657: CLINICAL UTILITY OF MRSA NASAL PCR ASSAYS IN CRITICALLY ILL PATIENTS WITH NOSOCOMIAL PNEUMONIAS

Background: Continuous electroencephalographic (cEEG) monitoring is essential to diagnosing non-convulsive seizures (NCS), reported to occur in 7-46% of at-risk critically ill patients. However, cEEG is labour-intensive, and given scarcity of resources at most centres cEEG is feasible in only selected patients. We aim to evaluate the clinical utility of cEEG at our centre in order to optimize further cEEG allocation among critically ill patients. Methods: Using a clinical database, we identified critically ill children who underwent cEEG monitoring in 2016, 2017 and 2018. We abstracted underlying diagnoses, indication for cEEG monitoring, cEEG findings, and associated changes in management. Results: Over this three year period, 928 cEEGs were performed. Among the 100 studies analyzed to date, primary indications for monitoring were characterization of events of unclear etiology (32%), diagnosis of NCS (30%), and monitoring of therapy for seizures (17%). Seizures were captured in 31% of patients (22% subclinical only, 5% electroclinical only, 4% both), which resulted in a treatment change in 90% of cases. Non-epileptic events were captured in 26% of patients. Conclusions: cEEG yielded clinically meaningful information in 57% of cases, frequently resulting in management changes. Subgroup analyses by cEEG indication and ICU location will be presented.

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A Physiologically Based Pharmacokinetic Perspective on the Clinical Utility of Albumin-Based Dose Adjustments in Critically Ill Patients

Clinical Pharmacokinetics ◽

10.1007/s40262-017-0549-x ◽

2017 ◽

Vol 57 (1) ◽

pp. 59-69 ◽

Cited By ~ 4

Author(s):

Huybrecht T’jollyn ◽

An Vermeulen ◽

Jan Van Bocxlaer ◽

Pieter Colin

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Clinical Utility ◽

Physiologically Based Pharmacokinetic ◽

Physiologically Based

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Clinical utility of the BioFire FilmArray Blood Culture Identification panel in the adjustment of empiric antimicrobial therapy in the critically ill septic patient

PLoS ONE ◽

10.1371/journal.pone.0254389 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254389

Author(s):

Roxanne Rule ◽

Fathima Paruk ◽

Piet Becker ◽

Matthew Neuhoff ◽

Julian Chausse ◽

...

Keyword(s):

Blood Culture ◽

Critically Ill ◽

Antimicrobial Therapy ◽

Critically Ill Patients ◽

Clinical Utility ◽

Infection Prevention And Control ◽

Culture Methods ◽

Conventional Culture ◽

Empiric Antimicrobial Therapy ◽

Culture Identification

Sepsis and septic shock are key contributors to mortality in critically ill patients and thus prompt recognition and management thereof is central to achieving improved patient outcomes. Early initiation of appropriate antimicrobial therapy constitutes a crucial component of the management strategy and thus early identification of the causative pathogen is essential in informing antimicrobial therapeutic choices. The BioFire FilmArray blood culture identification (BCID) panel is a US Food and Drug Administration (FDA) approved rapid, multiplex polymerase chain reaction assay for use on positive blood cultures. This study evaluated its clinical utility in the intensive care unit (ICU) setting, in terms of amendment of empiric antimicrobial therapy in critically ill patients with sepsis. The assay proved useful in this setting as final results were made available to clinicians significantly earlier than with conventional culture methods. This, in turn, allowed for modification of empirical antimicrobial therapy to more appropriate agents in 32% of patients. Additionally, the use of the BioFire FilmArray BCID panel permitted the prompt implementation of additional infection prevention and control practices in a sizeable proportion (14%) of patients in the study who were harbouring multidrug resistant pathogens. These findings support the use of the BioFire FilmArray BCID panel as a valuable adjunct to conventional culture methods for the diagnosis and subsequent management of critically ill patients with sepsis.

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