Table 8.
Hospital Length of Stay for Adult Survivors Reported to be Hospitalized for Anthrax by Meningitis Status, Route of Infection, Systemic Criteria, and Treatment During First 2 Days of Hospitalizationa, 1940–2018
| Localized Cutaneousb,c (N = 93 [89 Survivors]) |
Systemic (Without Meningitis)b,d (N = 136 [106 Survivors]) |
With Meningitis (N = 46 [8 Survivors]) |
||||
|---|---|---|---|---|---|---|
| Length of Stay | Length of Stay | Length of Stay | ||||
| Treatment | Median (N) | IQR | Median (N) | IQR | Median (N) | IQR |
| Nonee | 6 (1) | … | 9 (3) | 8–12 | - (-) | … |
| 1 Abx classf | 11 (28) | 8–14 | 14 (27) | 8–20 | 43 (3) | 14–56 |
| 2 Abx classes | 23 (3) | 5–31 | 28 (9) | 18–61 | - (-) | … |
| ≥3 Abx classes | 10 (2) | 6–14 | 19 (14) | 11–30 | 16 (3) | 8–21 |
| Antiserumg | - (-) | … | 14 (1) | … | - (-) | … |
| Antiserum and 1 Abx class | 17 (8) | 15–22 | - (-) | … | 21 (1) | … |
| Antiserum and ≥ 2 Abx classes | - (-) | … | 38 (5) | 31–42 | - (-) | … |
| Bactericidal(s) | 11 (25) | 8–14 | 15 (31) | 9–22 | 30 (4) | 15–50 |
| PSI(s) | 12 (4) | 8–16 | 18 (2) | 12–23 | - (-) | … |
| Bactericidal(s) and PSI(s) | 10 (4) | 6–19 | 17 (22) | 13–31 | 10 (3) | 8–21 |
Abbreviations: Abx, antimicrobial; IQR, interquartile range; PSI, protein synthesis inhibitor(s).
Treatments in this table refer to antimicrobials, antitoxin/antiserum, or a combination of both. Each line is the length of hospital stay for survivors on that treatment only (eg, “single antimicrobial” means that they received a single antimicrobial and they did not receive antitoxin/antiserum. “Bactericidal(s)” means that they received 1 or more bactericidal antimicrobial(s) but no protein synthesis inhibitor and no antitoxin/antiserum). Sulfa drugs and cephalosporins are not considered anthrax-appropriate antimicrobial treatment and therefore did not contribute to the count of antimicrobials in this table. Patients described by author Meselson (N = 24) were excluded because they lacked treatment data [2]. Additional exclusions included 63 patients who died on their first day of hospitalization and 8 who lacked survival status. Thirteen patients had at least 1 antimicrobial other than a sulfa or cephalosporin before hospitalization and 7 patients had their first treatment after day 2 of hospitalization and were excluded from this table. A few patients had unclear treatment timing and could not be classified.
Systemic refers to our definition published in “Identifying Meningitis During an Anthrax Mass Casualty Incident: Systemic Review of Systemic Anthrax Since 1880” except that we removed the qualification of “death” [11].
One localized cutaneous patient had possible meningitis and was excluded from these columns. This 1 patient had antimicrobial monotherapy (a bactericidal) and lived. The length of hospital stay for this patient was 14 days.
Systemic patients lacking meningitis consisted of the following: 61 cutaneous, 16 ingestion, 19 inhalation, and 40 injection.
“None” refers to no antimicrobials or antitoxin/antiserum given at all before or throughout hospitalization. This is the only category that is not restricted to the first 2 days of hospitalization.
Antimicrobials are lumped into classes; therefore, having 1 antimicrobial refers to 1 class of antimicrobials, 2 antimicrobials refers to having 2 different classes of antimicrobials, etc.
This includes both antiserum and antitoxin.