RATIONALE: Systemic candidiasis is usually seen in healthcare-associated conditions.However, opioid use disorder (OUD) has emerged as an increasingly common factor associated with candidemia.Recent trends of prevalence and characteristics are not well defined in opioid use disorder associated with systemic candidiasis.METHODS: We extracted our study cohort from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample from 2004 to 2014.Exclusion criteria were age <18 years and elective admission.Differences in sampling frames with time are accounted for in a separate reweighting procedure to make comparison across years possible.Systemic candidiasis hospitalizations and OUD were identified using ICD-9 diagnostic codes.We analyzed the characteristics and overall trends and within subgroups.We considered a two-tailed P value of <0.05 as statistically significant.RESULTS: A total of 41,775 hospitalizations with a principal diagnosis of systemic candidiasis were identified from 2004 to 2014, 755 (1.81%) hospitalizations have a concomitant diagnosis of opioid use disorder.Patients with concomitant OUD are more likely to be male (60.0% vs. 48.6%),younger (mean age 42.9±13.4vs. 66.9±16.4,age<45: 50.9% vs. 10.6%), has less comorbidities (41.4% vs. 15.7%Charlson's comorbidity score of 0), use Medicaid (36.3% vs. 10.4%), from Northeast region (25.5% vs. 13.2%).The proportion of opioid use disorder in systemic candidiasis increased from 5.3% in 2004 to 12.5% in 2014 (trend p <0.05), Figure 1.The total healthcare in-hospital economic burden of OUD related systemic candidiasis was $23 million.CONCLUSION: The proportion of systemic candidiasis hospitalizations associated with OUD more than doubled from 2004 to 2014, especially among young adults, likely reflects the relatively young age of the OUD population.We suggest that the opioid crisis is having an impact on the candidiasis epidemiology through a myriad of factors.Including more aggressive opioid prescribing practices, many aspects of the drug injection process susceptible to contamination, such as the use of citrus as an acidic solution.Also, disadvantaged socioeconomic status can create barriers to healthcare and social resources supporting system engagement.For example, opioid use disorder patients traditionally were not considered candidates for outpatient parenteral antifungal therapy, while prolonged hospital stays increase the risk of against medical advice discharge.Further investigation to address such challenges would be valuable in the context of the ongoing opioid epidemic.
Tetanus is a life-threatening infectious neurological disorder that is now a rare disease due to the institution of wide-spread vaccination strategies. We present an uncommon case of generalized severe tetanus with consequent respiratory failure requiring mechanical ventilation, which was associated with dysautonomia. A 20-year-old unvaccinated female presented with neck stiffness and diffuse muscle spasms following a laceration sustained 3 weeks prior. She was admitted to the intensive care unit for mechanical ventilation and was treated with immunoglobulin, tetanus toxoid, metronidazole, and high doses of sedatives. She also developed dysautonomia, with alternating bradycardia and tachycardia, as well as fluctuating blood pressure. She was successfully extubated and discharged. We also review the epidemiology, pathophysiology, and management of tetanus and discuss dysautonomia in the setting of tetanus.
PURPOSE:We conduct a retrospective study of hospital admissions associated with coronavirus (CoV) infection in the years 2016 and 2017 in the United States (U.S.).Since there was no reported Severe Acute Respiratory Syndrome (SARS) or Middle East respiratory syndrome coronavirus (MERS)-CoV infection in the U.S. over the period, all CoV infections in this study were presumably caused by serotype 229E, NL63, HKU1, or OC43. METHODS:We used the National Inpatient Sample (NIS) to analyze approximately 70 million inpatient admissions in the U.S. in 2016 and 2017.Admissions with discharge diagnosis included CoV infection and other non-bacterial respiratory pathogen infections (NBRPI) were identified using International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM).Multivariate logistic regression was used to model binary dependent variables.Covariates showed statistically significant association with dependent variables on univariate logistic regression were selected as confounders in multivariate logistic regression.All p-values were two-sided, with 0.05 as the threshold for statistical significance.RESULTS: There were 4,795 patients admitted to acute-care hospitals with at least one discharge diagnosis of CoV associated infections in the U.S. from 2016 to 2017, which constitutes 0.57% of all NBRPI, or 1.12% of non-influenza NBRPI.The age distribution of CoV infection was bimodal.Compared to other NBRPI, CoV related admissions occurred more often in pediatric patients and less common in elderly patients.The peak month for CoV was January, while for other NBRPI was February.Statistical differences between CoV infection and other NBRPI existed in sex, comorbidities, hospital characteristics, and geographic locations, but not in socioeconomic characteristics.Bacterial pneumonia (aOR 0.42, P < 0.001) and sepsis (aOR 0.62, P ¼ 0.015) were less common in CoV infections compared to other NBRPI.For the rate of in-hospital mortality, mechanical ventilation with intubation, and acute kidney injury, there was no statistically significant difference between CoV infection and other NBRPI.The mean length of stay and cost of hospitalization for CoV infection and other NBRPI were similar (P ¼ 0.815 and 0.196, respectively).The total cost of all CoV related admissions in 2016 and 2017 was approximately 71.2 million U.S. dollars. CONCLUSIONS:Our study summarized epidemiology, complications, mortality, and resource utilization of non-SARS/MERS CoV related hospitalization in the U.S. in 2016 and 2017.CLINICAL IMPLICATIONS: Our study adds to the knowledge of epidemiology, complications, mortality, and resource utilization of non-SARS/MERS CoV infection.
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