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Li J, Li G, Liu Z, Yang X, Yang Q. Prediction models for the risk of ventilator-associated pneumonia in patients on mechanical ventilation: A systematic review and meta-analysis. Am J Infect Control 2024:S0196-6553(24)00605-9. [PMID: 39025304 DOI: 10.1016/j.ajic.2024.07.006] [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: 04/25/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Identifying patients at risk of ventilator-associated pneumonia through prediction models can facilitate medical decision-making. Our objective was to evaluate the current models for ventilator-associated pneumonia in patients with mechanical ventilation. METHODS Nine databases systematically retrieved from establishment to March 6, 2024. Two independent reviewers performed study selection, data extraction, and quality assessment, respectively. The Prediction Model Risk of Bias Assessment Tool was used to evaluate the risk of model bias and applicability. Stata 17.0 was used to conduct a meta-analysis of discrimination of model validation. RESULTS The total of 34 studies were included, with reported 52 prediction models. The most frequent predictors in the models were mechanical ventilation duration, length of intensive care unit stay, and age. Each study was essentially considered having a high risk of bias. A meta-analysis of 17 studies containing 33 models with validation was performed with a pooled area under the receiver-operating curve of 0.80 (95% confidence interval: 0.78-0.83). CONCLUSIONS Despite the relatively excellent performance of the models, there is a high risk of bias of the model development process. Enhancing the methodological quality, especially the external validation, practical application, and optimization of the models need urgent attention.
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Affiliation(s)
- Jiaying Li
- School of Nursing, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Guifang Li
- Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
| | - Ziqing Liu
- School of Nursing, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xingyu Yang
- School of Nursing, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qiuyan Yang
- School of Nursing, Ningxia Medical University, Yinchuan, Ningxia, China
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2
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Kouroupis PC, O'Rourke N, Kelly S, McKittrick M, Noppe E, Reyes LF, Rodriguez A, Martin-Loeches I. Hospital-acquired bacterial pneumonia in critically ill patients: from research to clinical practice. Expert Rev Anti Infect Ther 2024; 22:423-433. [PMID: 38743435 DOI: 10.1080/14787210.2024.2354828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/09/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Hospital-acquired pneumonia (HAP) represents a significant cause of mortality among critically ill patients admitted to Intensive Care Units (ICUs). Timely and precise diagnosis is imperative to enhance therapeutic efficacy and patient outcomes. However, the diagnostic process is challenged by test limitations and a wide-ranging list of differential diagnoses, particularly in patients exhibiting escalating oxygen requirements, leukocytosis, and increased secretions. AREAS COVERED This narrative review aims to update diagnostic modalities, facilitating the prompt identification of nosocomial pneumonia while guiding, developing, and assessing therapeutic interventions. A comprehensive literature review was conducted utilizing the MEDLINE/PubMed database from 2013 to April 2024. EXPERT OPINION An integrated approach that integrates clinical, microbiological, and imaging tools is paramount. Progress in diagnostic techniques, including novel molecular methods, the expanding utilization and accuracy of bedside ultrasound, and the emergence of Artificial Intelligence, coupled with an improved comprehension of lung microbiota and host-pathogen interactions, continues to enhance our capability to accurately and swiftly identify HAP and its causative agents. This advancement enables the refinement of treatment strategies and facilitates the implementation of precision medicine approaches.
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Affiliation(s)
- Pompeo Costantino Kouroupis
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland
| | - Niall O'Rourke
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland
| | - Sinead Kelly
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland
| | - Myles McKittrick
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland
| | - Elne Noppe
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland
| | - Luis F Reyes
- Department of Intensive Care Medicine, Unisabana Center for Translational Science, Chia, Colombia
- Department of Intensive Care Medicine, Clinica Universidad de La Sabana, Chia, Colombia
- Department of Intensive Care Medicine, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Alejandro Rodriguez
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Department of Intensive Care Medicine, URV/IISPV/CIBERES, Tarragona, Spain
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland
- Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
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Miron M, Blaj M, Ristescu AI, Iosep G, Avădanei AN, Iosep DG, Crișan-Dabija R, Ciocan A, Perțea M, Manciuc CD, Luca Ș, Grigorescu C, Luca MC. Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia: A Literature Review. Microorganisms 2024; 12:213. [PMID: 38276198 PMCID: PMC10820465 DOI: 10.3390/microorganisms12010213] [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: 01/04/2024] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Hospital-acquired pneumonia (HAP) and its subtype, ventilator-associated pneumonia (VAP), remain two significant causes of morbidity and mortality worldwide, despite the better understanding of pathophysiological mechanisms, etiology, risk factors, preventive methods (bundle of care principles) and supportive care. Prior detection of the risk factors combined with a clear clinical judgement based on clinical scores and dosage of different inflammatory biomarkers (procalcitonin, soluble triggering receptor expressed on myelloid cells type 1, C-reactive protein, mid-regional pro-adrenomedullin, mid-regional pro-atrial natriuretic peptide) represent the cornerstones of a well-established management plan by improving patient's outcome. This review article provides an overview of the newly approved terminology considering nosocomial pneumonia, as well as the risk factors, biomarkers, diagnostic methods and new treatment options that can guide the management of this spectrum of infections.
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Affiliation(s)
- Mihnea Miron
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
| | - Mihaela Blaj
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Anesthesiology and Intensive Care Unit, “Sf. Spiridon” Hospital, 700111 Iasi, Romania
| | - Anca Irina Ristescu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Anesthesiology and Intensive Care Unit, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Gabriel Iosep
- Anesthesiology and Intensive Care Unit, Clinical Hospital of Pneumology, 700182 Iasi, Romania;
| | - Andrei-Nicolae Avădanei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
| | - Diana-Gabriela Iosep
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
| | - Radu Crișan-Dabija
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Pulmonology Department, Clinical Hospital of Pneumology, 700182 Iasi, Romania
| | | | - Mihaela Perțea
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Department of Surgery 1, “Sf. Spiridon” Hospital, 700111 Iasi, Romania
| | - Carmen Doina Manciuc
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Ștefana Luca
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
| | - Cristina Grigorescu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Thoracic Surgery Department, Clinical Hospital of Pneumology, 700182 Iasi, Romania
| | - Mihaela Cătălina Luca
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
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Gan W, Chen Z, Tao Z, Li W. Constructing a Nomogram Model to Estimate the Risk of Ventilator-Associated Pneumonia for Elderly Patients in the Intensive Care Unit. Adv Respir Med 2024; 92:77-88. [PMID: 38392034 PMCID: PMC10885902 DOI: 10.3390/arm92010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) causes heavy losses in terms of finances, hospitalization, and death for elderly patients in the intensive care unit (ICU); however, the risk is difficult to evaluate due to a lack of reliable assessment tools. We aimed to create and validate a nomogram to estimate VAP risk to provide early intervention for high-risk patients. METHODS Between January 2016 and March 2021, 293 patients from a tertiary hospital in China were retrospectively reviewed as a training set. Another 84 patients were enrolled for model validation from April 2021 to February 2022. Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis were employed to select predictors, and a nomogram model was constructed. The calibration, discrimination, and clinical utility of the nomogram were verified. Finally, a web-based online scoring system was created to make the model more practical. RESULTS The predictors were hypoproteinemia, long-term combined antibiotic use, intubation time, length of mechanical ventilation, and tracheotomy/intubation. The area under the curve (AUC) was 0.937 and 0.925 in the training and validation dataset, respectively, suggesting the model exhibited effective discrimination. The calibration curve demonstrated high consistency with the observed result and the estimated values. Decision curve analysis (DCA) demonstrated that the nomogram was clinically applicable. CONCLUSIONS We have created a novel nomogram model that can be utilized to anticipate VAP risk in elderly ICU patients, which is helpful for healthcare professionals to detect patients at high risk early and adopt protective interventions.
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Affiliation(s)
- Wensi Gan
- Department of Infection Control, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou 325001, China
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, and Center for Clinical Big Data and Statistics, The Second Hospital Affiliated to Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Zhihui Chen
- School of Public Health, Zhejiang University, Hangzhou 310058, China
| | - Zhen Tao
- Department of Intensive Care Unit, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou 325001, China
| | - Wenyuan Li
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, and Center for Clinical Big Data and Statistics, The Second Hospital Affiliated to Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China
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Bhowmick RS, Sarkar A, Ghosh S, Gope S, Chakraborty R. Postoperative pulmonary complication as an emerging complication in major head and neck cancer surgery: A retrospective study. Natl J Maxillofac Surg 2023; 14:471-476. [PMID: 38273923 PMCID: PMC10806327 DOI: 10.4103/njms.njms_399_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 01/27/2024] Open
Abstract
Purpose Postoperative pulmonary complications (PPCs) are one of the most significant complications following head and neck cancer surgery (HNCS). Patients requiring tracheostomy, free tissue transfer reconstruction, and postoperative ventilation in an intensive care unit (ICU) may have a high incidence of PPCs. This study aimed to identify the most likely situations for developing PPCs in HNCS. Materials and Methods A retrospective analysis of 40 patients who had undergone HNCS has been conducted. We individually traced each patient for 7 days postoperatively and collected data on various parameters. Result The incidence of PPCs after HNCS is more with free flap reconstruction. Patient-related risk factors with PPCs were advanced age, smoking, body mass index (BMI) >25, and bilateral or unilateral neck dissection. Postoperative ICU stay was significantly related to an increased incidence of PPCs. In terms of specific surgical sites, both the maxilla and mandible also showed significant relationship with PPCs. Tracheostomy was also considered a related factor in developing PPCs. Conclusion To reduce PPCs in HNCS, patients with one or more of these risk factors should be subjected to exaggerated postoperative pulmonary care.
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Affiliation(s)
- Ritoban S. Bhowmick
- Department of Oral and Maxillofacial Surgery and Head and Neck Oncology, AMRI Hospital, Dhakuria, West Bengal, India
| | - Aniket Sarkar
- Department of Oral and Maxillofacial Surgery, Guru Nanak Institute of Dental Sciences and Research, Panihati, Kolkata, West Bengal, India
| | - Samiran Ghosh
- Department of Oral and Maxillofacial Surgery, Guru Nanak Institute of Dental Sciences and Research, Panihati, Kolkata, West Bengal, India
| | - Shamik Gope
- Department of Oral and Maxillofacial Surgery and Head and Neck Oncology, AMRI Hospital, Dhakuria, West Bengal, India
| | - Rittika Chakraborty
- Department of Biostatistics and Demography, International Institute for Population Sciences, Mumbai, Maharashtra, India
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Hassan ME, Al-Khawaja SA, Saeed NK, Al-Khawaja SA, Al-Awainati M, Radhi SSY, Alsaffar MH, Al-Beltagi M. Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain: Prevalence and antibiotics susceptibility pattern. World J Crit Care Med 2023; 12:165-175. [PMID: 37397586 PMCID: PMC10308340 DOI: 10.5492/wjccm.v12.i3.165] [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: 12/23/2022] [Revised: 02/03/2023] [Accepted: 03/24/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that. It is the most common infection encountered among intubated patients. VAP incidence showed wide variability between countries.
AIM To define the VAP incidence in the intensive care unit (ICU) in the central government hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.
METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020. It included adult and adolescent patients (> 14 years old) admitted to the ICU and required intubation and mechanical ventilation. VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score, which considers the clinical, laboratory, microbiological, and radiographic evidence.
RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155. Forty-six patients developed VAP during their ICU stay (29.7%). The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period, with a mean age of 52 years ± 20. Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96 ± 6.55. Gram-negative contributed to most VAP cases in our unit, with multidrug-resistant Acinetobacter being the most identified pathogen.
CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark, which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.
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Affiliation(s)
- Mohamed Eliwa Hassan
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Safaa Abdulaziz Al-Khawaja
- Infectious Disease Unit, Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
- Medical Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Bahrain, Busiateen 15503, Muharraq, Bahrain
| | - Sana Abdulaziz Al-Khawaja
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Mahmood Al-Awainati
- Department of Family Medicine, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Sara Salah Yusuf Radhi
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Mohamed Hameed Alsaffar
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Manama, Bahrain
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Hegazy EE, Bahey MG, Abo Hagar AM, Elkholy AA, Mohamed EA. Carbapenem-Resistant Gram-Negative Bacilli Causing Ventilator Associated Pneumonia: Study of MASTDISCS Combi Carba Plus for Detection of Carbapenemase Producing Enterobacterales. Infect Drug Resist 2022; 15:6331-6342. [PMID: 36337932 PMCID: PMC9635390 DOI: 10.2147/idr.s385294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
Background Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria has been proven to be an escalating public health challenge in Egypt owing to its high mortality rate and raised health care costs. Purpose Detection of carbapenem-resistant gram-negative bacilli among VAP patients, genotypic identification of carbapenemase genes in the isolated strains with evaluation of their impact on patient outcome and detection of carbapenemase-producing enterobacterales by MASTDISCS combi Carba plus disc system. Methods Broncho-alveolar lavage fluid (BALF) and endotracheal aspirate were collected aseptically from clinically suspected VAP patients. Pathogen identification and antibiotic sensitivity testing were done. Carbapenemase-encoding genes (blaKPC, blaNDM, and blaOXA-48) were tested by PCR in all carbapenem-resistant gram-negative isolates. Performance of MASTDISCS combi Carba plus in isolated Enterobacterales was assessed in relation to the PCR results. Results Eighty-three carbapenem-resistant gram-negative isolates were detected. The most frequent pathogens were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa representing 34.9%, 20.5% and 18.1%, respectively. blaKPC was the predominant gene. Patients with persistent mechanical ventilation less than 15 days and Pseudomonas aeruginosa infection were significantly associated with a higher death rate. MAST-Carba plus had the highest sensitivity, specificity, positive and negative predictive values for detecting OXA-48 carbapenemases representing 81.8%, 92.5%, 75% and 94.9%, respectively. Conclusion Worse outcome in VAP patients was associated with carbapenem-resistant gram-negative bacilli. MASTDISCS combi Carba plus is an efficient simple method for identification of different carbapenemases among enterobacterales.
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Affiliation(s)
- Eman E Hegazy
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt,Correspondence: Eman E Hegazy, Tel +20 10 99008274, Email
| | - Marwa Gamal Bahey
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Alaa Mohammed Abo Hagar
- Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Esraa A Mohamed
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Marcus K, Sullivan CB, Al-Qurayshi Z, Buchakjian MR. Can Red Blood Cell Distribution Width Predict Laryngectomy Complications or Survival Outcomes? Ann Otol Rhinol Laryngol 2022; 131:1102-1108. [PMID: 34715735 DOI: 10.1177/00034894211056117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Red blood cell distribution width (RDW), a reported biomarker for morbidity and mortality in chronic disease and following certain surgeries, has not been well-studied in head and neck cancer patients. The aim of the study was to examine the association of RDW with postoperative complications and survival among patients who underwent primary or salvage laryngectomy. METHODS We analyzed a retrospective case series study of patients diagnosed with squamous cell carcinoma of the larynx treated with total laryngectomy. Survival outcomes were examined using Kaplan-Meier analysis. RESULTS One hundred seventy-seven patients were included in the final analysis. The most common tumor subsite was the supraglottis (60%). On bivariate analysis, patients with RDW ≥14.5 had higher prevalence of non-surgical, systemic complications, including deep venous thrombosis, pneumonia, cardiovascular events, and difficulty weaning from mechanical ventilation. However, there was no significant difference in laryngectomy-specific post-operative complications, including pharyngocutaneous fistula, wound infection, stoma complications, and chyle leak. RDW was not found to be associated with survival outcomes following laryngectomy. CONCLUSIONS Among laryngectomy patients, RDW ≥14.5 is associated with higher prevalence of systemic morbidity, but not with specific local surgical complications or decreased survival.
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Affiliation(s)
- Kathryn Marcus
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Marisa R Buchakjian
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Post-Operative Infections in Head and Neck Cancer Surgery: Risk Factors for Different Infection Sites. J Clin Med 2022; 11:jcm11174969. [PMID: 36078898 PMCID: PMC9456570 DOI: 10.3390/jcm11174969] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Post-operative infections in head and neck cancer (HNC) surgery represent a major problem and are associated with an important increase in mortality, morbidity, and burden on the healthcare system. The aim of this retrospective observational study was to evaluate post-operative infections in HNC surgery and to analyze risk factors, with a specific focus on different sites of infection. Methods: Clinical data about 488 HNC patients who underwent surgery were recorded. Univariate and multivariate analyses were performed to identify risk factors for post-operative infections. Results: Post-operative infections were observed in 22.7% of cases. Respiratory and surgical site infections were the most common. Multiple site infections were observed in 3.9% of cases. Considering all infection sites, advanced stage, tracheotomy, and higher duration of surgery were risk factors at multivariate analysis. Median hospital stay was significantly longer in patients who had post-operative infection (38 vs. 9 days). Conclusions: Post-operative infections may negatively affect surgical outcomes. A correct identification of risk factors may help the physicians to prevent post-operative infections in HNC surgery.
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Abstract
Severe pneumonia is associated with high mortality (short and long term), as well as pulmonary and extrapulmonary complications. Appropriate diagnosis and early initiation of adequate antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill patients. Identifying the underlying causative pathogen is also critical for antimicrobial stewardship. However, establishing an etiological diagnosis is challenging in most patients, especially in those with chronic underlying disease; those who received previous antibiotic treatment; and those treated with mechanical ventilation. Furthermore, as antimicrobial therapy must be empiric, national and international guidelines recommend initial antimicrobial treatment according to the location's epidemiology; for patients admitted to the intensive care unit, specific recommendations on disease management are available. Adherence to pneumonia guidelines is associated with better outcomes in severe pneumonia. Yet, the continuing and necessary research on severe pneumonia is expansive, inviting different perspectives on host immunological responses, assessment of illness severity, microbial causes, risk factors for multidrug resistant pathogens, diagnostic tests, and therapeutic options.
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Affiliation(s)
- Catia Cillóniz
- Department of pneumology, Hospital Clinic of Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Antoni Torres
- Department of pneumology, Hospital Clinic of Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Michael S Niederman
- Weill Cornell Medical College, Department of Pulmonary Critical Care Medicine, New York, NY, USA
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Assessing the Impact of Gender and COPD on the Incidence and Mortality of Hospital-Acquired Pneumonia. A Retrospective Cohort Study Using the Spanish National Discharge Database (2016-2019). J Clin Med 2021; 10:jcm10225453. [PMID: 34830733 PMCID: PMC8625205 DOI: 10.3390/jcm10225453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We aim to analyze incidence and outcomes of patients hospitalized with hospital-acquired pneumonia (HAP) according to chronic obstructive pulmonary disease (COPD) status and sex in Spain (2016-2019). METHODS We conducted a retrospective cohort study using national hospital discharge data of patients ≥40 years with a primary diagnosis of HAP, using the specific diagnostics of non-ventilator (NV)-HAP and ventilator-associated pneumonia (VAP). RESULTS We identified 37,029 patients with HAP ((NV)-HAP 87.28%, VAP 12.72%), 13.40% with COPD. HAP incidence increased over time, but only in subjects without COPD (p < 0.001). In women, incidence of HAP and (NV)-HAP was similar regardless of COPD status, but VAP incidence was lower in COPD women (p = 0.007). In men, the incidence of (NV)-HAP was significantly higher in those with COPD, while VAP incidence was lower in COPD men (p < 0.001). The in-hospital mortality (IHM) was similar in men and women with and without COPD. The risk of dying in hospital increased with age, congestive heart failure, cancer, and dialysis among men and women with COPD. Men that underwent surgery had a lower risk of IHM. VAP increased 2.58-times the probability of dying in men and women. Finally, sex was not associated with IHM among COPD patients. CONCLUSIONS Incidence of HAP was significantly higher in COPD patients than in those without COPD, at the expense of (NV)-HAP but not of VAP. When stratifying by sex, we found that the difference was caused by men. IHM was similar in COPD and non-COPD patients, with no significant change overtime. In addition, sex was not associated with IHM.
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Weber ML, Kaplow R. Complex Oncologic Surgeries and Implications for the Intensive Care Unit Nurse. AACN Adv Crit Care 2021; 32:297-305. [PMID: 34490449 DOI: 10.4037/aacnacc2021574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
There are many challenges in caring for the postsurgical patient in the intensive care unit. When the postsurgical patient has an active malignancy, this can make the intensive care unit care more challenging. Nutrition, infection, and the need for postoperative mechanical ventilatory support for the patient with cancer present challenges that may increase the patient's length of stay in the intensive care unit. Critical care nurses must be aware of these challenges as they provide care to this patient population.
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Affiliation(s)
- Michele L Weber
- Michele L. Weber is Clinical Nurse Specialist in Oncology Critical Care, The Ohio State University Wexner Medical Center and The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 460 West 10th Avenue, Columbus, OH 43210
| | - Roberta Kaplow
- Roberta Kaplow is Clinical Nurse Specialist, Emory University Hospital, Atlanta, Georgia
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Go BC, Chorath K, Frost AS, Moreira A, Cannady SB, Newman JG, Rajasekaran K. Intensive Care Versus Nonintensive Care Ward for Postoperative Management of Head and Neck Free Flaps: A Meta-Analysis. Facial Plast Surg Aesthet Med 2020; 23:408-416. [PMID: 33411570 DOI: 10.1089/fpsam.2020.0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Although advances in surgical technique and medical management have drastically improved outcomes of free flap reconstructive surgery in head and neck patients, there is no clear consensus on appropriate level of postoperative care. Methods: The literature was searched systematically for all comparative studies of intensive care unit (ICU) and non-ICU admissions for head and neck patients. The primary outcomes were flap failure rate, flap complications, and hospital length of stay (LOS). Secondary outcomes included cost implications, medical complications, and rates of revision surgery, readmission, and mortality. Results: Nine articles (2510 patients) were included. Patients admitted to non-ICU wards were not significantly at increased risk for free flap failure, flap-related complications, or longer LOS. Total medical complications were found to have a pooled relative risk (RR) of 0.57 [95% confidence interval (CI) 0.40 to 0.83], favoring the non-ICU cohort. In particular, the non-ICU cohort was less likely to develop neuropsychiatric complications (RR 0.34 [95% CI 0.24 to 0.48]) and sepsis (RR 0.18 [95% CI 0.05 to 0.68]) with no difference in cardiovascular or pulmonary complications. Discussion: Patients admitted to non-ICU wards did not experience higher rates of adverse flap-related outcomes and had decreased risk of developing medical complications in the studies included in this meta-analysis.
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Affiliation(s)
- Beatrice C Go
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Chorath
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ariel S Frost
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alvaro Moreira
- Division of Neonatology, Department of Pediatrics, University of Texas Health-San Antonio, San Antonio, Texas, USA
| | - Steven B Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason G Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Cornejo-Juárez P, González-Oros I, Mota-Castañeda P, Vilar-Compte D, Volkow-Fernández P. Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria. World J Crit Care Med 2020; 9:43-53. [PMID: 32844090 PMCID: PMC7416360 DOI: 10.5492/wjccm.v9.i3.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/22/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation (MV). The emergence of multidrug resistant bacteria (MDRB) has become a public health problem, creating a new burden on medical care in hospitals, particularly for patients admitted to the intensive care unit (ICU).
AIM To describe risk factors for ventilator-acquired pneumonia (VAP) in patients with cancer and to evaluate the impact of MDRB.
METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City, which included all patients who were admitted to the ICU and required MV ≥ 48 h. They were classified as those who developed VAP versus those who did not; pathogens isolated, including MDRB. Clinical evolution at 60-d was assessed. Descriptive analysis was carried out; comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.
RESULTS Two hundred sixty-three patients were included in the study; mean age was 51.9 years; 52.1% were male; 68.4% had solid tumors. There were 32 episodes of VAP with a rate of 12.2%; 11.5 episodes/1000 ventilation-days. The most frequent bacteria isolated were the following: Klebsiella spp. [n = 9, four were Extended-Spectrum Beta-Lactamase (ESBL) producers, one was Carbapenem-resistant (CR)]; Escherichia coli (n = 5, one was ESBL), and Pseudomonas aeruginosa (n = 8, two were CR). One Methicillin-susceptible Staphylococcus aureus was identified. In multivariate analysis, the sole risk factor associated for VAP was length of ICU stay (OR = 1.1; 95%CI: 1.03-1.17; P = 0.003). Sixty-day mortality was 53% in VAP and 43% without VAP (P = 0.342). There was not higher mortality in those patients with MDRB.
CONCLUSION This study highlights the high percentage of Gram-negative bacteria, which allows the initiation of empiric antibiotic coverage for these pathogens. In this retrospective, single center, observational study, MDRB VAP was not directly linked to increased mortality at 60 days.
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Affiliation(s)
- Patricia Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Ivan González-Oros
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Paola Mota-Castañeda
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Diana Vilar-Compte
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Patricia Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
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15
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Cornejo-Juárez P, González-Oros I, Mota-Castañeda P, Vilar-Compte D, Volkow-Fernández P. Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria. World J Crit Care Med 2020. [DOI: 10.5492/wjccm.v9.i3.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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16
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Nusrat T, Akter N, Rahman NAA, Godman B, D Rozario DT, Haque M. Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh. Hosp Pract (1995) 2020; 48:128-136. [PMID: 32271642 DOI: 10.1080/21548331.2020.1754687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), accounting for 25% of all ICU infections. Antimicrobial resistance is increasing and becoming a significant health problem worldwide, increasing hospital length of stay, mortality and costs. Identifying antibiotic resistance patterns in VAP is important as this can cause outbreaks in ICUs. To date, there have been limited studies assessing this in Bangladesh. Consequently, the primary objective of this research was to study the species of bacterial growth and to determine the antibiotic resistance patterns of Metallo-β-Lactamase (MBL) producing gram-negative bacilli among ICU patients with VAP in a public medical school hospital, Bangladesh. In addition, identify the factors associated with a positive culture to provide future guidance. METHOD Cross-sectional study performed in the Chattogram Medical College Hospital, Bangladesh. Mueller Hinton agar plates were used for antibiotic sensitivity testing by the Kirby-Buer disc diffusion test. RESULTS Among 105 clinically suspected VAP cases, qualitative cultures were positive in 95 (90%) of them. The most common bacteria identified were Acinetobacter spp. (43.2%), Klebsiella spp. (20%) and Pseudomonas spp. (18.9%). A positive culture was not associated with patients' age or gender. Among 41 isolated Acinetobacter spp., 38 (92.7%) were resistant to gentamicin followed by 36 (87.8%) to ceftriaxone. Among 24 isolated Klebsiella spp., 22 (83.3%) were resistant to ceftriaxone. Among 18 isolated Pseudomonas spp., 16 (88.8%) were resistant to ciprofloxacin, and 13 (72.2%) were resistant to ceftriaxone. Among nine isolated E. coli, all were resistant to ceftriaxone and ciprofloxacin. All four Proteus spp. (100%) isolated were resistant to ciprofloxacin. Additionally, phenotype MBL producing was 65.22% and genotype was 45.65% among imipenem resistant pathogens. Imipenem resistant pathogens were sensitive to amoxyclav, amikacin¸ azithromycin, ceftazidime, ceftriaxone, colistin and gentamycin. CONCLUSION A positive culture was detected in 90% of VAP patients, but it was not associated with the patients' age and gender. The most common bacteria identified were Acinetobacter spp., Klebsiella spp. and Pseudomonas spp., where the majority of these were resistant to ceftriaxone. The results are being used to provide future guidance on the empiric management of VAP in this hospital.
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Affiliation(s)
- Tanzina Nusrat
- Department of Microbiology, Chittagong Medical College , Panchlaish, Chattogram, Bangladesh
| | - Nasima Akter
- Department of Microbiology, Chittagong Medical College , Panchlaish, Chattogram, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia , Bandar Indera Mahkota, Kuantan, Malaysia
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow, UK
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University , Pretoria, South Africa
- Health Economics Centre, University of Liverpool , Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | | | - Mainul Haque
- Faculty of Medicine and Defense Health, Universiti Pertahanan Nasional Malaysia (National Defense University of Malaysia) , Kem Sungai Besi, Kuala Lumpur, Malaysia
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17
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Shaw LM, Iseli TA, Wiesenfeld D, Ramakrishnan A, Granger CL. Postoperative pulmonary complications following major head and neck cancer surgery. Int J Oral Maxillofac Surg 2020; 50:302-308. [PMID: 32682644 DOI: 10.1016/j.ijom.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/16/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
The primary aim of this observational study was to describe the incidence of postoperative pulmonary complications (PPCs) in 60 consecutive, surgically treated head and neck cancer patients requiring free flap reconstruction and tracheostomy, using both a prospective and a retrospective outcome measure. Secondary aims were to identify risk factors for PPC development, explore the effects of PPC on outcomes, and describe the provision of postoperative physiotherapy in this population. Postoperative pulmonary complications occurred in nine (15%) patients based on the Melbourne Group Scale and 27 (45%) patients based on Health Information Service coding data. The occurrence of a PPC was not statistically correlated with age, smoking history, comorbidities, operative time, or type of resection or free flap. Patients who developed a PPC, compared to those who did not, had a higher preoperative body mass index (P=0.022) and were more likely to be sat out of bed earlier post-surgery (P=0.038). Overall, patients required a median of 9.0 (interquartile range 7.0-11.0) physiotherapy sessions. Patients developing a PPC required significantly more physiotherapy sessions (P=0.007) and additional days of supplemental oxygen (P=0.022) as compared to those without a PPC, despite a similar hospital length of stay. In future, targeted physiotherapy interventions may reduce PPCs in this population.
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Affiliation(s)
- L M Shaw
- Department of Allied Health (Physiotherapy), The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - T A Iseli
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - D Wiesenfeld
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - A Ramakrishnan
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia; Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - C L Granger
- Department of Allied Health (Physiotherapy), The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
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18
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Wu D, Wu C, Zhang S, Zhong Y. Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients. Front Pharmacol 2019; 10:482. [PMID: 31143118 PMCID: PMC6521332 DOI: 10.3389/fphar.2019.00482] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/16/2019] [Indexed: 12/29/2022] Open
Abstract
Ventilator-associated pneumonia (VAP), a hospital acquired pneumonia that occurs more than 48 h after mechanical ventilation, is a common complication of mechanical ventilation with a high mortality rate. VAP can cause patients to have difficulty weaning off the ventilator and to stay in the hospital longer, which results in a huge financial burden to patients and a huge demand for medical resources. Several strategies, such as drugs including chlorhexidine, β-lactam antibiotics and probiotics, have been used to prevent VAP in clinic. The incidence and the mortality rate of VAP have been decreased with the development of preventative strategies in the past decades, but VAP remains one of the most common causes of nosocomial infections and death in the intensive care unit. Current challenges in the management of VAP involved the lack of a gold standard for diagnosis, the absence of effective preventative strategies, and the rise in antibiotic resistance. Therefore, in order to reduce the incidence of VAP and improve the outcome of patients with mechanical ventilation, it is necessary to clarify the risk factors of VAP for clinical prevention and control of VAP. This paper reviews the international risk factors of VAP occurrence reported in recent years, including patient characteristics, increased mechanical ventilation time and prolonged length of hospital stay, disorders of consciousness, burns, comorbidities, prior antibiotic therapy, invasive operations, gene polymorphisms, and mentions the corresponding preventive measures. Each factor is not only an independent risk factor of VAP, but also has an influence on each other. A better understanding of risk factors for VAP is helpful for predicting the occurrence of VAP, improving the prevention and control of VAP, and reducing the morbidity and mortality rates of patients with VAP.
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Affiliation(s)
- Diling Wu
- ICU Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chenfang Wu
- ICU Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Siye Zhang
- ICU Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanjun Zhong
- ICU Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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19
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Koulenti D, Parisella FR, Xu E, Lipman J, Rello J. The relationship between ventilator-associated pneumonia and chronic obstructive pulmonary disease: what is the current evidence? Eur J Clin Microbiol Infect Dis 2019; 38:637-647. [PMID: 30680576 DOI: 10.1007/s10096-019-03486-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/10/2019] [Indexed: 02/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) affects approximately 65 million people from which > 25% will require intensive care unit (ICU) admission. Ventilator-associated pneumonia (VAP) is the commonest ICU infection and results in increased morbidity/mortality and costs. The literature on the interaction between COPD and VAP is scarce and controversial. The project aimed to search the literature in order to address the following: (i) Is COPD a risk factor for VAP development? (ii) Does COPD impact the outcome of patients with VAP? (iii) Does VAP development impact the outcome of COPD patients? (iv) Does COPD impact the aetiology of VAP? Current evidence on the topic is controversial. Regarding the impact of VAP on COPD patients, the majority of the existing limited number of studies suggests that VAP development results in higher mortality and longer duration of mechanical ventilation and ICU stay. Also, the majority of the studies exploring the impact of COPD on VAP outcomes suggest that COPD is independently associated with a decrease in survival, although the number of such studies is limited. Regarding the aetiology, Pseudomonas aeruginosa is the most frequent pathogen in VAP patients with COPD. Noteworthy, one study suggests that P. aeruginosa is higher in COPD patients even in the early-onset VAP subgroup. This manuscript provides a comprehensive overview of the available literature on the interaction between COPD and VAP, highlighting the differences and limitations that may have led to controversial results, and it may act as a platform for further research with important clinical implications.
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Affiliation(s)
- Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Royal Brisbane Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Francesca Romana Parisella
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Elena Xu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Royal Brisbane Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jordi Rello
- Vall d'Hebron Institute of Research (VHIR) & CIBERES, Instituto Salud Carlos III, Barcelona, Spain
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20
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Battaglia CC, Hale K. Hospital-Acquired Infections in Critically Ill Patients With Cancer. J Intensive Care Med 2018; 34:523-536. [PMID: 30012057 DOI: 10.1177/0885066618788019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hospital-acquired infections are a common and costly problem facing critically ill patients in the intensive care unit (ICU). Critically ill patients with cancer are a particularly vulnerable subpopulation who possesses additional, nonmodifiable risk factors for developing these infections and, in many cases, are at increased risk of death as a result. This review will describe the most common nosocomial infections patients with cancer acquire while in the ICU: ventilator-associated events, central line-associated bloodstream infection, catheter-associated urinary tract infections, and Clostridium difficile infection.
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Affiliation(s)
| | - Kaye Hale
- 2 Anesthesia and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bartella AK, Sander AK, Kamal M, Steegmann J, Kloss-Brandstätter A, Teichmann J, Hölzle F, Lethaus B. Preoperative assessment of the risk of postoperative death in patients with oral squamous cell carcinoma: a consideration beyond age, sex, and stage of cancer. Br J Oral Maxillofac Surg 2018; 56:322-326. [PMID: 29628170 DOI: 10.1016/j.bjoms.2018.03.006] [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] [Received: 10/10/2017] [Accepted: 03/16/2018] [Indexed: 12/26/2022]
Abstract
Despite improvements in the management of patients in critical care, about 3% patients who have an operation with curative intent for oral squamous cell carcinoma (SCC) do not survive their stay in hospital. Our aim was to assess the risk factors for postoperative death that were independent of the stage of the cancer, or the age and sex of the patients. We screened 4760 consecutive inpatients at a maxillofacial tertiary care centre from 2011 to 2016, and 34 of them had died within the first three months after operation. We matched them with a further 34 patients with the same TNM stage, age, and sex. General personal and clinical data and preoperative laboratory values were screened, and we applied a Charlson Comorbidity Score (for anaesthetic risk) for each group. Patients' mean (SD) age was 66 (12) years old. There was no significant difference in sex (p=1), age (p=0.718), or TNM classification. Those who died after operation had significantly more renal (p=0.027) and gastrointestinal (p=0.006) diseases, but cardiac diseases (p=0.468) and diabetes mellitus (p=1) were not significant risk factors in themselves. Patients who died postoperatively had significantly worse risk scores (p=0.001) overall. The most common causes of death were septic shock (n=10) and acute cardiac (n=9) or respiratory failure (n=7). Our findings suggested that general diseases were not intrinsically a contraindication for operation with curative intent. The Charlson Comorbidity Score helped to detect potentially fatal courses and could be useful in the preoperative assessment of patients whose general health is not good.
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Affiliation(s)
- A K Bartella
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - A-K Sander
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - M Kamal
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - J Steegmann
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - A Kloss-Brandstätter
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany; Carinthia University of Applied Sciences, Europastrasse 4, 9524 Villach, Austria.
| | - J Teichmann
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - F Hölzle
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - B Lethaus
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
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Xu J, Hu J, Yu P, Wang W, Hu X, Hou J, Fang S, Liu X. Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases. PLoS One 2017; 12:e0188167. [PMID: 29135994 PMCID: PMC5685601 DOI: 10.1371/journal.pone.0188167] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/01/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Postoperative pneumonia (POP) is common and results in prolonged hospital stays, higher costs, increased morbidity and mortality. However, data on the incidence and risk factors of POP after oral and maxillofacial surgery are rare. This study aims to identify perioperative risk factors for POP after major oral cancer (OC) surgery. Methods Perioperative data and patient records of 331 consecutive subjects were analyzed in the period of April 2014 to March 2016. We individually traced each OC patient for a period to discharge from the hospital or 45 days after surgery, whichever occur later. Results The incidence of POP after major OC surgery with free flap construction or major OC surgery was 11.6% or 4.5%, respectively. Patient-related risk factors for POP were male sex, T stage, N stage, clinical stage and preoperative serum albumin level. Among the investigated procedure-related variables, incision grade, mandibulectomy, free flap reconstruction, tracheotomy, intraoperative blood loss, and the length of the operation were shown to be associated with the development of POP. Postoperative hospital stay was also significantly related to increased incidence of POP. Using a multivariable logistic regression model, we identified male sex, preoperative serum albumin level, operation time and postoperative hospital stay as independent risk factors for POP. Conclusion Several perioperative risk factors can be identified that are associated with POP. At-risk oral cancer patients should be subjected to intensified postoperative pulmonary care.
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Affiliation(s)
- Jieyun Xu
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Jing Hu
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Pei Yu
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Weiwang Wang
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Xingxue Hu
- Department of Immunology and Infectious Diseases, the Forsyth Institute, Cambridge, Massachusetts, United States of America
- Division of General Practice and Materials Science, the Ohio State University College of Dentistry, Columbus, Ohio, United States of America
| | - Jinsong Hou
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Silian Fang
- Department of Oral and Maxillofacial Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- * E-mail: (SF); (XL)
| | - Xiqiang Liu
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- * E-mail: (SF); (XL)
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Kanazawa Y, Takeuchi M, Tateya I, Omori K, Kawakami K. Clinical epidemiology of tracheal invasion from thyroid cancer in Japanese population: Functional outcomes and effect of aging. Cancer Epidemiol 2017; 50:107-112. [DOI: 10.1016/j.canep.2017.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/17/2017] [Accepted: 08/19/2017] [Indexed: 10/19/2022]
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