scholarly journals The impact of early percutaneous tracheotomy on reduction of the incidence of ventilator associated pneumonia and the course and outcome of ICU patients

2018 ◽  
Vol 14 (1) ◽  
pp. 75
Keyword(s):  
Ventilator Associated Pneumonia ◽  
Icu Patients ◽  
Percutaneous Tracheotomy ◽  
The Impact

scholarly journals The Impact of Intervention-Related Risk Factors on the Risk of Ventilator-Associated Pneumonia Is High in a Neurosurgical Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s407-s409
Author(s):  
Ksenia Ershova ◽  
Oleg Khomenko ◽  
Olga Ershova ◽  
Ivan Savin ◽  
Natalia Kurdumova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Negative Slope ◽  
Infection Prevention And Control ◽  
Ventilator Associated Pneumonia ◽  
Related Factors ◽  
Icu Patients ◽  
The Impact ◽  
Adf Test ◽  
Over Time

Background: Ventilator-associated pneumonia (VAP) represents the highest burden among all healthcare-associated infections (HAIs), with a particularly high rate in patients in neurosurgical ICUs. Numerous VAP risk factors have been identified to provide a basis for preventive measures. However, the impact of individual factors on the risk of VAP is unclear. The goal of this study was to evaluate the dynamics of various VAP risk factors given the continuously declining prevalence of VAP in our neurosurgical ICU. Methods: This prospective cohort unit-based study included neurosurgical patients who stayed in the ICU >48 consecutive hours in 2011 through 2018. The infection prevention and control (IPC) program was implemented in 2010 and underwent changes to adopt best practices over time. We used a 2008 CDC definition for VAP. The dynamics of VAP risk factors was considered a time series and was checked for stationarity using theAugmented Dickey-Fuller test (ADF) test. The data were censored when a risk factor was present during and after VAP episodes. Results: In total, 2,957 ICU patients were included in the study, 476 of whom had VAP. Average annual prevalence of VAP decreased from 15.8 per 100 ICU patients in 2011 to 9.5 per 100 ICU patients in 2018 (Welch t test P value = 7.7e-16). The fitted linear model showed negative slope (Fig. 1). During a study period we observed substantial changes in some risk factors and no changes in others. Namely, we detected a decrease in the use of anxiolytics and antibiotics, decreased days on mechanical ventilation, and a lower rate of intestinal dysfunction, all of which were nonstationary processes with a declining trend (ADF testP > .05) (Fig. 2). However, there were no changes over time in such factors as average age, comorbidity index, level of consciousness, gender, and proportion of patients with brain trauma (Fig. 2). Conclusions: Our evidence-based IPC program was effective in lowering the prevalence of VAP and demonstrated which individual measures contributed to this improvement. By following the dynamics of known VAP risk factors over time, we found that their association with declining VAP prevalence varies significantly. Intervention-related factors (ie, use of antibiotics, anxiolytics and mechanical ventilation, and a rate of intestinal dysfunction) demonstrated significant reduction, and patient-related factors (ie, age, sex, comorbidity, etc) remained unchanged. Thus, according to the discriminative model, the intervention-related factors contributed more to the overall risk of VAP than did patient-related factors, and their reduction was associated with a decrease in VAP prevalence in our neurosurgical ICU.Funding: NoneDisclosures: None

Incidence and Outcomes of Ventilator-Associated Pneumonia in Japanese Intensive Care Units: The Japanese Nosocomial Infection Surveillance System

2007 ◽  
Vol 28 (3) ◽  
pp. 307-313 ◽  
Author(s):  
Machi Suka ◽  
Katsumi Yoshida ◽  
Hideo Uno ◽  
Jun Takezawa
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Nosocomial Infection ◽  
Patient Outcomes ◽  
Ventilator Associated Pneumonia ◽  
Drug Resistant ◽  
Icu Patients ◽  
The Mean ◽  
The Impact

Objectives.To determine the incidence of ventilator-associated pneumonia (VAP) among intensive care unit (ICU) patients in Japan and to assess the impact of VAP on patient outcomes, including mortality, length of stay, and duration of mechanical ventilation.Design.Multicenter cohort study.Setting.Twenty-eight ICUs in multidisciplinary Japanese hospitals with more than 200 beds.Patients.A total of 21,909 patients 16 years or older who were admitted to an ICU between June 2002 and June 2004, stayed in the ICU for 24 to 1,000 hours, and were not transferred to another ICU.Results.The overall infection rates for nosocomial pneumonia and VAP were 6.5 cases per 1,000 patient-days and 12.6 cases per 1,000 ventilator-days, respectively. The standardized mortality rates for the patients with VAP was 1.3 (95% confidence interval [CI], 1.1-1.6): 1.1 (95% CI, 0.9-1.4) for the cases due to drug-susceptible pathogens and 1.5 (95% CI, 1.1-1.9) for the cases due to drug-resistant pathogens. After adjusting for Acute Physiology and Chronic Health Evaluation II score, the mean length of stay for the patients with VAP caused by drug-susceptible pathogens (15.2 days [95% CI, 14.6-15.8]) and by drug-resistant pathogens (17.8 days [95% CI, 17.0-18.6]) was significantly longer than that in the patients without nosocomial infection (6.8 days [95% CI, 6.7-6.9]). The mean duration of mechanical ventilation in the patients with VAP caused by drug-susceptible pathogens (12.0 days [95% CI, 11.5-12.5]) and drug-resistant pathogens (14.1 days [95% CI, 13.5-14.8]) was significantly longer than that in the patients without nosocomial infection (4.7 days [95% CI, 4.6-4:8]).Conclusion.The incidence of VAP is substantial among ICU patients in Japan. The potential impact of VAP on patient outcomes emphasizes the importance of preventive measures against VAP, especially for VAP caused by drug-resistant pathogens.

scholarly journals 1590. Activity of Meropenem-Vaborbactam and Single-Agent Comparators against Enterobacterales Isolates Including KPC-Producing Isolates, from European Patients Hospitalized with Pneumonia Including Ventilator-Associated Pneumonia (2014-2019)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S792-S792
Author(s):  
Dee Shorttidge ◽  
Lalitagauri M Deshpande ◽  
Leonard R Duncan ◽  
Jennifer M Streit ◽  
Mariana Castanheira
Keyword(s):  
Single Agent ◽  
Chemical Diversity ◽  
Ventilator Associated Pneumonia ◽  
Services Research ◽  
Icu Patients ◽  
Active Comparator ◽  
Extended Spectrum Beta Lactamase ◽  
Abdominal Infections ◽  
Hospital Acquired ◽  
Research Grant

Abstract Background Meropenem-vaborbactam (MVB) was recently approved in Europe for the treatment of complicated UTIs, including acute pyelonephritis, complicated intra-abdominal infections, hospital-acquired bacterial pneumonia, ventilator-associated pneumonia (VAP), and bacteremia. KPC-producing Enterobacterales (ENT) isolates have disseminated worldwide. We analysed the activity of MVB and single-agent comparators against 6,846 ENT isolates from patients hospitalised with pneumonia (PHP) including VAP in European hospitals (2014–2019). Methods Among 6,846 ENT clinical isolates from PHP collected in 40 European hospitals located in 20 countries that were susceptibility (S) tested using reference broth microdilution methods. Of the carbapenem-resistant isolates submitted to whole genome sequencing, 75 carried blaKPC. ENT isolates were also characterized for an extended spectrum beta-lactamase (ESBL) phenotype as described (CLSI, 2020). EUCAST (2020) interpretive criteria were used. %S from patients in the intensive care unit (ICU), ICU patients with VAP, and non-ICU isolates were also analysed. Results The most common ENT pathogens isolated from PHP were Klebsiella pneumoniae (KPN; n=1,877) and Escherichia coli (EC; n=1,646). The %S of MVB and comparators to ENT, ICU, ICU/VAP, and non-ICU are shown in the table. Overall, 98.2% of ENT were S to MVB. For 3,218 ENT isolates from ICU patients, MVB %S was 96.6% and for 2,627 non-ICU isolates MVB %S was 98.5%. The %S of comparators for ICU vs non-ICU isolates were similar, except for levofloxacin. 29 KPC-producing isolates were from ICU (11 from VAP), 46 were from non-ICU. Most KPC-producing isolates were KPN (n=71; 54 blaKPC-3, 16 blaKPC-2 and 1 blaKPC-12). 4 EC contained blaKPC-3. KPC were from 7 countries, Italy had the highest number of KPC-producing isolates at 42 (56%). MVB inhibited 100% of KPC-producing isolates. Amikacin was the most active comparator against all ENT (94.2%S); colistin was the most active comparator against KPC-producing isolates (79.7%S). Conclusion These results demonstrate MVB has potent activity against ENT isolates from PHP including those producing KPC enzymes and suggest MVB is a useful treatment option for ICU and non-ICU PHP including VAP. Table 1 Disclosures Leonard R. Duncan, PhD, A. Menarini Industrie Farmaceutiche Riunite S.R.L. (Research Grant or Support)Basilea Pharmaceutica International, Ltd. (Research Grant or Support)Dept of Health and Human Services (Research Grant or Support) Jennifer M. Streit, BS, A. Menarini Industrie Farmaceutiche Riunite S.R.L. (Research Grant or Support)A. Menarini Industrie Farmaceutiche Riunite S.R.L. (Research Grant or Support)Allergan (Research Grant or Support)Melinta Therapeutics, Inc. (Research Grant or Support)Melinta Therapeutics, Inc. (Research Grant or Support)Melinta Therapeutics, Inc. (Research Grant or Support)Merck (Research Grant or Support)Paratek Pharma, LLC (Research Grant or Support) Mariana Castanheira, PhD, 1928 Diagnostics (Research Grant or Support)A. Menarini Industrie Farmaceutiche Riunite S.R.L. (Research Grant or Support)Allergan (Research Grant or Support)Allergan (Research Grant or Support)Amplyx Pharmaceuticals (Research Grant or Support)Cidara Therapeutics (Research Grant or Support)Cidara Therapeutics (Research Grant or Support)Cipla Ltd. (Research Grant or Support)Cipla Ltd. (Research Grant or Support)Fox Chase Chemical Diversity Center (Research Grant or Support)GlaxoSmithKline (Research Grant or Support)Melinta Therapeutics, Inc. (Research Grant or Support)Melinta Therapeutics, Inc. (Research Grant or Support)Melinta Therapeutics, Inc. (Research Grant or Support)Merck (Research Grant or Support)Merck (Research Grant or Support)Merck & Co, Inc. (Research Grant or Support)Merck & Co, Inc. (Research Grant or Support)Paratek Pharma, LLC (Research Grant or Support)Pfizer (Research Grant or Support)Qpex Biopharma (Research Grant or Support)

scholarly journals The impact of viremia on organ failure, biomarkers and mortality in a Swedish cohort of critically ill COVID-19 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Josef D. Järhult ◽  
Michael Hultström ◽  
Anders Bergqvist ◽  
Robert Frithiof ◽  
Miklos Lipcsey
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Independent Predictor ◽  
Corticosteroid Treatment ◽  
Blood Stream ◽  
Common Finding ◽  
Icu Patients ◽  
Extra Pulmonary ◽  
The Impact ◽  
Swedish Cohort

AbstractThe spread of virus via the blood stream has been suggested to contribute to extra-pulmonary organ failure in Coronavirus disease 2019 (COVID-19). We assessed SARS-CoV-2 RNAemia (RNAemia) and the association between RNAemia and inflammation, organ failure and mortality in critically ill COVID-19 patients. We included all patients with PCR verified COVID-19 and consent admitted to ICU. SARS-CoV-2 RNA copies above 1000/ml measured by PCR in plasma was defined as RNAemia and used as surrogate for viremia. In this cohort of 92 patients 59 (64%) were invasively ventilated. RNAemia was found in 31 patients (34%). Hypertension and corticosteroid treatment was more common in patients with RNAemia. Extra-pulmonary organ failure biomarkers and the extent of organ failure were similar in patients with and without RNAemia, but the former group had more renal replacement therapy and higher mortality (26 vs 16%; 35 vs 16%, respectively, p = 0.04). RNAemia was not an independent predictor of death at 30 days after adjustment for age. SARS-CoV2 RNA copies in plasma is a common finding in ICU patients with COVID-19. Although viremia was not associated with extra pulmonary organ failure it was more common in patients who did not survive to 30 days after ICU admission.Trial registration: ClinicalTrials NCT04316884.

Effect Of Cluster Intervention Strategy Combined with Targeted Nursing on Prevention of Ventilator-Associated Pneumonia in Icu Patients

2021 ◽  
Vol 7 (6) ◽  
pp. 6395-6401
Author(s):  
XueQin Li ◽  
XiuYing Chen
Keyword(s):  
Mechanical Ventilation ◽  
Detection Rate ◽  
Pathogenic Bacteria ◽  
Nursing Intervention ◽  
Apache Ii Score ◽  
Control Group ◽  
Study Group ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients ◽  
Mechanical Ventilation Time

Background VAP is a common complication of ventilator maintenance therapy. The occurrence of VAP is related to many factors such as long duration of breathing, invasive operation, pollution of respiratory tubes and instruments, and low immunity of patients. The prevention of VAP in critically ill patients I the primary problem for clinical medical staff. Avoiding exogenous bacteria invading the respiratory tract and endogenous bacterial infection is the main method. Objective To investigate the value of optimized cluster nursing intervention combined with targeted nursing measures in reducing the incidence of ventilator-associated pneumonia (VAP) in patients with mechanical ventilation in intensive care unit (ICU). Methods 200 patients with mechanical ventilation in ICU of our institute from January 2017 to June 2020 were selected and randomly divided into study group and control group, with 100 cases in each group. The study group was treated with cluster nursing intervention combined with targeted nursing measures optimized by muItL criteria decision analysis method, and the control group was treated with targeted nursing measures. The incidence of VAP, the detection rate of pathogenic bacteria in sputum specimens and the effect of nursing execution were compared between the two groups. 200 patients were divided into VAP group and non-VAP group according to whether VAP occurred. Multivariate Logistic regression model analysis was used to explore the risk factors of VAP in AECOPD patients. Results A total of 4 strains were detected in the study group and 18 strains were detected in the control group. The detection rate of pathogenic bacteria in the study group was higher than that in the control group (y2=10.010, P=0.002<0.05). The incidence of VAP in the study group was 4.00% lower than 17.00% in the control group, and the difference was statistically significant (P<0.05). Compared with VAP group and non-VAP group, the proportion of patients with serum albumin<30g/L, diabetes mellitus rate, APACHE II score>15 points, tracheotomy rate and mechanical ventilation time≥5 days in VAP group were significantly higher than those in non-VAP group, which had statistical significance (P<0.05). The results of logistic regression model snowed that serum albumin ≥30g/L and optimized cluster nursing could effectively reduce the risk of VAP in ICU patients with mechanical ventilation (P<0.05). The risk of VAP in ICU patients with mechanical ventilation was increased by the combination of diabetes rate. APACHE II score≥15 points, tracheotomy and mechanical ventilation time ≥ 5 days (P<0.05). Conclusion The risk of VAP in ICU patients with mechanical ventilation is high, and the optimized cluster nursing intervention combined with targeted nursing measures can effectively reduce the incidence of VAP.

Cardiac Health Indicators in Critical COVID-19 Cases

2021 ◽  
Vol 7 (1) ◽  
pp. 1-6
Author(s):  
Sultan Alasmari ◽  
Mohammed Makkawi ◽  
Mutaib M Mashraqi ◽  
Saleh Alqahtani ◽  
Mustafa Alqahtani ◽  
...  
Keyword(s):  
Creatine Phosphokinase ◽  
Health Indicators ◽  
Total Serum ◽  
Healthy Individuals ◽  
Icu Patients ◽  
Cardiac Health ◽  
Serum Creatine Phosphokinase ◽  
Global Concern ◽  
Asir Region ◽  
The Impact

Coronavirus disease-2019 (COVID-19) is an infectious disease that has spread worldwide and led to ongoing global concern. The pandemic prompted researchers to examine the impact of COVID-19 on human organs. The heart is one such organ. This study investigates the possible prediction of heart condition using some biochemical markers of particularly critically ill patients referred to an intensive care unit (ICU). Results of various serum biomarkers of patients infected with COVID-19 receiving treatment in the ICU, Asir Central Hospital, Asir Region, Saudi Arabia, were extracted and compared with healthy individuals using the Mann-Whitney U test. The study showed a distinguished increase in total Serum creatine phosphokinase-Total (CPK-Total), Serum creatine phosphokinase-MP (CPK-MP) levels among COVID-19/ICU patients. But, this increase was not statistically significant. Besides, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels revealed a statistically significant increase in the infected group compared with controls. Examination of electrolytes showed a reduction in calcium median value in COVID-19/ICU patients. Data revealed a possible influence of COVID-19 on the heart. Herein, we observe significant parameters that may reflect cardiovascular injury elicited by the virus. These biomarkers possibly used to monitor the severity of disease on the cardiovascular system.

scholarly journals Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

2021 ◽  
Vol 9 (11) ◽  
pp. 2332
Author(s):  
Nitin Chandra Teja Dadi ◽  
Barbora Radochová ◽  
Jarmila Vargová ◽  
Helena Bujdáková
Keyword(s):  
Medical Devices ◽  
Surgical Site Infections ◽  
Central Line ◽  
Ventilator Associated Pneumonia ◽  
Healthcare Associated Infections ◽  
Care Bundles ◽  
Planktonic Form ◽  
Novel Approaches ◽  
Healthcare Associated ◽  
The Impact

Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections. The most relevant microorganisms are mentioned in terms of their frequency of infection on medical devices. Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. This review concisely summarizes relevant and up-to-date information on HAIs and HAI-associated microorganisms and also provides a description of several useful approaches for tackling HAIs.

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