Role of Blood Culture Systems in the Evaluation of Epidemiological Features of Coagulase-Negative Staphylococcal Bloodstream Infection in Critically Ill Patients

1999 ◽  
Vol 18 (12) ◽  
pp. 899-901 ◽  
Author(s):  
L. Oud *, ‡ , S. Krimerman ◽  
N. Salam ◽  
I. Srugo
Keyword(s):  
Blood Culture ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Culture Systems ◽  
Epidemiological Features

scholarly journals 112. Physiological Signature of Bloodstream Infection in Critically Ill Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S87-S88
Author(s):  
Alex Zimmet ◽  
Matthew Clark ◽  
Shrirang M Gadrey ◽  
Taison Bell ◽  
J Randall Moorman ◽  
...  
Keyword(s):  
Blood Culture ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Positive Blood Culture ◽  
Critically Ill Patients ◽  
Vital Sign ◽  
Physiological Data ◽  
Surgical Trauma ◽  
Critically Ill Adults ◽  
Ill Adults

Abstract Background Bloodstream infection (BSI) is associated with high mortality rates in critically ill patients but is difficult to identify clinically. This uncertainty results in frequent blood culture testing, which exposes patients to additional costs and the potential harms of unnecessary antibiotics. Accordingly, we aimed to identify signatures in physiological data from critically ill adults that characterize BSI. Methods We reviewed all blood culture, vital sign, laboratory, and cardiorespiratory monitoring (CRM) data from patients admitted to the medical and surgical/trauma ICUs at the University of Virginia Medical Center from February 2011 to June 2015. Blood culture results were categorized as positive, negative, or contaminant. For the BSI population, we included data obtained within 12 hours before or 24 hours after the acquisition of a positive blood culture. The control population included data greater than 12 hours before or 24 hours after the acquisition of a positive blood culture, and all data from patients without BSI. We used multivariable logistic regression to identify the physiological characteristics of BSI. Results We analyzed 9,955 ICU admissions with 144 patient-years of vital sign and CRM data (1.3M hourly measurements). The average age was 59 years; the population was mostly Caucasian (81%) and male (56%). There were 5,671 (57%) admissions with ≥1 blood culture, and 744 (7%) had a BSI. The in-hospital mortality rate for patients with BSI was 28% vs. 12% for all others. The physiological signature of BSI was characterized by abnormalities in 12 parameters (Figure 1)—e.g., BSI was more likely in patients with a higher pulse and lower platelets. Several associations were nonlinear—e.g., temperature and WBC had U-shaped relationships with BSI. The internally validated C-statistic was 0.77. Conclusion Statistical modeling revealed a clinically sensible physiological signature of BSI that could assist with bedside decisions regarding the utility of blood culture testing in critically ill adults. Disclosures All authors: No reported disclosures.

scholarly journals 303. Physiological Changes Due to Bloodstream Infection in Intensive Care Unit Patients Differ According to Transplant Status

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S149-S150
Author(s):  
Alex Zimmet ◽  
Douglas Lake ◽  
Amanda M Zimmet ◽  
Shrirang M Gadrey ◽  
Taison Bell ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Blood Culture ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Positive Blood Culture ◽  
Critically Ill Patients ◽  
Regression Modeling ◽  
Transplant Recipients ◽  
Logistic Regression Modeling

Abstract Background Transplant recipients are at increased risk of bloodstream infection (BSI), which often leads to critical illness. Due to immunosuppression, BSI in these patients may manifest with different pathophysiology compared to non-transplant recipients. We aimed to identify different trends in the pathophysiology of critically ill patients with BSI based on transplant status. Methods We reviewed data from patients admitted to the medical and surgical/trauma intensive care units (ICUs) at the University of Virginia Medical Center from 2011 to 2015. We included both solid organ and hematopoietic stem cell transplant recipients. We performed univariate logistic regression modeling to evaluate trends in different physiological features in both transplant and non-transplant recipients in the 96 hours surrounding a positive blood culture. We then performed multivariate logistic regression modeling to identify features independently associated with a positive blood culture in the next 24 hours in transplant recipients. Results We analyzed 9,954 ICU patient-admissions (including 505 transplant recipients), with a total of 144 patient-years of physiological data, 1.3 million hourly measurements, and 15,577 blood culture instances. Of the 1,068 blood culture instances in transplant recipients, 125 (12%) were positive, compared to 1,051 of 14,509 (7%) blood culture instances in non-transplant recipients. Critically ill transplant recipients with BSI had greater abnormalities in vital signs, oxygen requirement, markers of organ damage, APACHE score, and Charlson Comorbidity Index (CCI) compared to non-transplant recipients (Figure 1). Trends in many of these features also differed based on transplant status. The multivariable logistic regression model of BSI in transplant recipients included, in decreasing strength of association: total bilirubin, systolic blood pressure, fraction of inspired oxygen, number of intravenous lines, and CCI. This model had an AUC of 0.75. Figure 1. Trends in pathophysiological abnormalities in 9,954 critically ill patients with BSI based on transplant status, 2011–2015. Each graph demonstrates the average value of the physiological variable over time relative to the acquisition of a positive blood culture. Blue curves depict trends in transplant recipients, while red curves depict trends in non-transplant recipients. We assessed 108 physiological features and show the 24 features with the greatest change around the time of blood culture. Conclusion Critically ill transplant recipients have a higher prevalence of BSI and different pathophysiological manifestations of BSI compared to non-transplant recipients. This may have implications regarding early detection and treatment of BSI in these patients. Disclosures Randall Moorman, MD, Advanced Medical Predictive Devices, Diagnostics, and Displays (Board Member, Shareholder)

Diagnostic accuracy of the BioFire FilmArray blood culture identification panel when used in critically ill patients with sepsis

2021 ◽  
Vol 189 ◽  
pp. 106303
Author(s):  
Roxanne Rule ◽  
Fathima Paruk ◽  
Piet Becker ◽  
Matthew Neuhoff ◽  
Julian Chausse ◽  
...  
Keyword(s):  
Blood Culture ◽  
Diagnostic Accuracy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Culture Identification

scholarly journals Serum Procalcitonin Level and Mortality Risk in Critically ill Patients with Ventilator-Associated Pneumonia

2015 ◽  
Vol 37 (5) ◽  
pp. 1967-1972 ◽  
Author(s):  
Bo Li ◽  
Xin Zhao ◽  
Shumei Li
Keyword(s):  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
High Serum ◽  
Ventilator Associated Pneumonia ◽  
Prognostic Role ◽  
Procalcitonin Level ◽  
Increased Risk

Background/Aims: The prognostic role of serum procalcitonin level in critically ill patients with ventilator-associated pneumonia was unclear. The aim of our study was to investigate the relationship between serum procalcitonin level and mortality risk in critically ill patients with ventilator-associated pneumonia. Methods: Data of critically ill patients with ventilator-associated pneumonia were retrospectively collected. Demographics, comorbidities, and serum procalcitonin level were extracted from electronic medical records. The primary outcome was mortality within two months after diagnosis. Multivariable Cox regression analyses were performed to assess the prognostic role of serum procalcitonin level in those patients. Results: A total of 115 critically ill patients with ventilator-associated pneumonia were enrolled in our study. Serum procalcitonin level was not associated with age, gender, or other comorbidities. Univariate Cox regression model showed that high serum procalcitonin level was associated increased risk of morality within 2 months after diagnosis (OR = 2.32, 95% CI 1.25-4.31, P = 0.008). Multivariable Cox regression model showed that high serum procalcitonin level was independently associated increased risk of morality within 2 months after diagnosis (OR = 2.38, 95% CI 1.26-4.50, P = 0.008). Conclusion: High serum procalcitonin level is an independent prognostic biomarker of mortality risk in critically ill patients with ventilator-associated pneumonia, and it's a promising biomarker of prognosis in critically ill patients.

scholarly journals Do Aspirin and Other Antiplatelet Drugs Reduce the Mortality in Critically Ill Patients?

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Wolfgang Lösche ◽  
Janina Boettel ◽  
Björn Kabisch ◽  
Johannes Winning ◽  
Ralf A. Claus ◽  
...  
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Option ◽  
Bleeding Risk ◽  
Antiplatelet Drugs ◽  
Beneficial Effects ◽  
Prospective Trials ◽  
High Bleeding Risk

Platelet activation has been implicated in microvascular thrombosis and organ failure in critically ill patients. In the first part the present paper summarises important data on the role of platelets in systemic inflammation and sepsis as well as on the beneficial effects of antiplatelet drugs in animal models of sepsis. In the second part the data of retrospective and prospective observational clinical studies on the effect of aspirin and other antiplatelet drugs in critically ill patients are reviewed. All of these studies have shown that aspirin and other antiplatelet drugs may reduce organ failure and mortality in these patients, even in case of high bleeding risk. From the data reviewed here interventional prospective trials are needed to test whether aspirin and other antiplatelet drugs might offer a novel therapeutic option to prevent organ failure in critically ill patients.

scholarly journals A Comparison of Blood Pathogen Detection Among Droplet Digital PCR, Metagenomic Next-Generation Sequencing, and Blood Culture in Critically Ill Patients With Suspected Bloodstream Infections

2021 ◽  
Vol 12 ◽  
Author(s):  
Bangchuan Hu ◽  
Yue Tao ◽  
Ziqiang Shao ◽  
Yang Zheng ◽  
Run Zhang ◽  
...  
Keyword(s):  
Next Generation Sequencing ◽  
Blood Culture ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pathogen Detection ◽  
Bloodstream Infections ◽  
Digital Pcr ◽  
Droplet Digital Pcr ◽  
Next Generation ◽  
Generation Sequencing

Metagenomic next-generation sequencing (mNGS) and droplet digital PCR (ddPCR) have recently demonstrated a great potential for pathogen detection. However, few studies have been undertaken to compare these two nucleic acid detection methods for identifying pathogens in patients with bloodstream infections (BSIs). This prospective study was thus conducted to compare these two methods for diagnostic applications in a clinical setting for critically ill patients with suspected BSIs. Upon suspicion of BSIs, whole blood samples were simultaneously drawn for ddPCR covering 20 common isolated pathogens and four antimicrobial resistance (AMR) genes, mNGS, and blood culture. Then, a head-to-head comparison was performed between ddPCR and mNGS. A total of 60 episodes of suspected BSIs were investigated in 45 critically ill patients, and ddPCR was positive in 50 (83.3%), mNGS in 41 (68.3%, not including viruses), and blood culture in 10 (16.7%) episodes. Of the 10 positive blood cultures, nine were concordantly identified by both mNGS and ddPCR methods. The head-to-head comparison showed that ddPCR was more rapid (~4 h vs. ~2 days) and sensitive (88 vs. 53 detectable pathogens) than mNGS within the detection range of ddPCR, while mNGS detected a broader range of pathogens (126 vs. 88 detectable pathogens, including viruses) than ddPCR. In addition, a total of 17 AMR genes, including 14 blaKPC and 3 mecA genes, were exclusively identified by ddPCR. Based on their respective limitations and strengths, the ddPCR method is more useful for rapid detection of common isolated pathogens as well as AMR genes in critically ill patients with suspected BSI, whereas mNGS testing is more appropriate for the diagnosis of BSI where classic microbiological or molecular diagnostic approaches fail to identify causative pathogens.

scholarly journals Low albumin levels are associated with poorer outcomes in a case series of COVID-19 patients in Spain: a retrospective cohort study

2020 ◽  
Author(s):  
Roberto de la Rica ◽  
Marcio Borges ◽  
María Aranda ◽  
Alberto del Castillo ◽  
Antonia Socias ◽  
...  
Keyword(s):  
Disease Severity ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Series ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Limited Information ◽  
Icu Patients ◽  
Epidemiological Features ◽  
Initial Symptoms

ABSTRACTOBJECTIVETo describe the clinical characteristics and epidemiological features of severe (non-ICU) and critically patients (ICU) with COVID-19 at triage, prior hospitalization, in one of the main hospitals in The Balearic Islands health care system.DESIGNRetrospective observational studySETTINGSon Llatzer University Hospital in Palma de Mallorca (Spain)PARTICIPANTSAmong a cohort of 52 hospitalized patients as of 31 March 2020, 48 with complete demographic information and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive test, were analyzed. Data were collected between March 15th, 2020, and March 31th 2020, inclusive of these dates.MAIN OUTCOMESClinical, vital signs and routine laboratory outcomes at the time of hospitalization, including symptoms reported prior to hospitalization. Demographics and baseline comorbidities were also collected. Mortality was reported at the end of the study.RESULTS48 patients (27 non-ICU and 21 ICU) resident in Mallorca, Spain (mean age, 66 years, [range, 33-88 years]; 67% males) with positive SARS-CoV-2 infection were analyzed. There were no differences in age or sex among groups (p >.05). Initial symptoms included fever (100%), coughing (85%), dyspnea (76%), diarrhea (42%) and asthenia (21%). The majority of patients in this case series were hospitalized because of low SpO2 (SpO2 below 90%) and presentation of bilateral pneumonia (94%) at triage. ICU patients had a higher prevalence of dyspnea compared to non-ICU patients (95% vs 61%, p = .022). Acute respiratory syndrome (ARDS) was presented in 100% of the ICU-patients. All the patients included in the study required oxygen therapy. ICU-patients had lymphopenia as well as hypoalbuminemia. Inflammatory markers such as lactate dehydrogenase (LDH), C-reactive protein (CRP), and procalcitonin were significantly higher in ICU patients compared to non-ICU (p < .001).Lower albumin levels were associated with poor prognosis measured as longer hospital length (r= −0.472, p <.001) and mortality (r= −0.424, p=.003). Interestingly we also found, that MCV was lower among of those patients who died (p=.0002). As of April 28, 2020, 10 patients (8 ICU and 2 non-ICU) had died (21% mortality) and while 100% of the non-ICU patients had been discharged, 33% of ICU patients still remained hospitalized (5 in ICU and 2 had been transferred to ward).CONCLUSIONCritically ill patients with COVID-19 present lymphopenia, hypoalbuminemia as well high levels of inflammation. Lower levels of albumin were associated with poorer outcomes in COVID-19 patients. Albumin might be of importance because of its association with disease severity in patients infected with SARS-CoV-2.WHAT IS ALREADY KNOWN IN THIS TOPICSpain has been hit particularly hard by the pandemic. By the time that this manuscript was written more than 25.000 deaths related to COVID-19 have been confirmed. There is limited information available describing the clinical and epidemiological features of Spanish patients requiring hospitalization for COVID-19. Also, it is important to know the characteristics of the hospitalized patients who become critically illWHAT THIS STUDY ADDSThis small case series provides the first steps towards a comprehensive clinical characterization of severe and critical COVID-19 adult patients in Spain. The overall mortality in our patients was 21%. To our knowledge this is the first report with reporting these features in Spain. At triage the majority of patients had lower SpO2 (<90%) and bilateral pneumonia. The most common comorbidities were hypertension (70%), dyslipidemia (62%) and cardiovascular disease (30%). Critically ill patients present hypoalbuminemia and lymphopenia, as well as higher levels of inflammation. Albumin might be of importance because of its association with disease severity and mortality in patients infected with SARS-CoV-2.

scholarly journals Effect of Central Venous Catheter Care Bundle Implementation on Outcomes of Critically Ill Patients

2020 ◽  
Vol 2 (1) ◽  
pp. 12
Author(s):  
Gehan A. F. Atia
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Venous Catheter ◽  
Care Bundle ◽  
Central Venous ◽  
Significant Difference ◽  
Post Test ◽  
Catheter Care

Context: Central venous access device (CVAD) bundles for insertion and maintenance demonstrate a reduction in the frequency of complications and bloodstream infection when implemented with compliance monitoring, with the reported success of CVAD bundles. Aim: This study aimed to examine the effect of central venous catheter care bundle implementation on outcomes of critically ill patients. Methods: Quasi-experimental research (pre/post-test design) used to achieve the aim of this study. The study conducted at general and surgical intensive care units affiliated to Menoufia University and teaching hospital. Two study samples recruited in this study. All nurses working at the ICUs, as mentioned above, were recruited in this study. They were 6o critical care nurses. A convenient sample of all available critically ill patients at the time of the study was subjected to treatment via a central venous catheter. Four study tools used to collect the data of this study. These are a structured interview questionnaire, CVC nurses’ knowledge assessment questionnaire, nurses’ compliance assessment checklists, and patient complications assessment records. Results: The study result showed a highly statistically significant difference between pre and post-test knowledge scores of studied nurses regarding assisting line insertion, removal, maintenance, care, and infection control practices. Besides, a highly statistically significant difference between pre and post-test scores of nurses’ compliance to central venous catheter care practices of assisting in CVC insertion, blood sample withdrawal, medication and fluid administration, CVP measurements, CVC removal, and the management of central venous line complications. The study also revealed a highly statistically significant difference between the study and control group patients regarding the central venous catheter complications. However, signs of infection were the most frequent complications in both groups. Conclusion. The study concluded that a statistically significant difference between pre and post nurses’ knowledge and compliance with the CVC care bundle. The patients’ outcomes were also improved significantly after the implementation of the CVC care bundle compared to the controls. The study recommended the adoption of the current care bundle that should be disseminated and updated following the international organizations’ recommendation for implementing evidence-based practices for successful central line-associated bloodstream infection (CLABSI) prevention.

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