scholarly journals A Systematic Literature Review and Meta-Analysis of Factors Associated with Methicillin-ResistantStaphylococcus aureusColonization at Time of Hospital or Intensive Care Unit Admission

2013 ◽  
Vol 34 (10) ◽  
pp. 1077-1086 ◽  
Author(s):  
James A. McKinnell ◽  
Loren G. Miller ◽  
Samantha J. Eells ◽  
Eric Cui ◽  
Susan S. Huang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Hospital Admission ◽  
Systematic Evaluation ◽  
Factors Associated ◽  
Icu Admission ◽  
Increased Risk ◽  
Healthcare Associated ◽  
Mrsa Colonization

Objective.Screening for methicillin-resistantStaphylococcus aureus(MRSA) in high-risk patients is a legislative mandate in 9 US states and has been adopted by many hospitals. Definitions of high risk differ among hospitals and state laws. A systematic evaluation of factors associated with colonization is lacking. We performed a systematic review of the literature to assess factors associated with MRSA colonization at hospital admission.Design.We searched MEDLINE from 1966 to 2012 for articles comparing MRSA colonized and noncolonized patients on hospital or intensive care unit (ICU) admission. Data were extracted using a standardized instrument. Meta-analyses were performed to identify factors associated with MRSA colonization.Results.We reviewed 4,381 abstracts; 29 articles met inclusion criteria (n= 76,913 patients). MRSA colonization at hospital admission was associated with recent prior hospitalization (odds ratio [OR], 2.4 [95% confidence interval (CI), 1.3–4.7];P<.01), nursing home exposure (OR, 3.8 [95% CI, 2.3–6.3];P< .01), and history of exposure to healthcare-associated pathogens (MRSA carriage: OR, 8.0 [95% CI, 4.2–15.1];Clostridium difficileinfection: OR, 3.4 [95% CI, 2.2–5.3]; vancomycin-resistantEnterococcicarriage: OR, 3.1 [95% CI, 2.5–4.0];P< .01 for all). Select comorbidities were associated with MRSA colonization (congestive heart failure, diabetes, pulmonary disease, immunosuppression, and renal failure;P< .01 for all), while others were not (human immunodeficiency virus, cirrhosis, and malignancy). ICU admission was not associated with an increased risk of MRSA colonization (OR, 1.1 [95% CI, 0.6–1.8];P= .87).Conclusions.MRSA colonization on hospital admission was associated with healthcare contact, previous healthcare-associated pathogens, and select comorbid conditions. ICU admission was not associated with MRSA colonization, although this is commonly used in state mandates for MRSA screening. Infection prevention programs utilizing targeted MRSA screening may consider our results to define patients likely to have MRSA colonization.

scholarly journals Quantifying the Impact of Extranasal Testing of Body Sites for Methicillin-ResistantStaphylococcus aureusColonization at the Time of Hospital or Intensive Care Unit Admission

2013 ◽  
Vol 34 (2) ◽  
pp. 161-170 ◽  
Author(s):  
James A. McKinnell ◽  
Susan S. Huang ◽  
Samantha J. Eells ◽  
Eric Cui ◽  
Loren G. Miller
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Prevention ◽  
Weighted Average ◽  
Icu Admission ◽  
High Prevalence ◽  
Healthcare Associated ◽  
Low Prevalence ◽  
The Impact ◽  
Mrsa Colonization

Objective.Methicillin-resistantStaphylococcus aureus(MRSA) is a common cause of healthcare-associated infections. Recent legislative mandates require nares screening for MRSA at hospital and intensive care unit (ICU) admission in many states. However, MRSA colonization at extranasal sites is increasingly recognized. We conducted a systematic review of the literature to identify the yield of extranasal testing for MRSA.Design.We searched MEDLINE from January 1966 through January 2012 for articles comparing nasal and extranasal screening for MRSA colonization. Studies were categorized by population tested, specifically those admitted to ICUs and those admitted to hospitals with a high prevalence (6% or greater) or low prevalence (less than 6%) of MRSA carriers. Data were extracted using a standardized instrument.Results.We reviewed 4,381 abstracts and 735 articles. Twenty-three articles met the criteria for analysis (n= 39,479 patients). Extranasal MRSA screening increased the yield by approximately one-third over nares alone. The yield was similar at ICU admission (weighted average, 33%; range, 9%–69%) and hospital admission in high-prevalence (weighted average, 37%; range, 9%–86%) and low-prevalence (weighted average, 50%; range, 0%–150%) populations. For comparisons between individual extranasal sites, testing the oropharynx increased MRSA detection by 21% over nares alone; rectum, by 20%; wounds, by 17%; and axilla, by 7%.Conclusions.Extranasal MRSA screening at hospital or ICU admission in adults will increase MRSA detection by one-third compared with nares screening alone. Findings were consistent among subpopulations examined. Extranasal testing may be a valuable strategy for outbreak control or in settings of persistent disease, particularly when combined with decolonization or enhanced infection prevention protocols.

scholarly journals Low 25-Hydroxyvitamin D Levels on Admission to the Intensive Care Unit May Predispose COVID-19 Pneumonia Patients to a Higher 28-Day Mortality Risk: A Pilot Study on a Greek ICU Cohort

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3773
Author(s):  
Alice G. Vassiliou ◽  
Edison Jahaj ◽  
Maria Pratikaki ◽  
Stylianos E. Orfanos ◽  
Ioanna Dimopoulou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Vitamin D ◽  
Intensive Care ◽  
Critically Ill ◽  
Mortality Risk ◽  
Rank Test ◽  
Icu Admission ◽  
Hydroxyvitamin D ◽  
Increased Risk ◽  
25 Hydroxyvitamin D

We aimed to examine whether low intensive care unit (ICU) admission 25-hydroxyvitamin D (25(OH)D) levels are associated with worse outcomes of COVID-19 pneumonia. This was a prospective observational study of SARS-CoV2 positive critically ill patients treated in a multidisciplinary ICU. Thirty (30) Greek patients were included, in whom 25(OH)D was measured on ICU admission. Eighty (80%) percent of patients had vitamin D deficiency, and the remaining insufficiency. Based on 25(OH)D levels, patients were stratified in two groups: higher and lower than the median value of the cohort (15.2 ng/mL). The two groups did not differ in their demographic or clinical characteristics. All patients who died within 28 days belonged to the low vitamin D group. Survival analysis showed that the low vitamin D group had a higher 28-day survival absence probability (log-rank test, p = 0.01). Critically ill COVID-19 patients who died in the ICU within 28 days appeared to have lower ICU admission 25(OH)D levels compared to survivors. When the cohort was divided at the median 25(OH)D value, the low vitamin D group had an increased risk of 28-day mortality. It seems plausible, therefore, that low 25(OH)D levels may predispose COVID-19 patients to an increased 28-day mortality risk.

Factors Associated with Risk and Prognosis of Intensive Care Unit Admission in Patients with Acute Myeloid Leukemia: A Danish Nationwide Cohort Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4783-4783
Author(s):  
Cecilie Velsoe Maeng ◽  
Christian Fynbo Christiansen ◽  
Kathleen Dori Liu ◽  
Lene Sofie Granfeldt Oestgaard
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Myeloid Leukemia ◽  
Risk Group ◽  
Remission Induction ◽  
First Year ◽  
Icu Patients ◽  
Icu Admission ◽  
Increased Risk ◽  
Acute Myeloid

Significance Patients with acute myeloid leukemia (AML) are at high risk of critical illness requiring admission to the intensive care unit (ICU) due to both disease- and treatment-related complications. A better understanding of risk factors for ICU admission and prognosis may help with prevention of life-threatening complications and informed decision-making when treating AML patients. Methods This study included all adult Danish AML patients, who received remission-induction chemotherapy alone or in combination with allogeneic stem cell transplantation from 2005 to 2016. The cohort was identified using the Danish Acute Leukemia Registry (DNLR) and information on ICU admission was obtained from the Danish Intensive Care Database. We examined risk of ICU admission within 1 and 3 years of diagnosis considering competing risk of death and investigated a number of possible risk factors for ICU admission. We computed 1-, 3-, and 5-year mortality from time of ICU admission and in the matched non-ICU comparison group using a risk set matching (1:1) on time since diagnosis, sex, and age. Finally, we used the pseudo-value approach to compute the relative risk (RR) of death in the ICU admitted cohort compared to the matched cohort. We adjusted for ECOG/WHO performance status (PS), year of diagnosis, cytogenetic risk group, number of comorbidities, and secondary/therapy-related AML. Results A total of 1383 AML patients were included in the study. The median follow-up time was 1.65 (IQR: 0.60-4.36) years. The risk of ICU admission within 1 year of AML diagnosis was 22.7%, and the risk within 3 years was 28.1%. Median time to ICU was 59 (IQR: 15-272) days. Male sex was associated with increased risk of ICU admission after 1 year (adjusted RR: 1.26, 95% CI: 1.01-1.57) and PS >1 was associated with an increased risk after both 1 year (adjusted RR: 1.74, 95% CI: 1.33-1.30) and 3 years (adjusted RR: 1.54, 95% CI: 1.22-1.96). Other factors listed in Table 1 (age, comorbidity, cytogenetic risk group, secondary or therapy-related AML, and year of diagnosis) were not associated with increased risk of ICU admission. In AML patients admitted to the ICU, the 1-year mortality from time of ICU admission was 69.2%, compared to a 1-year mortality rate of 31.0% in the matched non-ICU patients (adjusted RR: 3.25, 95% CI: 2.56-4.12). Long-term mortality was increased in ICU patients; 3-year mortality was 82.1% compared to 49.7% (adjusted RR: 2.43, 95% CI: 1.97-3.01), and the 5-year mortality was 83.1% compared to 60.6%, (adjusted RR: 2.12, 95% CI: 1.70-2.66). Conclusion In this national population-based cohort study, more than one fourth of AML patients treated with remission-induction chemotherapy were admitted to an ICU within 3 years of diagnosis with the majority of ICU admissions occurring within the first year. ICU admission was associated with high mortality, especially within the first year after admission. The risk of mortality decreased over time but remained increased 3 and 5 years after admission compared to the matched cohort. Early monitoring and management of high-risk patients may be effective in preventing ICU admissions and PS may serve as a possible tool to identify patients at high risk of ICU admission. Disclosures No relevant conflicts of interest to declare.

Risk Factors Associated With Resistance to Ciprofloxacin in Clinical Bacterial Isolates From Intensive Care Unit Patients

2007 ◽  
Vol 28 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Phillip D. Levin ◽  
Robert A. Fowler ◽  
Cameron Guest ◽  
William J. Sibbald ◽  
Alex Kiss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prior Treatment ◽  
Bacterial Isolates ◽  
Icu Patients ◽  
Gram Negative ◽  
Factors Associated ◽  
Icu Admission ◽  
Ciprofloxacin Resistance

Objective.To determine risk factors and outcomes associated with ciprofloxacin resistance in clinical bacterial isolates from intensive care unit (ICU) patients.Design.Prospective cohort study.Setting.Twenty-bed medical-surgical ICU in a Canadian tertiary care teaching hospital.Patients.All patients admitted to the ICU with a stay of at least 72 hours between January 1 and December 31, 2003.Methods.Prospective surveillance to determine patient comorbidities, use of medical devices, nosocomial infections, use of antimicrobials, and outcomes. Characteristics of patients with a ciprofloxacin-resistant gram-negative bacterial organism were compared with characteristics of patients without these pathogens.Results.Ciprofloxacin-resistant organisms were recovered from 20 (6%) of 338 ICU patients, representing 38 (21%) of 178 nonduplicate isolates of gram-negative bacilli. Forty-nine percent ofPseudomonas aeruginosaisolates and 29% ofEscherichia coliisolates were resistant to ciprofloxacin. In a multivariate analysis, independent risk factors associated with the recovery of a ciprofloxacin-resistant organism included duration of prior treatment with ciprofloxacin (relative risk [RR], 1.15 per day [95% confidence interval {CI}, 1.08-1.23];P< .001), duration of prior treatment with levofloxacin (RR, 1.39 per day [95% CI, 1.01-1.91];P= .04), and length of hospital stay prior to ICU admission (RR, 1.02 per day [95% CI, 1.01-1.03];P= .005). Neither ICU mortality (15% of patients with a ciprofloxacin-resistant isolate vs 23% of patients with a ciprofloxacin-susceptible isolate;P= .58 ) nor in-hospital mortality (30% vs 34%;P= .81 ) were statistically significantly associated with ciprofloxacin resistance.Conclusions.ICU patients are at risk of developing infections due to ciprofloxacin-resistant organisms. Variables associated with ciprofloxacin resistance include prior use of fluoroquinolones and duration of hospitalization prior to ICU admission. Recognition of these risk factors may influence antibiotic treatment decisions.

Factors Associated With Rapid Response Call Conversion To Code Blue Or Intensive Care Unit (ICU) Admission

2012 ◽  
Author(s):  
Jennifer Maguire ◽  
Shannon S. Carson ◽  
Loc Culp ◽  
Celeste Mayer ◽  
Renae E. Stafford ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Rapid Response ◽  
Factors Associated ◽  
Icu Admission ◽  
Code Blue

Multicenter, Prospective Surveillance Study of Staphylococcus aureus Nasal Colonization in 28 Italian Intensive Care Units: The ISABEL Study

2011 ◽  
Vol 32 (2) ◽  
pp. 193-197 ◽  
Author(s):  
Pierluigi Viale ◽  
Giovanni Gesu ◽  
Gaetano Privitera ◽  
Biagio Allaria ◽  
Nicola Petrosillo ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Invasive Disease ◽  
Invasive Infection ◽  
Icu Admission ◽  
Increased Risk ◽  
Mrsa Colonization ◽  
The Relationship ◽  
Colonization Status

The role of methicillin-resistant Staphylococcus aureus (MRSA) colonization as a predictor of invasive disease in intensive care unit (ICU) patients was established many years ago. The role of mefhicillin-susceptible Staphylococcus aureus (MSSA) colonization is more debated, although in a recent report patients who were carriers of MRSA or MSSA at ICU admission were found to be at increased risk. Whether carriage at ICU admission involves a higher risk of invasive infection than carriage acquired during an ICU stay has not been established. We report the results of a study aimed at estimating the frequency of S. aureus (MRSA and MSSA) colonization at admission and at discharge in patients admitted to several ICUs in Italy and at estimating the relationship between colonization status and infection by S. aureus.

scholarly journals Vitamin D Status and SARS-CoV-2 Infection and COVID-19 Clinical Outcomes

2021 ◽  
Vol 9 ◽  
Author(s):  
Iacopo Chiodini ◽  
Davide Gatti ◽  
Davide Soranna ◽  
Daniela Merlotti ◽  
Christian Mingiano ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Vitamin D ◽  
Intensive Care ◽  
Meta Analysis ◽  
Vitamin D Status ◽  
Icu Admission ◽  
Primary Endpoints ◽  
Severe Deficiency ◽  
Increased Risk ◽  
Vitamin D Levels

Background: Several studies suggest an association between serum 25-hydroxyvitamin D (25OHD) and the outcomes of Severe Acute Respiratory Syndrome Corona-Virus-2 (SARS-CoV-2) infection, in particular Coronavirus Disease-2019 (COVID-19) related severity and mortality. The aim of the present meta-analysis was to investigate whether vitamin D status is associated with the COVID-19 severity, defined as ARDS requiring admission to intensive care unit (ICU) or mortality (primary endpoints) and with the susceptibility to SARS-CoV-2 and COVID-19-related hospitalization (secondary endpoints).Methods: A search in PubMed, ScienceDirect, Web of Science, Google Scholar, Scopus, and preprints repositories was performed until March 31th 2021 to identify all original observational studies reporting association measures, or enough data to calculate them, between Vitamin D status (insufficiency &lt;75, deficiency &lt;50, or severe deficiency &lt;25 nmol/L) and risk of SARS-CoV-2 infection, COVID-19 hospitalization, ICU admission, or death during COVID-19 hospitalization.Findings: Fifty-four studies (49 as fully-printed and 5 as pre-print publications) were included for a total of 1,403,715 individuals. The association between vitamin D status and SARS-CoV2 infection, COVID-19 related hospitalization, COVID-19 related ICU admission, and COVID-19 related mortality was reported in 17, 9, 27, and 35 studies, respectively. Severe deficiency, deficiency and insufficiency of vitamin D were all associated with ICU admission (odds ratio [OR], 95% confidence intervals [95%CIs]: 2.63, 1.45–4.77; 2.16, 1.43–3.26; 2.83, 1.74–4.61, respectively), mortality (OR, 95%CIs: 2.60, 1.93–3.49; 1.84, 1.26–2.69; 4.15, 1.76–9.77, respectively), SARS-CoV-2 infection (OR, 95%CIs: 1.68, 1.32–2.13; 1.83, 1.43–2.33; 1.49, 1.16–1.91, respectively) and COVID-19 hospitalization (OR, 95%CIs 2.51, 1.63–3.85; 2.38, 1.56–3.63; 1.82, 1.43–2.33). Considering specific subgroups (i.e., Caucasian patients, high quality studies, and studies reporting adjusted association estimates) the results of primary endpoints did not change.Interpretations: Patients with low vitamin D levels present an increased risk of ARDS requiring admission to intensive care unit (ICU) or mortality due to SARS-CoV-2 infection and a higher susceptibility to SARS-CoV-2 infection and related hospitalization.

Early Admission to the Intensive Care Unit In High Risk Acute Myeloid Leukemia Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4364-4364
Author(s):  
Etienne Lengliné ◽  
Emmanuel Raffoux ◽  
Vincent Peigne ◽  
Virginie Lemiale ◽  
Mickael Darmon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Respiratory Rate ◽  
Conflicts Of Interest ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Newly Diagnosed ◽  
Icu Admission ◽  
Early Admission

Abstract Abstract 4364 INTRODUCTION: Acute Myeloblastic Leukemia (AML) is considered as an oncology emergency as a proportion of patients experience life threatening complications within the first hours or days after diagnosis. Early death had been demonstrated to be statistically related to high white blood cell (WBC) and monoblastic leukemia, with leukostasis and lysis syndrome as the most deadful events. OBJECTIVES: To evaluate the relationship between timing of admission to the Intensive Care Unit (ICU) and outcomes in high risk AML patients at the earliest phase of the malignancy (before any chemotherapy) METHODS: Retrospective study in a tertiary care center teaching hospital between 1998 and 2008. Adult patients with newly diagnosed AML were included. Patients admitted for an immediate life sustaining therapy (ventilation, vasopressors or renal replacement therapy) were excluded. 42 patients admitted directly to the ICU (Early admission) were matched for age, WBC and FAB subtype with 42 patients primarily admitted in hematology ward. Medical charts were reviewed and datasets extracted. RESULTS: Overall 84 patients were included in the study (42 patients early admitted to the ICU and 42 patients admitted first to the wards). Median follow up was 10,3 months. Median age was 46,5 years (36-57). FAB M4 or M5 was retrieved in 58% of the patients. According to MRC, karyotype was favorable for 30% and poor for 19%. Median WBC was 103×109.L-1. No statistical difference was seen for demographic and hematological parameters between early admitted patients and matched controls. Among the 42 patients admitted first to the wards (controls), 20 were subsequently admitted to the ICU (Lately admitted) and 22 remained in ward during the entire treatment course (Never admitted). The median time between diagnostic and ICU admission of this last group was 4 (1-9) days. Strikingly, patients lately admitted had more frequently dyspnea, oxygen requirement, high respiratory rate, low diastolic arterial pressure and lower first 24h urine output (p<0,05 for each). Lately admitted patients were less likely to receive the complete dose of induction chemotherapy than early admitted patients (68% vs. 88%,p<0,05) Furthermore, Late admission resulted in increased use of invasive mechanical ventilation (60 vs. 33%) and vaso-active drugs (60 vs. 16%,p<0,05) These differences resulted in longer stay in ICU and decreased survival. CONCLUSIONS: Patients at the earliest phase of High risk AML who are lately admitted to the ICU experience worse outcomes, with increased use of life-sustaining therapies and higher mortality, compared to patients early admitted to the ICU. Physiologic parameters at the time of AML diagnosis such as respiratory rate, diastolic blood pressure, SpO2, or oxygen need are likely to help clinicians distinguish those patients at risk of late ICU admission and subsequent adverse outcomes. Studies are needed to assess the right place for newly diagnosed AML with physiological abnormalities but no organ dysfunction. Disclosures: No relevant conflicts of interest to declare.

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