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Song H, Hu W, Zhou X, Tao J, Zhang S, Su X, Wu W. Clinical Benefits From Administering Probiotics to Mechanical Ventilated Patients in Intensive Care Unit: A PRISMA-Guided Meta-Analysis. Front Nutr 2022; 8:798827. [PMID: 35155520 PMCID: PMC8829544 DOI: 10.3389/fnut.2021.798827] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background The use of probiotics has been considered as a new intervention for ventilator-associated pneumonia (VAP) prevention in the intensive care unit (ICU). The aim of this meta-analysis was to evaluate the effect of probiotics on mechanical-ventilated patients in ICU. Methods PubMed, Embase, Scopus, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) from their respective inception through October 10, 2021. All studies meeting the inclusion criteria were selected to evaluate the effect of probiotics on patients receiving mechanical ventilation in ICU. Results A total of 15 studies involving 4,693 participants met our inclusion criterion and were included in this meta-analysis. The incidence of VAP in the probiotic group was significantly lower (odds ratio [OR] 0.58, 95% CI 0.41 to 0.81; p = 0.002; I2 = 71%). However, a publication bias may be present as the test of asymmetry was significant (p = 0.007). The probiotic administration was associated with a significant reduction in the duration of mechanical ventilation (mean difference [MD] −1.57, 95% CI −3.12 to −0.03; p = 0.05; inconsistency [I]2 = 80%), length of ICU stay (MD −1.87, 95% CI −3.45 to −0.28; p = 0.02; I2 = 76%), and incidence of bacterial colonization (OR 0.59, 95% CI 0.45 to 0.78; p = 0.0001; I2 = 34%). Moreover, no statistically significant differences were observed regarding the incidence of diarrhea (OR 0.90, 95% CI 0.65 to 1.25; p = 0.54; I2 = 12%) and mortality (OR 0.91, 95% CI 0.80 to 1.05; p = 0.19; I2 = 0%) between probiotics group and control group. Conclusion Our meta-analysis shows that probiotics are associated with a reduction in VAP, as well as the duration of mechanical ventilation, ICU length of stay, and bacterial colonization, but no significant effects on ICU mortality and occurrence of diarrhea. However, in consideration of the significant heterogeneity and publication bias, our findings need to be further validated. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42020150770.
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Affiliation(s)
- Hongzhuan Song
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Wenqing Hu
- Department of Emergency, Haining People's Hospital, Haining, China
| | - Xiujie Zhou
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Jiaping Tao
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Siyi Zhang
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Xuhong Su
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Wenjun Wu
- Department of Hematology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Wenjun Wu
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Chaurasia RC, Gupta BK, Yadav G, Pandey AR, Banerjee T, Sharma S. Quantitative correlation of colony forming units of Acinetobacter baumannii obtained from endotracheal tube aspirate culture with clinical pulmonary infection score. Indian J Anaesth 2021; 65:S163-S167. [PMID: 34908568 PMCID: PMC8613467 DOI: 10.4103/ija.ija_649_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Ventilator-associated pneumonia (VAP) is the most common healthcare-associated infection in adult critical care units. The reason behind the different levels of severity and the outcome in different individuals is not established yet.Co-morbidities and age may be a valid reason.In an attempt to find out the reason behind the different levels of severity of VAP in different individuals, we conducted a studywith the primary objective being to assess the quantitative correlation between the colony forming units (CFU) of Acinetobacter baumannii in the endotracheal tube aspirate and the Clinical Pulmonary Infection Score (CPIS) in mechanically ventilated patients without co-morbidities. The secondary objective was to see whether the severity of VAP depends on the number of CFU(>105/ml). Methods: This observational study was conducted in a 27-bedded intensive care unit of a tertiary care hospital in northern India. Endotracheal tube aspirate was collected from patients with suspected VAP.A total of 81 patients without any prior co-morbidity and having Acinetobacter baumannii in their endotracheal tube aspirate were included in the study group. Quantification of Acinetobacter baumannii was done by counting CFU.The CPIS was calculated for all Acinetobacter baumannii positive patients. Correlation between CFU of Acinetobacter baumannii and CPIS was assessed using Spearman's Rho correlation coefficient. Results: Among 81 patients having Acinetobacter baumannii infection, only 61.9% had a CPIS >4. There was an insignificant correlation between the quantity of CFUs of Acinetobacter baumannii and CPIS (P value = 0.784). Conclusion: Number of CFU >105/ml in an endotracheal tube aspirate culture bears no relation to the severity of VAP as predicted by the CPIS.
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Affiliation(s)
| | - Bikram K Gupta
- Department of Anaesthesia, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Ghanshyam Yadav
- Department of Anaesthesia, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Arun R Pandey
- Department of Anaesthesia, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Tuhina Banerjee
- Department of Microbiology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Swati Sharma
- Department of Microbiology, IMS, BHU, Varanasi, Uttar Pradesh, India
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Anti-virulence Bispecific Monoclonal Antibody Mediated Protection Against Pseudomonas aeruginosa Ventilator-Associated Pneumonia in a Rabbit Model. Antimicrob Agents Chemother 2021; 66:e0202221. [PMID: 34902264 PMCID: PMC8846318 DOI: 10.1128/aac.02022-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ventilator-associated pneumonia is an important clinical manifestation of the nosocomial pathogen Pseudomonas aeruginosa. We characterized the correlates of protection of MEDI3902, a bispecific human IgG1 mAb that targets the P. aeruginosa type-3-secretion PcrV protein and the Psl exopolysaccharide, in a rabbit model of ventilator-associated pneumonia using lung-protective, low-tidal volume mechanical ventilation. Rabbits infused with MEDI3902 prophylactically were protected, whereas those pretreated with irrelevant isotype-control IgG (c-IgG) succumbed between 12 and 44 hours post infection [100% (8/8) vs. 0% (8/8) survival, P<0.01 by log-rank test]. Lungs from rabbits pretreated with c-IgG, but not those with MEDI3902, had bilateral, multifocal areas of marked necrosis, hemorrhage, neutrophilic inflammatory infiltrate, diffuse fibrinous edema in alveolar spaces. All rabbits pretreated with c-IgG developed worsening bacteremia that peaked at the time of death, whereas only 38% (3/8) rabbits pretreated with MEDI3902 developed such high-grade bacteremia (two-sided Fisher's exact test, P=0.026). Biomarkers associated with acute respiratory distress syndrome were evaluated longitudinally in blood samples collected every 2-4 hours to assess systemic pathophysiological changes in rabbits pretreated with MEDI3902 or c-IgG. Biomarkers were sharply increased or decreased in rabbits pretreated with c-IgG, but not those pretreated with MEDI3902, including ratio of arterial oxygen partial pressure to fractional inspired oxygen PaO2/FiO2 <300, hypercapnia or hypocapnia, severe lactic acidosis, leukopenia and neutropenia. Cytokines and chemokines associated with ARDS were significantly downregulated in lungs from rabbits pretreated with MEDI3902 compared with c-IgG. These results suggest that MEDI3902 prophylaxis could have potential clinical utility for decreasing severity of P. aeruginosa ventilator-associated pneumonia.
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Chang Y, Jeon K, Lee SM, Cho YJ, Kim YS, Chong YP, Hong SB. The Distribution of Multidrug-resistant Microorganisms and Treatment Status of Hospital-acquired Pneumonia/Ventilator-associated Pneumonia in Adult Intensive Care Units: a Prospective Cohort Observational Study. J Korean Med Sci 2021; 36:e251. [PMID: 34697926 PMCID: PMC8546312 DOI: 10.3346/jkms.2021.36.e251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND It is essential to determine the distribution of the causative microorganisms in the region and the status of local antibiotic resistance for the proper treatment of hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP). This study aimed to investigate the occurrence and causative strains of HAP/VAP, distribution of resistant bacteria, use of antibiotics, and the ensuing outcomes of patients in Korea. METHODS A multicenter prospective observational cohort study was conducted among patients with HAP/VAP admitted to the medical intensive care unit of 5 tertiary referral centers between August 2012 and June 2015. Patients' demographic and clinical data were collected. RESULTS A total of 381 patients were diagnosed with HAP/VAP. Their median age was 69 (59-76) years and 71% were males. A majority of the patients (88%) had late-onset (> 5 days) HAP/VAP. One-quarter of the patients (n = 99) had at least one risk factor for multidrug-resistant (MDR) pathogens, such as prior intravenous antibiotic use within the last 90 days. Microbiological specimens were mostly obtained noninvasively (87%) using sputum or endotracheal aspirates. Pathogens were identified in 235 (62%) of the 381 patients. The most common bacterial pathogen was Acinetobacter baumannii (n = 89), followed by Staphylococcus aureus (n = 52), Klebsiella pneumoniae (n = 25) and Pseudomonas aeruginosa (n = 22). Most of isolated A. baumannii (97%) and S. aureus (88%) were multidrug resistant. The most commonly used empirical antibiotic regimens were carbapenem-based antibiotics (38%), followed by extended-spectrum penicillin/β-lactamase inhibitor (34%). Glycopeptide or linezolid were also used in combination in 54% of patients. The 28-day mortality rate of the patients with HAP/VAP was 30% and the 60-day mortality was 46%. Patients who used empirical antibiotics appropriately had significantly lower mortality rates than those who did not (28-day mortality: 25% vs. 40%, P = 0.032; 60-day mortality: 41% vs. 55%, P = 0.032, respectively). Administration of appropriate empirical antibiotics (odds ratio [OR], 0.282; confidence interval [CI], 0.092-0.859; P = 0.026), Day 7 treatment failure (OR, 4.515; CI, 1.545-13.192; P = 0.006), and APACHE II score on day 1 (OR, 1.326; CI, 0.988-1.779; P = 0.012) were the factors that determined the 28-day mortality in patients with HAP who had identified bacteria as pathogens. CONCLUSION In HAP/VAP patients, there was a large burden of MDR pathogens, and their associated mortality rate was high. Proper selection of empirical antibiotics was significantly associated with the patient's prognosis; however, there was a discrepancy between major pathogens and empirical antibiotic therapy.
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Affiliation(s)
- Youjin Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Côrtes MF, de Almeida BL, Espinoza EPS, Campos AF, do Nascimento Moura ML, Salomão MC, Boszczowski I, Freire MP, de Carvalho LB, Paranhos-Baccalà G, Costa SF, Guimarães T. Procalcitonin as a biomarker for ventilator associated pneumonia in COVID-19 patients: Is it an useful stewardship tool? Diagn Microbiol Infect Dis 2021; 101:115344. [PMID: 34243136 PMCID: PMC7879055 DOI: 10.1016/j.diagmicrobio.2021.115344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 11/22/2022]
Abstract
Ventilator associated pneumonia(VAP) is a severe complication that can lead to high mortality when not early identified or when therapy is delayed. The aim of this study was to evaluate procalcitonin(PCT) as a biomarker for VAP development. In total, 73 hospitalized patients with COVID-19 were analyzed. PCT levels greater than 0.975ng/mL were more related to VAP. No association was found for C-reactive protein (CRP). The results show that procalcitonin may be a pertinent biomarker for VAP diagnosis and can be a helpful tool for antibiotic withdrawal.
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Affiliation(s)
- Marina Farrel Côrtes
- Department of Infection Diseases, LIM-49, Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Open Innovation and Partnership Department at bioMérieux, São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Bianca Leal de Almeida
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Evelyn Patricia Sanchez Espinoza
- Department of Infection Diseases, LIM-49, Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Aléia Faustina Campos
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Matias C Salomão
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Icaro Boszczowski
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Gláucia Paranhos-Baccalà
- Open Innovation and Partnership Department at bioMérieux, São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Department of Infection Diseases, LIM-49, Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thaís Guimarães
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Decavèle M, Gault N, Moyer JD, Gennequin M, Allain PA, Foucrier A. Prediction models of methicillin sensitive Staphylococcus aureus ventilator associated pneumonia relapse in trauma and brain injury patients: A retrospective analysis. J Crit Care 2021; 66:20-25. [PMID: 34399115 DOI: 10.1016/j.jcrc.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the incidence and risk factors of methicillin sensitive Staphylococcus aureus ventilator associated pneumonia (MSSA-VAP) relapse in trauma and non-traumatic brain injury patients. MATERIALS AND METHODS Retrospective observational monocentric cohort study of consecutive ICU patients who developed a first episode of MSSA-VAP after trauma and non-traumatic brain injury. MSSA-VAP relapse encompass MSSA-VAP treatment failure (persistence or recurrence of MSSA) or other pathogen - VAP. RESULTS A total of 165 patients (71% of trauma and 29% of non-traumatic brain injury) with MSSA-VAP were included. MSSA-VAP relapse occurred in 54 (33%) patients, including 28 (17%) MSSA-VAP treatment failure and 46 (28%) other pathogen-VAP. Empirical first-line antibiotic therapy was appropriate in 96% of cases. In multivariate analysis, the presence of Streptococcus species (Odds ratio [OR] 7.37) and oropharyngeal flora (OR 3.64) as initial MSSA co-pathogen, suggested aspiration at the time of admission and independently predicted MSSA-VAP treatment failure. Initial Glasgow coma scale (OR 0.89), need for emergent surgery (OR 5.71) and the presence of an acute respiratory distress syndrome at the time of the first MSSA-VAP (3.99), independently predicted the onset of other pathogen - VAP. CONCLUSION Early and simple factors may help to identify patients with high-risk of MSSA-VAP relapse.
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Affiliation(s)
- Maxens Decavèle
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 92110 Clichy, France; Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France.
| | - Nathalie Gault
- APHP, Département Epidémiologie Biostatistiques et Recherche Clinique, Hôpital Beaujon, 92110 Clichy, France; INSERM, CIC-EC 1425, Hôpital Bichat, 75018 Paris, France
| | - Jean Denis Moyer
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 92110 Clichy, France
| | - Maël Gennequin
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 92110 Clichy, France
| | - Pierre-Antoine Allain
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 92110 Clichy, France
| | - Arnaud Foucrier
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 92110 Clichy, France
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Choi ES, Noh HJ, Chung WG, Mun SJ. Development of a competency for professional oral hygiene care of endotracheally-intubated patients in the intensive care unit: development and validity evidence. BMC Health Serv Res 2021; 21:748. [PMID: 34315462 PMCID: PMC8316100 DOI: 10.1186/s12913-021-06755-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 07/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Professional oral care in the intensive care unit may reduce the incidence of Ventilator Associated Pneumonia, which increases the patient's mortality rate. This study aimed to develop a competency for professional oral hygiene care of endotracheally-intubated intensive-care patients. METHODS First, we developed a competency draft by reviewing the literature on oral hygiene care of patients in the intensive care unit. Next, we developed expert validity test questionnaires using this draft and conducted expert validity tests twice on 18 experts. We determined competency as a content validity index of 0.8 or more and received expert additive opinions about competency through an open-questionnaire expert validity test paper in this methodology study. RESULTS The content validity index ranged from 0.8 ~ 1.0 for all items. The competency of 'professionalism' comprised 2 sub-competencies with 7 behavioral indicators. 'POHC preparation' comprised 3 sub-competencies with 10 behavioral indicators. 'POHC implementation' comprised 3 sub-competencies with 6 behavioral indicators. 'POHC evaluation' comprised 2 sub-competencies with 8 behavioral indicators. Lastly 'Cooperation among experts' comprised 3 sub-competencies with 7 behavioral indicatiors. CONCLUSIONS To provide patients with high quality oral hygiene care, these competencies should be implemented, and oral hygiene care professionals and related medical personnel should form a cooperative system.
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Affiliation(s)
- Eun-Sil Choi
- Department of Dental Hygiene, The Graduate School, Yonsei University, Wonju, South Korea
| | - Hie-Jin Noh
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwondo, 26493, Republic of Korea
| | - Won-Gyun Chung
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwondo, 26493, Republic of Korea
| | - So-Jung Mun
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwondo, 26493, Republic of Korea.
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Pseudomonas aeruginosa Ventilator-Associated Pneumonia Rabbit Model for Preclinical Drug Development. Antimicrob Agents Chemother 2021; 65:e0272420. [PMID: 33972247 DOI: 10.1128/aac.02724-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Development and validation of large animal models of Pseudomonas aeruginosa ventilator-associated pneumonia are needed for testing new drug candidates in a manner that mimics how they will be used clinically. We developed a new model in which rabbits were ventilated with low tidal volume and challenged with P. aeruginosa to recapitulate hallmark clinical features of acute respiratory distress syndrome (ARDS): acute lung injury and inflammation, progressive decrease in arterial oxygen partial pressure to fractional inspired oxygen PaO2:FiO2, leukopenia, neutropenia, thrombocytopenia, hyperlactatemia, severe hypotension, bacterial dissemination from lung to other organs, multiorgan dysfunction, and ultimately death. We evaluated the predictive power of this rabbit model for antibiotic efficacy testing by determining whether a humanized dosing regimen of meropenem, a potent antipseudomonal β-lactam antibiotic, when administered with or without intensive care unit (ICU)-supportive care (fluid challenge and norepinephrine), could halt or reverse natural disease progression. Our humanized meropenem dosing regimen produced a plasma concentration-time profile in the rabbit model similar to those reported in patients with ventilator-associated bacterial pneumonia. In this rabbit model, treatment with humanized meropenem and ICU-supportive care achieved the highest level of survival, halted the worsening of ARDS biomarkers, and reversed lethal hypotension, although treatment with humanized meropenem alone also conferred some protection compared to treatment with placebo (saline) alone or placebo plus ICU-supportive care. In conclusion, this rabbit model could help predict whether an antibiotic will be efficacious for the treatment of human ventilator-associated pneumonia.
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Creace TDG, Marson FAL, Cannonieri-Nonose GC. Indicative Factors for 48 or More Hours of Mechanical Ventilation to Optimize the Use of Orotracheal Tubes with Supra-cuff Suction Devices: a Retrospective Study. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:2141-2148. [PMID: 34155484 PMCID: PMC8208058 DOI: 10.1007/s42399-021-00994-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
The objective of this study is to verify the risk factors for invasive mechanical ventilation (IMV) for ≥48h, aiming at the best indication of orotracheal tubes (OTTs) with supra-cuff suction devices. This retrospective and observational study was carried out at the Adult Intensive Care Unit of the University Hospital during a 2-year period. Patients undergoing orotracheal intubation were enrolled. Demographic and clinical data were collected from medical records. A total of 1185 medical records were analyzed, of which 820 were included in the study. The markers associated with intubation for ≥48h were as follows: positive history of diseases (RR=1.42; 95%CI=1.17 to 1.74), especially alcohol addiction (RR=1.60; 95%CI=1.22 to 2.09) or former alcohol addiction (RR=1.50; 95%CI=1.06 to 2.13); clinical hospitalization (RR=1.06; 95%CI=0.98 to 1.16); emergency intubation (RR=3.24; 95%CI=3.01 to 3.95); intubation performed in the emergency department (RR=3.44; 95%CI=3.01 to 3.95) and other hospital facilities (RR=2.92; 95%CI=2.49 to 3.42); and intubation due to lowered level of consciousness (RR=3.40; 95%CI=2.95 to 3.93), acute respiratory failure (RR=3.43; 95%CI=2.98 to 3.54), and airway protection (RR=2.87; 95%CI=2.32 to 3.54). Patients on IMV for ≥48h had an RR of 2.07 (95%CI=1.79 to 2.40) for death. Patients with history of diseases, especially past or current history of alcoholism with clinical hospitalization, who underwent emergency intubation in the emergency department or in other hospital facilities due to lowered level of consciousness, acute respiratory failure, or protect airways, are most likely to require IMV for ≥48h. Also, patients on IMV for ≥48h had an high RR for death.
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Affiliation(s)
- Tainã de Godoy Creace
- Multiprofessional Residency Program in Adult Intensive Health in Physiotherapy, São Francisco University, Jardim São José, Bragança Paulista, São Paulo, 12916-900 Brazil
| | - Fernando Augusto Lima Marson
- Multiprofessional Residency Program in Adult Intensive Health in Physiotherapy, São Francisco University, Jardim São José, Bragança Paulista, São Paulo, 12916-900 Brazil
- Postgradutate Program in Health Sciences, Laboratory of Medical and Human Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Course of Physiotherapy, São Francisco University, Bragança Paulista, São Paulo, Brazil
| | - Gianna Carla Cannonieri-Nonose
- Multiprofessional Residency Program in Adult Intensive Health in Physiotherapy, São Francisco University, Jardim São José, Bragança Paulista, São Paulo, 12916-900 Brazil
- Course of Physiotherapy, São Francisco University, Bragança Paulista, São Paulo, Brazil
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Watson K, Reoch J, Heales LJ, Fernando J, Tan E, Smith K, Austin D, Divanoglou A. The incidence and characteristics of ventilator-associated pneumonia in a regional nontertiary Australian intensive care unit: A retrospective clinical audit study. Aust Crit Care 2021; 35:294-301. [PMID: 34144862 DOI: 10.1016/j.aucc.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation in the intensive care unit. The incidence, patient characteristics, and outcomes have not been described in a regional Australian setting. OBJECTIVES Τhe primary objective was to establish the incidence of VAP in a regional intensive care unit using predetermined diagnostic criteria. The secondary objective was to compare the agreement between criteria-based and physician-based diagnostic processes. The tertiary objectives were to compare patient characteristics and clinical outcomes of cases with and without VAP. METHODS A retrospective clinical audit was performed of adult patients admitted to Rockhampton Intensive Care Unit, Australia, between 2013 and 2016. We included all patients ventilated for ≥72 h and not diagnosed with a pneumonia before or during the first 72 h of ventilation. RESULTS A total of 170 cases met the inclusion criteria. The incidence of VAP as per the criteria-based diagnosis was 27.3 cases per 1000 ventilator days (95% confidence interval [CI]: 18.4-36.2) and as per the physician-based diagnosis was 25.8 cases per 1000 ventilator days (95% CI: 17.1-34.4). There was a moderate chance-corrected agreement between the criteria- and physician-based diagnosis. Very obese cases (body mass index [BMI] ≥40) were nearly four times more likely to develop VAP than cases with normal BMI (BMI <30) (odds ratio: 3.664; 95% CI: 1.394-9.634; p = 0.008). After controlling for sex, BMI category, comorbidities, and Acute Physiology and Chronic Health Evaluation II scores, there was a trend (p = 0.283) for higher adjusted mortality rate for cases with VAP (10.1%, 95% CI: 4.8-21.5) than for those without VAP (6.1%, 95% CI: 3.0-12.4). Cases with VAP had a higher total hospital cost ($123,223 AUD vs $66,425 AUD, p < 0.001), than cases without VAP. CONCLUSIONS This is the first study reporting incidence of VAP in an Australian regional intensive care unit setting. An increased length of stay and significantly higher hospital costs warrant research investigating reliable and valid clinical prediction rules to forecast those at risk of VAP.
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Affiliation(s)
- Kirsty Watson
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, QLD, Australia; Allied Health, Rockhampton Hospital, Rockhampton, QLD, Australia.
| | - Josephine Reoch
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, QLD, Australia.
| | - Luke J Heales
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.
| | - Jeremy Fernando
- Rural Clinical School, Rockhampton, University of Queensland, Australia.
| | - Elise Tan
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, QLD, Australia.
| | - Karen Smith
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, QLD, Australia.
| | - David Austin
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, QLD, Australia.
| | - Anestis Divanoglou
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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Makhoul M, Heuts S, Mansouri A, Taccone FS, Obeid A, Mirko B, Broman LM, Malfertheiner MV, Meani P, Raffa GM, Delnoij T, Maessen J, Bolotin G, Lorusso R. Understanding the "extracorporeal membrane oxygenation gap" in veno-arterial configuration for adult patients: Timing and causes of death. Artif Organs 2021; 45:1155-1167. [PMID: 34101843 PMCID: PMC8518076 DOI: 10.1111/aor.14006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/08/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Abstract
Timing and causes of hospital mortality in adult patients undergoing veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) have been poorly described. Aim of the current review was to investigate the timing and causes of death of adult patients supported with V‐A ECMO and subsequently define the “V‐A ECMO gap,” which represents the patients who are successfully weaned of ECMO but eventually die during hospital stay. A systematic search was performed using electronic MEDLINE and EMBASE databases through PubMed. Studies reporting on adult V‐A ECMO patients from January 1993 to December 2020 were screened. The studies included in this review were studies that reported more than 10 adult, human patients, and no mechanical circulatory support other than V‐A ECMO. Information extracted from each study included mainly mortality and causes of death on ECMO and after weaning. Complications and discharge rates were also extracted. Sixty studies with 9181 patients were included for analysis in this systematic review. Overall mortality was 38.0% (95% confidence intervals [CIs] 34.2%‐41.9%) during V‐A ECMO support (reported by 60 studies) and 15.3% (95% CI 11.1%‐19.5%, reported by 57 studies) after weaning. Finally, 44.0% of patients (95% CI 39.8‐52.2) were discharged from hospital (reported by 60 studies). Most common causes of death on ECMO were multiple organ failure, followed by cardiac failure and neurological causes. More than one‐third of V‐A ECMO patients die during ECMO support. Additionally, many of successfully weaned patients still decease during hospital stay, defining the “V‐A ECMO gap.” Underreporting and lack of uniformity in reporting of important parameters remains problematic in ECMO research. Future studies should uniformly define timing and causes of death in V‐A ECMO patients to better understand the effectiveness and complications of this support.
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Affiliation(s)
- Maged Makhoul
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Cardiac Surgery Unit, Rambam Medical Centre, Haifa, Israel
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Abdulrahman Mansouri
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Fabio Silvio Taccone
- Department of Intensive Care Medicine, Clinique Universitaire de Bruxelles (CUB) Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Amir Obeid
- Cardiac Surgery Unit, Rambam Medical Centre, Haifa, Israel
| | - Belliato Mirko
- U.O.C. Anestesia e Rianimazione II Cardiopolmonare, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lars Mikael Broman
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | - Paolo Meani
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Giuseppe Maria Raffa
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Thijs Delnoij
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy.,Intensive Care Department, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Gil Bolotin
- Cardiac Surgery Unit, Rambam Medical Centre, Haifa, Israel
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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62
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Nseir S, Martin-Loeches I, Povoa P, Metzelard M, Du Cheyron D, Lambiotte F, Tamion F, Labruyere M, Makris D, Boulle Geronimi C, Pinetonde Chambrun M, Nyunga M, Pouly O, Mégarbane B, Saade A, Gomà G, Magira E, Llitjos JF, Torres A, Ioannidou I, Pierre A, Coelho L, Reignier J, Garot D, Kreitmann L, Baudel JL, Voiriot G, Contou D, Beurton A, Asfar P, Boyer A, Thille AW, Mekontso-Dessap A, Tsolaki V, Vinsonneau C, Floch PE, Le Guennec L, Ceccato A, Artigas A, Bouchereau M, Labreuche J, Duhamel A, Rouzé A. Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:177. [PMID: 34034777 PMCID: PMC8146175 DOI: 10.1186/s13054-021-03588-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022]
Abstract
Background Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. Methods Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox’s regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event.
Findings Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 group (adjusted HR 1.65 (95% CI 1.11–2.46), p = 0.013), but not in influenza (1.74 (0.99–3.06), p = 0.052), or no viral infection groups (1.13 (0.68–1.86), p = 0.63). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. Interpretation VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality.
Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03588-4.
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Affiliation(s)
- Saad Nseir
- Médecine Intensive-Réanimation, CHU de Lille, F-59000, Lille, France. .,Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Univ. Lille, Lille, France.
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, St. James Street, Dublin 8, Dublin, Eire, Ireland.,Hospital Clinic, IDIBAPS, Universided de Barcelona, CIBERes, Barcelona, Spain
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, and NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | | | - Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France
| | - Fabien Lambiotte
- Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Fabienne Tamion
- Medical Intensive Care Unit, Rouen University Hospital, Normandie Université, UNIROUEN, Inserm U1096, FHU-REMOD-VHF, 76000, Rouen, France
| | - Marie Labruyere
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Demosthenes Makris
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly, 41110, Biopolis Larissa, Greece
| | - Claire Boulle Geronimi
- Service de Réanimation Et de Soins Intensifs, Centre Hospitalier de Douai, Route de Cambrai, Douai, France
| | - Marc Pinetonde Chambrun
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | | | - Olivier Pouly
- Médecine Intensive Réanimation, Hôpital Saint Philibert GHICL, Université Catholique, Lille, France
| | - Bruno Mégarbane
- Réanimation Médicale Et Toxicologique, Hôpital Lariboisière, Université de Paris, INSERM UMRS-1144, Paris, France
| | - Anastasia Saade
- Service de Médecine Intensive Et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Gemma Gomà
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Eleni Magira
- 1St Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos Hospital, Athens, Greece
| | - Jean-François Llitjos
- Medical Intensive Care Unit, Cochin Hospital, AP-HP. Centre, Université de Paris, Paris, France
| | - Antoni Torres
- Department of Pulmonology, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERES, ICREA, Barcelona, Spain
| | - Iliana Ioannidou
- 1St Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, "Sotiria" Chest Hospital, Athens, Greece
| | | | - Luis Coelho
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, and NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France
| | - Denis Garot
- Service de Médecine Intensive Réanimation, CHU de Tours, Hôpital Bretonneau, 2 Bd Tonnellé, 37000, Tours, France
| | - Louis Kreitmann
- Service de Médecine Intensive - Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5, place d'Arsonval, 69437, Lyon Cedex 03, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Guillaume Voiriot
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Damien Contou
- Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France
| | - Alexandra Beurton
- Service de Pneumologie, Médecine Intensive - Réanimation (Département "R3S"), AP-HP, Sorbonne Université, Groupe Hospitalier Universitaire Pitié-Salpêtrière Charles Foix, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France
| | - Pierre Asfar
- Département de Médecine Intensive-Réanimation, CHU D'Angers, Université D'Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Alexandre Boyer
- Intensive Care Unit, Pellegrin-Tripode Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Arnaud W Thille
- CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Armand Mekontso-Dessap
- APHP, CHU Henri Mondor, Service de Médecine Intensive RéanimationUniversité Paris Est-Créteil, Faculté de Santé, Groupe de Recherche Clinique CARMASINSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
| | - Vassiliki Tsolaki
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly, 41110, Biopolis Larissa, Greece
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Réseau de Recherche Boréal, 62408, Béthune, France
| | - Pierre-Edouard Floch
- Service de Réanimation, Hôpital Duchenne, Rue Monod, 62200, Boulogne-sur-Mer, France
| | - Loïc Le Guennec
- Sorbonne Université, AP-HP, Hôpital de La Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Paris, France
| | - Adrian Ceccato
- Intensive Care Unit, Hospital Universitari Sagrat Cor, and Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028)-Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Artigas
- Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Parc Tauli 1, 08028, Sabadell, Spain
| | | | - Julien Labreuche
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Anahita Rouzé
- Médecine Intensive-Réanimation, CHU de Lille, F-59000, Lille, France.,Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Univ. Lille, Lille, France
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63
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Ben Lakhal H, M’Rad A, Naas T, Brahmi N. Antimicrobial Susceptibility among Pathogens Isolated in Early- versus Late-Onset Ventilator-Associated Pneumonia. Infect Dis Rep 2021; 13:401-410. [PMID: 33925385 PMCID: PMC8167786 DOI: 10.3390/idr13020038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is associated with increased hospital stay and high morbidity and mortality in critically ill patients. The aims of this study were to (i) determine the incidence of multidrug-resistant (MDR) pathogens in the first episodes of VAP and to assess potential differences in bacterial profiles of subjects with early- versus late-onset VAP. This was a retrospective cohort study over a period of 18 months including all patients who had a first episode of VAP confirmed by positive bacterial culture. Subjects were distributed into two groups according to the number of intubation days: early-onset VAP (<5 days) or late-onset VAP (≥5 days). The primary endpoint was the nature of causative pathogens and their resistance profiles. Sixty patients were included, 29 men and 31 women, with an average age of 38 ± 16 years. The IGS 2 at admission was 40.5 [32–44] and APACHE was 19 [15–22]. Monomicrobial infections were diagnosed in 77% of patients (n = 46). The most frequently isolated bacteria were A. baumannii, 53% (n = 32); P. aeruginosa in 37% (n = 22); Enterobacterales in 28% (n = 17) and S. aureus in 5% (n = 3). Ninety-seven percent of the bacteria were MDR. The VAP group comprised 36 (60%) episodes of early-onset VAP and 24 (40%) episodes of late-onset VAP. There was no significant difference in the distribution of the bacterial isolates, nor in terms of antibacterial resistances between early- and late-onset VAPs. Our data support recent observations that there is no microbiological difference in the prevalence of potential MDR pathogens or in their resistance profiles associated with early- versus late-onset VAPs, especially in countries with high rates of MDR bacteria.
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Affiliation(s)
- Hend Ben Lakhal
- Service de Reanimation, Centre Hospitalier de Chartres, 4, Rue Claude-Bernard, 28630 Le Coudray, France
- Service de Reanimation, Centre d’Assistance Médicale Urgente (CAMU) de Tunis, 50 Rue Abou Kacem Chebbi, Tunis 1089, Tunisia; (A.M.); (N.B.)
- Correspondence:
| | - Aymen M’Rad
- Service de Reanimation, Centre d’Assistance Médicale Urgente (CAMU) de Tunis, 50 Rue Abou Kacem Chebbi, Tunis 1089, Tunisia; (A.M.); (N.B.)
| | - Thierry Naas
- Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France;
- Team ReSIST, INSERM U1184, School of Medicine Université Paris-Saclay, LabEx LERMIT, 94270 Le Kremlin-Bicêtre, France
| | - Nozha Brahmi
- Service de Reanimation, Centre d’Assistance Médicale Urgente (CAMU) de Tunis, 50 Rue Abou Kacem Chebbi, Tunis 1089, Tunisia; (A.M.); (N.B.)
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64
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Mojtahedzadeh M, Mashhadi Akbar Boojar M, Habtemariam S, Nabavi SM, Najafi A, Ghahremanian A, Baktash M, Aghaabdollahian S, Sureda A, Bagheri M. Systematic review: Effectiveness of herbal oral care products on ventilator-associated pneumonia. Phytother Res 2021; 35:3665-3672. [PMID: 33891776 DOI: 10.1002/ptr.7060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022]
Abstract
Ventilator-associated pneumonia (VAP) resulting from bacterial infection is a prevalent medical problem in intensive care units (ICUs). The purpose of this study was to systematically review available studies on oral products employed to control and reduce VAP in patients undergoing tracheal intubation. This study was based on a systematic review of clinical trial data from science databases such as PubMed, Cochrane, Scopus, and Web of science. Articles were reviewed and selected according to defined criteria and assessed by the primary evaluation checklist. After a critical review of 3,143 search hits, only 18 relevant articles were finally selected for discussion. Our assessment revealed that chlorhexidine and some other oral herbal medications are beneficial in preventing VAP. Chlorhexidine oral dosage forms provide a remarkable role in oral health and prevention of VAP by decreasing the microbial flora in the mouth. Because of similar benefits and comparable effects, some herbal medicines can be suggested as a practical alternative to chlorhexidine.
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Affiliation(s)
- Mojtaba Mojtahedzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Mashhadi Akbar Boojar
- Nanobiotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Solomon Habtemariam
- Pharmacognosy Research Laboratories and Herbal Analysis Services, The University of Greenwich, London, UK
| | | | - Atabak Najafi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhosein Ghahremanian
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Poisoning Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Baktash
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Poisoning Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Safieh Aghaabdollahian
- Department of Nanobiotechnology, New Technologies Research Group, Pasteur Institute of Iran, Tehran, Iran
| | - Antoni Sureda
- Research Group on Community Nutrition and Oxidative Stress, Department of Fundamental Biology and Health Sciences, University of Balearic Islands, Palma, Spain
| | - Mahdi Bagheri
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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65
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Cendra MDM, Torrents E. Pseudomonas aeruginosa biofilms and their partners in crime. Biotechnol Adv 2021; 49:107734. [PMID: 33785375 DOI: 10.1016/j.biotechadv.2021.107734] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022]
Abstract
Pseudomonas aeruginosa biofilms and the capacity of the bacterium to coexist and interact with a broad range of microorganisms have a substantial clinical impact. This review focuses on the main traits of P. aeruginosa biofilms, such as the structural composition and regulatory networks involved, placing particular emphasis on the clinical challenges they represent in terms of antimicrobial susceptibility and biofilm infection clearance. Furthermore, the ability of P. aeruginosa to grow together with other microorganisms is a significant pathogenic attribute with clinical relevance; hence, the main microbial interactions of Pseudomonas are especially highlighted and detailed throughout this review. This article also explores the infections caused by single and polymicrobial biofilms of P. aeruginosa and the current models used to recreate them under laboratory conditions. Finally, the antimicrobial and antibiofilm strategies developed against P. aeruginosa mono and multispecies biofilms are detailed at the end of this review.
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Affiliation(s)
- Maria Del Mar Cendra
- Bacterial Infections and Antimicrobial therapies Group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 15-21, 08028 Barcelona, Spain.
| | - Eduard Torrents
- Bacterial Infections and Antimicrobial therapies Group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 15-21, 08028 Barcelona, Spain; Microbiology Section, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, 643 Diagonal Ave., 08028 Barcelona, Spain.
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66
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Lewis SR, Baker PE, Parker R, Smith AF. High-flow nasal cannulae for respiratory support in adult intensive care patients. Cochrane Database Syst Rev 2021; 3:CD010172. [PMID: 33661521 PMCID: PMC8094160 DOI: 10.1002/14651858.cd010172.pub3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND High-flow nasal cannulae (HFNC) deliver high flows of blended humidified air and oxygen via wide-bore nasal cannulae and may be useful in providing respiratory support for adults experiencing acute respiratory failure, or at risk of acute respiratory failure, in the intensive care unit (ICU). This is an update of an earlier version of the review. OBJECTIVES To assess the effectiveness of HFNC compared to standard oxygen therapy, or non-invasive ventilation (NIV) or non-invasive positive pressure ventilation (NIPPV), for respiratory support in adults in the ICU. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane COVID-19 Register (17 April 2020), clinical trial registers (6 April 2020) and conducted forward and backward citation searches. SELECTION CRITERIA We included randomized controlled studies (RCTs) with a parallel-group or cross-over design comparing HFNC use versus other types of non-invasive respiratory support (standard oxygen therapy via nasal cannulae or mask; or NIV or NIPPV which included continuous positive airway pressure and bilevel positive airway pressure) in adults admitted to the ICU. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We included 31 studies (22 parallel-group and nine cross-over designs) with 5136 participants; this update included 20 new studies. Twenty-one studies compared HFNC with standard oxygen therapy, and 13 compared HFNC with NIV or NIPPV; three studies included both comparisons. We found 51 ongoing studies (estimated 12,807 participants), and 19 studies awaiting classification for which we could not ascertain study eligibility information. In 18 studies, treatment was initiated after extubation. In the remaining studies, participants were not previously mechanically ventilated. HFNC versus standard oxygen therapy HFNC may lead to less treatment failure as indicated by escalation to alternative types of oxygen therapy (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.45 to 0.86; 15 studies, 3044 participants; low-certainty evidence). HFNC probably makes little or no difference in mortality when compared with standard oxygen therapy (RR 0.96, 95% CI 0.82 to 1.11; 11 studies, 2673 participants; moderate-certainty evidence). HFNC probably results in little or no difference to cases of pneumonia (RR 0.72, 95% CI 0.48 to 1.09; 4 studies, 1057 participants; moderate-certainty evidence), and we were uncertain of its effect on nasal mucosa or skin trauma (RR 3.66, 95% CI 0.43 to 31.48; 2 studies, 617 participants; very low-certainty evidence). We found low-certainty evidence that HFNC may make little or no difference to the length of ICU stay according to the type of respiratory support used (MD 0.12 days, 95% CI -0.03 to 0.27; 7 studies, 1014 participants). We are uncertain whether HFNC made any difference to the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) within 24 hours of treatment (MD 10.34 mmHg, 95% CI -17.31 to 38; 5 studies, 600 participants; very low-certainty evidence). We are uncertain whether HFNC made any difference to short-term comfort (MD 0.31, 95% CI -0.60 to 1.22; 4 studies, 662 participants, very low-certainty evidence), or to long-term comfort (MD 0.59, 95% CI -2.29 to 3.47; 2 studies, 445 participants, very low-certainty evidence). HFNC versus NIV or NIPPV We found no evidence of a difference between groups in treatment failure when HFNC were used post-extubation or without prior use of mechanical ventilation (RR 0.98, 95% CI 0.78 to 1.22; 5 studies, 1758 participants; low-certainty evidence), or in-hospital mortality (RR 0.92, 95% CI 0.64 to 1.31; 5 studies, 1758 participants; low-certainty evidence). We are very uncertain about the effect of using HFNC on incidence of pneumonia (RR 0.51, 95% CI 0.17 to 1.52; 3 studies, 1750 participants; very low-certainty evidence), and HFNC may result in little or no difference to barotrauma (RR 1.15, 95% CI 0.42 to 3.14; 1 study, 830 participants; low-certainty evidence). HFNC may make little or no difference to the length of ICU stay (MD -0.72 days, 95% CI -2.85 to 1.42; 2 studies, 246 participants; low-certainty evidence). The ratio of PaO2/FiO2 may be lower up to 24 hours with HFNC use (MD -58.10 mmHg, 95% CI -71.68 to -44.51; 3 studies, 1086 participants; low-certainty evidence). We are uncertain whether HFNC improved short-term comfort when measured using comfort scores (MD 1.33, 95% CI 0.74 to 1.92; 2 studies, 258 participants) and responses to questionnaires (RR 1.30, 95% CI 1.10 to 1.53; 1 study, 168 participants); evidence for short-term comfort was very low certainty. No studies reported on nasal mucosa or skin trauma. AUTHORS' CONCLUSIONS HFNC may lead to less treatment failure when compared to standard oxygen therapy, but probably makes little or no difference to treatment failure when compared to NIV or NIPPV. For most other review outcomes, we found no evidence of a difference in effect. However, the evidence was often of low or very low certainty. We found a large number of ongoing studies; including these in future updates could increase the certainty or may alter the direction of these effects.
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Affiliation(s)
- Sharon R Lewis
- Lancaster Patient Safety Research Unit, Royal Lancaster Infirmary, Lancaster, UK
| | - Philip E Baker
- Academic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Roses Parker
- Cochrane MOSS Network, c/o Cochrane Pain Palliative and Supportive Care Group, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew F Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
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Kang SY, DiStefano MJ, Yehia F, Koszalka MV, Padula WV. Critical Care Beds With Continuous Lateral Rotation Therapy to Prevent Ventilator-Associated Pneumonia and Hospital-Acquired Pressure Injury: A Cost-effectiveness Analysis. J Patient Saf 2021; 17:149-155. [PMID: 30896557 DOI: 10.1097/pts.0000000000000582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Mechanical ventilation increases the risk of hospital-acquired conditions (HACs) such as ventilator-associated pneumonia (VAP) and pressure injury (PrI). Beds with continuous lateral rotation therapy (CLRT) are shown to reduce HAC incidence, but the value of switching to CLRT beds is presently unknown. We compared the cost-effectiveness of CLRT beds with standard care in intensive care units. METHODS A cost-effectiveness analysis from the healthcare sector and societal perspectives was conducted. A Markov model was constructed to predict health state transitions from time of ventilation through 28 days for the healthcare sector perspective and 1 year for the U.S. societal perspective. Value of information was calculated to determine whether parameter uncertainty warranted further research. RESULTS Our analysis suggested that CLRT beds dominate standard care from both perspectives. From the healthcare sector perspective, expected cost for CLRT was U.S. $47,165/patient compared with a higher cost of U.S. $49,258/patient for standard care. The expected effectiveness of CLRT is 0.0418 quality-adjusted life years/patient compared with 0.0416 quality-adjusted life years/patient for standard care. Continuous lateral rotation therapy dominated standard care in approximately 93% of Monte Carlo simulations from both perspectives. Value of information analysis suggests that additional research is potentially cost-effective. CONCLUSIONS Continuous lateral rotation therapy is highly cost-effective compared with standard care by preventing HACs that seriously harm patients in the intensive care unit.
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Affiliation(s)
- So-Yeon Kang
- From the Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael J DiStefano
- From the Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Farah Yehia
- From the Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Nanao T, Nishizawa H, Fujimoto J, Ogawa T. Additional medical costs associated with ventilator-associated pneumonia in an intensive care unit in Japan. Am J Infect Control 2021; 49:340-344. [PMID: 32721417 DOI: 10.1016/j.ajic.2020.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Additional health care costs associated with ventilator-associated pneumonia (VAP) vary widely per country; none of which have been explored in Japan. Thus, we aimed to examine the economic and clinical effects of VAP in Japan. METHODS This was a retrospective matched case-control study of 22 patients with VAP who were treated in the intensive care unit of Yokohama Rosai Hospital between January 2012 and December 2018. Twenty-two matched controls were selected based on 5 variables (ie, sex, age, diagnosis and surgical procedure, underlying disease with or without advanced malignant tumor, and best motor response). The additional health care costs incurred owing to VAP were calculated from the difference between the mean costs of VAP and control cases. RESULTS VAP incurred an additional cost of approximately United States Dollars (USD) 34,884 per case. The length of hospitalization itself was the major factor contributing to additional medical costs, generating a difference of 9,824 USD. DISCUSSION VAP not only worsens patient outcomes but also generates significant additional medical costs. Patients who had developed VAP required more medical resources such as the performance of a tracheostomy. CONCLUSIONS VAP incurs a higher mean total hospital medical cost. Thus, appropriate infection control strategies should be implemented.
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Affiliation(s)
- Taikan Nanao
- Department of Intensive Care Medicine, Yokohama Rosai Hospital, Yokohama, Japan; International University of Health and Welfare Graduate School of Public Health, Tokyo, Japan.
| | - Hideo Nishizawa
- Department of Intensive Care Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Junichi Fujimoto
- Department of Intensive Care Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Toshio Ogawa
- International University of Health and Welfare Graduate School of Public Health, Tokyo, Japan
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69
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Labarinas S, Coss-Bu JA, Onyearugbulem C, Heinle JS, Mallory GB, Gazzaneo MC. Influence of early extubation on post-operative outcomes after pediatric lung transplantation. Pediatr Transplant 2021; 25:e13776. [PMID: 32780552 DOI: 10.1111/petr.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/27/2022]
Abstract
Lung transplantation has become an accepted therapeutic option for a select group of children with end-stage lung disease. We evaluated the impact of early extubation in a pediatric lung transplant population and its post-operative outcomes. Single-center retrospective study. PICU within a tertiary academic pediatric hospital. Patients <22 years after pulmonary transplant between January 2011 and December 2016. A total of 74 patients underwent lung transplantation. The primary pretransplantation diagnoses included cystic fibrosis (58%), pulmonary fibrosis (9%), and surfactant dysfunction disorders (10%). Of 60 patients, 36 (60%) were extubated within 24 hours and 24 patients after 24 hours (40%). A total of seven patients (11.6%) required reintubation within 24 hours. Median length of stay for the early extubation group was shorter at 3 days ([(IQR) 2.2-4.7]) compared to 5 days (IQR, 3-7) (P = .02) in the late extubation group. Median costs were lower for the early extubation group with 13,833 US dollars (IQR, 9980-22,822) vs 23 671 US dollars (IQR, 16 673-39 267) (P = .043). Fourteen patients were in the PICU prior to their transplantation; this did not affect their early extubation success. Neither did the fact of requiring invasive or non-invasive mechanical ventilation before transplantation. Early extubation appears to be safe in a pediatric population after lung transplantation and is associated with a shorter LOS and decreased hospital costs. It may prevent known complications associated with mechanical ventilation.
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Affiliation(s)
- Sonia Labarinas
- Section of Critical Care Medicine, Department of Pediatrics, The University of Texas Health Science Center, Houston, TX, USA
| | - Jorge A Coss-Bu
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Chinyere Onyearugbulem
- Section of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Edinburg, TX, USA
| | - Jeffery S Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine, TX, USA
| | - George B Mallory
- Section of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Maria C Gazzaneo
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Section of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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70
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Hurley JC. Is selective decontamination (SDD/SOD) safe in the ICU context? J Antimicrob Chemother 2021; 74:1167-1172. [PMID: 30753529 DOI: 10.1093/jac/dky573] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Multiple individual studies of selective digestive decontamination/selective oropharyngeal decontamination (SDD/SOD) among ICU patients appear to show potent infection prevention effects. Surprisingly, the event rates for multiple endpoints including ventilator-associated pneumonia, bacteraemia and candidaemia among concurrent control groups within SDD/SOD studies appear unusually high versus other rates in the literature. These paradoxical observations raise concern that the contextual effects of SDD/SOD, as postulated in the original SDD/SOD study, not only exist but also are strong. Until these effects are addressed within an optimally designed study, the safety of SDD/SOD within the 'whole of ICU' remains questionable.
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Affiliation(s)
- James C Hurley
- Rural Health Academic Center, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Division of Internal Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
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71
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Araujo de Franca S, Tavares WM, Salinet ASM, Paiva WS, Teixeira MJ. Early tracheostomy in stroke patients: A meta-analysis and comparison with late tracheostomy. Clin Neurol Neurosurg 2021; 203:106554. [PMID: 33607581 DOI: 10.1016/j.clineuro.2021.106554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 01/22/2021] [Accepted: 02/06/2021] [Indexed: 11/17/2022]
Abstract
Tracheostomy (TQT) timing and its benefits is a current discussion in medical society. We aimed to compare the outcomes of early (ET) versus late tracheostomy (LT) in stroke patients with systematic review and meta-analysis, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Five hundred and nineteen studies were retrieved, whereas three were selected for the systematic review and meta-analysis. There were 5636 patients in the ET group (3151 male, 2470 female, 15 not reported - NR) and 7637 patients in the LT group (4098 male, 3542 female, and 33 NR). ET was significantly associated with fewer days in the hospital (weighted mean difference: -7.73 [95 % CI -8.59-6.86], p < 0.001) and reduced cases of ventilator-associated pneumonia (VAP) (risk difference: 0.71 [95 % CI 0.62-0.81], p < 0.001). There were no between-group statistical differences in intensive care unit stay duration, mechanical ventilation duration, or mortality. The findings from this meta-analysis cannot state that ET in severe stroke patients contributes to better outcomes when compared with LT. Scandalized assessments and randomized trials are encourage for better assessment.
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Affiliation(s)
- Sabrina Araujo de Franca
- Department of Research of IPSPAC, Instituto Paulista de Saúde para Alta Complexidade, 199 Padre Anchieta Avenue - Room 2, Jardim, Santo Andre, SP, 09090-710, Brazil.
| | - Wagner M Tavares
- Department of Research of IPSPAC, Instituto Paulista de Saúde para Alta Complexidade, 199 Padre Anchieta Avenue - Room 2, Jardim, Santo Andre, SP, 09090-710, Brazil; Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil.
| | - Angela S M Salinet
- Department of Research of IPSPAC, Instituto Paulista de Saúde para Alta Complexidade, 199 Padre Anchieta Avenue - Room 2, Jardim, Santo Andre, SP, 09090-710, Brazil; Division of Functional Neurosurgery, Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar Avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil.
| | - Wellingson S Paiva
- Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil.
| | - Manoel J Teixeira
- Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil.
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Zilberberg MD, Nathanson BH, Sulham K, Shorr AF. Multiple antimicrobial resistance and outcomes among hospitalized patients with complicated urinary tract infections in the US, 2013-2018: a retrospective cohort study. BMC Infect Dis 2021; 21:159. [PMID: 33557769 PMCID: PMC7869420 DOI: 10.1186/s12879-021-05842-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Complicated urinary tract infection (cUTI) is common among hospitalized patients. Though carbapenems are an effective treatment in the face of rising resistance, overuse drives carbapenem resistance (CR). We hypothesized that resistance to routinely used antimicrobials is common, and, despite frequent use of carbapenems, associated with an increased risk of inappropriate empiric treatment (IET), which in turn worsens clinical outcomes. Methods We conducted a retrospective cohort study of patients hospitalized with a culture-positive non-CR cUTI. Triple resistance (TR) was defined as resistance to > 3 of the following: 3rd generation cephalosporins, fluoroquinolones, trimethoprim-sulfamethoxazole, fosfomycin, and nitrofurantoin. Multivariable models quantified the impact of TR and inappropriate empiric therapy (IET) on mortality, hospital LOS, and costs. Results Among 23,331 patients with cUTI, 3040 (13.0%) had a TR pathogen. Compared to patients with non-TR, those with TR were more likely male (57.6% vs. 47.7%, p < 0.001), black (17.9% vs. 13.6%, p < 0.001), and in the South (46.3% vs. 41.5%, p < 0.001). Patients with TR had higher chronic (median [IQR] Charlson score 3 [2, 4] vs. 2 [1, 4], p < 0.001) and acute (mechanical ventilation 7.0% vs. 5.0%, p < 0.001; ICU admission 22.3% vs. 18.6%, p < 0.001) disease burden. Despite greater prevalence of empiric carbapenem exposure (43.3% vs. 16.2%, p < 0.001), patient with TR were also more likely to receive IET (19.6% vs. 5.4%, p < 0.001) than those with non-TR. Although mortality was similar between groups, TR added 0.38 (95% CI 0.18, 0.49) days to LOS, and $754 (95% CI $406, $1103) to hospital costs. Both TR and IET impacted the outcomes among cUTI patients whose UTI was not catheter-associated (CAUTI), but had no effect on outcomes in CAUTI. Conclusions TR occurs in 1 in 8 patients hospitalized with cUTI. It is associated with an increase in the risk of IET exposure, as well as a modest attributable prolongation of LOS and increase in total costs, particularly in the setting of non-CAUTI. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05842-0.
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Affiliation(s)
| | | | - Kate Sulham
- Spero Therapeutics, 675 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - Andrew F Shorr
- Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA
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73
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Yu XR, Xu N, Huang ST, Zhang QL, Wang ZC, Cao H, Chen Q. Effects of different oral care strategies on postoperative pneumonia in infants with mechanical ventilation after cardiac surgery: a prospective randomized controlled study. Transl Pediatr 2021; 10:359-365. [PMID: 33708522 PMCID: PMC7944187 DOI: 10.21037/tp-20-295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To explore the effects of different oral care strategies on postoperative pneumonia in infants with mechanical ventilation after cardiac surgery. METHODS A prospective randomized controlled study was conducted at a hospital in Fujian Province, China. Participants were randomly divided into the breast milk oral care group, physiological saline oral care group, and sodium bicarbonate oral care group to explore the effects of different oral care strategies on postoperative pneumonia in infants on mechanical ventilation cardiac surgery. RESULTS The mechanical ventilation duration, the hospitalization costs, and the length of intensive care unit (ICU) stay and postoperative hospital stay in the breast milk oral care group were significantly shorter than those in the physiological saline oral care group and the sodium bicarbonate oral care group. The incidence of postoperative pneumonia in the breast milk oral care group was 3.2%, which was significantly lower than that in the physiological saline oral care group (22.6%) and the sodium bicarbonate oral care group (19.4%). CONCLUSIONS Using breast milk for oral care in infants after cardiac surgery has a lower incidence of postoperative pneumonia than traditional oral care strategies of physiological saline and sodium bicarbonate, and it is worthy of clinical application.
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Affiliation(s)
- Xian-Rong Yu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Zeng-Chun Wang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Chin
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Chin
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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Abstract
BACKGROUND Tools to assist clinicians in predicting pneumonia could lead to a significant decline in morbidity. Therefore, we sought to develop a model in combat trauma patients for identifying those at highest risk of pneumonia. METHODS This was a retrospective study of 73 primarily blast-injured casualties with combat extremity wounds. Binary classification models for pneumonia prediction were developed with measurements of injury severity from the Abbreviated Injury Scale (AIS), transfusion blood products received before arrival at Walter Reed National Military Medical Center (WRNMMC), and serum protein levels. Predictive models were generated with leave-one-out-cross-validation using the variable selection method of backward elimination (BE) and the machine learning algorithms of random forests (RF) and logistic regression (LR). BE was attempted with two predictor sets: (1) all variables and (2) serum proteins alone. RESULTS Incidence of pneumonia was 12% (n = 9). Different variable sets were produced by BE when considering all variables and just serum proteins alone. BE selected the variables ISS, AIS chest, and cryoprecipitate within the first 24 h following injury for the first predictor set 1 and FGF-basic, IL-2R, and IL-6 for predictor set 2. Using both variable sets, a RF was generated with AUCs of 0.95 and 0.87-both higher than LR algorithms. CONCLUSION Advanced modeling allowed for the identification of clinical and biomarker data predictive of pneumonia in a cohort of predominantly blast-injured combat trauma patients. The generalizability of the models developed here will require an external validation dataset.
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Saseedharan S, Karanam R, Kadam V, Shirsekar S. Smart secretion management to protect nurses from COVID19 and other infectious diseases. Nurs Crit Care 2021; 27:706-710. [PMID: 33432704 PMCID: PMC8013287 DOI: 10.1111/nicc.12586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 01/10/2023]
Abstract
Background COVID‐19 has been linked to over 40 million infections and 1.1 million deaths in 210 countries as of October 19, 2020. This highly contagious communicable disease has put not only infected individuals but other patients and frontline workers like nurses at risk in hospitals, especially in Intensive Care units (ICUs). There is a need for minimizing patient contact, improving hand hygiene practices, and optimizing healthcare provider time, especially nurses. Globally it is estimated that nearly a million health care providers have been infected with COVID‐19 as of the end of October 2020. Methods This retrospective service evaluation documents the experience of health care providers in a COVID‐19 ICU in India that was used to implement new protocols for secretion management and oral hygiene. Patient chart information and staff feedback were utilized. Intervention This pilot study captures the practical benefits of using VAPCare, an automated, closed‐loop system for oral secretion removal. Results Six patients were included in this small‐scale study; three patients following the current standard of care for suctioning and oral hygiene and three receiving the new VAPCare and Lumen device protocol. With the new device protocol, the number of infected secretion interactions by a nurse was 50% lower, and nursing time spent on oral hygiene and secretion management 70% less than seen with the current standard of care. The number of disposable gloves used with VAPCare and Lumen was reduced by over 50%. All 10 nurses and six doctors gave positive feedback on device usage. The department recommended updating protocols to prioritize the use of the new secretion management system for patients with COVID19 and other highly contagious conditions. Conclusion The findings are an early indication that using VAPCare for patients could help protect infected patients, other ICU patients, and health care workers.
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Affiliation(s)
- Sanjith Saseedharan
- Head of Department of Critical Care, S L Raheja Hospital, Mumbai, Maharashtra, India
| | - Roopa Karanam
- Consultant of Department of Critical Care, S L Raheja Hospital, Mumbai, Maharashtra, India
| | - Vaijayanti Kadam
- Consultant of Department of Critical Care, S L Raheja Hospital, Mumbai, Maharashtra, India
| | - Suvarna Shirsekar
- Registered Nurse of Department of Critical Care, S L Raheja Hospital, Mumbai, Maharashtra, India
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Degroote T, Jaillette E, Reignier J, Zerimech F, Girault C, Brunin G, Chiche A, Lacherade JC, Mira JP, Maboudou P, Balduyck M, Nseir S. Is COPD associated with increased risk for microaspiration in intubated critically ill patients? Ann Intensive Care 2021; 11:7. [PMID: 33428002 PMCID: PMC7798009 DOI: 10.1186/s13613-020-00794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although COPD patients are at higher risk for aspiration when breathing spontaneously, no information is available on the risk for microaspiration in invasively ventilated COPD patients. The aim of our study was to determine the relationship between COPD and abundant microaspiration in intubated critically ill patients. Methods This was a retrospective analysis of prospectively collected data, provided by 3 randomized controlled trials on microaspiration in critically ill patients receiving invasive mechanical ventilation for more than 48 h. Abundant microaspiration was defined as the presence of pepsin and or alpha-amylase at significant levels in tracheal aspirates. In all study patients, pepsin and alpha-amylase were quantitatively measured in all tracheal aspirates collected during a 48-h period. COPD was defined using spirometry criteria. Results Among the 515 included patients, 70 (14%) had proven COPD. Pepsin and alpha-amylase were quantitatively measured in 3873 and 3764 tracheal aspirates, respectively. No significant difference was found in abundant microaspiration rate between COPD and non-COPD patients (62 of 70 patients (89%) vs 366 of 445 (82%) patients, p = 0.25). Similarly, no significant difference was found in abundant microaspiration of gastric contents (53% vs 45%, p = 0.28), oropharyngeal secretions (71% vs 71%, p = 0.99), or VAP (19% vs 22%, p = 0.65) rates between the two groups. No significant difference was found between COPD and non-COPD patients in duration of mechanical ventilation, ICU length of stay, or ICU mortality. Conclusions Our results suggest that COPD is not associated with increased risk for abundant microaspiration in intubated critically ill patients.
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Affiliation(s)
- Thècle Degroote
- Service de Médecine Intensive et Réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | | | - Jean Reignier
- Medecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - Farid Zerimech
- Centre de Biologie Et de Pathologie, CHU Lille, 59000, Lille, France
| | - Christophe Girault
- Normandie Univ, UNIROUEN, EA 3830, Rouen University Hospital, Medical Intensive Care Unit, 76000, Rouen, France
| | - Guillaume Brunin
- Intensive Care Unit, Boulogne Sur Mer Hospital, Boulogne-sur-Mer, France
| | - Arnaud Chiche
- Intensive Care Unit, Tourcoing Hospital, Tourcoing, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de La Vendée, La Roche sur Yon, France
| | - Jean-Paul Mira
- Groupe Hospitalier Paris Centre-Université de Paris, Cochin University Hospital, Medical Intensive Care Unit, Paris, France
| | - Patrice Maboudou
- Centre de Biologie Et de Pathologie, CHU Lille, 59000, Lille, France
| | - Malika Balduyck
- Centre de Biologie Et de Pathologie, CHU Lille, 59000, Lille, France
| | - Saad Nseir
- Critical Care Center, CHU Lille, 59000, Lille, France. .,INSERM U995, Lille Inflammation Research International Center E2, Lille University, Lille, France.
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Teimoori F, Haghighat A, Mohammadi I, Tahani B. Knowledge, attitude, and expertise of nurses in intensive care unit regarding oral and dental care in hospitalized patients. Dent Res J (Isfahan) 2021. [DOI: 10.4103/1735-3327.328751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shaikh F, Janaapureddy YR, Mohanty S, Reddy PK, Sachane K, Dekate PS, Yerra A, Chirla D. Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES). Indian J Crit Care Med 2021; 25:181-184. [PMID: 33707897 PMCID: PMC7922465 DOI: 10.5005/jp-journals-10071-23737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To study if protocolized monitoring of endotracheal tube (ETT) cuff pressure every 6 hours is better than adjusting endotracheal tube cuff inflation by the only bedside clinical assessment. Materials and methods This was a single-center prospective randomized controlled study done between July 1, 2017 and March 31, 2019. Children between 1 month and 18 years, intubated with cuffed ETT by our trained doctors were included. After obtaining consent, patients were randomized into two groups, standard group (SG) and cuff pressure monitoring group (MG). Sample size was calculated with 80 patients in each group with a power of 80%, significance level (alpha 0.05 and beta 0.2). In the SG, ETT cuff inflation was adjusted by clinical assessment (bedside minimal leak technique and monitoring the percentage of leak displayed on ventilator display) at 6 hours interval. In the MG, cuff pressures were monitored by the device every 6 hours to maintain between 20 and 25 mm Hg. Results Out of 543 mechanically ventilated children during the study period, 266 were eligible and randomized for study. During the study, 89 patients died and 17 were left against medical advice, leaving 80 patients in each group. Incidence of post-extubation stridor (PES), re-intubation rate, ventilator-associated pneumonia (VAP) rate, ventilator days, and length of pediatric intensive care unit (PICU) stay were analyzed and found no advantage of protocolized monitoring of cuff pressures in the reduction of any of the above variables. Conclusion Our findings if confirmed by large multicentric studies can bring an end to routine ETT cuff pressure measurements and emphasize more on clinical assessment. Clinical trial registry (CTRI/2019/05/019098). Indian Journal of Critical Care Medicine (2021): 10.5005/jp-journals-10071-23737 How to cite this article Shaikh F, Janaapureddy YR, Mohanty S, Reddy PK, Sachane K, Dekate PS, et al. Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES). Indian J Crit Care Med 2021;25(2):181–184.
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Affiliation(s)
- Farhan Shaikh
- Department of Pediatric Intensive Care Unit, Rainbow Children' s Hospital, Hyderabad, Telangana, India
| | - Yeshwanth R Janaapureddy
- Department of Pediatric Intensive Care Unit, Rainbow Children' s Hospital, Hyderabad, Telangana, India
| | - Shashwat Mohanty
- Department of Pediatric Intensive Care Unit, Rainbow Children' s Hospital, Hyderabad, Telangana, India
| | - Preetham K Reddy
- Department of Pediatric Intensive Care Unit, Rainbow Children' s Hospital, Hyderabad, Telangana, India
| | - Kapil Sachane
- Department of Pediatric Intensive Care Unit, Rainbow Children' s Hospital, Hyderabad, Telangana, India
| | - Parag S Dekate
- Department of Pediatric Intensive Care Unit, Rainbow Children' s Hospital, Hyderabad, Telangana, India
| | - Anupama Yerra
- Department of Pediatric Intensive Care Unit, Rainbow Children' s Hospital, Hyderabad, Telangana, India
| | - Dinesh Chirla
- Department of Pediatric Intensive Care Unit, Rainbow Children' s Hospital, Hyderabad, Telangana, India
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Jutras C, Autmizguine J, Chomton M, Marquis C, Nguyen TTD, Roumeliotis N, Emeriaud G. Inhaled Antibiotics for the Prevention of Respiratory Tract Infections in Children With a Tracheostomy. Front Pediatr 2021; 9:633039. [PMID: 33614559 PMCID: PMC7893104 DOI: 10.3389/fped.2021.633039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: To describe the use of prophylactic inhaled antibiotics in children with a tracheostomy and assess if its use is associated with a reduction in exposition to broad-spectrum antibiotics and a lower risk of acquired respiratory tract infections. Methods: A case series study was performed in a tertiary care university affiliated hospital. All consecutive children (<18 years old) with a tracheostomy, hospitalized between January 2004 and November 2016, and treated with prophylactic inhaled antibiotics were identified. We analyzed the 3 month- period before and after initiation of prophylactic inhaled antibiotics and described exposure to broad spectrum antibiotics, the number of respiratory tract infections and the associated adverse events. Results: Six children (median age: 11 months, range: 8-100) were included. One received colimycin, 3 received tobramycin and 2 were treated with both antibiotics in alternance. The median duration of treatment was 74 days (22-173) with one patient still being treated at the end of the study. Patients were exposed to systemic antibiotics for 18 days (2-49) in the 3 months preceding the treatment vs. 2 days (0-15) in the 3 months following the treatment initiation (p = 0.115). The number of respiratory tract infections went from median of 2 (0-3) to 1 (0-1) during the same periods (p = 0.07). Adverse events most commonly reported were cough (n = 2) and increased respiratory secretions post-inhalation (n = 4). Only one new bacterial resistance was observed. Conclusions: This series of consecutive cases underlines the need for future studies evaluating the potential benefit of prophylactic inhaled antibiotics in children with a tracheostomy.
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Affiliation(s)
- Camille Jutras
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - Julie Autmizguine
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montréal, QC, Canada.,Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Maryline Chomton
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - Christopher Marquis
- Department of Pharmacy, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - The Thanh-Diem Nguyen
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada.,Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Nadia Roumeliotis
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - Guillaume Emeriaud
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada.,Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
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El Fawy DM, Ibrahim AY, Abdulmageed AMM, El Seddek EAB. A comparative study between effect of combined intravenous and nebulized amikacin versus intravenous amikacin alone in mechanically ventilated patients with ventilator-associated pneumonia (VAP). AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2020. [PMCID: PMC7538850 DOI: 10.1186/s42077-020-00098-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Aerosolized antibiotic administration offers the theoretical advantages of achieving high drug concentrations at the infection site together with lower systemic absorption. This study aims to compare the effect of combining nebulized amikacin with intravenous amikacin to the effect of the usual intravenous route alone in the treatment of patients with ventilator-associated pneumonia and its impact on the duration of mechanical ventilation, laboratory, and clinical picture of the patients.
Results
This study was carried out on 64 mechanically ventilated patients with Gram-negative VAP. The patients were divided into 2 groups. Group A included 32 patients treated with nebulized amikacin plus IV amikacin, and group B included 32 patients treated with IV amikacin alone. The duration of treatment for both groups was 8 days with a daily assessment of Clinical Pulmonary Infection Score (CPIS) and monitoring of clinical and laboratory parameters. Sputum cultures were obtained thereafter. In our study, the CPIS score and overall ICU mortality were less in the nebulized than in the IV group but the difference failed to be statistically significant. Increase of oxygenation level (Pao2/Fio2 ratio), organism clearance, decrease in serum creatinine level, duration of mechanical ventilation, and length of ICU stay were significantly different in favor of group A than group B.
Conclusion
Nebulized and IV amikacin offered better oxygenation, organism clearance, less nephrotoxicity, and less duration of mechanical ventilation and ICU stay than the IV group. Combined and IV routes were comparable regarding the decrease in CPIS score and ICU mortality with no significant difference between them. However, we prefer to use the combined regimen for the mentioned reasons. Further large-scale studies are required to confirm these findings and to establish a definite conclusion.
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Davis MD, Winters BR, Madden MC, Pleil JD, Sessler CN, Wallace MAG, Ward-Caviness CK, Montpetit AJ. Exhaled breath condensate biomarkers in critically ill, mechanically ventilated patients. J Breath Res 2020; 15:016011. [DOI: 10.1088/1752-7163/abc235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Neuschwander A, Chhor V, Yavchitz A, Resche-Rigon M, Pirracchio R. Automated weaning from mechanical ventilation: Results of a Bayesian network meta-analysis. J Crit Care 2020; 61:191-198. [PMID: 33181416 DOI: 10.1016/j.jcrc.2020.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Mechanical ventilation (MV) weaning is a crucial step. Automated weaning modes reduce MV duration but the question of the best automated mode remains unanswered. Our objective was to compare the major automated modes for MV weaning in critically ill and post-operative adult patients. MATERIAL AND METHODS We conducted a network Bayesian meta-analysis to compare different automated modes. We searched MEDLINE, EMBASE and Cochrane central registry for randomized control trials comparing automated weaning modes either to another automated mode or to standard-of-care. The primary outcome was the duration of MV weaning extracted from the original trials. RESULTS 663 articles were screened and 26 trials (2097patients) were included in the final analysis. All automated modes included in the study (ASV°, Intellivent ASV, Smartcare, Automode°, PAV° and MRV°) outperformed standard-of-care but no automated mode reduced the duration of mechanical ventilation weaning as compared to others in the network meta-analysis. CONCLUSION Compared to standard weaning practice, all automated modes significantly reduced the duration of MV weaning in critically ill and post-operative adult patients. When cross-compared using a network meta-analysis, no specific mode was different in reducing the duration of MV weaning. The study was registered in PROSPERO (CRD42015024742).
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Affiliation(s)
- Arthur Neuschwander
- Service d'Anesthésie Réanimation, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Vibol Chhor
- Service d'Anesthésie Réanimation, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Amélie Yavchitz
- Service d'Anesthésie Réanimation, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Matthieu Resche-Rigon
- Service de Biostatistiques et Information Médicale, Hôpital Saint Louis, Unité INSERM UMR-1153, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Romain Pirracchio
- Service d'Anesthésie Réanimation, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Anesthesia and Perioperative Medicine, San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA.
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Collins T, Plowright C, Gibson V, Stayt L, Clarke S, Caisley J, Watkins CH, Hodges E, Leaver G, Leyland S, McCready P, Millin S, Platten J, Scallon M, Tipene P, Wilcox G. British Association of Critical Care Nurses: Evidence-based consensus paper for oral care within adult critical care units. Nurs Crit Care 2020; 26:224-233. [PMID: 33124119 DOI: 10.1111/nicc.12570] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection. AIM To provide an evidence-based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically ill patients. DESIGN A nominal group technique was adopted. A consensus committee of adult critical care nursing experts from the United Kingdom met in 2018 to evaluate and review the literature relating to oral care, its application in reducing pneumonia in critically ill adults and to make recommendations for practice. An elected national board member for the British Association of Critical Care Nurses chaired the round table discussion. METHODS The committee focused on 5 aspects of oral care practice relating to critically ill adult patients. The evidence was evaluated for each practice within the context of reducing pneumonia in the mechanically ventilated patient or pneumonia in the non-ventilated patient. The five practices included the frequency for oral care; tools for oral care; oral care technique; solutions used and oral care in the non-ventilated patient who is critically ill and is at risk of aspiration. The group searched the best available evidence and evaluated this using the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence from high to very low, and to formulate recommendations as strong, moderate, weak, or best practice consensus statement when applicable. RESULTS The consensus group generated recommendations, delineating an approach to best practice for oral care in critically ill adult patients. Recommendations included guidance for frequency and procedure for oral assessment, toothbrushing, and moisturising the mouth. Evidence on the use of chlorhexidine is not consistent and caution is advised with its routine use. CONCLUSION Oral care is an important part of the care of critically ill patients, both ventilated and non-ventilated. An effective oral care programme reduces the incidence of pneumonia and promotes patient comfort. RELEVANCE TO CLINICAL PRACTICE Effective oral care is integral to safe patient care in critical care.
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Affiliation(s)
| | | | | | | | - Sarah Clarke
- Acute Care Team, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jo Caisley
- Princess Mary's Royal Air Force Nursing Service, UK
| | - Claire Harcourt Watkins
- Intensive Care, Glangwili General Hospital, Hywel Dda University Health Board, Haverfordwest, UK
| | - Emily Hodges
- The Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK
| | - Gillian Leaver
- Thames Valley and Wessex Operational Delivery Network, UK
| | - Sarah Leyland
- Clinical Placements, St Georges University Hospitals NHS Foundation Trust, UK
| | | | | | - Julie Platten
- North of England Critical Care Network, North Shields, UK
| | | | - Patsy Tipene
- The Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK
| | - Gabby Wilcox
- Swansea Bay University Health Board, Morriston Hospital, Swansea, UK
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Candida- Acinetobacter-Pseudomonas Interaction Modelled within 286 ICU Infection Prevention Studies. J Fungi (Basel) 2020; 6:jof6040252. [PMID: 33121074 PMCID: PMC7712580 DOI: 10.3390/jof6040252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Whether Candida interacts to enhance the invasive potential of Acinetobacter and Pseudomonas bacteria cannot be resolved within individual studies. There are several anti-septic, antibiotic, anti-fungal, and non-decontamination-based interventions to prevent ICU acquired infection. These effective prevention interventions would be expected to variably impact Candida colonization. The collective observations within control and intervention groups from numerous ICU infection prevention studies simulates a multi-centre natural experiment with which to evaluate Candida, Acinetobacter and Pseudomonas interaction (CAPI). METHODS Eight Candidate-generalized structural equation models (GSEM), with Candida, Pseudomonas and Acinetobacter colonization as latent variables, were confronted with blood culture and respiratory tract isolate data derived from >400 groups derived from 286 infection prevention studies. RESULTS Introducing an interaction term between Candida colonization and each of Pseudomonas and Acinetobacter colonization improved model fit in each case. The size of the coefficients (and 95% confidence intervals) for these interaction terms in the optimal Pseudomonas (+0.33; 0.22 to 0.45) and Acinetobacter models (+0.32; 0.01 to 0.5) were similar to each other and similar in magnitude, but contrary in direction, to the coefficient for exposure to topical antibiotic prophylaxis (TAP) on Pseudomonas colonization (-0.45; -0.71 to -0.2). The coefficient for exposure to topical antibiotic prophylaxis on Acinetobacter colonization was not significant. CONCLUSIONS GSEM modelling of published ICU infection prevention data supports the CAPI concept. The CAPI model could account for some paradoxically high Acinetobacter and Pseudomonas infection incidences, most apparent among the concurrent control groups of TAP studies.
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Howatt M, Klompas M, Kalil AC, Metersky ML, Muscedere J. Carbapenem Antibiotics for the Empiric Treatment of Nosocomial Pneumonia: A Systematic Review and Meta-analysis. Chest 2020; 159:1041-1054. [PMID: 33393468 DOI: 10.1016/j.chest.2020.10.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 09/21/2020] [Accepted: 10/16/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Previous meta-analyses suggested that treating hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP), with empiric carbapenems was associated with lower mortality rates but higher rates of clinical failure for pseudomonal pneumonia. This study was an updated meta-analysis with sensitivity analyses and meta-regression to better understand the impact of carbapenem use in HAP/VAP. RESEARCH QUESTION What is the efficacy of carbapenems for empiric treatment of nosocomial pneumonia? STUDY DESIGN AND METHODS Databases were searched for randomized controlled studies evaluating empiric treatment for HAP and/or VAP, and studies were included comparing carbapenem- vs non-carbapenem-containing regimens. The primary outcome was all-cause mortality. Secondary outcomes included subgroup stratification and resistance development. RESULTS Of 9,140 references, 20 trials enrolling 5,489 patients met inclusion criteria. For mortality, carbapenem use had a risk ratio (RR) of 0.84 (95% CI, 0.74-0.96; P = .01). Stratified according to VAP proportion (< 33%, 33%-66%, and > 66%), RRs were 0.95 (95% CI, 0.77-1.17; P = .66), 0.78 (95% CI, 0.57-1.07; P = .13), and 0.81 (95% CI, 0.65-0.99; P = .04), respectively. Stratified according to severity, only groups with Acute Physiology and Chronic Health Evaluation II scores < 14 and between 14 and 17 showed mortality benefit (RRs of 0.64 [95% CI, 0.45-0.92; P = .01] and 0.77 [95% CI, 0.61-0.97; P = .03]). Meta-regression did not show an association between Pseudomonas prevalence and mortality (P = .44). Carbapenem use showed a trend toward developing resistance (RR, 1.40; 95% CI, 0.95-2.06; P = .09) and a 96% probability of resistance emergence. INTERPRETATION Carbapenem-based empiric regimens were associated with lower mortality rates compared with non-carbapenems, largely driven by trials of VAP. The mortality effect was not observed in trials with high disease severity and was not associated with Pseudomonas. The mortality difference was observed mainly in studies that used ceftazidime as control. There was a trend toward increasing resistance associated with carbapenems. TRIAL REGISTRY International Prospective Register of Systematic Reviews; No. CRD42018093602; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Mackenzie Howatt
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Andre C Kalil
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
| | - Mark L Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, CT
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
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Bhavnani SM, Hammel JP, Lakota EA, Safir MC, VanScoy BD, Nagira Y, Rubino CM, Sato N, Koresawa T, Kondo K, Ambrose PG. Pharmacokinetic-Pharmacodynamic Target Attainment Analyses To Support Dose Selection for ME1100, an Arbekacin Inhalation Solution. Antimicrob Agents Chemother 2020; 64:e02367-19. [PMID: 32661000 PMCID: PMC7508573 DOI: 10.1128/aac.02367-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/03/2020] [Indexed: 11/20/2022] Open
Abstract
ME1100 (arbekacin inhalation solution) is an inhaled aminoglycoside that is being developed to treat patients with hospital-acquired and ventilator-associated bacterial pneumonia (HABP and VABP, respectively). Pharmacokinetic-pharmacodynamic (PK-PD) target attainment analyses were undertaken to evaluate ME1100 regimens for the treatment of patients with HABP/VABP. The data used included a population pharmacokinetic (PPK) 4-compartment model with 1st-order elimination, nonclinical PK-PD targets from one-compartment in vitro and/or in vivo infection models, and in vitro surveillance data. Using the PPK model, total-drug epithelial lining fluid (ELF) concentration-time profiles were generated for simulated patients with varying creatinine clearance (CLcr) (ml/min/1.73 m2) values. Percent probabilities of PK-PD target attainment by MIC were determined based on the ratio of total-drug ELF area under the concentration-time curve (AUC) to MIC (AUC/MIC ratio) targets associated with 1- and 2-log10 CFU reductions from baseline for Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus Percent probabilities of PK-PD target attainment based on PK-PD targets for a 1-log10 CFU reduction from baseline at MIC values above the MIC90 value for K. pneumoniae (8 μg/ml), P. aeruginosa (4 μg/ml), and S. aureus (0.5 μg/ml) were ≥99.8% for ME1100 600 mg twice daily (BID) in simulated patients with CLcr values >80 to ≤120 ml/min/1.73 m2 ME1100 600 mg BID, 450 mg BID, and 600 mg once daily in simulated patients with CLcr values >50 to ≤80, >30 to ≤50, and 0 to ≤30 ml/min/1.73 m2, respectively, provided arbekacin exposures that best matched those for 600 mg BID in simulated patients with normal renal function. These data provide support for ME1100 as a treatment for patients with HABP/VABP.
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Affiliation(s)
- Sujata M Bhavnani
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
| | - Jeffrey P Hammel
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
| | - Elizabeth A Lakota
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
| | - M Courtney Safir
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
| | - Brian D VanScoy
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
| | - Yu Nagira
- Meiji Seika Pharma Co., Ltd., Tokyo, Japan
| | | | - Nobuo Sato
- Meiji Seika Pharma Co., Ltd., Tokyo, Japan
| | | | | | - Paul G Ambrose
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
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88
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Wagner AP, Enne VI, Livermore DM, Craig JV, Turner DA. Review of health economic models exploring and evaluating treatment and management of hospital-acquired pneumonia and ventilator-associated pneumonia. J Hosp Infect 2020; 106:745-756. [PMID: 32971194 DOI: 10.1016/j.jhin.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 09/08/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hospital-acquired pneumonia (HAP) is pneumonia that occurs ≥48 h after hospital admission; it is the most common hospital-acquired infection contributing to death. Ventilator-associated pneumonia (VAP) arises ≥48-72 h after intubation. Opinions differ on whether VAP is a subset of HAP; the same pathogens predominate in both. Compared with VAP-free controls, patients developing VAP are twice as likely to die and have significantly longer stays in intensive care units. Guidelines recommend that microbiological cultures should guide antibiotic treatment, but these lack sensitivity and take 48-72 h to process, meaning that initial therapy must be empiric, generally with broad-spectrum agents. Given increasing pressure to improve both antibiotic stewardship and patient outcomes, the National Institute for Health and Care Excellence and the Infectious Diseases Society of America recommend research into rapid molecular diagnostic tests to identify causative organisms and their antibiotic resistances. Ideally, these would supersede culture, being quicker and more sensitive. In the UK, the INHALE research programme, funded by the National Institute for Health Research, is exploring rapid molecular diagnostics to inform treatment of HAP/VAP and, given resource implications, incorporates a health economic component. AIM To identify previous economic modelling of HAP/VAP costs to inform this component. METHODS Literature review of HAP/VAP studies with economic modelling identified from three databases. FINDINGS Twenty studies were identified. Only one study specifically evaluated strategies to improve diagnosis; the remaining 19 studies omitted this important aspect. CONCLUSION HAP/VAP modelling would be improved by better awareness of long-term outcomes and treatment complexity. To the authors' knowledge, no similar literature reviews of economic modelling for HAP/VAP have been published.
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Affiliation(s)
- A P Wagner
- Norwich Medical School, University of East Anglia, Norwich, UK; National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK.
| | - V I Enne
- University College London, London, UK
| | - D M Livermore
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J V Craig
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - D A Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
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Effects of hospital-acquired pneumonia on long-term recovery and hospital resource utilization following moderate to severe traumatic brain injury. J Trauma Acute Care Surg 2020; 88:491-500. [PMID: 31804412 DOI: 10.1097/ta.0000000000002562] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Individuals with traumatic brain injury (TBI) have extended inpatient hospital stays that include prolonged mechanical ventilation, increasing risk for infections, including pneumonia. Studies show the negative short-term effects of hospital-acquired pneumonia (HAP) on hospital-based outcomes; however, little is known of its long-term effects. METHODS A prospective cohort study was conducted. National Trauma Databank and Traumatic Brain Injury Model Systems were merged to derive a cohort of 3,717 adults with moderate-to-severe TBI. Exposure data were gathered from the National Trauma Databank, and outcomes were gathered from the Traumatic Brain Injury Model Systems. The primary outcome was the Glasgow Outcome Scale-Extended (GOS-E), which was collected at 1, 2, and 5 years postinjury. The GOS-E was categorized as favorable (>5) or unfavorable (≤5) outcomes. A generalized estimating equation model was fitted estimating the effects of HAP on GOS-E over the first 5 years post-TBI, adjusting for age, race, ventilation status, brain injury severity, injury severity score, thoracic Abbreviated Injury Scale score of 3 or greater, mechanism of injury, intraventricular hemorrhage, and subarachnoid hemorrhage. RESULTS Individuals with HAP had a 34% (odds ratio, 1.34; 95% confidence interval, 1.15-1.56) increased odds for unfavorable GOS-E over the first 5 years post-TBI compared with individuals without HAP, after adjustment for covariates. There was a significant interaction between HAP and follow-up, such that the effect of HAP on GOS-E declined over time. Sensitivity analyses that weighted for nonresponse bias and adjusted for differences across trauma facilities did not appreciably change the results. Individuals with HAP spent 10.1 days longer in acute care and 4.8 days longer in inpatient rehabilitation and had less efficient functional improvement during inpatient rehabilitation. CONCLUSION Individuals with HAP during acute hospitalization have worse long-term prognosis and greater hospital resource utilization. Preventing HAP may be cost-effective and improve long-term recovery for individuals with TBI. Future studies should compare the effectiveness of different prophylaxis methods to prevent HAP. LEVEL OF EVIDENCE Prospective cohort study, level III.
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Allahbakhhsian A, Gholizadeh L, Allahbakhshian M, Sarbakhsh P, Abbaszadeh Y. The effects of foot reflexology on agitation and extubation time in male patients following coronary artery bypass surgery: A randomized controlled clinical trial. Complement Ther Clin Pract 2020; 40:101201. [DOI: 10.1016/j.ctcp.2020.101201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/22/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
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Nusrat T, Akter N, Rahman NAA, Godman B, D Rozario DT, Haque M. Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh. Hosp Pract (1995) 2020; 48:128-136. [PMID: 32271642 DOI: 10.1080/21548331.2020.1754687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), accounting for 25% of all ICU infections. Antimicrobial resistance is increasing and becoming a significant health problem worldwide, increasing hospital length of stay, mortality and costs. Identifying antibiotic resistance patterns in VAP is important as this can cause outbreaks in ICUs. To date, there have been limited studies assessing this in Bangladesh. Consequently, the primary objective of this research was to study the species of bacterial growth and to determine the antibiotic resistance patterns of Metallo-β-Lactamase (MBL) producing gram-negative bacilli among ICU patients with VAP in a public medical school hospital, Bangladesh. In addition, identify the factors associated with a positive culture to provide future guidance. METHOD Cross-sectional study performed in the Chattogram Medical College Hospital, Bangladesh. Mueller Hinton agar plates were used for antibiotic sensitivity testing by the Kirby-Buer disc diffusion test. RESULTS Among 105 clinically suspected VAP cases, qualitative cultures were positive in 95 (90%) of them. The most common bacteria identified were Acinetobacter spp. (43.2%), Klebsiella spp. (20%) and Pseudomonas spp. (18.9%). A positive culture was not associated with patients' age or gender. Among 41 isolated Acinetobacter spp., 38 (92.7%) were resistant to gentamicin followed by 36 (87.8%) to ceftriaxone. Among 24 isolated Klebsiella spp., 22 (83.3%) were resistant to ceftriaxone. Among 18 isolated Pseudomonas spp., 16 (88.8%) were resistant to ciprofloxacin, and 13 (72.2%) were resistant to ceftriaxone. Among nine isolated E. coli, all were resistant to ceftriaxone and ciprofloxacin. All four Proteus spp. (100%) isolated were resistant to ciprofloxacin. Additionally, phenotype MBL producing was 65.22% and genotype was 45.65% among imipenem resistant pathogens. Imipenem resistant pathogens were sensitive to amoxyclav, amikacin¸ azithromycin, ceftazidime, ceftriaxone, colistin and gentamycin. CONCLUSION A positive culture was detected in 90% of VAP patients, but it was not associated with the patients' age and gender. The most common bacteria identified were Acinetobacter spp., Klebsiella spp. and Pseudomonas spp., where the majority of these were resistant to ceftriaxone. The results are being used to provide future guidance on the empiric management of VAP in this hospital.
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Affiliation(s)
- Tanzina Nusrat
- Department of Microbiology, Chittagong Medical College , Panchlaish, Chattogram, Bangladesh
| | - Nasima Akter
- Department of Microbiology, Chittagong Medical College , Panchlaish, Chattogram, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia , Bandar Indera Mahkota, Kuantan, Malaysia
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow, UK
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University , Pretoria, South Africa
- Health Economics Centre, University of Liverpool , Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | | | - Mainul Haque
- Faculty of Medicine and Defense Health, Universiti Pertahanan Nasional Malaysia (National Defense University of Malaysia) , Kem Sungai Besi, Kuala Lumpur, Malaysia
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Pradhan S, Shrestha PS, Shrestha GS, Marhatta MN. Clinical impact of lung ultrasound monitoring for diagnosis of ventilator associated pneumonia: A diagnostic randomized controlled trial. J Crit Care 2020; 58:65-71. [DOI: 10.1016/j.jcrc.2020.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 11/26/2022]
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Lau VI, Cook DJ, Fowler R, Rochwerg B, Johnstone J, Lauzier F, Marshall JC, Basmaji J, Heels-Ansdell D, Thabane L, Xie F. Economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (E-PROSPECT): study protocol. BMJ Open 2020; 10:e036047. [PMID: 32595159 PMCID: PMC7322334 DOI: 10.1136/bmjopen-2019-036047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the intensive care unit (ICU). Probiotics are defined as live microorganisms that may confer health benefits when ingested. Prior randomised trials suggest that probiotics may prevent infections such as VAP and Clostridioides difficile-associated diarrhoea (CDAD). PROSPECT (Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial) is a multicentre, double-blinded, randomised controlled trial comparing the efficacy of the probiotic Lactobacillus rhamnosus GG with usual care versus usual care without probiotics in preventing VAP and other clinically important outcomes in critically ill patients admitted to the ICU. METHODS AND ANALYSIS The objective of E-PROSPECT is to determine the incremental cost-effectiveness of L. rhamnosus GG plus usual care versus usual care without probiotics in critically ill patients. E-PROSPECT will be performed from the public healthcare payer's perspective over a time horizon from ICU admission to hospital discharge.We will determine probabilities of in-ICU and in-hospital events from all patients alongside PROSPECT. We will retrieve unit costs for each resource use item using jurisdiction-specific public databases, supplemented by individual site unit costs if such databases are unavailable. Direct costs will include medications, personnel costs, radiology/laboratory testing, operative/non-operative procedures and per-day hospital 'hoteling' costs not otherwise encompassed. The primary outcome is the incremental cost per VAP prevented between the two treatment groups. Other clinical events such as CDAD, antibiotic-associated diarrhoea and in-hospital mortality will be included as secondary outcomes. We will perform pre-specified subgroup analyses (medical/surgical/trauma; age; frailty status; antibiotic use; prevalent vs no prevalent pneumonia) and probabilistic sensitivity analyses for VAP, then generate confidence intervals using the non-parametric bootstrapping approach. ETHICS AND DISSEMINATION Study approval for E-PROSPECT was granted by the Hamilton Integrated Research Ethics Board of McMaster University on 29 July 2019. Informed consent was obtained from the patient or substitute decision-maker in PROSPECT. The findings of this study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT01782755; Pre-results.
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Affiliation(s)
- Vincent Issac Lau
- Department of Critical Care, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Robert Fowler
- Sunnybrook Health Sciences Institute, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Jennie Johnstone
- Public Health Ontario, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - John C Marshall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John Basmaji
- Department of Medicine, Division of Critical Care, Western University, London, Ontario, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Analysis of oral risk factors for ventilator-associated pneumonia in critically ill patients. Clin Oral Investig 2020; 25:1217-1222. [PMID: 32594308 PMCID: PMC7320842 DOI: 10.1007/s00784-020-03426-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
Objective This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and methods Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results At oral physical examination, the most frequent findings were tooth loss (568–85.67%), coated tongue (422–63.65%) and oral bleeding (192–28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14 vs 13.69%, p = 0.02; 23.44 vs 15.50%, p = 0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development (OR = 1.61 (1.03–2.51) and OR = 1.69 (1.08–2.66), respectively). Conclusions The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance The results of this paper reinforce the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU.
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Association between sepsis at ICU admission and mortality in patients with ICU-acquired pneumonia: An infectious second-hit model. J Crit Care 2020; 59:207-214. [PMID: 32717592 DOI: 10.1016/j.jcrc.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE We explore the hypothesis that critically ill patients developing ICU-acquired pneumonia (ICU-AP) have worse outcomes and an altered inflammatory response if their ICU admission was sepsis-related. METHODS Prospective cohort study in two centers. Patients with ICU-AP were evaluated according to their previous exposure to sepsis at ICU-admission. Demographic variables, comorbidities, severity scores at admission and at the time of acquisition of ICU-AP, and serum biomarkers of the inflammatory response were evaluated. PRIMARY OUTCOME 90-day mortality. SECONDARY OUTCOMES ICU and hospital length of stay, mortality at days 28 and 180, in-hospital mortality, ventilator-free days (day-28), and inflammatory response. Propensity scoring weighted the risk of previously-acquired sepsis. Multivariate analysis evaluated the risk of mortality by day-90. Sensitivity analyses evaluated the primary outcome in different subgroups. RESULTS Of 341 patients enrolled, 147 had sepsis on ICU-admission. Adjusted risk of mortality at 90 days did not differ overall [hazard ratio (HR) = 0.94(CI:0.65-1.37)], nor in subpopulations with a confirmed etiology of pneumonia [HR = 0.93(CI:0.57-1.53)] or sepsis [HR = 0.91(0.54-1.55)], ventilator-associated pneumonia (VAP) [HR = 1.01(CI:0.61-1.68)], nor non-VAP ICU-AP [HR = 0.83(CI:0.40-1.71)]. No differences were found in clinical secondary outcomes, the inflammatory response was similar. CONCLUSIONS Previous sepsis does not appear to predispose to higher mortality nor worse outcomes in patients who develop ICU-acquired pneumonia.
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Preventive use of respiratory support after scheduled extubation in critically ill medical patients-a network meta-analysis of randomized controlled trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:370. [PMID: 32571369 PMCID: PMC7306939 DOI: 10.1186/s13054-020-03090-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/12/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Respiratory support has been increasingly used after extubation for the prevention of re-intubation and improvement of prognosis in critically ill medical patients. However, the optimal respiratory support method is still under debate. This network meta-analysis (NMA) aims to evaluate the comparative effectiveness of various respiratory support methods used for preventive purposes after scheduled extubation in critically ill medical patients. METHODS A systematic database search was performed from inception to December 19, 2019, for randomized controlled trials (RCTs) that compared a preventive use of different respiratory support methods, including conventional oxygen therapy (COT), noninvasive ventilation (NIV), high-flow oxygen therapy (HFOT), and combinational use of HFOT and NIV (HFOT+NIV), after planned extubation in adult critically ill medical patients. Study selection, data extraction, and quality assessments were performed in duplicate. The primary outcomes included re-intubation rate and short-term mortality. RESULTS Seventeen RCTs comprising 3341 participants with 4 comparisons were included. Compared with COT, NIV significantly reduced the re-intubation rate [risk ratio (RR) 0.55, 95% confidence interval (CI) 0.39 to 0.77; moderate quality of evidence] and short-term mortality (RR 0.66, 95% CI 0.48 to 0.91; moderate quality of evidence). Compared to COT, HFOT had a beneficial effect on the re-intubation rate (RR 0.55, 95% CI 0.35 to 0.86; moderate quality of evidence) but no effect on short-term mortality (RR 0.79, 95% CI 0.56 to 1.12; low quality of evidence). No significant difference in the re-intubation rate or short-term mortality was found among NIV, HFOT, and HFOT+NIV. The treatment rankings based on the surface under the cumulative ranking curve (SUCRA) from best to worst for re-intubation rate were HFOT+NIV (95.1%), NIV (53.4%), HFOT (51.2%), and COT (0.3%), and the rankings for short-term mortality were NIV (91.0%), HFOT (54.3%), HFOT+NIV (43.7%), and COT (11.1%). Sensitivity analyses of trials with a high risk of extubation failure for the primary outcomes indicated that the SUCRA rankings were comparable to those of the primary analysis. CONCLUSIONS After scheduled extubation, the preventive use of NIV is probably the most effective respiratory support method for comprehensively preventing re-intubation and short-term death in critically ill medical patients, especially those with a high risk of extubation failure.
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Wang J, Chen H, Lin X, Ji C, Chen B. Multiple cross displacement amplification-a more applicable technique in detecting Pseudomonas aeruginosa of ventilator-associated pneumonia (VAP). CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:306. [PMID: 32513206 PMCID: PMC7276953 DOI: 10.1186/s13054-020-03003-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/19/2020] [Indexed: 01/10/2023]
Abstract
Background Early and rapid identification of Pseudomonas aeruginosa (P. aeruginosa) in patients with suspected ventilator-associated pneumonia (VAP) provides theoretical clinical advantages in therapeutic optimization strategies. Methods The P. aeruginosa-multiple cross displacement amplification (PA-MCDA) assay was conducted at an isothermal temperature during the amplification stage, and products were visually detected by color changes. The entire process was completed within 1 h. A total of 77 strains, including P. aeruginosa species and various other species of non-P. aeruginosa, were used to evaluate PA-MCDA assays. Bronchoalveolar lavage fluid (BALF) of suspected VAP patients was examined by the MCDA assay. Results The MCDA assay exhibited a 100% analytical specificity in detecting PA from all 77 strains, and the limit of detection was as low as 100 fg DNA per reaction. A temperature of 65 °C was recommended as standard during the amplification stage. The agreement between PA-MCDA and bacteria culture was 91.18% (κ = 0.787; p = 0.000) in the identification of P. aeruginosa in BALF from suspected VAP. The PA-MCDA assay showed values of 92.31%, 90.78%, 77.41%, and 97.18% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively. PA-MCDA had a higher detective rate of P. aeruginosa than bacteria culture in patients with antipseudomonal therapy. Conclusions The instrument-free platform of the MCDA assay makes it a simple, rapid, and applicable procedure for “on-site” diagnosis and point-of-care testing for the presence of P. aeruginosa without the need for specific bacterial culture.
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Affiliation(s)
- Juxiang Wang
- Department of Intensive Care Unit, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Huimin Chen
- Department of Intensive Care Unit, The Third Hospital of Xiamen, Xiamen, Fujian, China
| | - Xiaomin Lin
- Department of Intensive Care Unit, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, Fujian, China
| | - Chengyi Ji
- Department of Intensive Care Unit, The Third Hospital of Xiamen, Xiamen, Fujian, China
| | - Bin Chen
- Department of Healthcare, Xiamen Port Clinic of Xiamen Customs, Xiamen, Fujian, China.
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Huang D, Qi M, Hu Y, Yu M, Liang Z. The impact of Candida spp airway colonization on clinical outcomes in patients with ventilator-associated pneumonia: A systematic review and meta-analysis. Am J Infect Control 2020; 48:695-701. [PMID: 31813630 DOI: 10.1016/j.ajic.2019.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous studies have drawn different conclusions about the impact of Candida airway colonization on clinical outcomes in patients with ventilator-associated pneumonia (VAP). METHODS We searched PubMed, the Cochrane Library, Embase (via OVID), and Web of Science database. We included both retrospective and prospective observational studies. The mean difference (MD) or risk ratio (RR) with 95% confidence intervals (CI) were applied to assess the association between Candida colonization and clinical outcomes. RESULTS A total of 8 studies with 1,661 patients were pooled in our final studies. Compared with patients with VAP without Candida colonization, patients with Candida colonization had significantly longer durations of mechanical ventilation (MD, 1.93; 95% CI, 0.53-3.33). The intensive care unit (ICU) length of stay seems to be longer among Candida colonized patients than noncolonized patients, although the results were not so significant (MD, 1.15; 95% CI, -1.04 to 3.34). Patients with colonization had higher 28-day mortality and ICU mortality than those without colonization (28-day mortality: RR, 1.64; 95% CI, 1.27-2.12; ICU mortality: RR, 1.57; 95% CI, 1.26-1.94). CONCLUSIONS The presence of Candida spp airway colonization is associated with longer durations of mechanical ventilation, higher 28-day mortality, higher ICU mortality, and probably longer ICU length of stay compared with the absence of colonization in patients with VAP.
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Najjar S, Almutairi AF, Massoud R, Al-Surimi K, Boghdadly S. Assessing the Feasibility and Effects of Introducing the USA National Surgical Quality Improvement Program on Clinical Outcomes and Cost in Saudi Arabia: An Observational Study. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2020; 3:14-21. [PMID: 37440969 PMCID: PMC10335779 DOI: 10.4103/jqsh.jqsh_1_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/29/2019] [Accepted: 01/02/2020] [Indexed: 07/15/2023]
Abstract
Introduction This study aimed at introducing a systematic clinical registry to assess the outcomes of surgical performances and the associated costs of surgical complications in hospitals of Saudi Arabia. Materials and Methods This was an observational retrospective cohort study. Three large Saudi public hospitals from different regions participated in the study. A systematic sample consisting of 2077 medical records was retrospectively reviewed after being received from the hospitals' surgical wards. The inclusion criteria of the study were inpatients of the surgical cases, patients older than 18 years, and those who underwent major surgery under general anesthesia. The occurrence of adverse events in surgical wards and the direct costs associated with these surgical adverse events were estimated. Results were reported in terms of odds ratio and 95% confidence interval. A value of p < 0.05 was considered statistically significant. Results Introducing the systematic clinical registry to assess surgical outcomes and complications across multiple hospital sites is feasible. The findings of the study suggest that some areas are exemplary and others need improvement, such as sepsis cases, renal failure, ventilator use for more than 48 h, urinary tract infection, surgical site infection (SSI), length of stay after colorectal surgery, and rehospitalization. Additional costs from surgical complications in Riyadh only were approximately 0.5 million Saudi Arabian Riyal (127,764.40 USD) during that year. Most of the additional costs were due to sepsis and SSI. Conclusion Empirical evidence derived from the idea of introducing a National Surgical Quality Improvement Program might be generally applicable to other countries in the region and worldwide, and can be used to measure surgical adverse events and track interventions over time. As a result, quality improvement initiatives could be identified to be implemented immediately focusing on preventing several surgical adverse events. A future study is needed to explore the underlying factors that contribute to the occurrence of surgical adverse events to be prevented and/or mitigated.
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Affiliation(s)
- Shahenaz Najjar
- Department of Health Informatics, Arab American University, Ramallah, Palestine
- Department of Population Health, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Adel F. Almutairi
- Department of Science Technology, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rashad Massoud
- University Research Co. (URC), Bethesda, MD, USA
- USAID Applying Science to Strengthen and Improve Systems Project (ASSIST), Chevy Chase, MD, USA
| | - Khaled Al-Surimi
- Department of Health Systems and Quality Management, College of Public Health and Health Informatics, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Sami Boghdadly
- Operation Room Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Lau VI, Rochwerg B, Xie F, Johnstone J, Basmaji J, Balakumaran J, Iansavichene A, Cook DJ. Probiotics in hospitalized adult patients: a systematic review of economic evaluations. Can J Anaesth 2020; 67:247-261. [PMID: 31721100 PMCID: PMC7222908 DOI: 10.1007/s12630-019-01525-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Probiotics may prevent healthcare-associated infections, such as ventilator-associated pneumonia, Clostridioides difficile-associated diarrhea, and other adverse outcomes. Despite their potential benefits, there are no summative data examining the cost-effectiveness of probiotics in hospitalized patients. This systematic review summarized studies evaluating the economic impact of using probiotics in hospitalized adult patients. METHODS We searched MEDLINE, EMBASE, CENTRAL, ACP Journal Club, and other EBM reviews (inception to January 31, 2019) for health economics evaluations examining the use of probiotics in hospitalized adults. Independently and in duplicate, we extracted data study characteristics, risk of bias, effectiveness and total costs (medications, diagnostics/procedures, devices, personnel, hospital) associated with healthcare-associated infections (ventilator-associated pneumonia, Clostridioides difficile-associated diarrhea and antibiotic-associated diarrhea). We used Grading of Recommendations Assessment, Development and Evaluation methods to assess certainty in the overall cost-effectiveness evidence. RESULTS Of 721 citations identified, we included seven studies. For the clinical outcomes of interest, there was one randomized-controlled trial (RCT)-based health economic evaluation, and six model-based health economic evaluations. Probiotics showed favourable cost-effectiveness in six of seven (86%) economic evaluations. Three of the seven studies were manufacturer-supported, all which suggested cost-effectiveness. Certainty of cost-effectiveness evidence was very low because of risk of bias, imprecision, and inconsistency. CONCLUSION Probiotics may be an economically attractive intervention for preventing ventilator-associated pneumonia, Clostridioides difficile-associated diarrhea, and antibiotic-associated diarrhea in hospitalized adult patients. Nevertheless, certainty about their cost-effectiveness evidence is very low. Future RCTs examining probiotics should incorporate cost data to inform bedside practice, clinical guidelines, and healthcare policy. TRIAL REGISTRATION PROSPERO CRD42019129929; Registered 25 April, 2019.
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Affiliation(s)
- Vincent I Lau
- Department of Medicine, Division of Critical Care Medicine, Western University, London, ON, Canada.
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
- Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, 800 Commissioners Road East, London, ON, Canada.
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Jennie Johnstone
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - John Basmaji
- Department of Medicine, Division of Critical Care Medicine, Western University, London, ON, Canada
| | - Jana Balakumaran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Deborah J Cook
- Department of Medicine, Division of Critical Care Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
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