Characterization of critically ill patients with severe bacterial infections using cardiovascular MRI

Acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) pneumonia is the main cause of the pandemic’s death toll. The assessment of ARDS and time on invasive mechanical ventilation (IMV) could enhance the characterization of outcomes and management of this condition. This is a city-wide retrospective study of hospitalized patients with COVID-19 pneumonia from 5 March 2020 to 30 June 2020. Patients with critical illness were compared with those with non-critical illness. We examined the severity of ARDS and other factors associated with (i) weaning patients off IMV and (ii) mortality in a city-wide study in Louisville, KY. Of 522 patients with COVID-19 pneumonia, 219 (41.9%) were critically ill. Among critically ill patients, the median age was 60 years; 53% were male, 55% were White and 32% were African American. Of all critically ill patients, 52% had ARDS, and 38% of these had severe ARDS. Of the 25% of patients who were weaned off IMV, those with severe ARDS were weaned within eleven days versus five days for those without severe ARDS, p = 0.023. The overall mortality for critically ill patients was 22% versus 1% for those not critically ill. Furthermore, the 14-day mortality was 31% for patients with severe ARDS and 12% for patients without severe ARDS, p = 0.019. Patients with severe ARDS versus non-severe ARDS needed twice as long to wean off IMV (eleven versus five days) and had double the 14-day mortality of patients without severe ARDS.

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Caracterização dos casos de COVID-19 em pacientes críticos: revisão de escopo/ Characterization of COVID-19 cases in critically ill patients: scoping review

Ciência Cuidado e Saúde ◽

10.4025/ciencuidsaude.v20i0.57572 ◽

2021 ◽

Vol 20 ◽

Author(s):

Thatiane Monick De Souza Costa ◽

Kauanny Vitoria Gurgel dos Santos ◽

Eloysa Dos Santos Oliveira ◽

Bruna Vilar Soares da Silva ◽

Evelin Beatriz Bezerra de Melo ◽

...

Keyword(s):

Critically Ill ◽

Systematic Reviews ◽

Scoping Review ◽

Critically Ill Patients ◽

Scoping Reviews ◽

Terapia Intensiva ◽

Population Concept

Introdução: A principal causa de mortalidade pelo novo coronavírus é a insuficiência respiratória. Assim, os cuidados intensivos devem ser prontamente prestados ao paciente crítico. Objetivo: Explorar as evidências acerca dos achados clínicos, tratamento e desfecho de pacientes infectados pelo Sars-CoV-2 internados em Unidades de Terapia Intensiva. Método: Revisão de escopo, realizada em abril de 2021, em oito fontes de dados nacionais e internacionais, conforme orientações do Instituto Joanna Briggs, seguindo o checklist Preferred Reporting Items for Systematic reviews and Meta-Analysesextension for Scoping Reviews, sem restrição de idioma ou temporal. Adotou-se a estratégia Population, Concept and Contextpara a elaboração da questão de pesquisa. Resultados: Incluíram-se 15 artigos científicos, com predominância de publicações na China, Estados Unidos da América e Canadá. Dos estudos, 80% foram com adultos e idosos em Unidade de Terapia Intensiva. Os principais achados clínicos foram febre, tosse, Síndrome do Desconforto Respiratório Agudo e lesão renal, tratamento com ventilação mecânica invasiva e não invasiva, oxigenoterapia de alto fluxo e corticoesteroides. Como principal desfecho, o óbito. Conclusão: A maioria dos pacientes apresentou febre, tosse e Síndrome do Desconforto Respiratório Agudo, recebendo cuidados como ventilação mecânica, oxigenoterapia de alto fluxo e corticoesteroides, com alto índice de óbitos.

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Therapeutic Drug Monitoring of Protein Unbound Ciprofloxacin Concentrations to avoid inadequate Treatment of severe Bacterial Infections in Critically ill Patients

Journal of Applied Bioanalysis ◽

10.17145/jab.18.021 ◽

2018 ◽

Vol 4 (5) ◽

pp. 166-174

Author(s):

Nora J mabelis ◽

Kimberly N. Shudofsky ◽

Joost J. van Raaij ◽

Sjoerd D. Meenks ◽

Thomas Havenith ◽

...

Keyword(s):

Therapeutic Drug Monitoring ◽

Critically Ill ◽

Drug Monitoring ◽

Critically Ill Patients ◽

Bacterial Infections ◽

Therapeutic Drug

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Population Pharmacokinetics of Piperacillin following Continuous Infusion in Critically Ill Patients and Impact of Renal Function on Target Attainment

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02556-19 ◽

2020 ◽

Vol 64 (7) ◽

Author(s):

Vibeke Klastrup ◽

Anders Thorsted ◽

Merete Storgaard ◽

Steffen Christensen ◽

Lena E. Friberg ◽

...

Keyword(s):

Continuous Infusion ◽

Critically Ill ◽

Critically Ill Patients ◽

Bacterial Infections ◽

Population Pharmacokinetic ◽

Target Attainment ◽

Content Type ◽

Daily Dose ◽

Linear Elimination ◽

Severe Infections

ABSTRACT Pharmacokinetic changes are often seen in patients with severe infections. Administration by continuous infusion has been suggested to optimize antibiotic exposure and pharmacokinetic/pharmacodynamic (PK/PD) target attainment for β-lactams. In an observational study, unbound piperacillin concentrations (n = 196) were assessed in 78 critically ill patients following continuous infusion of piperacillin-tazobactam (ratio 8:1). The initial dose of 8, 12, or 16 g (piperacillin component) was determined by individual creatinine clearance (CRCL). Piperacillin concentrations were compared to the EUCAST clinical breakpoint MIC for Pseudomonas aeruginosa (16 mg/liter), and the following PK/PD targets were evaluated: 100% free time (fT) > 1× MIC and 100% fT > 4× MIC. A population pharmacokinetic model was developed using NONMEM 7.4.3 consisting of a one-compartment disposition model with linear elimination separated into nonrenal and renal (linearly increasing with patient CRCL) clearances. Target attainment was predicted and visualized for all individuals based on the utilized CRCL dosing algorithm. The target of 100% fT > 1× MIC was achieved for all patients based on the administered dose, but few patients achieved the target of 100% fT > 4× MIC. Probability of target attainment for a simulated cohort of patients showed that increasing the daily dose by 4-g increments (piperacillin component) did not result in substantially improved target attainment for the 100% fT > 4× MIC target. To conclude, in patients with high CRCL combined with high-MIC bacterial infections, even a continuous infusion (CI) regimen with a daily dose of 24 g may be insufficient to achieve therapeutic concentrations.

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Steady‐state pharmacokinetic and pharmacodynamic profiling of colistin in critically ill patients with multi‐drug–resistant gram‐negative bacterial infections, along with differences in clinical, microbiological and safety outcome

Basic & Clinical Pharmacology & Toxicology ◽

10.1111/bcpt.13482 ◽

2020 ◽

Vol 128 (1) ◽

pp. 128-140

Author(s):

Kishna Ram ◽

Salim Sheikh ◽

Rahul Kumar Bhati ◽

Chakra Dhar Tripathi ◽

Jagdish Chander Suri ◽

...

Keyword(s):

Steady State ◽

Critically Ill ◽

Critically Ill Patients ◽

Bacterial Infections ◽

Drug Resistant ◽

Gram Negative ◽

Safety Outcome

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197: Characterization of Cytokine Expression in Critically Ill Patients With COVID-19

Critical Care Medicine ◽

10.1097/01.ccm.0000726676.98717.84 ◽

2020 ◽

Vol 49 (1) ◽

pp. 84-84

Author(s):

Zachary Pedretti ◽

Brandon Powell ◽

Tanner Hedrick ◽

Brian Murray ◽

William Fischer

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Cytokine Expression

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B.03 Clinical utility of critical care EEG monitoring in a Canadian paediatric centre

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.92 ◽

2019 ◽

Vol 46 (s1) ◽

pp. S10-S11

Author(s):

F Din ◽

S Lalgudi Ganesan ◽

A Ochi ◽

H Otsubo ◽

C Go ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Clinical Utility ◽

Critically Ill Children ◽

Treatment Change ◽

Convulsive Seizures ◽

Unclear Etiology ◽

Scarcity Of Resources ◽

Management Changes

Background: Continuous electroencephalographic (cEEG) monitoring is essential to diagnosing non-convulsive seizures (NCS), reported to occur in 7-46% of at-risk critically ill patients. However, cEEG is labour-intensive, and given scarcity of resources at most centres cEEG is feasible in only selected patients. We aim to evaluate the clinical utility of cEEG at our centre in order to optimize further cEEG allocation among critically ill patients. Methods: Using a clinical database, we identified critically ill children who underwent cEEG monitoring in 2016, 2017 and 2018. We abstracted underlying diagnoses, indication for cEEG monitoring, cEEG findings, and associated changes in management. Results: Over this three year period, 928 cEEGs were performed. Among the 100 studies analyzed to date, primary indications for monitoring were characterization of events of unclear etiology (32%), diagnosis of NCS (30%), and monitoring of therapy for seizures (17%). Seizures were captured in 31% of patients (22% subclinical only, 5% electroclinical only, 4% both), which resulted in a treatment change in 90% of cases. Non-epileptic events were captured in 26% of patients. Conclusions: cEEG yielded clinically meaningful information in 57% of cases, frequently resulting in management changes. Subgroup analyses by cEEG indication and ICU location will be presented.

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Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19

Microorganisms ◽

10.3390/microorganisms9081773 ◽

2021 ◽

Vol 9 (8) ◽

pp. 1773

Author(s):

Daniela Pasero ◽

Andrea Pasquale Cossu ◽

Pierpaolo Terragni

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Bacterial Infections ◽

Invasive Mechanical Ventilation ◽

Multi Drug Resistance ◽

Icu Admission ◽

Risk Of Death ◽

Stewardship Program ◽

Secondary Infections ◽

Tract Infections

Introduction. It is known that bacterial infections represent a common complication during viral respiratory tract infections such as influenza, with a concomitant increase in morbidity and mortality. Nevertheless, the prevalence of bacterial co-infections and secondary infections in critically ill patients affected by coronavirus disease 2019 (COVID-19) is not well understood yet. We performed a review of the literature currently available to examine the incidence of bacterial secondary infections acquired during hospital stay and the risk factors associated with multidrug resistance. Most of the studies, mainly retrospective and single-centered, highlighted that the incidence of co-infections is low, affecting about 3.5% of hospitalized patients, while the majority are hospital acquired infections, developed later, generally 10–15 days after ICU admission. The prolonged ICU hospitalization and the extensive use of broad-spectrum antimicrobial drugs during the COVID-19 outbreak might have contributed to the selection of pathogens with different profiles of resistance. Consequently, the reported incidence of MDR bacterial infections in critically ill COVID-19 patients is high, ranging between 32% to 50%. MDR infections are linked to a higher length of stay in ICU but not to a higher risk of death. The only risk factor independently associated with MDR secondary infections reported was invasive mechanical ventilation (OR 1.062; 95% CI 1.012–1.114), but also steroid therapy and prolonged length of ICU stay may play a pivotal role. The empiric antimicrobial therapy for a ventilated patient with suspected or proven bacterial co-infection at ICU admission should be prescribed judiciously and managed according to a stewardship program in order to interrupt or adjust it on the basis of culture results.

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