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664. Factors Associated with the Need for ICU Care Among Patients with Human Ehrlichiosis

BACKGROUND: Despite the availability of effective therapy, the case fatality rate of human monocytic ehrlichiosis (HME) is 3%, and has been reported to be higher among the immunocompromised. Little is known about predictors of severe disease. METHODS: We performed an observational cohort study at a...

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Autores principales: Kuriakose, Kevin, Pettit, April, Schmitz, Jonathan, Moncayo, Abelardo, Bloch, Karen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253857/
http://dx.doi.org/10.1093/ofid/ofy210.671
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author Kuriakose, Kevin
Pettit, April
Schmitz, Jonathan
Moncayo, Abelardo
Bloch, Karen
author_facet Kuriakose, Kevin
Pettit, April
Schmitz, Jonathan
Moncayo, Abelardo
Bloch, Karen
author_sort Kuriakose, Kevin
collection PubMed
description BACKGROUND: Despite the availability of effective therapy, the case fatality rate of human monocytic ehrlichiosis (HME) is 3%, and has been reported to be higher among the immunocompromised. Little is known about predictors of severe disease. METHODS: We performed an observational cohort study at a tertiary care medical center in Nashville, TN. Patients with a positive whole blood or cerebrospinal fluid Ehrlichia polymerase chain reaction between 2007 and 2017 were included. Clinical and demographic data were obtained by chart abstraction. Modified Poisson Regression was used to estimate the adjusted relative risk (aRR) of requiring intensive care unit (ICU) care, adjusting for age, sex, race, Charlson Comorbidity Index, immunosuppression, patient-reported tick exposure, and number of days from first contact with healthcare system to treatment initiation. RESULTS: We included 155 patients; median age was 48 years, 64% were male, 94% were Caucasian, 74% reported a tick exposure, and 21% were immunocompromised. 28% of patients required ICU care. Immunosuppression and reported tick exposure were associated with a decreased risk of requiring ICU care. An increasing number of days from first contact with the healthcare system to treatment initiation were associated with an increased risk of requiring ICU care. CONCLUSION: Twenty-eight percent of patients required ICU care. We found that a delay in initiation of therapy was associated with an increased risk of requiring ICU care. In contrast to other studies, we found immunosuppression to be associated with milder clinical illness, perhaps reflecting a lower threshold to seek care and thus earlier presentation. Patients with recent tick exposure were also less likely to require ICU care, potentially reflecting a higher index of suspicion for HME among providers. Future studies evaluating the impact of provider education on early recognition and treatment may lead to a decreased need for ICU care in patients with HME. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62538572018-11-28 664. Factors Associated with the Need for ICU Care Among Patients with Human Ehrlichiosis Kuriakose, Kevin Pettit, April Schmitz, Jonathan Moncayo, Abelardo Bloch, Karen Open Forum Infect Dis Abstracts BACKGROUND: Despite the availability of effective therapy, the case fatality rate of human monocytic ehrlichiosis (HME) is 3%, and has been reported to be higher among the immunocompromised. Little is known about predictors of severe disease. METHODS: We performed an observational cohort study at a tertiary care medical center in Nashville, TN. Patients with a positive whole blood or cerebrospinal fluid Ehrlichia polymerase chain reaction between 2007 and 2017 were included. Clinical and demographic data were obtained by chart abstraction. Modified Poisson Regression was used to estimate the adjusted relative risk (aRR) of requiring intensive care unit (ICU) care, adjusting for age, sex, race, Charlson Comorbidity Index, immunosuppression, patient-reported tick exposure, and number of days from first contact with healthcare system to treatment initiation. RESULTS: We included 155 patients; median age was 48 years, 64% were male, 94% were Caucasian, 74% reported a tick exposure, and 21% were immunocompromised. 28% of patients required ICU care. Immunosuppression and reported tick exposure were associated with a decreased risk of requiring ICU care. An increasing number of days from first contact with the healthcare system to treatment initiation were associated with an increased risk of requiring ICU care. CONCLUSION: Twenty-eight percent of patients required ICU care. We found that a delay in initiation of therapy was associated with an increased risk of requiring ICU care. In contrast to other studies, we found immunosuppression to be associated with milder clinical illness, perhaps reflecting a lower threshold to seek care and thus earlier presentation. Patients with recent tick exposure were also less likely to require ICU care, potentially reflecting a higher index of suspicion for HME among providers. Future studies evaluating the impact of provider education on early recognition and treatment may lead to a decreased need for ICU care in patients with HME. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6253857/ http://dx.doi.org/10.1093/ofid/ofy210.671 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Kuriakose, Kevin
Pettit, April
Schmitz, Jonathan
Moncayo, Abelardo
Bloch, Karen
664. Factors Associated with the Need for ICU Care Among Patients with Human Ehrlichiosis
title 664. Factors Associated with the Need for ICU Care Among Patients with Human Ehrlichiosis
title_full 664. Factors Associated with the Need for ICU Care Among Patients with Human Ehrlichiosis
title_fullStr 664. Factors Associated with the Need for ICU Care Among Patients with Human Ehrlichiosis
title_full_unstemmed 664. Factors Associated with the Need for ICU Care Among Patients with Human Ehrlichiosis
title_short 664. Factors Associated with the Need for ICU Care Among Patients with Human Ehrlichiosis
title_sort 664. factors associated with the need for icu care among patients with human ehrlichiosis
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253857/
http://dx.doi.org/10.1093/ofid/ofy210.671
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