Characteristics of Adult Sepsis Patients in the Intensive Care Units in a Tertiary Hospital in Jordan: An Observational Study

Sepsis is a global health issue that is commonly encountered in the intensive care unit (ICU) and is associated with high morbidity and mortality. Available data regarding sepsis in low- and middle-income countries (LMIC) is lacking compared to higher income countries, especially using updated sepsis definitions. The lack of recent data on sepsis in Jordan prompted us to investigate the burden of sepsis among Jordanian ICU patients. We conducted a prospective cohort study at Jordan University Hospital, a tertiary teaching hospital in the capital, Amman. All adult patients admitted to the adult ICUs between June 2020 and January 2021 were included in the study. Patients’ clinical and demographic data, comorbidities, ICU length of stay (LOS), medical interventions, microbiological findings, and mortality rate were studied. Descriptive and inferential statistics were used to analyse data from patients with and without sepsis. We observed 194 ICU patients during the study period; 45 patients (23.3%) were diagnosed with sepsis using the Sepsis-3 criteria. Mortality rate and median ICU LOS in patients who had sepsis were significantly higher than those in other ICU patients (mortality rate, 57.8% vs. 6.0%, p value < 0.001, resp., and LOS 7 days vs. 4 days, p value < 0.001, resp.). Additionally, sepsis patients had a higher combined number of comorbidities (2.27 ± 1.51 vs. 1.27 ± 1.09, p value < 0.001). The use of mechanical ventilation, endotracheal intubation, and blood transfusions were all significantly more common among sepsis patients. A causative organism was isolated in 68.4% of sepsis patients with a prevalence of Gram-negative bacteria in 77.1% of cases. While the occurrence of sepsis in the ICU in Jordan is comparable to other regions in the world, the mortality rate of sepsis patients in the ICU remains high. Further studies from LMIC are required to reveal the true burden of sepsis globally.

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Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience

SAGE Open Medicine ◽

10.1177/20503121211001144 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110011

Author(s):

Thabit Alotaibi ◽

Abdulrhman Abuhaimed ◽

Mohammed Alshahrani ◽

Ahmed Albdelhady ◽

Yousef Almubarak ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Acinetobacter Baumannii ◽

Care Setting ◽

Multidrug Resistant ◽

University Hospital ◽

Published Data ◽

Tertiary Teaching ◽

The Mean

Background: The management of Acinetobacter baumannii infection is considered a challenge especially in an intensive care setting. The resistance rate makes it difficult to manage and is believed to lead to higher mortality. We aim to investigate the prevalence of Acinetobacter baumannii and explore how different antibiotic regimens could impact patient outcomes as there are no available published data to reflect our population in our region. Methods: We conducted a retrospective review of all infected adult patients admitted to the intensive care unit at King Fahad University Hospital with a confirmed laboratory diagnosis of Acinetobacter baumannii from 1 January 2013 until 31 December 2017. Positive cultures were obtained from the microbiology department and those meeting the inclusive criteria were selected. Variables were analyzed using descriptive analysis and cross-tabulation. Results were further reviewed and audited by blinded co-authors. Results: A comprehensive review of data identified 198 patients with Acinetobacter baumannii. The prevalence of Acinetobacter baumannii is 3.37%, and the overall mortality rate is 40.81%. Our sample consisted mainly of male patients, that is, 68.7%, with a mean age of 49 years, and the mean age of female patients was 56 years. The mean age of survivors was less than that of non-survivors, that is, 44.95 years of age. We observed that prior antibiotic use was higher in non-survivors compared to survivors. From the review of treatment provided for patients infected with Acinetobacter baumannii, 65 were treated with colistin alone, 18 were treated with carbapenems, and 22 were treated with a combination of both carbapenems and colistin. The mean length of stay of Acinetobacter baumannii–infected patients was 20.25 days. We found that the survival rates among patients who received carbapenems were higher compared to those who received colistin. Conclusion: We believe that multidrug-resistant Acinetobacter baumannii is prevalent and associated with a higher mortality rate and represents a challenging case for every intensive care unit physician. Further prospective studies are needed.

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Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

Annals of Nutrition and Metabolism ◽

10.1159/000477675 ◽

2017 ◽

Vol 71 (1-2) ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Emilia Gómez-Hoyos ◽

Martín Cuesta ◽

Nayade Del Prado-González ◽

Pilar Matía ◽

Natalia Pérez-Ferre ◽

...

Keyword(s):

Body Mass Index ◽

Mortality Rate ◽

Parenteral Nutrition ◽

Demographic Data ◽

Tertiary Hospital ◽

Hospital Length ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Control Subjects ◽

Comorbidity Index

Background: The objective of the study was to determine the prevalence of hyponatremia (HN) and its associated morbimortality in hospitalized patients receiving parenteral nutrition (PN). Methods: A retrospective study including 222 patients receiving total PN (parenteral nutrition group [PNG]) over a 7-month period in a tertiary hospital and 176 matched to 179 control subjects without PN (control subjects group [CSG]). Demographic data, Charlson Comorbidity Index (CCI), date of HN detection-(serum sodium or SNa <135 mmol/L)-intrahospital mortality, and hospital length-of-stay (LOS) were registered. In the PNG, body mass index (BMI) and SNa before, during, and after PN were recorded. Results: HN was more prevalent in the PNG: 52.8 vs. 35.8% (p = 0.001), and independent of age, gender, or CCI (OR 1.8 [95% CI 1.1-2.8], p = 0.006). In patients on PN, sustained HN (75% of all intraindividual SNa <135 mmol/L) was associated with a higher mortality rate independent of age, gender, CCI, or BMI (OR 7.38 [95% CI 1.07-50.8], p = 0.042). The absence of HN in PN patients was associated with a shorter hospital LOS (<30 days) and was independent of other comorbidities (OR 3.89 [95% CI 2.11-7.18], p = 0.001). Conclusions: HN is more prevalent in patients on PN. Sustained HN is associated with a higher intrahospital mortality rate. Absence of HN is associated with a shorter hospital LOS.

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Morbidity and mortality after fragility hip fracture in a Saudi Arabian population: Report from a single center

Journal of International Medical Research ◽

10.1177/0300060517706283 ◽

2017 ◽

Vol 45 (3) ◽

pp. 1175-1180 ◽

Cited By ~ 6

Author(s):

Mir Sadat-Ali ◽

Moaad Alfaraidy ◽

Abdulaziz AlHawas ◽

Ahmed Abdallah Al-Othman ◽

Dakheel A Al-Dakheel ◽

...

Keyword(s):

Hip Fracture ◽

Mortality Rate ◽

Demographic Data ◽

Femoral Fractures ◽

Morbidity And Mortality ◽

High Morbidity ◽

Fragility Hip Fracture ◽

Asa Score ◽

Telephone Interviews ◽

American Society

Objective To determine the functional morbidity and mortality after fragility hip fracture and compare the mortality with three other common diseases. Methods Data were collected from patients admitted to King Fahd Hospital of the University, AlKhobar from January 2010 to December 2014. Demographic data included the preoperative American Society of Anesthesiologists (ASA) score as assessed by the anesthetist and the type of surgery. Personal and telephone interviews were performed, and data were entered into a database and analyzed. Results We identified 203 patients with fragility proximal femoral fractures, and the data of 189 patients (109 male, 80 female; average age, 66.90 ± 13.43 years) were available for analysis. The overall mortality rate was 26.98% (51 patients). The mortality rate was significantly higher among patients with an ASA score of 4 (36.36%) than 1 (20.45%). With respect to morbidity, only 48.23% of patients were able to return to their pre-fracture status; 32.35% of those who required assisted walking and 83.4% of those who required a wheelchair became bedridden. Conclusions Our data demonstrate that patients with fragility hip fractures have high morbidity and a mortality rate approaching 30%. Age and the ASA score significantly influence this high mortality rate.

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Spectrum of childhood interstitial and diffuse lung diseases at a tertiary hospital in Egypt

ERJ Open Research ◽

10.1183/23120541.00880-2020 ◽

2021 ◽

pp. 00880-2020

Author(s):

Salma G. Abdelhady ◽

Eman M. Fouda ◽

Malak A. Shaheen ◽

Faten A. Ghazal ◽

Ahmed M. Mostafa ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Lung Diseases ◽

Demographic Data ◽

Tertiary Hospital ◽

University Hospital ◽

Systematic Evaluation ◽

Pulmonary Hemosiderosis ◽

Diffuse Lung Diseases ◽

Diffuse Lung

BackgroundChildhood interstitial and diffuse lung diseases (chILD) encompass a broad spectrum of rare pulmonary disorders. In most developing middle eastern countries, chILD is still underdiagnosed. Objective: To describe and investigate patients diagnosed with chILD in a tertiary university hospital in Egypt.MethodsWe analyzed data of consecutive subjects (<18 years) referred for further evaluation at the Children's Hospital, Ain Shams University. Diagnosis of chILD was made in accordance with the chILD-EU criteria. The following information was obtained: demographic data, clinical characteristics, chest CT findings, laboratory studies, spirometry, BAL and histopathology findings.Results22 subjects were enrolled over 24 months. Median age at diagnosis was 7 years (range 3.5–14 years). The most common manifestations were dyspnea (100%), cough (90.9%), clubbing (95.5%) and tachypnea (90.9%). Systematic evaluation led to the following diagnoses: hypersensitivity pneumonitis (n=3), idiopathic interstitial pneumonias (n=4), chILD related to chronic granulomatous disease (n=3), chILD related to small airway disease (n=3), postinfectious chILD (n=2), Langerhans cell histiocytosis (n=2), Idiopathic pulmonary hemosiderosis (n=2), granulomatous lymphocytic interstitial lung disease (n=1), systemic sclerosis (n=1), familial interstitial lung disease (n=1). Among the subjects who completed the diagnostic evaluation (n=19), treatment was changed in 13 (68.4%) subjects.ConclusionSystematic evaluation and multidisciplinary peer review of chILD patients at our tertiary hospital led to changes in management in 68% of the patients. This study also highlights the need for an Egyptian chILD network with genetic testing, as well as the value of collaborating with international groups in improving health care for children with chILD.

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MOBILISASI PROGRESIF TERHADAP PERUBAHAN TEKANAN DARAH PASIEN DI INTENSIVE CARE UNIT (ICU)

Jurnal Ilmiah Kesehatan Keperawatan ◽

10.26753/jikk.v12i1.136 ◽

2016 ◽

Vol 12 (1) ◽

Author(s):

Ainnur Rahmanti ◽

Dyah Kartika Putri

Keyword(s):

Blood Pressure ◽

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Respiratory Function ◽

Lateral Position ◽

High Morbidity ◽

Left Lateral Position ◽

Critical Patients

Patient with critical condition had high morbidity and mortality rate. This condition is worsened by long term immobilization. Instability vital sign made nurses stationed delayed mobilization activities in ICU. Progressive mobilization must be started for ICU patient to decrease respiratory function, level of awareness and cardiovascular function. The objective of this study was to identify progressive mobilization activities on blood pressure parameters among critical patients in ICU. The design of this study was quai experiment design. Thirty respondents were included to the study using concequtive sampling. Progressive mobilization was given with head of bed 300 (HOB 300), head of bed450 (HOB 450) with passive range of motion, continued with right and left lateral position. Anova repeated measurement was used to identify mean difference each of blood pressure. The result of this study show there is two moment sistolic change between HOB 300 to HOB 450 and HOB 450 to right lateral position (3,3%). There is nine moment diastolic change between HOB 450 to right lateral position (16,7%). Keywords: blood pressure, ICU, Progressive mobilization

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Acute Pulmonary Thromboembolism: A Retrospective Study in a Nigerian Private Tertiary Hospital

Annals of Health Research ◽

10.30442/ahr.0702-03-122 ◽

2021 ◽

Vol 7 (2) ◽

pp. 107-117

Author(s):

JO Ogunkoya ◽

AO Oluwole ◽

BO Adefuye ◽

AO Adebola-Yusuf ◽

O Ehioghae

Keyword(s):

Retrospective Study ◽

Mortality Rate ◽

Large Population ◽

Tertiary Hospital ◽

Pulmonary Angiography ◽

University Teaching ◽

Western World ◽

High Morbidity ◽

Co Morbidity ◽

Few Data

Background: Pulmonary embolism (PE) is a disease associated with high morbidity and mortality in the more technically advanced western world. However, in Africa and Nigeria in particular, the burden of PE is largely poorly defined as few data are available. Objectives: To characterize the clinical profile, management and outcomes in PE patients confirmed with Computerized Tomography Pulmonary Angiography (CTPA). Methods: A retrospective study was conducted at Babcock University Teaching Hospital, Ilishan-Remo, Nigeria. The medical records of PE patients confirmed by CTPA and admitted to the intensive care unit of the hospital spanning July 2016 to June 2020 were retrieved for analysis. Results: Thirty-one patients with the age range of 26 to 93 years were included and the mean age was 55.5±18.5 years. Breathlessness was the most prevalent presenting symptom. In the majority of patients (48.4%), the risk factors were not known. However, the most common risk factor and co-morbidity was pregnancy (16.1%). The in-hospital mortality rate was 9.7%. Conclusion: The clinical characteristics of PE in this cohort were similar to those described in the literature. The high mortality rate in this study also underscores the need for large population studies in black Africans.

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Neutrophil-to-lymphocyte Ratio as a Predictor of Mortality in ICU Patients: An Analysis of MIMIC-III Database

10.21203/rs.3.rs-88295/v1 ◽

2020 ◽

Author(s):

Xie Wu ◽

Zhanhao Su ◽

Qipeng Luo ◽

Yinan Li ◽

Hongbai Wang ◽

...

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Hospital Mortality ◽

Predictive Power ◽

Inflammatory Marker ◽

Survival Group ◽

Icu Patients ◽

Lymphocyte Ratio ◽

Saps Ii ◽

Death Group

Abstract Background: Identifying high-risk patients in intensive care unit (ICU) is very important because of the high mortality rate. Existing scoring systems are numerous but lack effective inflammatory markers. Our objective was to identify and evaluate a low-cost, easily accessible and effective inflammatory marker that can predict mortality in ICU patients.Methods: We conducted a retrospective study using data from the Medical Information Mart for Intensive Care III database. We first divided the patients into the survival group and the death group based on in-hospital mortality. Receiver operating characteristic analyses were performed to find the best inflammatory marker (i.e. neutrophil-to-lymphocyte ratio, NLR). We then re-divided the patients into three groups based on NLR levels. Univariate and multivariate logistic regression were performed to evaluate the association between NLR and mortality. The area under the curve (AUC), Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) were used to assess whether the incorporate of NLR can improve the predictive power of existing predictive model. Results: A total of 21,822 patients were included in this study, with an in-hospital mortality rate of 14.43%. Among all inflammatory marker in routine blood test results, NLR had the best predictive ability, with a median (interquartile range) NLR of 5.40 (2.95, 10.46) in the survival group and 8.32 (4.25, 14.75) in the death group. We then re-divided the patients into low (≤1), medium (1-6) and high (≥6) groups based on NLR levels. Compared with the median NLR group, the in-hospital mortality rates were significantly higher in the low (odds ratio [OR] = 2.09; 95% confidence interval [CI], 1.64 to 2.66) and high (OR=1.64; 95%CI, 1.50-1.80) NLR groups. The addition of NLR to Simplified Acute Physiology Score II (SAPS II) improved the AUC from 0.789 to 0.798 (P<0.001), with NRI of 16.64% (P<0.001) and IDI of 0.27% (P<0.001).Conclusion: NLR is a good predictor of mortality in ICU patients, both low and high levels of NLR are associated with elevated mortality rate. The inclusion of NLR might improve the predictive power of SAPS II.

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Mycetoma in Timor-Leste and first report of nocardiosis

Infectious Disease Reports ◽

10.4081/idr.2018.7804 ◽

2018 ◽

Vol 10 (3) ◽

Cited By ~ 1

Author(s):

Nicola Townell ◽

Thomas Locke ◽

Margaret Gibbons ◽

Dan Murphy ◽

Joshua Francis ◽

...

Keyword(s):

Causative Organism ◽

Molecular Testing ◽

High Morbidity ◽

Middle Income ◽

Diagnosis And Management ◽

Middle Income Countries ◽

First Case ◽

Soft Tissue Involvement ◽

Timor Leste ◽

Resource Issue

Mycetoma is a neglected tropical disease with an unknown global burden. Although considered endemic to South-east Asia, it has not previously been reported from Timor-Lest. We describe two cases in Timor-Leste, highlighting the challenges surrounding microbiological diagnosis and management shared by many low to middle-income countries. As characteristically described, both patients lived rurally and presented late with marked soft tissue involvement and multiple draining sinuses following a prolonged period of high morbidity. Nocardia brasiliensis, a beadedbranched, modified acid-fast, gram-positive bacilli, was isolated and confirmed by molecular testing in the first case. The causative organism in the second case could not be confirmed due to limited microbiological capabilities. Due to limited local laboratory capabilities, Nocardia spp. infection cannot be routinely confirmed in Timor- Leste. However, the microbiology laboratory is essential for the successful diagnosis and management of Mycetoma. In both cases, medical therapy alone resulted in cure and favorable outcomes, although supply of antibiotic remains an ongoing resource issue.

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Anxiety and depression symptoms in family members of icu patients

Avances en Enfermería ◽

10.15446/av.enferm.v33n1.48670 ◽

2015 ◽

Vol 33 (1) ◽

pp. 47-54 ◽

Cited By ~ 5

Author(s):

Maria Kourti ◽

Efstathia Christofilou ◽

George Kallergis

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Demographic Data ◽

Family Members ◽

Depression Scale ◽

Self Report ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Hospital Anxiety ◽

Icu Patients

Objective: This study investigated symptoms of anxiety and depression in relatives of patients admitted in the Intensive Care Unit and determined whether these symptoms were associated to the seriousness of the patients’ condition.Metodology: A total of 102 patients’ relatives were surveyed during the study. They were given a self-report questionnaire in order to assess demographic data, anxiety and depression symptoms. The symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (hads). Patient’s condition was evaluated with a.p.a.ch.e ii Score.Results: More than 60% of patients’ relatives presented severe symptoms of anxiety and depression. No relation was found between symptoms of anxiety and depression of the relatives of patients and patients’ condition of health. On the contrary, these feelings used to exist regardless of the seriousness of patient’s condition.Conclusions: The assessment of these patients is recommended in order serious problems of anxiety and depression to be prevented.

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1211. Microbiologic Evaluation of Mobile Phones and Hands of Healthcare Professionals in Two Intensive Care Units in a Brazilian University Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1074 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S435-S435

Author(s):

Evelyn Patricia Sanchez Espinoza ◽

Lauro Viera Perdigão Neto ◽

Sania Alves dos Santos ◽

Camila Risek ◽

Maria Renata Gomes Franco ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Mobile Phones ◽

Bacterial Colonization ◽

Healthcare Setting ◽

University Hospital ◽

High Rate ◽

High Morbidity ◽

Dominant Hand ◽

Cross Sectional

Abstract Background Healthcare-associated infections (HAIs) are a worldwide concern because of their high morbidity, mortality, and associated costs. Mobile phones (MP) are an important work tool in the healthcare setting, but they can be a reservoir of nosocomial pathogens if not carefully cleaned and cause re-contamination of the healthcare professional’s (HCP) hands. We aimed to evaluate bacterial colonization of HCP’s hands and their respective MPs. Methods A cross-sectional study was performed in two Intensive Care Units (ICUs), an internal medicine and a burn unit, of a Brazilian tertiary university hospital. These units were chosen because of their different hand hygiene (HH) compliance. We assessed HH and MP handling practices by an electronic inquiry and collected samples from the dominant hand (DH) by the sterile bag technique and of MPs by moistened sterile swab. MALDI-TOF was used for bacterial identification and Dilution Agar (DA) was used to screen Gram-negative bacteria (GNB) susceptibility to carbapenems and colistin. Results Forty-seven HCPs were evaluated; of whom, 30% were medical residents, 19% nurses, 17% nurse-technicians, 17% physiotherapists, 13% cleaning staff, and 4% radiology technicians.Overall, 85% of HCPs reported use of MP at work, 26% had never cleaned it, and 34% reported optimal HH compliance practices. All of them believed that MPs can have HAIs agents. DH culture showed 94% of colonization and the most common Gram-positive bacteria (GPB) and GNB were S. epidermidis (n = 17∕44) and A. baumannii complex (n = 11∕44), respectively. MP were colonized in 89% of the cases and the most common GPB and GNB were S. epidermidis (n = 16∕42) and Pseudomonas spp (n = 9∕42), respectively. Overall, in the screening 38% of GNB were resistant to meropenem and 22% to colistin. A. baumannii was the most common meropenem (n = 4) and colistin (n = 2) resistant GNB. In the two units, 32% of HCPs had the same microorganism species isolated in the MP and in the DH (Table 1). Conclusion There was a high rate of bacterial colonization on the MP and DH of HCPs and some of these bacteria were carbapenem or colistin resistant. A policy for MP handling in the healthcare setting should be implemented in order to avoid cross-contamination between the MP and the hand of HCPs. Disclosures All authors: No reported disclosures.

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