683: NARROW-SPECTRUM EMPIRIC ANTIMICROBIAL THERAPY FOR VAP IN CRITICALLY ILL TRAUMA PATIENTS

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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Drugs that stimulate bone marrow might save lives in critically ill trauma patients

10.3310/signal-000280 ◽

2016 ◽

Author(s):

Keyword(s):

Bone Marrow ◽

Critically Ill ◽

Trauma Patients ◽

Stimulate Bone Marrow

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First reported case of Weissella confusa abundance in the lung microbiota of a critically ill trauma patient with acute respiratory distress syndrome - caution warranted in the use of the Weissella genus as a probiotic

10.31219/osf.io/v5rha ◽

2020 ◽

Author(s):

Sandeep Chakraborty

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Critically Ill ◽

Distress Syndrome ◽

Joint Infection ◽

Starter Cultures ◽

Trauma Patients ◽

Virulence Determinants ◽

Prosthetic Joint

Weissella strains are currently being used for biotechnological and probiotic purposes [1]. While, Weissella hellenica found in flounder intestine had probiotic effects [2], certain species from this genus are opportunistic pathogens in humans. Apart from being implicated in disease in farmed rainbow trout [3], Weissella has been found to cause the following disease in humans.1. endocarditis [4,5]2. bacteraemia [6]3. prosthetic joint infection [7]Whole genome sequences ‘find several virulence determinants such as collagen adhesins, aggregation sub- stances, mucus-binding proteins, and hemolysins in some species’, as well as antibiotic resistance-encoding genes [8]. Caution is warranted in selecting of Weissella strains as starter cultures or probiotics, if at all, since the other option, Lactobacillus, are rarely involved in human disease.Here, the analysis of the lung microbiota in critically ill trauma patients suffering from acute respiratory distress syndrome [9] shows (Accid:ERR1992912) shows complete colonization of Weissella (Fig 1). While, the study mentions ‘significant enrichment of potential pathogens including Streptococcus, Fusobacterium, Prevotella, Haemophilus and Treponema’, there is no reference to the Weissella genus. The percentages of Weissella strains are :confusa=81, soli=7 ,hellenica=5 ,diestrammenae=2. I believe this is the first reported case of Weissella causing ARDS in humans.

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Magnesium Infusion for Pain Management in Critically Ill Trauma Patients

Case Medical Research ◽

10.31525/ct1-nct04166877 ◽

2019 ◽

Author(s):

Keyword(s):

Pain Management ◽

Critically Ill ◽

Trauma Patients

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Algorithm for assessing renal dysfunction risk in critically ill trauma patients receiving aminoglycosides

The American Journal of Surgery ◽

10.1016/s0002-9610(05)81007-4 ◽

1990 ◽

Vol 160 (5) ◽

pp. 473-480 ◽

Cited By ~ 15

Author(s):

Bradley A. Boucher ◽

Bridgett C. Coffey ◽

David A. Kuhl ◽

Elizabeth A. Tolley ◽

Timothy C. Fabian

Keyword(s):

Renal Dysfunction ◽

Critically Ill ◽

Trauma Patients

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Appropriateness of empiric antimicrobial therapy with imipenem/colistin in severe septic patients: observational cohort study

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-018-0292-7 ◽

2018 ◽

Vol 17 (1) ◽

Author(s):

Ahlem Trifi ◽

Sami Abdellatif ◽

Cyrine Abdennebi ◽

Foued Daly ◽

Rochdi Nasri ◽

...

Keyword(s):

Cohort Study ◽

Antimicrobial Therapy ◽

Observational Cohort Study ◽

Empiric Antimicrobial Therapy ◽

Observational Cohort

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Impact of Inactive Empiric Antimicrobial Therapy on Inpatient Mortality and Length of Stay

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00466-06 ◽

2006 ◽

Vol 50 (10) ◽

pp. 3355-3360 ◽

Cited By ~ 27

Author(s):

Kimberly K. Scarsi ◽

Joe M. Feinglass ◽

Marc H. Scheetz ◽

Michael J. Postelnick ◽

Maureen K. Bolon ◽

...

Keyword(s):

Length Of Stay ◽

Antimicrobial Therapy ◽

Medical Center ◽

Academic Medical Center ◽

Bloodstream Infections ◽

Empiric Therapy ◽

Inpatient Mortality ◽

In Vitro Susceptibility ◽

Empiric Antimicrobial Therapy

ABSTRACT The consequences of inactive empiric antimicrobial therapy are not well-described and may cause prolonged hospitalization or infection-related mortality. In vitro susceptibility results for 884 patients hospitalized at an academic medical center with gram-negative bloodstream infections (GNBI) from 2001 to 2003 were matched to antimicrobial orders within 24 h of culture. Clinical characteristics, organism, inpatient mortality, and length of stay after culture for patients with GNBI were compared between patients receiving active versus inactive empiric antimicrobial therapy. A total of 14.1% of patients with GNBI received inactive empiric therapy, defined as no antimicrobial therapy within 24 h of the culture active against the identified organism based on in vitro microbiology reports. Patients who received inactive therapy were more likely to be younger, to be infected with Pseudomonas aeruginosa, to have a nosocomial infection, and to receive antimicrobial monotherapy but less likely to be bacteremic with Escherichia coli or to have sepsis (P < 0.05). There were no significant differences in mortality between patients receiving active versus inactive empiric therapy (16.1% versus 13.6%, respectively) or in length of stay after positive culture (11.5 days versus 12.6 days, respectively). Only 45 patients had greater than 2 days of exposure to inactive therapy; however, 8/30 patients (26.7%) who never received active antimicrobial therapy died while in the hospital. Inactive empiric therapy was more common in healthier patients. Inactive antimicrobial therapy in the first 24 h did not significantly impact average outcomes for GNBI among hospitalized patients but may have caused harm to specific individuals.

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