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Yu XL, Zhou LY, Huang X, Li XY, Pan QQ, Wang MK, Yang JS. Urgent call for attention to diabetes-associated hospital infections. World J Diabetes 2024; 15:1683-1691. [DOI: 10.4239/wjd.v15.i8.1683] [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] [Received: 04/03/2024] [Revised: 05/14/2024] [Accepted: 06/07/2024] [Indexed: 07/25/2024] Open
Abstract
In this editorial, we discuss the recent article by Zhao et al published in the World Journal of Diabetes, which highlights the importance of recognizing the risk indicators associated with diabetes mellitus (DM). Given the severe implications of healthcare-associated infections (HAIs) in hospitalized individuals- such as heightened mortality rates, prolonged hospitalizations, and increased costs- we focus on elucidating the connection between DM and nosocomial infections. Diabetic patients are susceptible to pathogenic bacterial invasion and subsequent infection, with some already harboring co-infections upon admission. Notably, DM is an important risk factor for nosocomial urinary tract infections and surgical site infections, which may indirectly affect the occurrence of nosocomial bloodstream infections, especially in patients with DM with poor glycemic control. Although evidence regarding the impact of DM on healthcare-associated pneumonias remains inconclusive, attention to this potential association is warranted. Hospitalized patients with DM should prioritize meticulous blood glucose management, adherence to standard operating procedures, hand hygiene pra-ctices, environmental disinfection, and rational use of drugs during hospitalization. Further studies are imperative to explore the main risk factors of HAIs in patients with DM, enabling the development of preventative measures and mitigating the occurrence of HAIs in these patients.
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Affiliation(s)
- Xue-Lu Yu
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Li-Yun Zhou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xiao Huang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xin-Yue Li
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Qing-Qing Pan
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
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Yang Y, Song Y, Hou D. Obesity and COVID-19 Pandemics: Epidemiology, Mechanisms, and Management. Diabetes Metab Syndr Obes 2023; 16:4147-4156. [PMID: 38145256 PMCID: PMC10749174 DOI: 10.2147/dmso.s441762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023] Open
Abstract
Obesity is a principle causative factor of various metabolic dysfunctions, chronic inflammation, and multi-organ impairment. The global epidemic of obesity has constituted the greatest threat to global health. Emerging evidence has associated obesity with an increased risk of severe infection and poor outcomes from coronavirus disease 2019 (COVID-19). During current COVID-19 pandemic, the interaction between COVID-19 and obesity has exaggerated the disease burden of obesity more than ever before. Thus, there is an urgent need for consideration of universal measures to reduce the risk of complications and severe illness from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in obesity population. In this review, we first summarized the clinical evidence on the effect of obesity on susceptibility, severity, and prognosis of COVID-19. Then we discussed and the underlying mechanisms, including respiratory pathophysiology of obesity, dysregulated inflammation, upregulated angiotensin-converting enzyme 2 (ACE2) expression, hyperglycemia, and adipokines. Finally, we proposed recommendations on how to reduce the spread and pandemic of SARS-CoV-2 infection by prevention and treatment of obesity.
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Affiliation(s)
- Yanping Yang
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, People’s Republic of China
| | - Yuanlin Song
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Respiratory Research Institute, Shanghai, People’s Republic of China
| | - Dongni Hou
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
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Strelkova D, Rachina S, Fedina L, Vlasenko A, Tetevina M, Drogashevskaya D, Chesnokova M, Kuleshov V, Burmistrova E, Sychev I, Ananicheva N. Identification of risk factors and development of a predictive model for bloodstream infection in intensive care unit COVID-19 patients. J Hosp Infect 2023; 139:150-157. [PMID: 37478910 DOI: 10.1016/j.jhin.2023.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES To identify risk factors for nosocomial bloodstream infections (BSIs) in intensive care unit (ICU) patients with COVID-19 and to build a predictive model for BSIs. PATIENTS AND METHODS The retrospective case-control study included 236 ICU COVID-19 patients with BSIs group and 234 patients in the control group. Demographic and laboratory data, comorbidities, drug use, invasive procedures and identified pathogens were recorded separately for patients directly admitted and transferred to ICU. Fine and Gray's multi-variate competing risk model was used to build a predictive model for patients transferred to ICU. RESULTS The risk factors were: interleukin inhibitors (HR = 6.1 (95% CI: 2.0-18.5)) and dexamethasone (HR = 3.0 (95% CI: 1.3-7.1)) use in previous hospitalization, glomerular filtration rate <60 mL/min per 1.73 m2 (HR = 4.0 (95% CI: 2.1-7.6)) and blood glucose >9 mmol/L (HR = 2.5 (95% CI: 1.4-4.6)) in patients directly admitted to ICU; and dexamethasone use in previous hospitalization (HR = 4.5 (95% CI: 1.8-11)), the total dexamethasone dose before transfer to ICU (HR = 1.2 (95% CI: 1.06-1.37)), diabetes mellitus (HR = 1.4 (95% CI: 1.1-1.9)), alanine transaminase (ALT) ≥35.5 U/L on hospital admission (HR = 1.5 (95% CI: 1.1-2.1)), and the use of low-flow oxygen versus high-flow oxygen therapy or non-invasive mechanical ventilation on admission to ICU ((HR = 2.7 (95% CI: 5.6-11.1)) in patients transferred to ICU. A predictive model had sensitivity of 63-73% and specificity of 71-83% at different times of ICU stay. CONCLUSIONS Our findings may help clinicians detect patients at high risk of developing BSIs.
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Affiliation(s)
- D Strelkova
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
| | - S Rachina
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - L Fedina
- Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - A Vlasenko
- Samara State Medical University, Samara, Russian Federation
| | - M Tetevina
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - D Drogashevskaya
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - M Chesnokova
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - V Kuleshov
- City Clinical Hospital S. S. Yudin, Moscow, Russian Federation
| | - E Burmistrova
- City Clinical Hospital S. S. Yudin, Moscow, Russian Federation
| | - I Sychev
- Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - N Ananicheva
- City Clinical Hospital S. S. Yudin, Moscow, Russian Federation
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4
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Lee SH, Kim CH, Lee HY, Park KH, Han SH. Epidemiology of Carbapenem-Resistant Enterobacteriaceae Bacteremia in Gyeonggi Province, Republic of Korea, between 2018 and 2021. Antibiotics (Basel) 2023; 12:1286. [PMID: 37627706 PMCID: PMC10451680 DOI: 10.3390/antibiotics12081286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
The incidence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing since 2008, with Gyeonggi Province in South Korea being particularly vulnerable due to its large number of healthcare facilities. This study examines the trends of CRE occurrence in Gyeonggi Province over the past four years and the epidemiological characteristics of the infected patients. Patients with positive CRE blood cultures admitted to healthcare facilities in Gyeonggi Province from January 2018 to December 2021 were evaluated in this study. Risk factors for CRE-related death were analyzed using data from patients who died within 30 days of the last blood sampling. Older adults aged 70 years and above constituted the majority of patients with CRE bacteremia. Antibiotic use did not significantly affect mortality risk. Non-survivors were more common in tertiary hospitals and intensive care units and included patients with hypertension, malignant tumors, and multiple underlying diseases. Klebsiella pneumoniae was the most common CRE strain, with Klebsiella pneumoniae carbapenemase being the predominant carbapenemase. Our study suggests the endemicity of CRE in Gyeonggi Province and highlights the increasing isolation of CRE strains in South Korean long-term care hospitals within the province. Further, infection control measures and government support specific to each healthcare facility type are crucial.
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Affiliation(s)
- Seung Hye Lee
- Gyeonggi Infectious Disease Control Center, Health Bureau, Gyeonggi Provincial Government, Suwon-si 16508, Gyeonggi-do, Republic of Korea; (S.H.L.)
| | - Chan Hee Kim
- Gyeonggi Infectious Disease Control Center, Health Bureau, Gyeonggi Provincial Government, Suwon-si 16508, Gyeonggi-do, Republic of Korea; (S.H.L.)
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam-si 13620, Gyeonggi-do, Republic of Korea;
| | - Kun Hee Park
- Pyeongchang County Health and Medical Center, Pyeongchang-gun 25374, Gangwon-do, Republic of Korea;
| | - Su Ha Han
- Department of Nursing, College of Medicine, SoonChunHyang University, Cheonan-si 31151, Chungcheongnam-do, Republic of Korea
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Nevanlinna V, Huttunen R, Aittoniemi J, Luukkaala T, Rantala S. Major risk factors for Streptococcus dysgalactiae subsp. equisimilis bacteremia: a population-based study. BMC Infect Dis 2023; 23:43. [PMID: 36690934 PMCID: PMC9869575 DOI: 10.1186/s12879-023-07992-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Streptococcus dysgalactiae subspecies equisimilis is a human pathogen causing severe invasive infections. Detailed information on S. dysgalactiae subsp. equisimilis bacteremia and especially of predisposing factors are lacking. The purpose of the study is to investigate the risk factors of S. dysgalactiae subsp. equisimilis bacteremia compared to the general population in Finland. METHODS We retrospectively reviewed all patients older than 18 years with S. dysgalactiae subsp. equisimilis bacteremia in the Pirkanmaa health district from August 2015 to July 2018. The risk factors for S. dysgalactiae subsp. equisimilis bacteremia were investigated with respect to the normal population in Finland using the Finhealth study data provided by the Finnish institute for health and welfare. The study group was matched with the Finhealth study by age and sex. RESULTS Altogether 230 cases of S. dysgalactiae subsp. equisimilis bacteremia were detected. The medical records of 217 episodes of S. dysgalactiae subsp. equisimilis bacteremia (involving 211 patients) were available for analysis. Obesity was a statistically significant risk factor for S. dysgalactiae subsp. equisimilis bacteremia (Odds Ratio 2.96 [95% CI 2.22-3.96]). Diabetes and coronary artery disease were also associated with an increased risk of S. dysgalactiae subsp. equisimilis bacteremia (OR 4.82 [95% CI 3.62-6.42]) and (OR 3.03 [95% CI 2.18-4.19]). CONCLUSIONS We found obesity, diabetes, and coronary artery disease to be associated with an increased risk for S. dysgalactiae subsp. equisimilis bacteremia. These results provide an increased understanding of risk factors for S. dysgalactiae subsp. equisimilis bacteremia.
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Affiliation(s)
- Viivi Nevanlinna
- grid.412330.70000 0004 0628 2985Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Reetta Huttunen
- grid.412330.70000 0004 0628 2985Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Janne Aittoniemi
- grid.511163.10000 0004 0518 4910Fimlab Laboratories, Tampere, Finland
| | - Tiina Luukkaala
- grid.412330.70000 0004 0628 2985Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland ,grid.502801.e0000 0001 2314 6254Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sari Rantala
- grid.412330.70000 0004 0628 2985Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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6
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Královcová M, Karvunidis T, Matějovič M. Critical care for multimorbid patients. VNITRNI LEKARSTVI 2023; 69:166-172. [PMID: 37468311 DOI: 10.36290/vnl.2023.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Multimorbidity - the simultaneous presence of several chronic diseases - is very common in the critically ill patients. Its prevalence is roughly 40-85 % and continues to increase further. Certain chronic diseases such as diabetes, obesity, chronic heart, pulmonary, liver or kidney disease and malignancy are associated with higher risk of developing serious acute complications and therefore the possible need for intensive care. This review summarizes and discusses selected specifics of critical care for multimorbid patients.
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7
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Rui F, Yang H, Guo Z, Ge Z, Hu X, Zhang L, Xue Q, Chen H, Xu Y, Tan M, Qin C, He Z, Li J. Derivation and validation of prognostic models for predicting survival outcomes in Acute-on-chronic liver failure patients. J Viral Hepat 2021; 28:1719-1728. [PMID: 34496100 DOI: 10.1111/jvh.13611] [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: 06/24/2021] [Revised: 08/05/2021] [Accepted: 08/28/2021] [Indexed: 12/09/2022]
Abstract
Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of chronic liver disease associated with high bacterial infection (BI) and short-term mortality. However, many ACLF prognostic predictive modelsare complicated. The aim of this study is to develop prognostic models for ACLF patients to predict BI and mortality. We retrospective recruited 263 patients with ACLF from Shandong Provincial Hospital and Taizhou Enze Medical Center (Group) Enze Hospital. ACLF was defined according to the Asian Pacific Association for the Study of the Liver (APASL) criteria. Multivariable logistic regression was used to derive prediction models for occurring BI and 28-day mortality in ACLF patients. Ninety seven of 263 patients (37%) occurred BI and 41 of 155 (26%) died within 28 days of admission. C-reactive protein (CRP), glucose, and albumin were the independent predictors for occurring BI during the hospital stay. We also found that hepatic encephalopathy (HE), prothrombin time, activated partial thromboplastin time (APRI), and glucose were the independent predictors of 28-day mortality of ACLF patients. Using logistic regression model, we generated a new modified MELD model (M-MELD) by incorporating HE, APRI, and glucose. AUC of M-MELD model was 0.871, which were significantly higher than MELD score (AUC:0.734), MELD-Na score (AUC:0.742), and integrated MELD score (iMELD) (AUC:0.761). HE, MELD score, APRI, and blood glucose were independent risk factors for 28-day mortality of ACLF patients. The modified MELD model (M-MELD) by incorporating HE, APRI, and glucose has better discriminative performances compared with MELD in predicting 28-day mortality.
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Affiliation(s)
- Fajuan Rui
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong Frist Medical University, Ji'nan, China
| | - Hongli Yang
- Department of Infectious Disease, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Zhaoyang Guo
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong Frist Medical University, Ji'nan, China
| | - Zhengming Ge
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
| | - Xinyu Hu
- Department of Infectious Disease, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Lulu Zhang
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
| | - Qi Xue
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong Frist Medical University, Ji'nan, China
| | - Haiping Chen
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
| | - Yayun Xu
- Department of Infectious Disease, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Meng Tan
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
| | - Chengyong Qin
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong Frist Medical University, Ji'nan, China
| | - Zebao He
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China.,Department of Infectious Diseases, Taizhou Enze Medical Center (Group), Enze Hospital, Taizhou, China
| | - Jie Li
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, China
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8
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Westheim AJF, Bitorina AV, Theys J, Shiri-Sverdlov R. COVID-19 infection, progression, and vaccination: Focus on obesity and related metabolic disturbances. Obes Rev 2021; 22:e13313. [PMID: 34269511 PMCID: PMC8420274 DOI: 10.1111/obr.13313] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 01/08/2023]
Abstract
Coronaviruses are constantly circulating in humans, causing common colds and mild respiratory infections. In contrast, infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for coronavirus disease-2019 (COVID-19), can cause additional severe complications, particularly in patients with obesity and associated metabolic disturbances. Obesity is a principal causative factor in the development of the metabolic syndrome; a series of physiological, biochemical, clinical, and metabolic factors that increase the risk of obesity-associated diseases. "Metabolically unhealthy" obesity is, in addition to metabolic disturbances, also associated with immunological disturbances. As such, patients with obesity are more prone to develop serious complications from infections, including those from SARS-CoV-2. In this review, we first describe how obesity and related metabolic disturbances increase the risk of SARS-CoV-2 infection. Then, mechanisms contributing to COVID-19 complications and poor prognosis in these patients are discussed. Finally, we discuss how obesity potentially reduces long-term COVID-19 vaccination efficacy. Despite encouraging COVID-19 vaccination results in patients with obesity and related metabolic disturbances in the short-term, it is becoming increasingly evident that long-term COVID-19 vaccination efficacy should be closely monitored in this vulnerable group.
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Affiliation(s)
- Annemarie J F Westheim
- Department of Precision Medicine, GROW-Research School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Albert V Bitorina
- Department of Molecular Genetics, NUTRIM-School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jan Theys
- Department of Precision Medicine, GROW-Research School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Molecular Genetics, NUTRIM-School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
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Cheuk N, Worth LJ, Tatoulis J, Skillington P, Kyi M, Fourlanos S. The relationship between diabetes and surgical site infection following coronary artery bypass graft surgery in current-era models of care. J Hosp Infect 2021; 116:47-52. [PMID: 34332004 DOI: 10.1016/j.jhin.2021.07.009] [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: 05/12/2021] [Revised: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although diabetes is a recognized risk factor for postoperative infections, the seminal Portland Diabetic Project studies in cardiac surgery demonstrated intravenous insulin infusions following open-cardiac surgery achieved near normal glycaemia and decreased deep sternal wound infection to similar rates to those without diabetes. AIM We sought to examine a contemporary cohort of patients undergoing coronary artery bypass graft surgery (CABGS) to evaluate the relationship between diabetes, hyperglycaemia and risk of surgical site infection (SSI) in current-era models of care. METHODS Consecutive patients who underwent CABGS between 2016 and 2018 were identified through a state-wide data repository for healthcare-associated infections. Clinical characteristics and records of postoperative SSIs were obtained from individual chart review. Type 2 diabetes (T2D), perioperative glycaemia and other clinical characteristics were analysed in relation to the development of SSI. FINDINGS Of the 953 patients evaluated, 11% developed SSIs a median eight days post CABGS, with few cases of deep SSIs (<1%). T2D was evident in 41% and more prevalent in those who developed SSIs (51%). On multivariate analysis T2D was not significantly associated with development of SSI (odds ratio (OR) 1.35; P=0.174) but body mass index (BMI) remained a significant risk factor (OR 1.07, P<0.001). In patients with T2D, perioperative glycaemia was not significantly associated with SSI. CONCLUSION In a specialist cardiac surgery centre using perioperative intravenous insulin infusions and antibiotic prophylaxis, deep SSIs were uncommon; however, approximately one in 10 patients developed superficial SSIs. T2D was not independently associated with SSI yet BMI was independently associated with SSI post CABGS.
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Affiliation(s)
- N Cheuk
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Australia.
| | - L J Worth
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute, Australia; National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - J Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Australia
| | - P Skillington
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Australia
| | - M Kyi
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia
| | - S Fourlanos
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia
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10
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Yasuda H, Yamamoto R, Hayashi Y, Kotani Y, Kishihara Y, Kondo N, Sekine K, Shime N, Morikane K, Abe T, Takebayashi T, Maeda M, Shiga T, Furukawa T, Inaba M, Fukuda S, Kurahashi K, Murakami S, Yasumoto Y, Kamo T, Sakuraya M, Yano R, Hifumi T, Horiguchi M, Nakayama I, Nakane M, Ota K, Yatabe T, Yoshida M, Murata M, Fujii K, Ishii J. Occurrence and incidence rate of peripheral intravascular catheter-related phlebitis and complications in critically ill patients: a prospective cohort study (AMOR-VENUS study). J Intensive Care 2021; 9:3. [PMID: 33407891 PMCID: PMC7789473 DOI: 10.1186/s40560-020-00518-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022] Open
Abstract
Background The lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically ill patients results in the absence of appropriate preventive measures. Therefore, we aimed to describe the epidemiology of the use of PIVCs and the incidence/occurrence of phlebitis and complications in the intensive care unit (ICU). Methods This prospective multicenter cohort study was conducted in 23 ICUs in Japan. All consecutive patients aged ≥ 18 years admitted to the ICU were enrolled. PIVCs inserted prior to ICU admission and those newly inserted after ICU admission were included in the analysis. Characteristics of the ICU, patients, and PIVCs were recorded. The primary and secondary outcomes were the occurrence and incidence rate of PIVC-related phlebitis and complications (catheter-related blood stream infection [CRBSI] and catheter failure) during the ICU stay. Results We included 2741 patients and 7118 PIVCs, of which 48.2% were inserted in the ICU. PIVC-related phlebitis occurred in 7.5% (95% confidence interval [CI] 6.9–8.2%) of catheters (3.3 cases / 100 catheter-days) and 12.9% (95% CI 11.7–14.2%) of patients (6.3 cases / 100 catheter-days). Most PIVCs were removed immediately after diagnosis of phlebitis (71.9%). Grade 1 was the most common phlebitis (72.6%), while grade 4 was the least common (1.5%). The incidence rate of CRBSI was 0.8% (95% CI 0.4–1.2%). In cases of catheter failure, the proportion and incidence rate per 100 intravenous catheter-days of catheter failure were 21% (95% CI 20.0-21.9%) and 9.1 (95% CI 8.7–10.0), respectively. Conclusion PIVC-related phlebitis and complications were common in critically ill patients. The results suggest the importance of preventing PIVC-related complications, even in critically ill patients. Trial registration UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017). Supplementary Information The online version contains supplementary material available at 10.1186/s40560-020-00518-4.
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Affiliation(s)
- Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan. .,Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Tokyo, Japan. .,Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
| | - Ryohei Yamamoto
- Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
| | - Yoshiro Hayashi
- Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
| | - Yuki Kotani
- Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan.,Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Yuki Kishihara
- Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Natsuki Kondo
- Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
| | - Kosuke Sekine
- Department of Medical Engineer, Kameda Medical Center, Chiba, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keita Morikane
- Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan
| | - Takayuki Abe
- Biostatistics, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan.,Faculty of Data Science, Yokohama City University School of Data Science, Yokohama, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Mikihiro Maeda
- Department of Pharmacy, St. Marianna University Hospital, Kanagawa, Japan
| | - Takuya Shiga
- Intensive Care Unit, Tohoku University Hospital, Miyagi, Japan
| | - Taku Furukawa
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Mototaka Inaba
- Department of Emergency and Critical Care Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Sachito Fukuda
- Intensive Care Unit, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kiyoyasu Kurahashi
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Sarah Murakami
- Intensive Care Unit, Sakai city medical center, Osaka, Japan
| | - Yusuke Yasumoto
- Emergency And Critical Care Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Tetsuro Kamo
- Division of Critical Care Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Rintaro Yano
- Division of Intensive Care Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Masahito Horiguchi
- Division of Emergency Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Izumi Nakayama
- Intensive Care Unit, Okinawa Chubu Hospital, Okinawa, Japan
| | - Masaki Nakane
- Critical Care Center, Yamagata University Hospital, Yamagata, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoaki Yatabe
- Intensive Care Unit, Kochi Medical School Hospital, Kochi, Japan
| | | | - Maki Murata
- Department of Acute Care and General Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kenichiro Fujii
- Emergency Intensive Care Unit, Fujita Health University, Nagoya, Japan
| | - Junki Ishii
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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11
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Akinosoglou K, Kapsokosta G, Mouktaroudi M, Rovina N, Kaldis V, Stefos A, Kontogiorgi M, Giamarellos-Bourboulis E, Gogos C. Diabetes on sepsis outcomes in non-ICU patients: A cohort study and review of the literature. J Diabetes Complications 2021; 35:107765. [PMID: 33187869 DOI: 10.1016/j.jdiacomp.2020.107765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/17/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023]
Abstract
AIMS We sought to determine whether primary outcomes differ between non-ICU septic patients with and without type 2 diabetes (T2D). METHODS This study utilized the Hellenic Sepsis Study Group Registry, collecting nationwide data for sepsis patients since 2006, and classified patients upon presence or absence of T2D. Patients were perfectly matched for a) Sepsis 3 definition criteria (including septic shock) b) gender, c) age, d) APACHE II score and e) Charlson's comorbidity index (CCI). Independent sample t-test and chi-square t-test was used to compare prognostic indices and primary outcomes. RESULTS Of 4320 initially included non-ICU sepsis patients, 812 were finally analysed, following match on criteria. Baseline characteristics were age 76 [±10.3] years, 46% male, APACHE II 15.5 [±6], CCI 5.1 [±1.8], 24% infection, 63.8% sepsis and 12.2% septic shock. No significant difference was noted between two groups in qSOFA, SOFA, or suPAR1 levels (p = 0.7, 0.1 & 0.3) respectively. Primary sepsis syndrome resolved in 70.9% of cases (p = 0.9), while mortality was 24% in 28-days time. Cause of death was similar between patients with and without T2D (sepsis 17.8% vs 15.8%, heart event 3.7% vs 3.2%, CNS event 0.5% vs 0.5%, malignancy 0.7% vs 2% respectively, p = 0.6). CONCLUSIONS DM does not appear to negatively affect outcomes in septic patients not requiring ICU.
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Affiliation(s)
- Karolina Akinosoglou
- Dept of Internal Medicine and Infectious Diseases, University Hospital of Patras, Greece.
| | | | - Maria Mouktaroudi
- 4th Dept of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Nikoletta Rovina
- 1st Dept of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, Greece
| | | | - Aggelos Stefos
- Dept of Internal Medicine, Larissa University General Hospital, University of Thessaly, Greece
| | - Marina Kontogiorgi
- 2nd Dept of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | | | - Charalambos Gogos
- Dept of Internal Medicine and Infectious Diseases, University Hospital of Patras, Greece
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12
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Lin S, He W, Zeng M. Association of Diabetes and Admission Blood Glucose Levels with Short-Term Outcomes in Patients with Critical Illnesses. J Inflamm Res 2020; 13:1151-1166. [PMID: 33376380 PMCID: PMC7764887 DOI: 10.2147/jir.s287510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/04/2020] [Indexed: 12/16/2022] Open
Abstract
Background Association of diabetes and admission glucose on the short-term prognosis in patients with critical illnesses are currently ambiguous. We aimed to determine whether diabetes and admission glucose affects short-term prognosis of critically ill patients. Methods We performed a retrospective analysis of data on 46,476 critically ill patients from the critical care database. Association of diabetes with 28-day mortality was assessed by inverse probability weighting based on the propensity score. Smoothing splines and threshold effect analysis were applied to explore the relationship between admission glucose and clinical outcomes. Results Of the 33,680 patients enrolled in the study, 8,701 (25.83%) had diabetes. In the main analysis, the 28-day mortality was reduced by 29% (hazard ratio (HR)=0.71, 95% confidence interval (CI) 0.67–0.76) in patients with diabetes compared to those without diabetes. The E-value of 2.17 indicated robustness to unmeasured confounders. Significant interactions were observed for glucose at ICU admission, admission type, and insulin use (Interaction P <0.05). A V-shaped relationship was observed between admission glucose and 28-day mortality in non-diabetic patients, with the lowest 28-day mortality corresponding to a glucose level of 101.75 mg/dl (95% CI 94.64–105.80 mg/dl), and admission hypoglycemia or hyperglycemia should be avoided, especially in patients admitted to the surgical intensive care unit (SICU), cardiac surgery recovery unit (CSRU), and coronary care unit (CCU); for diabetic patients, elevated admission glucose does not appear to be associated with a poor prognosis and perhaps may be beneficial except for CCU and CSRU. Conclusion The non-detrimental effect of diabetes on the short-term prognosis of critically ill patients was further confirmed, which would reduce 28-day mortality by approximately 29%. For non-diabetic patients, the admission glucose level corresponding to the lowest 28-day mortality was 101.75 mg/dl (95% CI 94.64–105.80 mg/dl); however, for diabetics, the appropriate admission glucose threshold remains unresolved.
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Affiliation(s)
- Shan Lin
- Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Wanmei He
- Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Mian Zeng
- Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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13
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Łącka M, Obłój P, Spychalski P, Łaski D, Rostkowska O, Wieszczy P, Kobiela J. Clinical presentation and outcomes of cholecystectomy for acute cholecystitis in patients with diabetes - A matched pair analysis. A pilot study. Adv Med Sci 2020; 65:409-414. [PMID: 32823170 DOI: 10.1016/j.advms.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/06/2020] [Accepted: 08/06/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The primary aim of this study is to compare the clinical course and laboratory parameters of acute cholecystitis in patients with diabetes vs. patients without diabetes. MATERIALS AND METHODS The study involved patients who underwent emergency cholecystectomy in the Department of General, Endocrine and Transplant Surgery of University Clinical Center in Gdansk (Poland) between 2007 and 2017. There were 267 patients included in the study. The control group of 197 patients was age and sex matched at a 3:1 ratio. The following was compared between the groups: symptoms at admission, course of surgery, postoperative course, length of hospitalization, total costs of hospitalization and antibiotic therapy, other than routine perioperative prophylaxis. RESULTS There was no significant difference between the patients with and without diabetes regarding symptoms at admission. Operative and postoperative complication rates were significantly higher in the patients with diabetes. The operative time and length of hospitalization were significantly longer in the study group. The conversion rate was not higher in the study group, but classic surgery was performed significantly more often. The patients without diabetes had less pronounced symptoms with more locally advanced disease. CONCLUSIONS Our study demonstrates that patients with diabetes have a significantly more eventful course of acute cholecystitis than patients without diabetes. Patients with diabetes should therefore be qualified for cholecystectomy early in the course of acute cholecystitis.
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Affiliation(s)
- Monika Łącka
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland.
| | - Paweł Obłój
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland
| | - Piotr Spychalski
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland
| | - Dariusz Łaski
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland
| | - Olga Rostkowska
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland
| | - Paulina Wieszczy
- Central Coordination Center for Cervical Cancer Screening Program, Department of Cancer Prevention, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Jarek Kobiela
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland
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14
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Hale AJ, Vicks E, LaSalvia MT, Giurini JM, Karchmer AW. Methicillin-Resistant Staphylococcus aureus Endocarditis from a Diabetic Foot Ulcer Understanding and Mitigating the Risk. J Am Podiatr Med Assoc 2018; 108:528-531. [PMID: 30742500 DOI: 10.7547/17-139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diabetic foot infections are a common cause of morbidity and mortality in the United States, and successful treatment often requires an aggressive and prolonged approach. Recent work has elucidated the importance of appropriate therapy for a given severity of diabetic foot infection, and highlighted the ongoing risk such patients have for subsequent invasive life-threatening infection should diabetic foot ulcers fail to heal. The authors describe the case of a man with diabetes who had prolonged, delayed healing of a diabetic foot ulcer. The ulcer subsequently became infected by methicillin-resistant Staphylococcus aureus (MRSA). The infection was treated conservatively with oral therapy and minimal debridement. Several months later, he experienced MRSA bloodstream infection and complicating endocarditis. The case highlights the ongoing risk faced by patients when diabetic foot ulcers do not heal promptly, and emphasizes the need for aggressive therapy to promote rapid healing and eradication of MRSA.
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Affiliation(s)
- Andrew J. Hale
- University of Vermont Medical Center and Larner College of Medicine, University of Vermont, Burlington, VT
| | | | - Mary T. LaSalvia
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - John M. Giurini
- Division of Podiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Adolf W. Karchmer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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15
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Karamnov S, Brovman EY, Greco KJ, Urman RD. Risk Factors and Outcomes Associated With Sepsis After Coronary Artery Bypass and Open Heart Valve Surgeries. Semin Cardiothorac Vasc Anesth 2018; 22:359-368. [PMID: 29992859 DOI: 10.1177/1089253218785362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Sepsis causes significant morbidity and mortality after cardiac surgery and carries a significant burden on health care costs. There is a general association of increased risk of post-cardiac surgery sepsis in patients with postoperative complications. We sought to investigate significant patient and procedural risk factors and outcomes associated with sepsis after cardiac surgery. MATERIALS AND METHODS In this retrospective study, we analyzed 531 coronary artery bypass grafting and open heart valve surgery cases that developed postoperative sepsis in the National Surgical Quality Improvement Program database between 2007 and 2014. Patient-based and surgery-based parameters were analyzed for risk factors and outcomes reported in the 30 days postoperatively. The association between sepsis and patient outcomes was assessed in a propensity-matched cohort using univariable logistic regression. RESULTS Modifiable and nonmodifiable patient characteristics, including age >80, poor preoperative functional status, chronic diseases such as diabetes mellitus, congestive heart failure, chronic kidney disease with serum creatinine ⩾1.5, as well as serum albumin <3.5 and emergent nature of the case were associated with post-cardiac surgery sepsis. Surgical outcomes associated with sepsis included mortality (15.4% vs 4.5%), unplanned intubation (29.8% vs 8.2%), transfusion (53.4% vs 48.4%), acute kidney injury (7.1% vs 1.4%), postoperative dialysis (18.8% vs 3.5%), and return to the operating room (29.8% vs 8.2%). CONCLUSIONS We identified multiple patient and surgical characteristics as well as postoperative outcomes associated with postoperative sepsis development in the high-risk population of patients undergoing cardiac surgery. Early identification of patients who are at high risk for postoperative sepsis can facilitate early treatment interventions.
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Affiliation(s)
- Sergey Karamnov
- 1 Brigham and Women's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Ethan Y Brovman
- 1 Brigham and Women's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Katherine J Greco
- 1 Brigham and Women's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Richard D Urman
- 1 Brigham and Women's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
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16
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Bacteriological profile of sepsis and its correlation with procalcitonin in patients with diabetes mellitus. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0651-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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17
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Hasanzadeh Kiabi F, Alipour A, Darvishi-Khezri H, Aliasgharian A, Emami Zeydi A. Zinc Supplementation in Adult Mechanically Ventilated Trauma Patients is Associated with Decreased Occurrence of Ventilator-associated Pneumonia: A Secondary Analysis of a Prospective, Observational Study. Indian J Crit Care Med 2017; 21:34-39. [PMID: 28197049 PMCID: PMC5278588 DOI: 10.4103/0972-5229.198324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the Intensive Care Unit (ICU). The aim of this analysis is to determine potential association between zinc supplementation with the occurrence of VAP in adult mechanically ventilated trauma patients. SUBJECTS AND METHODS This secondary analysis of a prospective observational study was carried out over a period of 1 year in ICUs of one teaching hospital in Iran. A total of 186 adults mechanically ventilated trauma patients, who required at least 48 h of MV and received zinc sulfate supplement (n = 82) or not (n = 104) during their ICU stay, were monitored for the occurrence of VAP until their discharge from the ICU or death. RESULTS Forty-one of 186 patients developed VAP, 29.09 days after admission (95% confidence interval [CI]: 26.27-31.9). The overall incidence of VAP was 18.82 cases per 1000 days of intubation (95% CI: 13.86-25.57). Patients who received zinc sulfate supplement have smaller hazard of progression to VAP than others (hazard ratio: 0.318 [95% CI: 0.138-0.732]; P < 0.0001). CONCLUSION The findings show that zinc supplementation may be associated with a significant reduction in the occurrence of VAP in adult mechanically ventilated trauma patients. Further well-designed randomized clinical trials to confirm the efficacy of this potential preventive modality are warranted.
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Affiliation(s)
- Farshad Hasanzadeh Kiabi
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Department of Community Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Aily Aliasgharian
- Student Research Committee, Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Emami Zeydi
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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19
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Darvishi-Khezri H, Alipour A, Emami Zeydi A, Firouzian A, Mahmudi G, Omrani-Nava M. Is type 2 diabetes mellitus in mechanically ventilated adult trauma patients potentially related to the occurrence of ventilator-associated pneumonia? JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:19. [PMID: 27904565 PMCID: PMC5121997 DOI: 10.4103/1735-1995.179887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/21/2015] [Accepted: 02/09/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the intensive care unit (ICU). Patients with type 2 diabetes mellitus (T2DM) are considered to be more susceptible to several types of infections including community-acquired pneumonia. However, it is not clear whether T2DM is a risk factor for the development of VAP. The purpose of this study was to determine the risk of VAP for diabetic and nondiabetic mechanically ventilated trauma patients. MATERIALS AND METHODS This study is a secondary analysis of a prospective observational study of the history of T2DM in the ICU over a period of 1 year at Imam Khomeini Hospital in Iran. A total of 186 critically ill trauma patients who required at least 48 h of MV were monitored for the occurrence of VAP by their clinical pulmonary infection score (CPIS) until ICU discharge, VAP diagnosis, or death. RESULTS Forty-one of the 186 patients developed VAP. The median time from hospitalization to VAP was 29.09 days (95% CI: 26.27-31.9). The overall incidence of VAP was 18.82 cases per 1,000 days of intubation (95% CI: 13.86-25.57). Risk of VAP in diabetic patients was greater than nondiabetic patients after adjustments for other potential factors [hazard ratio (HR): 10.12 [95% confidence interval (CI): 5.1-20.2); P < 0.0001)]. CONCLUSION The findings show that T2DM is associated with a significant increase in the occurrence of VAP in mechanically ventilated adult trauma patients.
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Affiliation(s)
| | - Abbas Alipour
- Department of Community Medicine, Thalassemia Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Emami Zeydi
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolfazl Firouzian
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ghahraman Mahmudi
- Hospital Management Research Centers, Department of Health Services Management, Sari Branch, Islamic Azad University, Sari, Iran
| | - Melody Omrani-Nava
- Department of Infectious Diseases, Sari Branch, Islamic Azad University, Sari, Iran
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20
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Langley G, Hao Y, Pondo T, Miller L, Petit S, Thomas A, Lindegren ML, Farley MM, Dumyati G, Como-Sabetti K, Harrison LH, Baumbach J, Watt J, Van Beneden C. The Impact of Obesity and Diabetes on the Risk of Disease and Death due to Invasive Group A Streptococcus Infections in Adults. Clin Infect Dis 2016; 62:845-52. [PMID: 26703865 PMCID: PMC11331490 DOI: 10.1093/cid/civ1032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/09/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Invasive group A Streptococcus (iGAS) infections cause significant morbidity and mortality worldwide. We analyzed whether obesity and diabetes were associated with iGAS infections and worse outcomes among an adult US population. METHODS We determined the incidence of iGAS infections using 2010-2012 cases in adults aged ≥ 18 years from Active Bacterial Core surveillance (ABCs), a population-based surveillance system, as the numerator. For the denominator, we used ABCs catchment area population estimates from the 2011 to 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey. The relative risk (RR) of iGAS was determined by obesity and diabetes status after adjusting for age group, gender, race, and other underlying conditions through binomial logistic regression. Multivariable logistic regression was used to determine whether obesity or diabetes was associated with increased odds of death due to iGAS compared to normal weight and nondiabetic patients, respectively. RESULTS Between 2010 and 2012, 2927 iGAS cases were identified. Diabetes was associated with an increased risk of iGAS in all racial groups (adjusted risk ratio [aRR] ranged from 2.71 to 5.08). Grade 3 obesity (body mass index [BMI] ≥ 40) was associated with an increased risk of iGAS for whites (aRR = 3.47; 95% confidence interval [CI], 3.00-4.01). Grades 1-2 (BMI = 30.0-<40.0) and grade 3 obesity were associated with an increased odds of death (odds ratio [OR] = 1.55, [95% CI, 1.05, 2.29] and OR = 1.62 [95% CI, 1.01, 2.61], respectively) when compared to normal weight patients. CONCLUSIONS These results may help target vaccines against GAS that are currently under development. Efforts to develop enhanced treatment regimens for iGAS may improve prognoses for obese patients.
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Affiliation(s)
- Gayle Langley
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yongping Hao
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa Miller
- Colorado Department of Public Health and Environment, Denver
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Ann Thomas
- Oregon Department of Human Services, Portland
| | - Mary Louise Lindegren
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Monica M Farley
- Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, Georgia
| | | | | | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - James Watt
- California Department of Public Health, Richmond
| | - Chris Van Beneden
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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21
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Bannier K, Lichtenauer M, Franz M, Fritzenwanger M, Kabisch B, Figulla HR, Pfeifer R, Jung C. Impact of diabetes mellitus and its complications: survival and quality-of-life in critically ill patients. J Diabetes Complications 2015; 29:1130-5. [PMID: 26361811 DOI: 10.1016/j.jdiacomp.2015.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Diabetes mellitus represents an increasing problem for patients and health care systems worldwide. We sought to investigate the effect of diabetes and its associated comorbidities on long-term survival and quality of life following an admission to a medical intensive care unit (ICU). METHODS A total of 6662 consecutive patients admitted to ICU between 2004 and 2009 were included (patients with diabetes n=796, non-diabetic patients n=5866). The primary endpoint of the study was death of any cause. Data on mortality was collected upon review of medical records or phone interviews. Moreover, a questionnaire was sent to 500 randomly selected patients addressing Health related Quality of Life (HrQoL) after ICU treatment. RESULTS Overall mortality did not differ significantly between diabetic and non-diabetic patients after ICU treatment (mean follow-up time: 490 days). For a subgroup of patients already exhibiting comorbidities associated with diabetes, the mortality rate was significantly higher (p=0.022). Regarding quality of life, no differences were found between groups. CONCLUSIONS Diabetes was not associated with increased mortality or reduced quality of life in a general population of medical ICU patients. However, once comorbidities associated with diabetes occurred, the survival rate of patients with comorbidities associated with hyperglycemia was significantly reduced.
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Affiliation(s)
- Katharina Bannier
- Friedrich-Schiller-University, Clinic of Internal Medicine I, Jena, Germany
| | - Michael Lichtenauer
- University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Marcus Franz
- Friedrich-Schiller-University, Clinic of Internal Medicine I, Jena, Germany
| | | | - Bjoern Kabisch
- Friedrich-Schiller-University, Clinic of Internal Medicine I, Jena, Germany
| | | | - Ruediger Pfeifer
- Friedrich-Schiller-University, Clinic of Internal Medicine I, Jena, Germany
| | - Christian Jung
- Friedrich-Schiller-University, Clinic of Internal Medicine I, Jena, Germany.
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22
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Venot M, Weis L, Clec’h C, Darmon M, Allaouchiche B, Goldgran-Tolédano D, Garrouste-Orgeas M, Adrie C, Timsit JF, Azoulay E. Acute Kidney Injury in Severe Sepsis and Septic Shock in Patients with and without Diabetes Mellitus: A Multicenter Study. PLoS One 2015; 10:e0127411. [PMID: 26020231 PMCID: PMC4447271 DOI: 10.1371/journal.pone.0127411] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/14/2015] [Indexed: 01/04/2023] Open
Abstract
Introduction Whether diabetes mellitus increases the risk of acute kidney injury (AKI) during sepsis is controversial. Materials and Methods We used a case-control design to compare the frequency of AKI, use of renal replacement therapy (RRT), and renal recovery in patients who had severe sepsis or septic shock with or without diabetes. The data were from the Outcomerea prospective multicenter database, in which 12 French ICUs enrolled patients admitted between January 1997 and June 2009. Results First, we compared 451 patients with severe sepsis or septic shock and diabetes to 3,277 controls with severe sepsis or septic shock and without diabetes. Then, we compared 318 cases (with diabetes) to 746 matched controls (without diabetes). Diabetic patients did not have a higher frequency of AKI (hazard ratio [HR], 1.18; P = 0.05]) or RRT (HR, 1.09; P = 0.6). However, at discharge, diabetic patients with severe sepsis or septic shock who experienced acute kidney injury during the ICU stay and were discharged alive more often required RRT (9.5% vs. 4.8%; P = 0.02), had higher serum creatinine values (134 vs. 103 µmoL/L; P<0.001) and had less often recovered a creatinine level less than 1.25 fold the basal creatinine (41.1% vs. 60.5%; P<0.001). Conclusions In patients with severe sepsis or septic shock, diabetes is not associated with occurrence of AKI or need for RRT but is an independent risk factor for persistent renal dysfunction in patients who experience AKI during their ICU stay.
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Affiliation(s)
- Marion Venot
- Service de Réanimation Médicale, AP-HP, Hôpital Saint-Louis, Paris, France
- * E-mail:
| | - Lise Weis
- Service de Médecine Vasculaire et Hypertension artérielle, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Christophe Clec’h
- Service de Réanimation, AP-HP, Hôpital Avicenne, Paris, France
- Faculté de Médecine, Université Paris 13, Bobigny, France
| | - Michael Darmon
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
- Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France
| | - Bernard Allaouchiche
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire Edouard Herriot, Lyon, France
| | | | - Maité Garrouste-Orgeas
- Service de Réanimation Polyvalente, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | | | - Jean-François Timsit
- Service de Réanimation Polyvalente, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
- U 823, Université de Grenoble 1, Grenoble, France
| | - Elie Azoulay
- Service de Réanimation Médicale, AP-HP, Hôpital Saint-Louis, Paris, France
- Faculté de Médecine, Université Paris 5, Paris, France
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Burekovic A, Dizdarevic-Bostandzic A, Godinjak A. Poorly Regulated Blood Glucose in Diabetic Patients-predictor of Acute Infections. Med Arch 2014; 68:163-6. [PMID: 25568525 PMCID: PMC4240338 DOI: 10.5455/medarh.2014.68.163-166] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 04/18/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction: Diabetes mellitus, the most frequent endocrinology disease is a predisposing factor for infections. Diabetic patients have 4,4 times greater risk of systemic infection than non diabetics. Aim: a) To determine the prevalence and characteristics of acute infectious diseases in hospitalized diabetics; b) To correlate values of blood glucose levels and HbA1c with acute infections in hospitalized diabetics; c) To identify the etiology of infectious diseases. Material and methods: The study included 450 diabetic patients hospitalized in the 24-month period in the Intensive care unit of the Clinic for Endocrinology, Diabetes and Metabolic Disorders CCUS. In 204 patients (45,3%) there was an acute infectious condition and the following data was registered: a) gender and age; b) basic illness; c) laboratory parameters of inflammation (Le, CRP); d) blood glucose upon admission, parameters of glucoregulation (HbA1c, fructosamine); e) type of infection; f) verification of etiological agent; g) late complications of diabetes; and h) outcome. Results: Out of 204 diabetic patients with infection, there was 35,3% men and 64,7% women. More than half of patients (61%) were in the age group 61-80 years. The most common primary disease was Diabetes mellitus type 2. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection compared to diabetics without acute infection. There is a positive correlation between HbA1c levels and CRP, and blood glucose and CRP in diabetic patients with acute infection. Most frequent infections: urinary tract infection (70,0%), followed by respiratory infections (11,8%), soft tissue infections (10,3%), generalized–bacteremia / sepsis (6,9%). The most common cause of urinary infection and generalized infection was Escherichia colli. The most common bacteria causing soft tissue infections was Staphylococcus aureus. Conclusion: Almost half (45,3%) of hospitalized diabetic patients had acute infectious condition. They present most frequently in women, aged 61-80 years, with Type 2 Diabetes mellitus. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection. There is a positive correlation between the parameters of inflammation and glucoregulation in diabetics with acute infection. Most frequent was a urinary tract infection and the most common causative agent was Escherichia coli. The most common cause of soft tissue infections was Staphylococcus aureus. Out of 21 patients with verified soft tissue infections, 18 of them (85,7%) had confirmed diagnosis of diabetic microangiopathy diabetica. A total of 96,1% of patients fully recovered.
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Affiliation(s)
- Azra Burekovic
- Clinic for endocrinology, diabetes and metabolic disorders, Clinical center of University of Sarajevo, Bosnia and Herzegovina
| | - Amela Dizdarevic-Bostandzic
- Clinic for endocrinology, diabetes and metabolic disorders, Clinical center of University of Sarajevo, Bosnia and Herzegovina
| | - Amina Godinjak
- Medical Intensive Care Unit, Clinical center of University of Sarajevo, Bosnia and Herzegovina
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Diabetes and hemoglobin a1c as risk factors for nosocomial infections in critically ill patients. Crit Care Res Pract 2013; 2013:279479. [PMID: 24459586 PMCID: PMC3891611 DOI: 10.1155/2013/279479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/17/2013] [Accepted: 10/09/2013] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED Objective. To evaluate whether diabetes mellitus (DM) and hemoglobin A1c (HbA1c) are risk factors for ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) in critically ill patients. Methods. Prospective observational study; patients were recruited from the intensive care unit (ICU) of a general district hospital between 2010 and 2012. INCLUSION CRITERIA ICU hospitalization >72 hours and mechanical ventilation >48 hours. HbA1c was calculated for all participants. DM, HbA1c, and other clinical and laboratory parameters were assessed as risk factors for VAP or BSI in ICU. Results. The overall ICU incidence of VAP and BSI was 26% and 30%, respectively. Enteral feeding OR (95%CI) 6.20 (1.91-20.17; P = 0.002) and blood transfusion 3.33 (1.23-9.02; P = 0.018) were independent risk factors for VAP. BSI in ICU (P = 0.044) and ICU mortality (P = 0.038) were significantly increased in diabetics. Independent risk factors for BSI in ICU included BSI on admission 2.45 (1.14-5.29; P = 0.022) and stroke on admission2.77 (1.12-6.88; P = 0.029). Sepsis 3.34 (1.47-7.58; P = 0.004) and parenteral feeding 6.29 (1.59-24.83; P = 0.009) were independently associated with ICU mortality. HbA1c ≥ 8.1% presented a significant diagnostic performance in diagnosing repeated BSI in ICU. Conclusion. DM and HbA1c were not associated with increased VAP or BSI frequency. HbA1c was associated with repeated BSI episodes in the ICU.
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McKane CK, Marmarelis M, Mendu ML, Moromizato T, Gibbons FK, Christopher KB. Diabetes mellitus and community-acquired bloodstream infections in the critically ill. J Crit Care 2013; 29:70-6. [PMID: 24090695 DOI: 10.1016/j.jcrc.2013.08.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/18/2013] [Accepted: 08/27/2013] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Community-acquired bloodstream infections have not been studied related to diabetes mellitus in the critically ill. HYPOTHESIS We hypothesized that the diagnosis of diabetes mellitus and poor chronic glycemic control would increase the risk of community-acquired bloodstream infections (CA-BSIs) in the critically ill. METHODS We performed an observational cohort study between 1998 and 2007 in 2 teaching hospitals in Boston, Massachusetts. We studied 2551 patients 18 years or older, who received critical care within 48 hours of admission and had blood cultures obtained within 48 hours of admission. The exposure of interest was diabetes mellitus defined by International Classification of Diseases, Ninth Revision, Clinical Modification, code 250.xx in outpatient or inpatient records. The primary end point was CA-BSI (<48 hours of hospital admission). Patients with a single coagulase-negative Staphylococcus positive blood culture were not considered to have bloodstream infection. Associations between diabetes groups and bloodstream infection were estimated by bivariable and multivariable logistic regression models. Subanalyses included evaluation of the association between hemoglobin A1c (HbA1c) and bloodstream infection, diabetes and risk of sepsis, and the proportion of the association between diabetes and CA-BSI that was mediated by acute glycemic control. RESULTS Diabetes is a predictor of CA-BSI. After adjustment for age, sex, race, patient type (medical vs surgical), and acute organ failure, the risk of bloodstream infection was significantly higher in patients with diabetes (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.10-1.82; P = .006) relative to patients without diabetes. The adjusted risk of bloodstream infection was increased in patients with HbA1c of 6.5% or higher (OR, 1.31; 95% CI, 1.04-1.65; P = .02) relative to patients with HbA1c less than 6.5%. Furthermore, the adjusted risk of sepsis was significantly higher in patients with diabetes (OR, 1.26; 95% CI, 1.04-1.54; P = .02) relative to patients without diabetes. Maximum glucose did not significantly mediate the relationship between diabetes mellitus diagnosis and CA-BSI. CONCLUSIONS A diagnosis of diabetes mellitus and HbA1c of 6.5% or higher is associated with the risk of CA-BSI in the critically ill.
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Affiliation(s)
- Caitlin K McKane
- Department of Nursing, Brigham and Women's Hospital, Boston, MA, USA
| | - Melina Marmarelis
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mallika L Mendu
- Renal Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Takuhiro Moromizato
- The Nathan E. Hellman Memorial Laboratory, Renal Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Fiona K Gibbons
- Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth B Christopher
- The Nathan E. Hellman Memorial Laboratory, Renal Division, Brigham and Women's Hospital, Boston, MA, USA.
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Gender differences in risk of bloodstream and surgical site infections. J Gen Intern Med 2013; 28:1318-25. [PMID: 23605308 PMCID: PMC3785652 DOI: 10.1007/s11606-013-2421-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/17/2012] [Accepted: 03/13/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Identifying patients most at risk for hospital- and community-associated infections is one essential strategy for preventing infections. OBJECTIVE To investigate whether rates of community- and healthcare-associated bloodstream and surgical site infections varied by patient gender in a large cohort after controlling for a wide variety of possible confounders. DESIGN Retrospective cohort study. PARTICIPANTS All patients discharged from January 1, 2006 through December 31, 2008 (133,756 adult discharges and 66,592 pediatric discharges) from a 650-bed tertiary care hospital, a 220-bed community hospital, and a 280-bed pediatric acute care hospital within a large, academic medical center in New York, NY. MAIN MEASURES Data were collected retrospectively from various electronic sources shared by the hospitals and linked using patients' unique medical record numbers. Infections were identified using previously validated computerized algorithms. KEY RESULTS Odds of community-associated bloodstream infections, healthcare-associated bloodstream infections, and surgical site infections were significantly lower for women than for men after controlling for present-on-admission patient characteristics and events during the hospital stay [odds ratios (95 % confidence intervals) were 0.85 (0.77-0.93), 0.82 (0.74-0.91), and 0.78 (0.68-0.91), respectively]. Gender differences were greatest for older adolescents (12-17 years) and adults 18-49 years and least for young children (<12 years) and older adults (≥ 70 years). CONCLUSIONS In this cohort, men were at higher risk for bloodstream and surgical site infections, possibly due to differences in propensity for skin colonization or other anatomical differences.
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Karamanos E, Sivrikoz E, Beale E, Chan L, Inaba K, Demetriades D. Effect of Diabetes on Outcomes in Patients Undergoing Emergent Cholecystectomy for Acute Cholecystitis. World J Surg 2013; 37:2257-64. [DOI: 10.1007/s00268-013-2086-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Dandona P, Ghanim H, Green K, Sia CL, Abuaysheh S, Kuhadiya N, Batra M, Dhindsa S, Chaudhuri A. Insulin infusion suppresses while glucose infusion induces Toll-like receptors and high-mobility group-B1 protein expression in mononuclear cells of type 1 diabetes patients. Am J Physiol Endocrinol Metab 2013; 304:E810-8. [PMID: 23403945 DOI: 10.1152/ajpendo.00566.2012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The purpose of this study was to determine whether an insulin infusion exerts an anti-inflammatory effect and whether the infusion of small amounts of glucose results in oxidative and inflammatory stress in patients with type 1 diabetes. Ten patients with type 1 diabetes were infused with either 2 U/h of insulin with 100 ml 5% dextrose/h to or just dextrose (100 ml/h) or physiological saline (100 ml/h) for 4 h after an overnight fast on three separate days. Blood samples were collected at 0, 2, 4, and 6 h. Insulin with glucose infusion led to the maintenance of euglycemia and a significant suppression of reactive oxygen species (ROS) generation, p47(phox) expression, Toll-like receptor (TLR)-4, TLR-2, TLR-1, CD14, high-mobility group-B1 (HMGB1), p38 mitogen-activated protein (MAP) kinase, c-Jun NH2-terminal kinase (JNK)-1, and platelet/endothelial cell adhesion molecule expression and a fall in serum concentrations of C-reactive protein, HMGB1, and rapid upon activation T cell expressed and secreted. Glucose infusion led to an increase in plasma glucose concentration from 115 (fasting) to 215 (at 4 and 6 h) mg/dl and to an increase in ROS generation, the expression of TLR-4, TLR-2, TLR-1, HMGB1, p38 MAP kinase, and JNK-1, and plasma concentrations of HMGB1. While insulin reduces indexes of oxidative and inflammatory stress in patients with type 1 diabetes, even small amounts of glucose (20 g over 4 h) induce oxidative and inflammatory stress. These effects are reflected in TLR, p38 MAP kinase, and HMGB1 expression. The induction of significant oxidative and inflammatory stress by small amounts of glucose in patients with type 1 diabetes may have important pathophysiological and therapeutic implications.
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Affiliation(s)
- Paresh Dandona
- Division of Endocrinology, Diabetes, and Metabolism, State University of New York at Buffalo and Kaleida Health, Buffalo, NY 14209, USA.
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29
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Is diabetes a risk factor for central venous access port-related bloodstream infection in oncological patients? Eur J Clin Microbiol Infect Dis 2012; 32:133-8. [DOI: 10.1007/s10096-012-1728-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 08/08/2012] [Indexed: 01/09/2023]
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Koh GCKW, Peacock SJ, van der Poll T, Wiersinga WJ. The impact of diabetes on the pathogenesis of sepsis. Eur J Clin Microbiol Infect Dis 2012; 31:379-88. [PMID: 21805196 PMCID: PMC3303037 DOI: 10.1007/s10096-011-1337-4] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 06/21/2011] [Indexed: 02/06/2023]
Abstract
Diabetes is associated with an increased susceptibility to infection and sepsis. Conflicting data exist on whether the mortality of patients with sepsis is influenced by the presence of diabetes, fuelling the ongoing debate on the benefit of tight glucose regulation in patients with sepsis. The main reason for which diabetes predisposes to infection appears to be abnormalities of the host response, particularly in neutrophil chemotaxis, adhesion and intracellular killing, defects that have been attributed to the effect of hyperglycaemia. There is also evidence for defects in humoral immunity, and this may play a larger role than previously recognised. We review the literature on the immune response in diabetes and its potential contribution to the pathogenesis of sepsis. In addition, the effect of diabetes treatment on the immune response is discussed, with specific reference to insulin, metformin, sulphonylureas and thiazolidinediones.
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Affiliation(s)
- G C K W Koh
- The Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK.
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Abstract
OBJECTIVE To review the current knowledge of common comorbidities in the intensive care unit, including diabetes mellitus, chronic obstructive pulmonary disease, cancer, end-stage renal disease, end-stage liver disease, HIV infection, and obesity, with specific attention to epidemiology, contribution to diseases and outcomes, and the impact on treatments in these patients. DATA SOURCE Review of the relevant medical literature for specific common comorbidities in the critically ill. RESULTS Critically ill patients are admitted to the intensive care unit for various reasons, and often the admission diagnosis is accompanied by a chronic comorbidity. Chronic comorbid conditions commonly seen in critically ill patients may influence the decision to provide intensive care unit care, decisions regarding types and intensity of intensive care unit treatment options, and outcomes. The presence of comorbid conditions may predispose patients to specific complications or forms of organ dysfunction. The impact of specific comorbidities varies among critically ill medical, surgical, and other populations, and outcomes associated with certain comorbidities have changed over time. Specifically, outcomes for patients with cancer and HIV have improved, likely related to advances in therapy. Overall, the negative impact of chronic comorbidity on survival in critical illness may be primarily influenced by the degree of organ dysfunction or the cumulative severity of multiple comorbidities. CONCLUSION Chronic comorbid conditions are common in critically ill patients. Both the acute illness and the chronic conditions influence prognosis and optimal care delivery for these patients, particularly for adverse outcomes and complications influenced by comorbidities. Further work is needed to fully determine the individual and combined impact of chronic comorbidities on intensive care unit outcomes.
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Siegelaar SE, Hoekstra JBL, DeVries JH. Special considerations for the diabetic patient in the ICU; targets for treatment and risks of hypoglycaemia. Best Pract Res Clin Endocrinol Metab 2011; 25:825-34. [PMID: 21925081 DOI: 10.1016/j.beem.2011.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Due to the diabetes pandemic the number of diabetic patients admitted to the intensive care unit (ICU) increases. Diabetic patients admitted to the ICU are more vulnerable for developing complications as compared to non-diabetic patients, but this does not directly translate into higher mortality rates. However, mortality might differ per admission diagnosis. Hyperglycaemia is common in diabetic as well as non-diabetic critically ill patients, but probably chronic hyperglycaemia is pathophysiologically different from acute hyperglycaemia. As opposed to non-diabetic patients, there is discussion about the association between hyperglycaemia and mortality in diabetic patients. They do not seem to benefit from strict glycaemic control and also glucose variability appears less harmful, although clinical trials in diabetic populations have not been performed yet. Diabetes is a risk factor for hypoglycaemia and evidence suggests that even near-normal glucose levels are associated with worse outcome. Taking this together, it is suggested to strive for moderate targets when treating hyperglycaemia in critically ill diabetic patients.
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Affiliation(s)
- Sarah E Siegelaar
- Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, Room F4-257, 1105 AZ Amsterdam, The Netherlands.
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Siegelaar SE, Hickmann M, Hoekstra JBL, Holleman F, DeVries JH. The effect of diabetes on mortality in critically ill patients: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R205. [PMID: 21914173 PMCID: PMC3334749 DOI: 10.1186/cc10440] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/20/2011] [Accepted: 09/13/2011] [Indexed: 12/21/2022]
Abstract
Introduction Critically ill patients with diabetes are at increased risk for the development of complications, but the impact of diabetes on mortality is unclear. We conducted a systematic review and meta-analysis to determine the effect of diabetes on mortality in critically ill patients, making a distinction between different ICU types. Methods We performed an electronic search of MEDLINE and Embase for studies published from May 2005 to May 2010 that reported the mortality of adult ICU patients. Two reviewers independently screened the resultant 3,220 publications for information regarding ICU, in-hospital or 30-day mortality of patients with or without diabetes. The number of deaths among patients with or without diabetes and/or mortality risk associated with diabetes was extracted. When only crude survival data were provided, odds ratios (ORs) and standard errors were calculated. Data were synthesized using inverse variance with ORs as the effect measure. A random effects model was used because of anticipated heterogeneity. Results We included 141 studies comprising 12,489,574 patients, including 2,705,624 deaths (21.7%). Of these patients, at least 2,327,178 (18.6%) had diabetes. Overall, no association between the presence of diabetes and mortality risk was found. Analysis by ICU type revealed a significant disadvantage for patients with diabetes for all mortality definitions when admitted to the surgical ICU (ICU mortality: OR [95% confidence interval] 1.48 [1.04 to 2.11]; in-hospital mortality: 1.59 [1.28 to 1.97]; 30-day mortality: 1.62 [1.13 to 2.34]). In medical and mixed ICUs, no effect of diabetes on all outcomes was found. Sensitivity analysis showed that the disadvantage in the diabetic surgical population was attributable to cardiac surgery patients (1.77 [1.45 to 2.16], P < 0.00001) and not to general surgery patients (1.21 [0.96 to 1.53], P = 0.11). Conclusions Our meta-analysis shows that diabetes is not associated with increased mortality risk in any ICU population except cardiac surgery patients.
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Affiliation(s)
- Sarah E Siegelaar
- Department of Internal Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Inappropriate intravascular device use: a prospective study. J Hosp Infect 2011; 78:128-32. [DOI: 10.1016/j.jhin.2011.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 03/02/2011] [Indexed: 11/18/2022]
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Affiliation(s)
- Philipp Schuetz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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36
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Infusion fluids contain harmful glucose degradation products. Intensive Care Med 2010; 36:1213-20. [PMID: 20397009 PMCID: PMC2882046 DOI: 10.1007/s00134-010-1873-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 03/07/2010] [Indexed: 01/04/2023]
Abstract
Purpose Glucose degradation products (GDPs) are precursors of advanced glycation end products (AGEs) that cause cellular damage and inflammation. We examined the content of GDPs in commercially available glucose-containing infusion fluids and investigated whether GDPs are found in patients’ blood. Methods The content of GDPs was examined in infusion fluids by high-performance liquid chromatography (HPLC) analysis. To investigate whether GDPs also are found in patients, we included 11 patients who received glucose fluids (standard group) during and after their surgery and 11 control patients receiving buffered saline (control group). Blood samples were analyzed for GDP content and carboxymethyllysine (CML), as a measure of AGE formation. The influence of heat-sterilized fluids on cell viability and cell function upon infection was investigated. Results All investigated fluids contained high concentrations of GDPs, such as 3-deoxyglucosone (3-DG). Serum concentration of 3-DG increased rapidly by a factor of eight in patients receiving standard therapy. Serum CML levels increased significantly and showed linear correlation with the amount of infused 3-DG. There was no increase in serum 3-DG or CML concentrations in the control group. The concentration of GDPs in most of the tested fluids damaged neutrophils, reducing their cytokine secretion, and inhibited microbial killing. Conclusions These findings indicate that normal standard fluid therapy involves unwanted infusion of GDPs. Reduction of the content of GDPs in commonly used infusion fluids may improve cell function, and possibly also organ function, in intensive-care patients. Electronic supplementary material The online version of this article (doi:10.1007/s00134-010-1873-x) contains supplementary material, which is available to authorized users.
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Siegelaar SE, Devries JH, Hoekstra JB. Patients with diabetes in the intensive care unit; not served by treatment, yet protected? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:126. [PMID: 20236468 PMCID: PMC2887115 DOI: 10.1186/cc8881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetes is associated with severe complications and decreased life expectancy. However, in the previous issue of Critical Care, Vincent and colleagues report no difference in mortality between patients with insulin-treated diabetes and patients without diabetes in the intensive care unit (ICU), despite larger severity of illness in the diabetes group at admission. This study contributes to the growing evidence that diabetes in itself is not a risk factor for ICU mortality, although the mechanisms are not yet fully understood. On the other hand, patients with diabetes seem not to benefit from tight glycemic control during their ICU stay. Different treatment approaches may be needed for patients with diabetes and patients with stress hyperglycemia.
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Affiliation(s)
- Sarah E Siegelaar
- Academic Medical Centre, Department of Internal Medicine, Meibergdreef 9, Amsterdam, The Netherlands.
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Abstract
OBJECTIVE Chronic diabetes mellitus (DM) is a known cause of multisystem injury. The effect of DM in acute critical illness may also be detrimental, but is not specifically known. We hypothesized that the preexisting diagnosis of DM is an independent risk factor for mortality in critically ill patients. DESIGN Parallel retrospective and prospective cohort study. SETTING Two large patient datasets were used: the retrospective University HealthSystem Consortium database (UHC) and the prospective Mayo Clinic Acute Physiology And Chronic Health Evaluation III critical care database (Mayo). PATIENTS Inclusion criteria were admission to an intensive care unit and age > or =18 yrs. Patients with diabetic ketoacidosis or hyperosmolar nonketotic coma were excluded. A total of 1,509,890 patients (including 143,078 deaths) in the UHC cohort and 36,414 patients (including 3562 deaths) in the Mayo cohort were included in the study analysis. MEASUREMENTS AND MAIN RESULTS The primary outcome was in-hospital mortality compared between patients with a history of DM and all other patients. Other outcomes included in-hospital mortality in prespecified subgroups. In the UHC dataset, patients with DM had a lower unadjusted odds ratio (0.90, 95% confidence interval 0.89-0.91, p < .001) and a lower adjusted effect on mortality (odds ratio 0.75, 0.74-0.76, p < .001) compared with that seen in patients without DM. In the Mayo dataset, patients with DM had a comparable unadjusted odds ratio (1.07, 0.97-1.17, p = NS) and a lower adjusted effect on mortality (odds ratio 0.88, 0.79-0.98, p = .022) compared with that seen in patients without DM. A lower mortality in diabetic patients held across multiple demographic subgroups, including patients who underwent coronary-artery bypass grafting (UHC data: unadjusted odds ratio 0.66, 0.62-0.71, p < .001). CONCLUSIONS Critically ill adults with DM do not have an increased mortality compared with that seen in patients without DM, and may have a decreased mortality. Further investigation needs to be done to determine the mechanism for this effect.
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Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Lemaire F, Gerlach H, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Pugin J, Wernerman J, Zhang H. Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control. Intensive Care Med 2010; 36:196-209. [PMID: 20057995 PMCID: PMC2816797 DOI: 10.1007/s00134-009-1742-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 12/18/2009] [Indexed: 12/17/2022]
Affiliation(s)
- Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy.
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