RISK FACTORS FOR THE DEVELOPMENT OF CRITICAL CONDITIONS REQUIRING HOSPITALIZATION IN THE INTENSIVE CARE UNIT AND INTENSIVE CARE UNIT IN PATIENTS WITH TUBERCULOSIS

2021 ◽  
pp. 44-48
Author(s):  
S. N. Alyushin ◽  
A. M. Skrahina ◽  
M. I. Dziusmikeyeva ◽  
V. V. Solodovnikova ◽  
A. Y. Skrahin
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Extrapulmonary Tuberculosis ◽  
Underlying Disease ◽  
Multidrug Resistant ◽  
Critical Conditions ◽  
Cd4 Cell Count ◽  
Resistant Tuberculosis ◽  
Cd4 Cell

The mortality rate among tuberculosis patients requiring intensive care is high. The development of severe conditions in patients with tuberculosis may be associated with the course of the underlying disease and with concomitant pathology. The aim of this work was to study the risk factors for the development of severe conditions in patients with tuberculosis to prevent death. A retrospective study of risk factors for the development of critical conditions, depending on the nature of the tuberculosis process, co-infection, concomitant diseases and bad habits, was carried out in 154 patients with pulmonary tuberculosis and extrapulmonary tuberculosis hospitalized in the intensive care unit. In a cohort of patients admitted to the intensive care unit and intensive care unit, statistically significant factors influencing the development of critical conditions were: the presence of extrapulmonary localization of the tuberculous process; the presence of bilateral tuberculous lung lesions; the presence of destructive forms of tuberculosis; the presence of tuberculous meningitis/encephalitis; the presence of multidrug-resistant and extensively drug-resistant tuberculosis; application of the traditional "old" treatment regimen; the presence of concomitant HIV infection with a CD4 cell count of less than 200/ul; the presence of concomitant diabetes.

scholarly journals Impacts of Multidrug-Resistant Pathogens and Inappropriate Initial Antibiotic Therapy on the Outcomes of Neonates with Ventilator-Associated Pneumonia

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 760
Author(s):  
Hsiao-Chin Wang ◽  
Chen-Chu Liao ◽  
Shih-Ming Chu ◽  
Mei-Yin Lai ◽  
Hsuan-Rong Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Treatment Failure ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Ventilator Associated Pneumonia ◽  
Neurological Sequelae ◽  
Independent Risk Factors

It is unknown whether neonatal ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) pathogens and inappropriate initial antibiotic treatment is associated with poor outcomes after adjusting for confounders. Methods: We prospectively observed all neonates with a definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and March 2020. All clinical features, therapeutic interventions, and outcomes were compared between the MDR–VAP and non-MDR–VAP groups. Multivariate regression analyses were used to investigate independent risk factors for treatment failure. Results: Of 720 neonates who were intubated for more than 2 days, 184 had a total of 245 VAP episodes. The incidence rate of neonatal VAP was 10.1 episodes/per 1000 ventilator days. Ninety-six cases (39.2%) were caused by MDR pathogens. Neonates with MDR–VAP were more likely to receive inadequate initial antibiotic therapy (51.0% versus 4.7%; p < 0.001) and had delayed resolution of clinical symptoms (38.5% versus 25.5%; p = 0.034), although final treatment outcomes were comparable with the non-MDR–VAP group. Inappropriate initial antibiotic treatment was not significantly associated with worse outcomes. The VAP-attributable mortality rate and overall mortality rate of this cohort were 3.7% and 12.0%, respectively. Independent risk factors for treatment failure included presence of concurrent bacteremia (OR 4.83; 95% CI 2.03–11.51; p < 0.001), septic shock (OR 3.06; 95% CI 1.07–8.72; p = 0.037), neonates on high-frequency oscillatory ventilator (OR 4.10; 95% CI 1.70–9.88; p = 0.002), and underlying neurological sequelae (OR 3.35; 95% CI 1.47–7.67; p = 0.004). Conclusions: MDR–VAP accounted for 39.2% of all neonatal VAP in the neonatal intensive care unit (NICU), but neither inappropriate initial antibiotics nor MDR pathogens were associated with treatment failure. Neonatal VAP with concurrent bacteremia, septic shock, and underlying neurological sequelae were independently associated with final worse outcomes.

Plasma pharmacokinetics of bedaquiline administered by nasogastric tube in an intensive care unit

2020 ◽  
Vol 24 (1) ◽  
pp. 110-112 ◽  
Author(s):  
E. Dang ◽  
F. Sayagh ◽  
M. P. Lê ◽  
M. Neuville ◽  
F. Sinnah ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nasogastric Tube ◽  
Multidrug Resistant ◽  
Therapeutic Drug ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Plasma Pharmacokinetics ◽  
Drug Pharmacokinetics

We present the case of a 21-year-old man admitted to the intensive care unit with multi-organ failure due to multidrug-resistant tuberculosis (TB). TB treatment initially comprised moxifloxacin, ethambutol, linezolid and amikacin administered intravenously. Due to suspected moxifloxacin-induced liver injury, we stopped all fluoroquinolones and switched to bedaquiline (BDQ), which is only available in tablets for oral administration. Since our patient had to be fed through a nasogastric tube (NGT), BDQ was administered after being crushed and dissolved in water; drug pharmacokinetics were studied using repeated blood sampling. Therapeutic drug monitoring showed that BDQ was detectable in blood plasma with a trough concentration above the supposed efficacy threshold, suggesting that this molecule could be administered through NGT.

scholarly journals Risk Factors for Colonization with Multidrug-Resistant Bacteria among Patients Admitted to the Intensive Care Unit after Returning from Abroad

2015 ◽  
Vol 22 (5) ◽  
pp. 300-305 ◽  
Author(s):  
Marion Angue ◽  
Nicolas Allou ◽  
Olivier Belmonte ◽  
Yannick Lefort ◽  
Nathalie Lugagne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria

scholarly journals Risk Factors and Outcomes Associated with Multidrug-Resistant Acinetobacter baumannii upon Intensive Care Unit Admission

2017 ◽  
Vol 62 (1) ◽  
Author(s):  
Natalia Blanco ◽  
Anthony D. Harris ◽  
Clare Rock ◽  
J. Kristie Johnson ◽  
Lisa Pineles ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Cohort Analysis ◽  
Multidrug Resistant ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Content Type ◽  
Icu Admission

ABSTRACT Multidrug-resistant (MDR) Acinetobacter baumannii, associated with broad-spectrum antibiotic use, is an important nosocomial pathogen associated with morbidity and mortality. This study aimed to investigate the prevalence of MDR A. baumannii perirectal colonization among adult patients upon admission to the intensive care unit (ICU) over a 5-year period and to identify risk factors and outcomes associated with colonization. A retrospective cohort analysis of patients admitted to the medical intensive care unit (MICU) and surgical intensive care unit (SICU) at the University of Maryland Medical Center from May 2005 to September 2009 was performed using perirectal surveillance cultures on admission. Poisson and logistic models were performed to identify associated risk factors and outcomes. Four percent of the cohort were positive for MDR A. baumannii at ICU admission. Among patients admitted to the MICU, those positive for MDR A. baumannii at admission were more likely to be older, to have received antibiotics before ICU admission, and to have shorter length of stay in the hospital prior to ICU admission. Among patients admitted to the SICU, those colonized were more likely to have at least one previous admission to our hospital. Patients positive for MDR A. baumannii at ICU admission were 15.2 times more likely to develop a subsequent positive clinical culture for A. baumannii and 1.4 times more likely to die during the current hospitalization. Risk factors associated with MDR A. baumannii colonization differ by ICU type. Colonization acts as a marker of disease severity and of risk of developing a subsequent Acinetobacter infection and of dying during hospitalization. Therefore, active surveillance could guide empirical antibiotic selection and inform infection control practices.

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