Mycotic pseudoaneurysm (infected pseudoaneurysm) rarely complicates the presentation of community-acquired pneumonia, which leads to diagnostic challenges. In this case report, we describe a 66-year-old male who presented with fever, breathlessness and hemoptysis. Initial workup with clinical findings and chest x-ray suggested a diagnosis of community-acquired pneumonia. However, CECT followed by CT pulmonary angiogram confirmed the presence of a pseudoaneurysm in the background of pneumonia. This case report highlights that pseudoaneurysm complicating pneumonia can be associated with a rare cause of hemoptysis. Chest Heart J. 2024; 48(2) : 115-119
Extensive literature has established equivalent efficacy of early intravenous (IV) to oral antibiotic transition. However, there is variability in adoption across practice settings. Unlike Outpatient Parenteral Antimicrobial Therapy (OPAT) programs, Complex Outpatient Antimicrobial Therapy with Oral Agents (COpAT) programs face significant implementation science challenges. We used a clinical trial with broad enrollment criteria to determine impact of early oral transition in a real-world setting and studied its influence on practice transformation. C omparing Oral vs. Parenteral Antimicrobial Therapy (COPAT) Trial was a pragmatic, randomized controlled trial at five hospitals in one rural health system. Patients requiring two or more weeks of IV antibiotics (for all but central nervous system infections) were randomized 2:1 to Experimental (early oral) vs. Control (IV-only). Two primary outcomes and hypotheses were assessed at three months: early oral group safety superiority and efficacy equivalence. Clinical cases of patients who completed the trial were presented at multiple forums. The trial was stopped early after two-thirds enrollment for a significant safety benefit. Early oral group demonstrated a significantly lower adverse event rate (3.2% vs. 6.5%, p= 0.02). Lower cumulative hazard for first study related adverse event in early oral group (HR 0.24, 95% CI 0.08-0.75, p= 0.01) appeared to emerge by day 10. Therapeutic efficacy was equivalent. Cumulative enrollment in the trial had a significant association with COpAT:OPAT program consult ratio (R2= 0.54, p< 0.001). Early oral antibiotic transition was significantly safer. At our academic health system, implementation of the COPAT Trial accelerated practice transformation.
Objective Studies exploring the relationship between neonatal abstinence syndrome (NAS) and congenital anomalies (CA) in the United States are limited given the small sample size or data prior to the opioid epidemic. We aimed to determine if there is an association between NAS and CA in a nationally representative cohort of newborn hospitalization in the United States. Study Design This was a cross-sectional analysis of NAS-related hospitalizations within the 2016 Kids Inpatient Database. International Classification of Diseases (ICD-10-CM) diagnostic codes were used to identify NAS hospitalizations and those with and without CA. The primary outcome was the odds of CAs in NAS hospitalizations. Multivariate survey logistic regression was used to analyze the relationship between NAS and CA. Results Among 3.7 million newborn hospitalizations, 25,394 had NAS (6.7 per 1,000). The prevalence of any CA was higher in those with NAS when compared with non-NAS hospitalizations (10.3 vs. 4.9%; odds ratio = 2.27; 95% confidence interval [CI]: 2.13-2.43). Adjusted analysis showed similar results (adjusted odds ratio: = 1.83, CI: 1.71-1.95). NAS hospitalizations with CA had a higher mortality rate (0.6 vs 0.04%, p < 0.0001) and higher resource use. Conclusion This nationwide study shows that NAS may be associated with increased odds of CAs, suggesting that NAS may be a risk factor for increased morbidity in the newborn period.
Hess, Elizabeth MD; Tharakan, Jennifer MD; Tharakan, Kevin MD; Radcliffe, Eric MD Author Information
