scholarly journals High Rates of Bacterial Pulmonary Co-Infections and Superinfections Identified by Multiplex PCR among Critically Ill COVID-19 Patients

2021 ◽  
Vol 9 (12) ◽  
pp. 2483
Author(s):  
Regev Cohen ◽  
Frida Babushkin ◽  
Talya Finn ◽  
Keren Geller ◽  
Hanna Alexander ◽  
...  
Keyword(s):  
Critically Ill ◽  
Patient Outcomes ◽  
Community Acquired Pneumonia ◽  
Ventilator Associated Pneumonia ◽  
Pulmonary Infections ◽  
Predictive Values ◽  
Panel Testing ◽  
Poor Patient ◽  
Ventilated Patients

Background: The role of bacterial co-infection and superinfection among critically ill COVID-19 patients remains unclear. The aim of this study was to assess the rates and characteristics of pulmonary infections, and associated outcomes of ventilated patients in our facility. Methods: This was a retrospective study of ventilated COVID-19 patients between March 2020 and March 2021 that underwent BioFire®, FilmArray® Pneumonia Panel, testing. Community-acquired pneumonia (CAP) was defined when identified during the first 72 h of hospitalization, and ventilator-associated pneumonia (VAP) when later. Results: 148 FilmArray tests were obtained from 93 patients. With FilmArray, 17% of patients had CAP (16/93) and 68% had VAP (64/93). Patients with VAP were older than those with CAP or those with no infection (68.5 vs. 57–59 years), had longer length of stay and higher mortality (51% vs. 10%). The most commonly identified FilmArray target organisms were H. influenzae, S. pneumoniae, M. catarrhalis and E. cloacae for CAP and P. aeruginosa and S. aureus for VAP. FilmArray tests had high negative predictive values (99.6%) and lower positive predictive values (~60%). Conclusions: We found high rates of both CAP and VAP among the critically ill, caused by the typical and expected organisms for both conditions. VAP diagnosis was associated with poor patient outcomes.

scholarly journals Serum Procalcitonin Level and Mortality Risk in Critically ill Patients with Ventilator-Associated Pneumonia

2015 ◽  
Vol 37 (5) ◽  
pp. 1967-1972 ◽  
Author(s):  
Bo Li ◽  
Xin Zhao ◽  
Shumei Li
Keyword(s):  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
High Serum ◽  
Ventilator Associated Pneumonia ◽  
Prognostic Role ◽  
Procalcitonin Level ◽  
Increased Risk

Background/Aims: The prognostic role of serum procalcitonin level in critically ill patients with ventilator-associated pneumonia was unclear. The aim of our study was to investigate the relationship between serum procalcitonin level and mortality risk in critically ill patients with ventilator-associated pneumonia. Methods: Data of critically ill patients with ventilator-associated pneumonia were retrospectively collected. Demographics, comorbidities, and serum procalcitonin level were extracted from electronic medical records. The primary outcome was mortality within two months after diagnosis. Multivariable Cox regression analyses were performed to assess the prognostic role of serum procalcitonin level in those patients. Results: A total of 115 critically ill patients with ventilator-associated pneumonia were enrolled in our study. Serum procalcitonin level was not associated with age, gender, or other comorbidities. Univariate Cox regression model showed that high serum procalcitonin level was associated increased risk of morality within 2 months after diagnosis (OR = 2.32, 95% CI 1.25-4.31, P = 0.008). Multivariable Cox regression model showed that high serum procalcitonin level was independently associated increased risk of morality within 2 months after diagnosis (OR = 2.38, 95% CI 1.26-4.50, P = 0.008). Conclusion: High serum procalcitonin level is an independent prognostic biomarker of mortality risk in critically ill patients with ventilator-associated pneumonia, and it's a promising biomarker of prognosis in critically ill patients.

Cytomorphometric Neutrophil and Monocyte Markers May Strengthen the Diagnosis of Sepsis

2016 ◽  
Vol 33 (12) ◽  
pp. 656-662
Author(s):  
Joy Mammen ◽  
Jui Choudhuri ◽  
Joshua Paul ◽  
Thomas Isaiah Sudarsan ◽  
T. Josephine ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Donors ◽  
Area Under The Curve ◽  
Standard Test ◽  
Suspected Sepsis ◽  
Predictive Values ◽  
Reactive Protein ◽  
Sensitivity Specificity

Background: The diagnosis of sepsis is challenging in the absence of a gold standard test. Recent studies have explored the role of neutrophil and monocyte volume, conductivity, and scatter (VCS), derived from automated hematology analyzers, in diagnosing sepsis. We assessed the diagnostic accuracy of VCS parameters in critically ill patients with sepsis. Methodology: In this prospective study, VCS parameters, procalcitonin, and C-reactive protein (CRP) were assessed in patients with proven sepsis (cases) and 2 control groups (intensive care unit [ICU] patients without sepsis and healthy blood donors). The diagnostic property of each test was explored by calculating sensitivity, specificity, negative and positive predictive values, and area under the curve (AUC). Results: The study included 65 patients with sepsis, 58 nonseptic ICU controls, and 98 blood donors. Procalcitonin and CRP were not significantly different ( P > .06) between patients with sepsis and nonseptic patients. Mean (95% confidence interval [CI]) neutrophil volume (MNV) was significantly higher ( P < .001) in patients with sepsis (165.5; 95%CI 161.6-169.4) than in nonseptic (157.3; 95%CI 154.6-160.1) patients and donors (148.9; 95%CI 147.9-150). A similar pattern was seen with mean monocyte volume (MMoV). Neutrophil and monocyte conductivity and scatter parameters were variably associated. The AUC was highest for MMoV (0.74) and lowest for CRP (0.62). Among all parameters, MNV and MMoV had the highest specificity of 85% and 80%, respectively. Conclusion: In critically ill patients with suspected sepsis, VCS parameters may help strengthen the diagnostic probability of sepsis. Future studies may explore the role of serial monitoring of VCS to track response to antimicrobial therapy.

Bronchoalveolar Lavage in the Diagnosis of Ventilator-Associated Pneumonia: To Quantitate or Not, That is the Question

2011 ◽  
Vol 77 (3) ◽  
pp. 297-303 ◽  
Author(s):  
Omer J. Riaz ◽  
Ajai K. Malhotra ◽  
Michel B. Aboutanos ◽  
Therese M. Duane ◽  
Aaron E. Goldberg ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Antimicrobial Use ◽  
Ventilator Associated Pneumonia ◽  
Predictive Values ◽  
Colony Forming Units ◽  
Ventilated Patients

Quantitative bronchoalveolar lavage (BAL) is used to diagnose ventilator-associated pneumonia (VAP). We prospectively compared semiquantitative (SQ) and quantitative (Qu) culture of BAL for VAP diagnosis. Ventilated patients suspected of VAP underwent bronchoscopic BAL. BAL fluid was examined by both Qu (colony-forming units [CFUs]/mL) and SQ culture (none, sparse, moderate, or heavy) and results were compared. VAP was defined as 105 CFU/mL or greater on Qu culture. Over 36 months, 319 BALs were performed. Sixty-three of 319 (20%) showed diagnostic growth by Qu culture identifying a total of 81 organisms causing VAP. All 63 specimens showed growth of some organism(s) on SQ culture with 79 of 81 causative organisms identified and two ( Pseudomonas, one; Corynebacterium, one) not identified. The remaining 256 specimens did not meet the threshold for VAP by the Qu method. Among these, 79 did not show any growth on SQ culture. Among the 240 specimens showing some growth on SQ culture, a total of 384 organisms were identified. VAP rates in relation to strength of growth on SQ culture were: sparse, 10 of 140 (7%); moderate, 24 of 147 (16%); and heavy, 45 of 97 (46%). Sensitivity (Sn), specificity (Sp), positive (PPV), and negative (NPV) predictive values of SQ culture of BAL fluid for the diagnosis of VAP were 97, 21, 21, and 97 per cent, respectively. Nonquantitative culture of BAL fluid is fairly accurate in ruling out VAP (high Sn and NPV). It however has poor Sp and PPV and using this method will lead to unnecessary antimicrobial use with its attendant complications of toxicity, cost, and resistance.

Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: A Systematic Review

2017 ◽  
Vol 33 (8) ◽  
pp. 447-455 ◽  
Author(s):  
Leonardo Jönck Staub ◽  
Roberta Rodolfo Mazzali Biscaro ◽  
Rosemeri Maurici
Keyword(s):  
Systematic Review ◽  
Lung Ultrasound ◽  
Clinical Score ◽  
Community Acquired Pneumonia ◽  
Ventilator Associated Pneumonia ◽  
Qualitative Synthesis ◽  
Diagnosis Accuracy ◽  
Ultrasound Score

Background: Lung ultrasound (LUS) is an accurate tool to diagnose community-acquired pneumonia. However, it is not yet an established tool to diagnose ventilator-associated pneumonia (VAP). Purpose: To assess the evidence about LUS in the diagnosis of VAP, we conducted a systematic review of the literature. Methods: We searched PubMed, Embase, Scopus, Web of Science, and LILACS. Two researchers independently selected the studies that met the inclusion criteria. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of the studies. In a qualitative synthesis, 3 questions guided the review: Q1. What are the sonographic signs of VAP? Q2. How can LUS be combined with others tests or signs of VAP? Q3. What is the role of LUS in VAP screening? Main Results: Three studies (n = 377 patients) with different designs were included. In terms of Q1, the 3 studies assessed the accuracy of sonographic consolidations. In patients suspected for VAP, lobar or hemilobar consolidation alone was not sufficient to diagnose VAP but seems useful to exclude it. The most useful signs were small subpleural consolidations (sensitivity: 81%; specificity: 41%) and dynamic air bronchograms (sensitivity: 44%; specificity: 81%). Two studies were assessed for Q2, when the 2 signs above were included in a clinical score (Ventilator-associated Pneumonia Lung Ultrasound Score associated with quantitative culture of endotracheal aspirate—VPLUS-EAquant), the accuracy was amplified (sensitivity: 48% and specificity: 97% for score ≥4; sensitivity: 78% and specificity: 77% for score ≥3 points). Finally, regarding Q3, no studies have assessed the use of LUS in screening of VAP. Conclusion: Small subpleural consolidations and dynamic air bronchograms were the most useful sonographic signs to diagnose VAP in suspected patients. Clinical scores including LUS had better diagnosis accuracy than LUS alone. There are no data on LUS for VAP screening.

scholarly journals The Effect of Oral Care and Chlorhexidine on the Rate of Ventilator Associated Pneumonia (VAP)

2021 ◽  
Vol 14 (2) ◽  
pp. 30
Author(s):  
Mohammed Fathudeen Zakri ◽  
Salah Hussain Shammakhi ◽  
Ghadeer Hassan Ghadeer Hassan Ajlan ◽  
Majed Yahia Sabei ◽  
Mohammed Abdulrahman Zurbotan
Keyword(s):  
Patient Outcomes ◽  
Health Care Cost ◽  
Oral Care ◽  
Cochrane Library ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Hospital Stays ◽  
Ventilated Patients ◽  
Selection Of

OBJECTIVE: Ventilator-associated pneumonia is considered major pneumonia, which develops in the intensive care unit patients following mechanical ventilation for about two days. This study reviews oral care and chlorhexidine effect on ventilator associated pneumonia occurrence. METHODS: A critical review approach was adopted where publications from 2007 to 2017 were considered. These publications were gathered from electronic searches through the different databases, for instance, MEDLINE, EMBASE, CINAHL, and Cochrane Library. This protocol was used for the selection of the studies and their analysis. RESULTS: The review showed that 0.12% Chlorhexidine use assists in reducing bacterial growth. It also suggests that the use of affirmative outcomes for mechanically ventilated patients, including improved patient outcomes, decreased in the duration of the patients&rsquo; hospital stays, and reduced health care cost.

scholarly journals Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

2019 ◽  
Vol 11 (6) ◽  
pp. 111
Author(s):  
Iyad Abbas Salman ◽  
Waleed Ibraheem Ali ◽  
Amir Ibrahim Moushib ◽  
Hayder Adnan Fawzi
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Tube ◽  
Invasive Mechanical Ventilation ◽  
Tracheal Aspirate ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Subglottic Secretion ◽  
Radiological Features ◽  
Ventilated Patients

BACKGROUND: development of ventilator associated pneumonia (VAP) leads to &lrm;prolonged hospital stay, increased health care cost, and mortality rates. Subglottic &lrm;secretion drainage through a dedicated endotracheal tube has been advocated as a mean &lrm;to decrease the incidence of VAP and thereby assisting in &lrm;the decrease of morbidity associated with invasive mechanical ventilation.&lrm; OBJECTIVE: Investigate the role of subglottic secretion suctioning in the prevention of VAP in mechanically ventilated patients in intensive care unit.&lrm; METHODS: A cross sectional study done in the intensive care unit of Ghazi Al-Hariri &lrm;hospital for surgical specialties in medical city complex, 30 patients who &lrm;are in need for invasive mechanical ventilation were intubated with endotracheal tube &lrm;that have special port for subglottic secretion suctioning. Daily monitoring of patients &lrm;clinical and radiological data to detect features of VAP was &lrm;done, and if there was a suspicion of pneumonia, culture for tracheal aspirate performed &lrm;to confirm diagnosis.&lrm; RESULTS: &lrm;Patient&rsquo;s age was 37.1 &plusmn; &lrm;&lrm;15.39 years, the highest proportion of study patients was found in &lrm;age group &lt; 30 and &lrm;&lrm;30&ndash;49 years (40% in &lrm;each group), most of the patients were males (70%) with a male to female ratio of &lrm;&lrm;2.33:1&lrm;&rlm;, &rlm;Subglottic secretion suctioning lead to reduction in VAP by relative risk (95%CI) of &rlm;&lrm;0.167 (0.045&ndash;0.559)&lrm;&rlm;, p-&rlm;value = 0.001. &rlm;Twenty eight patients didn&rsquo;t show any sign, symptoms &lrm;or radiological features suggesting a &lrm;diagnosis of pneumonia while two patients developed &lrm;features of pneumonia (suggestive signs and &lrm;symptoms, radiological features and &lrm;positive culture of tracheal aspirate).&lrm; CONCLUSION: the use of endotracheal tube with subglottic &lrm;secretions suctioning can have a role in the prevention of VAP in mechanically ventilated patients.&lrm;

Association between High miR-211 microRNA Expression and the Poor Prognosis of Oral Carcinoma

2008 ◽  
Vol 87 (11) ◽  
pp. 1063-1068 ◽  
Author(s):  
K.-W. Chang ◽  
C.-J. Liu ◽  
T.-H. Chu ◽  
H.-W. Cheng ◽  
P.-S. Hung ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Poor Prognosis ◽  
Nodal Metastasis ◽  
Carcinoma Cells ◽  
Oral Carcinoma ◽  
Reporter Plasmid ◽  
Oral Carcinogenesis ◽  
Poor Patient ◽  
Non Coding Rnas

MicroRNAs (miRNAs) are non-coding RNAs that play roles in gene silencing and may be involved in tumorigenesis. miR-211 was mapped to chromosome 15q13, a locus frequently altered in cancers. The role of miR-211in carcinogenesis has not been clearly defined, however. This study investigated the pathogenetic implications of miR-211 in oral carcinogenesis. An association was found between higher miR-211 expression and the most advanced nodal metastasis, vascular invasion, and poor prognosis of oral carcinoma. The function of enforced miR-211 expression in oral carcinoma cells was confirmed by the repression of LacZ in a reporter plasmid via miR-211 targeting. Enforced miR-211 expression significantly increased the proliferation, migration, and anchorage-independent colony formation of oral carcinoma cells, while it enhanced the tumorigenicity of only SAS high-grade oral carcinoma cells, but not OECM-1 non-tumorigenic cells. The findings suggest that high miR-211 expression may be associated with the progression of oral carcinoma and poor patient outcomes.

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