Infectious Diseases in Critical Care Medicine

2009 ◽  
Keyword(s):  
Critical Care ◽  
Infectious Diseases ◽  
Critical Care Medicine

scholarly journals Evaluation of Clinical Outcomes after Introduction of a Dedicated Infectious Diseases- Critical Care Medicine Service in Critical Care Units

2021 ◽  
Author(s):  
Polina Trachuk ◽  
Vagish Hemmige ◽  
Ruth Eisenberg ◽  
Kelsie Cowman ◽  
Victor Chen ◽  
...  
Keyword(s):  
Critical Care ◽  
Infectious Diseases ◽  
Clinical Outcomes ◽  
Broad Spectrum ◽  
Critical Care Medicine ◽  
Care Hospital ◽  
Intervention Period ◽  
Broad Spectrum Antibiotics ◽  
Antibiotic Utilization ◽  
The Impact

Abstract Objective Infection is a leading cause of admission to intensive care units (ICU), with critically ill patients often receiving empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely established. An ID-Critical Care Medicine (ID-CCM) pilot program was designed at a 400-bed tertiary care hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide ID consultation on select patients. We sought to evaluate the impact of this dedicated ID program on antibiotic utilization and clinical outcomes in patients admitted to the ICU. Method In this single site retrospective study, we analyzed antibiotic utilization and clinical outcomes in patients admitted to an ICU during post-intervention period from January 1, 2017 to December 31, 2017 and compared it to antibiotic utilization in the same ICUs during the pre-intervention period from January 1, 2015 to December 31, 2015. Results Our data showed a statistically significant reduction in usage of most frequently prescribed antibiotics including vancomycin, piperacillin-tazobactam and cefepime during the intervention period. When compared to pre-intervention period there was no difference in-hospital mortality, hospital length of stay and re-admission. Conclusion With this multidisciplinary intervention, we saw a decrease in the use of the most frequently prescribed broad-spectrum antibiotics without a negative impact on clinical outcomes. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents.

scholarly journals Infectious Diseases Society of America (IDSA) POSITION STATEMENT: Why IDSA Did Not Endorse the Surviving Sepsis Campaign Guidelines

2017 ◽  
Vol 66 (10) ◽  
pp. 1631-1635 ◽  
Author(s):  
◽  
Andre C Kalil ◽  
David N Gilbert ◽  
Dean L Winslow ◽  
Henry Masur ◽  
...  
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Infectious Diseases ◽  
Position Statement ◽  
Critical Care Medicine ◽  
Surviving Sepsis Campaign ◽  
Diagnosis And Therapy

The Infectious Diseases Society of America elected not to endorse the Surviving Sepsis Campaign Guidelines due to lack of agreement with the Society of Critical Care Medicine regarding specific recommendations related to diagnosis and therapy for patients with apparent or documented sepsis/septic shock.

scholarly journals Synergy, Salary, and Satisfaction: Benefits of Training in Critical Care Medicine and Infectious Diseases Gleaned From a National Pilot Survey of Dually Trained Physicians

2016 ◽  
Vol 63 (7) ◽  
pp. 868-875 ◽  
Author(s):  
Sameer S. Kadri ◽  
Chanu Rhee ◽  
Gabriela Magda ◽  
Jeffrey R. Strich ◽  
Rongman Cai ◽  
...  
Keyword(s):  
Critical Care ◽  
Infectious Diseases ◽  
Critical Care Medicine ◽  
Pilot Survey

The Year in Review: Critical Care Medicine

2001 ◽  
Vol 14 (1) ◽  
pp. 70-85
Author(s):  
Maria I. Rudis ◽  
David Q. Hoang
Keyword(s):  
Critical Care ◽  
Cardiovascular Diseases ◽  
Infectious Diseases ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Treatment Guidelines ◽  
Neuromuscular Blocking ◽  
Critical Care Medicine ◽  
Icu Patients ◽  
Adult Intensive Care Unit

Background: There have been significant recent advances in the pharmacotherapeutic management of critically ill patients. The purpose of this article is to review and discuss the most pertinent published literature in the areas of neurology, cardiovascular diseases, infectious diseases, nephrology, hematology, and gastroenterology as it pertains to critical care in order to provide an update for the critical care practitioner. Methods: We performed a Medline search from July 1999 to December 2000 utilizing terms relating to the pharmacotherapy of the specific aforementioned topics in critical care medicine. We focused on English-language clinical studies performed in adult intensive care unit (ICU) patients. From these articles we selected those that would have a practical impact on drug therapy in the ICU or the development of drug usage guidelines for critically ill patients. Review articles were generally not included. Results: The following topics were found to be either new developments or of potentially significant impact in the management of adult critically ill patients. In the area of neurology, advances were found with respect to optimization of regimens for sedative and neuromuscular blocking agents, validation of sedation scales and tools, and in the treatment of head injury patients. In the cardiovascular diseases, most studies related to the hemodynamic support of septic shock. We focus on developments in fluid resuscitation, optimization of global and regional oxygen transport variables, the repositioning of vasopressor agents, and a return to the use of steroids. Given the high mortality rate associated with the development of acute renal failure in the ICU, there has been a consistent attempt to develop preventative and treatment strategies for these patients, including optimization of antimicrobial dosing methods. Several epidemiological and longitudinal studies document changes in multi-drug antimicrobial resistance patterns. The use of treatment guidelines for antimicrobials in the critically ill improves outcomes in most patients. Significant attention has focused on the characterization of anemia in the ICU and the development of alternative pharmacological strategies in its treatment. Finally, in gastroenterology, the main focus has been the investigation of methods to optimize the delivery of enteral nutrition given its proven benefits in critically ill patients. Conclusions: Significant advances in the areas of neurological, cardiovascular, infectious diseases, renal, hematological, and gastrointestinal issues in the pharmacotherapy of critically ill patients have been published over the course of the past year. Many of these studies have yielded data that may be incorporated into the pharmacotherapeutic management of ICU patients, hence maximizing outcomes.

scholarly journals Vancomycin Dosing Practices among Critical Care Pharmacists: A Survey of Society of Critical Care Medicine Pharmacists

2020 ◽  
Vol 13 ◽  
pp. 117863372095207
Author(s):  
Alexander H Flannery ◽  
Drayton A Hammond ◽  
Douglas R Oyler ◽  
Chenghui Li ◽  
Adrian Wong ◽  
...  
Keyword(s):  
Critical Care ◽  
Infectious Diseases ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Online Survey ◽  
Critical Care Medicine ◽  
Guideline Recommendation ◽  
Critically Ill Patient ◽  
Critically Ill Adults ◽  
Monitoring Protocols

Introduction: Critically ill patients and their pharmacokinetics present complexities often not considered by consensus guidelines from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Prior surveys have suggested discordance between certain guideline recommendations and reported infectious disease pharmacist practice. Vancomycin dosing practices, including institutional considerations, have not previously been well described in the critically ill patient population. Objectives: To evaluate critical care pharmacists’ self-reported vancomycin practices in comparison to the 2009 guideline recommendations and other best practices identified by the study investigators. Methods: An online survey developed by the Research and Scholarship Committee of the Clinical Pharmacy and Pharmacology (CPP) Section of the Society of Critical Care Medicine (SCCM) was sent to pharmacist members of the SCCM CPP Section practicing in adult intensive care units in the spring of 2017. This survey queried pharmacists’ self-reported practices regarding vancomycin dosing and monitoring in critically ill adults. Results: Three-hundred and sixty-four responses were received for an estimated response rate of 26%. Critical care pharmacists self-reported largely following the 2009 vancomycin dosing and monitoring guidelines. The largest deviations in guideline recommendation compliance involve consistent use of a loading dose, dosing weight in obese patients, and quality improvement efforts related to systematically monitoring vancomycin-associated nephrotoxicity. Variation exists regarding pharmacist protocols and other practices of vancomycin use in critically ill patients. Conclusion: Among critical care pharmacists, reported vancomycin practices are largely consistent with the 2009 guideline recommendations. Variations in vancomycin dosing and monitoring protocols are identified, and rationale for guideline non-adherence with loading doses elucidated.

scholarly journals 1877. Evaluation of Antibiotic Utilization After Introduction of a Dedicated Infectious Diseases-Critical Care Medicine Service in Critical Care Units

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S48-S48
Author(s):  
Polina Trachuk ◽  
Vagish Hemmige ◽  
Victor Chen ◽  
Gregory Weston ◽  
Kelsie Cowman ◽  
...  
Keyword(s):  
Critical Care ◽  
Infectious Diseases ◽  
Broad Spectrum ◽  
Critical Care Medicine ◽  
Intervention Period ◽  
Broad Spectrum Antibiotics ◽  
Antibiotic Utilization ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Infection is a leading cause of admission to intensive care units (ICU), with critically ill patients often receiving a high volume of empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely implemented. An ID-Critical Care Medicine (ID-CCM) pilot program was designed at a large tertiary hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide an ID consult on select patients. We sought to evaluate the impact of this dedicated ID consultation and stewardship program on antibiotic utilization in the ICU. Methods This is an IRB-approved single-site retrospective study. We analyzed antibiotic utilization in the ICU during the post-intervention period from January 1, 2017 to December 31, 2017 and compared it to antibiotic utilization in the same ICU during the pre-intervention period from January 1, 2015 to December 31, 2015. Using Poisson regression analysis, we evaluated antibiotic utilization of each agent, expressed as days of therapy (DOT) per 1,000 patient-days, between the two groups. Results The six most commonly used broad-spectrum antibiotic agents were included in the final analysis. During the intervention period, statistically significant reductions were seen in cefepime (131 vs. 101 DOT per 1,000 patient-days, P = 0.01), piperacillin-tazobactam (268 vs. 251 DOT per 1,000 patient-days, P = 0.02) and vancomycin (265 vs. 228 DOT per 1,000 patient-days, P = 0.01). The utilization of other antibiotics including daptomycin, linezolid, and meropenem did not differ significantly (Figure 1). Conclusion With this multidisciplinary intervention, we saw a decrease in the use of the most frequently administered broad-spectrum antibiotics. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents. Disclosures All Authors: No reported Disclosures.

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