scholarly journals Blood Cultures and Broad-Spectrum Antimicrobials are Essential for Patients with Out-of-Hospital Cardiac Arrest

2020 ◽  
Author(s):  
Ching-Chi Lee ◽  
Po-Lin Chen ◽  
Ming-Yuan Hong ◽  
Chih-Hao Lin ◽  
Wen-Chien Ko
Keyword(s):  
Cardiac Arrest ◽  
Critically Ill ◽  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Critically Ill Patients ◽  
Clinical Information ◽  
Bloodstream Infections ◽  
Extended Spectrum Beta Lactamase ◽  
Tract Infections ◽  
Hospital Cardiac Arrest

Abstract Background: Etiologies of out-of-hospital cardiac arrest (OHCA) have been majorly focused on cardiac origins. Little is known regarding the role of bloodstream infections (BSIs) in OHCA episodes. Our aim was to disclose clinical features and incidences of BSIs and the survival benefit of prompt administration of appropriate antimicrobial therapy (AAT) in adults with OHCA.Methods: In the 10-year multicenter cohort, clinical information was retrospectively collected and causative microorganisms were prospectively stored for species identification and susceptibilities. The effect of delayed AAT administration on 30-day mortality was examined after adjustment for independent predictors of mortality, recognized by a multivariate regression analysis.Results: Of 1,021,177 emergency department encounters, OHCA visits had a higher BSI incidence than non-OHCA visits (413/3,429, 12.0% vs. 7,429/242,302, 3.1%; P<0.001). Compared with the matched non-OHCA (2,478) patients, OHCA (413) patients experienced more bacteremic episodes due to lower respiratory tract infections, fewer urosepsis events, fewer Escherichia coli bacteremia, and more streptococcal and anaerobes bacteremia. More antimicrobial-resistant organisms, such as methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing Enterobacteriaceae, were evident in OHCA patients. Notably, each hour delay in AAT administration was associated with an average increase of 0.8% in crude 30-day mortality rates (adjusted odds ratio [AOR], 1.008; P = 0.04) in OHCA patients, 7% (AOR, 1.007; P < 0.001) in critically ill patients without OHCA, and 3% (AOR, 1.003; P < 0.001) in less critically ill patients.Conclusions: BSIs should be considered in patients experiencing OHCA; bacteremia sources, causative microorganisms, and antimicrobial susceptibilities differed between the OHCA and non-OHCA patients. The incorporation of blood culture samplings and rapid initiation of broad-spectrum antimicrobial therapy as the first-aids is essential for OHCA patients.

scholarly journals Blood Cultures and Appropriate Antimicrobial Administration after Achieving Sustained Return of Spontaneous Circulation in Adults with Nontraumatic Out-of-Hospital Cardiac Arrest

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 876
Author(s):  
Chih-Hao Lin ◽  
Po-Lin Chen ◽  
Yi-Tzu Huang ◽  
Ching-Yu Ho ◽  
Chih-Chia Hsieh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Critically Ill ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Extended Spectrum Beta Lactamase ◽  
Tract Infections ◽  
Hospital Cardiac Arrest ◽  
Community Onset ◽  
Control Study ◽  
Antimicrobial Administration

We aimed to determine the incidence of bacteremia and prognostic effects of prompt administration of appropriate antimicrobial therapy (AAT) on nontraumatic out-of-hospital cardiac arrest (OHCA) patients achieving a sustained return of spontaneous circulation (sROSC), compared with non-OHCA patients. In the multicenter case-control study, nontraumatic OHCA adults with bacteremia episodes after achieving sROSC were defined as case patients, and non-OHCA patients with community-onset bacteremia in the emergency department were regarded as control patients. Initially, case patients had a higher bacteremia incidence than non-OHCA visits (231/2171, 10.6% vs. 10,430/314,620, 3.3%; p < 0.001). Compared with the matched control (2288) patients, case (231) patients experienced more bacteremic episodes due to low respiratory tract infections, fewer urosepsis events, fewerEscherichia coli bacteremia, and more streptococcal and anaerobes bacteremia. Antimicrobial-resistant organisms, such as methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing Enterobacteriaceae, were frequently evident in case patients. Notably, each hour delay in AAT administration was associated with an average increase of 10.6% in crude 30-day mortality rates in case patients, 0.7% in critically ill control patients, and 0.3% in less critically ill control patients. Conclusively, the incidence and characteristics of bacteremia differed between the nontraumatic OHCA and non-OHCA patients. The incorporation of blood culture samplings and rapid AAT administration as first-aids is essential for nontraumatic OHCA patients after achieving sROSC.

scholarly journals Survival After In-Hospital Cardiac Arrest in Critically Ill Patients

2020 ◽  
Vol 13 (7) ◽  
Author(s):  
Saket Girotra ◽  
Yuanyuan Tang ◽  
Paul S. Chan ◽  
Brahmajee K. Nallamothu ◽  
Keyword(s):  
Cardiac Arrest ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hospital Cardiac Arrest

scholarly journals Development of Institutional Guidelines for Management of Gram-Negative Bloodstream Infections: Incorporating Local Evidence

2017 ◽  
Vol 52 (10) ◽  
pp. 691-697 ◽  
Author(s):  
Elizabeth B. Nimmich ◽  
P. Brandon Bookstaver ◽  
Joseph Kohn ◽  
Julie Ann Justo ◽  
Katie L. Hammer ◽  
...  
Keyword(s):  
Health Care ◽  
Critically Ill ◽  
Antimicrobial Therapy ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
Bloodstream Infections ◽  
Evidence Based ◽  
Gram Negative ◽  
Empirical Antimicrobial Therapy ◽  
Hospital Acquired

Background: Appropriate empirical antimicrobial therapy is associated with improved outcomes of patients with Gram-negative bloodstream infections (BSI). Objective: Development of evidence-based institutional management guidelines for empirical antimicrobial therapy of Gram-negative BSI. Methods: Hospitalized adults with Gram-negative BSI in 2011-2012 at Palmetto Health hospitals in Columbia, SC, USA, were identified. Logistic regression was used to examine the association between site of infection acquisition and BSI due to Pseudomonas aeruginosa or chromosomally mediated AmpC-producing Enterobacteriaceae (CAE). Antimicrobial susceptibility rates of bloodstream isolates were stratified by site of acquisition and acute severity of illness. Retained antimicrobial regimens had predefined susceptibility rates ≥90% for noncritically ill and ≥95% for critically ill patients. Results: Among 390 patients, health care–associated (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.5-6.3] and hospital-acquired sites of acquisition (OR: 3.7, 95% CI: 1.6-8.4) were identified as risk factors for BSI due to P aeruginosa or CAE, compared with community-acquired BSI (referent). Based on stratified bloodstream antibiogram, ceftriaxone met predefined susceptibility criteria for community-acquired BSI in noncritically ill patients (95%). Cefepime and piperacillin-tazobactam monotherapy achieved predefined susceptibility criteria in noncritically ill (95% both) and critically ill patients with health care–associated and hospital-acquired BSI (96% and 97%, respectively) and critically ill patients with community-acquired BSI (100% both). Conclusions: Incorporation of site of acquisition, local antimicrobial susceptibility rates, and acute severity of illness into institutional guidelines provides objective evidence-based approach for optimizing empirical antimicrobial therapy for Gram-negative BSI. The suggested methodology provides a framework for guideline development in other institutions.

scholarly journals In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study

BMJ ◽  
2020 ◽  
pp. m3513 ◽  
Author(s):  
Salim S Hayek ◽  
Samantha K Brenner ◽  
Tariq U Azam ◽  
Husam R Shadid ◽  
Elizabeth Anderson ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multicenter Cohort Study ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Hospital Cardiac Arrest

Abstract Objectives To estimate the incidence, risk factors, and outcomes associated with in-hospital cardiac arrest and cardiopulmonary resuscitation in critically ill adults with coronavirus disease 2019 (covid-19). Design Multicenter cohort study. Setting Intensive care units at 68 geographically diverse hospitals across the United States. Participants Critically ill adults (age ≥18 years) with laboratory confirmed covid-19. Main outcome measures In-hospital cardiac arrest within 14 days of admission to an intensive care unit and in-hospital mortality. Results Among 5019 critically ill patients with covid-19, 14.0% (701/5019) had in-hospital cardiac arrest, 57.1% (400/701) of whom received cardiopulmonary resuscitation. Patients who had in-hospital cardiac arrest were older (mean age 63 (standard deviation 14) v 60 (15) years), had more comorbidities, and were more likely to be admitted to a hospital with a smaller number of intensive care unit beds compared with those who did not have in-hospital cardiac arrest. Patients who received cardiopulmonary resuscitation were younger than those who did not (mean age 61 (standard deviation 14) v 67 (14) years). The most common rhythms at the time of cardiopulmonary resuscitation were pulseless electrical activity (49.8%, 199/400) and asystole (23.8%, 95/400). 48 of the 400 patients (12.0%) who received cardiopulmonary resuscitation survived to hospital discharge, and only 7.0% (28/400) survived to hospital discharge with normal or mildly impaired neurological status. Survival to hospital discharge differed by age, with 21.2% (11/52) of patients younger than 45 years surviving compared with 2.9% (1/34) of those aged 80 or older. Conclusions Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among older patients.

scholarly journals Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 76
Author(s):  
Matthaios Papadimitriou-Olivgeris ◽  
Christina Bartzavali ◽  
Alexandra Georgakopoulou ◽  
Fevronia Kolonitsiou ◽  
Chrisavgi Papamichail ◽  
...  
Keyword(s):  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Carbapenemase Gene ◽  
Comorbidity Index

Background: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. Methods: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. blaKPC, blaVIM, blaNDM, and blaOXA genes were detected by PCR. Results: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. blaKPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. Conclusions: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.

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