scholarly journals Staphylococcus pettenkoferi Bacteremia in an American Intensive Care Unit

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Cameron Strong ◽  
Michael Cosiano ◽  
Melanie Cabezas ◽  
J. W. Barwatt ◽  
L. Gayani Tillekeratne
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Reports ◽  
Bloodstream Infections ◽  
Signs And Symptoms ◽  
The United States ◽  
Coagulase Negative Staphylococci ◽  
Prosthetic Devices ◽  
Increased Risk ◽  
Clinically Significant

Coagulase-negative staphylococci (CoNS) are considered the most common cause of nosocomial bloodstream infections; yet, these species are frequently designated as contaminants in the absence of systemic signs and symptoms of infection. Immunocompromised patients or those with prosthetic devices are at increased risk for clinically significant bacteremia. With the advent of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) in clinical practice, there has been improved specificity of CoNS isolate identification and further elucidation of underrecognized pathogenic species. Staphylococcus pettenkoferi was a novel CoNS species first identified in 2002 and thought to be misdiagnosed as other CoNS due to limitations in biochemical identification. There is increasing identification of S. pettenkoferi isolates; however, there are limited case reports of clinically significant S. pettenkoferi bacteremia and no reported cases within the United States. We present the first known case of S. pettenkoferi from an American intensive care unit.

scholarly journals Catheter-Associated Bloodstream Infections in General Medical Patients Outside the Intensive Care Unit: A Surveillance Study

2007 ◽  
Vol 28 (8) ◽  
pp. 905-909 ◽  
Author(s):  
Jonas Marschall ◽  
Carole Leone ◽  
Marilyn Jones ◽  
Deborah Nihill ◽  
Victoria J. Fraser ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
The United States ◽  
Medical Patients ◽  
Coagulase Negative Staphylococci ◽  
Saint Louis ◽  
Medical Icus ◽  
Medical Wards

Objective.To determine the incidence of central venous catheter (CVC)-associated bloodstream infection (CA-BSI) among patients admitted to general medical wards outside the intensive care unit (ICU).Design.Prospective cohort study performed over a 13-month period, from April 1, 2002, through April 30, 2003.Setting.Four selected general medical wards at Barnes-Jewish Hospital, a 1,250-bed teaching hospital in Saint Louis, Missouri.Patients.All patients admitted to 4 general medical wards.Results.A total of 7,337 catheter-days were observed during 33,174 patient-days. The device utilization ratio (defined as the number of catheter-days divided by the number of patient-days) was 0.22 overall and was similar among the 4 wards (0.21, 0.25, 0.19, and 0.24). Forty-two episodes of CA-BSI were identified (rate, 5.7 infections per 1,000 catheter-days). Twenty-four (57%) of the 42 cases of CA-BSI were caused by gram-positive bacteria: 10 isolates (24%) were coagulase-negative staphylococci, 10 (24%) were Enterococcus species, and 3 (7%) were Staphylococcus aureus. Gram-negative bacteria caused 7 infections (17%). Five CA-BSIs (12%) were caused by Candida albicans, and 5 infections (12%) had a polymicrobial etiology. Thirty-five patients (83%) with CA-BSI had nontunneled CVCs in place.Conclusions.Non-ICU medical wards in the study hospital had device utilization rates that were considerably lower than those of medical ICUs, but CA-BSI rates were similar to CA-BSI rates in medical ICUs in the United States. Studies of catheter utilization and on CVC insertion and care should be performed on medical wards. CA-BSI prevention strategies that have been used in ICUs should be studied on medical wards.

An Analysis of Patients Transferred to a Tertiary Oncological Intensive Care Unit for Defined Procedures

2015 ◽  
Vol 24 (3) ◽  
pp. 241-247 ◽  
Author(s):  
Sunil Kamat ◽  
Sanjay Chawla ◽  
Prabalini Rajendram ◽  
Stephen M. Pastores ◽  
Natalie Kostelecky ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cancer Patients ◽  
Signs And Symptoms ◽  
The United States ◽  
Outcome Data ◽  
Lengths Of Stay ◽  
Intensive Care Unit Transfer ◽  
Tumor Bleeding ◽  
Oncological Center

Background Up to 50 000 intensive care unit interhospital transfers occur annually in the United States. Objective To determine the prevalence, characteristics, and outcomes of cancer patients transferred from an intensive care unit in one hospital to another intensive care unit at an oncological center and to evaluate whether interventions planned before transfer were performed. Methods Data on transfers for planned interventions from January 2008 through December 2012 were identified retrospectively. Demographic and clinical variables, receipt of planned interventions, and outcome data were analyzed. Results Of 4625 admissions to an intensive care unit at the oncological center, 143 (3%) were transfers from intensive care units of other hospitals. Of these, 47 (33%) were transfers for planned interventions. Patients’ mean age was 57 years, and 68% were men. At the time of intensive care unit transfer, 20 (43%) were receiving mechanical ventilation. Interventions included management of airway (n = 19) or gastrointestinal (n = 2) obstruction, treatment of tumor bleeding (n = 12), chemotherapy (n = 10), and other (n = 4). A total of 37 patients (79%) received the planned interventions within 48 hours of intensive care unit arrival; 10 (21%) did not because their signs and symptoms abated. Median intensive care unit and hospital lengths of stay at the oncological center were 4 and 13 days, respectively. Intensive care unit and hospital mortality rates were 11% and 19%, respectively. Deaths occurred only in patients who received interventions. Conclusions Interhospital transfers of cancer patients to an intensive care unit at an oncological center are infrequent but are most commonly done for direct interventional care. Most patients received planned interventions soon after transfer.

scholarly journals Delay of Active Antimicrobial Therapy and Mortality among Patients with Bacteremia: Impact of Severe Neutropenia

2008 ◽  
Vol 52 (9) ◽  
pp. 3188-3194 ◽  
Author(s):  
Michael Y. Lin ◽  
Robert A. Weinstein ◽  
Bala Hota
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Antimicrobial Therapy ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
The United States ◽  
Severe Neutropenia ◽  
Urban Hospital ◽  
The Impact

ABSTRACT Increasing bacterial antimicrobial resistance has prompted physicians to choose broad-spectrum antimicrobials in order to reduce the likelihood of inactive empirical therapy. However, for bacteremic patients already receiving supportive care, it is unclear whether delay of active antimicrobial therapy significantly impacts patient outcomes. We performed a retrospective cohort study of patients with monomicrobial bloodstream infections at a large urban hospital in the United States from 2001 to 2006. We assessed the impact of delay of active antimicrobial therapy on mortality by using multivariable logistic regression modeling with and without propensity score methodology. We evaluated 1,523 episodes of monomicrobial bacterial bloodstream infections at our institution. Nine hundred eighty-three bacteremic episodes (64.5%) were treated with an active antimicrobial agent within 24 h of the index blood culture; the remaining 540 episodes (35.5%) were considered to have delay of active antimicrobial therapy. In adjusted analysis, among patients in the non-intensive-care-unit setting with an absolute neutrophil count (ANC) of <100 cells/μl, delay was associated with increased mortality (odds ratio [OR], 18.0; 95% confidence interval [CI], 2.84 to 114.5; P < 0.01); among intensive-care-unit patients with an ANC of <100 cells/μl, the effect of delay on mortality was nearly significant (OR, 5.56; 95% CI, 0.85 to 36.3; P = 0.07). However, for patients who were nonneutropenic (ANC, >500 cells/μl) or had ANCs of 100 to 500 cells/μl, delay was not associated with increased mortality. While the delay of active antimicrobial therapy was not significantly associated with higher mortality for most patients in this cohort, patients with severe neutropenia appeared to be vulnerable.

scholarly journals Invasive Haemophilus influenzae Disease in Adults ≥65 Years, United States, 2011

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Amy Blain ◽  
Jessica MacNeil ◽  
Xin Wang ◽  
Nancy Bennett ◽  
Monica M. Farley ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Haemophilus Influenzae ◽  
Disease Severity ◽  
Burden Of Disease ◽  
The United States ◽  
Age Group ◽  
Do Not Resuscitate ◽  
Increased Risk

Abstract Background.  Since the introduction of the Haemophilus influenzae serotype b vaccine, H influenzae epidemiology has shifted. In the United States, the largest burden of disease is now in adults aged ≥65 years. However, few data exist on risk factors for disease severity and outcome in this age group. Methods.  A retrospective case-series review of invasive H influenzae infections in patients aged ≥65 years was conducted for hospitalized cases reported to Active Bacterial Core surveillance in 2011. Results.  There were 299 hospitalized cases included in the analysis. The majority of cases were caused by nontypeable H influenzae, and the overall case fatality ratio (CFR) was 19.5%. Three or more underlying conditions were present in 63% of cases; 94% of cases had at least 1. Patients with chronic heart conditions (congestive heart failure, coronary artery disease, and/or atrial fibrillation) (odds ratio [OR], 3.27; 95% confidence interval [CI], 1.65–6.46), patients from private residences (OR, 8.75; 95% CI, 2.13–35.95), and patients who were not resuscitate status (OR, 2.72; 95% CI, 1.31–5.66) were more likely to be admitted to the intensive care unit (ICU). Intensive care unit admission (OR, 3.75; 95% CI, 1.71–8.22) and do not resuscitate status (OR, 12.94; 95% CI, 4.84–34.55) were significantly associated with death. Conclusions.  Within this age group, burden of disease and CFR both increased significantly as age increased. Using ICU admission as a proxy for disease severity, our findings suggest several conditions increased risk of disease severity and patients with severe disease were more likely to die. Further research is needed to determine the most effective approach to prevent H influenzae disease and mortality in older adults.

Journey to Zero Central Line-Associated Bloodstream Infections: An Intensive Care Unit's Story of Sustained Success and Quality Improvement

2016 ◽  
Vol 21 (2) ◽  
pp. 76-80 ◽  
Author(s):  
Leighann Jock ◽  
Laurie Emery ◽  
Lorri Jameson ◽  
Phyllis A. Woods
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Chlorhexidine Gluconate ◽  
Staff Education ◽  
Increased Risk ◽  
The Face ◽  
Sustained Success ◽  
Clabsi Rate

Abstract Background: Patients who have a central line (CL) are at increased risk for developing a CL-associated bloodstream infection (CLABSI), which increases morbidity, length of stay, and cost. Our goal is zero CLABSI infections. Methodology: In 2009 our organization implemented a CL bundle to prevent CLABSIs, and staff education was introduced in 2012. In 2013 a 2% chlorhexidine gluconate (CHG) wipe was introduced and used to clean around CL dressings. In 2014 a new CL dressing was adopted and during 2015 the organization began using a 3.15% CHG/70% alcohol swab for disinfection of needleless connectors. A final intervention was put into place in 2015 called “nose to toes” in which a patient is bathed from nose to toes (excluding the face) using 2% CHG wipes. Results: Before implementation of the above methods, our intensive care unit had an average infection rate of 1.9/1000 CL-days in 2009. Incidence of CLABSIs continued to decrease as the organization implemented the additional products and practices. In the 15 months following implementation, the ICU has been able to consistently maintain a zero CLABSI rate. Conclusions: The implementation of these changes in practice along with bringing in new products has made it possible to achieve the goal of reaching and maintaining zero infections. Due to the successful results in our intensive care unit, we have implemented these changes to all patient care areas in the hospital for use on all CLs.

scholarly journals Prophylaxis for Stress Ulcers With Proton Pump Inhibitors Is Not Associated With Increased Risk of Bloodstream Infections in the Intensive Care Unit

2017 ◽  
Vol 15 (7) ◽  
pp. 1030-1036.e1 ◽  
Author(s):  
Margot E. Cohen ◽  
Joanne M. Hathway ◽  
Hojjat Salmasian ◽  
Jianfang Liu ◽  
Melissa Terry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Bloodstream Infections ◽  
Stress Ulcers ◽  
Increased Risk

scholarly journals Considerations in the provision of teleconsultations for outpatient obstetric anaesthesia care during the Covid-19 pandemic

2021 ◽  
pp. 201010582199117
Author(s):  
Leonard Wei Wen Loh ◽  
Yingke He ◽  
Hairil Rizal Abdullah ◽  
Kai Lee Ng ◽  
Un Sam Mok
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Severe Illness ◽  
Continuing Care ◽  
Short Report ◽  
Obstetric Anaesthesia ◽  
Increased Risk ◽  
Process And Outcome ◽  
Risk Of Exposure ◽  
Anaesthesia Care

Evidence has emerged that pregnant women who contract coronavirus disease 2019 (Covid-19) are at increased risk of certain forms of severe illness as well as complications requiring intensive care unit admission and resultant mortality. Teleconsultations can facilitate continuing care for obstetric patients during the Covid-19 pandemic while reducing their risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this short report, we share our experience in the provision of teleconsultations for ambulatory obstetric anaesthesia patients in our high-risk obstetric anaesthesia clinic during the Covid-19 pandemic. Appropriate labour analgesia or anaesthesia plans were able to be formulated and communicated to the patients by teleconsultation, resulting in no delay or compromise in their peripartum care. Both patients and clinicians reported satisfaction with the teleconsultation process and outcome. The considerations and challenges in setting up a teleconsultation service as well as the factors in favour of teleconsultation are also explored.

scholarly journals Observational study of thrombosis and bleeding in COVID-19 VV ECMO patients

2021 ◽  
pp. 039139882198906
Author(s):  
Brianda Ripoll ◽  
Antonio Rubino ◽  
Martin Besser ◽  
Chinmay Patvardhan ◽  
William Thomas ◽  
...  
Keyword(s):  
Intensive Care ◽  
Ct Scan ◽  
Thrombotic Event ◽  
Area Under The Curve ◽  
Whole Body ◽  
Bleeding Events ◽  
Heparin Resistance ◽  
Increased Risk ◽  
Thrombotic Complications ◽  
Clinically Significant

Introduction: COVID-19 has been associated with increased risk of thrombosis, heparin resistance and coagulopathy in critically ill patients admitted to intensive care. We report the incidence of thrombotic and bleeding events in a single center cohort of 30 consecutive patients with COVID-19 supported by veno-venous extracorporeal oxygenation (ECMO) and who had a whole body Computed Tomography Scanner (CT) on admission. Methodology: All patients were initially admitted to other hospitals and later assessed and retrieved by our ECMO team. ECMO was initiated in the referral center and all patients admitted through our CT scan before settling in our intensive care unit. Clinical management was guided by our institutional ECMO guidelines, established since 2011 and applied to at least 40 patients every year. Results: We diagnosed a thrombotic event in 13 patients on the initial CT scan. Two of these 13 patients subsequently developed further thrombotic complications. Five of those 13 patients had a subsequent clinically significant major bleeding. In addition, two patients presented with isolated intracranial bleeds. Of the 11 patients who did not have baseline thrombotic events, one had a subsequent oropharyngeal hemorrhage. When analyzed by ROC analysis, the area under the curve for % time in intended anticoagulation range did not predict thrombosis or bleeding during the ECMO run (0.36 (95% CI 0.10–0.62); and 0.51 (95% CI 0.25–0.78); respectively). Conclusion: We observed a high prevalence of VTE and a significant number of hemorrhages in these severely ill patients with COVID-19 requiring veno-venous ECMO support.

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