Latent Class Analysis of Specialized Palliative Care Needs in Adult Intensive Care Units From a Single Academic Medical Center

Background Ketamine has seen increased use for sedation in the intensive care unit. In contrast to propofol or dexmedetomidine, ketamine may provide a positive effect on hemodynamics. Objective The objective of this study was to compare the development of clinically significant hypotension or bradycardia (ie, negative hemodynamic event) between critically ill adults receiving sedation with ketamine and either propofol or dexmedetomidine. Methods This was a retrospective cohort study of adults admitted to an intensive care unit at an academic medical center between January 2016 and January 2021. Results Patients in the ketamine group (n = 78) had significantly less clinically significant hypotension or bradycardia compared with those receiving propofol or dexmedetomidine (n = 156) (34.6% vs 63.5%; P < 0.001). Patients receiving ketamine also experienced smaller degree of hypotension observed by percent decrease in mean arterial pressure (25.3% [17.4] vs 33.8% [14.5]; P < 0.001) and absolute reduction in systolic blood pressure (26.5 [23.8] vs 42.0 [37.8] mm Hg; P < 0.001) and bradycardia (15.5 [24.3] vs 32.0 [23.0] reduction in beats per minute; P < 0.001). In multivariate logistic regression modeling, receipt of propofol or dexmedetomidine was the only independent predictor of a negative hemodynamic event (odds ratio [OR]: 3.3, 95% confidence interval [CI], 1.7 to 6.1; P < 0.001). Conclusion and Relevance Ketamine was associated with less clinically relevant hypotension or bradycardia when compared with propofol or dexmedetomidine, in addition to a smaller absolute decrease in hemodynamic parameters. The clinical significance of these findings requires further investigation.

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Stress ulcer prophylaxis upon discharge from intensive care units in an academic medical center

International Journal of Academic Medicine ◽

10.4103/ijam.ijam_64_17 ◽

2018 ◽

Vol 4 (2) ◽

pp. 105

Author(s):

AnthonyT Gerlach ◽

SheaA Liput ◽

LindsayP Ryder ◽

TrishaA Jordan

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Stress Ulcer ◽

Medical Center ◽

Academic Medical Center ◽

Stress Ulcer Prophylaxis ◽

Academic Medical ◽

Ulcer Prophylaxis

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2424. Shedding of Viable Clostridiodes difficile in Patients Admitted to a Medical Intensive Care Unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2102 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S837-S838

Author(s):

Vincent B Young ◽

Micah Keidan ◽

Rachel D Yelin ◽

Thelma E Dangana ◽

Pamela B Bell ◽

...

Keyword(s):

Intensive Care ◽

Medical Center ◽

Academic Medical Center ◽

Secondary Analysis ◽

Icu Patients ◽

Specific Pcr ◽

Patient Admissions ◽

Academic Medical ◽

Healthcare Associated ◽

Record Review

Abstract Background Hospitalized patients are at risk of colonization with a range of healthcare-associated bacterial pathogens, including C. difficile. In patients admitted to intensive care units (ICUs), in whom C. difficile infection (CDI) is associated with increased morbidity and mortality. To understand the risk for acquisition of C. difficile and development of CDI, we monitored ICU patients daily for shedding of C. difficile by culture. Methods We conducted a secondary analysis of daily rectal/fecal swab samples collected from medical ICU patients of a 720-bed academic medical center in Chicago, IL. Selective culture for C. difficile was performed on swab samples from patients who had 2 or more samples obtained using selective media. Confirmation of putative C. difficile isolates was done by specific PCR assays for the 16S rRNA-encoding gene and the toxin genes tcdA, tcdB, cdtA and cdtB. Clinical testing for CDI was performed using the Xpert® C. difficile PCR assay (Cepheid). Clinical and demographic metadata were collected at bedside and by electronic medical record review. Results Culture was attempted on 2106 swab samples from 451 patients (486 ICU admissions) (Figure 1). A mean of 4.33 samples was obtained from each patient. C. difficile was isolated from 211 (10%) samples from 79 patients (Table 1). The first sample was positive by culture for 48 (9.9%) of patient admissions to the ICU. 31 (6.4%) patients who were initially negative by culture had a subsequent sample from which C. difficile was isolated. Persistence of culture-positivity varied from patient to patient (Figure 2). Of 80 patients who were tested for CDI based on physician suspicion, 12 patients had a positive Cepheid PCR test; 9 had diarrhea and were treated for CDI. Conclusion Surveillance for shedding of C. difficile by daily culture reveals that patients admitted to the ICU can shed the pathogen intermittently without attributable disease. This can be in the form patients who are admitted carrying the organism as well as those who appear to acquire the organism during their stay. It is unclear whether patient or microbiome factors underlie the differences seen in patterns of shedding. Furthermore, intermittent shedding may reflect multiple episodes of exposure to C. difficile spores and asymptomatic shedding without stable colonization. Disclosures All authors: No reported disclosures.

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Impact of Changes in Urine Culture Ordering Practice on Antimicrobial Utilization in Intensive Care Units at an Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.334 ◽

2016 ◽

Vol 37 (4) ◽

pp. 448-454 ◽

Cited By ~ 15

Author(s):

Mohamed Sarg ◽

Greer E. Waldrop ◽

Mona A. Beier ◽

Emily L. Heil ◽

Kerri A. Thom ◽

...

Keyword(s):

Intensive Care ◽

Urine Culture ◽

Medical Center ◽

Academic Medical Center ◽

Intervention Group ◽

Antimicrobial Use ◽

Post Intervention ◽

Icu Patients ◽

Antimicrobial Utilization ◽

Academic Medical

OBJECTIVETo assess antimicrobial utilization before and after a change in urine culture ordering practice in adult intensive care units (ICUs) whereby urine cultures were only performed when pyuria was detected.DESIGNQuasi-experimental studySETTINGA 700-bed academic medical centerPATIENTSPatients admitted to any adult ICUMETHODSAggregate data for all adult ICUs were obtained for population-level antimicrobial use (days of therapy [DOT]), urine cultures performed, and bacteriuria, all measured per 1,000 patient days before the intervention (January–December 2012) and after the intervention (January–December 2013). These data were compared using interrupted time series negative binomial regression. Randomly selected patient charts from the population of adult ICU patients with orders for urine culture in the presence of indwelling or recently removed urinary catheters were reviewed for demographic, clinical, and antimicrobial use characteristics, and pre- and post-intervention data were compared.RESULTSStatistically significant reductions were observed in aggregate monthly rates of urine cultures performed and bacteriuria detected but not in DOT. At the patient level, compared with the pre-intervention group (n=250), in the post-intervention group (n=250), fewer patients started a new antimicrobial therapy based on urine culture results (23% vs 41%, P=.002), but no difference in the mean total DOT was observed.CONCLUSIONA change in urine-culture ordering practice was associated with a decrease in the percentage of patients starting a new antimicrobial therapy based on the index urine-culture order but not in total duration of antimicrobial use in adult ICUs. Other drivers of antimicrobial use in ICU patients need to be evaluated by antimicrobial stewardship teams.Infect. Control Hosp. Epidemiol. 2016;37(4):448–454

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Universal Glove and Gown Use Is Associated With a Significant Reduction in the Central Line-Associated Bloodstream Infection Rate in the Medical Intensive Care Unit at an Academic Medical Center: 5 Years of Evaluation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.280 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Jason E. Bowling ◽

Anthony D. Harris ◽

Daniel Morgan ◽

Ronald Estrella ◽

Stephanie Levine ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Bloodstream Infection ◽

Infection Rate ◽

Medical Intensive Care Unit ◽

Medical Center ◽

Academic Medical Center ◽

Central Line ◽

Academic Medical ◽

Medical Intensive Care

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The impact of formulary restriction on the relative consumption of carbapenems in intensive care units at an academic medical center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.170 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1056-1058

Author(s):

Jacob W. Pierce ◽

Andrew Kirk ◽

Kimberly B. Lee ◽

John D. Markley ◽

Amy Pakyz ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Medical Center ◽

Academic Medical Center ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Surgical Intensive Care ◽

Academic Medical ◽

The Impact ◽

Formulary Restriction

AbstractAntipseudomonal carbapenems are an important target for antimicrobial stewardship programs. We evaluated the impact of formulary restriction and preauthorization on relative carbapenem use for medical and surgical intensive care units at a large, urban academic medical center using interrupted time-series analysis.

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