Cumulative antibiotic exposure is associated with ceftriaxone resistance among patients with urinary source Gram-negative bloodstream infection: A retrospective cohort study.

Background: We investigated the relationship between cumulative, historical antibiotic therapy and the presence of ceftriaxone-resistant (CRO-R) Enterobacterales bloodstream infections (BSI) from urinary sources.

Methods: Adult patients established with primary care at Mayo Clinic with a first episode of monomicrobial Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, or Proteus mirabilis BSI from a urinary source from May 2019-May 2023 were included. Antibiotic therapy over the year prior to BSI was quantified as days of therapy (DOT), cumulative modified Antibiotic Spectrum Index (mASI), and cumulative Days of Antibiotic Spectrum Coverage (DASC) using prescription data.

Obesity-Conduit Selection and Effect on Outcomes of Coronary Artery Bypass Grafting.

Objective: To evaluate how obesity affects outcomes in CABG patients, focusing on conduit selection.

Methods: Between 1993 and 2019, 13,120 patients undergoing isolated CABG were categorized as obese (body mass index [BMI], ≥30; n=5525, 42.1%) and nonobese (BMI, <30; n=7595, 57.

Correlation Between Blood Culture Time to Positivity and Vegetation Size in Infective Endocarditis.

The relationship between vegetation characteristics in infective endocarditis (IE) and blood culture time to positivity (TTP) has not been investigated. This study evaluates the correlation between vegetation length and TTP in patients with IE. A retrospective cohort study was conducted that included 164 definite cases IE.

Thrombin Generation in Pediatric Cardiac Surgery Patients: A Prospective Single-center Cohort Study.

Background: The objective of this study was to describe thrombin generation in children undergoing cardiac surgery with cardiopulmonary bypass. Change in the endogenous thrombin potential (ETP) across three measurements before and after cardiopulmonary bypass (after protamine and at chest closure) was the primary outcome. Secondary analyses explored an association between thrombin generation and transfusion requirements and predictors of the thrombin generation decline.

Postoperative Treatment Regimens in Patients With Native Valve Endocarditis due to Who Undergo Valve Replacement or Repair.

Background: There remains a lack of consensus regarding the postoperative treatment regimen in patients with native valve infective endocarditis who undergo surgical valve replacement or repair.

Methods: We conducted a multicenter retrospective review of patients with native valve endocarditis who underwent surgical valve replacement or repair at Mayo Clinic Enterprise (Minnesota, Florida, Arizona, and Mayo Clinic Health Systems) between 1 January 2012 and 31 December 2022. Postoperative treatment regimens were classified as either monotherapy with a methicillin-sensitive or methicillin-resistant active agent or combination therapy that included rifampin and/or gentamicin with either active agent.

Stroke debility during non-full sternotomy versus full sternotomy access cardiac valve operations.

Objective: Previous studies have reported an increased risk of stroke with non-full sternotomy access during cardiac valve operations, but the clinical significance of these strokes has not yet been explored. We sought to determine the incidence and clinical magnitude of postoperative stroke following non-full versus full sternotomy access.

Methods: We analyzed the records of 12,406 patients who underwent a cardiac valve operation with full median sternotomy (n = 10,863; 88%), partial sternotomy (n = 219; 1.

Comprehensive Assessment of the Risk of Symptomatic Embolism in Patients With Infective Endocarditis.

Background: Echocardiographic evaluation of vegetations is crucial in infective endocarditis (IE). Although several studies have noted a link between larger vegetations and an increased risk of embolization, a more comprehensive evaluation of vegetation characteristics in a contemporary cohort has not been conducted. Our study aimed to define the short-term risk of symptomatic embolization in patients with IE.

The utility of disc space and vertebral body specimens cell count differential for the diagnosis of native vertebral osteomyelitis: a prospective cohort study.

Background: Diagnostic methods for native vertebral osteomyelitis (NVO) often yield inconclusive results. Image-guided spine biopsies for culture are specific but diagnose NVO in only 50% of cases. Pre-exposure to antimicrobials further reduces diagnostic yield.

Effect of Antibiotic Therapy Before Arthrocentesis on Synovial Fluid Cell Count and Differential for Diagnosis of Native Joint Septic Arthritis.

We examined the effect of preoperative antibiotic exposure and duration on synovial fluid samples from patients with native joint septic arthritis of the hip/knee. While exposure before diagnostic arthrocentesis did not affect fluid parameters, increased duration was associated with a decreased total nucleated cell count, underscoring the complex antibiotic effects on synovial fluid parameters.

Changes in left ventricular-aortic angulation are associated with the development of obstruction in hypertrophic cardiomyopathy.

Objective: To characterize changes in ventricular morphology in patients with hypertrophic cardiomyopathy who develop left ventricular (LV) outflow tract obstruction.

Methods: We reviewed patients with hypertrophic cardiomyopathy with LV outflow tract obstruction who underwent septal myectomy from May 2012 to June 2023. Among 68 patients initially without obstruction documented up to 7.

County Rurality and Incidence and Prevalence of Diagnosed Diabetes in the United States.

Objective: To examine differences in the incidence and prevalence of diagnosed diabetes by county rurality.

Patients And Methods: This observational, cross-sectional study used US Centers for Disease Control and Prevention data from 2004 through 2019 for county estimates of incidence and prevalence of diagnosed diabetes. County rurality was based on 6 levels (large central metro counties [most urban] to noncore counties [most rural]).

Effect of Preoperative Antibiotic Therapy on Operative Culture Yield for Diagnosis of Native Joint Septic Arthritis.

Background: Native joint septic arthritis (NJSA) is definitively diagnosed by a positive Gram stain or culture, along with supportive clinical findings. Preoperative antibiotics are known to alter synovial fluid cell count, Gram stain, and culture results and are typically postponed until after arthrocentesis to optimize diagnostic accuracy. However, data on the impact of preoperative antibiotics on operative culture yield for NJSA diagnosis are limited.

Percutaneous mechanical aspiration in patients with right-sided infective endocarditis: An analysis of the national inpatient sample database-2016-2020.

Background: Given the challenges of conventional therapies in managing right-sided infective endocarditis (RSIE), percutaneous mechanical aspiration (PMA) of vegetations has emerged as a novel treatment option. Data on trends, characteristics, and outcomes of PMA, however, have largely been limited to case reports and case series.

Aims: The aim of the current investigation was to provide a descriptive analysis of PMA in the United States and to profile the frequency of PMA with a temporal analysis and the patient cohort.

Analysis of Anemia, Transfusions, and CABG Outcomes in The Society of Thoracic Surgeons National Database.

Background: This study characterized the association of preoperative anemia and intraoperative red blood cell (RBC) transfusion on outcomes of elective coronary artery bypass grafting (CABG).

Methods: Data from 53,856 patients who underwent CABG included in The Society of Thoracic Surgeons (STS) Adult Cardiac Database in 2019 were used. The primary outcome was operative mortality.

Risk Factors for Surgical-site Infections After Liver Transplant: Does Perioperative Antibiotic Regimen Matter?

Background: Surgical-site infections (SSIs) are common in liver transplant recipients. The optimal SSI antimicrobial prophylaxis agent and duration are not established. We aimed to explore risk factors for SSIs after transplant, with a particular interest in the impact of perioperative antibiotic regimen on the development of SSIs.

COVID-19 outcome is not affected by anti-CD20 or high-titer convalescent plasma in immunosuppressed patients.

The role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) convalescent plasma in the treatment of Coronavirus Disease 2019 (COVID-19) in immunosuppressed individuals remains controversial. We describe the course of COVID-19 in patients who had received anti-CD20 therapy within the 3 years prior to infection. We compared outcomes between those treated with and those not treated with high titer SARS-CoV2 convalescent plasma.

Incidence and Outcomes of Bloodstream Infection After Arterial Aneurysm Repair: Findings From a Population-Based Study.

Background: Limited research has focused on bloodstream infection (BSI) in patients with arterial grafts. This study aims to describe the incidence and outcomes of BSI after arterial aneurysm repair in a population-based cohort.

Methods: The expanded Rochester Epidemiology Project (e-REP) was used to analyze aneurysm repairs in adults (aged ≥18 years) residing in 8 counties in southern Minnesota from January 2010 to December 2020.

Bloodstream Infection Due to Coagulase-Negative Staphylococci: Impact of Species on Prevalence of Infective Endocarditis.

(1) Background: Coagulase-negative staphylococci (CoNS) are an important group of organisms that can cause bloodstream infection (BSI) and infective endocarditis (IE). The prevalence of IE in patients with BSI due to different CoNS species, however, has received limited attention; (2) Methods: A retrospective study of adults with monomicrobial CoNS BSI who had undergone echocardiography and a risk factor analysis was done to determine the most common CoNS species that cause definite IE; (3) Results: 247 patients with CoNS BSI were included in the investigation; 49 (19.8%) had definite IE, 124 (50.

Vascular Graft Infection After Aneurysm Repair: A Population-Based Study.

Objective: To describe the incidence, epidemiology, and outcomes of vascular graft infection (VGI) in a population-based study in southern Minnesota.

Patients And Methods: Retrospective review of all adult patients from 8 counties who underwent arterial aneurysm repair between January 1, 2010, and December 31, 2020. Patients were identified through the expanded Rochester Epidemiology Project.

Impact of Perioperative Prophylaxis With Activity on Risk of Surgical-Site Infection After Pancreas Transplantation.

Unlabelled: Surgical-site infection (SSI) is the most common early infectious complication after pancreas transplantation (PT). Although SSI has been shown to worsen outcomes, little data exist to guide optimal choices in perioperative prophylaxis.

Methods: We performed a retrospective cohort study of PT recipients from 2010-2020 to examine the effect of perioperative antibiotic prophylaxis with coverage.

Evaluating antimicrobial duration for Gram-negative bacteremia in patients with neutropenia due to hematologic malignancy or hematopoietic stem cell transplantation.

Background: In the management of Gram-negative bloodstream infection (GN-BSI), short antimicrobial courses have been increasingly demonstrated to be non-inferior to prolonged therapy, with lower risk of Clostridioides difficile infection (CDI) and emergence of multi-drug resistant (MDR) organisms. However, immunocompromised hosts were excluded from these studies. We investigated outcomes of short (≤10 days), intermediate (11-14 days), and prolonged (≥15 days) antimicrobial durations for GN-BSI in neutropenic patients.

Activated Prothrombin Complex Concentrate in Pediatric Cardiac Patients, Our Early Experience.

Background: Pediatric cardiac surgery is associated with abnormal coagulation, bleeding, and nearly ubiquitous transfusions. With the popularization of patient blood management, attempts are being made to decrease liberal transfusions by administering prothrombin complex concentrates (PCCs). The safety and efficacy of PCCs in adult cardiac surgery has been studied extensively, but only few reports address this in children.