Prevalence and Clinical Outcomes of Clostridium difficile Infection in the Intensive Care Unit: A Systematic Review and Meta-Analysis

Abstract Background. Intensive care unit (ICU) patients are at higher risk for Clostridium difficile infection (CDI). Methods. We performed a systematic review and meta-analysis of published studies from 1983 to 2015 using the PubMed, EMBASE, and Google Scholar databases to study the prevalence and outcomes of CDI in this patient population. Among the 9146 articles retrieved from the studies, 22 articles, which included a total of 80 835 ICU patients, were included in our final analysis. Results. The prevalence of CDI among ICU patients was 2% (95% confidence interval [CI], 1%–2%), and among diarrheic ICU patients the prevalence was 11% (95% CI, 6%–17%). Among CDI patients, 25% (95% CI, 5%–51%) were diagnosed with pseudomembranous colitis, and the estimated length of ICU stay before CDI acquisition was 10.74 days (95% CI, 5%–51%). The overall hospital mortality among ICU patients with CDI was 32% (95% CI, 26%–39%), compared with 24% (95% CI, 14%–36%) among those without CDI presenting a statistically significant difference in mortality risk (P = .030). It is worth noting that the length of ICU and hospital stay among CDI patients was significantly longer, compared with non-CDI patients (standardized mean of difference [SMD] = 0.49, 95% CI, .39%–.6%, P = .00 and SMD = 1.15, 95% CI, .44%–1.91%, P = .003, respectively). It is noteworthy that the morbidity score at ICU admission (Acute Physiology and Chronic Health Evaluation II [APACHE II]) was not statistically different between the 2 groups (P = .911), implying that the differences in outcomes can be attributed to CDI. Conclusions. The ICU setting is associated with higher prevalence of CDI. In this setting, CDI is associated with increased hospital mortality and prolonged ICU and overall hospital stay. These findings highlight the need for additional prevention and treatment studies in this setting.

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Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis

Anaesthesia and Intensive Care ◽

10.1177/0310057x20962113 ◽

2021 ◽

Vol 49 (1) ◽

pp. 23-34

Author(s):

Katherine P Hooper ◽

Matthew H Anstey ◽

Edward Litton

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Meta Analysis ◽

Diagnostic Testing ◽

Intervention Group ◽

Cochrane Central Register ◽

Safety And Efficacy ◽

Significant Difference

Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). A predetermined protocol and search strategy included OVID MEDLINE, OVID EMBASE and the Cochrane Central Register of Controlled Trials from inception until 20 November 2019. Eligible publications included interventional studies of patients admitted to an ICU. There were no language restrictions. The primary outcomes were in-hospital mortality and test reduction. Key secondary outcomes included ICU mortality, length of stay, costs and adverse events. This systematic review analysed 26 studies (with more than 44,00 patients) reporting an intervention to reduce one or more diagnostic tests. No studies were at low risk of bias. In-hospital mortality, reported in seven studies, was not significantly different in the post-implementation group (829 of 9815 patients, 8.4%) compared with the pre-intervention group (1007 of 9848 patients, 10.2%), (relative risk 0.89, 95% confidence intervals 0.79 to 1.01, P = 0.06, I2 39%). Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%–72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.

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Higher PEEP versus Lower PEEP Strategies for Patients in ICU without Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-306348/v1 ◽

2021 ◽

Author(s):

Hongyu Yi ◽

Xiaoming Li ◽

Zhi Mao ◽

Chao Liu ◽

Xin Hu ◽

...

Keyword(s):

Systematic Review ◽

Hospital Mortality ◽

Hospital Stay ◽

Meta Analysis ◽

Risk Of Bias ◽

High Peep ◽

Icu Patients ◽

Icu Stay ◽

Significant Difference ◽

Duration Of Ventilation

Abstract Background: The application of high PEEP remains to be a controversial issue when it comes to ICU patients underwent ventilation. There are studies supporting the usage of high PEEP in patients with ARDS, while for those without ARDS, the conclusion is of great ambiguity. We performed this systematic review and meta-analysis to compare the effects of high and low level of PEEP on ICU patients without ARDS.Methods: We searched public databases (including PubMed, EMBASE, Cochrane Library and Clinicaltrial.gov) to find eligible randomized controlled trials (RCTs). The primary outcomes included in this meta-analysis were in-hospital mortality, 28-day mortality and the duration of ventilation, ICU stay, and hospital stay. We used the Cochrane risk of bias assessment tool to evaluate risk of bias. Trial Sequential Analysis (TSA) was conducted. Results: We included 2307 patients from 24 trials using high and low PEEP. Although no significant difference was found between high and low PEEP applications in in-hospital mortality (risk ratio[RR] 0.98, 95% confidence interval[CI] [0.81, 1.19], P=0.87), 28-day mortality (RR 0.68, 95% CI [0.33, 1.40], P=0.30) and the duration of ventilation (mean difference[MD] -0.30, 95% CI [-0.64, 0.04], P=0.09), ICU stay (MD -0.38, 95% CI [-1.03, 0.27], P=0.25), and hospital stay (MD -0.56, 95% CI [-1.44, 0.32], P=0.22), high PEEP indeed increased the level of PaO2/FIO2 (MD 32.39, 95% CI [13.06, 51.72], P=0.001), and therefore decreased the incidences of ARDS (RR 0.57, 95% CI [0.37, 0.89], P=0.01) and hypoxaemia (RR 0.60, 95% CI [0.41, 0.88], P=0.009). In addition, although total results did not reveal the advantage of high PEEP on other secondary outcomes regarding atelectasis, barotrauma, ventilator associated pneumonia (VAP), hypotension, mean arterial pressure (MAP), SaO2 and lactate, subgroup analysis seemed to obtain different results. The TSA results suggested more RCTs were needed. Conclusion: Ventilation with high PEEP in ICU patients without ARDS may improve the level of oxygenation (PaO2/FIO2) resulting in low incidences of ARDS and hypoxaemia. Nevertheless, other clinical outcomes including in-hospital and 28-day mortality, duration of ventilation, ICU stay and hospital stay, pulmonary complications, hemodynamics and post-operative fluid balance did not show any significant difference.

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Antimicrobial therapy ofClostridium difficileinfection. Systematic literature review and meta-analysis

Orvosi Hetilap ◽

10.1556/oh.2013.29627 ◽

2013 ◽

Vol 154 (23) ◽

pp. 890-899 ◽

Cited By ~ 1

Author(s):

Valentin Brodszky ◽

László Gulácsi ◽

Endre Ludwig ◽

Gyula Prinz ◽

János Banai ◽

...

Keyword(s):

Systematic Review ◽

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Clinical Cure ◽

Meta Analysis ◽

Scientific Evidence ◽

Pharmaceutical Products ◽

Efficacy And Safety ◽

The Past ◽

Significant Difference

Introduction:Clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. Limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of Clostridium difficile infection. The available scientific evidence is limited and hardly comparable. Aim: To analyse the clinical efficacy and safety of metronidazole, vancomycin and fidaxomicin in the therapy of Clostridium difficile infection. Methods: Systematic review and meta-analysis of the literature data. Results: Meta-analysis of literature data showed no significant difference between these antibiotics in clinical cure endpoint (odss ratios: fidaxomicin vs. vancomycin 1.19; vancomycin vs. metronidazol 1.69 and fidaxomicin vs. metronidazol 2.00). However, fidaxomicin therapy was significantly more effective than vancomicin and metronidazol in endpoints of recurrence and global cure (odds ratios: fidaxomicin vs. vancomycin 0.47; vancomycin vs. metronidazol 0.91 és fidaxomicin vs. metronidazol 0.43). There was no significant difference between fidaxomicin, vancomycin and metronidazole in safety endpoints. Conclusions: Each antibiotic similarly improved clinical cure. Fidaxomicin was the most effective therapeutic alternative in lowering the rate of recurrent Clostridium difficile infections. Orv. Hetil., 2013, 154, 890–899.

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Clinical and Economic Outcomes of Telemedicine Programs in the Intensive Care Unit: A Systematic Review and Meta-Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066617726942 ◽

2017 ◽

Vol 33 (7) ◽

pp. 383-393 ◽

Cited By ~ 33

Author(s):

Jing Chen ◽

Dalong Sun ◽

Weiming Yang ◽

Mingli Liu ◽

Shufan Zhang ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Meta Analysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Icu Length Of Stay ◽

The Impact

Objective: To evaluate the impact of telemedicine programs in intensive care unit (Tele-ICU) on ICU or hospital mortality or ICU or hospital length of stay and to summarize available data on implementation cost of Tele-ICU. Methods: Controlled trails or observational studies assessing outcomes of interest were identified by searching 7 electronic databases from inception to July 2016 and related journals and conference literatures between 2000 and 2016. Two reviewers independently screened searched records, extracted data, and assessed the quality of included studies. Random-effect models were applied to meta-analyses and sensitivity analysis. Results: Nineteen of 1035 records fulfilled the inclusion criteria. The pooled effects demonstrated that Tele-ICU programs were associated with reductions in ICU mortality (15 studies; risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.96; P = .01), hospital mortality (13 studies; RR, 0.74; 95% CIs, 0.58 to 0.96; P = .02), and ICU length of stay (9 studies; mean difference [MD], −0.63; 95% CI, −0.28 to 0.17; P = .007). However, there is no significant association between the reduction in hospital length of stay and Tele-ICU programs. Summary data concerning costs suggested approximately US$50 000 to US$100 000 per Tele-ICU bed was required to implement Tele-ICU programs for the first year. Hospital costs of US$2600 reduction to US$5600 increase per patient were estimated using Tele-ICU programs. Conclusions: This systematic review and meta-analysis provided limited evidence that Tele-ICU approaches may reduce the ICU and hospital mortality, shorten the ICU length of stay, but have no significant effect in hospital length of stay. Implementation of Tele-ICU programs substantially costs and its long-term cost-effectiveness is still unclear.

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