scholarly journals Severe Tuberculosis Requiring Intensive Care: A Descriptive Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Raquel Pacheco Duro ◽  
Paulo Figueiredo Dias ◽  
Alcina Azevedo Ferreira ◽  
Sandra Margarida Xerinda ◽  
Carlos Lima Alves ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Descriptive Analysis ◽  
Univariate Analysis ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Hospital Acquired Infection ◽  
Positive Smear ◽  
Laboratory Investigations ◽  
Hospital Acquired

Background. This study aims to describe the characteristics of tuberculosis (TB) patients requiring intensive care and to determine the in-hospital mortality and the associated predictive factors.Methods. Retrospective cohort study of all TB patients admitted to the ICU of the Infectious Diseases Department of Centro Hospitalar de São João (Porto, Portugal) between January 2007 and July 2014. Comorbid diagnoses, clinical features, radiological and laboratory investigations, and outcomes were reviewed. Univariate analysis was performed to identify risk factors for death.Results. We included 39 patients: median age was 52.0 years and 74.4% were male. Twenty-one patients (53.8%) died during hospital stay (15 in the ICU). The diagnosis of isolated pulmonary TB, a positive smear for acid-fast-bacilli and a positive PCR forMycobacterium tuberculosisin patients of pulmonary disease, severe sepsis/septic shock, acute renal failure and Multiple Organ Dysfunction Syndrome on admission, the need for mechanical ventilation or vasopressor support, hospital acquired infection, use of adjunctive corticotherapy, smoking, and alcohol abuse were significantly associated with mortality (p<0.05).Conclusion. This cohort of TB patients requiring intensive care presented a high mortality rate. Most risk factors for mortality were related to organ failure, but others could be attributed to delay in the diagnostic and therapeutic approach, important targets for intervention.

Multiple Organ Dysfunction Syndrome

2015 ◽  
Author(s):  
Vishal Bansal ◽  
Jay Doucet
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Failure ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Ultimate Outcome

The concept of and approach to multiple organ dysfunction syndrome (MODS), also known as progressive systems failure, multiple organ failure, and multiple system organ failure, have evolved over the last decade. Characterized by progressive but potentially reversible tissue damage and dysfunction of two or more organ systems that arise after a significant physiologic insult and its subsequent management, MODS evolves in the wake of a profound disruption of systemic homeostasis. Pre-existing illness, nutritional status, hospital course, and genetic variation all lead to the development of organ dysfunction in patients exposed to these risk factors. The ultimate outcome from MODS is influenced not only by a patient’s genetic and biological predisposition but also by specific management principles practiced by intensivists. This review details the clinical definitions, quantification, prevention, evaluation, support, and outcomes of organ dysfunction. A figure shows the increasing severity of organ dysfunction correlated with increasing intensive care unit mortality, and an algorithm details the approach to MODS. Tables list risk factors and prognosis for MODS, the multiple organ dysfunction (MOD) score, the sequential organ failure assessment (SOFA) score, intensive care unit interventions that reduce mortality or attenuate organ dysfunction along with unproven or disproven ICU interventions, and the temporal evolution of MODS. This review contains 1 figure, 7 tables, and 159 references.

Multiple Organ Dysfunction Syndrome

2015 ◽  
Author(s):  
Vishal Bansal ◽  
Jay Doucet
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Failure ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Ultimate Outcome

The concept of and approach to multiple organ dysfunction syndrome (MODS), also known as progressive systems failure, multiple organ failure, and multiple system organ failure, have evolved over the last decade. Characterized by progressive but potentially reversible tissue damage and dysfunction of two or more organ systems that arise after a significant physiologic insult and its subsequent management, MODS evolves in the wake of a profound disruption of systemic homeostasis. Pre-existing illness, nutritional status, hospital course, and genetic variation all lead to the development of organ dysfunction in patients exposed to these risk factors. The ultimate outcome from MODS is influenced not only by a patient’s genetic and biological predisposition but also by specific management principles practiced by intensivists. This review details the clinical definitions, quantification, prevention, evaluation, support, and outcomes of organ dysfunction. A figure shows the increasing severity of organ dysfunction correlated with increasing intensive care unit mortality, and an algorithm details the approach to MODS. Tables list risk factors and prognosis for MODS, the multiple organ dysfunction (MOD) score, the sequential organ failure assessment (SOFA) score, intensive care unit interventions that reduce mortality or attenuate organ dysfunction along with unproven or disproven ICU interventions, and the temporal evolution of MODS. This review contains 1 figure, 7 tables, and 159 references.

Multiple Organ Dysfunction Syndrome

2015 ◽  
Author(s):  
Vishal Bansal ◽  
Jay Doucet
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Failure ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Ultimate Outcome

The concept of and approach to multiple organ dysfunction syndrome (MODS), also known as progressive systems failure, multiple organ failure, and multiple system organ failure, have evolved over the last decade. Characterized by progressive but potentially reversible tissue damage and dysfunction of two or more organ systems that arise after a significant physiologic insult and its subsequent management, MODS evolves in the wake of a profound disruption of systemic homeostasis. Pre-existing illness, nutritional status, hospital course, and genetic variation all lead to the development of organ dysfunction in patients exposed to these risk factors. The ultimate outcome from MODS is influenced not only by a patient’s genetic and biological predisposition but also by specific management principles practiced by intensivists. This review details the clinical definitions, quantification, prevention, evaluation, support, and outcomes of organ dysfunction. A figure shows the increasing severity of organ dysfunction correlated with increasing intensive care unit mortality, and an algorithm details the approach to MODS. Tables list risk factors and prognosis for MODS, the multiple organ dysfunction (MOD) score, the sequential organ failure assessment (SOFA) score, intensive care unit interventions that reduce mortality or attenuate organ dysfunction along with unproven or disproven ICU interventions, and the temporal evolution of MODS. This review contains 1 figure, 7 tables, and 159 references.

Epidemiology, antimicrobial resistance, and incremental medical costs of hospital-acquired infections in the Intensive Care Unit: 2-year experience from Serbia

2019 ◽  
Author(s):  
Aleksa Jovan Despotovic ◽  
Branko Milosevic ◽  
Ivana Milosevic ◽  
Andja Cirkovic ◽  
Snezana D Jovanovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Length Of Stay ◽  
Fold Increase ◽  
Antimicrobial Treatment ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Resistance Rates ◽  
Hospital Acquired

Abstract Background: Hospital-acquired infections are a major complication of hospital treatment. The growing presence of multidrug-resistant pathogens contributes to increased mortality and costs, particularly in intensive care units where patients are predisposed to numerous risk factors. Comprehensive data about hospital-acquired infections from Serbian intensive care units is scarce. The aim of this study was to determine the presence of hospital-acquired infections among intensive care unit patients and look into the patterns of antimicrobial resistance, risk factors, and incremental costs of diagnosis and antimicrobial treatment. Methods: This retrospective study included 355 patients over a two-year period. Etiology, antimicrobial resistance patterns, and incremental costs of diagnosis and antimicrobial treatment were examined. Risk factors for infection acquisition, as well as length of stay, were statistically analyzed using Pearson’s chi-square tests and logistic regression analysis. Results: At least one hospital-acquired infection was identified in 32.7% of patients. A total of 204 infection episodes were documented, the most common type being urinary tract infections (36.3%). Clostridium difficile , Klebsiella spp. , and Acinetobacter baumanii were the most common isolates. Antimicrobial resistance rates < 20% were observed for linezolid (0%), colistin (9%), and tigecycline (14%). Resistance rates > 50% were seen in all other tested antibiotic agents. Mortality rates were not higher in patients who acquired only one hospital-acquired infection (p=0.09), but were significantly higher for patients in whom more than one episode occurred (p=0.038). Length of stay > 20 days carried a 7.5-fold increase in odds of acquiring an infection (CI 4.4-12.7, p<0.001), whereas length of stay > 30 days carried a 10-fold increase (CI 5.5-16.1, p<0.001). During the study period, over 37,000 EUR was incrementally spent on diagnosis and antimicrobial treatment for hospital-acquired infections. Conclusion: Our results suggest a high prevalence of hospital-acquired infections and very high antimicrobial resistance rates compared to most European countries. Together with the first published results regarding incremental costs from Serbia, our observations require large-scale prospective follow-up studies in order to obtain a deeper insight into the actual burden of hospital-acquired infections.

scholarly journals Nosocomial Infection in an Iranian Neonatal Intensive Care Unit: Hospital Epidemiology and Risk Factors

2020 ◽  
Vol 8 (4) ◽  
Author(s):  
Farhad Choobdar ◽  
Zahra Vahedi ◽  
Nastaran Khosravi ◽  
Nasrin Khalesi ◽  
Asma Javid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Hospital Stay ◽  
Neonatal Intensive Care ◽  
Infected Group ◽  
Control Group ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Hospital Infection Control ◽  
Hospital Acquired

Background: Hospital-acquired infection is one of the main concerns in Neonatal Intensive Care Units (NICUs), leading to increased mortality, hospital stay, and costs. Objectives: This study aimed to investigate the risk factors of hospital-acquired infection in NICUs. Methods: A descriptive, cross-sectional, prospective study was conducted in the NICU of Ali Asghar Children Hospital for one year. All admitted newborns were sampled on a simple basis. The criteria for the diagnosis of hospital-acquired infection were based on the definitions of the CDC and the NNIS system. Risk factors such as days of fully catheters usage, nurse-to-patient ratio, history of surgery, prematurity, and mechanical ventilation were considered as variables. The data collection tools consisted of a patient information questionnaire, the monthly report of the hospital infection control committee based on the NNIS system, a daily schedule of all risk factors for each infant, and the monthly nurse-to-patient ratio in the NICU. The STATA software was used for data analysis. Results: In our study, 654 newborns were enrolled. The rate of hospital-acquired infections was 13.5%. Moreover, 80.7% of the cases exhibited sepsis (72.7% diagnosed based on clinical findings and 8% based on positive blood culture). Statistical analysis showed 9% pneumonia cases, 8% surgical site infection cases, and 2.3% urinary tract infection cases. The average time to the occurrence of hospital-acquired infection was 13.5 days after admission. All risk factors were significantly higher in the infected group than in the control group (P = 0.0001). Furthermore, surgical interventions were significantly more in the infected group than in the non-infected group (34.1% vs. 6.7%, respectively, P = 0.0001). The prevalence rates in different weight ranges (less than 1000 g, 1001 to 1500 g, 1501 to 2500, and above 2501 g) were 2.6%, 6.9%, 21.4%, and 69.1%, respectively, in the infected group, which were significantly different from those of the non-infected group (P = 0.0001). The most common etiologic microorganism was Acinetobacter baumannii. Conclusions: Factors such as surgery, the presence of a central venous catheter, and the increased length of hospital stay significantly increased the hospital-acquired infections. Reducing invasive procedures, maintenance of full catheters, and providing optimal nursing care can help control hospital-acquired infections.

scholarly journals Emergence of Vancomycin Resistance after Treatment of Enterococcus: Risk Factors for Subsequent Pathogen Resistance

2020 ◽  
Vol 41 (S1) ◽  
pp. s211-s212
Author(s):  
Zachary Shepard ◽  
Robert Woods ◽  
Twisha Patel
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Descriptive Analysis ◽  
Univariate Analysis ◽  
Pathogen Resistance ◽  
Fisher Exact Test ◽  
Retrospective Case ◽  
Exact Test ◽  
Increased Risk

Background: Vancomycin-resistant Enterococcus (VRE) is a leading cause of nosocomial infections that carries an increased risk of mortality when compared to vancomycin-sensitive Enterococcus (VSE). Data on the frequency of conversion between VSE and VRE in patients are scarce. Among patients presenting with VSE infections, little is known about the subsequent risk of conversion to VRE in the initial treatment period. Methods: A descriptive analysis of VSE to VRE conversion and a retrospective case-control study were performed examining cases of VSE that had subsequent cultures positive for VRE within 90 days within a quaternary healthcare system. Cases were obtained from June 2013 through December 2018. Controls were patients who had VSE culture followed by another VSE culture and were matched by organism (E. faecalis or E. faecium), time between cultures, and initial culture site. Age, gender, healthcare, antibiotic, Clostridiodes difficile, proton pump inhibitor (PPI) exposure, and H2 blocker exposures, and prior VRE infection or colonization were abstracted from the electronic medical record. A univariate analysis with the Fisher exact test was performed with significance considered for P < .05. Results: In total, 8,913 cases of E. faecalis and 2,322 cases of E. faecium were included in the study. Of 8,913 cases of E. faecalis, 51 of 8,503 (0.6%) cultured VRE after VSE, and 47 of 403 (11.7%) cultured VSE after initial VRE. Of E. faecium, 51 of 783 (6.5%) cultured VRE after VSE, and 76 of 1,532 (5.0%) cultured VSE after initial VRE. In total, 76 cases were matched with 99 controls. Patients converting from VSE to VRE were more likely to have prior admission to an intensive care unit (P = .0207), prior positive swab or culture for VRE (P = .0114), previous C. difficile infection (P = .0155), prior vancomycin (P = .0022) and cefepime (P = .0089) exposure. Patients receiving vancomycin after initial VSE culture were more likely to have subsequent cultures positive for VRE (P = .0053). There was no difference in age (P = .966) or male sex (P = .7588). Conclusions: Conversion from VSE to VRE is common, and E. faecium is more likely to become resistant than E. faecalis. Reversion to a vancomycin-sensitive phenotype is also common, and E. faecalis is more likely to show subsequent sensitivity than E. faecium. Previous admission to an intensive care unit, prior colonization or infection with VRE, prior C. difficile infection, and exposure to vancomycin and cefepime are risk factors for emergence of VRE after treatment for vancomycin-sensitive Enterococcus.Funding: NoneDisclosures: None

scholarly journals Risk Factors for Hospital-Acquired Infection in Pediatric Intensive Care Unit

2014 ◽  
Vol 1 (1) ◽  
pp. 9-16
Author(s):  
Ayse Berna Anil ◽  
Murat Anil ◽  
Nihal Onal Ozdemir ◽  
Nuri Bayram ◽  
Zumrut Sahbudak Bal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Hospital Acquired Infection ◽  
Hospital Acquired

scholarly journals Hospital-Acquired Infections among Adult Patients Admitted for COVID-19

2021 ◽  
pp. 1-15
Author(s):  
Leigh Smith ◽  
Sara M Karaba ◽  
Joe Amoah ◽  
George Jones ◽  
Robin Avery ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Antibiotic Exposure ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Multicenter Cohort ◽  
Hospital Acquired

Abstract In a multicenter cohort of 963 adults hospitalized due to COVID-19, 5% had a proven hospital-acquired infection (HAI) and 21% had a proven/probable or possible HAI. Risk factors for proven/probable HAIs included intensive care unit admission, dexamethasone use, severe COVID-19, heart failure and antibiotic exposure upon admission.

scholarly journals COVID-19 and Multiorgan Dysfunction Syndrome

2021 ◽  
Author(s):  
Jitendra D. Lakhani ◽  
Sajni Kapadia ◽  
Rohit Choradiya ◽  
Roop Preet Gill ◽  
Som J. Lakhani
Keyword(s):  
Organ Failure ◽  
Kidney Injury ◽  
Glycemic Variability ◽  
Multiple Organ ◽  
Organ Support ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Treatment Support ◽  
Laboratory Investigations ◽  
Hospital Acquired

Severe acute respiratory syndrome (SARS) is the leading cause of death in COVID-19 infection, however, multi-organ dysfunction due to COVID-19 and/or because of co-morbidities is a usual accompaniment causing unfavorable outcome. Early detection of organ failure and giving appropriate organ support may improve the chances of survival. Arterial Blood Gas (ABG) analysis; electrolytes coupled with clinical picture and with organ related laboratory investigations may help in diagnosis of MODS and sepsis in COVID-19 SEVERE SYNDROME. Acute kidney injury (AKI), myocarditis, thromboembolism, acute liver de-compensation, hospital acquired infections, cardiac arrest, glycemic variability, thyroid dysfunction and other organ failure may lead to MODS.As patients having multiple organ syndrome requires ICU admission and interventions like intubation, hemodialysis and other extracorporeal treatment support knowing holistically about “COVID-19 MODS” is important for treating physicians.

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