The presence of MRSA in bone culture and whether antibiotic use had anti-MRSA activity was not associated with increased treatment failure of diabetic foot osteomyelitis in our institution. Empiric antibiotic coverage of MRSA may not be necessary for many patients presenting with foot osteomyelitis.

The use of central venous catheters (CVCs) remains standard of care for delivering vasopressors in patients with shock though it is associated with mechanical and infectious complications. In an initiative to reduce central line days, a multi-disciplinary team devised a protocol for the administration of vasopressors via peripheral IV (PIV). In February 2019, the protocol was implemented in the 9-bed medical intensive care unit (MICU) of the Michael E. DeBakey VA Medical Center, a 349-bed teaching hospital. We hypothesized that central line days would be reduced with initiation of this protocol. Methods: A retrospective chart review was conducted on all veterans in the MICU that received vasopressors peripherally at the MEDVAMC between Feb 1 st 2019 till October 26 th 2019. The primary end point evaluated was central line days. Additional data collected included PIV site, vasopressor medication choice, duration and dosage, as well as escalation from PIV to central venous catheter (CVC). Extravasation events were monitored. Results: Of the 46 patients that met the inclusion criteria for peripheral vasopressor use, 93% were male and the mean age of the study participants was 66 years of age. Eighty-three percent of patients (n=38) had peripheral IV placement in the forearm or upper arm with the remainder having vascular access through the external jugular, antecubital and wrist veins. The majority of the patients received norepinephrine (n=43, 94%) with an average dose of 12 mcg/min (range of 2-40 mcg/min). The remaining patients received epinephrine (n=1, 2%), dopamine (n=1, 2%) and phenylephrine (n=1, 2%). The average duration of vasopressors was 24.06 hours with 35% of patients (n=16) receiving peripheral vasopressors for greater than one day. The total number of CVC days from February through September of 2018 and 2019 were 526 and 408, respectively. CVC placement was required in nine patients (20%); five of those patients required escalation to CVC due to requirement for multiple vasopressors. There were no extravasation events associated with peripheral administration of vasopressors. Conclusions: Central line days were reduced by 22% when comparing an eight-month period of time to historical control. There were no adverse events related to peripheral administration of vasopressors. Further research is required over a longer period to quantify trends in central line days as well as impact on patient outcomes including mortality.

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Background Patient and treatment-related factors have been used to stratify COVID-19 outcomes; however, studies in the general population and specifically veterans have yielded variable results. This study was designed to assess how baseline characteristics and interventions correlate with clinical outcomes in patients admitted with COVID-19 at a large academic Veterans Affairs hospital. Methods Retrospective chart review was conducted on veterans admitted to the hospital with COVID-19 between March 1 to December 31, 2020. Veterans without respiratory symptoms attributed to COVID-19 or enrolled in a COVID-19 clinical trial were excluded. Primary outcome was in-hospital mortality up to 28 days. Secondary outcomes were 90-day mortality, discharge to higher level of care or remained in the hospital within 28 days, and discharge with new oxygen requirement within 28 days. Patient characteristics and therapeutic interventions were assessed for correlation with primary and secondary outcomes. Results Of 497 hospitalized patients reviewed, 293 were included for analysis; 94% were male; average age was 68 years with 64.9% of veterans greater than 65 years of age; 43.7% were Black; 17.4% were Hispanic. In-hospital mortality at 28-days and 90-day mortality were 18.1% and 21.5%, respectively. At discharge, 34.1% had a new oxygen requirement and 17.5% went to a higher level of care. Patients that died in-hospital were more likely to be greater than 65 years of age (p< 0.001), Hispanic (p=0.007), have chronic kidney disease (CKD) (p=0.005), be admitted to ICU (p< 0.001); receive dexamethasone (p< 0.001), convalescent plasma (p< 0.001), or antibiotics (p< 0.001); require mechanical ventilation (p< 0.001); or have new onset atrial fibrillation (p< 0.001). Veterans also had higher levels of inflammatory markers within 48 hours of hospital admission (see Table 2) and longer length of hospital stay (< 0.001). There was a trend for patients that died in the hospital within 28-days to be less likely to be Black (p=0.06). Table 1. Primary and Secondary Outcomes of Study Population (n=293) Table 2. Patient Characteristics Stratified by Primary Outcome Table 3. Characteristics of the Patients that Survived to Discharge Stratified by Secondary Outcome Measures Conclusion Patients were more likely to die in-hospital within 28-days if they were greater than 65 years of age, Hispanic and had CKD. Veterans that died in-hospital within 28-days had higher inflammatory marker levels and were more likely to receive COVID-19 treatments. Disclosures All Authors: No reported disclosures