Antibiotic Use and Fatal Outcomes among Critically Ill Patients with COVID-19 in Tacna, Peru

Overuse of antibiotics during the Coronavirus Disease 2019 (COVID-19) pandemic could increase the selection of extensively resistant bacteria (XDR). However, it is unknown what impact they could have on the evolution of patients, particularly critically ill patients. This study aimed to evaluate the characteristics and impact of ICU-acquired infections in patients with COVID-19. A retrospective cohort study was conducted, evaluating all patients with critical COVID-19 admitted to the intensive care unit (ICU) of a hospital in Southern Peru from 28 March 2020 to 1 March 2021. Of the 124 patients evaluated, 50 (40.32%) developed a healthcare-associated infection (HAI), which occurred at a median of 8 days (IQR 6–17) after ICU admission. The proportion of patients with HAI that required ceftriaxone was significantly higher; the same was true for the use of dexamethasone. Forty bacteria isolations (80%) were classified as XDR to antibiotics, with the most common organisms being Acinetobacter baumannii (54%) and Pseudomonas aeruginosa (22%); 33% (41/124) died at the ICU during the follow-up. In the adjusted analysis, healthcare-associated infection was associated with an increased risk of mortality (aHR= 2.7; 95% CI: 1.33–5.60) and of developing acute renal failure (aRR = 3.1; 95% CI: 1.42–6.72). The incidence of healthcare infection mainly by XDR pathogens is high in critically ill patients with COVID-19 and is associated with an increased risk of complications or death.

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HSV-1 reactivation is associated with an increased risk of mortality and pneumonia in critically ill COVID-19 patients

Critical Care ◽

10.1186/s13054-021-03843-8 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Antoine Meyer ◽

Niccolò Buetti ◽

Nadhira Houhou-Fidouh ◽

Juliette Patrier ◽

Moustafa Abdel-Nabey ◽

...

Keyword(s):

Critically Ill ◽

Mortality Risk ◽

Risk Of Mortality ◽

Increased Risk ◽

Hospital Acquired Pneumonia ◽

Simplex Virus ◽

Healthcare Associated ◽

Hospital Acquired ◽

The Impact ◽

Hsv 1

Abstract Background Data in the literature about HSV reactivation in COVID-19 patients are scarce, and the association between HSV-1 reactivation and mortality remains to be determined. Our objectives were to evaluate the impact of Herpes simplex virus (HSV) reactivation in patients with severe SARS-CoV-2 infections primarily on mortality, and secondarily on hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) and intensive care unit-bloodstream infection (ICU-BSI). Methods We conducted an observational study using prospectively collected data and HSV-1 blood and respiratory samples from all critically ill COVID-19 patients in a large reference center who underwent HSV tests. Using multivariable Cox and cause-specific (cs) models, we investigated the association between HSV reactivation and mortality or healthcare-associated infections. Results Of the 153 COVID-19 patients admitted for ≥ 48 h from Feb-2020 to Feb-2021, 40/153 (26.1%) patients had confirmed HSV-1 reactivation (19/61 (31.1%) with HSV-positive respiratory samples, and 36/146 (24.7%) with HSV-positive blood samples. Day-60 mortality was higher in patients with HSV-1 reactivation (57.5%) versus without (33.6%, p = 0.001). After adjustment for mortality risk factors, HSV-1 reactivation was associated with an increased mortality risk (hazard risk [HR] 2.05; 95% CI 1.16–3.62; p = 0.01). HAP/VAP occurred in 67/153 (43.8%) and ICU-BSI in 42/153 (27.5%) patients. In patients with HSV-1 reactivation, multivariable cause-specific models showed an increased risk of HAP/VAP (csHR 2.38, 95% CI 1.06–5.39, p = 0.037), but not of ICU-BSI. Conclusions HSV-1 reactivation in critically ill COVID-19 patients was associated with an increased risk of day-60 mortality and HAP/VAP.

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Effects of daily treatment with acid suppressants for stress ulcer prophylaxis on risk of ventilator-associated events

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.323 ◽

2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Xiaojuan Li ◽

Michael Klompas ◽

John T. Menchaca ◽

Jessica G. Young

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Low Dose ◽

Cumulative Risk ◽

Daily Treatment ◽

High Dose ◽

Risk Of Mortality ◽

Competing Events ◽

Ulcer Prophylaxis

Abstract Objective: To estimate the effects of continuous daily treatment with different acid suppressants on the risk of ventilator-associated events in critically ill patients. Design: Retrospective cohort study. Patients: Adult critically ill patients who underwent mechanical ventilation for ≥3 days during an inpatient admission between January 2006 and December 2014. Methods: We estimated the 30-day cumulative risk ratios (RRs) for ventilator-associated events comparing daily proton pump inhibitor (PPI) versus daily histamine-2-receptor antagonist (H2RA) strategies while controlling for time-fixed and time-varying confounding and accounting for competing events. Results: Of 6,133 patients, on ventilation day 3, 58.8% received H2RAs, 26.1% received PPIs, and 4.1% received sucralfate. Patients frequently changed treatment throughout follow-up. Among 4,595 patients receiving PPIs or H2RAs on day 3, we found no differences in risk estimates for ventilator mortality and extubation alive comparing daily PPI versus daily H2RA strategies: RR, mortality, 1.03 (95% CI, 0.89–1.22); extubation alive, 1.00 (95% CI, 0.96–1.03). We found similar results after accounting for PPI dose. For possible ventilator-associated pneumonia (PVAP) and infection-related ventilator-associated complication (IVAC), point estimates were larger, but the 95% CIs crossed 1.0: RR PVAP, 1.25 (95% CI, 0.80–1.94); IVAC, 0.89 (95% CI, 0.64–1.17). The magnitude of effect estimates depended on PPI dose. The RR for PVAP, high-dose PPI versus H2RA, was 1.53 (95% CI, 0.82–2.51), and for low-dose PPI versus H2RA, the RR was 0.97 (95% CI, 0.47–1.63). For IVAC, high-dose PPI versus H2RA, the RR was 1.01 (95% CI, 0.66–1.42), and for low-dose PPI versus H2RA, the RR was 0.78 (95% CI, 0.50–1.11). Conclusions: We estimated no effect of daily PPI versus daily H2RA on risk of mortality or extubation alive in critically ill patients. Further investigation with larger samples is warranted for PVAP and IVAC.

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Prognostic value of hematocrit levels among critically ill patients with acute kidney injury

European Journal of Inflammation ◽

10.1177/2058739219846820 ◽

2019 ◽

Vol 17 ◽

pp. 205873921984682

Author(s):

Ying Zhou ◽

Ming-Hua Zheng ◽

Chao-Sheng Chen ◽

Dan-Qin Sun ◽

Xin-Xin Chen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Prognostic Value ◽

Univariate Analysis ◽

Kidney Injury ◽

Inverse Association ◽

Risk Of Mortality ◽

Increased Risk

The aim of this study was to investigate the value of hematocrit (HCT) level in predicting the outcomes of critically ill patients with acute kidney injury (AKI). A retrospective study of a total of 14,350 intensive care unit (ICU) patients, who were selected from Beth Israel Deaconess Medical Center (Boston, MA, USA) and met the inclusion criteria, was carried out. And the patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMIC-III v1.3). In our study, HCT quintiles were used to categorize the subjects into groups. The clinical outcomes were 30- and 90-day mortality in the ICU. Cox proportional-hazards models were used to evaluate the association between the HCT and survival. A total of 2827 30-day deaths and 3828 90-day deaths occurred. In univariate analysis, low HCT was significantly associated with increased 30- and 90-day mortality among females, which, however, was not observed in multivariate analysis adjusted for age, ethnicity, dialysate, continuous renal replacement therapy (CRRT), use of insulin, use of ventilator, AKI stages, and report of obesity. In subgroup analysis, an inverse association between HCT levels and risk of mortality for 90-day outcome was observed for female patients by exclusion of dialysate use, receiving CRRT, and obesity reports. Therefore, these findings suggest that lower HCT was associated with an increased risk of mortality in critically ill patients with AKI, and the effect appears to be stronger among women than men. The prognostic value of HCT seems dependent on other factors, for example, dialysate use, CRRT, and obesity. Further multicenter study is in demand to confirm the validity of the results presented in this article.

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Critically Ill Patients Requiring Acute Renal Replacement Therapy Are at an Increased Risk of Long-Term Renal Dysfunction, but Rarely Receive Specialist Nephrology Follow-Up

Nephron ◽

10.1159/000371448 ◽

2015 ◽

Vol 129 (3) ◽

pp. 164-170 ◽

Cited By ~ 29

Author(s):

Christopher J. Kirwan ◽

Mark J. Blunden ◽

Hamish Dobbie ◽

Ajith James ◽

Ambika Nedungadi ◽

...

Keyword(s):

Renal Replacement Therapy ◽

Renal Dysfunction ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Increased Risk

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Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02276-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiao-Ming Zhang ◽

Denghong Chen ◽

Xiao-Hua Xie ◽

Jun-E Zhang ◽

Yingchun Zeng ◽

...

Keyword(s):

Systematic Review ◽

Skeletal Muscle ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Muscle Area ◽

Risk Of Mortality ◽

Increased Risk

Abstract Background The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality. Methods We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model. Results Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83–2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71–5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60–2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37–3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15–3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45–2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36–3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00). Conclusions Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.

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Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study

Critical Care ◽

10.1186/s13054-021-03882-1 ◽

2022 ◽

Vol 26 (1) ◽

Author(s):

Jessica González ◽

Iván D. Benítez ◽

David de Gonzalo-Calvo ◽

Gerard Torres ◽

Jordi de Batlle ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Cohort ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Risk Of Mortality ◽

Early Intubation ◽

Delayed Group

Abstract Question We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae. Materials and methods Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge. Results We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29–4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42–4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of − 10.77 (95% CI − 18.40 to − 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89–2.13]) and a greater TSS (+ 4.35 [95% CI 2.41–6.27]) in the chest CT scan. Conclusions Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.

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The Relationship Between Sedatives, Sedative Strategy, and Healthcare-Associated Infection: A Systematic Review

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.129 ◽

2016 ◽

Vol 37 (10) ◽

pp. 1234-1242 ◽

Cited By ~ 6

Author(s):

Daniel A. Caroff ◽

Paul M. Szumita ◽

Michael Klompas

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Bloodstream Infections ◽

Infection Risk ◽

Healthcare Associated Infection ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Observational Series ◽

Healthcare Associated ◽

Ventilated Patients

BACKGROUNDHealthcare-associated infections (HAIs) cause significant morbidity in critically ill patients. An underappreciated but potentially modifiable risk factor for infection is sedation strategy. Recent trials suggest that choice of sedative agent, depth of sedation, and sedative management can influence HAI risk in mechanically ventilated patients.OBJECTIVETo better characterize the relationships between sedation strategies and infection.METHODSSystematic literature review.RESULTSWe found 500 articles and accepted 70 for review. The 3 most common sedatives for mechanically ventilated patients (benzodiazepines, propofol, and dexmedetomidine) have different pharmacologic and immunomodulatory effects that may impact infection risk. Clinical data are limited but retrospective observational series have found associations between sedative use and pneumonia whereas prospective studies of sedative interruptions have reported possible decreases in bloodstream infections, pneumonia, and ventilator-associated events.CONCLUSIONInfection rates appear to be highest with benzodiazepines, intermediate with propofol, and lowest with dexmedetomidine. More data are needed but studies thus far suggest that a better understanding of sedation practices and infection risk may help hospital epidemiologists and critical care practitioners find new ways to mitigate infection risk in critically ill patients.Infect Control Hosp Epidemiol 2016;1–9

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Clostridium difficile Infection: An Epidemiology Update

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0040-1701229 ◽

2020 ◽

Vol 33 (02) ◽

pp. 049-057 ◽

Cited By ~ 5

Author(s):

Ana C. De Roo ◽

Scott E. Regenbogen

Keyword(s):

Risk Factors ◽

Antibiotic Use ◽

Recurrence Risk ◽

Epidemiologic Studies ◽

High Morbidity ◽

Healthcare Associated Infection ◽

Clostridioides Difficile ◽

Increased Risk ◽

Hospitalized Older Adults ◽

Healthcare Associated

Abstract Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) is a healthcare-associated infection and significant source of potentially preventable morbidity, recurrence, and death, particularly among hospitalized older adults. Additional risk factors include antibiotic use and severe underlying illness. The increasing prevalence of community-associated CDI is gaining recognition as a novel source of morbidity in previously healthy patients. Even after recovery from initial infection, patients remain at risk for recurrence or reinfection with a new strain. Some pharmaco-epidemiologic studies have suggested an increased risk associated with proton pump inhibitors and protective effect from statins, but these findings have not been uniformly reproduced in all studies. Certain ribotypes of C. difficile, including the BI/NAP1/027, 106, and 018, are associated with increased antibiotic resistance and potential for higher morbidity and mortality. CDI remains a high-morbidity healthcare-associated infection, and better understanding of ribotypes and medication risk factors could help to target treatment, particularly for patients with high recurrence risk.

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Effect of Antipyretic Therapy on Mortality in Critically Ill Patients with Sepsis Receiving Mechanical Ventilation Treatment

Canadian Respiratory Journal ◽

10.1155/2017/3087505 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Sheng Ye ◽

Dan Xu ◽

Chenmei Zhang ◽

Mengyao Li ◽

Yanyi Zhang

Keyword(s):

Mechanical Ventilation ◽

Regression Model ◽

Critically Ill ◽

Mortality Risk ◽

Critically Ill Patients ◽

Risk Of Death ◽

External Cooling ◽

Risk Of Mortality ◽

Increased Risk ◽

Significant Difference

Purpose. The study aimed to investigate the effectiveness of antipyretic therapy on mortality in critically ill patients with sepsis requiring mechanical ventilation. Methods. In this study, we employed the multiparameter intelligent monitoring in intensive care II (MIMIC-II) database (version 2.6). All patients meeting the criteria for sepsis and also receiving mechanical ventilation treatment were included for analysis, all of whom suffer from fever or hyperthermia. Logistic regression model and R language (R version 3.2.3 2015-12-10) were used to explore the association of antipyretic therapy and mortality risk in critically ill patients with sepsis receiving mechanical ventilation treatment. Results. A total of 8,711 patients with mechanical ventilator were included in our analysis, and 1523 patients died. We did not find any significant difference in the proportion of patients receiving antipyretic medication between survivors and nonsurvivors (7.9% versus 7.4%, p=0.49). External cooling was associated with increased risk of death (13.5% versus 9.5%, p<0.001). In our regression model, antipyretic therapy was positively associated with mortality risk (odds ratio [OR]: 1.41, 95% CI: 1.20–1.66, p<0.001). Conclusions. The use of antipyretic therapy is associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation. External cooling may even be deleterious.

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Tocilizumab Association with Emerging Multi-drug Resistance Organisms and Mortality in critically ill patients with Coronavirus disease 2019 (COVID-19): A Multicenter, Retrospective Cohort Study

10.21203/rs.3.rs-469073/v1 ◽

2021 ◽

Author(s):

Ohoud Aljuhani ◽

Khalid Al Sulaiman ◽

Adel Alshabasy ◽

Khalid Eljaaly ◽

Abdulrahman I. Al Shaya ◽

...

Keyword(s):

Cohort Study ◽

Respiratory Failure ◽

Critically Ill ◽

Retrospective Cohort Study ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Resistant Bacteria ◽

Microbial Isolation ◽

Increased Risk ◽

Significant Difference

Abstract Background:Tocilizumab is an IgG1 class recombinant humanized monoclonal antibody that directly inhibits IL-6 receptor. Several randomized clinical trials (RCTs) have evaluated tocilizumab’s safety and efficacy in patients with COVID-19. These studies demonstrated conflicting results regarding tocilizumab’s efficacy and safety. Our study aim is to determine the association between treatment with tocilizumab and emergence of multidrug-resistant bacteria and its effect on mortality in critically ill patients with Coronavirus disease 2019 (COVID-19).Methods:A multicenter, retrospective, cohort study conducted at two governmental tertiary hospitals in Saudi Arabia. All critically ill patients who were admitted to intensive care units (ICUs) with a positive COVID-19 PCR test between March 1st, 2020 and January 31st, 2021 were included. Patients who received tocilizumab were compared to patients who did not receive it. Results:A total of 738 patients met our inclusion criteria and were included in the analysis. Of these 262 (35.5%) received tocilizumab and 476 (64.5%) were included in the control group. Patients who received tocilizumab did not have higher odds for the microbial isolation (OR 1.34; 95% CI, 0.91-1.94 p = 0.13), development of resistant organisms (OR 1.00; 95% CI, 0.51-1.98 p = 0.99), or detection of Carbapenem-Resistant Enterobacteria (CRE) (OR 0.67; 95% CI, 0.29-1.54 p = 0.34). In a multivariable logistic regression adjusting for possible cofounders, there was no difference in 30-day ICU mortality (OR 0.96; 95% CI, 0.65-1.43 p = 0.85) or in-hospital mortality (OR 1.18; 95% CI, 0.79-1.76 p = 0.42). However, there was a significant difference in the incidence of respiratory failure requiring MV between the two groups (OR 2.27; 95% CI, 1.05-4.89 p = 0.03).Conclusions: Tocilizumab use in critically ill COVID-19 patients was not associated with microbial isolation, emergence of resistant organisms, detection of CRE organisms, or mortality benefits. However, tocilizumab use was associated with an increased risk of respiratory failure requiring mechanical ventilation.

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