Background: Infections following cardiac implantable electronic device (CIED) implantation can require surgical device removal and often results in significant cost, morbidity, and potentially mortality. We aimed to systemically review the literature and identify risk factors associated with mortality following CIED infection. Methods: Electronic searches (up to June 2021) were performed on PubMed and Scopus. Twelve studies (10 retrospective, 2 prospective cohort studies) were included for analysis. Meta-analysis was conducted with the restricted maximum likelihood method, with mortality as the outcome. The overall mortality was 13.7% (438/1398) following CIED infection. Results: On meta-analysis, the male sex (OR 0.77, 95%CI 0.57–1.01, I2 = 2.2%) appeared to have lower odds for mortality, while diabetes mellitus appeared to be associated with higher mortality (OR 1.47, 95%CI 0.67–3.26, I2 = 81.4%), although these trends did not reach statistical significance. Staphylococcus aureus as the causative organism (OR 2.71, 95%CI 1.76–4.19, I2 = 0.0%), presence of heart failure (OR 1.92, 95%CI 1.42–4.19, I2 = 0.0%) and embolic phenomena (OR 4.00, 95%CI 1.67–9.56, I2 = 69.8%) were associated with higher mortality. Surgical removal of CIED was associated with lower mortality compared with conservative management with antibiotics alone (OR 0.22, 95%CI 0.09–0.50, I2 = 62.8%). Conclusion: We identified important risk factors associated with mortality in CIED infections, including Staphyloccocus aureus as the causative organism, and the presence of complications, such as heart failure and embolic phenomena. Surgery, where possible, was associated with better outcomes.

Cefazolin is a widely used first-generation cephalosporin. While generally well tolerated, several case reports have described severe coagulopathy induced by intravenous (IV) cefazolin. This was seen particularly in patients with impaired renal function, where antibiotic choice is limited and may require specific dose adjustments. Altered renal handling of antibiotics and their metabolites may potentiate toxicity and side effects. We report a case of a 72-year-old Chinese man who had been treated for methicillin-sensitive staphylococcus aureus (MSSA, coagulase-positive) infective endocarditis with cefazolin and, consequently, developed significantly elevated international normalised ratio (INR) while on therapy. This resolved within 48 h after cessation of cefazolin and administration of oral vitamin K. Malnourished patients with pre-existing or acute kidney injury may be at an increased risk of cefazolin-related coagulopathy.

Patients with preexisting kidney disease or acute kidney injury had poorer outcomes in coronavirus disease 2019 illness. Lymphopenia was associated with more severe illness. Risk stratification with simple laboratory tests may help appropriate site patients in a cost-effective manner and ease the burden on healthcare systems. We examined a ratio of serum creatinine level to absolute lymphocyte count at presentation (creatinine-lymphocyte ratio, CLR) in predicting outcomes in hospitalized patients with COVID-19. We analyzed 553 consecutive polymerase chain reaction-positive SARS-COV-2 hospitalized patients. Patients with end-stage kidney disease were excluded. Serum creatinine and full blood count (FBC) examination were obtained within the first day of admission. We examined the utility of CLR in predicting adverse clinical outcomes (requiring intensive care, mechanical ventilation, acute kidney injury requiring renal replacement therapy or death). An optimized cutoff of CLR > 77 was derived for predicting adverse outcomes (72.2% sensitivity, and 83.9% specificity). Ninety-seven patients (17.5%) fell within this cut off. These patients were older and more likely to have chronic medical conditions. A higher proportion of these patients had adverse outcomes (13.4% vs 1.1%, P < .001). On receiver operating curve analyses, CLR predicted patients who had adverse outcomes well (area under curve [AUC] = 0.82, 95%CI 0.72-0.92), which was comparable to other laboratory tests like serum ferritin, C-reactive protein and lactate dehydrogenase. Elevated CLR on admission, which may be determined by relatively simple laboratory tests, was able to reasonably discriminate patients who had experienced adverse outcomes during their hospital stay. This may be a simple and cost-effective means of risk stratification and triage.Abbreviations: AKI = acute kidney injury, AUC = area under curve, CLR = creatinine-to-lymphocyte ratio, COVID-19 = coronavirus disease 2019, FBC = full blood count, ROC = receiver operating characteristic, SARS-CoV-2 = severe acute respiratory distress syndrome coronavirus 2.

Background In the early months of the COVID-19 pandemic, the vast majority of infected persons were migrant workers living in dormitories who were young and with few medical co-morbidities. In 2021, this shifted to the more vulnerable and elderly population within the local community. We examined trends amongst the hospitalised cases, in order to demonstrate changes in disease severity in association with the evolving demographics. Demographic shifts in hospitalised patients with COVID-19. Proportion of hospitalised patients with COVID-19 requiring intensive care over time in Singapore Methods All patients with PCR-positive SARS-CoV-2 admitted from February 2020 to October 2021 were included, and subsequently stratified by their year of admission (2020 or 2021). Demographics were also classified by sex, ethnicity, as well as mode of transmission, namely i) imported cases, ii) locally-transmitted cases outside of migrant worker dormitories, and iii) migrant worker dormitory cases. We compared the baseline clinical characteristics, clinical presentation and outcomes. Results A majority of cases were seen in 2020 (n=1359), compared with 2021 (n=422), due to the large outbreaks in migrant worker dormitories. Nevertheless, the greater proportion of locally-transmitted cases outside of dormitories in 2021 (78.7% vs 12.3%) compared with 2020 meant a significantly older population with more medical co-morbidities were exposed to COVID-19. This led to an observably higher proportion of patients with severe disease, presenting with raised inflammatory markers, need for therapeutics, supplemental oxygenation and higher mortality. Baseline characteristics of hospitalised patients with COVID-19 in Singapore over time. Conclusion Changing demographics and the characteristics of the exposed populations are associated with distinct differences in clinical presentation and outcomes. Understanding demographic shifts may be crucial in appropriate allocation of healthcare resources in managing hospitalised patients with COVID-19. Disclosures All Authors: No reported disclosures.