Impact of Pharmacist-Directed Simplified Procalcitonin Algorithm on Antibiotic Therapy in Critically Ill Patients With Sepsis

Purpose: The purpose was to determine whether a simplified procalcitonin (PCT) algorithm guided by pharmacist recommendations reduces antibiotic duration of therapy in critically ill patients with suspected sepsis. Methods: This was a single-centered pre-post study conducted at a 1368-bed community teaching hospital in the United States. A prospective cohort with pharmacist intervention utilizing a simplified PCT algorithm was compared with a retrospective historical cohort with standard therapy. Adult patients admitted to the intensive care unit (ICU) with suspected sepsis who received intravenous antibiotics were included. A pharmacist recommended continuation or discontinuation of antibiotics based on the PCT level per our algorithm and full clinical assessment of the patient. Primary outcome was total duration of antibiotic therapy. Secondary outcomes were ICU and hospital length of stay (LOS), reinitiation of antibiotic therapy within 72 hours of discontinuation, and 28-day in-hospital mortality. Results: From September 2017 to May 2018, 360 patients were screened for eligibility. Of these, 26 patients were included in the PCT group and 26 patients in the standard therapy group. Baseline characteristics were similar between groups. A significant difference in duration of antibiotic therapy was detected with a median of 9 days in the PCT group versus 12 days in the standard therapy group ( P = .02). There were no significant differences in secondary endpoints of ICU and hospital LOS, reinitiation of antibiotics at 72 hours, or 28-day mortality. Conclusion: Use of a simplified PCT algorithm with pharmacist-guided recommendations significantly reduced the duration of antibiotic therapy in critically ill patients with sepsis.

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Impact of Pharmacist-Led Procalcitonin-Guided Antibiotic Therapy in Critically Ill Patients With Pneumonia

Hospital Pharmacy ◽

10.1177/0018578719836643 ◽

2019 ◽

Vol 55 (3) ◽

pp. 204-210

Author(s):

Bibidh Subedi ◽

Patricia Louzon ◽

Kristie Zappas ◽

Wilfred Onyia ◽

Kevin DeBoer

Keyword(s):

Antibiotic Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Standard Therapy ◽

Therapy Group ◽

The United States ◽

Hospital Length Of Stay ◽

Standard Therapy Group ◽

Historical Cohort ◽

Secondary Endpoints

Purpose: Procalcitonin (PCT) is a peptide that is released in response to bacterial infections. The 2016 Infectious Diseases Society of America pneumonia guidelines recommend PCT monitoring to help guide antibiotic discontinuation. Utilization of PCT is well described in the literature; however, there is a paucity of literature regarding pharmacists’ involvement for using PCT in antibiotic interventions. The objective of this study was to investigate the effect of pharmacist-led intervention with PCT-guided antibiotic therapy in critically ill patients with pneumonia. Methods: This was a pre-post study conducted at a 1368-bed community teaching hospital in the United States. A prospective cohort with pharmacist intervention utilizing PCT-algorithm guidance was compared with a retrospective historical cohort with standard therapy. Adult patients admitted to the intensive care unit (ICU) with pneumonia were included. The primary endpoint was duration of antibiotic therapy. Secondary endpoints included 28-day mortality, ICU and hospital length of stay, reinitiation of antibiotic therapy, and the incidence of Clostridium difficile infection. Results: From August 2016 to July 2017, 113 patients were screened in the PCT group and 123 patients in the standard therapy group. Of these, 37 patients were included in the PCT group and 37 patients in the standard therapy group. Baseline characteristics were similar between the 2 groups. The antibiotic duration of therapy was 6.3 days in the PCT group versus 9.7 days in the standard therapy group ( P < .001). There were no differences in secondary endpoints between the 2 groups. Conclusion: Clinical pharmacists’ intervention with PCT-guided antibiotic therapy led to a reduction in the duration of antibiotic therapy in critically ill patients with pneumonia without increasing complications.

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Losartan therapy and hyperuricemia correction in patients with metabolic syndrome and arterial hypertension

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2011-6-24-29 ◽

2011 ◽

Vol 10 (6) ◽

pp. 24-29

Author(s):

S. V. Nedogoda ◽

E. V. Chumachok ◽

A. A. Ledyaeva ◽

V. V. Tsoma

Keyword(s):

Metabolic Syndrome ◽

Arterial Hypertension ◽

Standard Therapy ◽

Therapy Group ◽

Angiotensin Ii Receptor ◽

Standard Therapy Group ◽

Significant Difference ◽

Losartan Group ◽

Randomised Controlled

Aim. To assess the potential of the angiotensin II receptor antagonist losartan for the correction of hyperuricemia (HU) in patients with arterial hypertension (AH) and metabolic syndrome (MS). Material and methods. This open, randomised, controlled comparative study in parallel groups included 60 AH patients with MS and HU. The patients received losartan or standard therapy for 12 weeks. Results. Throughout the follow-up period, no significant difference in antihypertensive effect was observed between the losartan and standard therapy groups. Losartan group patients demonstrated a more pronounced decrease in uric acid levels (-34,7 % vs. -7,8 % in the standard therapy group; p<0,05). In addition, losartan therapy, compared to the standard treatment, was associated with improved vascular elasticity, as manifested by the pulse wave velocity decrease (-27,8 % vs. -8,1 % for carotid-femoral index, and -30,2 % vs. -12,6 % for carotidradial index, respectively; both p<0,05).

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Ofloxacin versus standard therapy in treatment of community-acquired pneumonia requiring hospitalization. Pneumonia Study Group.

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.40.5.1175 ◽

1996 ◽

Vol 40 (5) ◽

pp. 1175-1179 ◽

Cited By ~ 49

Author(s):

J F Plouffe ◽

M T Herbert ◽

T M File ◽

I Baird ◽

J N Parsons ◽

...

Keyword(s):

Standard Therapy ◽

Clinical Success ◽

Therapy Group ◽

The United States ◽

Community Acquired Pneumonia ◽

Oral Antibiotic ◽

Respiratory Pathogens ◽

Standard Therapy Group ◽

Empiric Treatment ◽

The Mean

Community-acquired pneumonia occurs 3 to 4 million times per year in the United States, accounting for about 500,000 hospitalizations annually. Empiric treatment is usually instituted because of a lack of early organism-specific diagnostic tests. This study compared empiric therapy with ofloxacin to standard antibiotic regimens (usually a beta-lactam with or without a macrolide) for patients hospitalized for community-acquired pneumonia. Therapy was administered to 298 patients (146 receiving ofloxacin and 152 receiving standard therapy); 227 patients (ofloxacin, 109; standard treatment, 118) were evaluable for treatment efficacy. The most common pyogenic respiratory pathogens were Haemophilus influenzae (30 isolates) and Streptococcus pneumoniae (24 isolates). There was evidence of infection with either Mycoplasma pneumoniae (38 patients), Chlamydia pneumoniae (40 patients), or a Legionella sp. (8 patients) in a total of 79 patients (35%). The clinical success rates were similar in both groups among evaluable patients (92%, ofloxacin; 87%, standard therapy) and among patients with atypical respiratory pathogens (88%, ofloxacin; 81%, standard therapy). The mean numbers (+/- the standard deviations) of intravenous doses of antibiotics were 7.5 +/- 8.0 in the ofloxacin group and 18.4 +/- 18.5 in the standard therapy group (P < 0.001); the mean number of oral doses of ofloxacin per patient was 19.7 +/- 11.2, compared with 30.2 +/- 16.0 oral antibiotic doses in the standard therapy group (P < 0.001). All treatments were well tolerated and associated with no significant clinical or laboratory abnormalities. The findings of this study indicate that ofloxacin is active against traditional bacterial pathogens as well as the major atypical respiratory pathogens. When given as monotherapy for the empiric treatment of community-acquired pneumonia, ofloxacin is as effective as standard antimicrobial therapy.

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The Prognostic Importance of Serum Sodium for Mortality among Critically Ill Patients Requiring Continuous Renal Replacement Therapy

Nephron ◽

10.1159/000519686 ◽

2021 ◽

pp. 1-7

Author(s):

Tananchai Petnak ◽

Charat Thongprayoon ◽

Wisit Cheungpasitporn ◽

Khaled Shawwa ◽

Michael A. Mao ◽

...

Keyword(s):

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Serum Sodium ◽

Critically Ill Patients ◽

The United States ◽

Tertiary Hospital ◽

Normal Serum ◽

Historical Cohort

Background: Serum sodium derangement is common in critically ill patients requiring continuous renal replacement therapy (CRRT). We aimed to assess the association between serum sodium before and during CRRT with mortality. Methods: This is a historical cohort study of 1,520 critically ill patients receiving CRRT from December 2006 through November 2015 in a tertiary hospital in the United States. Using logistic regression analysis, we used serum sodium before CRRT, mean serum sodium, and serum sodium changes during CRRT to predict 90-day mortality after CRRT initiation. Results: Compared with the normal serum sodium levels, the odds ratio (OR) of 90-day mortality in patients with serum sodium before CRRT of 143–147 and ≥148 mmol/L were 1.45 (95% CI 1.03–2.05) and 2.24 (95% CI 1.33–3.87), respectively. There was no significant increase in 90-day mortality in serum sodium of ≤137 mmol/L. During CRRT, the mean serum sodium levels of ≤137 (OR 1.41; 95% CI 1.01–1.98) and ≥143 mmol/L (OR 1.52; 95% CI 1.14–2.03) were associated with higher 90-day mortality. The greater serum sodium changes during CRRT were associated with higher 90-mortality (OR 1.35; 95% CI 1.21–1.51 per 5-mmol/L increase). Conclusion: Before CRRT initiation, hypernatremia and during CRRT, hypo- and hypernatremia were associated with increased mortality.

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Operation of a hyperbaric oxygen therapy center in Korea: Report of our experience from a setting in its nascent stages

Undersea and Hyperbaric Medicine ◽

10.22462/04.06.2019.6 ◽

2019 ◽

pp. 135-143

Author(s):

Yoon Seop Kim ◽

Yoonsuk Lee ◽

Sun Ju Kim ◽

Sung Oh Hwang ◽

Yong Sung Cha ◽

...

Keyword(s):

Critically Ill ◽

Hyperbaric Oxygen ◽

Critically Ill Patients ◽

Demographic Data ◽

Developed Countries ◽

The United States ◽

Medical Society ◽

Hyperbaric Medicine ◽

Therapy Center ◽

Hbo2 Therapy

Purpose: Hyperbaric medicine is nascent in Korea when compared to other developed countries, such as the United States and Japan. Our facility has been managed by physicians with certifications from the Undersea and Hyperbaric Medical Society (UHMS) and National Oceanic and Atmospheric Administration in diving and clinical diseases since October 2016. This study was conducted to share similar issues that are encountered during the establishment of a program in a new area through our experiences in the operation of a hyperbaric oxygen (HBO2) therapy center. Methods: In this retrospective observational study we collected data on HBO2 patients treated at our center between October 2016 and June 2018 after HBO2 was conducted by HBO2-certified physicians. We then compared demographic data of patients with data from January 2011 to September 2015 – before HBO2 operations were conducted by HBO2-certified physicians. Result: A total of 692 patients received 5,130 treatments. Twelve indicated diseases were treated using HBO2 therapy. Fifty-six critically ill patients with intubation received HBO2. Although two patients experienced seizure due to oxygen toxicity during the study period, certified physicians and inside attendant took immediate corrective action. Conclusion: After the establishment of the HBO2 center operated by physicians with certification, more patients, including critically ill patients, received HBO2 safely for various diseases. In order to improve the practice of hyperbaric medicine in Korea, the Korean Academy of Undersea and Hyperbaric Medicine (KAUHM), an advanced and well-organized academic society, should communicate often with HBO2 centers, with the aim to set Korean education programs at UHMS course levels and increase reimbursement for HBO2 therapy.

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Can the cytokine adsorber CytoSorb® help to mitigate cytokine storm and reduce mortality in critically ill patients? A propensity score matching analysis

Annals of Intensive Care ◽

10.1186/s13613-021-00905-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Christina Scharf ◽

Ines Schroeder ◽

Michael Paal ◽

Martin Winkels ◽

Michael Irlbeck ◽

...

Keyword(s):

Propensity Score ◽

Critically Ill ◽

Critically Ill Patients ◽

Wilcoxon Test ◽

Relative Reduction ◽

Cytokine Storm ◽

Saps Ii ◽

Significant Difference ◽

Group 2 ◽

Group 1

Abstract Background A cytokine storm is life threatening for critically ill patients and is mainly caused by sepsis or severe trauma. In combination with supportive therapy, the cytokine adsorber Cytosorb® (CS) is increasingly used for the treatment of cytokine storm. However, it is questionable whether its use is actually beneficial in these patients. Methods Patients with an interleukin-6 (IL-6) > 10,000 pg/ml were retrospectively included between October 2014 and May 2020 and were divided into two groups (group 1: CS therapy; group 2: no CS therapy). Inclusion criteria were a regularly measured IL-6 and, for patients allocated to group 1, CS therapy for at least 90 min. A propensity score (PS) matching analysis with significant baseline differences as predictors (Simplified Acute Physiology Score (SAPS) II, extracorporeal membrane oxygenation, renal replacement therapy, IL-6, lactate and norepinephrine demand) was performed to compare both groups (adjustment tolerance: < 0.05; standardization tolerance: < 10%). U-test and Fisher’s-test were used for independent variables and the Wilcoxon test was used for dependent variables. Results In total, 143 patients were included in the initial evaluation (group 1: 38; group 2: 105). Nineteen comparable pairings could be formed (mean initial IL-6: 58,385 vs. 59,812 pg/ml; mean SAPS II: 77 vs. 75). There was a significant reduction in IL-6 in patients with (p < 0.001) and without CS treatment (p = 0.005). However, there was no significant difference (p = 0.708) in the median relative reduction in both groups (89% vs. 80%). Furthermore, there was no significant difference in the relative change in C-reactive protein, lactate, or norepinephrine demand in either group and the in-hospital mortality was similar between groups (73.7%). Conclusion Our study showed no difference in IL-6 reduction, hemodynamic stabilization, or mortality in patients with Cytosorb® treatment compared to a matched patient population.

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The Efficacy of Convalescent Plasma Use in Critically Ill COVID-19 Patients

Medicina ◽

10.3390/medicina57030257 ◽

2021 ◽

Vol 57 (3) ◽

pp. 257

Author(s):

Livius Tirnea ◽

Felix Bratosin ◽

Iulia Vidican ◽

Bianca Cerbu ◽

Mirela Turaiche ◽

...

Keyword(s):

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Therapeutic Option ◽

White Blood Cells ◽

The United States ◽

Plasma Therapy ◽

Reactive Protein ◽

United States Food ◽

States Food

Background and Objectives: On 24 March 2020, the United States Food and Drug Administration (FDA) announced the approval of convalescent plasma therapy for critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an emergency investigational new drug. This pilot study from Romania aimed to determine if convalescent plasma transfusion can be beneficial in the treatment of selected critically ill patients diagnosed with a SARS-CoV-2 infection. Materials and Methods: Donor and receiver eligibility for critically ill coronavirus disease 2019 (COVID-19) patients was based on Romanian guidelines issued at the time of the study. Here, we describe the evolution of a total of five eligible patients diagnosed with COVID-19 who received convalescent plasma (CP) in Romania. Results: In spite of our efforts and convalescent plasma administration, three of the five patients did not survive, while the other two recovered completely. Over the course of our five-day laboratory record, the surviving patients had significantly lower values for C-reactive protein, interleukin-6, and white blood cells. Conclusions: This pilot study provides insufficient evidence to determine the efficacy of convalescent plasma use as a therapeutic option for critically ill COVID-19 patients.

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ABO blood types and sepsis mortality

Annals of Intensive Care ◽

10.1186/s13613-021-00844-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Theis S. Itenov ◽

Daniel I. Sessler ◽

Ashish K. Khanna ◽

Sisse R. Ostrowski ◽

Pär I. Johansson ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

The United States ◽

Endothelial Damage ◽

Blood Type ◽

Type B ◽

Blood Concentrations ◽

Soluble Thrombomodulin ◽

Blood Types

Abstract Background We aimed to determine if the ABO blood types carry different risks of 30-day mortality, acute kidney injury (AKI), and endothelial damage in critically ill patients with sepsis. This was a retrospective cohort study of three independent cohorts of critically ill patients from the United States and Scandinavia consisting of adults with septic shock. We compared the 30-day mortality across the blood types within each cohort and pooled the results in a meta-analysis. We also estimated the incidence of AKI and degree of endothelial damage, as measured by blood concentrations of soluble thrombomodulin and syndecan-1. Results We included 12,342 patients with severe sepsis. In a pooled analysis blood type B carried a slightly lower risk of 30-day all-cause mortality compared to non-blood type B (adjusted HR 0.88; 95%-CI 0.79–0.98; p = 0.02). There was no difference in the risk of AKI. Soluble thrombomodulin and syndecan-1 concentrations were lower in patients with blood type B and O compared to blood type A, suggesting less endothelial damage. Conclusion Septic patients with blood type B had less endothelial damage, and a small reduction in mortality. The exposure is, however, unmodifiable.

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Ceftaroline versus standard therapy for pneumococcal meningitis in critically ill patients

Medicina Intensiva ◽

10.1016/j.medin.2021.05.011 ◽

2021 ◽

Author(s):

M. Martín-Cerezuela ◽

M.Á. Padrós Olmedo ◽

S.P. Piqueres ◽

M.B. de Pedro ◽

J.F. Artés ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Standard Therapy ◽

Pneumococcal Meningitis

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Effect of Central Venous Catheter Care Bundle Implementation on Outcomes of Critically Ill Patients

Evidence-Based Nursing Research ◽

10.47104/ebnrojs3.v2i1.93 ◽

2020 ◽

Vol 2 (1) ◽

pp. 12

Author(s):

Gehan A. F. Atia

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infection ◽

Critically Ill ◽

Critically Ill Patients ◽

Venous Catheter ◽

Care Bundle ◽

Central Venous ◽

Significant Difference ◽

Post Test ◽

Catheter Care

Context: Central venous access device (CVAD) bundles for insertion and maintenance demonstrate a reduction in the frequency of complications and bloodstream infection when implemented with compliance monitoring, with the reported success of CVAD bundles. Aim: This study aimed to examine the effect of central venous catheter care bundle implementation on outcomes of critically ill patients. Methods: Quasi-experimental research (pre/post-test design) used to achieve the aim of this study. The study conducted at general and surgical intensive care units affiliated to Menoufia University and teaching hospital. Two study samples recruited in this study. All nurses working at the ICUs, as mentioned above, were recruited in this study. They were 6o critical care nurses. A convenient sample of all available critically ill patients at the time of the study was subjected to treatment via a central venous catheter. Four study tools used to collect the data of this study. These are a structured interview questionnaire, CVC nurses’ knowledge assessment questionnaire, nurses’ compliance assessment checklists, and patient complications assessment records. Results: The study result showed a highly statistically significant difference between pre and post-test knowledge scores of studied nurses regarding assisting line insertion, removal, maintenance, care, and infection control practices. Besides, a highly statistically significant difference between pre and post-test scores of nurses’ compliance to central venous catheter care practices of assisting in CVC insertion, blood sample withdrawal, medication and fluid administration, CVP measurements, CVC removal, and the management of central venous line complications. The study also revealed a highly statistically significant difference between the study and control group patients regarding the central venous catheter complications. However, signs of infection were the most frequent complications in both groups. Conclusion. The study concluded that a statistically significant difference between pre and post nurses’ knowledge and compliance with the CVC care bundle. The patients’ outcomes were also improved significantly after the implementation of the CVC care bundle compared to the controls. The study recommended the adoption of the current care bundle that should be disseminated and updated following the international organizations’ recommendation for implementing evidence-based practices for successful central line-associated bloodstream infection (CLABSI) prevention.

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