scholarly journals Treatment with a Broad-Spectrum Cephalosporin versus Piperacillin-Tazobactam and the Risk for Isolation of Broad-Spectrum Cephalosporin-Resistant Enterobacter Species

2003 ◽  
Vol 47 (6) ◽  
pp. 1882-1886 ◽  
Author(s):  
Mitchell J. Schwaber ◽  
Camilla S. Graham ◽  
Bruce E. Sands ◽  
Howard S. Gold ◽  
Yehuda Carmeli
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Broad Spectrum ◽  
Multivariable Analysis ◽  
Treatment Groups ◽  
Increased Risk ◽  
Enterobacter Species ◽  
Treatment Onset ◽  
Group 1

ABSTRACT Receipt of a broad-spectrum cephalosporin is a strong risk factor for isolation of broad-spectrum cephalosporin-resistant Enterobacter species, and yet the risk from other broad-spectrum β-lactams hydrolyzed by group 1 β-lactamases has not been well characterized. We compared the risk conferred by broad-spectrum cephalosporins to that conferred by piperacillin-tazobactam, alone or in combination with an aminoglycoside or a fluoroquinolone. A retrospective cohort was monitored from treatment onset until a broad-spectrum cephalosporin-resistant Enterobacter strain was isolated or the patient was discharged. There were 447 patients in the piperacillin-tazobactam group and 2,341 patients in the broad-spectrum cephalosporin group. Groups were similar in age (mean, 62.5 years). The piperacillin-tazobactam group had a smaller percentage of men (32% versus 44%, P < 0.001) and a lower rate of intensive care unit stay (25% versus 38%, P < 0.001) but a higher rate of surgery (41% versus 26%, P < 0.001). Groups differed in the distribution of comorbidities. Resistant Enterobacter strains were isolated from 62 patients, 2% in each group (hazard ratio [RR] = 1.02 [P = 0.95]). In multivariable analysis, risk was similar among treatment groups (RR = 0.71 [P = 0.32]). Intensive care unit stay and surgery were associated with increased risk (RR = 4.53 [P < 0.001] and RR = 1.97 [P = 0.015], respectively), fluoroquinolones were protective (RR = 0.24 [P = 0.003]), and aminoglycosides did not affect risk (RR = 0.98 [P = 0.95]). The protective effect of fluoroquinolones against isolation of broad-spectrum cephalosporin-resistant Enterobacter spp. and the equivalence in risk associated with piperacillin-tazobactam and broad-spectrum cephalosporins may have important clinical and epidemiologic implications.

scholarly journals Impact of ToxigenicClostridium difficileColonization on the Risk of SubsequentC. difficileInfection in Intensive Care Unit Patients

2015 ◽  
Vol 36 (11) ◽  
pp. 1324-1329 ◽  
Author(s):  
Sarah Tschudin-Sutter ◽  
Karen C. Carroll ◽  
Pranita D. Tamma ◽  
Madeleine L. Sudekum ◽  
Reno Frei ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Relative Risk ◽  
Independent Risk Factor ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Johns Hopkins Hospital ◽  
Increased Risk ◽  
Colonization Rates

BACKGROUNDClostridium difficileinfection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal highC. difficilecolonization rates on admission.OBJECTIVETo determine the rate of colonization with toxigenicC. difficileamong intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI.METHODSProspective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenicC. difficile. The primary outcome was risk of developing CDI.RESULTSAmong 542 patients, 17 (3.1%) were colonized with toxigenicC. difficileon admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenicC. difficileon admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24–47.40],P=.003; and 15.66 [4.01–61.08],P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48–50.25],P=.017; and 10.93 [1.49–80.20],P=.019, respectively), while adjusting for potential confounders.CONCLUSIONSIn intensive care unit patients, colonization with toxigenicC. difficileis an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenicC. difficilecolonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.Infect. Control Hosp. Epidemiol.2015;36(11):1324–1329

Management of the Open Abdomen in Obese Trauma Patients

2015 ◽  
Vol 81 (11) ◽  
pp. 1134-1137 ◽  
Author(s):  
Matthew Johnston ◽  
Karen Safcsak ◽  
Michael L. Cheatham ◽  
Chadwick P. Smith
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Resource Utilization ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Group 4 ◽  
Trauma Population ◽  
Group 1

Obesity incidence in the trauma population is increasing. Abdominal compartment syndrome has poor outcomes when left untreated. Surgeons may treat obese patients differently because of concern for increased morbidity and mortality. We studied the effects of body mass index (BMI) on resource utilization and outcome. An Institutional Review Board-approved retrospective review of trauma patients requiring temporary abdominal closure (TAC) was performed. Patients were stratified as follows: Group 1-BMI = 18.5 to 24.9 kg/m2, Group 2-BMI = 25 to 29.9 kg/m2, Group 3-BMI = 30 to 39.9 kg/m2, Group 4-BMI ≥ 40 kg/m2. Demographic data, illness severity as defined by Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score Version II and Simplified Acute Physiology Score Version II scores, resource utilization, fascial closure rate, and survival were collected. About 380 patients required TAC. Median age of Group 1 was significantly lower than Groups 2 and 3 ( P = 0.001). Severity of illness did not differ. Group 4 had a longer intensive care unit stay compared with Groups 1 and 2 ( P = 0.005). Group 4 required mechanical ventilation longer than Group 1 ( P = 0.027). Hospital stay, fascial closure, and survival were equivalent. Obese trauma patients with TAC have a longer intensive care unit stay and more ventilator days, but there is no difference in survival or type of closure. TAC can be used safely in trauma patients with a BMI ≥ 30 kg/m2.

scholarly journals Adverse events during the intrahospital transfer of critically ill perioperative patients in a South African tertiary hospital

2020 ◽  
pp. 131-138
Author(s):  
LY Seilbea ◽  
K de Vasconcellos
Keyword(s):  
Intensive Care Unit ◽  
Adverse Event ◽  
Intensive Care ◽  
Adverse Events ◽  
South African ◽  
Critically Ill ◽  
Multivariable Analysis ◽  
Inotropic Support ◽  
Physiological Changes ◽  
Increased Risk

Background: Critically ill patients frequently require intrahospital transfer for diagnostic or therapeutic procedures, or transfer to the intensive care unit. Intrahospital transfer exposes patients to an increased risk of adverse events. The reported rate of adverse events ranges from 4.2% to 79% based on data from high income countries. There is limited data available on intrahospital transfers in the South African context. This study aimed to determine the incidence of adverse events during intrahospital transfer, the physiological effects of intrahospital transfer, identify potential risk factors for adverse events and determine if adverse events were associated with poor clinical outcomes. Methods: The study was a single-centre, prospective, observational study of adult patients undergoing transport between the operating theatre and the intensive care unit (or vice versa) of a tertiary academic hospital in South Africa. Demographic data, transfer data (including adverse events, and the physiological parameters of the patients before and after transfer), and intensive care unit outcome data was collected between September 2018 and May 2019. Results: Data on 94 transfers was collected. Adverse events occurred in 23.4% (95% CI 14.7–32.1%) of transfers. Clinical adverse events, namely hypotension requiring management, made up 55% of the adverse events, while the remaining were technical adverse events (32% monitor failure, 9% ventilator failure and 4% infusion pump failure). The median transfer time was 10 minutes. Patients who developed adverse events during transfer were significantly older (median age 48 years versus 37 years, p = 0.037) and were significantly more likely to be receiving inotropic support (81.8% versus 51.4%, OR 4.26; 95% CI 1.31–13.82, p = 0.011) than those who did not have adverse events. Only the association with inotropic support remained on multivariable analysis. Patients who suffered an adverse event during transfer had a significantly higher mortality than those who did not have an adverse event (63.6% versus 30.6%, OR 3.98; 95% CI 1.46–10.84, p = 0.005) on univariate analysis, however this association was no longer significant on multivariable analysis. Increasing age, inotropic support and transfer by a medical officer as opposed to a registrar remained significant predictors on multivariable analysis. Significant physiological changes were noted in 80.9% of patients, with 64.9% of patients showing deterioration in at least one physiological parameter. Conclusion: Adverse events are common during the transfer of critically ill patients between the operating theatre and the intensive care unit. Even in the absence of adverse events, physiological changes occur in the majority of patients undergoing transfer. Patients receiving inotropic support are at increased risk of adverse events during transfer and enhanced attention to pre-transfer preparation and intratransfer management is warranted in these patients. The potential associations between adverse events during transfer and transferring personnel and ICU mortality needs to be explored in further studies.

Effect of Prolonged Intensive Care Stay on Survival following Coronary Surgery

2005 ◽  
Vol 13 (4) ◽  
pp. 345-350 ◽  
Author(s):  
Sanjay V Ghotkar ◽  
Antony D Grayson ◽  
Walid C Dihmis
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Multivariable Analysis ◽  
Coronary Bypass ◽  
Patient Characteristics ◽  
Coronary Surgery ◽  
Intensive Care Stay ◽  
Prolonged Recovery ◽  
The Uk

The aim of the study was to examine midterm survival in patients who required prolonged recovery in the intensive care unit. The 5,186 consecutive patients who underwent isolated coronary surgery between April 1997 and March 2002 were retrospectively analyzed. Patients were classified as having prolonged (> 3 days) or normal (≤ 3 days) stay in the intensive care unit. Patient records were matched to the National Health Service Strategic Tracing Service which records all-cause mortality in the UK. Case-mix was controlled for by constructing a propensity score from core patient characteristics, which was included along with the comparison variable in a multivariable analysis of outcome. Prolonged intensive care unit stay was recorded in 475 (9.16%) patients. Mortality was 9.14% during the study period with a total follow-up of 19,618 patient-years (mean, 3.8 years). Adjusted 5-year survival was 78.0% for prolonged intensive care unit stay vs. 90.7% for normal stay, with an adjusted hazard ratio for midterm mortality of 2.6 ( p < 0.001). Midterm mortality was significantly higher in patients with a prolonged intensive care unit stay following coronary bypass.

Interacting risk factors determine the outcome of patients with a prolonged intensive care unit stay after cardiac surgery

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
J Schöttler ◽  
C Grothusen ◽  
T Attmann ◽  
C Friedrich ◽  
S Freitag-Wolf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Unit Stay

Survival after cardiac surgery and long-term intensive care unit stay

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
C Schimmer ◽  
K Hamouda ◽  
M Özkur ◽  
SP Sommer ◽  
I Aleksic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Unit Stay

scholarly journals Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

Infection ◽  
2021 ◽  
Author(s):  
A. Oliva ◽  
G. Ceccarelli ◽  
C. Borrazzo ◽  
M. Ridolfi ◽  
G. D.’Ettorre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Features ◽  
Multivariable Analysis ◽  
Invasive Pulmonary Aspergillosis ◽  
Lower Percentage ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Single Centre Study ◽  
Male Sex

Abstract Background Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). Materials/methods Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. Results Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58–76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). Conclusions In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.

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