scholarly journals Incidence and Risk Factors of Ventilator-Associated Pneumonia among Patients with Delirium in the Intensive Care Unit: A Prospective Observational Study

2022 ◽  
Vol 2022 ◽  
pp. 1-6
Author(s):  
Morteza Shamsizadeh ◽  
Ali Fathi Jouzdani ◽  
Farshid Rahimi-Bashar
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Observational Study ◽  
Early Onset ◽  
Prospective Observational Study ◽  
Cox Regression ◽  
Cox Proportional Hazards Model ◽  
Icu Mortality ◽  
Icu Stay ◽  
The Impact

Introduction. The incidence and risk factors for ventilator-related pneumonia (VAP) in patients with delirium are deficient, and there is a lack of in-depth knowledge of the impact of VAP on outcomes in this population. We investigated the incidence, risk factors, and outcomes of VAP in patients with delirium. Materials and Methods. This prospective observational study was performed in a surgical ICU at Be’sat Hospital in Hamadan, Iran, between 2018 and 2019. A total of 108 patients with delirium were identified using the Confusion Assessment Method (CAM) for the ICU and Intensive Care Delirium Screening Checklist (ICDSC) and enrolled in this study. The association between VAP and delirium, risk factors, and outcomes (ICU length of stay and ICU mortality) for VAP were investigated using the Cox proportional hazards model and logistic and simple linear regression analyses with a 95% confidence interval. Results. Of 108 delirium patients, 86 patients (79.6%) underwent mechanical ventilation (MV) and 16 patients (18.6%) experienced VAP during ICU stay. The median onset of VAP was 6.5 (IQR 4.2–7.7) days after intubation. Delirium patients with VAP stayed longer in the ICU (21.68 ± 4.26 vs.12.93 ± 1.71, P < 0.001 ) and also had higher ICU mortality (31.25% vs. 0%, P < 0.001 ) than subjects without VAP. According to multivariate cox regression, the expected HR for VAP was 53.5% lower for patients with early-onset delirium than in patients with late-onset delirium (HR: 0.465, 95% CI: 0.241–0.894, P = 0.022 ). However, the expected hazard for VAP was 1.854 times and 4.604 times higher in patients with longer ICU stay (HR: 1.854, 95% CI: 1.689–3.059, P = 0.032 ) and in patients with a prolonged MV duration (HR: 4.604, 95%CI: 1.567–6.708, P = 0.023 ). Conclusion. According to the results, there seems to be an inverse relationship between early onset of delirium and VAP. This finding cannot be conclusively cited, and more studies in this filed should be conducted with a larger sample size. Furthermore, VAP in delirium patients is associated with increases in poor outcomes (higher ICU mortality) and the use of medical resources (longer stay in the ICU and MV duration).

scholarly journals Mortality dynamics of Pseudomonas aeruginosa bloodstream infections and the influence of defective OprD on mortality: prospective observational study

2019 ◽  
Vol 74 (9) ◽  
pp. 2774-2783 ◽  
Author(s):  
Eun-Jeong Yoon ◽  
Dokyun Kim ◽  
Hyukmin Lee ◽  
Hye Sun Lee ◽  
Jeong Hwan Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Cox Regression ◽  
Bloodstream Infections ◽  
Clinical Settings ◽  
Kaplan Meier ◽  
Steep Decrease

Abstract Background To assess the mortality dynamics of patients with Pseudomonas aeruginosa bloodstream infections (BSIs) and the influence of OprD deficiencies of the microorganism on early mortality. Methods A prospective multicentre observational study was conducted with 120 patients with P. aeruginosa BSIs occurring between May 2016 and April 2017 in six general hospitals in South Korea. PCR and sequencing were carried out to identify the alterations in oprD and the presence of virulence factors. Cox regression was used to estimate the risk factors for mortality at each timepoint and Kaplan–Meier survival analyses were performed to determine the mortality dynamics. Results During the 6 week follow-up, 10.8% (13/120) of the patients with P. aeruginosa BSIs died in 2 weeks, 14.2% (17/120) in 4 weeks and 20.0% (24/120) in 6 weeks, revealing a steep decrease in cumulative survival between the fourth and sixth weeks. ICU admission and SOFA score were risk factors for mortality in any weeks after BSI onset and causative OprD-defective P. aeruginosa had a risk tendency for mortality within 6 weeks. Among the 120 P. aeruginosa blood isolates, 14 were XDR, nine produced either IMP-6 or VIM-2 MBL, and 21 had OprD deficiency. Conclusions BSIs caused by OprD-defective P. aeruginosa resulted in a 2-fold higher 6 week mortality rate (33.3%) than that of BSIs caused by OprD-intact P. aeruginosa (17.2%), likely due to the decreased susceptibility to carbapenems and bacterial persistence in clinical settings.

Candida auris candidaemia in an intensive care unit – Prospective observational study to evaluate epidemiology, risk factors, and outcome

2020 ◽  
Vol 57 ◽  
pp. 42-48 ◽  
Author(s):  
Prakash S. Shastri ◽  
Shamanth A. Shankarnarayan ◽  
Jaswinder Oberoi ◽  
Shivaprakash M. Rudramurthy ◽  
Chand Wattal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Candida Auris

Drug interactions and creatinine levels are associated with QTc prolongation in intensive care units: a prospective, observational study

2019 ◽  
Vol 34 (4) ◽  
Author(s):  
Zeinab Hosseinpoor ◽  
Behrooz Farzanegan ◽  
Seyyed Reza Seyyedi ◽  
Mehdi Rajabi ◽  
Shadi Baniasadi
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Observational Study ◽  
Drug Interactions ◽  
Prospective Observational Study ◽  
High Serum ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Icu Admission ◽  
Life Threatening

Abstract Background Prolongation of the QTc interval may lead to life threatening arrhythmias. QTc prolongation is common in intensive care unit (ICU) patients. The objectives of this study were to identify the role of drug-drug interactions (DDIs) and other predictors (age, sex, cardiovascular diseases, and electrolyte abnormalities) in life threatening QTc prolongation in patients admitted to medical (M), surgical (S) and emergency (E) ICUs. Methods This prospective, observational study included patients above the age of 18 years who were admitted to SICU, EICU, and MICU at a tertiary respiratory referral center. Electrocardiogram (ECG) monitoring was performed during the first 5 days of ICU admission. Risk factors and DDIs which were anticipated to be associated with the prolongation of the QTc interval were assessed for all patients. Results Two hundred patients were included in the study. QTc prolongation occurred in 10.7% of patients and the majority of patients presenting with QTc prolongation had creatinine levels above 1.3 mg/dL during their 5 days of ICU admission. Incidence of pharmacodynamic (PD) DDIs was significantly higher in patients with QTc prolongation vs. other patients. Creatinine levels above 1.3 mg/dL and PD DDIs were associated with QTc prolongation during 5 days of ICU admission. Conclusions High serum creatinine and PD DDIs can increase the risk of QTc prolongation in patients admitted to the ICU. QTc interval measurements should be performed prior to initiation or after starting any drug that is associated with QT prolongation, specifically in patients with the known risk factors.

The Introduction of Intensive Care-Led Echocardiography into a Tertiary Care Unit

2013 ◽  
Vol 14 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Shirjel Alam ◽  
Annemarie Docherty ◽  
Ian Mackle ◽  
Michael Gillies
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
British Society ◽  
Tertiary Referral ◽  
Trained Staff ◽  
The Impact ◽  
Echocardiographic Findings

The objective of this study was to evaluate the feasibility and impact of an intensive care-led trans-thoracic echocardiography (TTE) service replacing a cardiology-led service. Three intensivists were trained and accredited with the British Society of Echocardiography, and between 1st February and 1st August 2010 intensive care implemented a 24-hour scanning service. A prospective observational study was performed to examine the impact in our tertiary referral general intensive care unit. ECG, echocardiographic findings, technical difficulties and any changes in management made as a result of a TTE were recorded. Of 125 attempted scans, 120 patients had full studies (96%), four had limited studies (3%) and one was not possible. TTE changed management in 61 (49%) cases. This compares to only 57 scans performed in total in the preceding six months with a cardiology-led service. We conclude that intensive care-led TTE is feasible when carried out by trained staff, led to greater use of echocardiography and a change in management in almost half the patients studied.

scholarly journals Prospective Observational Study of the Impact of VIM-1 Metallo-β-Lactamase on the Outcome of Patients with Klebsiella pneumoniae Bloodstream Infections

2009 ◽  
Vol 53 (5) ◽  
pp. 1868-1873 ◽  
Author(s):  
George L. Daikos ◽  
Panayiotis Petrikkos ◽  
Mina Psichogiou ◽  
Chris Kosmidis ◽  
Evangelos Vryonis ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Cox Regression ◽  
Carbapenem Resistance ◽  
Bloodstream Infections ◽  
Underlying Disease ◽  
Cox Regression Analysis ◽  
Definitive Therapy ◽  
The Impact

ABSTRACT VIM-1-producing Klebsiella pneumoniae (VPKP) is an emerging pathogen. A prospective observational study was conducted to evaluate the importance of VIM production on outcome of patients with K. pneumoniae bloodstream infections (BSIs). Consecutive patients with K. pneumoniae BSIs were identified and followed up until patient discharge or death. A total of 162 patients were included in the analysis; 67 (41.4%) were infected with VPKP, and 95 were infected with non-VPKP. Fourteen of the patients infected with VPKP were carbapenem resistant (Carbr) (MIC > 4 μg/ml), whereas none of the non-VPKP exhibited carbapenem resistance. The patients infected with a Carbr organism were more likely (odds ratio, 4.08; 95% confidence interval [CI], 1.29 to 12.85; P = 0.02) to receive inappropriate empirical therapy. The all-cause 14-day mortality rates were 15.8% (15 of 95) for patients infected with VIM-negative organisms, 18.9% (10 of 53) for those infected with VIM-positive carbapenem-susceptible organisms, and 42.9% (6 of 14) for those infected with VIM-positive Carbr organisms (P = 0.044). In Cox regression analysis, age (hazard ratio [HR], 1.03; 95% CI, 1.01 to 1.06; P = 0.021), rapidly fatal underlying disease (HR, 2.84; 95% CI, 1.26 to 6.39; P = 0.012), and carbapenem resistance (HR, 2.83; 95% CI, 1.08 to 7.41; P = 0.035) were independent predictors of death. After adjustment for inappropriate empirical or definitive therapy, the effect of carbapenem resistance on outcome was reduced to a level of nonsignificance. In patients with K. pneumoniae BSIs, carbapenem resistance, advanced, age, and severity of underlying disease were independent predictors of outcome, whereas VIM production had no effect on mortality. The higher mortality associated with carbapenem resistance was probably mediated by the failure to provide effective therapy.

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