scholarly journals Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients

2020 ◽  
Vol 8 (2) ◽  
pp. 287 ◽  
Author(s):  
Georgios Papathanakos ◽  
Ioannis Andrianopoulos ◽  
Athanasios Papathanasiou ◽  
Efthalia Priavali ◽  
Despoina Koulenti ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acinetobacter Baumannii ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Problem ◽  
Hospital Infections ◽  
Colistin Resistance ◽  
Icu Patients ◽  
Icu Admission ◽  
Comorbidity Index

The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.

scholarly journals Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 76
Author(s):  
Matthaios Papadimitriou-Olivgeris ◽  
Christina Bartzavali ◽  
Alexandra Georgakopoulou ◽  
Fevronia Kolonitsiou ◽  
Chrisavgi Papamichail ◽  
...  
Keyword(s):  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Carbapenemase Gene ◽  
Comorbidity Index

Background: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. Methods: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. blaKPC, blaVIM, blaNDM, and blaOXA genes were detected by PCR. Results: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. blaKPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. Conclusions: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.

Serum Coenzyme Q10 Levels are Decreased in Critically-Ill Septic Patients: Results From a Preliminary Study

2020 ◽  
pp. 109980042094448
Author(s):  
Alice G. Vassiliou ◽  
Zafeiria Mastora ◽  
Edison Jahaj ◽  
Chrysi Keskinidou ◽  
Maria E. Pratikaki ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Septic Shock ◽  
Critically Ill ◽  
Coenzyme Q10 ◽  
Inflammatory Biomarkers ◽  
Healthy Controls ◽  
Icu Patients ◽  
Icu Admission ◽  
Icu Discharge ◽  
Sepsis And Septic Shock

Background: The increased oxidative stress resulting from the inflammatory responses in sepsis initiates changes in mitochondrial function which may result in organ damage, the most common cause of death in the intensive care unit (ICU). Deficiency of coenzyme Q10 (CoQ10), a key cofactor in the mitochondrial respiratory chain, could potentially disturb mitochondrial bioenergetics and oxidative stress, and may serve as a biomarker of mitochondrial dysfunction. Hence, we aimed to investigate in initially non-septic patients whether CoQ10 levels are decreased in sepsis and septic shock compared to ICU admission, and to evaluate its associations with severity scores, inflammatory biomarkers, and ICU outcomes. Methods: Observational retrospective analysis on 86 mechanically-ventilated, initially non-septic, ICU patients. CoQ10 was sequentially measured on ICU admission, sepsis, septic shock or at ICU discharge. CoQ10 was additionally measured in 25 healthy controls. Inflammatory biomarkers were determined at baseline and sepsis. Results: On admission, ICU patients who developed sepsis had lower CoQ10 levels compared to healthy controls (0.89 vs. 1.04 µg/ml, p < 0.05), while at sepsis and septic shock CoQ10 levels decreased further (0.63 µg/ml; p < 0.001 and 0.42 µg/ml; p < 0.0001, respectively, from admission). In ICU patients who did not develop sepsis, admission CoQ10 levels were also lower than healthy subjects (0.81 µg/ml; p < 0.001) and were maintained at the same levels until discharge. Conclusion: CoQ10 levels in critically-ill patients are low on ICU admission compared to healthy controls and exhibit a further decrease in sepsis and septic shock. These results suggest that sepsis severity leads to CoQ10 depletion.

scholarly journals Association of Serum Calprotectin Concentrations with Mortality in Critically Ill and Septic Patients

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 990
Author(s):  
Theresa H. Wirtz ◽  
Lukas Buendgens ◽  
Ralf Weiskirchen ◽  
Sven H. Loosen ◽  
Nina Haehnsen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
University Hospital ◽  
Therapeutic Interventions ◽  
Neutrophil Granulocytes ◽  
Icu Patients ◽  
Long Term Outcome ◽  
Icu Admission

Background: Calprotectin is present in the cytosol of neutrophil granulocytes and released upon activation. Fecal calprotectin is applied in the clinical management of inflammatory bowel disease whereas serum calprotectin has been discussed as a biomarker in inflammatory disorders. However, its long-term prognostic relevance in critical illness remains unclear. Our aim was to investigate serum calprotectin concentrations as a prognostic biomarker in critically ill and septic patients. Methods: Serum calprotectin concentrations were analyzed in 165 critically ill patients (108 with sepsis, 57 without sepsis) included in our observational study. Patients were enrolled upon admission to the medical intensive care unit (ICU) of the RWTH Aachen University Hospital. Calprotectin concentrations were compared to 24 healthy controls and correlated with clinical parameters, therapeutic interventions, and survival. Results: Serum calprotectin concentrations were significantly increased in ICU patients as well as in septic patients compared to respective controls (p < 0.001 for ICU patients and p = 0.001 for septic patients). Lower calprotectin concentrations were measured in patients with comorbidities i.e., coronary artery disease. Calprotectin concentrations strongly correlated with the C-reactive protein (p < 0.001) and were closely associated to parameters of mechanical ventilation (i.a. inspiratory oxygen fraction, FiO2; p < 0.001). The overall survival was significantly impaired in septic patients with high baseline calprotectin concentrations (p = 0.036). However, patients with increasing calprotectin serum concentrations within the first week of ICU admission showed an improved overall survival (p = 0.009). Conclusions: In summary, serum calprotectin concentrations are significantly increased in critically ill patients with sepsis. High calprotectin concentrations at ICU admission predict long-term mortality risk, whereas increasing calprotectin concentrations are associated with a favorable long-term outcome.

scholarly journals Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shmeylan A. Al Harbi ◽  
Hasan M. Al-Dorzi ◽  
Albatool M. Al Meshari ◽  
Hani Tamim ◽  
Sheryl Ann I. Abdukahil ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Serum Phosphate ◽  
The Other ◽  
Icu Admission ◽  
Surgical Icus

Abstract Objective The aim of this study is to examine the association of hypophosphatemia and hyperphosphatemia on the first day of ICU admission with mortality in septic critically ill patients. Methods In this retrospective cohort study, all adult patients who were admitted to the medical-surgical ICUs between 2014 and 2017 with sepsis or septic shock were categorized as having hypophosphatemia, normophosphatemia and hyperphosphatemia based on day 1 serum phosphate values. We compared the clinical characteristics and outcomes between the three groups. We used multivariate analysis to examine the association of hypophosphatemia and hyperphosphatemia with these outcomes. Results Of the 1422 patients enrolled in the study, 188 (13%) had hypophosphatemia, 865 (61%) normophosphatemia and 369 (26%) had hyperphosphatemia. The patients in the hyperphosphatemia group had significantly lower GCS, higher APACHE II scores, higher serum creatinine, increased use of vasopressors, and required more mechanical ventilation with lower PaO2/FiO2 ratio compared with the other two groups. In addition, the hyperphosphatemia group showed significantly higher ICU and hospital mortality in comparison with the other two groups. Conclusion Hyperphosphatemia and not hypophosphatemia on the first ICU admission day was associated with an increase in the ICU and hospital mortality in septic critically ill patients.

Impact of Ursodeoxycholic Acid in Critically Ill Patients With Sepsis: A Retrospective Study

2022 ◽  
pp. 089719002110383
Author(s):  
Khalid Al Sulaiman ◽  
Abdullah Kharbosh ◽  
Khalid Bin Salah ◽  
Thamer Alsulaiman ◽  
Norah Al Andas ◽  
...  
Keyword(s):  
Septic Shock ◽  
Retrospective Study ◽  
Ursodeoxycholic Acid ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
Adult Patients ◽  
P Value ◽  
Icu Admission ◽  
Medical City

Background: Using ursodeoxycholic acid (UDCA) in critically ill patients as adjunctive therapy for sepsis/septic shock in neonates and children is controversial, while it has not been extensively investigated in adults. This study aims to assess the effect of UDCA use on the early resolution of sepsis/septic shock in critically ill adult patients. Method: A retrospective study of critically ill adult patients in the intensive care unit (ICU) admitted with sepsis/septic shock at King Abdulaziz Medical City. Based on their usage of UDCA, patients were categorized into two groups. A total of 88 patients were included for analysis after matching, based on severity of illness scores within 24-hours of ICU admission. The primary outcome was to assess the effect of UDCA on the severity and resolution of shock at day three of ICU admission. The secondary outcomes were 30-day in-hospital mortality, mechanical ventilation (MV) duration, and ICU length of stay (LOS). Results: Out of the 88 patients matched, 44 patients (50%) received UDCA during the study period. Using UDCA was neither associated with improvement in Sequential Organ Failure Assessment (SOFA) score ( p-value: 0.32), inotropes/vasopressors requirement ( p-value: 0.79), Glasgow Coma Scale (GCS) ( p-value: 0.59) nor total bilirubin levels ( p-value: 0.79) at day three compared with the control. There was a significant association between using UDCA and improvement in PaO2/FiO2 ratio ( p-value: 0.01) and early extubation at day three ( p-value: 0.04). Conclusion: Using UDCA in critically ill patients with sepsis/septic shock was not associated with improvement in shock severity and resolution. However, patients who received UDCA were more likely to be extubated and not require MV on day three of ICU admission.

Can 1 μg of Cosyntropin Be Used to Evaluate Adrenal Insufficiency in Critically Ill Patients?

2005 ◽  
Vol 39 (4) ◽  
pp. 691-698 ◽  
Author(s):  
Elizabeth F Kozyra ◽  
Randy S Wax ◽  
Lisa D Burry
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Large Scale ◽  
Relative Adrenal Insufficiency ◽  
Acth Stimulation ◽  
Icu Patients ◽  
Insulin Tolerance

OBJECTIVE: To evaluate the utility of cosyntropin 1 μg in assessing adrenal function in critically ill patients. DATA SOURCES: A computerized literature search using MEDLINE, EMBASE, International Pharmaceutical Abstracts, and the Cochrane Database (1966–August 2004) was undertaken for trials evaluating cosyntropin 1 μg using the following search terms: adrenocorticotropin-releasing hormone (ACTH), cosyntropin, adrenal insufficiency, cortisol, corticosteroids, glucocorticoids, sepsis, septic shock, diagnosis, critically ill, intensive care, and critical care. STUDY SELECTION AND DATA SYNTHESIS: Identifying patients with sepsis with relative adrenal insufficiency (AI) using cosyntropin testing may identify those likely to benefit from corticosteroids. The results of 5 heterogeneous studies in non—intensive care unit (ICU) patients suggest that both 1 μg and 250 μg of cosyntropin stimulate similar cortisol responses and that testing using both doses correlates well with results from insulin tolerance testing. Some data from non-ICU patients suggest that the 1-μg test may be more sensitive to detect AI; 3 heterogeneous studies in ICU patients confirmed the improved sensitivity of the 1-μg test. CONCLUSIONS: Use of cosyntropin 1 μg should detect AI in all patients who would have been diagnosed using 250 μg. Unfortunately, all of the clinical trials evaluating the role of corticosteroids in septic shock that used the cosyntropin stimulation test administered 250 μg. Extrapolation of the existing guidelines to treat patients with septic shock testing positive for relative AI using the 1-μg test may provide effective therapy to appropriate patients not diagnosed by the 250-μg testing or may introduce additional adverse effects in patients who should not receive corticosteroids. Large-scale, head-to-head comparison data of steroid effectiveness after 1- and 250-μg ACTH stimulation tests are needed to expand upon these promising results.

scholarly journals Association Between Phosphate Disturbances and Mortality Among Critically Ill Patients With Sepsis or Septic Shock

2021 ◽  
Author(s):  
Shmeylan Al Harbi ◽  
Hasan Al-Dorzi ◽  
Albatool Al Meshari ◽  
Hani Tamim ◽  
Sheryl Ann Abdukahil ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Serum Phosphate ◽  
The Other ◽  
Icu Mortality ◽  
Icu Admission ◽  
Surgical Icus

Abstract Objective: The aim of this study is to examine the association of hypophosphatemia and hyperphosphatemia on the first day of ICU admission with mortality in septic critically ill patients. Methods: In this retrospective cohort study, all adult patients who were admitted to medical-surgical ICUs between 2014 and 2017 with sepsis or septic shock were categorized as having hypophosphatemia, hyperphosphatemia or based on day 1 serum phosphate values. We compared the clinical characteristics and outcomes between the three groups. We used multivariate analysis to examine the association of hypophosphatemia and hyperphosphatemia with these outcomes.Results: Of the 1422 patients enrolled in the study, 188 (13%) had hypophosphatemia, 865 (61%) normophosphatemia and 369 (26%) had hyperphosphatemia. Among the three groups, the patients in the hyperphosphatemia group had significantly lower GCS, higher APACHE II scores, higher serum creatinine, increased use of vasopressors, and required mechanical ventilation with lower PaO2/FiO2 ratio compared with the other two groups. In addition, hyperphosphatemia group also showed significantly higher ICU mortality and hospital mortality in comparison to the other two groups. Conclusion: Hyperphosphatemia and not hypophosphatemia on the first ICU admission day was associated with an increase in the ICU and hospital mortality in septic critically ill patients.

Pharmacokinetic data support 6-hourly dosing of intravenous vitamin C to critically ill patients with septic shock.

2020 ◽  
Vol 22 (2) ◽  
pp. 174-174
Keyword(s):  
Septic Shock ◽  
Vitamin C ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pharmacokinetic Data ◽  
Icu Admission ◽  
Data Support ◽  
Intravenous Vitamin

Hudson EP, Collie JT, Fujii T, et al. Pharmacokinetic data support 6-hourly dosing of intravenous vitamin C to critically ill patients with septic shock. Crit Care Resusc 2019; 21: 236-42. In this article, on page 238, Table 1 contained an error. Where it says “Time from randomisation to first dose of vitamin C (hours), median (IQR)”, it should read “Time from ICU admission to first dose of vitamin C (hours), median (IQR)”.

scholarly journals An international survey on aminoglycoside practices in critically ill patients: the AMINO III study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Claire Roger ◽  
◽  
Benjamin Louart ◽  
Loubna Elotmani ◽  
Greg Barton ◽  
...  
Keyword(s):  
Septic Shock ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multivariable Analysis ◽  
Therapeutic Drug ◽  
Target Attainment ◽  
Icu Patients ◽  
Optimal Dosing ◽  
Wide Variability ◽  
Dosing Strategy

Abstract Background While aminoglycosides (AG) have been used for decades, debate remains on their optimal dosing strategy. We investigated the international practices of AG usage specifically regarding dosing and therapeutic drug monitoring (TDM) in critically ill patients. We conducted a prospective, multicentre, observational, cohort study in 59 intensive-care units (ICUs) in 5 countries enrolling all ICU patients receiving AG therapy for septic shock. Results We enrolled 931 septic ICU patients [mean ± standard deviation, age 63 ± 15 years, female 364 (39%), median (IQR) SAPS II 51 (38–65)] receiving AG as part of empirical (761, 84%) or directed (147, 16%) therapy. The AG used was amikacin in 614 (66%), gentamicin in 303 (33%), and tobramycin in 14 (1%) patients. The median (IQR) duration of therapy was 2 (1–3) days, the number of doses was 2 (1–2), the median dose was 25 ± 6, 6 ± 2, and 6 ± 2 mg/kg for amikacin, gentamicin, and tobramycin respectively, and the median dosing interval was 26 (23.5–43.5) h. TDM of Cmax and Cmin was performed in 437 (47%) and 501 (57%) patients, respectively, after the first dose with 295 (68%) patients achieving a Cmax/MIC > 8 and 353 (71%) having concentrations above Cmin recommended thresholds. The ICU mortality rate was 27% with multivariable analysis showing no correlation between AG dosing or pharmacokinetic/pharmacodynamic target attainment and clinical outcomes. Conclusion Short courses of high AG doses are mainly used in ICU patients with septic shock, although wide variability in AG usage is reported. We could show no correlation between PK/PD target attainment and clinical outcome. Efforts to optimize the first AG dose remain necessary. Trial registration Clinical Trials, NCT02850029, registered on 29th July 2016, retrospectively registered, https://www.clinicaltrials.gov

Association of neurogranin with delirium among critically ill patients

2020 ◽  
Vol 14 (17) ◽  
pp. 1613-1617
Author(s):  
Márcia LZ Wanderlind ◽  
Renata Gonçalves ◽  
Cristiane D Tomasi ◽  
Felipe Dal-Pizzol ◽  
Cristiane Ritter
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alzheimer Disease ◽  
Critically Ill ◽  
Dendritic Spines ◽  
Critically Ill Patients ◽  
Icu Patients ◽  
Icu Admission

Background: Neurogranin (Ng) concentrates at dendritic spines. In patients with Alzheimer disease Ng levels are elevated. The role of Ng in delirium development has not been assessed, therefore we hypothesized that Ng levels are associated with delirium in critically ill patients. Materials & methods: From 94 critically ill patients, 47 developed delirium and 47 controls were included. Blood was collected during the first 24 h of intensive care unit (ICU) admission, and on the day of delirium diagnoses. Ng and IL-1β were determined. Results: Ng and IL-1β levels were higher in the delirium group at ICU admission and on the day of delirium diagnoses. IL-1β and Ng were independently associated with delirium occurrence. Conclusion: Ng levels are associated with delirium development in ICU patients.

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