Risk factors for readmission with preeclampsia: a call for more preventative surveillance and counseling.

BACKGROUND: Postpartum readmission for preeclampsia is a difficult predicament for patients which creates financial, psychosocial, and physical stress. It is often a challenge to predict postpartum preeclampsia and therefore identify patients that may be at risk prior to discharge. This study aims to identify risk factors in patients that are at high risk for readmission due to preeclampsia. The identification of these risk factors may also lead to enhanced education and counseling prior to discharge. METHODS: Researchers conducted a case-control study using a data set collected from 2015 to 2022 looking at obstetric readmissions within 6 weeks of delivery and then stratified these patients for preeclampsia diagnosis. A control set was created within the healthcare system's electronic medical record's search tools for patients diagnosed with preeclampsia who were not readmitted to the hospital. This study evaluates 78 patients who were readmitted with a diagnosis of preeclampsia and compared to 77 patients who were diagnosed with preeclampsia who were not readmitted. Again, the aim of this study was to investigate risk factors for readmission among patients with preeclampsia. RESULTS: A multivariable logistic regression model was used to assess predictors which revealed that older age (OR 1.13, CI 1.03-1.24), no history of preeclampsia with or without severe features within pregnancy before delivery (OR 15.29, CI 5.56-41.98 and 13.58, CI 4.46-12.85), no aspirin use in pregnancy (OR 4.38, CI 2.02-9.48), and number of triage visits related to hypertension during prenatal care were all significant predictors for readmission due to preeclampsia. CONCLUSION: With these risk factors in mind, better counseling and preventative surveillance can be provided to patients. Future studies are needed to evaluate the effectiveness of predictive models developed using these found risk factors.

A case series and literature review of blastomycosis during pregnancy amidst the COVID-19 crisis.

Blastomycosis dermatitidis is a rare fungus known for is classic mimicry of pneumonia, lung cancer, and mycobacterial infections. Whilst it is known best for affecting those in the Ohio and Mississippi River basins, several cases have erupted in the Midwest region. Few case reports have focused on blastomycosis and its sequalae in pregnancy. We present a case series of blastomycosis diagnosed during the second and third trimesters in two women amidst the COVID-19 pandemic. Given immunosuppression, complications and treatment can be challenging for clinicians. This case series and discussion hopes to provide future clinicians with the presentation, diagnosis, management, and treatment of this uncommon infection.

Can the use of probiotics reduce the incidence of nosocomial Clostridium difficile infection in 60 years or older patients?

BACKGROUND: Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotic use. The pathogenesis of AAD may be mediated by disruption of the host's normal flora resulting in overgrowth of pathogens. One of these pathogens is Clostridium difficile. Probiotics may help reestablish the disrupted intestinal flora and help clear the pathogen and its toxins from the host. Although numerous studies have been conducted, results are variable due to study design, type of probiotic, differing dose of probiotic, and duration of treatment. Our study aims to assess the efficacy and safety of the probiotics Lactobacillus GG and Saccharomyces boulardii for the prevention of C. difficile associated diarrhea. METHODS: Study data were collected from two community hospitals in Kansas City over a period of 5 months. All patients in the study were initiated on antibiotics and were then given probiotics. This study was controlled and not blinded. RESULTS: In data from two community hospitals, 816 patients who were being treated with antibiotics prior to the investigation served as a control; 14 (1.72%) had C. difficile Infections. During the study using probiotic administration, 803 patients also being treated with antibiotics prior to the investigation were followed and in this population; five patients (0.62%) contracted a C. difficile infection.