OBJECTIVE: We aimed to investigate the impact of enterococci on initial antibiotic treatment (IAT) failure and prolonged hospitalization in complicated urinary tract infection (cUTI) cases, and to identify risk factors for enterococcal cUTI.
METHODS: Adult cUTI patients were analyzed to compare the differences between the Enterococcus and non-Enterococcus groups. Univariate and multivariate analyses were employed to identify independent risk factors.
RESULTS: This study included 419 patients, with the Enterococcus group showing significantly higher IAT failure rates and an extended average length of stay by 4.4 days compared to the non-Enterococcus group. Multivariate analysis identified enterococci, hospital-acquired UTIs (HA-UTI), indwelling catheters, and bed rest (bedridden) as independent risk factors for IAT failure. Enterococci were notably linked to prolonged hospitalization, other independent risk factors included IAT failure, prior antimicrobial use, age-adjusted Charlson comorbidity index (ACCI) ≥ 4, hypoalbuminemia, and bed rest. Urological cancer, HA-UTI, indwelling catheters, urinary retention, and urologic surgery were risk factors for enterococcal cUTI.
CONCLUSIONS: We provide the first evidence that enterococci independently increase the risk for IAT failure and prolonged hospitalization in adults with cUTIs, highlighting the significance of timely identification to optimize measures including antibiotic regimens. Risk factors for enterococcal cUTI have also been identified to aid clinicians in managing this condition.

UNASSIGNED: To investigate the risk factors associated with prolonged hospitalization in patients diagnosed with diabetic foot ulcers (DFU), to develop a predictive model, and to conduct internal validation of the model.
UNASSIGNED: The clinical data of DFU patients admitted to West China Hospital, Sichuan University between January 2012 and December 2022 were retrospectively collected. The subjects were randomly assigned to a training cohort and a validation cohort at a ratio of 7 to 3. Hospital stays longer than 75th percentile were defined as prolonged length-of-stay. A thorough analysis of the risk factors was conducted using the training cohort, which enabled the development of an accurate risk prediction model. To ensure robustness, the model was internally validated using the validation cohort.
UNASSIGNED: A total of 967 inpatients with DFU were included, among whom 245 patients were identified as having an extended length-of-stay. The training cohort consisted of 622 patients, while the validation cohort comprised 291 patients. Multivariate logistic regression analysis revealed that smoking history (odds ratio [OR]=1.67, 95% confidence interval [CI], 1.13 to 2.48, P=0.010), Wagner grade 3 or higher (OR=7.13, 95% CI, 3.68 to 13.83, P<0.001), midfoot ulcers (OR=1.99, 95% CI, 1.07 to 3.72, P=0.030), posterior foot ulcers (OR=3.68, 95% CI, 1.83 to 7.41, P<0.001), multisite ulcers (OR=2.91, 95% CI, 1.80 to 4.69, P<0.001), wound size≥3 cm2 (OR=2.00, 95% CI, 1.28-3.11, P=0.002), and white blood cell count (OR=1.11, 95% CI, 1.05 to 1.18, P<0.001) were associated with an increased risk of prolonged length of stay. Additionally, a nomogram was constructed based on the identified risk factors. The areas under the receiver operating characteristic (ROC) curves for both the training cohort and the validation cohort were 0.782 (95% CI, 0.745 to 0.820) and 0.756 (95% CI, 0.694 to 0.818), respectively, indicating robust predictive performance. Furthermore, the calibration plot demonstrated optimal concordance between the predicted probabilities and the observed outcomes in both the training and the validation cohorts.
UNASSIGNED: Smoking history, Wagner grade≥3, midfoot ulcers, posterior foot ulcers, multisite ulcers, ulcer area≥3 cm2, and elevated white blood cell count are identified as independent predictors of prolonged hospitalization. Therefore, it is imperative that clinicians conduct a comprehensive patient evaluation and implement appropriate diagnostic and therapeutic strategies to effectively shorten the length of stay for DFU patients.

BACKGROUND: Prolonged hospitalization due to the COVID-19 pandemic gathered risk factors for developing invasive candidiasis.
OBJECTIVE: To describe Candida spp. isolated from patients with clinical suspicion of COVID treated in a public hospital specialized in COVID-19 during the pandemic, considering the susceptibility profiles and the risk factors related to the species detected in a positive yeast culture.
METHODS: From different samples of 33 patients with comorbidities, 42 clinical isolates were identified by VITEKⓇ MS Plus. Antifungal susceptibility testing was performed using VITEKⓇ 2 Compact with the AST-YS08 card.
RESULTS: The most frequently identified species were C. albicans and C. glabrata, which were also the most common co-infections, Saprochaete capitata, an uncommon yeast was isolated in one patient. 85% of the co-infections were COVID positive and 100% of patients with a co-infection required mechanical ventilation (MV) which has been described as one of the major predisposing factors to candidiasis. Candida species vary in their response to treatment. In this study, 44% of isolates identified as C. glabrata were fluconazole-resistant, which were also immediately susceptible to caspofungin; this profile limits therapeutic options and emphasizes the importance of evaluating the susceptibility profile.
CONCLUSIONS: This work highlights the increase in isolation of different Candida species during COVID-19 and the importance of establishing criteria to declare Candida colonization or infection and the correct etiological identification to establish an agent-based antifungal treatment, to reduce the spreading risk of Candida spp. in the hospital environment, mortality, time, and cost of hospitalization.

To assess whether older adults who spend a night in emergency departments (ED) awaiting admission are at increased risk of mortality. This was a retrospective review of a multipurpose cohort that recruited all patients ≥ 75 years who visited ED and were admitted to hospital on April 1 to 7, 2019, at 52 EDs across Spain. Study groups were: patients staying in ED from midnight until 8:00 a.m. (ED group) and patients admitted to a ward before midnight (ward group). The primary endpoint was in-hospital mortality, truncated at 30 days, and secondary outcomes assessed length of stay for the index episode. The sample comprised 3,243 patients (median [IQR] age, 85 [81-90] years; 53% women), with 1,096 (34%) in the ED group and 2,147 (66%) in the ward group. In-hospital mortality for patients spending the night in the ED the ED group was 10.7% and 9.5% for patients transferred to a ward bed before midnight the ward group (adjusted OR: 1.12, 95%CI: 0.80-1.58). Sensitivity analyses rendered similar results (ORs ranged 1.06-1.13). Interaction was only detected for academic/non-academic hospitals (p < 0.001), with increased mortality risk for the latter (1.01, 0.33-3.09 vs 2.86, 1.30-6.28). There were no differences in prolonged hospitalization (> 7 days), with adjusted OR of 1.16 (0.94-1.43) and 1.15 (0.94-1.42) depending on whether time spent in the ED was or was not taken into consideration. No increased risk of in-hospital mortality or prolonged hospitalization was found in older patients waiting overnight in the ED for admission. Nonetheless, all estimations suggest a potential harmful effect of staying overnight, especially if a proper bedroom and hospitalist ward bed and hospitalized care are not provided.

A 52-year-old woman, with a multifaceted medical background encompassing spinal cord injury, pneumonia, and recurrent hospitalizations, presents with enduring left hip and leg discomfort ultimately diagnosed as avascular necrosis (AVN). She previously underwent intraosseous direct anterior arthroplasty (DAA) of the left hip during the removal of orthopedic artifacts. Despite enduring hypertension, severe trochanter dislocation, and prosthesis fracture, she recovered and required additional surgery to address the dislocation and fracture. This case underscores the challenges in diagnosing and treating AVN, emphasizing the importance of meticulous postoperative care and a multidisciplinary approach. Challenges highlighted by AVN include delayed diagnosis, intricate surgical procedures, and the potential need for further interventions due to hardware complications and infection as seen in this patient.

BACKGROUND: Prolonged length of hospital stay (LOS) is associated with an increased risk of hospital-acquired conditions and worse outcomes. We conducted a nationwide, multicenter, retrospective cohort study to determine whether prolonged hospitalization before developing sepsis has a negative impact on its prognosis.
METHODS: We analyzed data from 19 tertiary referral or university-affiliated hospitals between September 2019 and December 2020. Adult patients with confirmed sepsis during hospitalization were included. In-hospital mortality was the primary outcome. The patients were divided into two groups according to their LOS before the diagnosis of sepsis: early- (< 5 days) and late-onset groups (≥ 5 days). Conditional multivariable logistic regression for propensity score matched-pair analysis was employed to assess the association between late-onset sepsis and the primary outcome.
RESULTS: A total of 1,395 patients were included (median age, 68.0 years; women, 36.3%). The early- and late-onset sepsis groups comprised 668 (47.9%) and 727 (52.1%) patients. Propensity score-matched analysis showed an increased risk of in-hospital mortality in the late-onset group (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.69-5.34). The same trend was observed in the entire study population (aOR, 1.85; 95% CI, 1.37-2.50). When patients were divided into LOS quartile groups, an increasing trend of mortality risk was observed in the higher quartiles (P for trend < 0.001).
CONCLUSIONS: Extended LOS before developing sepsis is associated with higher in-hospital mortality. More careful management is required when sepsis occurs in patients hospitalized for ≥ 5 days.

UNASSIGNED: A retrospective review of the early stages of the COVID-19 pandemic in 2020 and the challenges faced by hospitals is essential in the post-pandemic era of 2022.
UNASSIGNED: To identify the reasons for prolonged hospitalization after recovery for COVID-19 patients in the United Arab Emirates.
UNASSIGNED: This was a retrospective observational study of 150 (18.75%) patients with prolonged hospitalization in a tertiary hospital in Dubai from 1 April to 1 July 2020. Data was obtained from the electronic medical records of the hospital. Continuous variables are reported as mean and standard deviation, and categorical variables are reported as numbers and percentages.
UNASSIGNED: The mean duration of hospitalization was 48.5 (9-272) days, with an interquartile range (IQR) of 22 days. The mean duration of extended stay was 27.5 (2-231) days, with an IQR of 17 days. The common reasons for prolonged hospitalization were mandatory isolation 28% (n = 62), hospital-acquired infections 17% (n = 37), acute respiratory distress syndrome 15% (n = 32), myopathy/neuropathy 14% (n = 31), pulmonary fibrosis requiring oxygen supplementation 14% (n = 31), and completion of COVID-19 treatment 12% (n = 25).
UNASSIGNED: To make optimal use of available hospital resources, reasons that directly or indirectly contributed to the prolonged hospitalization of patients should be considered and addressed during future pandemics or disease outbreaks.
مدة وأسباب الاحتجاز المطوَّل لمرضى كوفيد- 19 في المستشفيات في الإمارات العربية المتحدة.
نياز أحمد شيخ، صوبية فاطمة، عائشة صديقي، لميس أبوفول، بسمة عاطف دميان، جهانجير أفضل مبشر، رانجانا براديب.
UNASSIGNED: كان من الضروري في حقبة ما بعد جائحة كوفيد-19 في عام 2022 إجراء استعراض استرجاعي للمراحل المبكرة للجائحة في عام 2020 والتحديات التي واجهتها المستشفيات.
UNASSIGNED: هدفت هذه الدراسة الى تحديد أسباب الاحتجاز المطوَّل لمرضى كوفيد-19 في المستشفيات بعد التعافي في الإمارات العربية المتحدة.
UNASSIGNED: أُجريت هذه الدراسة الرصدية الاسترجاعية على 150 مريضًا (18.75٪) احتُجزوا لمدد طويلة في مستشفى تخصصي في دبي في الفترة من 1 أبريل/ نيسان إلى 1 يوليو/ تموز 2020. وقد جُُمعت البيانات من السجلات الطبية الإلكترونية للمستشفى. ويُبلَّغ عن المتغيرات المستمرة في صورة متوسط وانحراف معياري، ويُبلَّغ عن المتغيرات الفئوية في صورة أعداد ونسب مئوية.
UNASSIGNED: كان متوسط مدة الاحتجاز في المستشفى 48.5 (9-272) يومًا، وبلغ المدى بين الرُبعي 22 يومًا. أما متوسط مدة الإقامة الممتدة 28٪ :يومًا. والأسباب الشائعة للاحتجاز المطوَّل في المستشفى هي العزل الإلزامي 17) يومًا، وبلغ المدى بين الرُبعي 231 (2-27.5 فكان والاعتلال ،(32 = العدد) 15٪ :ومتلازمة الضائقة التنفسية الحادة ،(37 = العدد) 17٪ :وحالات العدوى المكتسبة في المستشفى ،(62 = العدد) 12٪ :19-واستكمال علاج كوفيد ،(31 = العدد) 14٪ :والتليف الرئوي الذي يتطلب المعالجة بالأكسجين ،(31 = العدد) 14٪ :العضلي/ العصبي (25 = العدد).
UNASSIGNED: للاستفادة المثلى من الموارد المتاحة في المستشفيات، ينبغي النظر في الأسباب التي تسهم بشكل مباشر أو غير مباشر في استطالة مدد احتجاز المرضى في المستشفيات، ومعالجة هذه الأسباب أثناء الجوائح أو فاشيات الأمراض في المستقبل.
Durée et étiologie de l\'hospitalisation prolongée des patients atteints de COVID-19 aux Émirats arabes unis.
UNASSIGNED: Il est essentiel de procéder à un examen rétrospectif des premiers stades de la pandémie de COVID-19 en 2020 et des difficultés rencontrées par les hôpitaux dans l\'ère post-pandémique de 2022.
UNASSIGNED: Identifier les causes d\'une hospitalisation prolongée suite à une guérison des patients atteints de COVID-19 aux Émirats arabes unis.
UNASSIGNED: La présente étude observationnelle rétrospective a été réalisée auprès de 150 patients (18,75 %) hospitalisés de manière prolongée entre le 1er avril et le 1er juillet 2020 dans un hôpital tertiaire de Dubai. Les données ont été obtenues à partir des dossiers médicaux électroniques de l\'hôpital. Les variables continues sont présentées sous forme de moyennes et d\'écarts-types, et les variables catégorielles sont présentées en tant que nombres et pourcentages.
UNASSIGNED: La durée moyenne d\'hospitalisation était de 48,5 jours (9-272), avec un intervalle interquartile (IQR) de 22 jours. La durée moyenne de séjour prolongé était de 27,5 jours (2-231), avec un IQR de 17 jours. Les causes les plus courantes d\'hospitalisation prolongée étaient l\'isolement obligatoire pour 28 % (n = 62), les infections nosocomiales pour 17 % (n = 37), le syndrome de détresse respiratoire aiguë pour 15 % (n = 32), la myopathie ou la neuropathie pour 14 % (n = 31), la fibrose pulmonaire nécessitant une supplémentation en oxygène pour 14 % (n = 31) et l\'achèvement du traitement contre la COVID-19 pour 12 % (n = 25).
UNASSIGNED: Afin de tirer le meilleur parti des ressources hospitalières disponibles, les causes ayant contribué de manière directe ou indirecte à l\'hospitalisation prolongée des patients doivent être prises en compte et traitées pour les prochaines pandémies ou flambées de maladies.

UNASSIGNED: Pneumonia is a leading cause of morbidity and mortality among children aged under 5 years in Ethiopia. Prolonged hospitalization of severe community-acquired pneumonia is a significant problem in resource-limited countries. This study seeks to provide insights that can help improve the management and outcomes of severe community-acquired pneumonia, which is particularly important in the context of the Benishangul-Gumuz Region, Ethiopia, where access to quality healthcare services is limited, and childhood pneumonia is a significant health challenge.
UNASSIGNED: The aim of the study was to determine the predictors of prolonged hospitalization among children aged 2-59 months admitted with severe community-acquired pneumonia between 1 January 2016 and 30 December 2020 in the public hospitals in Benishangul-Gumuz Region, Ethiopia.
UNASSIGNED: A retrospective follow-up study design was conducted among randomly selected samples of 526 children. Data were entered into EPI data version 4.6 and analyzed using STATA version 14.0. The Cox proportional hazard regression model was fitted to identify the independent predictors of prolonged hospitalization, and variables with a p-value <0.05 in the multivariable model were considered statistically significant.
UNASSIGNED: The median hospital stay was 5 days (interquartile range 2-8 = 6). Approximately 149 (28.93%) children had prolonged hospitalization (>5 days) and the recovery rate from severe community-acquired pneumonia was 19.69 per 100 person-day observations. The significant predictors of prolonged hospitalization were as follows: having facility referral sources [0.79, 95% confidence interval (CI), 0.63-0.98]; a nutritional status of wasting (0.64, 95% CI, 0.44-0.94); anemia (0.65, 95% CI, 0.46-0.90); no identified hemoglobin level (0.53, 95% CI, 0.41-0.70); no identified blood film (0.65, 95% CI, 0.53-0.80); no chest x-ray investigation (0.81, 95% CI, 0.65-0.99); pulmonary effusion (0.31, 95% CI, 0.15-0.66); and late presenters to hospital (0.67, 95% CI, 0.53-0.84) at admission.
UNASSIGNED: The median length of stay in hospital was delayed compared to other studies. Wasting, late presenting to hospital, pulmonary effusion, anemia, absence of investigations of hemoglobin level, chest x-ray, and blood film at admission time were factors that significantly prolonged the hospitalization time. Hence, attention should be given to the prevention of malnutrition and anemia in children, increasing early health-seeking behavior in the community. Attention should be given to complications such as pleural effusion, and investigations, such as chest x-ray, hemoglobin levels, and blood films, should be performed when the child is admitted.

Despite the importance of hospital bed network during the pandemic, there are scarce data available regarding factors predictive of prolonged length of hospitalization of COVID-19 patients.
We retrospectively analyzed a total of 5959 consecutive hospitalized COVID-19 patients in period 3/2020-6/2021 from a single tertiary-level institution. Prolonged hospitalization was defined as hospital stay > 21 days to account for mandatory isolation period in immunocompromised patients.
Median length of hospital stay was 10 days. A total of 799 (13.4%) patients required prolonged hospitalization. Factors that remained independently associated with prolonged hospitalization in multivariate analysis were severe or critical COVID-19 and worse functional status at the time of hospital admission, referral from other institutions, acute neurological, acute surgical and social indications for admission vs admission indication of COVID-19 pneumonia, obesity, chronic liver disease, hematological malignancy, transplanted organ, occurrence of venous thromboembolism, occurrence of bacterial sepsis and occurrence of Clostridioides difficile infection during hospitalization. Patients requiring prolonged hospitalization experienced higher post-hospital discharge mortality (HR = 2.87, P < 0.001).
Not only severity of COVID-19 clinical presentation but also worse functional status, referral from other hospitals, certain indications for admission, certain chronic comorbidities, and complications that arise during hospital stay independently reflect on the need of prolonged hospitalization. Development of specific measures aimed at improvement of functional status and prevention of complications might reduce the length of hospitalization.

BACKGROUND: Prolonged hospitalization leads to poorer health outcomes and consumes limited hospital resources. This study identified factors associated with prolonged length of stay (PLOS) among internal medicine patients admitted in a tertiary government hospital.
METHODS: We reviewed the medical records of 386 adult patients admitted under the primary service of General Internal Medicine at the Philippine General Hospital from January 1 to December 31, 2019. PLOS was defined as at least 14 days for emergency admissions or 3 days for elective admissions. Sociodemographics, clinical characteristics, admission- and hospital system-related factors, disease-specific factors, outcome on the last day of hospitalization, and hospitalization costs were obtained. We determined the proportion with PLOS and reviewed reasons for discharge delays. We conducted multiple logistic regression analyses to assess associations between various factors and PLOS.
RESULTS: The prevalence of PLOS is 19.17% (95% CI 15.54, 23.42). Positive predictors include being partially dependent on admission (aOR 2.61, 95% CI 0.99, 6.86), more co-managing services (aOR 1.26, 95% CI 1.06, 1.50), and longer duration of intravenous antibiotics (aOR 1.36, 95% CI 1.22, 1.51). The only negative predictor is the need for intravenous antibiotics (aOR 0.14, 95% CI 0.04, 0.54). The most common reason for discharge delays was prolonged treatment. The median hospitalization cost of patients with PLOS was PHP 77,427.20 (IQR 102,596).
CONCLUSIONS: Almost a fifth of emergency admissions and a quarter of elective admissions had PLOS. Addressing factors related to predictors such as functional status on admission, number of co-managing services, and use of intravenous antibiotics can guide clinical and administrative decisions, including careful attention to vulnerable patients and judicious use of resources.