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Open Forum Infectious Diseases ; 9(Supplement 2):S429, 2022.
Article in English | EMBASE | ID: covidwho-2189690


Background. The coronavirus disease 2019 (COVID-19) pandemic dramatically affected the delivery of healthcare. Patients discharged on outpatient parenteral antibiotic therapy (OPAT) require clinic follow-up and laboratory monitoring which is a logistical challenge to standardize across discharge locations. We sought to investigate how COVID-19 impacted patients discharged with OPAT at an academic medical center. Primary objectives included 30-day readmission rates and ID clinic follow-up before and during COVID-19. Secondary outcomes included whether suspected infection type, antimicrobial selection and discharge location differed between the two cohorts. Baseline Patient Characteristics & Outcomes between pre-COVID-19 and COVID-19 cohorts Methods. Patients discharged on OPAT were evaluated in two 3-month cohorts from Oct-Dec 2019 (pre-COVID-19) and compared to Oct-Dec 2020 (COVID)-19. Demographics, infection type, discharge location, therapy characteristics, and outcomes were compared retrospectively (Fig 1). Statistical analysis was performed using Chi-square and Wilcoxon rank-Sum test with p< 0.05 considered statistically significant. Suspected Infectious Source among the two cohorts Results. A total of 316 pre-COVID patients were discharged with OPAT compared to 263 COVID-19 patients. Table 1 shows the comparison of OPAT characteristics between 2019 and 2020. There were significantly more patients discharged home and fewer patients discharged to facilities in COVID-19 group(p=0.001 and p=0.011, respectively). LOS, ID clinic follow-up, and 30-day readmission did not differ between groups. Reasons for readmission were similar (Fig 1). Antimicrobial prescribing was generally similar except for more vancomycin prescribed in the COVID-19 group (12.5% versus 7.3%, p=0.033). Suspected source of infection did not differ between groups (Fig 2), nor did isolation of pseudomonas, MRSA, or drug resistant organisms (Table 2). Conclusion. Sources of infection and antimicrobial classes were generally similar despite decrease in elective procedures during a COVID-19 related winter surge. Rates of readmission and clinic follow did not differ, however, patients discharged with OPAT post-COVID were more likely to go home versus a facility. Further analysis of this difference may help determine best practices to facilitate improved monitoring and clinic follow-up among OPAT patients.

Open Forum Infectious Diseases ; 9(Supplement 2):S101-S102, 2022.
Article in English | EMBASE | ID: covidwho-2189544


Background. Determination of vaccination rates for people living with HIV (PLWH) and factors that affect adherence to vaccination is important to ensure these vulnerable patients are optimally protected against vaccine-preventable diseases. We analyzed the rates of vaccination and associated factors in PLWH receiving care in the Henry Ford Health Infectious Diseases (HFH ID) Clinic in Detroit, MI. Methods. We implemented a retrospective, observational study. Inclusion criteria were all PLWH who had at minimum two clinic visits at HFH ID clinic within 12 months from 2015-2021. Charts were reviewed for demographic data. We analyzed the rates of all eligible vaccines including the hepatitis A and B, HPV, influenza, pneumococcal, tetanus, zoster, and COVID-19 vaccines. Results. A total of 661 met the inclusion criteria. Average age of the patients was 50 years. 78.6% were male, 74.3% black, and 57.6% patients were from Detroit. On average, patients had 1 clinic visit in the past year at HFH ID Clinic. Rates of influenza, pneumococcal, and tetanus vaccinations were above 90%. Rates of hepatitis A and B vaccinations were above 80%. Rates of zoster and HPV vaccinations were above 50%. COVID-19 vaccination had the lowest rate at 42.1%. Patients who had received all recommended vaccines were more likely to be male, have a HFH PCP, men who have sex with men (MSM), younger, more HFH ID clinic visits, and have a higher CD4 count on entry into care. Factors associated with increased vaccine uptake include having a HFH primary care physician (PCP), more HFH ID clinic visits, and a CD4 count above 200 on entry. Having 2 clinic visits in the previous year was associated with a higher likelihood of vaccine adherence [OR 5.85 (95% CI 0.360 - 0.723)]. Conclusion. Our study shows that even in this highly vulnerable, vaccinehesitant population, programs that integrate vaccines and promote adherence to clinic care into the routine care of PLWH results in high rates of vaccine uptake. (Table Presented).

Infectious Diseases in Clinical Practice ; 28(6):342-348, 2020.
Article in English | Scopus | ID: covidwho-939588


Background The deaths due to coronavirus disease (Covid-19) in Michigan have been disproportionately centered in the city of Detroit. We sought to characterize hospitalized veterans with Covid-19 infection in Detroit, MI and compare them to inpatients previously reported. Methods A retrospective observational study of 79 veterans admitted to a veteran's hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 10, through April 6, 2020. Each patient had at least 30 days of follow-up. Results The median age of 79 enrolled patients was 69.0 years (interquartile range, 57.0-75.0 years) and 74 (94%) were men. Twenty-four (30%) had a recent emergency department visit. Respiratory symptoms were present in 67 (85%). Gastrointestinal symptoms were common (49 [62%]), including diarrhea (27 [34%]) and loss of appetite (31 [39%]). Only 30 (38%) patients had fever on admission. Comorbidities included hypertension (73 [92%]), diabetes (48 [61%]), obesity (42 [53%]), chronic obstructive pulmonary disease (30 [38%]), coronary disease (28 [35%]), and obstructive sleep apnea (25 [32%]). Nine patients were admitted to the intensive care unit, and 18 (26%) of 70 required intensive care unit transfer. Twenty-Four (30%) were intubated;of which 3 were extubated and 20 (83%) died. Of the 57 (72%) patients discharged alive, 22 (39%) required supplemental oxygen and 8 (14%) were readmitted within 30 days. Conclusions Detroit veterans were primarily older African American men with more comorbidities than inpatients previously described. Gastrointestinal symptoms were twice as common as fever. Rates of mortality and readmission were higher than those previously reported in populations with shorter follow up. © Wolters Kluwer Health, Inc. All rights reserved.