Risk factors for 30-day mortality in patients with carbapenem-resistantAcinetobacter baumanniiduring an outbreak in an intensive care unit

2010 ◽  
Vol 139 (3) ◽  
pp. 411-418 ◽  
Author(s):  
C. G. PRATES ◽  
A. F. MARTINS ◽  
S. V. SUPERTI ◽  
F. S. LOPES ◽  
F. RAMOS ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Protective Factor ◽  
Cox Regression ◽  
Mortality Rates ◽  
Demographic Characteristics ◽  
Apache Ii Score ◽  
Carbapenem Resistant ◽  
Appropriate Therapy

SUMMARYThis study assessed risk factors for 30-day mortality in 66 patients with carbapenem-resistantAcinetobacter baumannii(CRAB) infection or colonization during an outbreak in an intensive-care unit. Clinical and demographic characteristics were evaluated. The overall 30-day mortality was 47·0%. In the multivariate Cox regression model, septic shock [adjusted hazard ratio (aHR) 5·01, 95% confidence interval (CI) 2·32–10·01] and APACHE II score at onset of infection (aHR 1·11, 95% CI 1·04–1·18) were significantly associated with 30-day mortality. Administration of appropriate therapy was a protective factor, but it was not statistically significant (aHR 0·48, 95% CI 0·21–1·12). A sample of isolates tested (n=27) carried theblaOXA-23gene. Severity of baseline condition and severity of infection presentation were major risk factors for mortality during the outbreak. Patients who received appropriate therapy tended to have lower mortality rates, although therapy was started late and dosage was suboptimal in most cases.

scholarly journals Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

2018 ◽  
Vol 27 (150) ◽  
pp. 180061 ◽  
Author(s):  
Julio A. Huapaya ◽  
Erin M. Wilfong ◽  
Christopher T. Harden ◽  
Roy G. Brower ◽  
Sonye K. Danoff
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Interstitial Lung Disease ◽  
Mortality Rate ◽  
Lung Disease ◽  
Mortality Rates ◽  
Population Heterogeneity

Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.

scholarly journals Surveillance of healthcare-associated infections in a Tunisian university hospital

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
H Hannachi ◽  
A Ben Cheikh ◽  
S Bhiri ◽  
H Ghali ◽  
S Khefacha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
University Hospital ◽  
Healthcare Associated Infections ◽  
Drug Resistant ◽  
Healthcare Associated Infection ◽  
Carbapenem Resistant ◽  
Independent Risk Factors ◽  
Healthcare Associated

Abstract Introduction Healthcare -associated infections has become a worldwide public health problem. The aim of this study was to estimate the incidence of healthcare- associated infections in a university hospital of Tunisia. Methods This was a cohort study conducted in six intensive care units in a university hospital of Tunisia during three months (from august to October 2018). Data was provided from patients’ files. Data entry and analysis was done using SPSS version 22. Multivariate analysis was used in order to identify independent risk factors for healthcare associated infection. Results A total of 202 patients were enrolled in this study. The incidence rate of healthcare-associated infections was 53,96%(109/202). The ratio infection/infected was estimated to 1.65(109/66). The incidence of multi-drug resistant pathogens was 21,28% (43/202). The most common resistant pathogens included pseudomonas aeruginosa resistant to cefdazidime in 13,76%(15/109) followed by those resistant to extended spectrum cephalosporin 11.92% (13/109), followed by carbapenem-resistant acinetobcater baumanii 6,42%(7/109) then by carbapenem resistant pathogens and enterococcus resistant to vancomycin 2.75%(3/109) and finally staphylococcus aureus resistant to methicillin 2.1%(2/1.83). The multivariate analysis showed that long duration of central line catheterisation (RR = 7.44; 95%CI[2.79-19.82]), tracheotomy(RR = 8.61;95%CI[2.09-35,39]) and length of stay (RR = 1.08; 95%CI[1.04-1.13]) were found as independent risk factors for healthcare -associated infection. Conclusions The emergence of mutli-drug resistant pathogens needs to be deeply studied and effective measures have to be taken in order to detect and prevent transmission of resistant strains and/or their resistance determinants, especially those with phenotypes having the fewest viable treatment options. Key messages The incidence of healthcare associated infection in the intensive care unit was high. Effective measures have to be taken in the intensive care unit to detect and prevent transmission of resistant pathogens.

scholarly journals Incidence, Risk Factors, and Outcome of Acute Kidney Injury in the Intensive Care Unit: A Single-Center Study from Jordan

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ashraf O. Oweis ◽  
Sameeha A. Alshelleh ◽  
Suleiman M. Momany ◽  
Shaher M. Samrah ◽  
Basheer Y. Khassawneh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Tertiary Hospital ◽  
Acute Kidney Injury Network ◽  
Apache Ii Score ◽  
Mortality And Morbidity ◽  
Incidence Risk

Background. Acute kidney injury (AKI) is a common serious problem affecting critically ill patients in intensive care unit (ICU). It increases their morbidity, mortality, length of ICU stay, and long-term risk of chronic kidney disease (CKD). Methods. A retrospective study was carried out in a tertiary hospital in Jordan. Medical records of patients admitted to the medical ICU between 2013 and 2015 were reviewed. We aimed to identify the incidence, risk factors, and outcomes of AKI. Acute kidney injury network (AKIN) classification was used to define and stage AKI. Results. 2530 patients were admitted to medical ICU, and the incidence of AKI was 31.6%, mainly in stage 1 (59.4%). In multivariate analysis, increasing age (odds ratio (OR) = 1.2 (95% CI 1.1–1.3), P = 0.0001) and higher APACHE II score (OR = 1.5 (95% CI 1.2–1.7), P = 0.001) were predictors of AKI, with 20.4% of patients started on hemodialysis. At the time of discharge, 58% of patients with AKI died compared to 51.3% of patients without AKI (P = 0.05). 88% of patients with AKIN 3 died by the time of discharge compared to patients with AKIN 2 and 1 (75.3% and 61.2% respectively, P = 0.001). Conclusion. AKI is common in ICU patients, and it increases mortality and morbidity. Close attention for earlier detection and addressing risk factors for AKI is needed to decrease incidence, complications, and mortality.

Carbapenem-Resistant Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit: Risk Factors for Mortality

2020 ◽  
Author(s):  
Meltem Bor ◽  
Ozkan Ilhan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Congenital Anomalies ◽  
Neonatal Intensive Care ◽  
Carbapenem Resistant ◽  
Group 2 ◽  
Antifungal Use ◽  
Group 1

Abstract Aim The aim of our study was to determine the factors associated with mortality in neonates with carbapenem-resistant Klebsiella pneumoniae (CRKP). Material and methods This retrospective, single-center study was conducted in the Neonatal Intensive Care Unit of Harran University Faculty of Medicine between January 2017 and July 2018 who had CRKP growth in their blood, urine or cerebrospinal fluid cultures. The discharged group was designated as the control group (Group 1), whereas the group that faced mortality was classified as the case group (Group 2). The demographic data, clinical findings and laboratory and microbiological results of the two groups were compared to identify risk factors. Results A total of 58 patients (36 in Group 1 and 22 in Group 2) exhibited CRKP growth during the study period. Low birth weight (p = 0.039), previous antifungal (p = 0.002) or amikacin use (p = 0.040), congenital anomalies (p = 0.002), total parenteral nutrition (TPN) administration (p = 0.002), surgery (p = 0.035), thrombocytopenia (p = 0.007), low platelet mass index (p = 0.011), elevated C-reactive protein (p = 0.004), high carbapenem minimum inhibitory concentration (MIC) (p = 0.029) and high amikacin MIC (p = 0.019) were associated with mortality. In a multivariate regression analysis, previous antifungal use (p = 0.028), congenital anomalies (p = 0.032) and TPN use (p = 0.013) were independent factors in predicting mortality. Conclusion Previous antifungal use, congenital anomalies and TPN use were found to be independent risk factors for mortality in neonates with CRKP infection.

Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients

2013 ◽  
Vol 39 (7) ◽  
pp. 1253-1261 ◽  
Author(s):  
Christina Routsi ◽  
Maria Pratikaki ◽  
Evangelia Platsouka ◽  
Christina Sotiropoulou ◽  
Vasileios Papas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Gram Negative Bacteremia

scholarly journals Risk factors for Clostridioides difficile infection and colonization among patients admitted to an intensive care unit in Shanghai, China

2019 ◽  
Author(s):  
Yingchao Cui ◽  
Danfeng Dong ◽  
Lihua Zhang ◽  
Daosheng Wang ◽  
Cen Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Large Scale ◽  
Protective Factor ◽  
Epidemic Clone ◽  
Clostridioides Difficile ◽  
And Control ◽  
Epidemiological Characteristics

Abstract Background: Clostridioides difficile is considered the main pathogen responsible for hospital-acquired infections. This prospective study determined the prevalence, molecular epidemiological characteristics, and risk factors for C. difficile infection (CDI) and C. difficile colonization (CDC) among patients in the intensive care unit (ICU) of a large-scale tertiary hospital in China, with the aim of providing strategies for efficient CDI and CDC prevention and control. Methods: Stool samples were collected and anaerobically cultured for C. difficile detection. The identified isolates were examined for toxin genes and subjected to multilocus sequence typing. Patients were classified into CDI, CDC, and control groups, and their medical records were analyzed to determine the risk factors for CDI and CDC. Results: Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) were identified to have CDI and CDC, respectively. Associations with CDI were found for fever (OR=13.993), metabolic disorder (OR=7.972), and treatment with fluoroquinolone (OR=42.696) or combined antibiotics (OR=2.856). CDC patients were characterized by prolonged hospital stay (OR=1.137), increased number of comorbidities (OR=36.509), respiratory diseases (OR=0.043), and treatment with vancomycin (OR=18.168). Notably, treatment with metronidazole was found to be a protective factor in both groups (CDI: OR=0.042; CDC: OR=0.013). Eighteen sequence types (STs) were identified. In the CDI group, the isolated strains were predominantly toxin A and toxin B positive (A+B+) and the epidemic clone was genotype ST2. In the CDC group, the dominant strains were A+B+ and the epidemic clone was ST81. Conclusions: The prevalences of CDC and CDI in our ICU were relatively high, suggesting the importance of routine screening for acquisition of C. difficile . Future prevention and treatment strategies for CDC and CDI should consider hospital stay, enteral nutrition, underlying comorbidities, and use of combined antibiotics. Moreover, metronidazole may be a protective factor for both CDI and CDC, and could be used empirically.

scholarly journals Influence of Tigecycline on Liver Function in Adult Patients in the Intensive Care Unit

2021 ◽  
Author(s):  
Jingnan Song ◽  
Pan Chen ◽  
Zhaoxia Tang ◽  
Yifan Zheng ◽  
Xiao Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Regression Analysis ◽  
Intensive Care ◽  
Liver Disease ◽  
Liver Injury ◽  
Liver Function ◽  
Adult Patients ◽  
Apache Ii Score ◽  
Cox Regression Analysis

Abstract Background There are few studies investigating TGC-associated hepatotoxicity in ICU patients, and the pathogenesis of hepatotoxicity and identification of risk factors are limited. Objectives To analyze the influence of tigecycline (TGC) on liver function in adult patients in the Intensive Care Unit to identify potential risk factors for tigecycline-induced liver injury (TILI). Methods Patients receiving tigecycline treatment in ICU during January 2019 to October 2020 were retrospectively enrolled. The liver function parameters before and after tigecycline treatment were collected, and risk factors associated with TILI was identified by logistic regression analysis. The probability of 28-day mortality was determined in Cox regression analysis. Results A total of 242 patients were enrolled, and TILI was identified in 24 patients (9.92%), of whom 75.0% had grade 1 liver injury, and 16.67%, 4.17%, 4.17% had grade 2 to 4 liver injury, respectively. The pattern of hepatotoxicity was hepatocellular in 16 patients (66.67%), cholestatic in 4 patients (16.67%), and mixed in 4 patients (16.67%). The median time from tigecycline start to symptoms was only 5 days (IQR, 3-7 days). Multivariate analysis identified tigecycline dose ≥ 200mg/day, longer course of treatment and preexisting liver disease tend to be independently associated with TILI. In addition, APACHE II score > 15, higher dose of tigecycline and TILI were independent risk factors of 28-day mortality, while longer course of tigecycline reduced this risk despite its association with TILI. Conclusions The maintenance dose and course of tigecycline, as well as liver disease is considered as risk factors of hepatotoxicity. 28-day mortality tended to be higher in TILI patients. The relationships among tigecycline dose and course, TILI and mortality should be further investigated.

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