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Amadieu R, Brehin C, Chahine A, Grouteau E, Dubois D, Munzer C, Flumian C, Brissaud O, Ros B, Jean G, Brotelande C, Travert B, Savy N, Boeuf B, Ghostine G, Popov I, Duport P, Wolff R, Maurice L, Dauger S, Breinig S. Compliance with antibiotic therapy guidelines in french paediatric intensive care units: a multicentre observational study. BMC Infect Dis 2024; 24:582. [PMID: 38867164 PMCID: PMC11170905 DOI: 10.1186/s12879-024-09472-0] [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: 07/05/2023] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Bacterial infections (BIs) are widespread in ICUs. The aims of this study were to assess compliance with antibiotic recommendations and factors associated with non-compliance. METHODS We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme (ASP) organised once a week for the most part. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 h old, neonates < 37 weeks, age ≥ 18 years and children under surgical antimicrobial prophylaxis were excluded. RESULTS 139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% with no BI, 40.3% presumed (i.e., not documented) BI and 35.3% documented BI. Non-compliance with antibiotic recommendations occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%) and length of antibiotic therapy (18.0%). In multivariate analyses, the main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69-9.74, p = 0.0017), duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16-5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04-11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as "other" (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42-12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15-34.44, p = 0.0338) and ≥ 1 risk factor for extended-spectrum β-lactamase-producing Enterobacteriaceae (OR 2.56, 95%CI 1.07-6.14, p = 0.0353). Main independent factors for compliance were using antibiotic therapy protocols (OR 0.42, 95%CI 0.19-0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14-0.90, p = 0.0281) and aspiration pneumonia (OR 0.37, 95%CI 0.14-0.99, p = 0.0486). CONCLUSIONS Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a day-to-day basis the benefit of using several antimicrobials or any broad-spectrum antibiotics and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations. TRIAL REGISTRATION ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020.
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Affiliation(s)
- Romain Amadieu
- Neonatal and Paediatric Intensive Care Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse Cedex 9, 31059, France.
| | - Camille Brehin
- Paediatric Infectious Diseases Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
- General Paediatrics Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Adéla Chahine
- Neonatal and Paediatric Intensive Care Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse Cedex 9, 31059, France
| | - Erick Grouteau
- Paediatric Infectious Diseases Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
- General Paediatrics Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Damien Dubois
- Bacteriology-Hygiene Department, Toulouse University Hospital, Toulouse, France
| | - Caroline Munzer
- Paediatric Clinical Research Department, Children's Hospital, Equipe MéDatAS-CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Clara Flumian
- Paediatric Clinical Research Department, Children's Hospital, Equipe MéDatAS-CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Olivier Brissaud
- Neonatal and Paediatric Intensive Care Unit, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Barbara Ros
- Neonatal and Paediatric Intensive Care Unit, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Gael Jean
- Neonatal and Paediatric Intensive Care Unit, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Camille Brotelande
- Paediatric Intensive Care Unit, Arnaud de Villeneuve University Hospital, Montpellier University, Montpellier, France
| | - Brendan Travert
- Neonatal and Paediatric Intensive Care Unit, Mère-Enfant University Hospital, Nantes University, Nantes, France
| | - Nadia Savy
- Neonatal and Paediatric Intensive Care Unit, Estaing University Hospital, Clermont-Ferrand University, Clermont-Ferrand, France
| | - Benoit Boeuf
- Neonatal and Paediatric Intensive Care Unit, Estaing University Hospital, Clermont-Ferrand University, Clermont-Ferrand, France
| | - Ghida Ghostine
- Neonatal and Paediatric Intensive Care Unit, Amiens-Picardie University Hospital, Amiens University, Amiens, France
| | - Isabelle Popov
- Neonatal and Paediatric Intensive Care Unit, Amiens-Picardie University Hospital, Amiens University, Amiens, France
| | - Pauline Duport
- Neonatal and Paediatric Intensive Care Unit, Felix Guyon University Hospital, La Réunion University, Saint-Denis, Ile de la Réunion, France
| | - Richard Wolff
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Laure Maurice
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Stephane Dauger
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Sophie Breinig
- Neonatal and Paediatric Intensive Care Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse Cedex 9, 31059, France
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Lorente L, Sabater-Riera J, Rello J. Surveillance and prevention of healthcare-associated infections: best practices to prevent ventilator-associated events. Expert Rev Anti Infect Ther 2024; 22:317-332. [PMID: 38642072 DOI: 10.1080/14787210.2024.2345877] [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: 02/12/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Ventilator associated pneumonia (VAP) leads to an increase in morbidity, mortality, and healthcare costs. In addition to increased evidence from the latest European and American guidelines (published in 2017 and 2022, respectively), in the last two years, several important clinical experiences have added new prevention tools to be included to improve the management of VAP. AREAS COVERED This paper is a narrative review of new evidence on VAP prevention. We divided VAP prevention measures into pharmacological, non-pharmacological, and ventilator care bundles. EXPERT OPINION Most of the effective strategies that have been shown to decrease the incidence of complications are easy to implement and inexpensive. The implementation of care bundles, accompanied by educational measures and a multidisciplinary team should be part of optimal management. In addition to ventilator care bundles for the prevention of VAP, it could possibly be beneficial to use ventilator care bundles for the prevention of noninfectious ventilator associated events.
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Affiliation(s)
- Leonardo Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Spain
| | - Joan Sabater-Riera
- IDIBELL, Hospitalet de Llobregat, Spain, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Jordi Rello
- CRIPS (Clinical Research in Pneumonia & Sepsis); Vall d'Hebron Institute of Research, Barcelona, Spain
- Formation, Recherche, Evaluation (FOREVA), CHU Nîmes, Nîmes, France
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain
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3
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Cousin VL, Mwizerwa L, Joye R, Wagner N, Nalecz T, Bouhabib M, Sologashvili T, Wacker J, Schrenzel J, Beghetti M, Polito A. Significance of colonization by antibiotic-resistant organisms prior to congenital heart disease surgery in children from low- to middle-income countries sent by non-governmental organizations to Switzerland. Infection 2024:10.1007/s15010-024-02251-8. [PMID: 38634988 DOI: 10.1007/s15010-024-02251-8] [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: 02/04/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Children with congenital heart disease (CHD) from low- to middle-income countries (LMIC) are suspected to have a high prevalence of antibiotic-resistant microorganisms (ARMOs) carriage, but data are currently lacking. Carriage of ARMOs could impact the post-operative course in pediatric intensive care unit (PICU). The aim of the study was to assess the prevalence of ARMOs carriage in children with CHD from LMIC and its impact on post-operative outcomes. METHODS This was a retrospective monocentric study from 01/2019 to 12/2022. Included patients were children (0-18 years) from a LMIC admitted after CHD surgery and with AMRO screening performed the week before. Infections and post-operative evolution were compared based on ARMOs carriage status. FINDINGS Among 224 surgeries (median age 38.5 months (IQR 22-85.5)), ARMOs carriage was evidenced in 95 cases (42.4%). Main organisms isolated were Extended Spectrum Beta-Lactamase (ESBL) producing E. coli (75/224) 33.5%)) and ESBL-K. pneumoniae (30/224) 13.4%)). Median mechanical ventilation duration was 1 day (IQR 0-1), PICU stay 3 days (IQR 2-4) and hospital stay 6.5 days (IQR 5-10). A total of 17 infectious episodes occurred in 15 patients, mostly consisting in hospital-acquired pneumonia (HAP) (12/17). Only two infections were caused by a colonizing ARMO. Occurrence of infections and patients' outcome were similar between ARMO carriers and non-carriers. Higher use of carbapenems (6 (6.3%) vs 1 (0.8%), p = 0.04) and a trend to a higher use of vancomycin (14 (13.7%) vs 9 (6.9%), p = 0.04) in case of ARMOs carriage. Applying current guidelines, negative swab screening could have led to sparing most of empirical vancomycin therapy (11/12) for HAP based on current guidelines. CONCLUSION Prevalence of AMROs carriage is high in children from LMIC and has a limited impact on patients' outcome. However, ARMOs carriage leads to higher consumption of antibiotics. Screening may help saving use of broad-spectrum antibiotic in non-carrier patients.
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Affiliation(s)
- Vladimir L Cousin
- Paediatric Intensive Care Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva University of Medicine, Rue Gabrielle-Perret-Gentil 4, 1206, Geneva, Switzerland.
- Paediatric Cardiology Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland.
| | - Leonce Mwizerwa
- Paediatric Cardiology Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Raphael Joye
- Paediatric Cardiology Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Noémie Wagner
- Paediatric Infectiology Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Tomasz Nalecz
- Paediatric Cardiac Surgery Unit, Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Maya Bouhabib
- Paediatric Cardiology Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Tornike Sologashvili
- Paediatric Cardiac Surgery Unit, Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Julie Wacker
- Paediatric Cardiology Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Jacques Schrenzel
- Bacteriology and Genomic Research Laboratories, Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Maurice Beghetti
- Paediatric Cardiology Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Angelo Polito
- Paediatric Intensive Care Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva University of Medicine, Rue Gabrielle-Perret-Gentil 4, 1206, Geneva, Switzerland
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Poulain C, Launey Y, Bouras M, Lakhal K, Dargelos L, Crémet L, Gibaud SA, Corvec S, Seguin P, Rozec B, Asehnoune K, Feuillet F, Roquilly A. Clinical evaluation of the BioFire Respiratory Pathogen Panel for the guidance of empirical antimicrobial therapy in critically ill patients with hospital-acquired pneumonia: A multicenter, quality improvement project. Anaesth Crit Care Pain Med 2024; 43:101353. [PMID: 38355044 DOI: 10.1016/j.accpm.2024.101353] [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: 10/20/2023] [Revised: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND We aimed to determine whether implementing antimicrobial stewardship based on multiplex bacterial PCR examination of respiratory fluid can enhance outcomes of critically ill patients with hospital-acquired pneumonia (HAP). METHODS We conducted a quality improvement study in two hospitals in France. Adult patients requiring invasive mechanical ventilation with a diagnosis of HAP were included. In the pre-intervention period (August 2019 to April 2020), antimicrobial therapy followed European guidelines. In the «intervention» phase (June 2020 to October 2021), treatment followed a multiplex PCR-guided protocol. The primary endpoint was a composite endpoint made of mortality on day 28, clinical cure between days 7 and 10, and duration of invasive mechanical ventilation on day 28. The primary outcome was analyzed with a DOOR strategy. RESULTS A total of 443 patients were included in 3 ICUs from 2 hospitals (220 pre-intervention; 223 intervention). No difference in the ranking of the primary composite outcome was found (DOOR: 50.3%; 95%CI, 49.9%-50.8%). The number of invasive mechanical ventilation-free days at day 28 was 10.0 [0.0; 19.0] in the baseline period and 9.0 [0.0; 20.0] days during the intervention period (p = 0.95). The time-to-efficient antimicrobial treatment was 0.43 ± 1.29 days before versus 0.55 ± 1.13 days after the intervention (p = 0.56). CONCLUSION Implementation of Rapid Multiplex PCR to guide empirical antimicrobial therapy for critically ill patients with HAP was not associated with better outcomes. However, adherence to stewardship was low, and the study may have had limited power to detect a clinically important difference.
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Affiliation(s)
- Cécile Poulain
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France.
| | - Yoann Launey
- Univ Rennes, CHU Rennes, Department of Anaesthesia, Critical Care and Perioperative Medicine, F-35000 Rennes, France
| | - Marwan Bouras
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France
| | - Karim Lakhal
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France
| | - Laura Dargelos
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France
| | - Lise Crémet
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France; Nantes Université, CHU Nantes, Service de bactériologie-hygiène, pôle de biologie, Nantes, France
| | - Sophie-Anne Gibaud
- Nantes Université, CHU Nantes, Service de bactériologie-hygiène, pôle de biologie, Nantes, France
| | - Stéphane Corvec
- Nantes Université, CHU Nantes, Service de bactériologie-hygiène, pôle de biologie, Nantes, France
| | - Philippe Seguin
- Univ Rennes, CHU Rennes, Department of Anaesthesia, Critical Care and Perioperative Medicine, F-35000 Rennes, France
| | - Bertrand Rozec
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France
| | - Karim Asehnoune
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France
| | - Fanny Feuillet
- Nantes Université, CHU de Nantes, DRI, Département promotion, cellule vigilances, Nantes, France; Nantes Université, CHU de Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, Nantes, France
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France
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Li X, Cheng L, Liu X, Wang X, Li R, Fan S, Yan Q, Ma T, Ma Y, Kang J. Dopamine promotes Klebsiella quasivariicola proliferation and inflammatory response in the presence of macrophages. Front Cell Infect Microbiol 2024; 14:1322113. [PMID: 38585654 PMCID: PMC10995343 DOI: 10.3389/fcimb.2024.1322113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
Background Dopamine, a frequently used therapeutic agent for critically ill patients, has been shown to be implicated in clinical infections recently, however, the precise mechanisms underlying this association remain elusive. Klebsiella quasivariicola, a novel strain belonging to the Klebsiella species, exhibits potential pathogenic attributes. The impact of dopamine on K. quasivariicola infection has aroused our interest. Objective Considering the contribution of host immune factors during infection, this study aimed to investigate the intricate interactions between K. quasivariicola, dopamine, and macrophages were explored. Methods RAW264.7 cells and C57/BL6 mice were infected with K. quasivariicola, and the bacterial growth within macrophage, the production of inflammatory cytokines and the pathological changes in mice lungs were detected, in the absence or presence of dopamine. Results Dopamine inhibited the growth of K. quasivariicola in the medium, but promoted bacterial growth when co-cultured with macrophages. The expression of proinflammatory cytokines increased in RAW 264.7 cells infected with K. quasivariicola, and a significant rise was observed upon the addition of dopamine. The infection of K. quasivariicola in mice induced an inflammatory response and lung injury, which were exacerbated by the administration of dopamine. Conclusions Our findings suggest that dopamine may be one of the potential risk factors associated with K. quasivariicola infection. This empirical insight provides solid references for clinical precision medicine. Furthermore, an in vitro model of microbes-drugs-host immune cells for inhibitor screening was proposed to more accurately replicate the complex in vivo environment. This fundamental work had contributed to the present understanding of the crosstalk between pathogen, dopamine and host immune cells.
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Affiliation(s)
- Xiang Li
- College of Basic Medical Sciences, Dalian Medical University, Dalian, China
- Department of Pathology, Changzhi People’s Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Lin Cheng
- College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Xueyang Liu
- College of Basic Medical Sciences, Dalian Medical University, Dalian, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoli Wang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Rui Li
- College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Shao Fan
- College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Qiulong Yan
- College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Tonghui Ma
- School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yufang Ma
- College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Jian Kang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, China
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6
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Cousin VL, Joye R, Sologashvili T, Wacker J, Polito A. Nosocomial infections after cardiac surgery in children from low- to middle- income countries operated in West-Switzerland. Anaesth Crit Care Pain Med 2024; 43:101367. [PMID: 38460885 DOI: 10.1016/j.accpm.2024.101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Vladimir L Cousin
- Pediatric Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland; Pediatric Cardiology Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland.
| | - Raphael Joye
- Pediatric Cardiology Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Tornike Sologashvili
- Pediatric Cardiac Surgery Unit, Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Angelo Polito
- Pediatric Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
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7
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Guillamet CV, Kollef MH. Is Zero Ventilator-Associated Pneumonia Achievable? Updated Practical Approaches to Ventilator-Associated Pneumonia Prevention. Infect Dis Clin North Am 2024; 38:65-86. [PMID: 38040518 DOI: 10.1016/j.idc.2023.11.001] [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] [Indexed: 12/03/2023]
Abstract
Ventilator-associated pneumonia (VAP) remains a significant clinical entity with reported incidence rates of 7% to 15%. Given the considerable adverse consequences associated with this infection, VAP prevention became a core measure required in most US hospitals. Many institutions took pride in implementing effective VAP prevention bundles that combined at least head of bed elevation, hand hygiene, chlorhexidine oral care, and subglottic drainage. Spontaneous breathing and awakening trials have also consistently been shown to shorten the duration of mechanical ventilation and secondarily reduce the occurrence of VAP.
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Affiliation(s)
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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8
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Nesseler N, Mansour A, Schmidt M, Para M, Porto A, Falcoz PE, Mongardon N, Fougerou C, Ross JT, Beurton A, Gaide-Chevronnay L, Guinot PG, Lebreton G, Flecher E, Vincentelli A, Massart N. Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study. Crit Care 2024; 28:54. [PMID: 38374103 PMCID: PMC10877839 DOI: 10.1186/s13054-024-04832-3] [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: 12/20/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality. METHODS For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France. RESULTS Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79-1.26], p = 0.986). CONCLUSIONS In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020).
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Affiliation(s)
- Nicolas Nesseler
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France.
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), 35000, Rennes, France.
- Univ Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN - UMR_A 1341, UMR_S 1241, 35000, Rennes, France.
- Hôpital Pontchaillou, Pôle Anesthésie, SAMU, Urgences, Réanimations, Médecine Interne Et Gériatrie (ASUR-MIG), 2 Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.
| | - Alexandre Mansour
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, IRSET, UMR_S 1085, CIC 1414 (Centre d'Investigation Clinique de Rennes), 35000, Rennes, France
| | - Matthieu Schmidt
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, PARIS, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Marylou Para
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France
- Laboratory of Vascular Translational Science, University of Paris, UMR 1148, Paris, France
| | - Alizée Porto
- Department of Cardiac Surgery, Timone Hospital, APHM, 13005, Marseille, France
| | - Pierre-Emmanuel Falcoz
- INSERM, UMR 1260, Regenerative Nanomedicine (RNM), FMTS, 67000, Strasbourg, France
- Faculté de Médecine et Pharmacie, Université de Strasbourg, 67000, Strasbourg, France
- Hôpitaux Universitaire de Strasbourg, Service de Chirurgie Thoracique - Nouvel Hôpital Civil, Strasbourg, France
| | - Nicolas Mongardon
- Service d'anesthésie-Réanimation, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France
- Faculté de Santé, Univ Paris Est Créteil, 94010, Créteil, France
- U955-IMRB, Equipe 03 « Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT), Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), 94700, Maisons-Alfort, France
| | - Claire Fougerou
- Department of Clinical Pharmacology, University Hospital, Rennes 1 University, 35033, Rennes, France
- Inserm CIC 1414, Clinical Investigation Centre, University Hospital, Rennes 1 University, 35033, Rennes, France
| | - James T Ross
- Department of Surgery, University Hospitals Cleveland and Case Western Reserve University, Cleveland, USA
| | - Antoine Beurton
- Department of Anaesthesia and Critical Care, CHU Bordeaux, Magellan Medico-Surgical Centre, 33000, Bordeaux, France
- UMR 1034, Biology of Cardiovascular Diseases, Univ. Bordeaux, INSERM, 33600, Pessac, France
| | - Lucie Gaide-Chevronnay
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Grenoble, Grenoble, France
| | - Pierre-Grégoire Guinot
- Department of Anesthesiology and Critical Care Medicine, Dijon University Hospital, Dijon, France
| | - Guillaume Lebreton
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Erwan Flecher
- Department of Thoracic and Cardiovascular Surgery, Signal and Image Treatment Laboratory (LTSI), Pontchaillou University Hospital, University of Rennes 1, Inserm U1099, Rennes, France
| | - André Vincentelli
- Cardiac Surgery, Univ. Lille, CHU Lille, 59000, Lille, France
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000, Lille, France
| | - Nicolas Massart
- Intensive Care Unit, Centre Hospitalier Yves Le Foll, Saint-Brieuc, France
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Dhanani J, Roberts JA, Monsel A, Torres A, Kollef M, Rouby JJ. Understanding the nebulisation of antibiotics: the key role of lung microdialysis studies. Crit Care 2024; 28:49. [PMID: 38373973 PMCID: PMC10875779 DOI: 10.1186/s13054-024-04828-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Nebulisation of antibiotics is a promising treatment for ventilator-associated pneumonia (VAP) caused by multidrug-resistant organisms. Ensuring effective antibiotic concentrations at the site of infection in the interstitial space fluid is crucial for clinical outcomes. Current assessment methods, such as epithelial lining fluid and tissue homogenates, have limitations in providing longitudinal pharmacokinetic data. MAIN BODY Lung microdialysis, an invasive research technique predominantly used in animals, involves inserting probes into lung parenchyma to measure antibiotic concentrations in interstitial space fluid. Lung microdialysis offers unique advantages, such as continuous sampling, regional assessment of antibiotic lung concentrations and avoidance of bronchial contamination. However, it also has inherent limitations including the cost of probes and assay development, the need for probe calibration and limited applicability to certain antibiotics. As a research tool in VAP, lung microdialysis necessitates specialist techniques and resource-intensive experimental designs involving large animals undergoing prolonged mechanical ventilation. However, its potential impact on advancing our understanding of nebulised antibiotics for VAP is substantial. The technique may enable the investigation of various factors influencing antibiotic lung pharmacokinetics, including drug types, delivery devices, ventilator settings, interfaces and disease conditions. Combining in vivo pharmacokinetics with in vitro pharmacodynamic simulations can become feasible, providing insights to inform nebulised antibiotic dose optimisation regimens. Specifically, it may aid in understanding and optimising the nebulisation of polymyxins, effective against multidrug-resistant Gram-negative bacteria. Furthermore, lung microdialysis holds promise in exploring novel nebulisation therapies, including repurposed antibiotic formulations, bacteriophages and immunomodulators. The technique's potential to monitor dynamic biochemical changes in pneumonia, such as cytokines, metabolites and inflammation/infection markers, opens avenues for developing theranostic tools tailored to critically ill patients with VAP. CONCLUSION In summary, lung microdialysis can be a potential transformative tool, offering real-time insights into nebulised antibiotic pharmacokinetics. Its potential to inform optimal dosing regimen development based on precise target site concentrations and contribute to development of theranostic tools positions it as key player in advancing treatment strategies for VAP caused by multidrug-resistant organisms. The establishment of international research networks, exemplified by LUMINA (lung microdialysis applied to nebulised antibiotics), signifies a proactive step towards addressing complexities and promoting multicentre experimental studies in the future.
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Affiliation(s)
- Jayesh Dhanani
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Australia.
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Antoine Monsel
- Unité Mixte de Recherche (UMR)-S 959, Immunology-Immunopathology-Immunotherapy, Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne University, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), DMU DREAM, Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), University of Barcelona, Barcelona, Spain
| | - Marin Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean-Jacques Rouby
- Sorbonne University, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), DMU DREAM, Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
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10
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Liu RT, Zhang D, Li S, Chen Y, Wan XX, Diao ST, Weng L, Peng JM, Du B. Comparison of different criteria of metagenomic next-generation sequencing for the diagnosis of invasive pulmonary aspergillosis in critically ill patients. Diagn Microbiol Infect Dis 2024; 108:116135. [PMID: 38065016 DOI: 10.1016/j.diagmicrobio.2023.116135] [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: 08/04/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To compare different criteria of Metagenomic Next-Generation Sequencing (mNGS) in bronchoalveolar lavage fluid (BALF) for diagnosing invasive pulmonary aspergillosis (IPA). METHODS We compared the diagnostic agreement and performances of six BALF mNGS-derived criteria (SDSMRN>1, SDSMRN≥3, SMRN≥10, SMRN≥50, RPM ratio≥10, and relative abundance of genus>30 %) in pneumonia patients. RESULTS A total of 115 patients were analyzed, with 28 identified with IPA. Diagnostic agreement among the six mNGS-derived criteria was moderate, with a Cohen's kappa of 0.577(P < 0.001). mNGS-derived criteria had low sensitivity ranging from 21.4 % to 57.1 % and high specificity from 88 % to 92 %. The optimal threshold of SDSMRN, SMRN, RPM ratio, and relative abundance of genus for diagnosing IPA were 5, 0.25, 8, and 20 %, respectively. Although using the optimal threshold, the sensitivity of mNGS is lower than 50 %. CONCLUSIONS All mNGS-derived criteria had low sensitivity for diagnosing IPA. A combination of mNGS and conventional mycological tests may be the best diagnostic strategy.
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Affiliation(s)
- Rui-Ting Liu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China; Department of Critical Care Medicine, The Second Affiliated Hospital of Air Force Medical University, Shaanxi, China
| | - Dong Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Shan Li
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Yan Chen
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Xi-Xi Wan
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Shi-Tong Diao
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Li Weng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Jin-Min Peng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China.
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
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11
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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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12
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Li J, Huang S, Shi L, Chen G, Liu X, Liu M, Guo G. Interaction between long noncoding RNA and microRNA in lung inflammatory diseases. Immun Inflamm Dis 2024; 12:e1129. [PMID: 38270295 PMCID: PMC10777888 DOI: 10.1002/iid3.1129] [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: 05/28/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Non-coding RNAs (ncRNAs) are a group of RNAs that cannot synthesize proteins, but are critical in gene expression regulation. Long non-coding RNAs (lncRNAs) and microRNAs (miRNAs), the two major family members, are intimately involved in controlling immune response, cell proliferation, apoptosis, differentiation and polarization, and cytokine secretion. Their interactions significantly influence lung inflammatory diseases and could be potential therapeutic targets. OBJECTIVES The review aims to elucidate the role of ncRNAs, especially the interactions between lncRNA and miRNA in lung diseases, including acute and chronic lung inflammatory diseases, as well as lung cancer. And provide novel insights into disease mechanisms and potential therapeutic methods. METHODS We conducted a comprehensive review of the latest studies on lncRNA and miRNA in lung inflammatory diseases. Our research involved searching through electronic databases like PubMed, Web of Science, and Scopus. RESULTS We explain the fundamental characteristics and functions of miRNA and lncRNA, their potential interaction mechanisms, and summarize the newly explorations on the role of lncRNA and miRNA interactions in lung inflammatory diseases. CONCLUSIONS Numerous lncRNAs and miRNAs have been found to partipicate in all stages of lung inflammatory diseases. While ncRNA-based therapies have been validated and developed, there remain challenges in developing more stable and effective drugs for clinical use.
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Affiliation(s)
- Jiaqi Li
- Medical Center of Burn Plastic and Wound RepairThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Shengyu Huang
- Medical Center of Burn Plastic and Wound RepairThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Liangliang Shi
- Medical Center of Burn Plastic and Wound RepairThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Guochang Chen
- Medical Center of Burn Plastic and Wound RepairThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Xiaoxiao Liu
- Medical Center of Burn Plastic and Wound RepairThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Mingzhuo Liu
- Medical Center of Burn Plastic and Wound RepairThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Guanghua Guo
- Medical Center of Burn Plastic and Wound RepairThe First Affiliated Hospital of Nanchang UniversityNanchangChina
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13
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Rohani R, Yarnold PR, Scheetz MH, Neely MN, Kang M, Donnelly HK, Dedicatoria K, Nozick SH, Medernach RL, Hauser AR, Ozer EA, Diaz E, Misharin AV, Wunderink RG, Rhodes NJ. Individual meropenem epithelial lining fluid and plasma PK/PD target attainment. Antimicrob Agents Chemother 2023; 67:e0072723. [PMID: 37975660 PMCID: PMC10720524 DOI: 10.1128/aac.00727-23] [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: 06/01/2023] [Accepted: 10/15/2023] [Indexed: 11/19/2023] Open
Abstract
It is unclear whether plasma is a reliable surrogate for target attainment in the epithelial lining fluid (ELF). The objective of this study was to characterize meropenem target attainment in plasma and ELF using prospective samples. The first 24-hour T>MIC was evaluated vs 1xMIC and 4xMIC targets at the patient (i.e., fixed MIC of 2 mg/L) and population [i.e., cumulative fraction of response (CFR) according to EUCAST MIC distributions] levels for both plasma and ELF. Among 65 patients receiving ≥24 hours of treatment, 40% of patients failed to achieve >50% T>4xMIC in plasma and ELF, and 30% of patients who achieved >50% T>4xMIC in plasma had <50% T>4xMIC in ELF. At 1xMIC and 4xMIC targets, 3% and 25% of patients with >95% T>MIC in plasma had <50% T>MIC in ELF, respectively. Those with a CRCL >115 mL/min were less likely to achieve >50%T>4xMIC in ELF (P < 0.025). In the population, CFR for Escherichia coli at 1xMIC and 4xMIC was >97%. For Pseudomonas aeruginosa, CFR was ≥90% in plasma and ranged 80%-85% in ELF at 1xMIC when a loading dose was applied. CFR was reduced in plasma (range: 75%-81%) and ELF (range: 44%-60%) in the absence of a loading dose at 1xMIC. At 4xMIC, CFR for P. aeruginosa was 60%-86% with a loading dose and 18%-62% without a loading dose. We found that plasma overestimated ELF target attainment inup to 30% of meropenem-treated patients, CRCL >115 mL/min decreased target attainment in ELF, and loading doses increased CFR in the population.
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Affiliation(s)
- Roxane Rohani
- Discipline of Cellular and Molecular Pharmacology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | - Marc H. Scheetz
- Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, Illinois, USA
- Pharmacometrics Center of Excellence, Midwestern University, Downers Grove, Illinois, USA
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Michael N. Neely
- Laboratory of Applied Pharmacokinetics and Bioinformatics, The Saban Research Institute, Children’s Hospital of Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mengjia Kang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Helen K. Donnelly
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kay Dedicatoria
- Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, Illinois, USA
| | - Sophie H. Nozick
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel L. Medernach
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alan R. Hauser
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Egon A. Ozer
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Estefani Diaz
- Robert H. Lurie Comprehensive Cancer Research Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexander V. Misharin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Richard G. Wunderink
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nathaniel J. Rhodes
- Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, Illinois, USA
- Pharmacometrics Center of Excellence, Midwestern University, Downers Grove, Illinois, USA
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
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14
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Hraiech S, Ladjal K, Guervilly C, Hyvernat H, Papazian L, Forel JM, Lopez A, Peres N, Dellamonica J, Leone M, Gragueb-Chatti I. Lung abscess following ventilator-associated pneumonia during COVID-19: a retrospective multicenter cohort study. Crit Care 2023; 27:385. [PMID: 37794402 PMCID: PMC10552315 DOI: 10.1186/s13054-023-04660-x] [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: 07/09/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Patients undergoing mechanical ventilation (MV) for COVID-19 exhibit an increased risk of ventilator-associated pneumonia (VAP). The occurrence of lung abscesses following VAP in these patients has been poorly studied. We aimed to describe the incidence, characteristics, risk factors and prognosis of lung abscesses complicating VAP after COVID-19. METHODS We conducted an observational, retrospective study in three French intensive care units. Patients admitted for acute respiratory failure with a confirmed SARS-CoV-2 PCR and requiring MV for more than 48 h were included. RESULTS Among the 507 patients included, 326 (64%) had a documented VAP. Of these, 23 (7%) developed a lung abscess. Enterobacterales (15/23, 65%) were the main documentation, followed by non-fermenting Gram-negative bacilli (10/23, 43%) and Gram-positive cocci (8/23, 35%). Lung abscesses were mainly plurimicrobial (15/23, 65%). In multivariate analysis, a plurimicrobial 1st VAP episode (OR (95% CI) 2.93 (1.16-7.51); p = 0.02) and the use of hydrocortisone (OR (95% CI) 4.86 (1.95-12.1); p = 0.001) were associated with lung abscess development. Intensive care unit (ICU) mortality of patients with lung abscesses reached 52%, but was not significantly higher than for patients with VAP but no lung abscess. Patients with lung abscesses had reduced ventilator-free days at day 60, a longer duration of MV and ICU stay than patients with VAP but no lung abscess (respectively, 0 (0-3) vs. 16 (0-42) days; p < 0.001, 49 (32-73) vs. 25 (11-41) days; p < 0.001, 52 (36-77) vs. 28 (16-47) days; p < 0.001). CONCLUSIONS Lung abscessing pneumonia is not uncommon among COVID-19 patients developing VAP. A plurimicrobial first VAP episode and the use of hydrocortisone are independently associated with this complication. In COVID-19 patients with persistent VAP, a chest CT scan investigating the evolution toward lung abscess should be considered.
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Affiliation(s)
- S Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France.
- Faculté de Médecine, Aix-Marseille Université, Centre d'Etudes Et de Recherches Sur Les Services de Santé Et Qualité de Vie EA 3279, 13005, Marseille, France.
| | - K Ladjal
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
| | - C Guervilly
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
| | - H Hyvernat
- CHU de Nice, Hôpital Archet 1, Médecine Intensive Réanimation, 06200, Nice, France
- Equipe 2 CARRES, UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - L Papazian
- Faculté de Médecine, Aix-Marseille Université, Centre d'Etudes Et de Recherches Sur Les Services de Santé Et Qualité de Vie EA 3279, 13005, Marseille, France
- Centre Hospitalier de Bastia, 20600, Bastia, Corsica, France
| | - J M Forel
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
- Faculté de Médecine, Aix-Marseille Université, Centre d'Etudes Et de Recherches Sur Les Services de Santé Et Qualité de Vie EA 3279, 13005, Marseille, France
| | - A Lopez
- Service d'Anesthésie Et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - N Peres
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal Toulon - La Seyne sur Mer, Toulon, France
| | - J Dellamonica
- CHU de Nice, Hôpital Archet 1, Médecine Intensive Réanimation, 06200, Nice, France
- Equipe 2 CARRES, UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - M Leone
- Service d'Anesthésie Et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - I Gragueb-Chatti
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
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Massart N, Dupin C, Legris E, Legay F, Cady A, Fillatre P, Reizine F. Prevention of ICU-acquired infection with decontamination regimen in immunocompromised patients: a pre/post observational study. Eur J Clin Microbiol Infect Dis 2023; 42:1163-1172. [PMID: 37597052 DOI: 10.1007/s10096-023-04650-5] [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: 05/22/2023] [Accepted: 08/07/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Although the proportion of immunocompromised patients admitted to the ICU is increasing, data regarding specific management, including acquired infection (ICU-AI) prophylaxis, in this setting are lacking. We aim to investigate the effect of multiple-site decontamination regimens (MSD) in immunocompromised patients. METHODS We conducted a prospective pre-/post-observational study in 2 ICUs in Bretagne, western France. Adults who required mechanical ventilation for 24 h or more were eligible. During the study period, MSD was implemented in participating ICUs in addition to standard care. It consists of the administration of topical antibiotics (gentamicin, colistin sulfate, and amphotericin B), four times daily in the oropharynx and the gastric tube, 4% chlorhexidine bodywash once daily, and a 5-day nasal mupirocin course. RESULTS Overall, 295 immunocompromised patients were available for analysis (151 in the post-implementation group vs 143 in the pre-implementation group). Solid organ cancer was present in 77/295 patients while immunomodulatory treatments were noticed in 135/295. They were 35 ICU-AI in 29/143 patients in the standard-care group as compared with 10 ICU-AI in 9/151 patients in the post-implementation group (p < 0.001). In a multivariable Poisson regression model, MSD was independently associated with a decreased incidence of ICU-AI (incidence rate ratio = 0.39; 95%CI [0.20-0.87] p = 0.008). There were 35/143 deaths in the standard-care group as compared with 22/151 in the post-implementation group (p = 0.046), this difference remained in a multivariable Cox model (HR = 0.58; 95CI [0.34-0.95] p = 0.048). CONCLUSION In conclusion, MSD appeared to be associated with improved outcomes in critically ill immunocompromised patients.
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Affiliation(s)
- Nicolas Massart
- Service de Réanimation, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France.
| | - Clarisse Dupin
- Service de Microbiologie, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
| | - Eleonore Legris
- Service de Pharmacie, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
| | - François Legay
- Service de Réanimation, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
| | - Anne Cady
- Service de Microbiologie, CH de Vannes, 20 bvd général maurice guillaudot, 56000, Vannes, France
| | - Pierre Fillatre
- Service de Réanimation, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
| | - Florian Reizine
- Service de Réanimation, CH de Vannes, 20, Bd Maurice Guillaudot, 56000, Vannes, France
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Villaamil A, Han L, Eloy P, Bachelet D, Gennequin M, Jeantrelle C, Moyer JD, Weiss E, Foucrier A. Risk factors of second ventilator-associated pneumonia in trauma patients: a retrospective cohort study. Eur J Trauma Emerg Surg 2023; 49:1981-1988. [PMID: 37031437 DOI: 10.1007/s00068-023-02269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/02/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Ventilator acquired pneumonia (VAP) is a frequent and serious complication in ICU. Second episodes of VAP are common in trauma patients and may be related to severity of underlying conditions, treatment or bacterial factors of the first VAP. The aim of this study was to identify risk factors of second VAP episodes in trauma injured patients (defined as the development of a new pulmonary infection during or remotely following the first episode). DESIGN This is a single-center, retrospective cohort study of trauma injured patients who underwent a first episode of VAP between January 1, 2013 and December 31, 2020 at Beaujon Hospital. RESULTS A total of 533 patients with a first episode of VAP were analyzed, mostly with head and/or thoracic traumatic injury. A second episode of VAP occurred in one hundred sixty-seven patients (31.3%). The main risk factors found was the degree of hypoxemia at the time of the first episode [PaO2/FiO2 ratio 100-200, OR 3.12 (1.77-5.69); < 100, OR 5.80 (2.70-12.8)] and severe traumatic brain injury characterized by an initial GCS ≤ 8 [OR 1.65 (1.01-2.74)]. CONCLUSION Depth of hypoxemia during the first VAP episode and severity of the initial brain injury are the main risk factors for VAP second episode in trauma injured patients.
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Affiliation(s)
- Alejandro Villaamil
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
| | - Lien Han
- Département d'épidémiologieBiostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, 75018, Paris, France
| | - Philippine Eloy
- Département d'épidémiologieBiostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, 75018, Paris, France
| | - Delphine Bachelet
- Département d'épidémiologieBiostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, 75018, Paris, France
| | - Maël Gennequin
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Caroline Jeantrelle
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Jean-Denis Moyer
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Arnaud Foucrier
- Department of Anaesthesiology and Critical Care Medecine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
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17
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Rossi M, Delamarre L, Duclos G, Lakbar I, Hammad E, Arbelot C, Zieleskiewicz L, Leone M. Compliance with a Procalcitonin-Based Protocol in Patients with Ventilation-Associated Pneumonia: An Observational, Retrospective Study. Antibiotics (Basel) 2023; 12:1208. [PMID: 37508304 PMCID: PMC10376829 DOI: 10.3390/antibiotics12071208] [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: 06/05/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Procalcitonin (PCT) protocols to guide antibiotic treatment for ventilator-associated pneumonia (VAP) in the intensive care unit aim at reducing antibiotic exposure. Our study goal was to measure compliance with a PCT protocol for VAP and to determine the associated variables. METHODS From 2017 to 2021, we conducted a retrospective, monocentric study including patients treated for VAP. In our PCT protocol, PCT was measured at the initiation of antibiotic treatment and every 48 h until treatment completion; antibiotics were stopped if PCT decreased by more than 80% from its highest value or fell below 0.5 ng/mL. We assessed the compliance with the PCT protocol and compared the compliant and noncompliant groups. RESULTS Among the 177 included patients, compliance with the PCT protocol was assessed at 58%. Noncompliance was due to lack of PCT measurements in 76% of cases. Compliance was higher in the medical patients (p = 0.04) and in those admitted for SARS-CoV-2 (p = 0.02). Compliance regarding the interruption of antibiotic therapy based on PCT was lower on weekends and holidays (p = 0.01). Outcomes did not differ according to compliance. CONCLUSION This study assessed real-life compliance with the PCT protocol to monitor antibiotic treatment for VAP. Improving the measurement of PCT at the bedside would increase the rate.
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Affiliation(s)
- Matthieu Rossi
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Louis Delamarre
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Gary Duclos
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Ines Lakbar
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Emmanuelle Hammad
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Charlotte Arbelot
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Laurent Zieleskiewicz
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Marc Leone
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
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Codru IR, Sava M, Vintilă BI, Bereanu AS, Bîrluțiu V. A Study on the Contributions of Sonication to the Identification of Bacteria Associated with Intubation Cannula Biofilm and the Risk of Ventilator-Associated Pneumonia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1058. [PMID: 37374262 DOI: 10.3390/medicina59061058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/27/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023]
Abstract
Ventilator-associated pneumonia is one of the most severe complications of critically ill patients that need mechanical respiratory support, as it poses a significant risk of prolonging hospitalization, disability, and even death. This is why physicians worldwide target newer methods for prevention, early diagnosis, and early target treatment for this condition. There are few methods for a quick etiological diagnosis of pneumonia, especially point of care, and most are only readily available in some intensive care units. This is why a new, simple, and cheap method is needed for determining the bacteria that might be infectious in a particular patient. The manner in question is sonication. Method: In this prospective, observational, single-center study, endotracheal cannula specimens will be collected from at least 100 patients in our intensive care unit. This specimen will be submitted to a specific sonication protocol for bacteria to dislodge the biofilm inside the cannula. The resulting liquid will be seeded on growth media, and then a comparison will be made between the germs in the biofilm and the ones in the tracheal secretion of the patient. The primary purpose is to determine the bacteria before the appearance of a manifest infection.
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Affiliation(s)
- Ioana Roxana Codru
- Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania
- County Clinical Emergency Hospital, 2-4, Corneliu Coposu Bld., 550245 Sibiu, Romania
| | - Mihai Sava
- Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania
- County Clinical Emergency Hospital, 2-4, Corneliu Coposu Bld., 550245 Sibiu, Romania
| | - Bogdan Ioan Vintilă
- Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania
- County Clinical Emergency Hospital, 2-4, Corneliu Coposu Bld., 550245 Sibiu, Romania
| | - Alina Simona Bereanu
- Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania
- County Clinical Emergency Hospital, 2-4, Corneliu Coposu Bld., 550245 Sibiu, Romania
| | - Victoria Bîrluțiu
- Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania
- County Clinical Emergency Hospital, 2-4, Corneliu Coposu Bld., 550245 Sibiu, Romania
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Foucrier A, Dessalle T, Tuffet S, Federici L, Dahyot-Fizelier C, Barbier F, Pottecher J, Monsel A, Hissem T, Lefrant JY, Demoule A, Constantin JM, Rousseau A, Simon T, Leone M, Bouglé A. Association between combination antibiotic therapy as opposed as monotherapy and outcomes of ICU patients with Pseudomonas aeruginosa ventilator-associated pneumonia: an ancillary study of the iDIAPASON trial. Crit Care 2023; 27:211. [PMID: 37254209 PMCID: PMC10230680 DOI: 10.1186/s13054-023-04457-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/20/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The optimal treatment duration and the nature of regimen of antibiotics (monotherapy or combination therapy) for Pseudomonas aeruginosa ventilator‑associated pneumonia (PA-VAP) remain debated. The aim of this study was to evaluate whether a combination antibiotic therapy is superior to a monotherapy in patients with PA-VAP in terms of reduction in recurrence and death, based on the 186 patients included in the iDIAPASON trial, a multicenter, randomized controlled trial comparing 8 versus 15 days of antibiotic therapy for PA-VAP. METHODS Patients with PA-VAP randomized in the iDIAPASON trial (short-duration-8 days vs. long-duration-15 days) and who received appropriate antibiotic therapy were eligible in the present study. The main objective is to compare mortality at day 90 according to the antibiotic therapy received by the patient: monotherapy versus combination therapy. The primary outcome was the mortality rate at day 90. The primary outcome was compared between groups using a Chi-square test. Time from appropriate antibiotic therapy to death in ICU or to censure at day 90 was represented using Kaplan-Meier survival curves and compared between groups using a Log-rank test. RESULTS A total of 169 patients were included in the analysis. The median duration of appropriate antibiotic therapy was 14 days. At day 90, among 37 patients (21.9%) who died, 17 received monotherapy and 20 received a combination therapy (P = 0.180). Monotherapy and combination antibiotic therapy were similar for the recurrence rate of VAP, the number of extra pulmonary infections, or the acquisition of multidrug-resistant (MDR) bacteria during the ICU stay. Patients in combination therapy were exposed to mechanical ventilation for 28 ± 12 days, as compared with 23 ± 11 days for those receiving monotherapy (P = 0.0243). Results remain similar after adjustment for randomization arm of iDIAPASON trial and SOFA score at ICU admission. CONCLUSIONS Except longer durations of antibiotic therapy and mechanical ventilation, potentially related to increased difficulty in achieving clinical cure, the patients in the combination therapy group had similar outcomes to those in the monotherapy group. TRIAL REGISTRATION NCT02634411 , Registered 15 December 2015.
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Affiliation(s)
- Arnaud Foucrier
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, Clichy, France.
| | - Thomas Dessalle
- Department of Anesthesia, Critical Care and Perioperative Care, Pitié-Salpetrière Hospital, 47-83, Boulevard de l'Hôpital, 75013, Paris, France
| | - Sophie Tuffet
- Department of Clinical Pharmacology-Clinical Research Platform, AP-HP, Sorbonne University, Paris, France
| | - Laura Federici
- Service de Réanimation Polyvalente, Centre Hospitalier d'Ajaccio, Ajaccio, France
| | - Claire Dahyot-Fizelier
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - François Barbier
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de l'Hôpital, 45100, Orléans, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Department of Anaesthesiology, Critical Care and Perioperative Medicine, Fédération de Médecine Translationnelle de Strasbourg, ER 3072, Strasbourg University Hospital, Strasbourg, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Tarik Hissem
- General Intensive Care Unit, Sud-Essonne Hospital, Étampes, France
| | - Jean-Yves Lefrant
- UR-UM103 IMAGINE, Univ. Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France, Nîmes University Hospital, Montpellier, France
| | - Alexandre Demoule
- Service de Médecine Intensive et Réanimation (Département R3S), APHP, Site Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Jean-Michel Constantin
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology-Clinical Research Platform, AP-HP, Sorbonne University, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform, AP-HP, Sorbonne University, Paris, France
| | - Marc Leone
- Service d'anesthésie et de Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
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20
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Hashemian M, Kazemian H, Kaviar VH, Karamolahi S, Nazari A, Bagheri MR, Sadeghifard N, Khoshnood S. Nosocomial infections and antimicrobial susceptibility patterns among patients admitted to intensive care unit of Imam Khomeini hospital in Ilam, Iran. Mol Biol Rep 2023:10.1007/s11033-023-08476-4. [PMID: 37155016 DOI: 10.1007/s11033-023-08476-4] [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: 02/10/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Nosocomial infections (NIs) are a major challenge worldwide. Identification of antibiotic resistance pattern extended spectrum beta-lactamases (ESBLs) and carbapenem-resistant Enterobacteriaceae (CRE) were the objectives of this study. METHODS In this cross-sectional study, the antimicrobial susceptibility pattern of bacterial isolates collected from patients with NIs in ICU was determined. Overall, 42 Escherichia coli and Klebsiella pneumoniae isolates from different infection sites were used to determine phenotypic tests of ESBLs, Metallo-β-lactamases (MBLs) and CRE. Detection of ESBLs, MBLs and CRE genes were performed by the polymerase chain reaction (PCR) method. RESULTS From 71 patients with NIs, 103 different bacterial strains were isolated. The most frequently isolated bacteria were E. coli (n = 29; 28.16%), Acinetobacter baumannii (n = 15; 14.56%), and K. pneumoniae (n = 13; 12.26%). Also, the rate of multidrug-resistant (MDR) isolates was 58.25% (60/103). Based on phenotypic confirmation tests, 32 (76.19%) isolates of E. coli and K. pneumoniae produced ESBLs, and 6 (14.28%) isolates were identified as CRE producers. PCR showed the high prevalence of the blaCTX-M (n = 29; 90.62%) in ESBL genes. In addition, blaNDM was detected in 4 (66.66%), blaOXA-23 in 3 (50%), and blaOXA-48 gene in 1 (16.66%) isolates. The blaVIM, blaKPC, and blaIMP genes were not detected in any of the isolates. CONCLUSION The Gram-negative bacteria E. coli, A. baumannii, and K. pneumoniae with high resistance levels were the most common bacteria causing NIs in the ICU. This study for the first time identified blaOXA-11, blaOXA-23, and blaNDM-1 genes in E. coli and K. pneumoniae in Ilam city of Iran.
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Affiliation(s)
- Marzieh Hashemian
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Hossein Kazemian
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Vahab Hassan Kaviar
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Somayeh Karamolahi
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Nazari
- Department of Infectious Diseases, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Reza Bagheri
- Department of Nursing, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Nourkhoda Sadeghifard
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
| | - Saeed Khoshnood
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran.
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Mokrani D, Chommeloux J, Pineton de Chambrun M, Hékimian G, Luyt CE. Antibiotic stewardship in the ICU: time to shift into overdrive. Ann Intensive Care 2023; 13:39. [PMID: 37148398 PMCID: PMC10163585 DOI: 10.1186/s13613-023-01134-9] [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: 01/05/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023] Open
Abstract
Antibiotic resistance is a major health problem and will be probably one of the leading causes of deaths in the coming years. One of the most effective ways to fight against resistance is to decrease antibiotic consumption. Intensive care units (ICUs) are places where antibiotics are widely prescribed, and where multidrug-resistant pathogens are frequently encountered. However, ICU physicians may have opportunities to decrease antibiotics consumption and to apply antimicrobial stewardship programs. The main measures that may be implemented include refraining from immediate prescription of antibiotics when infection is suspected (except in patients with shock, where immediate administration of antibiotics is essential); limiting empiric broad-spectrum antibiotics (including anti-MRSA antibiotics) in patients without risk factors for multidrug-resistant pathogens; switching to monotherapy instead of combination therapy and narrowing spectrum when culture and susceptibility tests results are available; limiting the use of carbapenems to extended-spectrum beta-lactamase-producing Enterobacteriaceae, and new beta-lactams to difficult-to-treat pathogen (when these news beta-lactams are the only available option); and shortening the duration of antimicrobial treatment, the use of procalcitonin being one tool to attain this goal. Antimicrobial stewardship programs should combine these measures rather than applying a single one. ICUs and ICU physicians should be at the frontline for developing antimicrobial stewardship programs.
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Affiliation(s)
- David Mokrani
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, ICAN, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Juliette Chommeloux
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, ICAN, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, ICAN, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Guillaume Hékimian
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, ICAN, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, ICAN, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
- Sorbonne Université, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
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22
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Roquilly A, Francois B, Huet O, Launey Y, Lasocki S, Weiss E, Petrier M, Hourmant Y, Bouras M, Lakhal K, Le Bel C, Flattres Duchaussoy D, Fernández-Barat L, Ceccato A, Flet L, Jobert A, Poschmann J, Sebille V, Feuillet F, Koulenti D, Torres A. Interferon gamma-1b for the prevention of hospital-acquired pneumonia in critically ill patients: a phase 2, placebo-controlled randomized clinical trial. Intensive Care Med 2023; 49:530-544. [PMID: 37072597 PMCID: PMC10112824 DOI: 10.1007/s00134-023-07065-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE We aimed to determine whether interferon gamma-1b prevents hospital-acquired pneumonia in mechanically ventilated patients. METHODS In a multicenter, placebo-controlled, randomized trial conducted in 11 European hospitals, we randomly assigned critically ill adults, with one or more acute organ failures, under mechanical ventilation to receive interferon gamma-1b (100 µg every 48 h from day 1 to 9) or placebo (following the same regimen). The primary outcome was a composite of hospital-acquired pneumonia or all-cause mortality on day 28. The planned sample size was 200 with interim safety analyses after enrolling 50 and 100 patients. RESULTS The study was discontinued after the second safety analysis for potential harm with interferon gamma-1b, and the follow-up was completed in June 2022. Among 109 randomized patients (median age, 57 (41-66) years; 37 (33.9%) women; all included in France), 108 (99%) completed the trial. Twenty-eight days after inclusion, 26 of 55 participants (47.3%) in the interferon-gamma group and 16 of 53 (30.2%) in the placebo group had hospital-acquired pneumonia or died (adjusted hazard ratio (HR) 1.76, 95% confidence interval (CI) 0.94-3.29; P = 0.08). Serious adverse events were reported in 24 of 55 participants (43.6%) in the interferon-gamma group and 17 of 54 (31.5%) in the placebo group (P = 0.19). In an exploratory analysis, we found that hospital-acquired pneumonia developed in a subgroup of patients with decreased CCL17 response to interferon-gamma treatment. CONCLUSIONS Among mechanically ventilated patients with acute organ failure, treatment with interferon gamma-1b compared with placebo did not significantly reduce the incidence of hospital-acquired pneumonia or death on day 28. Furthermore, the trial was discontinued early due to safety concerns about interferon gamma-1b treatment.
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Affiliation(s)
- Antoine Roquilly
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France.
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France.
| | - Bruno Francois
- ICU Department and Inserm CIC 1435 & UMR 1092, University Hospital of Limoges, Limoges, France
| | - Olivier Huet
- Département d'anesthésie réanimation et medecine peri-operatoire, CHRU de Brest, Université de Bretagne Occidentale, 29000, Brest, France
| | - Yoann Launey
- Department of Anaesthesia, Critical Care and Perioperative Medicine, Univ Rennes, CHU Rennes, 35000, Rennes, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Angers, 49000, Angers, France
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Université Paris Cité, INSERM UMR_S1149, and AP-HP Nord, Hôpital Beaujon, Clichy, France
| | - Melanie Petrier
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
| | - Yannick Hourmant
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
| | - Marwan Bouras
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
| | - Karim Lakhal
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
| | - Cecilia Le Bel
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
| | | | - Laia Fernández-Barat
- CELLEX research laboratories, CibeRes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 06/06/0028), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Servei de Pneumologia, Hospital Clinic, Barcelona, Universitat de Barcelona, CIBERES, Icrea, IDIBAPS, Barcelona, Spain
| | - Adrian Ceccato
- Servei de Pneumologia, Hospital Clinic, Barcelona, Universitat de Barcelona, CIBERES, Icrea, IDIBAPS, Barcelona, Spain
| | - Laurent Flet
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
| | - Alexandra Jobert
- Nantes Université, CHU Nantes, DRI, Département promotion, cellule vigilances recherche, Nantes, France
- Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
| | - Jeremie Poschmann
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
| | - Veronique Sebille
- Nantes Université, CHU Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, 44000, Nantes, France
- Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
| | - Fanny Feuillet
- Nantes Université, CHU Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, 44000, Nantes, France
- Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
| | - Despoina Koulenti
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Antoni Torres
- CELLEX research laboratories, CibeRes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 06/06/0028), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Salama G, Motamed C, Elmawieh J, Suria S. Impact of Preemptive Postoperative Pressure Support Ventilation and Physiotherapy on Postoperative Pulmonary Complications after Major Cervicofacial Cancer Surgery: A before and after Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040722. [PMID: 37109680 PMCID: PMC10142708 DOI: 10.3390/medicina59040722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023]
Abstract
Introduction: Complex cervicofacial cancer surgery with free flap reconstruction is known to have a high incidence of postoperative pulmonary complications (PPCs). We hypothesized that by implementing an optimized respiratory protocol, including preemptive postoperative pressure support ventilation, physiotherapy, and critical respiratory support and follow-up, we could decrease the incidence of PPCs. Patients and methods: We evaluated the incidence of PPCs over two periods in two groups of patients having a routine or optimized postoperative respiratory protocol: 156 adult patients undergoing major cervicofacial cancer surgery were assessed; 91 were in Group 1 (routine) and 65 were in Group 2 (optimized). In Group 1, no ventilatory support sessions were performed. The incidence of pulmonary complications in both groups was compared using a multivariate analysis. Mortality was also compared until one year postoperatively. Results: In Group 2 with an optimized protocol, the mean number of ventilatory support sessions was 3.7 ± 1 (minimum 2, maximum 6). The incidence of respiratory complications, which was 34% in Group 1 (routine), was reduced by 59% OR = 0.41 (0.16; 0.95), p = 0.043) to 21% for the optimized Group 2. No difference in mortality was found. Conclusions: The present retrospective study showed that using an optimized preemptive respiratory pressure support ventilation combined with physiotherapy after a major cervicofacial surgery could possibly help reduce the incidence of pulmonary complications. Prospective studies are needed to verify these findings.
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Affiliation(s)
- Guillaume Salama
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| | - Cyrus Motamed
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| | - Jamie Elmawieh
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| | - Stéphanie Suria
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
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Daghmouri MA, Dudoignon E, Chaouch MA, Baekgaard J, Bougle A, Leone M, Deniau B, Depret F. Comparison of a short versus long-course antibiotic therapy for ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. EClinicalMedicine 2023; 58:101880. [PMID: 36911269 PMCID: PMC9995933 DOI: 10.1016/j.eclinm.2023.101880] [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: 12/19/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND For ventilator-associated pneumonia (VAP), the safety of short-course versus long-course antibiotic therapy is still debated, especially regarding documented VAP due to non-fermenting Gram-negative bacilli (NF-GNB). The aim of this meta-analysis was to assess the rates of recurrence and relapse of VAP in patients receiving short-course (≤8 days) and long-course (≥10-15 days) of antibiotic therapy. METHODS The protocol for this study was registered in the PROSPERO database (ID: CRD42022365138). We performed an electronic search of the relevant literature and limited our search to data published from 2000 until September 1, 2022. We searched for randomized controlled trials (RCTs) in the United States National Library of Medicine, Cochrane Database of Systematic Reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, National Institutes of Health PubMed/MEDLINE, web of science and Google Scholar databases. The primary endpoint was the recurrence and relapses of VAP, secondary endpoints were 28-day mortality, mechanical ventilation duration, number of extra-pulmonary infections and length of ICU stay. FINDINGS We identified five relevant studies involving 1069 patients (530 patients in the short-course group and 539 patients in the long-course group). The meta-analysis did not reveal any significant difference between short and long-course antibiotic therapy for recurrence and relapses of VAP (odd ratio "OR" = 1.48, 95% confidence intervals (CI) [0.96, 2.28], p = 0.08 and OR = 1.45, 95% CI [0.94, 2.22], p = 0.09, respectively), including those due to NF-GNB (OR = 1.90, 95% CI [0.93, 3.33], p = 0.05 and OR = 1.76, 95% CI [0.93, 3.33], p = 0.08, respectively). No difference was found for 28 days-mortality (OR = 1.24, 95% CI [0.92, 1.67], p = 0.16), mechanical ventilation duration, number of extra-pulmonary infections and length of ICU stay. However, short-course therapy significantly increased the number of antibiotic-free days. INTERPRETATION Our meta-analysis showed that short-course antibiotic therapy did not result in increased number of recurence and relapses of VAP, suggesting that short-course should be preferred to reduce the exposure to antibiotics. FUNDING None.
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Affiliation(s)
- Mohamed Aziz Daghmouri
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis-Lariboisière, AP-HP, Paris, France
- Corresponding author. Hôpital Saint Louis, 1 Avenue Claude Vellefaux, Paris 75010, France.
| | - Emmanuel Dudoignon
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis-Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
| | - Mohamed Ali Chaouch
- Department of Visceral Surgery, University Hospital of Fattouma Bourguiba, Monastir, Tunisia
| | - Josefine Baekgaard
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis-Lariboisière, AP-HP, Paris, France
| | - Adrien Bougle
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marc Leone
- Service d'anesthésie et de Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Aix Marseille University, Marseille, France
| | - Benjamin Deniau
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis-Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- Department of Visceral Surgery, University Hospital of Fattouma Bourguiba, Monastir, Tunisia
| | - François Depret
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis-Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
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Foucrier A, Roquilly A, Bachelet D, Martin-Loeches I, Bougle A, Timsit JF, Montravers P, Zahar JR, Eloy P, Weiss E. Antimicrobial Stewardship for Ventilator Associated Pneumonia in Intensive Care (the ASPIC trial): study protocol for a randomised controlled trial. BMJ Open 2023; 13:e065293. [PMID: 36810173 PMCID: PMC9944671 DOI: 10.1136/bmjopen-2022-065293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) remains the leading cause of infections treated in the intensive care units (ICU). In a personalised care approach, we hypothesise that the duration of treatment of VAP can be reduced in function of the response to treatment. METHODS AND ANALYSIS The Antimicrobial Stewardship for Ventilator-Associated Pneumonia in Intensive Care (ASPIC) trial is a pragmatic national multicentre, phase III, non-inferiority, comparative randomised (1:1) single-blinded clinical trial. Five hundred and ninety adult patients hospitalised in 24 French ICU with a microbiologically confirmed first episode of VAP that received appropriate empirical antibiotic therapy will be included. They will be randomly allocated to standard management with duration of appropriate antibiotic fixed for 7 days according to international guidelines or antimicrobial stewardship based on daily clinical assessment of clinical cure. The assessment of clinical cure will be repeated daily until at least three criteria of clinical cure are met, allowing the discontinuation of antibiotic therapy in experimental group. The primary endpoint is a composite endpoint combining of all-cause mortality measured at day 28, treatment failure or new episode of microbiologically confirmed VAP until day 28.The aim of the study is to demonstrate that a strategy to reduce the duration of antibiotic therapy for VAP based on clinical assessment is safe could lead to changes in practice as part of a personalised therapeutic approach, by reducing exposure to antibiotics and their side effects. ETHICS AND DISSEMINATION The ASPIC trial has been approved by the French regulatory agency (Agence Nationale de Sécurité du Médicament et des Produits de Santé, ANSM; EUDRACT number 2021-002197-78, 19 August 2021) and an independent ethics committee the Comité de Protection des Personnes Ile-de-France III (CNRIPH : 21.03.25.60729, 10 October 2021) for the study protocol (version ASPIC-1.3; 03 September 2021) for all study centres. Participant recruitment is scheduled to begin in 2022. Results will be published in international peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT05124977.
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Affiliation(s)
- Arnaud Foucrier
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, Hospital Beaujon, Clichy, France
| | - Antoine Roquilly
- Pôle Anesthésie Réanimations, CIC Immunologie et Infectiologie, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, CHU Nantes, Nantes, France
| | - Delphine Bachelet
- Département D'épidémiologie, Biostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, Hopital Bichat-Claude-Bernard, Paris, France
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St. James's University Hospital, University of Dublin Trinity College, Dublin, Ireland
- Hospital Clinic, Universidad de Barcelona, CIBERes, IDIBAPS, Barcelona, Spain
| | - Adrien Bougle
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, APHP, Paris, France
| | - Jean-François Timsit
- Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Philippe Montravers
- Département d'anesthésie-réanimation, université Paris VII Sorbonne Cité, CHU Bichat-Claude-Bernard, CHU Bichat-Claude Bernard, Université Paris-Diderot, APHP, Paris, France
| | - Jean-Ralph Zahar
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention Du Risque Infectieux, Hopital Avicenne, Bobigny, France
| | - Philippine Eloy
- Département D'épidémiologie, Biostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, Hopital Bichat-Claude-Bernard, Paris, France
| | - Emmanuel Weiss
- Anesthesiology and Intensive Care, Hôpital Beaujon, Clichy, France
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Massart N, Dupin C, Legris E, Fedun Y, Barbarot N, Legay F, Wattecamps G, Le Gall F, La Combe B, Bouju P, Frerou A, Muller L, Rieul G, Fillatre P. Multiple-site decontamination in mechanically ventilated ICU patients: A real-life study. Infect Dis Now 2023; 53:104666. [PMID: 36736667 DOI: 10.1016/j.idnow.2023.104666] [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: 10/12/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Decontamination regimen decreases acquired infection (ICU-AI) incidence but has remained controversial, mostly because it contains a course of intravenous antibiotic. Multiple-site decontamination (MSD), which does not include systemic antibiotics, has been less widely studied but is associated with lower risks of ventilator-associated pneumonia (VAP), bloodstream infection (BSI) and multidrug resistant micro-organism (MDRO) acquisition. We aimed to confirm these favorable outcomes. METHODS A prospective pre/post-observational study was conducted in 5 ICUs in western France. Among them, 4 implemented MSD, whereas the fifth applied standard care (SC) throughout the study period. Patients who required intubation were eligible for study and divided into two groups: the MSD group if they were admitted to an ICU that already implemented MSD, or the SC group. The primary objective was to measure ICU-AI incidence. RESULTS Close to 1400 (1346) patients were available for analysis (334 in the MSD and 1012 patients in the SC group). In a multivariable Poisson regression model, MSD was independently associated with decreased incidence of ICU-AI (IRR = 0.33; 95 %CI [0.18-0.60] p < 0.001). Non-parsimonious propensity-score matching resulted in 334 patient-pairs with well-balanced baseline characteristics. There was a lower incidence of ICU-AI(6.3 % vs 20.7 % p < 0.001), VAP (3.6 % vs 16.2 % p < 0.001) and BSI (3.0 % vs 7.2 % p = 0.029) in the MSD group as compared with the SC group. Five (1.5 %) and 11 (3.3 %) patients respectively acquired MDRO (p = 0.206). CONCLUSION MSD is associated with decreased risk of ICU-AI, VAP and BSI, with no increase in MDRO acquisition.
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Affiliation(s)
- Nicolas Massart
- Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust 22000 Saint-Brieuc, France.
| | - Clarisse Dupin
- Service de Microbiologie, CH de St BRIEUC, 10, rue marcel Proust 22000 Saint-Brieuc, France
| | - Eleonore Legris
- Service de Pharmacie, CH de St BRIEUC, 10, rue marcel Proust 22000 Saint-Brieuc, France
| | - Yannick Fedun
- Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot,56000 Vannes, France
| | - Nicolas Barbarot
- Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust 22000 Saint-Brieuc, France
| | - François Legay
- Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust 22000 Saint-Brieuc, France
| | - Guilhem Wattecamps
- Service de Réanimation, CH de QUIMPER, 14bis Avenue Yves Thépot, 29107 Quimper, France
| | - Florence Le Gall
- Service de Microbiologie, CH de QUIMPER, 14bis Avenue Yves Thépot, 29107 Quimper, France
| | - Béatrice La Combe
- Service de Réanimation, CH bretagne SUD, LORIENT, 5 avenue de choiseul, 56322 Lorient, France
| | - Pierre Bouju
- Service de Réanimation, CH bretagne SUD, LORIENT, 5 avenue de choiseul, 56322 Lorient, France
| | - Aurélien Frerou
- Service de Réanimation, CH de Saint-Malo, 1 rue de la marne 35400 Saint-Malo, France
| | - Laura Muller
- Service de Réanimation, CH de Saint-Malo, 1 rue de la marne 35400 Saint-Malo, France
| | - Guillaume Rieul
- Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot,56000 Vannes, France
| | - Pierre Fillatre
- Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust 22000 Saint-Brieuc, France
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Airway and Respiratory Devices in the Prevention of Ventilator-Associated Pneumonia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020199. [PMID: 36837404 PMCID: PMC9965501 DOI: 10.3390/medicina59020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/04/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
Ventilator-associated pneumonia (VAP) is the most common ICU-acquired infection among patients under mechanical ventilation (MV). It may occur in up to 50% of mechanically ventilated patients and is associated with an increased duration of MV, antibiotic consumption, increased morbidity, and mortality. VAP prevention is a multifaceted priority of the intensive care team. The use of specialized artificial airways and other devices can have an impact on the prevention of VAP. However, these devices can also have adverse effects, and aspects of their efficacy in the prevention of VAP are still a matter of debate. This article provides a narrative review of how different airway and respiratory devices may help to reduce the incidence of VAP.
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Factors Affecting Incidence of Ventilator-Associated Pneumonia With Multidrug-Resistant Microbes in Intensive Care Unit. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Endotracheal tube biofilm in critically ill patients during the COVID-19 pandemic : description of an underestimated microbiological compartment. Sci Rep 2022; 12:22389. [PMID: 36575298 PMCID: PMC9794690 DOI: 10.1038/s41598-022-26560-w] [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: 08/05/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
Biofilm (BF) growth is believed to play a major role in the development of ventilator-associated pneumonia (VAP) in the intensive care unit. Despite concerted efforts to understand the potential implication of endotracheal tube (ETT)-BF dispersal, clinically relevant data are lacking to better characterize the impact of its mesostructure and microbiological singularity on the occurrence of VAP. We conducted a multicenter, retrospective observational study during the third wave of the COVID-19 pandemic, between March and May 2021. In total, 64 ETTs collected from 61 patients were included in the present BIOPAVIR study. Confocal microscopy acquisitions revealed two main morphological aspects of ETT-deposited BF: (1) a thin, continuous ribbon-shaped aspect, less likely monobacterial and predominantly associated with Enterobacter spp., Streptococcus pneumoniae or Viridans streptococci, and (2) a thicker, discontinuous, mushroom-shaped appearance, more likely characterized by the association of bacterial and fungal species in respiratory samples. The microbiological characterization of ETT-deposited BF found higher acquired resistance in more than 80% of analyzed BF phenotypes, compared to other colonization sites from the patient's environment. These findings reveal BF as a singular microbiological compartment, and are of added clinical value, with a view to future ETT-deposited BF-based antimicrobial stewardship in critically ill patients. Trial registration NCT04926493. Retrospectively registered 15 June 2021.
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Flick H, Hermann M, Urban M, Meilinger M. Nosokomiale Pneumonien und beatmungsassoziierte Krankenhauserreger. ANÄSTHESIE NACHRICHTEN 2022. [PMCID: PMC9645741 DOI: 10.1007/s44179-022-00108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Holger Flick
- ÖGP-Arbeitskreis „Pulmonale Infektionen und Tuberkulose“, Wien, Österreich
- Klinische Abteilung für Pulmonologie, Universitätsklinik für Innere Medizin, LKH-Univ. Klinikum Graz, Medizinische Universität Graz, Graz, Österreich
| | - Maria Hermann
- ÖGP-Arbeitskreis „Pulmonale Infektionen und Tuberkulose“, Wien, Österreich
- Klinische Abteilung für Pulmonologie, Universitätsklinik für Innere Medizin, LKH-Univ. Klinikum Graz, Medizinische Universität Graz, Graz, Österreich
| | - Matthias Urban
- Abteilung für Innere Medizin und Pneumologie, Klinik Floridsdorf, Wien, Österreich
- ÖGP-Arbeitskreis „Beatmung und Intensivmedizin“, Wien, Österreich
- Karl Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Wien, Österreich
| | - Michael Meilinger
- ÖGP-Arbeitskreis „Pulmonale Infektionen und Tuberkulose“, Wien, Österreich
- Abteilung für Innere Medizin und Pneumologie, Klinik Floridsdorf, Wien, Österreich
- Karl Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Wien, Österreich
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Lee PT, Krecko LK, Savage S, O'Rourke AP, Jung HS, Ingraham A, Zarzaur BL, Scarborough JE. Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement. J Trauma Acute Care Surg 2022; 93:446-452. [PMID: 35393378 PMCID: PMC9489599 DOI: 10.1097/ta.0000000000003645] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prevention of hospital-acquired conditions (HACs) is a focus of trauma center quality improvement. The relative contributions of various HACs to postinjury hospital outcomes are unclear. We sought to quantify and compare the impacts of six HACs on early clinical outcomes and resource utilization in hospitalized trauma patients. METHODS Adult patients from the 2013 to 2016 American College of Surgeons Trauma Quality Improvement Program Participant Use Data Files who required 5 days or longer of hospitalization and had an Injury Severity Score of 9 or greater were included. Multiple imputation with chained equations was used for observations with missing data. The frequencies of six HACs and five adverse outcomes were determined. Multivariable Poisson regression with log link and robust error variance was used to produce relative risk estimates, adjusting for patient-, hospital-, and injury-related factors. Risk-adjusted population attributable fractions estimates were derived for each HAC-outcome pair, with the adjusted population attributable fraction estimate for a given HAC-outcome pair representing the estimated percentage decrease in adverse outcome that would be expected if exposure to the HAC had been prevented. RESULTS A total of 529,856 patients requiring 5 days or longer of hospitalization were included. The incidences of HACs were as follows: pneumonia, 5.2%; urinary tract infection, 3.4%; venous thromboembolism, 3.3%; surgical site infection, 1.3%; pressure ulcer, 1.3%; and central line-associated blood stream infection, 0.2%. Pneumonia demonstrated the strongest association with in-hospital outcomes and resource utilization. Prevention of pneumonia in our cohort would have resulted in estimated reductions of the following: 22.1% for end organ dysfunction, 7.8% for mortality, 8.7% for prolonged hospitalization, 7.1% for prolonged intensive care unit stay, and 6.8% for need for mechanical ventilation. The impact of other HACs was comparatively small. CONCLUSION We describe a method for comparing the contributions of HACs to outcomes of hospitalized trauma patients. Our findings suggest that trauma program improvement efforts should prioritize pneumonia prevention. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Patrick T Lee
- From the Department of Surgery (P.T.L., L.K.K.), University of Wisconsin School of Medicine and Public Health; and Department of Surgery (S.S., A.P.O., H.S.J., A.I., B.L.Z., J.E.S.), Division of Acute Care and Regional General Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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What’s new in antibiotic stewardship for pneumonia in ICU? Anaesth Crit Care Pain Med 2022; 41:101135. [DOI: 10.1016/j.accpm.2022.101135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022]
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Roncin C, Vanel N, Morand A, Belghiti Alaoui M, Michel F. Systematic Endotracheal Aspiration in the Pediatric Intensive Care Unit Reduces Broad-spectrum Antibiotic Use for Ventilator-associated Pneumonia. Pediatr Infect Dis J 2022; 41:544-548. [PMID: 35363654 DOI: 10.1097/inf.0000000000003529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To determine the impact of a systematic endotracheal aspiration (ETA) sampling program for mechanically ventilated patients on initial antibiotic therapy for ventilator-acquired pneumonia (VAP). DESIGN Retrospective cohort study; before-after study design. SETTING Pediatric intensive care unit (PICU) with 16 medical and surgical beds in a tertiary teaching hospital. SUBJECTS Patients <16 years of age hospitalized in the PICU who fulfilled VAP criteria. INTERVENTION Biweekly systematic ETA sampling was conducted in mechanically ventilated patients. MEASUREMENTS We retrospectively studied patients who received antibiotic therapy for suspected VAP 12 months before and after the initiation of systematic ETA (periods 1 and 2, respectively), evaluating the initial antibiotic therapy spectrum in both periods. RESULTS During period 1, 56 patients developed VAP and 47 developed VAP during period 2. The incidence was 17 cases of VAP/1000 days of mechanical ventilation in both periods. Ideal antibiotic therapy was prescribed in 19.6% of cases for period 1 and 55.2% for period 2 (P = 0.001). Initial antibiotic therapy for VAP during period 2 had a significantly lower proportion of broad-spectrum antibiotics than therapy during period 1 (P = 0.01). CONCLUSION In our PICU, knowledge of bronchial colonization reduced initial broad-spectrum antibiotic use for VAP.
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Affiliation(s)
- César Roncin
- From the Anesthesia and Intensive Care Unit, Timone Children's Hospital, Hôpitaux Universitaires de Marseille, France
| | - Noémie Vanel
- From the Anesthesia and Intensive Care Unit, Timone Children's Hospital, Hôpitaux Universitaires de Marseille, France
| | - Aurelie Morand
- Pédiatrie spécialisée et médecine infantile Marseille, Timone Children's Hospital, Hôpitaux Universitaires de Marseille, France
| | - Myriem Belghiti Alaoui
- From the Anesthesia and Intensive Care Unit, Timone Children's Hospital, Hôpitaux Universitaires de Marseille, France
| | - Fabrice Michel
- From the Anesthesia and Intensive Care Unit, Timone Children's Hospital, Hôpitaux Universitaires de Marseille, France
- Aix Marseille University CNRS, EFS, ADES, UMR 7268, Marseille, France
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Li HY, Wang HS, Wang YL, Wang J, Huo XC, Zhao Q. Management of Ventilator-Associated Pneumonia: Quality Assessment of Clinical Practice Guidelines and Variations in Recommendations on Drug Therapy for Prevention and Treatment. Front Pharmacol 2022; 13:903378. [PMID: 35668946 PMCID: PMC9163435 DOI: 10.3389/fphar.2022.903378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/29/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: To assess the quality of clinical practice guidelines (CPGs) related to drug therapy for prevention and control of ventilator-associated pneumonia (VAP) and compare the differences and similarities between recommendations. Methods: Electronic databases (including PubMed, Cochrane library, Embase, Web of Science), guideline development organizations, and professional societies were searched to identify CPGs for VAP from 20 January 2012 to 20 January 2022. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. The recommendations on drug therapy for prevention and treatment for each guideline were extracted, and then a descriptive synthesis was performed to analyze the scope/topic, and consistency of the recommendations. Results: Thirteen CPGs were included. The median score and interquartile range (IQR) in each domain are shown below: scope and purpose 72.22% (63.89%,83.33%); stakeholder involvement 44.44% (38.89%,52.78%); rigor of development 43.75% (31.25%,57.29%); clarity and presentation 94.44% (77.78%,94.44%); applicability 20.83 (8.34%,33.34%) and editorial independence 50% (33.33%,66.67%). We extracted 21 recommendations on drug therapy for prevention of VAP and 51 recommendations on drugs used for treatment. Some controversies remained among the included guidelines. Conclusion: There is considerable variability in the development processes and reporting of VAP guidelines. Despite many similarities, the recommendations still had some inconsistencies in the details. For the prevention and treatment of VAP, local microbial epidemiology and antibiotic sensitivity must be considered, and recommendations should be regularly revised as new evidence emerges.
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Affiliation(s)
- Hong-Yan Li
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Hai-Shan Wang
- Department of Intensive Care Unit, Yantai YEDA Hospital, Yantai, China
| | - Ying-Lin Wang
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Jing Wang
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Xue-Chen Huo
- Department of Hepatobiliary Surgery, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
- *Correspondence: Xue-Chen Huo, ; Quan Zhao,
| | - Quan Zhao
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
- *Correspondence: Xue-Chen Huo, ; Quan Zhao,
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Bouglé A, Tuffet S, Federici L, Leone M, Monsel A, Dessalle T, Amour J, Dahyot-Fizelier C, Barbier F, Luyt CE, Langeron O, Cholley B, Pottecher J, Hissem T, Lefrant JY, Veber B, Legrand M, Demoule A, Kalfon P, Constantin JM, Rousseau A, Simon T, Foucrier A. Comparison of 8 versus 15 days of antibiotic therapy for Pseudomonas aeruginosa ventilator-associated pneumonia in adults: a randomized, controlled, open-label trial. Intensive Care Med 2022; 48:841-849. [PMID: 35552788 DOI: 10.1007/s00134-022-06690-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/22/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE Compared to long duration of antibiotic therapy, a short duration has a comparable clinical efficacy for ventilator-associated pneumonia (VAP), with the exception of documented VAP of non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA). We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) vs. prolonged antibiotic therapy (15 days) in VAP due to PA (PA-VAP). METHODS We conducted a nationwide, randomized, open-labeled, multicenter, non-inferiority trial to evaluate optimal duration of antibiotic treatment in PA-VAP. Eligible patients were adults with diagnosis of PA-VAP and randomly assigned in 1:1 ratio to receive a short-duration treatment (8 days) or a long-duration treatment (15 days). A pre-specified analysis was used to assess a composite endpoint combining mortality and PA-VAP recurrence rate during hospitalization in the intensive care unit (ICU) within 90 days. RESULTS In intention-to-treat population (n = 186), the percentage of patients who reached the composite endpoint was 25.5% (N = 25/98) in the 15-day group versus 35.2% (N = 31/88) in the 8-day group (difference 9.7%, 90% confidence interval (CI) 0.0-21.2%). The percentage of recurrence of PA-VAP during the ICU stay was 9.2% in the 15-day group versus 17% in the 8-day group. The two groups had similar median days of mechanical ventilation, of ICU stay, number of extra pulmonary infections and acquisition of multidrug-resistant (MDR) pathogens during ICU stay. CONCLUSIONS Our study showed no differences in the composite or separate outcomes (90-day mortality or VAP recurrence) between short- and long-duration treatments for PA-VAP. However, the lack of power limits the interpretation of this study.
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Affiliation(s)
- Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Sophie Tuffet
- Department of Clinical Pharmacology-Clinical Research Platform, Sorbonne University, AP-HP, Paris, France
| | - Laura Federici
- Service de Réanimation Polyvalente, Centre Hospitalier Sud Francilien, Corbeil, France
| | - Marc Leone
- Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesioloy and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Dessalle
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Julien Amour
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Claire Dahyot-Fizelier
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - François Barbier
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14, avenue de l'Hôpital, 45100, Orléans, France
| | - Charles-Edouard Luyt
- Medical Intensive Care Unit, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Olivier Langeron
- Multidisciplinary Intensive Care Unit, Department of Anesthesioloy and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Bernard Cholley
- Département d'Anesthésie et Réanimation, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Julien Pottecher
- Anaesthesiology, Critical Care and Perioperative Medicine, Strasbourg University Hospital-EA3072, FMTS, Strasbourg, France
| | - Tarik Hissem
- General Intensive Care Unit, Sud-Essonne Hospital, Étampes, France
| | - Jean-Yves Lefrant
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France
| | - Benoit Veber
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
| | - Matthieu Legrand
- Department of Anaesthesiology and Critical Care and Burn Unit, Groupe Hospitalier Lariboisière-Saint Louis, APHP, Paris, France
| | - Alexandre Demoule
- Service de Médecine Intensive Et Réanimation (Département R3S), APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
| | - Pierre Kalfon
- Service de Réanimation Polyvalente, Hôpital Louis Pasteur, CH de Chartres, Chartres, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology-Clinical Research Platform, Sorbonne University, AP-HP, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform, Sorbonne University, AP-HP, Paris, France
| | - Arnaud Foucrier
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, Clichy, France
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Wijers CDM, Pham L, Douglass MV, Skaar EP, Palmer LD, Noto MJ. Gram-negative bacteria act as a reservoir for aminoglycoside antibiotics that interact with host factors to enhance bacterial killing in a mouse model of pneumonia. FEMS MICROBES 2022; 3:xtac016. [PMID: 35909464 PMCID: PMC9326624 DOI: 10.1093/femsmc/xtac016] [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: 01/26/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 01/28/2023] Open
Abstract
In vitro exposure of multiple Gram-negative bacteria to an aminoglycoside (AG) antibiotic has previously been demonstrated to result in bacterial alterations that interact with host factors to suppress Gram-negative pneumonia. However, the mechanisms resulting in suppression are not known. Here, the hypothesis that Gram-negative bacteria bind and retain AGs, which are introduced into the lung and interact with host defenses to affect bacterial killing, was tested. Following in vitro exposure of one of several, pathogenic Gram-negative bacteria to the AG antibiotics kanamycin or gentamicin, AGs were detected in bacterial cell pellets (up to 208 μg/mL). Using inhibitors of AG binding and internalization, the bacterial outer membrane was implicated as the predominant kanamycin and gentamicin reservoir. Following intranasal administration of gentamicin-bound bacteria or gentamicin solution at the time of infection with live, AG-naïve bacteria, gentamicin was detected in the lungs of infected mice (up to 8 μg/g). Co-inoculation with gentamicin-bound bacteria resulted in killing of AG-naïve bacteria by up to 3-log10, mirroring the effects of intranasal gentamicin treatment. In vitro killing of AG-naïve bacteria mediated by kanamycin-bound bacteria required the presence of detergents or pulmonary surfactant, suggesting that increased bacterial killing inside the murine lung is facilitated by the detergent component of pulmonary surfactant. These findings demonstrate that Gram-negative bacteria bind and retain AGs that can interact with host-derived pulmonary surfactant to enhance bacterial killing in the lung. This may help explain why AGs appear to have unique efficacy in the lung and might expand their clinical utility.
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Affiliation(s)
- Christiaan D M Wijers
- Department of Pathology, Microbiology, and Immunology, Vanderbilt
University Medical Center, 1161 21st Avenue South, Nashville, TN 37232,
United States,Vanderbilt Institute for Infection, Immunology, and Inflammation,
Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville,
TN 37232, United States
| | - Ly Pham
- Department of Pathology, Microbiology, and Immunology, Vanderbilt
University Medical Center, 1161 21st Avenue South, Nashville, TN 37232,
United States,Vanderbilt Institute for Infection, Immunology, and Inflammation,
Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville,
TN 37232, United States
| | - Martin V Douglass
- Department of Pathology, Microbiology, and Immunology, Vanderbilt
University Medical Center, 1161 21st Avenue South, Nashville, TN 37232,
United States,Vanderbilt Institute for Infection, Immunology, and Inflammation,
Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville,
TN 37232, United States
| | - Eric P Skaar
- Department of Pathology, Microbiology, and Immunology, Vanderbilt
University Medical Center, 1161 21st Avenue South, Nashville, TN 37232,
United States,Vanderbilt Institute for Infection, Immunology, and Inflammation,
Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville,
TN 37232, United States
| | - Lauren D Palmer
- Department of Microbiology and Immunology, University of Illinois
Chicago, 835 South Wolcott Avenue, Chicago, IL 60612, United States
| | - Michael J Noto
- Corresponding author: Room 205H Whitehead Biomedical Research Building, Emory
University, 615 Michael Street, Atlanta, GA 30322, United States. Tel: (+404)712-2988;
E-mail:
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Pastene B, Labarriere A, Lopez A, Charvet A, Culver A, Fiocchi D, Cluzel A, Brioude G, Einav S, Tankel J, Hamidou Z, D’Journo XB, Thomas P, Leone M, Zieleskiewicz L. Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case-control study. BJS Open 2022; 6:zrac063. [PMID: 35607804 PMCID: PMC9127337 DOI: 10.1093/bjsopen/zrac063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Physiotherapy is a major cornerstone of enhanced rehabilitation after surgery (ERAS) and reduces the development of atelectasis after thoracic surgery. By initiating physiotherapy in the post-anaesthesia care unit (PACU), the aim was to evaluate whether the ultra-early initiation of rehabilitation (in the first hour following tracheal extubation) would improve the outcomes of patients undergoing elective thoracic surgery. METHODS A case-control study with a before-and-after design was conducted. From a historical control group, patients were paired at a 3:1 ratio with an intervention group. This group consisted of patients treated with the ultra-early rehabilitation programme after elective thoracic surgery (clear fluids, physiotherapy, and ambulation). The primary outcome was the incidence of postoperative atelectasis and/or pneumonia during the hospital stay. RESULTS After pairing, 675 patients were allocated to the historical control group and 225 patients to the intervention group. A significant decrease in the incidence of postoperative atelectasis and/or pneumonia was found in the latter (11.4 versus 6.7 per cent respectively; P = 0.042) and remained significant on multivariate analysis (OR 0.53, 95 per cent c.i. 0.26 to 0.98; P = 0.045). A subgroup analysis of the intervention group showed that early ambulation during the PACU stay was associated with a further significant decrease in the incidence of postoperative atelectasis and/or pneumonia (2.2 versus 9.5 per cent; P = 0.012). CONCLUSIONS Ultra-early rehabilitation in the PACU was associated with a decrease in the incidence of postoperative atelectasis and/or pneumonia after major elective thoracic surgery.
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Affiliation(s)
- Bruno Pastene
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
- Centre for Cardiovascular and Nutrition Research (C2VN), INRA, Aix Marseille Université, INSERM, Marseille, France
| | - Ambroise Labarriere
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Alexandre Lopez
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Aude Charvet
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Aurélien Culver
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - David Fiocchi
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Armand Cluzel
- Department of Thoracic Surgery, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Sharon Einav
- Intensive Care Unit of the Shaare Zedek Medical Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - James Tankel
- Division of Thoracic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Zeinab Hamidou
- Centre d’Études et de Recherches sur les Services de Santé et Qualité de Vie CEReSS/EA 3279, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Xavier Benoit D’Journo
- Department of Thoracic Surgery, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Pascal Thomas
- Department of Thoracic Surgery, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Marc Leone
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
- Centre for Cardiovascular and Nutrition Research (C2VN), INRA, Aix Marseille Université, INSERM, Marseille, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
- Centre for Cardiovascular and Nutrition Research (C2VN), INRA, Aix Marseille Université, INSERM, Marseille, France
- Department of Digestive and Hepatobiliary Surgery, CHU Estaing, Clermont-Ferrand, France
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Guillotin F, Poulain C, Gaborit B, Bouras M, Cinotti R, Lakhal K, Vourc’h M, Rozec B, Asehnoune K, Vibet MA, Riche VP, Gibaud SA, Crémet L, Roquilly A. Potential Impact of Rapid Multiplex PCR on Antimicrobial Therapy Guidance for Ventilated Hospital-Acquired Pneumonia in Critically Ill Patients, A Prospective Observational Clinical and Economic Study. Front Cell Infect Microbiol 2022; 12:804611. [PMID: 35493730 PMCID: PMC9043525 DOI: 10.3389/fcimb.2022.804611] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/14/2022] [Indexed: 01/23/2023] Open
Abstract
ObjectivesTo investigate the potential impact of the syndromic multiplex FilmArray® Pneumonia plus Panel (FAPP) on the antimicrobial treatment guidance of patients with ventilated hospital-acquired pneumonia (VHAP).MethodsRespiratory fluids from 100 adult patients with VHAP, receiving invasive mechanical ventilation in three intensive care units from one French university hospital, were tested prospectively using FAPP. Conventional cultures were performed in parallel as routine practice. Clinicians were left blinded to the FAPP results. Antimicrobial therapies based on FAPP results were simulated by independent blinded experts according to a predefined algorithm and compared to 1) those prescribed in practice according to local guidelines (real-life), and 2) those that complied with the international ERS/ESICM/ESCMID/ALAT recommendations. The primary endpoint was the number of days of broad-spectrum antimicrobial therapy. Secondary endpoints were the rates of microbiological treatment failure and cost-effectiveness ratio.ResultsThe predicted median duration of broad-spectrum antibiotics was 0 [0-1.25] day in the FAPP-based simulation, versus 2 [0-6] days in real-life (p<0.0001) and 2 [2-3.25] days in the recommendations-based simulation (p<0.0001). Treatment failure was predicted in 3% of cases with FAPP results versus observed in 11% in real-life (p=0.08) and 6% with recommendations-based simulation (p=0.37). The incremental cost-effectiveness ratio was 1 121 € [-7021; 6794] to avoid one day of non-optimized antimicrobial therapy.ConclusionsOur results suggest that using FAPP in patients with VHAP has the potential to reduce the use of broad-spectrum antimicrobial therapy without increasing the risk of microbial treatment failure.
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Affiliation(s)
- Florian Guillotin
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
- *Correspondence: Florian Guillotin, ; Antoine Roquilly,
| | - Cécile Poulain
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Benjamin Gaborit
- Service de Maladies Infectieuses et Tropicales et CIC 1413, CHU Nantes, Nantes, France
| | - Marwan Bouras
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Raphaël Cinotti
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Karim Lakhal
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Mickael Vourc’h
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Bertrand Rozec
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Karim Asehnoune
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Marie-Anne Vibet
- Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France
| | - Valéry-Pierre Riche
- Cellule Innovation - Département Partenariat et Innovation - Direction de la Recherche, CHU de Nantes, Nantes, France
| | - Sophie-Anne Gibaud
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU de Nantes, Nantes, France
| | - Lise Crémet
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU de Nantes, Nantes, France
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
- *Correspondence: Florian Guillotin, ; Antoine Roquilly,
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Kamel NA, Alshahrani MY, Aboshanab KM, El Borhamy MI. Evaluation of the BioFire FilmArray Pneumonia Panel Plus to the Conventional Diagnostic Methods in Determining the Microbiological Etiology of Hospital-Acquired Pneumonia. BIOLOGY 2022; 11:biology11030377. [PMID: 35336751 PMCID: PMC8945136 DOI: 10.3390/biology11030377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 01/13/2023]
Abstract
Hospital-acquired pneumonia (HAP) is a substantial public health issue that is associated with high mortality rates and is complicated by an arsenal of microbial etiologies, expressing multidrug-resistant phenotypes, rendering relatively limited therapeutic options. BioFire FilmArray Pneumonia Panel plus (BFPP) is a simple multiplexed PCR system that integrates sample preparation, nucleic acid extraction, amplification, and analysis of microbial etiology, with a turnaround time of about one hour. In comparison to standard culture methods, BFPP is simpler, easier to perform, and can simultaneously detect the most common pathogens involved in lower respiratory tract infections (34 targets). Accordingly, we evaluated the diagnostic performance of the multiplexed BFPP for the rapid detection of 27 clinically relevant respiratory pathogens and 7 genetic markers among 50 HAP cases admitted to the intensive care unit (ICU), who submitted mini-bronchoalveolar (mBAL) specimens. In comparison to standard culture methods, BFPP showed an overall sensitivity of 100% [95% CI; 90-100] and overall specificity of 90% [95% CI; 87.4-92.5] among all the tested bacterial targets. BFPP identified 11 viral targets (22%) among the tested specimens. The BFPP semi-quantitative analysis showed a concordance rate of 47.4% among positive culture specimens. For the investigation of the antibiotic resistance genes, BFPP showed a positive percent agreement (PPA), a negative percent agreement (NPA), and an overall percent agreement (OPA), reaching 97% [95% CI; 90-100], 95% [95% CI; 91.5-97], and 95% [95% CI; 93-97], respectively, with standard antibiotic sensitivity testing. In conclusion, BFPP has the potential to enhance the rapid microbiological diagnosis of HAP cases, and could aid in tailoring appropriate antibiotic therapies.
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Affiliation(s)
- Noha A. Kamel
- Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo P.O. Box 19648, Egypt; (N.A.K.); (M.I.E.B.)
| | - Mohammad Y. Alshahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, P.O. Box 61413, Abha 9088, Saudi Arabia;
| | - Khaled M. Aboshanab
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University, Organization of African Unity St., Abbassia, Cairo P.O. Box 11566, Egypt
- Correspondence: ; Tel.:+20-1007582620
| | - Mervat I. El Borhamy
- Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo P.O. Box 19648, Egypt; (N.A.K.); (M.I.E.B.)
- International Medical Center, Clinical Microbiology Laboratory, Cairo P.O. Box 11451, Egypt
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Boisson M, Bouglé A, Sole-Lleonart C, Dhanani J, Arvaniti K, Rello J, Rouby JJ, Mimoz O. Nebulized Antibiotics for Healthcare- and Ventilator-Associated Pneumonia. Semin Respir Crit Care Med 2022; 43:255-270. [PMID: 35042259 DOI: 10.1055/s-0041-1740340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Global emergence of multidrug-resistant and extensive drug-resistant gram-negative bacteria has increased the risk of treatment failure, especially for healthcare- or ventilator-associated pneumonia (HAP/VAP). Nebulization of antibiotics, by providing high intrapulmonary antibiotic concentrations, represents a promising approach to optimize the treatment of HAP/VAP due to multidrug-resistant and extensive drug-resistant gram-negative bacteria, while limiting systemic antibiotic exposure. Aminoglycosides and colistin methanesulfonate are the most common nebulized antibiotics. Although optimal nebulized drug dosing regimen is not clearly established, high antibiotic doses should be administered using vibrating-mesh nebulizer with optimized ventilator settings to ensure safe and effective intrapulmonary concentrations. When used preventively, nebulized antibiotics reduced the incidence of VAP without any effect on mortality. This approach is not yet recommended and large randomized controlled trials should be conducted to confirm its benefit and explore the impact on antibiotic selection pressure. Compared with high-dose intravenous administration, high-dose nebulized colistin methanesulfonate seems to be more effective and safer in the treatment of ventilator-associated tracheobronchitis and VAP caused by multidrug resistant and extensive-drug resistant gram-negative bacteria. Adjunctive nebulized aminoglycosides could increase the clinical cure rate and bacteriological eradication in patients suffering from HAP/VAP due to multidrug-resistant and extensive drug-resistant gram-negative bacteria. As nebulized aminoglycosides broadly diffuse in the systemic circulation of patients with extensive bronchopneumonia, monitoring of plasma trough concentrations is recommended during the period of nebulization. Large randomized controlled trials comparing high dose of nebulized colistin methanesulfonate to high dose of intravenous colistin methanesulfonate or to intravenous new β-lactams in HAP/VAP due to multidrug-resistant and extensive drug-resistant gram-negative bacteria are urgently needed.
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Affiliation(s)
- Matthieu Boisson
- INSERM U1070, Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.,Service de Prévention et de Contrôle de l'Infection, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Adrien Bouglé
- Medicine Sorbonne University, Anaesthesiology and Critical Care, Cardiology Institute, Paris, France.,Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Candela Sole-Lleonart
- Intensive Care Unit, Consorci Hospitalari de Vic (CHV), The University of Vic - Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Jayesh Dhanani
- Department of Intensive care medicine, Centre for Clinical Research, The University of Queensland, The Royal Brisbane and Women's Hospital Herston, Brisbane, Australia
| | - Kostoula Arvaniti
- Intensive Care Unit Department, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece
| | - Jordi Rello
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Clinical Research and Innovation in Pneumonia and Sepsis, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.,Clinical Research, CHU Nîmes, Université Montpellier-Nîmes, Nîmes, France
| | - Jean-Jacques Rouby
- Department of Anaesthesiology and Critical Care, Medicine Sorbonne University, Multidisciplinary Intensive Care Unit, La Pitié Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Olivier Mimoz
- INSERM U1070 Université de Poitiers, UFR de Médecine Pharmacie and Service des Urgences Adultes & SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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Dong J, Li W, Wang Q, Chen J, Zu Y, Zhou X, Guo Q. Relationships Between Oral Microecosystem and Respiratory Diseases. Front Mol Biosci 2022; 8:718222. [PMID: 35071321 PMCID: PMC8767498 DOI: 10.3389/fmolb.2021.718222] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023] Open
Abstract
Oral microecosystem is a very complicated ecosystem that is located in the mouth and comprises oral microbiome, diverse anatomic structures of oral cavity, saliva and interactions between oral microbiota and between oral microbiota and the host. More and more evidence from studies of epidemiology, microbiology and molecular biology is establishing a significant link between oral microecosystem and respiratory diseases. Microbiota settling down in oral microecosystem is known as the main source of lung microbiome and has been associated with the occurrence and development of respiratory diseases like pneumonia, chronic obstructive pulmonary disease, lung cancer, cystic fibrosis lung disease and asthma. In fact, it is not only indigenous oral microbes promote or directly cause respiratory infection and inflammation when inhaled into the lower respiratory tract, but also internal environment of oral microecosystem serves as a reservoir for opportunistic respiratory pathogens. Moreover, poor oral health and oral diseases caused by oral microecological dysbiosis (especially periodontal disease) are related with risk of multiple respiratory diseases. Here, we review the research status on the respiratory diseases related with oral microecosystem. Potential mechanisms on how respiratory pathogens colonize oral microecosystem and the role of indigenous oral microbes in pathogenesis of respiratory diseases are also summarized and analyzed. Given the importance of oral plaque control and oral health interventions in controlling or preventing respiratory infection and diseases, we also summarize the oral health management measures and attentions, not only for populations susceptible to respiratory infection like the elderly and hospitalized patients, but also for dentist or oral hygienists who undertake oral health care. In conclusion, the relationship between respiratory diseases and oral microecosystem has been established and supported by growing body of literature. However, etiological evidence on the role of oral microecosystem in the development of respiratory diseases is still insufficient. Further detailed studies focusing on specific mechanisms on how oral microecosystem participate in the pathogenesis of respiratory diseases could be helpful to prevent and treat respiratory diseases.
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Affiliation(s)
- Jiajia Dong
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qi Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiahao Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yue Zu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qiang Guo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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42
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Gong SC, Ryu H, Jang JY. Usefulness of delta neutrophil index as a biomarker to predict postoperative complication in patients who underwent esophagectomy: A case-control study. Medicine (Baltimore) 2021; 100:e28311. [PMID: 34941124 PMCID: PMC8702068 DOI: 10.1097/md.0000000000028311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 11/23/2021] [Indexed: 01/05/2023] Open
Abstract
Esophagectomy demonstrates a high incidence of complications owing to its complexity and invasiveness; hence, early detection of complications is important. We aimed to evaluate the predictive value of the delta neutrophil index (DNI) for complications after esophagectomy.We retrospectively analyzed patients who underwent esophagectomy in the department of general surgery at a single institution between January 2011 and October 2020. Patient characteristics, laboratory findings, and clinical outcomes were assessed.Fifty-seven patients were enrolled in this study, of whom 31 (54.4%) had complications. The complication group had significantly longer mean mechanical ventilation, hospital stay and intensive care unit stay periods, and higher acute physiology, age, chronic health evaluation score and mortality rate than the noncomplication group. DNI on postoperative day (POD) 2 was also significantly higher in the complication group. Logistic regression analysis showed that DNI on POD 2 was an independent risk factor associated with the complications. Receiver operating characteristic curve analysis showed that the area under curve of DNI on POD 2 was 0.712 (cutoff value: 2.15%, sensitivity 61.5%, and specificity 70.8%).Our study indicated that postoperative DNI can be useful as an early predictive biomarker of the complications after esophagectomy.
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Affiliation(s)
- Seong Chan Gong
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hoon Ryu
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Young Jang
- Department of Surgery, National Health Insurance Service, Goyang, Korea
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43
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Leone M, Lakbar I, Lopez A, Zunino C, Loeches IM. Selective digestive decontamination and COVID-19: Uncertainty in a moving area. Anaesth Crit Care Pain Med 2021; 41:101009. [PMID: 34920151 PMCID: PMC8670106 DOI: 10.1016/j.accpm.2021.101009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc Leone
- Aix Marseille Université, APHM, Service d'anesthésie et de réanimation, Hôpital Nord, 13015 Marseille, France.
| | - Ines Lakbar
- Aix Marseille Université, APHM, Service d'anesthésie et de réanimation, Hôpital Nord, 13015 Marseille, France
| | - Alexandre Lopez
- Aix Marseille Université, APHM, Service d'anesthésie et de réanimation, Hôpital Nord, 13015 Marseille, France
| | - Claire Zunino
- Aix Marseille Université, APHM, Service d'anesthésie et de réanimation, Hôpital Nord, 13015 Marseille, France
| | - Ignacio Martin Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
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Mazloomirad F, Hasanzadeh S, Sharifi A, Nikbakht G, Roustaei N, Khoramrooz SS. Identification and detection of pathogenic bacteria from patients with hospital-acquired pneumonia in southwestern Iran; evaluation of biofilm production and molecular typing of bacterial isolates. BMC Pulm Med 2021; 21:408. [PMID: 34886838 PMCID: PMC8662843 DOI: 10.1186/s12890-021-01773-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/29/2021] [Indexed: 12/01/2022] Open
Abstract
Background Hospital-acquired pneumonia (HAP) is the second most common nosocomial infection in intensive care units (ICUs). The present study aims to determine the prevalence of pathogenic bacteria, their biofilm formation, and molecular typing from patients with HAP in southwestern Iran. Methods Fifty-eight patients with HAP participated in this cross-sectional study. Sputum and endotracheal aspirate were collected from each patient for isolation and detection of bacteria. Biofilm formation was evaluated using Congo red agar or Microtiter plate assay. The antimicrobial susceptibility patterns of the isolates were investigated. The multiplex polymerase chain reaction (M-PCR) technique was used to determine the Staphylococcal Cassette Chromosome mec (SCCmec) types of methicillin-resistant Staphylococcus aureus (MRSA) strains. All S. aureus isolates were typed using the agr typing method. A repetitive element sequence-based PCR (rep-PCR) typing method was used for typing of Gram-negative bacteria. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 15 and the chi-square test. Results Bacteria were isolated in 52 (89.7%) of patients. Acinetobacter baumannii (A. baumannii) was the most prevalent organism (37%), followed by S. aureus, Pseudomonas aeruginosa (P. aeruginosa), and Escherichia coli (E. coli). Using the PCR method, 56 bacteria were detected. A. baumannii was the most prevalent (35.7%) organism. A. baumannii and P. aeruginosa were biofilm-producing. All Gram-negative isolates were colistin-sensitive, and most of the A. baumannii isolates were multidrug-resistant (MDR). MRSA was identified in 12 (80%) S. aureus isolates, and 91.6% of MRSA were SCCmec type III. The agr type III was the most predominant. The rep-PCR analysis showed seven different patterns in 20 A. baumannii, six patterns in 13 P. aeruginosa, and four patterns in 6 E. coli. Conclusion A. baumannii was more prevalent than S. aureus in ventilator-associated pneumonia (VAP), while S. aureus is a major pathogen in non-ventilator hospital-acquired pneumonia (NV-HAP), possibly due to the tendency of the former to aquatic environments. Based on the rep-PCR typing method, it was concluded that bacteria were transmitted from patients or healthcare workers among different wards. Colistin can be used as a treatment in Gram-negative MDR isolates.
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Affiliation(s)
- Farzad Mazloomirad
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Sajad Hasanzadeh
- Department of Internal Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Asghar Sharifi
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Gordafarin Nikbakht
- Department of Infectious Diseases, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Narges Roustaei
- Department of Epidemiology and Biostatistics, School of Health and Nutrition Sciences, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Seyed Sajjad Khoramrooz
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran. .,Department of Microbiology, Yasuj University of Medical Sciences, Yasuj, Iran.
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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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46
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Zhao J, Li LQ, Zhen NX, Du LL, Shan H, Yu Y, Zhang ZC, Cui W, Tian BP. Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study. Front Microbiol 2021; 12:720051. [PMID: 34925251 PMCID: PMC8678279 DOI: 10.3389/fmicb.2021.720051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
Background: The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent. Purpose: To determine the microbiology and outcomes of SAP in the lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV). Methods: In this observational study, included patients were divided into SAP and non-SAP based on a comprehensive analysis of symptom, imaging, and laboratory results. Baseline characteristics, clinical characteristics, microbiology, and outcomes were recorded and evaluated. Results: Of 200 patients, 42.5% developed SAP after the onset of stroke, and they had a lower proportion of non-smokers (p = 0.002), lower GCS score (p < 0.001), higher serum CRP (p < 0.001) at ICU admission, and a higher proportion of males (p < 0.001) and hypertension (p = 0.039) than patients with non-SAP. Gram-negative aerobic bacilli were the predominant organisms isolated (78.8%), followed by Gram-positive aerobic cocci (29.4%). The main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogenes, Serratia marcescens, and Burkholderia cepacia. SAP prolonged length of MV (p < 0.001), duration of ICU stay (p < 0.001) and hospital stay (p = 0.027), shortened MV-free days by 28 (p < 0.001), and caused elevated vasopressor application (p = 0.001) and 60-day mortality (p = 0.001). Logistic regression analysis suggested that patients with coma (p < 0.001) have a higher risk of developing SAP. Conclusion: The microbiology of SAP is similar to early phase of HAP and VAP. SAP prolongs the duration of MV and length of ICU and hospital stays, but also markedly increases 60-day mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bao-ping Tian
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Factors Associated with 90-Day Mortality in Invasively Ventilated Patients with COVID-19 in Marseille, France. J Clin Med 2021; 10:jcm10235650. [PMID: 34884353 PMCID: PMC8658321 DOI: 10.3390/jcm10235650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: To describe clinical characteristics and management of intensive care units (ICU) patients with laboratory-confirmed COVID-19 and to determine 90-day mortality after ICU admission and associated risk factors. Methods: This observational retrospective study was conducted in six intensive care units (ICUs) in three university hospitals in Marseille, France. Between 10 March and 10 May 2020, all adult patients admitted in ICU with laboratory-confirmed SARS-CoV-2 and respiratory failure were eligible for inclusion. The statistical analysis was focused on the mechanically ventilated patients. The primary outcome was the 90-day mortality after ICU admission. Results: Included in the study were 172 patients with COVID-19 related respiratory failure, 117 of whom (67%) received invasive mechanical ventilation. 90-day mortality of the invasively ventilated patients was 27.4%. Median duration of ventilation and median length of stay in ICU for these patients were 20 (9–33) days and 29 (17–46) days. Mortality increased with the severity of ARDS at ICU admission. After multivariable analysis was carried out, risk factors associated with 90-day mortality were age, elevated Charlson comorbidity index, chronic statins intake and occurrence of an arterial thrombosis. Conclusion: In this cohort, age and number of comorbidities were the main predictors of mortality in invasively ventilated patients. The only modifiable factor associated with mortality in multivariate analysis was arterial thrombosis.
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48
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Luque-Paz D, Tattevin P, Jaubert P, Reizine F, Kouatchet A, Camus C. Selective digestive decontamination to reduce the high rate of ventilator-associated pneumonia in critical COVID-19. Anaesth Crit Care Pain Med 2021; 41:100987. [PMID: 34844031 PMCID: PMC8619941 DOI: 10.1016/j.accpm.2021.100987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- David Luque-Paz
- Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, University Hospital of Rennes, Rennes, France; Intensive Care Unit, University Hospital of Angers, Angers, France.
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, University Hospital of Rennes, Rennes, France
| | - Paul Jaubert
- Intensive Care Unit, University Hospital of Angers, Angers, France
| | - Florian Reizine
- Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, University Hospital of Rennes, Rennes, France
| | | | - Christophe Camus
- Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, University Hospital of Rennes, Rennes, France
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Dongol S, Kayastha G, Maharjan N, Pyatha S, K. C. R, Thwaites L, Basnyat B, Baker S, Karkey A. Epidemiology, etiology, and diagnosis of health care acquired pneumonia including ventilator-associated pneumonia in Nepal. PLoS One 2021; 16:e0259634. [PMID: 34788314 PMCID: PMC8598067 DOI: 10.1371/journal.pone.0259634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
Epidemiologic data regarding health care acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) from Nepal are negligible. We conducted a prospective observational cohort study in the intensive care unit (ICU) of a major tertiary hospital in Nepal between April 2016 and March 2018, to calculate the incidence of VAP, and to describe clinical variables, microbiological etiology, and outcomes. Four hundred and thirty-eight patients were enrolled in the study. Demographic data, medical history, antimicrobial administration record, chest X-ray, biochemical, microbiological and haematological results, acute physiology and chronic health evaluation II score and the sequential organ failure assessment scores were recorded. Categorical variables were expressed as count and percentage and analyzed using the Fisher's exact test. Continuous variables were expressed as median and interquartile range and analyzed using Kruskal-Wallis rank sum test and the pairwise Wilcoxon rank-sum test. 46.8% (205/438) of the patients required intubation. Pneumonia was common in both intubated (94.14%; 193/205) and non-intubated (52.36%; 122/233) patients. Pneumonia developed among intubated patients in the ICU had longer days of stay in the ICU (median of 10, IQR 5-15, P< 0.001) when compared to non-intubated patients with pneumonia (median of 4, IQR 3-6, P< 0.001). The incidence rate of VAP was 20% (41/205) and incidence density was 16.45 cases per 1,000ventilator days. Mortality was significantly higher in patients with pneumonia requiring intubation (44.6%, 86/193) than patients with pneumonia not requiring intubation (10.7%, 13/122, p<0.001, Fisher's exact test). Gram negative bacteria such as Klebsiella and Acinetobacter species were the dominant organisms from both VAP and non-VAP categories. Multi-drug resistance was highly prevalent in bacterial isolates associated with VAP (90%; 99/110) and non-VAP categories (81.5%; 106/130). HAP including VAP remains to be the most prevalent hospital-acquired infections (HAIs) at Patan hospital. A local study of etiological agents and outcomes of HAP and VAP are required for setting more appropriate guidelines for management of such diseases.
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Affiliation(s)
- Sabina Dongol
- Patan Academy of Health Sciences, Patan Hospital, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Gyan Kayastha
- Patan Academy of Health Sciences, Patan Hospital, Kathmandu, Nepal
| | - Nhukesh Maharjan
- Patan Academy of Health Sciences, Patan Hospital, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Sarita Pyatha
- Patan Academy of Health Sciences, Patan Hospital, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Rajkumar K. C.
- Patan Academy of Health Sciences, Patan Hospital, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Louise Thwaites
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Buddha Basnyat
- Patan Academy of Health Sciences, Patan Hospital, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Abhilasha Karkey
- Patan Academy of Health Sciences, Patan Hospital, Oxford University Clinical Research Unit, Kathmandu, Nepal
- * E-mail:
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50
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Winiszewski H, Despres C, Puyraveau M, Lagoutte-Renosi J, Montange D, Besch G, Floury SP, Chaignat C, Labro G, Vettoretti L, Clairet AL, Capellier G, Vivet B, Piton G. β-lactam dosing at the early phase of sepsis: Performance of a pragmatic protocol for target concentration achievement in a prospective cohort study. J Crit Care 2021; 67:141-146. [PMID: 34768176 DOI: 10.1016/j.jcrc.2021.10.023] [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: 08/22/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We hypothesized that a protocol of standardized fixed dose using prolonged infusion during the early phase of sepsis may avoid insufficient β-lactam concentrations. METHODS In this single center prospective study, patients with sepsis and vasopressors were enrolled if they were treated by either piperacillin-tazobactam, meropenem or cefepime. Βeta-lactams were administered at fixed dose by prolonged infusion. Targeted plasma concentrations for piperacillin, meropenem and cefepime were above 80 mg/L, 8 mg/L and 38 mg/L respectively. Three blood samples were collected per patient over the first 48 h of treatment. Primary endpoint was target concentration achievement during the 48 first hours, defined as all plasma concentrations above the targeted threshold. RESULTS Among the 89 patients completing the three samples, target concentrations were achieved for 61 (69%). Target concentrations were achieved in 20 (53%), 32 (89%), and 9 (60%) of the patients treated with piperacillin, meropenem and cefepime, respectively. By multivariate analysis, lower APACHE 2 score, higher baseline MDRD creatinine clearance, and piperacillin use were independently associated with insufficient β-lactam concentrations. CONCLUSION Despite a fixed dose antibiotic administration protocol with prolonged infusion insufficient β-lactam concentration was frequent at the early phase of sepsis, especially in less severe patients, without renal failure, and treated with piperacillin. In septic patients with vasopressors, piperacillin dosing higher than 16 g may be needed to achieve the recommended target concentration. TRIAL REGISTRATION NCT02820987.
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Affiliation(s)
- Hadrien Winiszewski
- Medical Intensive Care Unit, Besançon University Hospital, Besançon, France.
| | - Cyrielle Despres
- Surgical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | - Marc Puyraveau
- Methodology Unit, Clinical Investigation Center INSERM 1431, Besançon University Hospital, Besançon, France
| | | | - Damien Montange
- Pharmacology Unit, Besançon University Hospital, Besançon, France
| | - Guillaume Besch
- Surgical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | | | | | - Guylaine Labro
- Medical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | - Lucie Vettoretti
- Medical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | | | - Gilles Capellier
- Medical Intensive Care Unit, Besançon University Hospital, Besançon, France; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia
| | | | - Gael Piton
- Medical Intensive Care Unit, Besançon University Hospital, Besançon, France
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