scholarly journals Detectable SARS-CoV-2 RNAemia in Critically Ill Patients, but Not in Mild and Asymptomatic Infections

2021 ◽  
Vol 48 (3) ◽  
pp. 154-160
Author(s):  
Enrico Richter ◽  
Doaa Al Arashi ◽  
Bianca Schulte ◽  
Christian Bode ◽  
Benjamin Marx ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Donation ◽  
Igg Antibodies ◽  
Blood Samples ◽  
Exact Test ◽  
Asymptomatic Patients ◽  
Neutralizing Capacity ◽  
Asymptomatic Individuals ◽  
Pcr Targeting

<b><i>Background:</i></b> The SARS-CoV-2 pandemic has challenged many of our current routine practices in the treatment and care of patients. Given the critical importance of blood donation and transfusion we analyzed 92 blood samples of individuals infected with SARS-CoV-2 stratified by symptoms. <b><i>Study Design and Methods:</i></b> We therefore tested blood samples for SARS-CoV-2 via RT-PCR targeting the E gene. In addition, we tested each blood sample for anti-SARS-CoV-2 IgG antibodies via ELISA and performed plaque reduction neutralization tests. <b><i>Results:</i></b> SARS-CoV-2 RNA was absent in the blood of mild to asymptomatic patients (57 individuals) and only detectable in individuals with severe COVID-19 who were admitted to the intensive care unit (35 individuals) (<i>n</i> = 6/92 [6.5%]; <i>p</i> = 0.023 Fisher’s exact test). Interestingly, anti-spike IgG antibodies were not significantly higher in intensive care unit patients compared to mild patients, but we found that their neutralizing capacity was disproportionately increased (<i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Our observations support the hypothesis that there are no potential hazards from blood or plasma transfusion of SARS-CoV-2-positive individuals with mild flu-like symptoms and more importantly of asymptomatic individuals.

Targeted Surveillance to Identify Children Colonized with Vancomycin-Resistant Enterococcus in the Pediatric Intensive Care Unit

2010 ◽  
Vol 31 (1) ◽  
pp. 95-98 ◽  
Author(s):  
Aaron M. Milstone ◽  
Lisa L. Maragakis ◽  
Karen C. Carroll ◽  
Trish M. Perl
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Infection Prevention ◽  
Pediatric Intensive Care ◽  
Vancomycin Resistant Enterococcus ◽  
Prevention Strategies ◽  
Asymptomatic Patients ◽  
Vancomycin Resistant ◽  
Pediatric Infection

Performing admission surveillance cultures is a resource-intensive strategy to identify asymptomatic patients with vancomycin-resistant Enterococcus (VRE) colonization. We measured VRE prevalence among children admitted to the pediatric intensive care unit. Targeted surveillance captured 94% of VRE-colonized children and may be an effective strategy to identify VRE carriers and facilitate pediatric infection prevention strategies.

Analysis of Central Line–Associated Bloodstream Infections in the Intensive Care Unit after Implementation of Central Line Bundles

2010 ◽  
Vol 31 (05) ◽  
pp. 551-553 ◽  
Author(s):  
Emily K. Shuman ◽  
Laraine L. Washer ◽  
Jennifer L. Arndt ◽  
Christy A. Zalewski ◽  
Robert C. Hyzy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Central Line ◽  
Line Bundles ◽  
Blood Samples ◽  
Central Lines ◽  
Definition Of ◽  
Contaminated Blood

Central line-associated bloodstream infections (CLABSIs) have been reduced in number but not eliminated in our intensive care units with use of central line bundles. We performed an analysis of remaining CLABSIs. Many bloodstream infections that met the definition of CLABSI had sources other than central lines or represented contaminated blood samples.

Changing the Time of Blood Collection to Determine Vancomycin Concentrations in Intensive Care Unit Patients

2018 ◽  
Vol 38 (1) ◽  
pp. 24-28
Author(s):  
Drayton A. Hammond ◽  
Taylor B. James ◽  
Lexis N. Atkinson ◽  
Jacob T. Painter ◽  
Katherine Lusardi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Sample ◽  
Medical Intensive Care Unit ◽  
Sample Collection ◽  
Blood Samples ◽  
Significant Difference ◽  
Vancomycin Trough ◽  
Medical Intensive Care ◽  
Trough Levels

BACKGROUND Clinical practice guidelines for initiation and therapeutic drug monitoring, but not timing, of vancomycin dosing exist at many institutions. Scheduling vancomycin trough measurements and doses around the morning blood sample collection could yield more interpretable troughs and increase patient safety. OBJECTIVE To evaluate the appropriateness of blood sample collection times for vancomycin trough measurements before and after an initiative to change the timing of blood sampling to determine vancomycin doses and trough levels in a medical intensive care unit. METHODS A retrospective cohort study was conducted of patients in a medical intensive care unit who received intravenous vancomycin at a scheduled interval. Differences in continuous and categorical data were compared between pre- and postintervention groups. The primary outcome was proportion of blood samples collected for vancomycin trough measurements within 30 minutes of the next scheduled vancomycin dose. RESULTS Baseline characteristics were similar between the preintervention (n = 68) and postintervention (n = 176) groups except for the percentage of blood samples drawn for trough measurements and morning laboratory tests (6% vs 81%; P &lt; .001). Frequency of loading doses was similar between patients in the pre- and postintervention groups, as was weight-based maintenance dosing. There was no significant difference in the percentage of blood samples collected to measure vancomycin trough levels appropriately at 30, 60, or 75 minutes from the next scheduled dose. CONCLUSION Measuring vancomycin trough levels in morning blood samples did not affect the percentage of inappropriately collected blood samples used to measure vancomycin trough levels.

scholarly journals Seroprevalence ofToxoplasma gondiiInfection in Patients of Intensive Care Unit in China: A Hospital Based Study

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Yong-Biao Zhang ◽  
Wei Cong ◽  
Zhi-Tao Li ◽  
Xiao-Gang Bi ◽  
Ying Xian ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lung Diseases ◽  
Latent Infection ◽  
Genetic Characterization ◽  
Kidney Diseases ◽  
Brain Diseases ◽  
Age Group ◽  
Igg Antibodies ◽  
Icu Patients

The objective of this study was to estimate the seroprevalence ofToxoplasma gondiiinfection in 394 patients of intensive care unit (ICU) in a hospital between April 2010 and March 2012 and analyze the association betweenT. gondiiinfection and ICU patients according to the species of disease.Toxoplasmaserology was evaluated by ELISA method using a commercially available kit. Data of patients were obtained from the patients, informants, and medical examination records. Seventy-four (18.78%) of 394 patients were positive for anti-T. gondiiIgG antibodies demonstrating latent infection.Of these, the highestT. gondiiseroprevalence was found in the age group of 31–45 years (27.45%), and the lowest was found in the age group of <30 years (12.5%). In addition, females (21.6%) had a higher seroprevalence than males (18.36%). With respect to the species of disease, the patients with kidney diseases (57.14%), lung diseases (27.84%), and brain diseases (24%) had highT. gondiiseroprevalence. The present study represents the first survey ofT. gondiiseroprevalence in ICU patients in China, revealing an 18.78% seropositivity. Considering the particularities of ICU patients, molecular identification, genetic characterization, and diagnosis ofT. gondiishould be considered in future study.

scholarly journals Is the COVID-19 Pandemic a Good Time to Include Aspergillus Molecular Detection to Categorize Aspergillosis in ICU Patients? A Monocentric Experience

2020 ◽  
Vol 6 (3) ◽  
pp. 105 ◽  
Author(s):  
Jean-Pierre Gangneux ◽  
Florian Reizine ◽  
Hélène Guegan ◽  
Kieran Pinceaux ◽  
Pierre Le Balch ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Invasive Aspergillosis ◽  
Molecular Detection ◽  
Good Time ◽  
Proof Of Concept ◽  
Icu Patients ◽  
Blood Samples ◽  
Fungal Burden ◽  
Higher Sensitivity

(1) Background: The diagnosis of invasive aspergillosis (IA) in an intensive care unit (ICU) remains a challenge and the COVID-19 epidemic makes it even harder. Here, we evaluated Aspergillus PCR input to help classifying IA in SARS-CoV-2-infected patients. (2) Methods: 45 COVID-19 patients were prospectively monitored twice weekly for Aspergillus markers and anti-Aspergillus serology. We evaluated the concordance between (I) Aspergillus PCR and culture in respiratory samples, and (II) blood PCR and serum galactomannan. Patients were classified as putative/proven/colonized using AspICU algorithm and two other methods. (3) Results: The concordance of techniques applied on respiratory and blood samples was moderate (kappa = 0.58 and kappa = 0.63, respectively), with a higher sensitivity of PCR. According to AspICU, 9/45 patients were classified as putative IA. When incorporating PCR results, 15 were putative IA because they met all criteria, probably with a lack of specificity in the context of COVID-19. Using a modified AspICU algorithm, eight patients were classified as colonized and seven as putative IA. (4) Conclusion: An appreciation of the fungal burden using PCR and Aspergillus serology was added to propose a modified AspICU algorithm. This proof of concept seemed relevant, as it was in agreement with the outcome of patients, but will need validation in larger cohorts.

scholarly journals Do Poor Functional Outcomes and Higher Morbidity Following Emergency Repair of Giant Hiatus Hernia Warrant Elective Surgery in Asymptomatic Patients?

2021 ◽  
Vol 8 ◽  
Author(s):  
Iulia Bujoreanu ◽  
Daniya Abrar ◽  
Savvas Lampridis ◽  
Ravindra Date
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hiatus Hernia ◽  
Surgical Repair ◽  
University Teaching ◽  
Chest Drain ◽  
Short Term ◽  
Major Morbidity ◽  
Emergency Repair ◽  
Asymptomatic Patients

Background: Patients with a giant hiatus hernia may present with acute symptoms caused by obstruction, strangulation, perforation and uncontrolled bleeding. Emergency surgical repair has been associated with significant mortality and even greater morbidity. The aim of this study is to investigate the short-term outcomes following emergency repair of giant hiatus hernias.Methods: Data were retrospectively collected for all patients who underwent emergency surgical repair of giant hiatus hernia in a university teaching hospital between 2009 and 2019. Outcomes were short-term morbidity and mortality. We also assessed the association of clinical predictor covariates, including age, ASA class and time to surgery, with risk for major morbidity.Results: Thirty-seven patients with a median age of 68 years were identified. Following surgery, 9 patients (24.3%) developed organ dysfunction that required admission to the intensive care unit. Two patients (5.4%) underwent revision surgery and 3 (8.1%) developed pneumothorax that necessitated chest drain insertion. The commonest complication was pneumonia, which occurred in 13 patients (35.1%). Two deaths (5.4%) occurred within 30 days from surgery.Conclusions: Emergency repair of giant hiatus hernia is associated with high rates of major morbidity, which includes poor functional status, further interventions, repeat surgery, and admission to the intensive care unit. Larger studies are warranted for long-term follow-up to assess post-operative quality of life is needed for asymptomatic patients and for those undergoing emergency surgery.

scholarly journals Bacteriological Profile and their Susceptibility Pattern in Neonatal Intensive Care Unit at Tertiary Care Hospital in Wah

2020 ◽  
Vol 24 (3) ◽  
pp. 219-224
Author(s):  
Saba Mushtaq ◽  
Sohail Ashraf ◽  
Lubna Ghazal ◽  
Rida Zahid ◽  
Basharat Hussain ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Blood Samples ◽  
Gram Negative ◽  
Gram Positive Cocci

Introduction: Neonatal sepsis is a clinical syndrome characterized by multiple symptoms and signs of infection during the first month of life. The objective of this study is to determine the frequency of commonly isolated bacteria from patients of neonatal sepsis and their susceptibility patterns in POF hospital at Wah. Methods: This cross-sectional study was carried out in POF Hospital Neonatal intensive care unit and Microbiology laboratory from January 2018 to December 2019. The blood samples of patients suspected with neonatal sepsis were processed as per standard methodology. Results: Out of ninety blood samples, fifty-one (56.7%) yielded the growth of Gram-negative rods and thirty-nine (43.3%) yielded Gram-positive cocci. Among Gram-positive bacteria, coagulase-negative staphylococci were the most common pathogen isolated from 53.8% cases followed by methicillin-resistant Staphylococcus aureus (15.3%). Among Gram-negative bacteria, Klebsiella pneumoniae (54.90%) was the most frequently identified bacteria followed by Serratia marcescens (27.45%). The Gram-positive cocci were the most susceptible to linezolid (100%) followed by vancomycin (87.2%). The Gram-negative rods depict remarkable resistance to ciprofloxacin (92.2%), gentamicin (100%), and meropenem (54.9%). Conclusions: The study concluded a predominance of Gram-negative bacteria as a causative agent of neonatal sepsis in our setup. The bacterial isolates are highly resistant to commonly prescribed oral as well as injectable antibiotics. Implementation of infection control policies is a dire need to combat the grave situation of increasing antibiotic resistance.

scholarly journals An Outbreak of Burkholderia Cepacia Septicemia in Neonatal Intensive Care Unit of a Tertiary Care Hospital, Peshawar

2021 ◽  
Author(s):  
Muhammad Abdullah ◽  
Maria Khan ◽  
Danyal Amjad ◽  
Farah Shireen ◽  
Shah masoom ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Burkholderia Cepacia ◽  
Neonatal Intensive Care ◽  
Physiological State ◽  
Tertiary Care ◽  
Diffusion Method ◽  
Care Hospital ◽  
Blood Samples

Abstract Background: Burkholderia cepacia (formerly Pseudomonas) is a gram-negative bacillus that can remain viable in low-nutrient water and is typically found in soil and moist settings. It is one of the leading causes of sepsis in infants, and it is spread by human contact with contaminated medical devices and disinfectants. B. cepacia has emerged as a significant opportunistic pathogen in hospitalized and immunocompromised patients, colonizing the lungs of individuals with cystic fibrosis. Hospital outbreaks have been associated to infected faucets, nebulizers, disinfection solutions, multi-dose antibiotic vials, drinking water, distilled water, flowmeters, nasal sprays, and ultrasound gels. We describe our investigation and successful management of a nosocomial Burkholderia cepacia sepsis outbreak in a tertiary care hospital's newborn intensive care unit in Peshawar, Pakistan.Methodology: Blood samples from 50 newborns with sepsis were collected using a standardized approach and incubated using an automated blood culture system (BACT/Alert 3D and BACTEC 9050). Disk diffusion and the Minimum inhibitory concentration methods were used to test antimicrobial susceptibility. Gram staining was used to identify bacteria, and API (Analytical Profile Index) 20 NE was used to characterize them biochemically. Environmental and epidemiological investigations were also conduct to investigate the source and route of infection.Results: All of the 50 patients admitted in NICU (Neonatal Intensive Care Unit) were included in this study, and had lately-onset neonatal sepsis, with B. cepacia. During an epidemic in the NICU from 30th, April to 21st, June 2021, B. cepacia was isolated from over 45 blood samples. In total 45 neonates 17(35%) were female and 28 (65%) were male. Average age of neonates was 14.88 days. Antibiotic susceptibility testing was performed on Muller Hinton agar using Kirby Bauer's disc diffusion method and interpreted according to Clinical Laboratory Standard Institute (CLSI 2021) guidelines. As B. cepacia has intrinsic resistant to polymyxin class (colistin sulphate) of antibiotics, the susceptibility pattern of all isolates were almost similar i.e. showing resistance to tetracycline 100% (minocycline) and cephalosporin 3rd generation 100% (ceftazidime). The isolates were 100% sensitive to fluoroquinolones (levofloxacin), carbapenem 100% (meropenem), chloramphenicol 100% and sulfonamide 100% (co trimaxazole).Conclusion: In present study, the index case might have been exposed to infection due to an intravenous fluid utilized for fluid and electrolyte replacement for intravenous delivery were the source of the current nosocomial outbreak and physiological state of low immunity (preterm, low birth weight, and mechanical ventilation). The rest of the cases might have been exposed to this organism due to inadequate hand hygiene/improper cleaning and disinfection practices. Timely reporting and implementation of infection control measures can play a significant role in curtailing this outbreak.

scholarly journals A Comparison of Syringes to Collect Blood for Analysis of Gases, Electrolytes and Glucose

1994 ◽  
Vol 22 (6) ◽  
pp. 698-702 ◽  
Author(s):  
B. G. Carter ◽  
J. Tibballs ◽  
M. Hochmann ◽  
A. Osborne ◽  
A. Chiriano ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Ionized Calcium ◽  
Blood Gas ◽  
Sodium Potassium ◽  
Blood Samples ◽  
Medical Products ◽  
Clinically Significant

We studied the interchangeability of two blood gas syringes (Johns, Hardie Health Care Products Pty Ltd and Marksman, Martell Medical Products Inc) for the collection of blood for the analysis of PCO2, PO2, pH, sodium, potassium and glucose in 71 intensive care unit patients. The interchangeability of these two syringes with a specially designed syringe (Radiometer, Radiometer A/S) for the collection of blood for the analysis of ionized calcium was also studied. Analysis of pH, sodium, potassium and glucose showed no clinically significant differences between samples collected with Johns and Marksman syringes. However, differences in PCO2 and PO2 in samples collected with these syringes may be clinically significant if the PO2 is less than 100 mmHg. There were no clinically significant differences in ionized calcium levels in blood samples collected with Johns, Marksman and Radiometer syringes. We conclude that Johns and Marksman syringes are interchangeable for the collection of blood for the analysis of PCO2, PO2, pH, sodium, potassium and glucose and they are also interchangeable with Radiometer syringes for the collection of blood for ionized calcium analysis.

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