Introduction Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the USA, and a major cause of medication discontinuation. However, DILI is often under-diagnosed, primarily due to the lack of agreed upon diagnostic criteria and limiting coding nomenclature. Previous attempts to address these issues have met with only partial success. Methods We conducted a retrospective observational analysis of demographic, clinical, and laboratory data for 55 patients hospitalized in an Israeli tertiary care medical center between 2005-2017 and diagnosed with DILI. Results We identified 55 patients hospitalized with DILI over 12 years. DILI was associated with female gender, and more patients were ≥ 50 years of age. Hepatocellular liver injury was the most common type of liver injury (49.0%). Common clinical manifestations included fever (41.8%), weakness (41.8%) and jaundice (34.5%). The major offending drug group was antibiotics (35.0%) with amoxicillin and clavulanate the most common single drug within the group (7.2%). Most cases were caused by drugs administered orally (84%), while most cholestatic injury was seen with intravenous administration. De Ritis ratio (AST/ALT) was above 1.0 in 75% of cases. Conclusions Most DILI was caused by oral antibiotics. The incidence of DILI in our study was low, possibly due to under-diagnosis or misclassification. The adoption of the updated international classification of disease 10th edition (ICD-10) may improve reporting rates. Utilization of the De Ritis ratio may help to differentiate between DILI and viral hepatitis.

Background: The first case of COVID-19 in Israel was reported on February 21, 2020. Shaare Zedek (SZ), a 1000-bed tertiary care medical center in Jerusalem, Israel, cared for a significant number of these patients. While attention focused on COVID-19 patients, uninfected patients were admitted to decreasing numbers of available internal medicine (IM) beds as IM departments were converted to COVID-19 isolation wards. Due to the increase in COVID-19 patients, closure of IM wards, re-assignment of staff, and dynamic changes in available community placement options, we investigated the impact of the outbreak on IM patient not admitted for COVID-19. Methods: We reviewed IM admissions during March 15 – April 30, 2020 for patients without COVID-19. Characteristics assessed included number of admissions, age, length of stay, mortality rate, number of discharges, number discharged home, and functional status of the patients. Data was compared to the previous three years (2017 – 2019) during the same time period. Results: During March 15 – April 30, 2020 there were 409 patients admitted to IM compared to a mean of 557 over the previous three years. Fewer patients were admitted to the ED and the IM wards during the outbreak. There was no significant difference between the two groups with regards to gender, in-hospital mortality rate, number discharged, number discharged home, and patient functional level. Patients admitted during the outbreak to IM were younger (74.85 vs 76.86 years) and had a mean shorter hospital length of stay (5.12 vs 7.63 days) compared to the previous three years. Conclusion: While the characteristics of patients admitted to IM during the outbreak were similar, hospital length of stay was significantly shorter. Internal management processes, as well as patient preferences may have contributed to this observation. An infectious disease outbreak may have a significant effect on uninfected admitted patients.