discharged from the hospital may benefit from ongoing monotherapy treatment to reduce subclinical infections and induce long-term eradication, and that elderly patients on dual therapy may benefit from continued hospitalization until they are appropriate for discharge on monotherapy.

These strategies could reduce the rate of readmissions, Dr. Psoinos concluded.

Dr. Psoinos reported having no relevant financial conflicts.

[email protected]

LAS VEGAS – More than one in 10 patients with Clostridium difficile infection at the time of hospital discharge are readmitted for C. difficile infection within 90 days, according to findings from a review of Medicare data from 2009 to 2011.

Of a random sample of nearly 900,000 Part A inpatients and Part D prescription drug claimants during the study period, about 8,500 were hospitalized with a primary or secondary diagnosis of C. difficile infection, and of 7,042 of those who were discharged alive and who were eligible for the study, 945 (13.4%) were readmitted within 90 days, Dr. Charles M. Psoinos reported at the annual meeting of the American Association for the Surgery of Trauma.

CDC/D. Holdeman

Compared with 1,900 patients not readmitted for any reason, those who were readmitted had more baseline comorbidities (average Elixhauser index, 5.9 vs. 4.7), and a significantly shorter length of stay during the index hospitalization (9.2 vs. 11.8 days), and those older than 95 years were twice as likely as those aged 65-70 years to be readmitted, as were those with an emergent vs. nonemergent index hospitalization, said Dr. Psoinos of the University of Massachusetts, Worcester.

Further, the readmission rate was lower in the 39% of patients discharged on oral metronidazole (19%), and in the 12% discharged on oral vancomycin (28%), than among the 38% discharged with no ongoing treatment (48%), while those discharged on both oral metronidazole and vancomycin were at increased risk for readmission (odds ratio, 1.29), he said.

The 90-day all cause mortality rate was nearly doubled in those who were readmitted, compared with those who were not (17.8% vs. 8.9%; OR, 1.77), he said.

Patients who were and were not readmitted did not differ significantly with respect to age (mean of about 80 years) and race distribution, and the outcomes were adjusted for the differences in baseline comorbidities and other confounding factors.

The findings could have important implications for reducing readmissions among Medicare beneficiaries, Dr. Psoinos said.

The incidence of C. difficile infections has increased nearly eightfold in the elderly population over the last several decades, and the elderly now account for more than 70% of hospitalized patients with such infections. Recurrence rates range from 5% to 31% after cessation of therapy, and readmission rates are similar, he explained, noting that treatment recommendations for C. difficile infections are commonly based on symptoms and their severity, with oral metronidazole recommended for mild and moderate disease, vancomycin only for severe disease, and dual therapy for complicated severe disease.

Though limited by the retrospective design of the study, the findings suggest that C. difficile patients discharged from the hospital may benefit from ongoing monotherapy treatment to reduce subclinical infections and induce long-term eradication, and that elderly patients on dual therapy may benefit from continued hospitalization until they are appropriate for discharge on monotherapy.

These strategies could reduce the rate of readmissions, Dr. Psoinos concluded.

Dr. Psoinos reported having no relevant financial conflicts.

[email protected]

LAS VEGAS – More than one in 10 patients with Clostridium difficile infection at the time of hospital discharge are readmitted for C. difficile infection within 90 days, according to findings from a review of Medicare data from 2009 to 2011.

Of a random sample of nearly 900,000 Part A inpatients and Part D prescription drug claimants during the study period, about 8,500 were hospitalized with a primary or secondary diagnosis of C. difficile infection, and of 7,042 of those who were discharged alive and who were eligible for the study, 945 (13.4%) were readmitted within 90 days, Dr. Charles M. Psoinos reported at the annual meeting of the American Association for the Surgery of Trauma.

CDC/D. Holdeman

Compared with 1,900 patients not readmitted for any reason, those who were readmitted had more baseline comorbidities (average Elixhauser index, 5.9 vs. 4.7), and a significantly shorter length of stay during the index hospitalization (9.2 vs. 11.8 days), and those older than 95 years were twice as likely as those aged 65-70 years to be readmitted, as were those with an emergent vs. nonemergent index hospitalization, said Dr. Psoinos of the University of Massachusetts, Worcester.

Further, the readmission rate was lower in the 39% of patients discharged on oral metronidazole (19%), and in the 12% discharged on oral vancomycin (28%), than among the 38% discharged with no ongoing treatment (48%), while those discharged on both oral metronidazole and vancomycin were at increased risk for readmission (odds ratio, 1.29), he said.

The 90-day all cause mortality rate was nearly doubled in those who were readmitted, compared with those who were not (17.8% vs. 8.9%; OR, 1.77), he said.

Patients who were and were not readmitted did not differ significantly with respect to age (mean of about 80 years) and race distribution, and the outcomes were adjusted for the differences in baseline comorbidities and other confounding factors.

The findings could have important implications for reducing readmissions among Medicare beneficiaries, Dr. Psoinos said.

The incidence of C. difficile infections has increased nearly eightfold in the elderly population over the last several decades, and the elderly now account for more than 70% of hospitalized patients with such infections. Recurrence rates range from 5% to 31% after cessation of therapy, and readmission rates are similar, he explained, noting that treatment recommendations for C. difficile infections are commonly based on symptoms and their severity, with oral metronidazole recommended for mild and moderate disease, vancomycin only for severe disease, and dual therapy for complicated severe disease.

Though limited by the retrospective design of the study, the findings suggest that C. difficile patients discharged from the hospital may benefit from ongoing monotherapy treatment to reduce subclinical infections and induce long-term eradication, and that elderly patients on dual therapy may benefit from continued hospitalization until they are appropriate for discharge on monotherapy.

These strategies could reduce the rate of readmissions, Dr. Psoinos concluded.

Dr. Psoinos reported having no relevant financial conflicts.

[email protected]

Every year I am amazed by the breadth of knowledge and information presented at the annual Clinical Congress. I find it deeply satisfying to realize how much I can still enjoy and learn from the wide variety of topics presented from all the surgical specialties.

First, there is so much new to absorb in each of our specialties and the Clinical Congress is a must in terms of hearing firsthand about innovation and change. The technical aspects of surgical techniques seemingly unrelated to my own area of specialization often have parallels to my own practice and raise questions or possible answers to problems I face in my own field.

Second, the vast amount of information about topics germane to all surgeons, such as surgical ethics, professionalism, critical care, surgical fundamentals, information technology, new surgical technology, advocacy and more, really can’t be found in any other venue.

The College has worked hard to offer learning environments that meet a variety of needs. The Town Hall meetings give groups of surgeons with a common interest the opportunity to freely discuss a wide variety of topics in a relatively unstructured environment. There will be 20 Town Hall meetings this year ranging from “Development of a Rural Track in Residency” to “The Surgeon Specific Registry (SSR): Maintenance of Certification (MOC), Physician Quality Reporting System (PQRS) and other Mandates,” to 18 additional sessions on such topics as incorporating surgical ethics into your practice, MOC, surgical education, and others.

Named Lectures are generally given by carefully chosen experts in a field and include the Martin Memorial Lecture during the opening ceremony, which this year will be given by Dr. John Meara: “Addressing Unmet Surgical Need: The Role of Academic Surgery.” Among the 10 other Named Lectures will be the Charles G. Drake History of Surgery Lecture, the Scudder Oration on Trauma, and the John J. Conley Ethics and Philosophy Lecture, to name but a few. These lectures often turn out to be highly memorable, groundbreaking explorations of critical issues in our profession and all attendees should try to hear one or more.

For those looking for an in-depth experience in a focused surgical topic, the Post Graduate Courses offer both didactic/experiential courses and surgical skills courses. Offerings this year include a General Surgery Review Course in the didactic format along with 14 others, and 15 surgical skills courses including courses on palliative surgical care, thyroid and parathyroid ultrasonography, advanced hepatopancreaticobiliary ultrasonography, laparoscopic inguinal and ventral hernia repair, total mesorectal excision, and many others.

There will be 48 Meet the Expert Luncheons, which offer a small group of participants the opportunity to sit down in a nonformal environment and engage in a case-based discussion of a wide variety of surgical issues. These luncheons can be a wonderful networking opportunity and a setting in which like-minded colleagues can interact face to face. A Meet the Expert conversation can be the beginning of a friendship or a professional relationship built around mutual interests.

Of course, there will also be the more traditional panel discussion sessions, the scientific forum for the presentation of scientific papers, and the video-based education sessions.

The point of all this is that the Clinical Congress offers a huge variety of ways in which to learn and interact with your fellow surgeons. Different learners prefer different formats, and the College offers something for everyone. In addition, the Clinical Congress offers unparalleled CME and other credit to address regulatory mandates with content specific to ethics, patient safety, pain management, palliative care, and trauma and critical care. Self-assessment credit can be earned to meet requirements of MOC part II.

Finally, part of the purpose of the Clinical Congress is to encourage social and networking interaction among our surgical sisters and brothers and to encourage the advancement of our profession as a group of individuals bound together by a bond of special knowledge and skill and a dedication to our fellow surgeons and our patients. Together in congress we advance the interests of our profession and our patients. See you in Chicago.

Dr. Weissler is the Joseph P. Riddle Distinguished Professor, department of otolaryngology–head and neck surgery, and chief, division of head and neck surgery, University of North Carolina (UNC) School of Medicine, Chapel Hill, and the chair of the ACS Board of Regents.

Every year I am amazed by the breadth of knowledge and information presented at the annual Clinical Congress. I find it deeply satisfying to realize how much I can still enjoy and learn from the wide variety of topics presented from all the surgical specialties.

First, there is so much new to absorb in each of our specialties and the Clinical Congress is a must in terms of hearing firsthand about innovation and change. The technical aspects of surgical techniques seemingly unrelated to my own area of specialization often have parallels to my own practice and raise questions or possible answers to problems I face in my own field.

Second, the vast amount of information about topics germane to all surgeons, such as surgical ethics, professionalism, critical care, surgical fundamentals, information technology, new surgical technology, advocacy and more, really can’t be found in any other venue.

The College has worked hard to offer learning environments that meet a variety of needs. The Town Hall meetings give groups of surgeons with a common interest the opportunity to freely discuss a wide variety of topics in a relatively unstructured environment. There will be 20 Town Hall meetings this year ranging from “Development of a Rural Track in Residency” to “The Surgeon Specific Registry (SSR): Maintenance of Certification (MOC), Physician Quality Reporting System (PQRS) and other Mandates,” to 18 additional sessions on such topics as incorporating surgical ethics into your practice, MOC, surgical education, and others.

Named Lectures are generally given by carefully chosen experts in a field and include the Martin Memorial Lecture during the opening ceremony, which this year will be given by Dr. John Meara: “Addressing Unmet Surgical Need: The Role of Academic Surgery.” Among the 10 other Named Lectures will be the Charles G. Drake History of Surgery Lecture, the Scudder Oration on Trauma, and the John J. Conley Ethics and Philosophy Lecture, to name but a few. These lectures often turn out to be highly memorable, groundbreaking explorations of critical issues in our profession and all attendees should try to hear one or more.

For those looking for an in-depth experience in a focused surgical topic, the Post Graduate Courses offer both didactic/experiential courses and surgical skills courses. Offerings this year include a General Surgery Review Course in the didactic format along with 14 others, and 15 surgical skills courses including courses on palliative surgical care, thyroid and parathyroid ultrasonography, advanced hepatopancreaticobiliary ultrasonography, laparoscopic inguinal and ventral hernia repair, total mesorectal excision, and many others.

There will be 48 Meet the Expert Luncheons, which offer a small group of participants the opportunity to sit down in a nonformal environment and engage in a case-based discussion of a wide variety of surgical issues. These luncheons can be a wonderful networking opportunity and a setting in which like-minded colleagues can interact face to face. A Meet the Expert conversation can be the beginning of a friendship or a professional relationship built around mutual interests.

Of course, there will also be the more traditional panel discussion sessions, the scientific forum for the presentation of scientific papers, and the video-based education sessions.

The point of all this is that the Clinical Congress offers a huge variety of ways in which to learn and interact with your fellow surgeons. Different learners prefer different formats, and the College offers something for everyone. In addition, the Clinical Congress offers unparalleled CME and other credit to address regulatory mandates with content specific to ethics, patient safety, pain management, palliative care, and trauma and critical care. Self-assessment credit can be earned to meet requirements of MOC part II.

Finally, part of the purpose of the Clinical Congress is to encourage social and networking interaction among our surgical sisters and brothers and to encourage the advancement of our profession as a group of individuals bound together by a bond of special knowledge and skill and a dedication to our fellow surgeons and our patients. Together in congress we advance the interests of our profession and our patients. See you in Chicago.

Dr. Weissler is the Joseph P. Riddle Distinguished Professor, department of otolaryngology–head and neck surgery, and chief, division of head and neck surgery, University of North Carolina (UNC) School of Medicine, Chapel Hill, and the chair of the ACS Board of Regents.

Every year I am amazed by the breadth of knowledge and information presented at the annual Clinical Congress. I find it deeply satisfying to realize how much I can still enjoy and learn from the wide variety of topics presented from all the surgical specialties.

First, there is so much new to absorb in each of our specialties and the Clinical Congress is a must in terms of hearing firsthand about innovation and change. The technical aspects of surgical techniques seemingly unrelated to my own area of specialization often have parallels to my own practice and raise questions or possible answers to problems I face in my own field.

Second, the vast amount of information about topics germane to all surgeons, such as surgical ethics, professionalism, critical care, surgical fundamentals, information technology, new surgical technology, advocacy and more, really can’t be found in any other venue.

The College has worked hard to offer learning environments that meet a variety of needs. The Town Hall meetings give groups of surgeons with a common interest the opportunity to freely discuss a wide variety of topics in a relatively unstructured environment. There will be 20 Town Hall meetings this year ranging from “Development of a Rural Track in Residency” to “The Surgeon Specific Registry (SSR): Maintenance of Certification (MOC), Physician Quality Reporting System (PQRS) and other Mandates,” to 18 additional sessions on such topics as incorporating surgical ethics into your practice, MOC, surgical education, and others.

Named Lectures are generally given by carefully chosen experts in a field and include the Martin Memorial Lecture during the opening ceremony, which this year will be given by Dr. John Meara: “Addressing Unmet Surgical Need: The Role of Academic Surgery.” Among the 10 other Named Lectures will be the Charles G. Drake History of Surgery Lecture, the Scudder Oration on Trauma, and the John J. Conley Ethics and Philosophy Lecture, to name but a few. These lectures often turn out to be highly memorable, groundbreaking explorations of critical issues in our profession and all attendees should try to hear one or more.

For those looking for an in-depth experience in a focused surgical topic, the Post Graduate Courses offer both didactic/experiential courses and surgical skills courses. Offerings this year include a General Surgery Review Course in the didactic format along with 14 others, and 15 surgical skills courses including courses on palliative surgical care, thyroid and parathyroid ultrasonography, advanced hepatopancreaticobiliary ultrasonography, laparoscopic inguinal and ventral hernia repair, total mesorectal excision, and many others.

There will be 48 Meet the Expert Luncheons, which offer a small group of participants the opportunity to sit down in a nonformal environment and engage in a case-based discussion of a wide variety of surgical issues. These luncheons can be a wonderful networking opportunity and a setting in which like-minded colleagues can interact face to face. A Meet the Expert conversation can be the beginning of a friendship or a professional relationship built around mutual interests.

Of course, there will also be the more traditional panel discussion sessions, the scientific forum for the presentation of scientific papers, and the video-based education sessions.

The point of all this is that the Clinical Congress offers a huge variety of ways in which to learn and interact with your fellow surgeons. Different learners prefer different formats, and the College offers something for everyone. In addition, the Clinical Congress offers unparalleled CME and other credit to address regulatory mandates with content specific to ethics, patient safety, pain management, palliative care, and trauma and critical care. Self-assessment credit can be earned to meet requirements of MOC part II.

Finally, part of the purpose of the Clinical Congress is to encourage social and networking interaction among our surgical sisters and brothers and to encourage the advancement of our profession as a group of individuals bound together by a bond of special knowledge and skill and a dedication to our fellow surgeons and our patients. Together in congress we advance the interests of our profession and our patients. See you in Chicago.

Dr. Weissler is the Joseph P. Riddle Distinguished Professor, department of otolaryngology–head and neck surgery, and chief, division of head and neck surgery, University of North Carolina (UNC) School of Medicine, Chapel Hill, and the chair of the ACS Board of Regents.

SAN DIEGO – The long-term use of ceftaroline is associated with neutropenia, results from a single-center retrospective study showed.

A fifth-generation cephalosporin antibiotic with activity against methicillin-resistant Staphylococcus aureus, ceftaroline is approved for the treatment of community-acquired pneumonia and skin and skin structure infections. It’s also an option for treating orthopedic and endovascular infections when primary therapy fails or is contraindicated, according to one of the study authors, Dr. Hollis R. O’Neal Jr. “There are small case reports of associations between ceftaroline use and neutropenia, and we were noticing that many patients in our clinical practice were developing neutropenia,” Dr. O’Neal, a pulmonologist at Louisiana State University Health Baton Rouge, said in an interview at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Doug Brunk/Frontline Medical News

In an effort to determine the incidence, severity, and outcome of neutropenia in patients receiving long-term ceftaroline therapy, Dr. O’Neal and his associates retrospectively evaluated 38 patients who received at least 7 days of ceftaroline initiated at LSU Health Baton Rouge between June 2012 and December 2014. They defined clinically significant neutropenia as having an absolute neutrophil count (ANC) below 2500 cells/mm³ and gathered pertinent data from medical records including comorbidities, chronic medications, and diagnoses.

The median age of the 38 patients was 47 years and their median body mass index was 28 kg/m². Of the 38 patients, 10 (26%) developed neutropenia. “That was surprising to me,” Dr. O’Neal said. “I thought we would find three or four cases.” Compared with those who were nonneutropenic, those who developed neutropenia tended to be younger (a median of 44 years vs. 51 years), have a lower body mass index (a median of 25 kg/m² vs. 32 kg/m²), and be more likely to have a longer duration of ceftaroline therapy (a median of 36 days vs. 26 days).

Of the 10 neutropenic patients, 7 had an ANC below 1,500 cells/mm³, and 4 had an ANC below 500 cells/mm³. The median time to first neutropenic day was day 21, with a median nadir of 1,156 cells/mm³. One hospitalization occurred that was believed to be due to neutropenia, but all 30 patients were alive at least 30 days after completing ceftaroline therapy.

“Once the ANC falls below 2,500 cells/mm³, the risk of developing true neutropenia is high,” Dr. O’Neal said. “So what we’re doing is monitoring ANC levels weekly. When they fall below 2,500 we monitor [ANC levels] twice weekly. When they reach 1,500 we stop the drug. So it’s really changed how we monitor the drug’s use.”

The study’s lead author is Dr. Katherine W. Lavie, an infectious diseases fellow at LSU Health Baton Rouge. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – The long-term use of ceftaroline is associated with neutropenia, results from a single-center retrospective study showed.

A fifth-generation cephalosporin antibiotic with activity against methicillin-resistant Staphylococcus aureus, ceftaroline is approved for the treatment of community-acquired pneumonia and skin and skin structure infections. It’s also an option for treating orthopedic and endovascular infections when primary therapy fails or is contraindicated, according to one of the study authors, Dr. Hollis R. O’Neal Jr. “There are small case reports of associations between ceftaroline use and neutropenia, and we were noticing that many patients in our clinical practice were developing neutropenia,” Dr. O’Neal, a pulmonologist at Louisiana State University Health Baton Rouge, said in an interview at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Doug Brunk/Frontline Medical News

In an effort to determine the incidence, severity, and outcome of neutropenia in patients receiving long-term ceftaroline therapy, Dr. O’Neal and his associates retrospectively evaluated 38 patients who received at least 7 days of ceftaroline initiated at LSU Health Baton Rouge between June 2012 and December 2014. They defined clinically significant neutropenia as having an absolute neutrophil count (ANC) below 2500 cells/mm³ and gathered pertinent data from medical records including comorbidities, chronic medications, and diagnoses.

The median age of the 38 patients was 47 years and their median body mass index was 28 kg/m². Of the 38 patients, 10 (26%) developed neutropenia. “That was surprising to me,” Dr. O’Neal said. “I thought we would find three or four cases.” Compared with those who were nonneutropenic, those who developed neutropenia tended to be younger (a median of 44 years vs. 51 years), have a lower body mass index (a median of 25 kg/m² vs. 32 kg/m²), and be more likely to have a longer duration of ceftaroline therapy (a median of 36 days vs. 26 days).

Of the 10 neutropenic patients, 7 had an ANC below 1,500 cells/mm³, and 4 had an ANC below 500 cells/mm³. The median time to first neutropenic day was day 21, with a median nadir of 1,156 cells/mm³. One hospitalization occurred that was believed to be due to neutropenia, but all 30 patients were alive at least 30 days after completing ceftaroline therapy.

“Once the ANC falls below 2,500 cells/mm³, the risk of developing true neutropenia is high,” Dr. O’Neal said. “So what we’re doing is monitoring ANC levels weekly. When they fall below 2,500 we monitor [ANC levels] twice weekly. When they reach 1,500 we stop the drug. So it’s really changed how we monitor the drug’s use.”

The study’s lead author is Dr. Katherine W. Lavie, an infectious diseases fellow at LSU Health Baton Rouge. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – The long-term use of ceftaroline is associated with neutropenia, results from a single-center retrospective study showed.

A fifth-generation cephalosporin antibiotic with activity against methicillin-resistant Staphylococcus aureus, ceftaroline is approved for the treatment of community-acquired pneumonia and skin and skin structure infections. It’s also an option for treating orthopedic and endovascular infections when primary therapy fails or is contraindicated, according to one of the study authors, Dr. Hollis R. O’Neal Jr. “There are small case reports of associations between ceftaroline use and neutropenia, and we were noticing that many patients in our clinical practice were developing neutropenia,” Dr. O’Neal, a pulmonologist at Louisiana State University Health Baton Rouge, said in an interview at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Doug Brunk/Frontline Medical News

In an effort to determine the incidence, severity, and outcome of neutropenia in patients receiving long-term ceftaroline therapy, Dr. O’Neal and his associates retrospectively evaluated 38 patients who received at least 7 days of ceftaroline initiated at LSU Health Baton Rouge between June 2012 and December 2014. They defined clinically significant neutropenia as having an absolute neutrophil count (ANC) below 2500 cells/mm³ and gathered pertinent data from medical records including comorbidities, chronic medications, and diagnoses.

The median age of the 38 patients was 47 years and their median body mass index was 28 kg/m². Of the 38 patients, 10 (26%) developed neutropenia. “That was surprising to me,” Dr. O’Neal said. “I thought we would find three or four cases.” Compared with those who were nonneutropenic, those who developed neutropenia tended to be younger (a median of 44 years vs. 51 years), have a lower body mass index (a median of 25 kg/m² vs. 32 kg/m²), and be more likely to have a longer duration of ceftaroline therapy (a median of 36 days vs. 26 days).

Of the 10 neutropenic patients, 7 had an ANC below 1,500 cells/mm³, and 4 had an ANC below 500 cells/mm³. The median time to first neutropenic day was day 21, with a median nadir of 1,156 cells/mm³. One hospitalization occurred that was believed to be due to neutropenia, but all 30 patients were alive at least 30 days after completing ceftaroline therapy.

“Once the ANC falls below 2,500 cells/mm³, the risk of developing true neutropenia is high,” Dr. O’Neal said. “So what we’re doing is monitoring ANC levels weekly. When they fall below 2,500 we monitor [ANC levels] twice weekly. When they reach 1,500 we stop the drug. So it’s really changed how we monitor the drug’s use.”

The study’s lead author is Dr. Katherine W. Lavie, an infectious diseases fellow at LSU Health Baton Rouge. The researchers reported having no financial disclosures.

[email protected]