American journal of hospital medicine, volume 8, issue 1 (2024 January-March)
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Item Staphylococcus aureus contamination rate on environmental surfaces and hands of staff in ICU and NICU ward of Rohani hospital in Babol, Iran(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2024-03) Hajismaeli, Mehrnaz; Moghadami, Morteza; Afkhami, Hamed; Mohammadi, Mohammad Reza; Amini, Parya; Yekanipour, Zahra; Davoodabadi, AbolfazlIntroduction: This study surveyed the frequency of Staphylococcus aureus contamination on different surfaces in the ICUs in central Iran. Contamination of the environmental surfaces is a cause of nosocomial infection. The survey of S. aureus contamination in ICU and NICU was the purpose of this study. Materials and Methods : Samples were taken from different surfaces of ICUs and NICU. Antibiotic resistance of isolated Staphylococcus aureus, SCCmec typing patterns, and abundance of mecA, PVL, TSST-1 genes were investigated. Results: 63.9% of positive cultures were detected as Staphylococcaceae family. S . aureus was identified in 6.6% of the total samples. Most of these isolates were resistant to cefazolin (93.9%), erythromycin (69.7%) and levofloxacin (63.6%). PVL and mecA genes accounted for 21.2% and 24.2%, respectively. SCCmec type I and HA-MRSA were seen in 87.5% of isolates, and just 22.5% of isolates had SCCmec IV and CA-MRSA Conclusion : Contamination on surfaces in the ICUs belonging to non- Staphylococcus aureus was at a high level. The high prevalence of SCCmec type I demonstrated that the origin of bacterial surface contamination in hospitals is patients infected by MRSA or MRSA carriers.Item Severe cefazolin-associated coagulopathy corrected with vitamin K supplementation : a case report(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2024-03) Smith, R. Vincent; Brott, Nathan; White, Brittany N.; Hall, Haden S.Cefazolin, a commonly used antibiotic in clinical practice, has been associated with coagulation disorders, including hypoprothrombinemia and elevated international normalized ratio (INR) in the absence of vitamin K antagonist administration. However, these cases often involve patients with renal dysfunction or malnutrition. We present a unique case of a 66-year-old male with severe cefazolin- associated coagulopathy despite normal kidney function. The patient had a complex medical history, including heart failure with preserved ejection fraction and rheumatoid arthritis on immunosuppression therapy. He was initially admitted to the hospital with COVID-19, acute pulmonary embolism, and non-ST-segment elevation myocardial infarction. Subsequently, he developed methicillin-sensitive Staphylococcus aureus bacteremia and epidural abscesses, for which high-dose cefazolin was initiated. The patient presented with gross hematuria and hematochezia, along with an elevated INR and prolonged prothrombin time. Despite holding rivaroxaban, his coagulation profile remained abnormal. After vitamin K administration and discontinuation of cefazolin, the INR quickly corrected. This case highlights the need for monitoring cefazolin therapy in patients with hemorrhagic complications to assess for coagulopathy.Item Idiopathic calciphylaxis with cutaneous necrosis : a case report(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2024-03) Tang, Wei (Charlene); Kang, Joo Young; Hoque, FarzanaCalciphylaxis is a rare medical condition that is characterized by calcification, microthrombosis, and fibrointimal hyperplasia within cutaneous arteries. This condition is associated with high morbidity and mortality. However, there are limited management guidelines available. We present a patient case of a woman with a prior prolonged hospital stay who presented with chronic wounds secondary to idiopathic, non- uremic calciphylaxis. She required multidisciplinary inpatient care and was subsequently discharged to a long-term care facility for chronic wound care and antibiotics. We also review relevant literature on treatment strategies, including antibiotics, wound debridement, and hyperbaric oxygen therapy.Item Delayed impact of COVID-19 on diabetes(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2024-03) Nelson, Leigh Anne; Hamed, Somia M.; Lang, Shelby E.Introduction: Active COVID-19 illness can worsen glycemic control and induce diabetes-related complications such as diabetic ketoacidosis (DKA) in patients with prediabetes and diabetes. There is a lack of available research and data for cases of delayed diabetic complications secondary to COVID-19. We report two cases of COVID- 19 induced worsening of diabetic disease with a delayed onset including DKA and deteriorating glycemic control. Case Presentation: Patient-A is a 28-year- old Hispanic male with a history of prediabetes controlled with diet and exercise. He was diagnosed with DKA approximately 10 weeks following his COVID-19 illness and recovery. At the time of the DKA diagnosis, his HbA1c was 11.6%. Prior to his COVID-19 illness, his HbA1c was 5.6%. Patient-B is a 63-year-old white male with type 2 diabetes. He was diagnosed with worsening peripheral neuropathic pain one month following COVID-19 illness. Prior to COVID-19, his HbA1c was 7.5% compared to 10.3% two months post COVID-19 illness. Discussion: It is well documented that an active COVID-19 illness can worsen diabetes. It is important to recognize that COVID-19’s effect on diabetes may appear or persist for several weeks after recovery. Monitoring glycemic parameters during the 12-week time frame after COVID-19 illness may help identify these delayed effects. Identification of delayed onset or impact of COVID-19 illness on diabetes can help restore glycemic control and reduce morbidity.Item A qualitative study of young women with high hospital utilization : patient perceptions of the transition from pediatric to adult care(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2024-03) Schwartz, Mika; Neergaard, Rebecca; Koilor, Christopher; Mezochow, Gabrielle; Shea, Judy A.; Knox, KirstinIntroduction: Patients who are frequently admitted to the hospital are a highly vulnerable population. Our interdisciplinary STEP program works intensively with these patients on the inpatient general medicine service to improve care coordination, improve health, and decrease hospital utilization. Of enrollees in the first three years of the program, over half were 18-35 years old, and of these patients, over 80% were women. We explored perceived challenges faced at the time of transition from pediatric to adult care. Materials and Methods: In depth, semi- structured interviews were carried out with 11 women ages 18-35 who were currently or previously enrolled in STEP. Interviews were audio recorded, transcribed, coded, and content analyzed. Results: Of the patients interviewed, 64% had a primary diagnosis of sickle cell disease. Three primary themes emerged: lack of support in transition from pediatric to adult care, strained communication with providers as a barrier to care, and worsening health as patients entered adulthood. Over 70% of participants reported 2 or more Adverse Childhood Experiences (ACEs), with an average of 3.6. Conclusions: The experiences of participants in this study suggest multiple avenues for patient-centered interventions that improve care in this population, all based on improving communication and shared decision making between patients and providers. One crucial area for improvement is the transition from pediatric to adult care. This transition represents a vulnerable time, during which many patients – and, in particular, individuals with ACEs – would likely benefit from additional support.