Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study

Objectives: Multiple risk factors have been described to be related to external ventricular drain (EVD) associated infections, with results varying between studies. Former studies were limited by a non-uniform definition of EVD associated infection, thus complicating a comparison between studies. In this regard, we assessed risk factors promoting EVD associated infections and propose a modified practice-oriented definition of EVD associated infections.Methods: We performed a retrospective, single-center study on patients who were treated with an EVD, at the neurosurgical intensive care unit (ICU) at a tertiary center between 2008 and 2019. Based on microbiological findings and laboratory results, patients were assigned into an infection and a non-infection group. Patient characteristics and potential risk factors were compared between the two groups (p < 0.05). Receiver operating characteristics (ROC) for significant clinical, serum laboratory and cerebrospinal fluid (CSF) parameters were calculated.Results: In total, 396 patients treated with an EVD were included into the study with a mean age of 54.3 (range: 18–89) years. EVD associated infections were observed in 32 (8.1%) patients. EVD insertion at another hospital (OR 3.86), and an increased CSF sampling frequency of more than every third day (OR 12.91) were detected as major risk factors for an EVD associated infection. The indication for EVD insertion, surgeon's experience, the setting of EVD insertion (ICU vs. operating room) and the operating time did not show any significant differences between the two groups. Furthermore, ROC analysis showed that clinical, serum laboratory and CSF parameters did not provide specific prediction of EVD associated infections (specificity 44.4%). This explains the high overtreatment rate in our cohort with the majority of our patients who received intrathecal vancomycin (63.3%), having either negative microbiological results (n = 12) or were defined as contaminations (n = 7).Conclusions: Since clinical parameters and blood analyzes are not very predictive to detect EVD associated infections in neurosurgical patients, sequential but not too frequent microbiological and laboratory analysis of CSF are still necessary. Furthermore, we propose a uniform classification for EVD associated infections to allow comparability between studies and to sensitize the treating physician in determining the right treatment.

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Intensive Care Unit Delirium

Journal of Pharmacy Practice ◽

10.1177/0897190013513804 ◽

2013 ◽

Vol 27 (2) ◽

pp. 195-207 ◽

Cited By ~ 27

Author(s):

Julie Kalabalik ◽

Luigi Brunetti ◽

Radwa El-Srougy

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Early Mobilization ◽

Patient Characteristics ◽

Screening Tools ◽

Clinical Complications ◽

Icu Delirium

Purpose: The recent literature regarding intensive care unit (ICU) delirium and updated clinical practice guidelines are reviewed. Summary: Recent studies show that ICU delirium in critically ill patients is an independent predictor of higher mortality, longer ICU and hospital stay, and is associated with multiple clinical complications. Delirium has been reported to occur in greater than 80% of hospitalized critically ill patients, yet it remains an underdiagnosed condition. Several subtypes of delirium have been identified including hypoactive, hyperactive, and mixed presentation. Although the exact mechanism is unknown, several factors are thought to interact to cause delirium. Multiple risk factors related to medications, acute illness, the environment, and patient characteristics may contribute to the development of delirium. Practical bedside screening tools have been validated and are recommended to identify ICU patients with delirium. Nonpharmacologic interventions such as early mobilization have resulted in better functional outcomes, decreased incidence and duration of delirium, and more ventilator-free days. Data supporting pharmacologic treatments are limited. Conclusion: Clinicians should become familiar with tools to identify delirium in order to initiate treatment and remove mitigating factors early in hospitalization to prevent delirium. Pharmacists are in a unique position to reduce delirium through minimization of medication-related risk factors and development of protocols.

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Pitfalls when comparing COVID-19 related outcomes across studies. Lessons learnt from the ERACODA collaboration

Clinical Kidney Journal ◽

10.1093/ckj/sfab027 ◽

2021 ◽

Author(s):

Marlies Noordzij ◽

Priya Vart ◽

Raphaël Duivenvoorden ◽

Casper F M Franssen ◽

Marc H Hemmelder ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Patient Characteristics ◽

Incidence Rates ◽

Analysis Phase ◽

Lessons Learnt ◽

Methodological Aspects

ABSTRACT Reported outcomes, such as incidence rates of mortality and intensive care unit admission, vary widely across epidemiological COVID-19 studies, also in the nephrology field. This variation can in part be explained by differences in patient characteristics, but also methodological aspects must be considered. In this review, we reflect on the methodological factors that contribute to the observed variation in COVID-19 related outcomes and their risk factors, that are identified in the various studies. We focus on issues that arose during the design and analysis phase of the European Renal Association COVID-19 Database (ERACODA) and use examples from recently published reports on COVID-19 to illustrate these issues.

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Risk factors and outcome of Acinetobacter infection in the intensive care unit of a tertiary center in Oyo State, Nigeria

African Journal of Microbiology Research ◽

10.5897/ajmr12.2172 ◽

2013 ◽

Vol 7 (18) ◽

pp. 1838-1844

Author(s):

V Ugochukwu Nwadike ◽

S Adetona Fayemiwo ◽

Adeola Fowotade ◽

R Ajani Bakare ◽

O O Olusanya

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Center ◽

Acinetobacter Infection

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Risk factors promoting external ventricular drain infections at the intensive care unit

Brain and Spine ◽

10.1016/j.bas.2021.100739 ◽

2021 ◽

Vol 1 ◽

pp. 100739

Author(s):

F. Khalaveh ◽

N. Fazel ◽

M. Mischkulnig ◽

M. Vossen ◽

A. Reinprecht ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

External Ventricular Drain

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384. Invasive aspergillosis in COVID-19 patients in an intensive care unit in Mexico City

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.579 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S261-S261

Author(s):

Mariana Velez-Pintado ◽

Mercedes Aguilar-Soto ◽

Antonio Camiro ◽

Dalia Cuenca-Abruch ◽

Renzo Alberto Pérez-Doramae ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Invasive Aspergillosis ◽

Mexico City ◽

Invasive Pulmonary Aspergillosis ◽

Serum Glucose ◽

Control Group ◽

Chi Squared ◽

Definition Of

Abstract Background An elevated incidence of invasive pulmonary aspergillosis (IPA) in patients with COVID-19 without traditional risk factors for IPA has been recently reported around the world. This co-infection has been described in patients requiring treatment in an intensive care unit. The risk factors for its development are still unclear. Methods We conducted a nested case-control study using the COVID-19 registry of the ARMII study group, based in the Centro Médico ABC, a private hospital in Mexico City. We included all patients that required admission to the intensive care unit (ICU) from March 12 to June 15, 2020, and excluded patients without serum galactomannan measurements or bronchial secretion cultures. We used the modified definition of IPA proposed by Schauwvlieghe et al for IPA in influenza patients. The control group was formed by patients with ruled-out IPA (negative galactomannan and secretion cultures). We compared both groups to identify risk factors for IPA using the chi-squared test or the Mann-Whitney U test as applicable. Results Out of a total 239 patients, 54 met the inclusion criteria. We identified 13 patients with IPA (24.07%) that met the definition of IPA (2 with positive cultures and 11 with positive galactomannan) and 41 without IPA. Only three patients with IPA had important comorbidities (COPD, chronic kidney disease, and HIV). Patients with IPA tended to have a higher median age (64.6 vs 53.59, p=0.075) and a higher serum glucose at their arrival (145 vs 119, p=0.028). All patients with IPA presented to the hospital with ARDS (100% vs 72.5%, p=0.034), but ultimately did not have a higher requirement for mechanical ventilation (100% vs 82.93%, p=0.110). There were no statistical significant differences in use of Tocilizumab, use of glucocorticoids, mortality (23.07% vs 17.50%, p=0.563) or length of stay. Conclusion It has been previously described that patients with acute respiratory disease syndrome triggered by viral infection, like the influenza virus, are prone to invasive aspergillosis even in the absence of underlying immunodeficiency. The use of antifungals to prevent aspergillosis in COVID-19 patients should be assessed because of the gravity presented in the patients with this co-infection. Disclosures All Authors: No reported disclosures

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Severe Influenza in 33 US Hospitals, 2013–2014: Complications and Risk Factors for Death in 507 Patients

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.170 ◽

2015 ◽

Vol 36 (11) ◽

pp. 1251-1260 ◽

Cited By ~ 24

Author(s):

Nirav S. Shah ◽

Jared A. Greenberg ◽

Moira C. McNulty ◽

Kevin S. Gregg ◽

James Riddell ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Influenza A ◽

Influenza Season ◽

Influenza Infection ◽

Patient Characteristics ◽

The United States ◽

Severe Influenza ◽

Influenza A H1n1

BACKGROUNDInfluenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013–2014 influenza season. Little is known about the epidemiology of severe influenza during this season.METHODSA retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes.RESULTSA total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (>65 years, odds ratio, 3.1 [95% CI, 1.4–6.9], P=.006 and 50–64 years, 2.5 [1.3–4.9], P=.007; reference age 18–49 years), male sex (1.9 [1.1–3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9–37.0], P<.001), and a higher Sequential Organ Failure Assessment score (for each increase by 1 in score, 1.3 [1.2–1.4], P<.001).CONCLUSIONRisk factors for death among US patients with severe influenza during the 2013–2014 season, when influenza A (H1N1) pdm09 was the predominant circulating strain type, shifted in the first postpandemic season in which it predominated toward those of a more typical epidemic influenza season.Infect. Control Hosp. Epidemiol. 2015;36(11):1251–1260

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