scholarly journals Candidemia in intensive care units over nine years at a large Italian university hospital: Comparison with other wards

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252165
Author(s):  
Sara Mazzanti ◽  
Lucia Brescini ◽  
Gianluca Morroni ◽  
Elena Orsetti ◽  
Antonella Pocognoli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Antifungal Therapy ◽  
Cumulative Incidence ◽  
Mortality Rates ◽  
University Hospital ◽  
Icu Patients ◽  
Risk Of Death ◽  
Significant Difference ◽  
Over Time

Purpose Candidemia is an alarming problem in critically ill patients including those admitted in intensive care units (ICUs). We aimed to describe the clinical and microbiological characteristics of bloodstream infections (BSIs) due to Candida spp. in patients admitted to ICUs of an italian tertiary referral university hospital over nine years. Methods A retrospective observational study of all cases of candidemia in adult patients was carried out from January 1, 2010 to December 31, 2018 at a 980-bedded University Hospital in Ancona, Italy, counting five ICUs. The incidence, demographics, clinical and microbiologic characteristics, therapeutic approaches and outcomes of ICU-patients with candidemia were collected. Non-ICU patients with candidemia hospitalized during the same time period were considered for comparison purposes. Early (7 days from the occurrence of the episode of Candida BSI) and late (30 days) mortality rates were calculated. Results During the study period, 188/505 (36%) episodes of candidemia occurred in ICU patients. Cumulative incidence was 9.9/1000 ICU admission and it showed to be stable over time. Candida albicans accounted for 52% of the cases, followed by C. parapsilosis (24%), and C. glabrata (14%). There was not a significant difference in species distribution between ICU and non-ICU patients. With the exception of isolates of C. tropicalis which showed to be fluconazole resistant in 25% of the cases, resistance to antifungals was not of concern in our patients. Early and late mortality rates, were 19% and 41% respectively, the latter being significantly higher than that observed in non-ICU patients. At multivariate analysis, factors associated with increased risk of death were septic shock, acute kidney failure, pulmonary embolism and lack of antifungal therapy. The type of antifungal therapy did not influence the outcome. Mortality did not increased significantly over time. Conclusion Neither cumulative incidence nor crude mortality of candidemia in ICU patients increased over time at our institution. However, mortality rate remained high and significantly associated with specific host-related factors in the majority of cases.

Candidemia in Intensive Care Units Over Nine Years at a Large Italian University Hospital 

2020 ◽  
Author(s):  
Sara Mazzanti ◽  
Lucia Brescini ◽  
Gianluca Morroni ◽  
Elena Orsetti ◽  
Antonella Pocognoli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Incidence Rate ◽  
Intensive Care Units ◽  
Antifungal Therapy ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
University Hospital ◽  
Related Factors ◽  
Icu Patients ◽  
Over Time

Abstract Purpose: Candidemia is an alarming problem in critically ill patients including those admitted in intensive care units (ICUs). We aimed to describe the clinical and microbiological characteristics of bloodstream infections (BSIs) due to Candida spp. in patients admitted to ICUs of an italian tertiary referral university hospital over nine years. Methods: A retrospective observational study of all cases of candidemia in adult patients was carried out from January 1, 2010 to December 31, 2018 at a 980-bedded University Hospital in Ancona, Italy, counting five ICUs. The incidence, demographics, clinical and microbiologic characteristics, therapeutic approaches and outcomes of ICU-patients with candidemia were collected. Early (7 days from the occurrence of the episode of Candida BSI) and late (30 days) mortality rates were calculated. Results: During the study period, 188/505 (36%) episodes of candidemia occurred in ICU patients. Incidence rate was 9.9/1000 ICU admission and it showed to be stable over time. Candida albicans accounted for 52% of the cases, followed by C. parapsilosis (24%), and C. glabrata (14%). With the exception of isolates of C. tropicalis which showed to be fluconazole resistant in 25% of the cases, resistance to antifungals was not of concern in our patients. Early and late mortality rates were 19% and 41%, respectively and did not increased significantly over time. Independent risk factors for higher mortality were septic shock, acute kidney failure, pulmonary embolism and lack of antifungal therapy. The type of antifungal therapy did not influence the outcome. Conclusion: Neither incidence rate nor crude mortality of candidemia in ICU patients increased over time at our institution. However, mortality rate remained high and significantly associated with specific host-related factors.

scholarly journals 2312. Mortality of Severe Dengue Patients Admitted to Intensive Care Units over 15 Years: Have We Improved?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S792-S792
Author(s):  
Fernando Rosso ◽  
Luis Gabriel Parra-Lara ◽  
Ana M Sanz ◽  
Gustavo A Ospina-Tascon ◽  
Marcela Granados
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Healthcare Management ◽  
Severe Dengue ◽  
Early Admission ◽  
Early Access ◽  
Monitoring Strategies ◽  
Significant Difference ◽  
Before And After ◽  
Over Time

Abstract Background Dengue mortality can be preventable in endemic regions. However, access to intensive care units (ICU) and continuous monitoring strategies are limited in developing countries. In 2010, WHO dengue clinical practice guidelines (CPG) were implemented in the Americas region which strengthened hospital healthcare management and prioritized early ICU admission in severe dengue cases. We hypothesized that early access to the ICU might decrease the mortality of patients with dengue. This study aimed to describe trends in dengue cases and mortality in the ICU for 15 years in Cali, Colombia. Methods An observational retrospective study about dengue cases treated in adult ICU was conducted, in the Fundación Valle del Lili. We included cases between 2001 to 2015 years. Clinical data were collected from the ICU database and medical charts. A Cochran-Armitage test for trend was used to assess the presence of an association between fatal cases and total cases in dengue patients at ICU during the study period, and to evaluate differences in the mortality cases before and after the implementation of the dengue CPG. Results A total of 49,962 episodes of attention in ICU were analyzed, and 70 cases with severe dengue and dengue shock attended in ICU were included. The median age was 42 years (IQR = 24–60), eight cases were older than 65 years, and 54% were male. Five fatal cases were reported during this period. The fatal cases had a length of stay in ICU of 2 days (IQR = 1–4) vs. 2 days (IQR = 1–3) for nonfatal cases. Overall mortality for dengue cases in the ICU was 7.14%. The highest mortality was presented in 2007 with 33.33% (1/3), and after 2010 there were no fatal cases. Dengue mortality showed a decreasing linear variation over time in the ICU (p = 0.047); also there was a statistically significant difference over time in adults mortality before and after of implementation of dengue CPG (P = 0.029). Conclusion Dengue mortality cases in the ICU have decreased in the last 15 years, which is related to early admission to the ICU and continuous clinical monitoring. Disclosures All authors: No reported disclosures.

Nosocomial Infection After Septic Shock Among Intensive Care Unit Patients

2008 ◽  
Vol 29 (11) ◽  
pp. 1054-1065 ◽  
Author(s):  
Caroline Landelle ◽  
Alain Lepape ◽  
Adrien Français ◽  
Eve Tognet ◽  
Hélène Thizy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Initial Phase ◽  
Pulmonary Infection ◽  
University Hospital ◽  
Icu Patients ◽  
Significant Difference ◽  
The Impact

Objectives.To measure the incidence of nosocomial infection (NI) among patients with septic shock according to the place of septic shock acquisition and to evaluate the increase in the risk of pulmonary infection associated with septic shock.Design.Prospective cohort study.Setting.TWO intensive care units (ICUs) of a French university hospital.Patients and Methods.The study included a total of 209 septic shock patients during the period December 1, 2001 through April 30, 2005. The place of septic shock acquisition for 108 patients was the community; for 87, the hospital; and for 14, the ICU. To evaluate the impact of septic shock on the development of pulmonary infection, a competitive and adjusted hazard ratio (aHR) model was applied to nontrauma ICU patients.Results.Among the 209 study patients, 48 (23%) experienced 66 NIs after septic shock. There was no significant difference in the NI attack rates according to place of acquisition: for the community acquisition group, 24 cases per 100 patients (95% confidence interval [CI], 16-32); for the hospital acquisition group, 20 cases per 100 patients (95% CI, 11-28); and for the ICU acquisition group, 36 cases per 100 patients (95% CI, 11-61) (P = .3). For nontrauma ICU patients, the presence of community-acquired septic shock was found to be independently associated with a higher incidence of pulmonary infection, compared with the absence of septic shock (aHR, 2.12 [95% CI, 1.08-4.16]; P = .03).Conclusions.The risk of NI did not differ by the place of septic shock acquisition. The risk of pulmonary infection was higher for ICU patients with community-acquired septic shock who were admitted for underlying nontrauma disease. Studies are needed to investigate the pathogenic mechanisms that facilitate pulmonary infection in this population, taking into account exposure to invasive devices and immunosuppression after the initial phase of septic shock.

scholarly journals Virtual Reality Hypnosis for Anxiety and Pain Management in Intensive Care Units. A Prospective Randomized Trial Among Cardiac Surgery Patients.

2020 ◽  
Author(s):  
Floriane Marie Rousseaux ◽  
Nadia Dardenne ◽  
Paul B Massion ◽  
Didier Ledoux ◽  
Marie-Elisabeth Faymonville ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Units ◽  
University Hospital ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Significant Difference ◽  
Before And After ◽  
French Speaking

Abstract Background: Although non-pharmacological tools are nowadays commonly used in medical settings, virtual reality and hypnosis are little studied in complex contexts such as intensive care, where patients need significant physical and psychological assistance. The aim of the project is to evaluate the benefits of hypnosis, virtual reality (VR) and the combination of hypnosis and virtual reality (VRH) on anxiety and pain on patients before and after a cardiac surgery.Methods: This prospective randomized and controlled clinical trial was conducted in the University Hospital of Liege (Belgium). Participants are adults undergoing cardiac surgery, French speaking. Exclusion criteria are patients with psychiatric diseases, claustrophobia, acrophobia, heavy hearing impairment, visual impairment, extreme fatigue, verbal incoherence, surgery cancelled or postponed. The day before the surgery, patients were randomly assigned to four arms (control, hypnosis, VR and VRH) and had 20 minutes of one of the technique. They received the same intervention one day after surgery, in intensive care units. Anxiety, pain, fatigue, relaxation and physiological parameters were evaluated before and after each session.Results: 100 patients (66.38 ± 11.48 years; 76 men, 24 women) were included. Results showed that anxiety decreased from baseline to postoperative day in all groups. Relaxation increased in all groups in preoperative (p = .000) and postoperative period (p = 0.03). There were no significant results for pain and fatigue (p > 0.05). There was no significant difference between control group and hypnosis, VR or VRH.Conclusion: Anxiety decreased and relaxation increased in all groups, including control group. We cannot affirm that one technique is better than another is. Nevertheless, this study helps to expand the knowledge regarding application of virtual reality, hypnosis and virtual reality hypnosis in the specific contexts of cardiac surgery and intensive care units. Additional studies are required to compare and evaluate the costs-effectiveness of these techniques for critical care patients and caregivers (see Figure 1).Trial registration: ClinicalTrials.gov: NCT03820700. https://clinicaltrials.gov/ct2/show/NCT03820700. Registered on January 29 2019. Retrospectively registered.

scholarly journals DOES THE USE OF DEXMEDETOMIDINE AFFECT THE OUTCOMES IN PATIENTS WITH SEVERE COVID-19?

2021 ◽  
Author(s):  
Kubilay İşsever ◽  
Ahmed Cihad Genç ◽  
Deniz Çekiç ◽  
Ahmed Bilal Genc ◽  
Selcuk Yaylaci ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Patient Group ◽  
Ivig Therapy ◽  
Daily Practice ◽  
Mortality Rates ◽  
Control Group ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
The Difference

Objective: Dexmedetomidine (DEX) is a highly selective α2-adrenoceptor agonist that is increasingly used in the daily practice of intensive care units (ICUs) with its sedative, analgesic, anxiolytic, and immunoprotective effects. In this study, we aimed to analyze whether Dexmedetomidine improves the outcomes in patients treated in ICU. Design: A retrospective study Place and Duration of Study: Intensive care units (ICU) of Sakarya University Training and Research Hospital, Sakarya, Turkey, from October 2020 to February 2021 Methodology: The medical records of the patients were analyzed retrospectively. We included 134 patients in the study, in 45 of whom the treatment regimen included dexmedetomidine and 89 of whom were not treated with dexmedetomidine. Patients treated with DEX were defined as the “patient group”, whereas patients not treated with DEX were defined as “control group” and the parameters were compared between these groups. Obtained data were analyzed in the biostatistical program. Results: The median age of all patients was 64 and 62.7% of them were male. No significant difference was found between the groups in terms of median ages (p>0.05). The patients with diabetes mellitus (DM), congestive heart failure (CHF), and undergoing insulin treatment were significantly less treated with DEX (p=0.04, p=0.03, and p=0.016 respectively) whereas intravenous immunoglobulin (IVIG) therapy was found to be more frequently applied to the patient group (p=0.043). The median duration between ICU admission and the time of intubation was 4 days for the control group whereas it was 1 day for the patient group and the difference was strongly significant (p=0.000, p<0.001). The other analyses concerning lab parameters, mortality rates, intubation rates and durations, applied treatments, and comorbidities revealed no significant difference between the groups. Conclusion: Our study revealed that DEX therapy can help us to gain time before intubation however can not reduce mortality rates in severe COVID-19.

scholarly journals Results of screening for emergent highly resistant bacteria in Tunisian intensive care units

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Ben Rejeb ◽  
A Ben Cheikh ◽  
S Bhiri ◽  
H Ghali ◽  
M Kahloul ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Early Identification ◽  
Infection Prevention ◽  
Screening Program ◽  
Control Measures ◽  
University Hospital ◽  
Infection Prevention And Control ◽  
Resistant Bacteria ◽  
Prevention Interventions

Abstract Background The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes. Methods Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018. Results During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%). Conclusions Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital. Key messages eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.

scholarly journals Early Prediction of Seven-Day Mortality in Intensive Care Unit Using a Machine Learning Model: Results from the SPIN-UTI Project

2021 ◽  
Vol 10 (5) ◽  
pp. 992
Author(s):  
Martina Barchitta ◽  
Andrea Maugeri ◽  
Giuliana Favara ◽  
Paolo Marco Riela ◽  
Giovanni Gallo ◽  
...  
Keyword(s):  
Machine Learning ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Learning Algorithm ◽  
Area Under The Curve ◽  
Support Vector ◽  
Icu Admission ◽  
Risk Of Death ◽  
Saps Ii ◽  
Svm Algorithm

Patients in intensive care units (ICUs) were at higher risk of worsen prognosis and mortality. Here, we aimed to evaluate the ability of the Simplified Acute Physiology Score (SAPS II) to predict the risk of 7-day mortality, and to test a machine learning algorithm which combines the SAPS II with additional patients’ characteristics at ICU admission. We used data from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” network. Support Vector Machines (SVM) algorithm was used to classify 3782 patients according to sex, patient’s origin, type of ICU admission, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II, presence of invasive devices, trauma, impaired immunity, antibiotic therapy and onset of HAI. The accuracy of SAPS II for predicting patients who died from those who did not was 69.3%, with an Area Under the Curve (AUC) of 0.678. Using the SVM algorithm, instead, we achieved an accuracy of 83.5% and AUC of 0.896. Notably, SAPS II was the variable that weighted more on the model and its removal resulted in an AUC of 0.653 and an accuracy of 68.4%. Overall, these findings suggest the present SVM model as a useful tool to early predict patients at higher risk of death at ICU admission.

scholarly journals Detection of SARS-CoV-2 and Other Infectious Agents in Lower Respiratory Tract Samples Belonging to Patients Admitted to Intensive Care Units of a Tertiary-Care Hospital, Located in an Epidemic Area, during the Italian Lockdown

2021 ◽  
Vol 9 (1) ◽  
pp. 185
Author(s):  
Adriana Calderaro ◽  
Mirko Buttrini ◽  
Sara Montecchini ◽  
Giovanna Piccolo ◽  
Monica Martinelli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Tract ◽  
Intensive Care Units ◽  
Lower Respiratory Tract ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Infectious Agents ◽  
Epidemic Area ◽  
Significant Difference

The aim of this study was the detection of infectious agents from lower respiratory tract (LRT) samples in order to describe their distribution in patients with severe acute respiratory failure and hospitalized in intensive care units (ICU) in an Italian tertiary-care hospital. LRT samples from 154 patients admitted to ICU from 27 February to 10 May 2020 were prospectively examined for respiratory viruses, including SARS-CoV-2, bacteria and/or fungi. SARS-CoV-2 was revealed in 90 patients (58.4%, 72 males, mean age 65 years). No significant difference was observed between SARS-CoV-2 positives and SARS-CoV-2 negatives with regard to sex, age and bacterial and/or fungal infections. Nonetheless, fungi were more frequently detected among SARS-CoV-2 positives (44/54, 81.4%, p = 0.0053). Candida albicans was the overall most frequently isolated agent, followed by Enterococcus faecalis among SARS-CoV-2 positives and Staphylococcus aureus among SARS-CoV-2 negatives. Overall mortality rate was 40.4%, accounting for 53 deaths: 37 among SARS-CoV-2 positives (mean age 69 years) and 16 among SARS-CoV-2 negatives (mean age 63 years). This study highlights the different patterns of infectious agents between the two patient categories: fungi were prevalently involved among SARS-CoV-2-positive patients and bacteria among the SARS-CoV-2-negative patients. The different therapies and the length of the ICU stay could have influenced these different patterns of infectious agents.

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