Summary Introduction Helicobacter pylori (HP) resistance is increasing in the US. Guidelines suggest treatment based on local resistance patterns, yet are poorly studied. Here, we describe resistance patterns of the Delaware Valley. Methods Retrospective study of patients referred to the Hospital of the University of Pennsylvania, between 2009 and 2019 who underwent endoscopy for culture. Chart review identified demographics, history, endoscopic and culture results, treatment and follow‐up. Results Of 109 patients referred for refractory HP, 90 had identified HP. Median age was 53.2 years and the majority was female (74%), with a median two previous antibiotic courses for HP. Gastric erythema was the most common endoscopic abnormality. Sixty‐five (72.2%) were culture positive, and 45 (69.2%) were resistant to levofloxacin, 27 (41.5%) to metronidazole and 39 (43.3%) to clarithromycin. Being resistant to any one of the three antibiotics was associated with resistance to either of the other two. There was an association with number of previous antibiotics with resistance (OR 1.74, P < 0.05). We prescribed therapy to 77 patients based on susceptibility profiles, and 34 (37.8%) were cured, 14 (15.6%) underwent endoscopic surveillance, 3 (3.3%) were followed by infectious disease, and 39 (43.3%) were lost to follow up. Conclusions Antibiotic resistance is associated with refractory HP, and continues to rise. Culturing is associated with cure, and its use in clinical practice regarding efficacy, cost‐effectiveness and ability to minimise antibiotic resistance should be further studied. Overall follow‐up is limited by loss to follow‐up, emphasising the need for appropriate treatment.

Linked Content This article is linked to Kumar et al and Pandey papers. To view these articles, visit https://doi.org//10.1002/ygh2.382 and https://doi.org//10.1002/ygh2.386.

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Background The introduction of Imatinib in 2001 has brought a paradigm shift in the management of CML. Patients on TKI therapy continue to require hospitalizations, however, for progressive disease, treatment side effects and other unrelated causes. In our study we compared the cost of inpatient health care, mortality, length of stay (LOS) and complications for patients who had stem cell transplants to those on TKI therapy. Methods We queried the NIS database from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality between 2002-2011 using ICD-9 code 205.1 for CML in the primary and secondary diagnosis fields. Patients 18 years or older were included in the analysis. Cost of hospitalization was adjusted for inflation in reference to 2011 and cost to charge ratio. We analyzed the trend in hospitalizations, cost and mortality. Linear and logistic regression models were generated to evaluate multivariate predictors of LOS, cost, mortality and complications. Odds ratios and odds estimates were generated comparing the group that underwent HSCT to the group that was treated with TKI therapy. We compared three groups: patients admitted for the transplant procedure (BMT procedure), patients readmitted post HSCT, and patients treated with TKIs. Multivariate analysis for complications from CML included splenic infarct, septic shock, splenomegaly, blast crises and DIC. Complications of graft versus host disease and graft rejection were included as they were complications of allogeneic transplant that warranted hospitalization. Age-related comorbidities, such as atrial fibrillation, congestive heart failure, and acute and chronic renal failure were also analyzed to further delineate the reason for hospitalization. A p value of <0.05 was considered significant. Results A total of 38,950 hospitalizations (weighted n= 19,1285) were analyzed (male 54.6% and age 65.9±0.08). There was a decrease of 81.96 % in mortality from 2002 to 2011 (p<0.0001). The average age was 66.7 years in the non-transplant group, and 45.6 years in the transplant group (p = 0.0016). 64% in the TKI group had Medicare, compared to 23.7% in the transplant group (p<0.0001). The inpatient mortality for transplant was 8.9%, but was 6.3% in the group readmitted after a successful transplant. It was 7.9 % in the TKI group (p = 0. 032). Admissions due to age-related co-morbidities was 28.5 % in the transplant group and 50.8% in the TKI group (p<0.0001). Only 14% of patients in the TKI group were admitted for CML related problems vs. 23.7% in the transplant group (0.0001). The average length of stay was 7.05 days in the TKI group and 18.4 days in the transplant group. The average length for the transplant procedure was 33.85 days (p<0.0001). The average cost of hospitalization in the transplant group was $173,780, and was $46,955 in the TKI group. The transplant procedure cost $338,229 (p<0.0001). The odds of mortality (OR) are in favor of TKI therapy with an OR of 1.9 against the transplant procedure. Discussion Patients on TKI therapy have a lower mortality, average length of stay and hospitalization cost compared to the transplant group. The main reasons for hospital admission for patients on TKI therapy were age-related comorbidities, rather than complications of CML. The mortality in the TKI group was lower than the HSCT group. However, the yearly cost of TKI therapy must be taken into account for health care costs of non-transplant patients. At present, Imatinib costs $92,000/ year and Dasatinib $118,000/year. Hence, Imatinib therapy for even 4 years would be more expensive than a transplant. Therefore, TKI therapy provides improved mortality and shorter length of hospital stay at the cost of a net higher expense. Disclosures No relevant conflicts of interest to declare.

Background: DVT and PE are common complications in hospitalized patients. Many hospitals have implemented EMR-based protocols to identify patients who could benefit from prophylactic anticoagulation, because of the increased morbidity, mortality, and cost associated with thrombotic disease. Several groups have sought to characterize the potential seasonal and winter variation in the incidence of DVT and PE, with several international studies supporting a so called "Winter effect" (Damnjanović et al., Hippokratia 2013); however, no study has demonstrated a "Winter effect" on patients within the US (Stein et al., Am J Cardiol 2004). Objective: (1) To compare mortality rates and length of stay (LOS) in hospitals by month to identify a "Winter effect" in patients diagnosed with either DVT or PE; and (2) characterize other factors that might influence mortality and LOS, using the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Methods: The NIS was queried from 1998-2011. Inclusion criteria were a diagnosis of DVT (ICD-9 453.4X, 453.8X) and/or PE (ICD-9 415.1X) in patients aged 18 years or more. The sample was weighted to approximate the full inpatient population of the United States over the period of interest. Admission data was then analyzed to compare mortality rates over those years by month. Demographics, Charlson Comorbidity Index (CCI), length of stay, hospital region, and admission type (emergent/urgent versus elective admissions) were assessed. Linear and logistic models were generated for complex survey design to assess predictors of mortality and LOS. Results: A total of 1,449,113 DVT/PE cases were identified in the NIS (weighted n = 7,150,613). 54.7% of admission were for females, 56.4% were white, and 49% of admissions were at a teaching facility. Mortality over the 12 months was 6.4% and was noted to be higher in four months: November (6.52%), December (6.9%), January (6.94%), and February (6.93%), as indicated in the graph below. A similar trend was noted on a regional basis with higher mortality noted in winter months for all hospital regions (Northeast, Midwest or North Central, South, and West). No significant trend was noted in DVT/PE hospitalization rates between regions over 12 months (p=0.7674). Mortality in the total cohort was found to be significantly higher in December, OR 1.10 (95% CI: 1.06-1.14), p<0.0001; January, OR 1.11 (95% CI: 1.08-1.15), p<0.0001; and February, OR 1.11 (95% CI: 1.07-1.15), p<0.0001 compared to June (Table 1). Mortality was significantly lower in the Midwest or North Central, OR 0.78 (95% CI: 0.72-0.83), p<0.0001; and West, OR 0.80 (95% CI: 0.73-0.87), p<0.0001 compared to the Northeast. Mortality was also significantly higher in teaching hospitals than in nonteaching hospitals (OR 1.16 [95% CI: 1.10-1.22], p<0.0001), with mortality higher in teaching hospitals in all months. Length of stay was also significantly increased in the winter months. Similar results were noted in the subgroups of patients greater than age 80 or with a CCI score of 2 or more. Conclusion: This national study identified an increased risk of mortality and increased LOS associated with hospitalizations for DVT/PE during the winter months (December, January, and February), supporting the existence of a "Winter effect" on hospital outcomes. Our data differs from previous reports on seasonal variation in DVT/PE in the US because of the database used (Bekkers et al., Clin Orthop Relat Res 2014). Since no regional variation was shown, decreased activity or cold temperature is unlikely to be the cause of this phenomenon. Alternative explanations should be sought. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.