bluuebunny/crossref_metadata_2025_split huggingface dataset:
135 Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection in Patients Above 75 Years of Age: A Tertiary Center Experience
Authors: Abdallah Mohamed , Abdalla Abdelmohaymin , Wiedel Noah , Baloun Brett , Gilbert Jorge 
Published: October 2019

INTRODUCTION:
Fecal microbiota transplantation (FMT) is established as an effective treatment for recurrent Clostridioides (formerly Clostridium) difficile infection (CDI). Incidence and mortality from CDI are significantly higher in the elderly population (CDI is 10 times more common and 92% of CDI-related deaths occur in the elderly). Risk of cardiopulmonary complications from sedation prior to colonoscopy is increased in the elderly. Efficacy and safety of FMT via colonoscopy in the elderly are unknown.

METHODS:
A retrospective study comparing patients ≥75 years, and patients < 75 years who had FMT at Sanford Medical Center, Sioux Falls, SD, between 2013–2018. All patients underwent FMT via colonoscopy. Antibiotics prior to FMT, donor screening, preparation and delivery of FMT, and post-procedural follow up were based on a standardized protocol in our institution. Data on baseline characteristics, co-morbidities, antibiotics-associated with CDI, safety, and success rate of treatment (defined by resolution of symptoms and absence of CDI recurrence at 8 and 52 weeks) were collected.

RESULTS:
Of 59 patients, 17 (28.8%) were ≥75 years with a mean age of 84.4 years, and 42 (71.2%) were <75 years and a mean age of 46.4 years. Baseline characteristics of both groups are described in Table 1. Number of CDI before FMT, history of severe CDI, nosocomial CDI were similar. No fulminant CDI was reported in our study. In ≥75 years vs. <75 years, serum albumin was lower (3.4 vs 4 g/dl, P < 0.002) and hypertension was more common (52.9 vs 23.8%, P = 0.03). 80% of our study population had a history of antibiotics exposure prior to CDI, but there was no statistically significant difference between groups. Of antibiotics-associated with CDI, penicillins were more likely to be reported in ≥75 vs. <75 years (38.1 vs 5.9%, P = 0.014). Cephalosporins, macrolides, fluoroquinolones, and clindamycin were similar in both groups. Prior to FMT, both groups were treated similarly with vancomycin with or without taper, oral or intravenous metronidazole, or fidaxomicin. No major complications related to anesthesia or FMT via colonoscopy or deaths attributed to FMT were reported in our study. The success rates at 8 and 52 weeks in both groups were similar (76.5 vs. 83.3%, and 76.5 vs. 71.4%, respectively).

CONCLUSION:
Despite the increased risk of CDI and colonoscopy in the elderly population, success rate and safety of FMT appears to be equivalent between elderly and non-elderly. Prospective studies with larger sample size are needed.
141 Changes in Antibiotic Usage Patterns for Treatment of Colon Ischemia Since ACG Guideline Recommendations
Authors: Noorian Shaya J. , Aroniadis Olga , Feuerstadt Paul , Kwah Joann 
Published: October 2019

INTRODUCTION:
In 2015, the ACG introduced a clinical guideline defining colon ischemia (CI) severity (mild, moderate, or severe) and recommending administration of antibiotics in those with moderate and severe CI. The goal of our study was to assess for differences in guideline-adherent antimicrobial use pre- and post- guideline publication.

METHODS:
A database of consecutive patients diagnosed with biopsy-proven CI at Montefiore Medical Center and Yale-New Haven Hospital was utilized. Patients admitted from 2012–2014 (CI 12–14) and 2015–2017 (CI 15–17) composed the pre- and post- guideline cohorts, respectively. Our primary outcome was the frequency of guideline-recommended antibiotic use, defined as: (i) metronidazole+ (ciprofloxacin or cephalosporin) or (ii) piperacillin-tazobactam in patients with moderate or severe CI. Secondary outcomes included overall antibiotic use for CI, individual antibiotic type and clinical outcomes (ICU requirement, length of stay, readmission, recurrence, mortality, and colectomy rates).

RESULTS:
The CI 12–14 (n = 169) and CI 15–17 (n = 84) cohorts were similar in background characteristics: mean age (68.2 vs. 69.5 yrs; P = 0.47), female sex (65.1% vs. 76.2%; P = 0.07), and Charlson comborbidity score (5.3 vs. 5.1; P = 0.65). CI severity was similar between cohorts: mild (1.2% vs. 0.0%; P = 0.55), moderate (41.4% vs. 47.6%; P = 0.35) and severe (57.4% vs. 52.4%; P = 0.65). A trend for increased guideline-recommended antibiotic use was observed from CI 12–14 to CI 15–17 (50.3% vs. 58.3%; P = 0.23) (Figure 1). A non-significant increase was observed in overall antibiotic use (69.8% vs. 77.4%; P = 0.21). Ciprofloxacin use decreased from CI 12–14 to CI 15–17 (61.0% vs. 44.6%; P = 0.03), but no significant differences were observed for other antibiotic types (Figure 2). The 30-day mortality (1.3% vs. 8.0%; P = 0.01) and 30-day mortality and/or colectomy rates (6.0% vs. 16.0%; P = 0.01) increased from CI 12–14 to CI 15–17. Non-significant differences were observed for other clinical outcomes (Figure 3).

CONCLUSION:
The trend of increased antibiotic use post-guideline publication may have been a result of the new recommendations or the treatment of acutely sicker patients experiencing worse clinical outcomes. The decrease in ciprofloxacin use follows a nationwide trend and may be due to antimicrobial stewardship efforts to minimize the risk of C. difficile infection. Further research is needed to better understand the indications for antimicrobial use in the post-guideline era and worsened outcomes.
145 Effectiveness and Tolerability of Very Low-Volume Preparation for Colonoscopy: A Prospective, Multicenter Observational Study
Authors: Maida Marcello , Morreale Gaetano , Sinagra Emanuele , Sferrazza Sandro , Manganaro Michele , Scalisi Giuseppe , Schillaci Dario , Vettori Giovanni , Conoscenti Giuseppe , Di Bartolo Concetta , Garufi Serena , Virgilio Clara Maria , Camilleri Salvatore 
Published: October 2019

INTRODUCTION:
The effectiveness of bowel cleansing is essential for a quality colonoscopy since it affects diagnostic accuracy and adenoma detection rate. This study aimed to assess the effectiveness and tolerability of NER1006, a novel 1L PEG preparation, compared to 4 and 2 L PEG solutions in a real-life setting.

METHODS:
All in- and out-patients scheduled for a screening, surveillance or diagnostic colonoscopy, after an afternoon only or afternoon/morning 1, 2 or 4L PEG-based preparation were consecutively enrolled from September 2018 to February 2019 in 5 Italian centres. Bowel cleansing was assessed through the Boston Bowel Preparation Scale (BBPS), a bowel cleansing success was defined as a total BBPS ≥6 with a partial BBPS ≥2 in each segment and a high-quality cleansing of the right colon as a partial BBPS = 3. Tolerability was evaluated through a semi-quantitative scale with a score ranging from 1 to 10.

RESULTS:
1289 patients meeting inclusion criteria were enrolled in the study. Of these, 490 performed a 4L PEG preparation, 566 a 2L PEG cleansing and 233 a 1L PEG preparation. Overall, bowel cleansing by BBPS was 6.3 ± 1.5, 6.2 ± 1.5 and 7.3 ± 1.5 (P < 0.001) for 4L, 2L and 1L PEG preparation respectively. Cleansing success was achieved in 72.4%, 74.5% and 90.1% (P < 0.001), while high-quality cleansing of the right colon in 15.5%, 11.7% and 39.5% (P < 0.001) for 4L, 2L and 1L PEG preparation groups, respectively. The 1L preparation was the most tolerated compared to the 2 and 4L PEG solutions, with an average score of 7.8 ± 1.7 vs 7.1 ± 2.0 and 7.3 ± 2.0 (P < 0.001) respectively, in the absence of serious adverse events. At multivariate analysis, age (OR = 0.98, 95% CI = 0.97–0.99; P = 0.02), absence of diabetes (OR = 1.51, 95% CI = 1.01–2.25; P = 0.04), adequate cleansing at previous colonoscopy (OR = 2.37, 95% CI = 1.37–4.09; P = 0.002), afternoon-morning split regimen (OR = 2.52, 95% CI = 1.65–3.83; P < 0.001), low-fiber diet for at least 3 days preceding colonoscopy (OR = 2.31, 95% CI = 1.61–3.31; P < 0.001), colonoscopy within 5 hours after the end of preparation (OR = 2.16, 95% CI = 1.30–3.60; P = 0.003) and tolerability score (OR = 1.22, 95% CI = 1.14–1.31; P < 0.001) were independently associated with bowel cleansing success.

CONCLUSION:
The novel 1L PEG-ASC solution (NER1006) presents greater effectiveness compared to higher-volume PEG preparation in terms of overall bowel cleansing and high-quality cleansing of the right colon with the advantage of better tolerability respect to comparators.
146 Safety of NER1006 in the Elderly: A Post-Hoc Analysis of a Prospective, Multicenter Cohort
Authors: Maida Marcello , Sferrazza Sandro , Sinagra Emanuele , Morreale Gaetano , Manganaro Michele , Scalisi Giuseppe , Schillaci Dario , Vettori Giovanni , Conoscenti Giuseppe , Di Bartolo Concetta , Garufi Serena , Virgilio Clara Maria , Camilleri Salvatore 
Published: October 2019

INTRODUCTION:
The effectiveness of bowel cleansing is a key element for a quality colonoscopy since it affects diagnostic accuracy and adenoma detection rate. A very-low-volume 1L PEG solution (NER1006) has been recently introduced after the publication of three phase 3 randomized controlled trials showing non-inferiority respect to comparators. Despite its proven effectiveness, the safety of NER1006 in the elderly has never been assessed in a real-life setting.

METHODS:
This study aimed to assess the safety profile of NER1006 in the elderly compared to younger patients in a real-life setting. We performed a post-hoc analysis of data from a cohort of 1289 patients undergoing a colonoscopy after a afternoon-only or a afternoon-morning preparation with a 1, 2 or 4L PEG-based solution consecutively enrolled from September 2018 to February 2019 in 5 Italian centers. The elderly population was defined by an age ≥65 years. Safety was monitored through adverse events reporting.

RESULTS:
Among 1289 patients, 233 subjects undergoing a bowel preparation with NER1006 were included in the analysis. The mean age was 59.5 ± 15.9 years, 52.4% of patients were male, and 43.5% were older than 65 years old. Mean age was 48.6 ± 11.9 years (range 18–64) in the group of patients aged <65 years, and 73.7 ± 6.3 years (range 65–91) in the group of patients aged ≥65 years, while prevalence of hypertension, diabetes, and obesity was 13.7 vs. 32.7% (P = 0.03), 3.1 vs. 9.9% (P = 0.001) and 12.2 vs. 13.9% (P = 0.7) in the two groups, respectively. Overall incidence of adverse events was 19.8% and 10.9% (P = 0.06) in the group of patients aged < 65 and ≥65 years. Incidence of nausea, vomit, abdominal pain, dehydration and headache was 3.1 vs. 3.0% (P = 0.9), 9.9 vs. 5.9% (P = 0.2), 0.8 vs. 0.0% (P = 0.3) 2.3 vs. 0.0% (P = 0.1) and 2.3 vs. 0.0% (P = 0.1), in the group of patients aged <65 and ≥65 years, respectively. No serious adverse events or deaths occurred in any of the two groups.

CONCLUSION:
In this post-hoc analysis, we did not find any substantial difference in the safety profile of NER1006 in the elderly compared to younger patients. Given the observational nature of our study, an assessment of blood electrolyte or creatinine was not feasible. Nevertheless, no clinical event attributable to electrolyte imbalance or dehydration was observed in any patient. These results confirm the safety of this product even in the elderly and in a real-life setting.
151 Teaching Hospitals Have Lower Adjusted Rates of Hospital-Onset C. difficile Infection Compared to Non-Teaching Hospitals
Authors: Dalal Rahul S. , Lichtenstein Gary R. 
Published: October 2019

INTRODUCTION:
Hospital-onset Clostridioides difficile infection (HoCDI) is a preventable but significant cause of morbidity among patients hospitalized at teaching hospitals (THs; Consumer Reports 2016). Prior research that did not adjust for patients' disease severity demonstrated higher HoCDI rates in THs compared to non-THs (Open Forum Inf Dis 2016, 3(suppl_1):2062). We therefore attempted to determine the impact of hospital teaching status (HTS) on HoCDI rates while adjusting for underlying disease severity using the Vizient clinical database.

METHODS:
In this cross-sectional study, we used the Vizient database to analyze all adult hospitalizations from 10/1/2014 to 3/31/2018. Vizient includes >90% of academic centers and their affiliated community hospitals in the US. Vizient hospitals (n = 369) were grouped into major THs (members of Council of THs), minor THs (medical school affiliation only), and non-THs (all other hospitals), as defined by the 2016 American Hospital Association (AHA) Survey. We excluded hospitals missing from the AHA survey and discharges to another hospital or against medical advice. We used multivariable linear regression (MVLR) of aggregated data to assess the impact of HTS on HoCDI rates while adjusting for demographics, comorbidities, severity of illness indices, case mix, and hospital factors. MVLR was also performed using hospital resident-to-bed ratios (RTBR) to reflect teaching intensity. Final models were generated using step-wise backward elimination of covariates using P < 0.05.

RESULTS:
We identified 18,247,643 hospitalizations among 337 hospitals (132 major THs, 110 minor THs, 95 non-THs) from 10/1/2014 to 3/31/2018. Hospitalization characteristics are presented in Table 1. Unadjusted rates of HoCDI were higher in major THs compared to non-THs (median 0.4% vs. 0.2%, P < 0.01). After MVLR to adjust for confounders, major and minor HTS (Table 2) and RTBR (Table 3) were negatively correlated with HoCDI. Because mean length of stay and ICU stay reflect not only disease severity but also effects of HoCDI, they were added separately to the final models and the negative correlations between HTS and HoCDI persisted.

CONCLUSION:
After adjusting for metrics of disease severity and complexity, THs may have lower rates of HoCDI compared to non-THs. Additional research is needed to determine how inpatient practices that may contribute to HoCDI differ in THs vs. non-THs.
155 Therapeutic Oxygen for Gastrointestinal Atomy (TOGA) Pilot Trial: Management of Acute Colonic Pseudo-Obstruction and Ileus With Oxygen Supplementation
Authors: Zhang Wei , Baumann Alexandra J. , Brar Tony , Banerjee Debdeep , Khan Walid , Westerveld Donevan , Sutchu Selina , Jacobson Max E. , Grajo Joseph R. , Forsmark Christopher , Weiner Brian 
Published: October 2019

INTRODUCTION:
Acute intestinal dysmotility can lead to bowel distension, which promotes hypoperfusion and further negates contractility in acute colonic pseudo-obstruction (ACPO) and ileus. Current medical treatment is supportive. When bowel distension worsens, endoscopic decompression or surgical intervention may be necessary to avoid mortality; Interventions are time-consuming and not without risk. New effective and safe management approaches are needed. Manipulation of partial pressures of oxygen trapped within the bowel has been shown in patients with ACPO and ileus to improve clinical and radiographic outcomes. Therapeutic oxygen for gastrointestinal atomy (TOGA) is a pilot study aimed to demonstrate the benefit of a six hour course of 100% oxygen by non-rebreather mask as an adjunctive treatment for patients with ACPO and ileus who have failed to respond to alternative medical therapy after 24 hours.

METHODS:
Eight patients with ACPO or ileus were enrolled in this pilot study (ClinicalTrials.gov Identifier: NCT03386136) between May 1, 2018 and March 1, 2019 and administered 100% oxygen by non-rebreather mask for 6 hours in conjunction with traditional medical management. Abdominal radiographs were examined before and after treatment. Patient demographics, maximum diameter of bowel lumen distension on radiography, and clinical symptoms were recorded.

RESULTS:
Of the 8 patients (mean age 53.6 ± 17.4 years; 37.5% female), 87.5% demonstrated clinical improvement of symptoms after 6 hours of 100% oxygen (Table 1). For 7 patients, maximum luminal diameter improved on average by 1.14 ± 0.87 cm, the percentage decrease in luminal diameter on average was 13.8 ± 7.1%. One patient failed to improve but was later determined to have malignant small bowel obstruction. Only one patient suffered a potential adverse event to the oxygen therapy (transient tachycardia). No patients developed complications from their underlying disease, such as ischemia or perforation. Responding patients also reported improvements in abdominal pain, distension, and bowel movements.

CONCLUSION:
TOGA demonstrates that high concentrations of supplemental oxygen is a feasible and tolerable intervention to improve the clinical status of patients with ACPO and ileus, which may shorten hospitalization and overall morbidity. Further prospective enrollment is needed to extrapolate these promising findings and ensure confidence of its incorporation into common clinical practice.
156 Predictive Factors for Inadequate Inpatient Bowel Preparation
Authors: Poola Shiva , Jampala Nannaya , Tumin Dmitry , Ali Eslam 
Published: October 2019

INTRODUCTION:
Colonoscopy is highly sensitive for the detection of precancerous polyps and for the visualization of the entire colon during colorectal screening. Inpatient colonoscopies pose a special risk of poor preparation. We reviewed bowel preparation methods and patient factors to identify predictors of inadequate bowel preparation for inpatient colonoscopy at our institution.

METHODS:
All patients ages older than 18 years of age undergoing inpatient colonoscopy in 2017–2018 were reviewed. The primary outcome was inadequate bowel preparation and secondary outcomes were successful cecal intubation, duration of colonoscopy, and hospital LOS. Outcomes were compared according to demographic characteristics, comorbidities, abdominal surgery, and medications using multivariable regression with stepwise covariate selection. Statistical significance was set at P < 0.05.

RESULTS:
The analysis included 315 patients (median age = 67 years; 45% female, Table 1). The majority of colonoscopies were performed for anemia (78%). Visualization was deemed adequate in 56%, fair in 27%, and poor in 17% of cases. Cecal intubation was successful in 84% of cases. The median duration of colonoscopy was 25 min and LOS was 2 days. Unsuccessful cecal intubation was most likely with poor visualization (36% vs 11%, P = 0.014). There was no increased colonoscopy duration with poor visualization (P = 0.075). There was no significant LOS with worse visualization quality (P = 0.185). Factors predicting worse visualization quality included older age, history of CHF, cirrhosis, and motility disorders (Table 2). Older age, COPD, and colonoscopy performed for other indications were associated with unsuccessful cecal intubation. Factors predicting prolonged LOS included several comorbidities and usage of iron or neuromodulators (Table 3).

CONCLUSION:
At our institution, patients who were older or had significant co-morbid conditions (CAD, CHF, COPD, motility disorders, or cirrhosis) were more likely to have inadequate inpatient bowel preparation. Other studies found similar findings in patients with diabetes, cirrhosis, history of stroke or TCA use. Bowel preparation type did not affect the duration, quality of visualization, or the success of cecal intubation. Further work is needed to optimize inpatient bowel preparation protocols in older patients with multiple co-morbidities. Future studies should evaluate the success of bowel preparation in inpatient setting with a standardized bowel preparation score like the Boston Bowel Prep score.
162 Development of a New Bowel Preparation Prediction Model Based on Patient's Questionnaire: To Proceed or Not to Proceed With Colonoscopy? A Study From Veterans Affairs Hospital to Stratify High Risk Population
Authors: Dhaliwal Amaninder , Buddam Avanija , Chandan Saurabh , Bhat Ishfaq , Singh Shailender , Sayles Harlan , Antoniak Derrick , Hewlett Alexander , Rochling Fedja A. 
Published: October 2019

INTRODUCTION:
Bowel preparation (BP) is one of the intra-procedural quality indicators. The percentage of poor BP leading to repeat colonoscopy in = or < 1 year should not exceed more than 15%. The challenge remains that before doing the colonoscopy, we cannot reliably predict, whether a BP will be adequate for a good quality examination? The aim of our study is to propose a model based on patient's questionnaire that can identify patients with poor BP in pre-operative (pre-op) area prior to their colonoscopy.

METHODS:
From November 2018 to May 2019, 461 consecutive patients of 18 years of age or older who presented to Veterans Affairs (VA) Nebraska-Western Iowa Health Care System for colonoscopy each completed a voluntary questionnaire in the pre-op prior to their colonoscopies. This study was approved by VA institutional review board (IRB#00163). Information was collected regarding gender, age, ethnicity, education level, first colonoscopy, days of BP, BP instructions, amount of BP completed, last solid meal, timing of last bowel movement (BM), travel time to VA, nausea/vomiting and abdominal pain/bloating while taking BP, Bristol stool scale and last BM stool character (A-clear liquid stool, B-turbid, C-soft stools). Information regarding the Boston bowel preparation scale (BBPS) was calculated during the colonoscopy. Accuracy of the model was measured by the area under ROC curve. Statistical analysis was performed using STATA version 14.2.

RESULTS:
461 patients were included (94% males, 92% Caucasians). BBPS score of 5 or greater was noted in 95% of the patients. We used a multivariable logistic regression model using most of the variables depicted in Table 1 to predict the outcome of a patient having a BBPS score of 5 or greater. Area under the ROC curve was 0.7675 (Figure 1). With a cut point for the predicted probability of having a Boston Prep Score of 5 or greater of ≥0.8935, we achieved a sensitivity of 87.4% and a specificity of 50%. The coefficients included in the predicted model are depicted in Table 2.

CONCLUSION:
Our new bowel preparation prediction model to predict probability of having a BBPS of 5 or greater in pre-op area achieved sensitivity of 87.4% and specificity of 50% with area under ROC = 0.7675. Only 5% of our patient population had BBPS < 5 which could explain the low specificity of our predicted model. Multi-center studies are needed to further validate our model.