scholarly journals Emerging aspergillosis by azole-resistant Aspergillus fumigatus at an intensive care unit in the Netherlands, 2010 to 2013

2016 ◽  
Vol 21 (30) ◽  
Author(s):  
Judith van Paassen ◽  
Anne Russcher ◽  
Astrid WM in 't Veld - van Wingerden ◽  
Paul E Verweij ◽  
Eduard J Kuijper
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
The Netherlands ◽  
Aspergillus Fumigatus ◽  
Resistance Mechanisms ◽  
Antifungal Treatment ◽  
University Hospital ◽  
Resistant Isolate ◽  
Azole Resistance ◽  
Icu Patients

The prevalence of invasive aspergillosis (IA) at the intensive care unit (ICU) is unknown and difficult to assess since IA also develops in patients lacking specific host factors. In the Netherlands, increasing azole-resistance in Aspergillus fumigatus complicates treatment of patients with IA. The aim of this study was to determine the prevalence of IA by azole-resistant A. fumigatus at the ICU among patients receiving antifungal treatment and to follow their clinical outcome and prognosis. A retrospective cohort study was conducted in a university hospital ICU from January 2010 to December 2013. From all patients who received antifungal treatment for suspected IA, relevant clinical and microbiological data were collected using a standardised questionnaire. Of 9,121 admitted ICU-patients, 136 had received antifungal treatment for suspected IA, of which 38 had a positive A. fumigatus culture. Ten of the 38 patients harboured at least one azole-resistant isolate. Resistance mechanisms consisted of alterations in the cyp51A gene, more specific TR34/L98H and TR46/T289A/Y121F. Microsatellite typing did not show clonal relatedness, though isolates from two patients were genetically related. The overall 90-day mortality of patients with IA by azole-resistant A. fumigatus and patients with suspicion of IA by azole-susceptible isolates in the ICU was 100% (10/10) vs 82% (23/28) respectively. We conclude that the changing pattern of IA in ICU patients requires appropriate criteria for recognition, diagnosis and rapid resistance tests. The increase in azole resistance rates also challenges a reconsideration of empirical antifungal therapy.

scholarly journals Use of a Combination Biomarker Algorithm To Identify Medical Intensive Care Unit Patients with Suspected Sepsis at Very Low Likelihood of Bacterial Infection

2015 ◽  
Vol 59 (10) ◽  
pp. 6494-6500 ◽  
Author(s):  
Jennifer H. Han ◽  
Irving Nachamkin ◽  
Susan E. Coffin ◽  
Jeffrey S. Gerber ◽  
Barry Fuchs ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Amyloid ◽  
University Hospital ◽  
Bacterial Sepsis ◽  
Suspected Sepsis ◽  
Icu Patients ◽  
Predictive Values ◽  
Time Points ◽  
Amyloid A

ABSTRACTSepsis remains a diagnostic challenge in the intensive care unit (ICU), and the use of biomarkers may help in differentiating bacterial sepsis from other causes of systemic inflammatory syndrome (SIRS). The goal of this study was to assess test characteristics of a number of biomarkers for identifying ICU patients with a very low likelihood of bacterial sepsis. A prospective cohort study was conducted in a medical ICU of a university hospital. Immunocompetent patients with presumed bacterial sepsis were consecutively enrolled from January 2012 to May 2013. Concentrations of nine biomarkers (α-2 macroglobulin, C-reactive protein [CRP], ferritin, fibrinogen, haptoglobin, procalcitonin [PCT], serum amyloid A, serum amyloid P, and tissue plasminogen activator) were determined at baseline and at 24 h, 48 h, and 72 h after enrollment. Performance characteristics were calculated for various combinations of biomarkers for discrimination of bacterial sepsis from other causes of SIRS. Seventy patients were included during the study period; 31 (44%) had bacterial sepsis, and 39 (56%) had other causes of SIRS. PCT and CRP values were significantly higher at all measured time points in patients with bacterial sepsis. A number of combinations of PCT and CRP, using various cutoff values and measurement time points, demonstrated high negative predictive values (81.1% to 85.7%) and specificities (63.2% to 79.5%) for diagnosing bacterial sepsis. Combinations of PCT and CRP demonstrated a high ability to discriminate bacterial sepsis from other causes of SIRS in medical ICU patients. Future studies should focus on the use of these algorithms to improve antibiotic use in the ICU setting.

Beta-lactam Resistance Mechanisms in Pathogens Isolated from Patients Admitted to Intensive Care Unit

2017 ◽  
Vol 68 (6) ◽  
pp. 1225-1228
Author(s):  
Carmen Axente ◽  
Delia Muntean ◽  
Luminita Baditoiu ◽  
Roxana Moldovan ◽  
Elena Hogea ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Resistance Mechanisms ◽  
University Hospital ◽  
Beta Lactam ◽  
Extended Spectrum Beta Lactamase ◽  
Beta Lactam Antibiotics ◽  
Current Context ◽  
A Prospective Study

Intensive care units (ICUs) are often referred to as the epicentre of infection diseases in a hospital. Many studies highlighted the importance of using local antimicrobial resistance data, to guide empirical antibiotic therapy. As a consequence, the present study is particularly important, especially in the current context, when we are witnessing an ascending trend of antimicrobial resistance. Beta-lactams are the most frequently used class of antibiotics for treating patients infected with various germs. The aim of this study is to analyse the modalities by which microorganisms become resistant to antibiotics of this class, in an intensive care unit of a Romanian university hospital. During the period between January, the 1st 2012 and December the 31st 2013, a prospective study was conducted in the largest ICU from the Western part of Romania. Various resistance mechanisms to beta-lactam antibiotics were detected. Among these, there is great concern regarding the high number of extended-spectrum beta-lactamase producing microorganisms, as in most cases they determine the use of carbapenems, thus increasing the risk of occurrence and dissemination of carbapenemase-producing bacteria.

scholarly journals Detection of Aspergillus fumigatus in Blood Samples from Critically Ill Patients in Intensive Care Units by Use of the SeptiFast Assay: TABLE 1

2016 ◽  
Vol 54 (7) ◽  
pp. 1918-1921 ◽  
Author(s):  
Joerg Steinmann ◽  
Jan Buer ◽  
Peter-Michael Rath
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Positive Predictive Value ◽  
Aspergillus Fumigatus ◽  
Critically Ill ◽  
Predictive Value ◽  
Icu Patients ◽  
Blood Samples ◽  
Content Type ◽  
Whole Blood Samples

We retrospectively analyzed the performance and relevance of the SeptiFast assay in detectingAspergillus fumigatusDNA in whole blood samples from 38 critically ill intensive care unit (ICU) patients with probable or proven invasive aspergillosis (IA) and 100 ICU patients without IA. The assay exhibited 66% sensitivity, 98% specificity, a 93% positive predictive value, and an 88% negative predictive value.A. fumigatusDNAemia was associated with poor outcome.

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 Cost Analysis of Open Surgical Bedside Tracheostomy in Intensive Care Unit Patients

2021 ◽  
pp. 014556132110185
Author(s):  
Mats Døving ◽  
Steven Anandan ◽  
Kjetil Gudmundson Rogne ◽  
Tor Paaske Utheim ◽  
Cathrine Brunborg ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cost Analysis ◽  
Operating Room ◽  
University Hospital ◽  
Annual Reports ◽  
Complication Rates ◽  
Icu Patients ◽  
Surgical Tracheostomy ◽  
Open Surgical Tracheostomy

Objectives: Open surgical tracheostomy (OST) is a common procedure performed on intensive care unit (ICU) patients. The procedure can be performed bedside in the ICU (bedside open surgical tracheostomy, BeOST) or in the operating room (operating room open surgical tracheostomy, OROST), with comparable safety and long-term complication rates. We aimed to perform a cost analysis and evaluate the use of human resources and the total time used for both BeOSTs and OROSTs. Methods: All OSTs performed in 2017 at 5 different ICUs at Oslo University Hospital Ullevål were retrospectively evaluated. The salaries of the personnel involved in the 2 procedures were obtained from the hospital’s finance department. The time taken and the number of procedures performed were extracted from annual reports and from the electronic patient record system, and the annual expenditures were calculated. Results: Altogether, 142 OSTs were performed, of which 122 (86%) and 20 (14%) were BeOSTs and OROSTs, respectively. A BeOST cost 343 EUR (95% CI: 241.4-444.6) less than an OROST. Bedside open surgical tracheostomies resulted in an annual cost efficiency of 41.818 EUR. In addition, BeOSTs freed 279 hours of operating room occupancy during the study year. Choosing BeOST instead of OROST made 1 nurse, 2 surgical nurses, and 1 anesthetic nurse redundant. Conclusion: Bedside open surgical tracheostomy appears to be cost-, time-, and resource-effective than OROST. In the absence of contraindications, BeOSTs should be performed in ICU patients whenever possible.

scholarly journals Rapid Induction of Multiple Resistance Mechanisms in Aspergillus fumigatus during Azole Therapy: a Case Study and Review of the Literature

2011 ◽  
Vol 56 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Simone M. T. Camps ◽  
Jan W. M. van der Linden ◽  
Yi Li ◽  
Ed J. Kuijper ◽  
Jaap T. van Dissel ◽  
...  
Keyword(s):  
Aspergillus Fumigatus ◽  
Resistance Mechanisms ◽  
Resistant Isolate ◽  
Azole Resistance ◽  
Multiple Resistance ◽  
Review Of The Literature ◽  
Wild Type ◽  
Content Type ◽  
Type Isolate ◽  
Rapid Induction

ABSTRACTNine consecutive isogenicAspergillus fumigatusisolates cultured from a patient with aspergilloma were investigated for azole resistance. The first cultured isolate showed a wild-type phenotype, but four azole-resistant phenotypes were observed in the subsequent eight isolates. Four mutations were found in thecyp51Agene of these isolates, leading to the substitutions A9T, G54E, P216L, and F219I. Only G54 substitutions were previously proved to be associated with azole resistance. Using a Cyp51A homology model and recombination experiments in which the mutations were introduced into a susceptible isolate, we show that the substitutions at codons P216 and F219 were both associated with resistance to itraconazole and posaconazole. A9T was also present in the wild-type isolate and thus considered a Cyp51A polymorphism. Isolates harboring F219I evolved further into a pan-azole-resistant phenotype, indicating an additional acquisition of a non-Cyp51A-mediated resistance mechanism. Review of the literature showed that in patients who develop azole resistance during therapy, multiple resistance mechanisms commonly emerge. Furthermore, the median time between the last cultured wild-type isolate and the first azole-resistant isolate was 4 months (range, 3 weeks to 23 months), indicating a rapid induction of resistance.

scholarly journals Suppression effect of thyme and carvacrol nano-emulsions on Aspergillus fumigatus isolated from patients in the intensive care unit of Assiut University Hospital, Egypt

2021 ◽  
Vol 7 (1) ◽  
pp. 116-121
Author(s):  
Alshimaa A. Hassanien ◽  
Walaa M. Elsherif ◽  
Rasha Hamed ◽  
Asmaa A. A. Hussein
Keyword(s):  
Electron Microscopy ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Aspergillus Fumigatus ◽  
Culture Method ◽  
University Hospital ◽  
Diffusion Method ◽  
Invasive Infection ◽  
Suppression Effect ◽  
Nano Emulsion

Background and Aim: Aspergillus fumigatus is a zoonotic fungus that causes several diseases in humans ranging from allergic reaction to fatal disseminated invasive infection, especially in immunocompromised patients. This study aimed to investigate the incidence of invasive A. fumigatus in patients admitted to the intensive care unit (ICU) of Assiut University Hospital, highlight the factors associated with their infection, and determine the antifungal effect of thyme nano-emulsion (TNE) and carvacrol nano-emulsion (CNE) on isolated A. fumigatus strains. Materials and Methods: Mycological culture method and scanning electron microscopy (SEM) were used in the identification of A. fumigatus in 630 blood samples collected from 210 patients. TNE and CNE at five concentrations (1%, 2%, 4%, 6%, and 8%) and average sizes of 90.3 and 75.6 nm, respectively, were characterized by transmission electron microscopy. Their effect on A. fumigatus isolate growth was evaluated by the well-diffusion method and SEM, which was used for the detection of the degenerative effect of A. fumigatus ultrastructure. Results: A. fumigatus was detected in 54 of 210 (25.7%) patients in the ICU. Advanced age and chronic diseases were considered important risk factors for invasive aspergillosis, especially in patients with more than 1 clinical disease. TNE and CNE showed an inhibitory effect on A. fumigatus isolates, which significantly increased with high concentrations. The respective values for TNE at concentrations of 6% and 8% were 6±0.41 mm and 15±0.67 mm. CNE completely inhibited A. fumigatus growth at concentrations of 4%, 6%, and 8%, while mean inhibition zones of 22±0.68 mm and 30±0.32 mm appeared at concentrations of 1% and 2%. SEM demonstrated degenerative changes in A. fumigatus structure. Conclusion: TNE and CNE can be used in bioactive treatments against A. fumigatus, and additional studies are required to determine the safe and effective doses and best method for application in human and veterinary medicine.

scholarly journals A phenomenological study on the experiences of patient transfer from the intensive care unit to general wards

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254316
Author(s):  
Eun-Young Lee ◽  
Jin-Hee Park
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Data Analysis ◽  
Phenomenological Study ◽  
General Ward ◽  
University Hospital ◽  
Nursing Interventions ◽  
Icu Patients ◽  
Holistic Understanding ◽  
General Wards

Objectives This study aimed to derive an in-depth understanding of the transfer experience of intensive care unit (ICU) patients in South Korea through a phenomenological analysis. Methods Participants were 15 adult patients who were admitted to a medical or surgical ICU at a university hospital for more than 48 hours before being transferred to a general ward. Data were collected three to five days after their transfer to the general ward from January to December 2017 through individual in-depth interviews and were analyzed using Colaizzi’s phenomenological data analysis method, phenomenological reduction, intersubjective reduction, and hermeneutic circle. Data analysis yielded eight themes and four theme clusters related to the unique experiences of domestic ICU patients in the process of transfer to the general ward. Results The four main themes of the patients’ transfer experiences were “hope amid despair,” “gratitude for being alive,” “recovery from suffering,” and “seeking a return to normality.” Conclusion Our findings expand the realistic and holistic understanding from the patient’s perspective. This study’s findings can contribute to the development of appropriate nursing interventions that can support preparation and adaptation to the transfer of ICU patients.

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