Objective Orotracheal intubation is a life-saving procedure commonly performed in the Intensive Care unit and Emergency Department as a part of emergency airway management. Prior to the COVID-19 pandemic, our center undertook a prospective observational study to characterize emergency intubation performed in the emergency department and critical care settings at Manitoba’s largest tertiary hospital. During this study, a natural experiment emerged when a standardized “COVID-Protected Rapid Sequence Intubation Protocol” was implemented in response to the pandemic. The resultant study aimed to answer the question; in adult ED patients undergoing emergent intubation by EM and CCM teams, does the use of a “COVID-Protected Rapid Sequence Intubation Protocol” impact first-pass success or other intubation-related outcomes? Methods A single-center prospective quasi-experimental before and after study was conducted. Data were prospectively collected on consecutive emergent intubations. The primary outcome was the difference in first-pass success rates. Secondary outcomes included best Modified Cormack–Lehane view, hypoxemia, hypotension, esophageal intubation, cannot intubate cannot oxygenate scenarios, CPR post intubation, vasopressors required post intubation, Intensive Care Unit (ICU) mortality, ICU length of stay (LOS), and mechanical ventilation days. Results Data were collected on 630 patients, 416 in the pre-protocol period and 214 in the post-protocol period. First-pass success rates in the pre-protocol period were found to be 73.1% ( n = 304). Following the introduction of the protocol, first-pass success rates increased to 82.2% ( n = 176, p = 0.0105). There was a statistically significant difference in Modified Cormack–Lehane view favoring the protocol ( p = 0.0191). Esophageal intubation rates were found to be 5.1% pre-protocol introduction versus 0.5% following the introduction of the protocol ( p = 0.0172). Conclusion A “COVID-Protected Protocol” implemented by Emergency Medicine and Critical Care teams in response to the COVID-19 pandemic was associated with increased first-pass success rates and decreases in adverse events. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00422-w.

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Over one third of NSM patients received chemotherapy and/or radiation. NSM patients with high-risk features were more likely to receive NAC and obtain a pCR. NSM patients did not experience worse outcomes or delayed adjuvant therapy compared to SSM.

Background Urinary tract infections (UTIs) are one of the most common bacterial infections. There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States. This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting. Methods We used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study. Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities. Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization. Results There were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older. The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%. The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin. Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization. Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively. Conclusion E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common. Disclosures All Authors: No reported disclosures

BackgroundHospitalizations attributable to urinary tract infections (UTI) have increased in recent years. One possible reason for the increase in admissions is a lack of effective oral agents, due to increasing rates of antimicrobial resistance, necessitating treatment with IV antibiotics. Our objective was to compare the rates of inpatient vs. outpatient treatment for UTIs.MethodsWe used the MarketScan database to identify UTI inpatient and outpatient visits from January 2001 through September 2015. Incidence rates for inpatient and outpatient visits were determined as a function of people at risk for UTIs. A difference-in-difference model with a change point in 2007 was used.ResultsDuring our study period, we identified 32,521,146 outpatient visits for UTI and 297,470 inpatient UTI visits. Rates for inpatient and outpatient visits were rising at similar rates before 2007. After 2007, the slopes differed, and the incidence of outpatient visits increased statistically (P = 0.023) when compared with inpatient visits.ConclusionIncidence of UTI hospitalizations is increasing but not as quickly as UTI outpatient visits. Since 2007, patients are more likely to be treated in the outpatient setting rather than in the inpatient setting.Disclosures All authors: No reported disclosures.