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de Araújo ECF, da Silva RO, Raymundo MLB, Vieira TI, de Sousa SA, Santiago BM, Cavalcanti YW. Does the presence of oral health teams influence the incidence of ventilator-associated pneumonia and mortality of patients in intensive care units? Systematic review. SPECIAL CARE IN DENTISTRY 2023; 43:452-463. [PMID: 36210508 DOI: 10.1111/scd.12785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/05/2022] [Accepted: 09/10/2022] [Indexed: 07/21/2023]
Abstract
AIMS To verify whether oral health teams influence the oral health status, ventilator-associated pneumonia incidence and mortality rate of patients in Intensive Care Units (ICU). MATERIALS AND METHODS Bibliographic searches were performed in PubMed, Scopus, Web of Science, Lilacs, Embase, Livivo, Open Grey, Academic Google, and Cochrane databases. The assessment of the methodological quality and risk of bias of the included studies and a random-effects meta-analysis to summarize relative risk data for ventilator-associated pneumonia (VAP) and mortality were performed. An analysis of the certainty of the evidence was performed for the main outcomes analyzed. RESULTS Records of 518 studies were analyzed by reading titles and abstracts. Five studies were included according to eligibility criteria. The meta-analysis showed that ICU patients undergoing dental care by an oral health team had a lower incidence of VAP (OR = 0.33; 95% CI: 014-0.76) but did not lower mortality rates (OR = 0.46 95% CI: 0.16-1.32). The certainty of the evidence was considered very low. CONCLUSION Dental care provided by oral health teams in a hospital environment did not influence oral health status or mortality, although it contributed to a reduction in VAP of patients admitted to the ICU.
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Affiliation(s)
- Elza Cristina Farias de Araújo
- Department of Clinical and Social Dentistry, University of Paraíba (UFPB), Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Rênnis Oliveira da Silva
- Department of Clinical and Social Dentistry, University of Paraíba (UFPB), Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Maria Letícia Barbosa Raymundo
- Department of Clinical and Social Dentistry, University of Paraíba (UFPB), Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Thiago Isidro Vieira
- Department of Clinical and Social Dentistry, University of Paraíba (UFPB), Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Simone Alves de Sousa
- Department of Clinical and Social Dentistry, University of Paraíba (UFPB), Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Bianca Marques Santiago
- Department of Clinical and Social Dentistry, University of Paraíba (UFPB), Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Yuri Wanderley Cavalcanti
- Department of Clinical and Social Dentistry, University of Paraíba (UFPB), Cidade Universitária, João Pessoa, Paraíba, Brazil
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Zhang F, Zhuang J, Li Z, Gong H, de Ávila BEF, Duan Y, Zhang Q, Zhou J, Yin L, Karshalev E, Gao W, Nizet V, Fang RH, Zhang L, Wang J. Nanoparticle-modified microrobots for in vivo antibiotic delivery to treat acute bacterial pneumonia. NATURE MATERIALS 2022; 21:1324-1332. [PMID: 36138145 PMCID: PMC9633541 DOI: 10.1038/s41563-022-01360-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/09/2022] [Indexed: 05/03/2023]
Abstract
Bioinspired microrobots capable of actively moving in biological fluids have attracted considerable attention for biomedical applications because of their unique dynamic features that are otherwise difficult to achieve by their static counterparts. Here we use click chemistry to attach antibiotic-loaded neutrophil membrane-coated polymeric nanoparticles to natural microalgae, thus creating hybrid microrobots for the active delivery of antibiotics in the lungs in vivo. The microrobots show fast speed (>110 µm s-1) in simulated lung fluid and uniform distribution into deep lung tissues, low clearance by alveolar macrophages and superb tissue retention time (>2 days) after intratracheal administration to test animals. In a mouse model of acute Pseudomonas aeruginosa pneumonia, the microrobots effectively reduce bacterial burden and substantially lessen animal mortality, with negligible toxicity. Overall, these findings highlight the attractive functions of algae-nanoparticle hybrid microrobots for the active in vivo delivery of therapeutics to the lungs in intensive care unit settings.
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Affiliation(s)
- Fangyu Zhang
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Jia Zhuang
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Zhengxing Li
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Hua Gong
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | | | - Yaou Duan
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Qiangzhe Zhang
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Jiarong Zhou
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Lu Yin
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Emil Karshalev
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Weiwei Gao
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Victor Nizet
- Department of Pediatrics and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Ronnie H Fang
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Liangfang Zhang
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA.
| | - Joseph Wang
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, CA, USA.
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Prasoon A, Singh R, Anand R, Kumar S, Singh S, Singh A. A Randomized Controlled Trial to Evaluate the Use of Probiotics in Prevention of Ventilator-Associated Pneumonia in Critically Ill ICU Patients. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1754161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Context Ventilator-associated pneumonia (VAP) is one of the most common causes of morbidity and mortality in mechanically ventilated patients. Curing and preventing effects of probiotics in promoting the growth of Bifidobacterium in the digestive system and the central role of bacteria colonization in the pathogenesis of VAP are evident.
Aims The purpose of this study was to evaluate the effects of administration of commercially available probiotics, that is, orodispersible probiotic sachets on VAP prevention and clinical outcomes in critically ill patients.
Settings and Design Randomized control trials.
Methods and Materials In this study, 120 mechanically ventilated patients were randomly divided into two groups (n = 60 per group). Group 1 was given orodispersible probiotic sachets by gavage, twice a day in addition to routine care, while group 2 received only routine care. Demographic and clinical data were analyzed and clinical outcomes to the primary component (prevalence of VAP) and secondary component (other clinical factors) were interpreted.
Statistical Analysis Used In this study, data were analyzed via SAS statistical software version 9.4, using Student's t-test, chi-squared test, repeated measure analysis of variance, and Wilcoxon test.
Results There was a significant reduction in VAP diagnosed patients, as well as Clostridium
difficile-associated diarrhea and some complications of mechanical ventilation, in group 1 in comparison to group 2. The improvement in VAP was significantly greater for group 1 as compared with group 2. However, the mortality rate was similar between two groups.
Conclusions This study demonstrated that a daily diet with orodispersible probiotic sachets can be used as add-on therapy with other medications in the prevention of VAP. As a result, the use of orodispersible probiotic sachets in the treatment plan of patients undergoing long-term intubation is recommended.
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Affiliation(s)
- Anand Prasoon
- Department of Trauma and Emergency, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ritu Singh
- Department of Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ravi Anand
- Department of Trauma and Emergency, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sanjeev Kumar
- Department of Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Siddharth Singh
- Department of Trauma and Emergency, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Akrity Singh
- Department of Trauma and Emergency, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Lan SH, Hung SH, Chang SP, Lu LC, Lai CC, Lin WT. Pro-, pre- and synbiotics for the prevention of incidental ventilator-associated pneumonia among critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Expert Rev Anti Infect Ther 2022; 20:1205-1215. [PMID: 35695312 DOI: 10.1080/14787210.2022.2089652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study investigated the preventive effects of pro-, pre- and synbiotics on ventilator-associated pneumonia (VAP) among critically ill patients. METHODS The PubMed, Web of Science, Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for relevant articles written before 19 February 2022. Only randomized controlled trials (RCTs) comparing the clinical efficacy of pro-, pre- and synbiotics with placebos or standard treatments for the prevention of incidental VAP were included. RESULTS A total of 15 RCTs were included. Patients receiving pro-, pre- and synbiotics had a lower risk than the control group of contracting VAP (risk ratio [RR], 0.70; 95% CI, 0.57-0.85; I2 = 67%). The duration of mechanical ventilation was significantly shorter in the study group than in the control group (mean difference [MD], -1.61 days; 95% CI, -2.72 to -0.50; I2 = 86%), and the study group had a shorter duration of stay in the intensive care unit than the control group did (MD, -1.72 days; 95% CI, -3.22 to -0.23; I2 = 87%). CONCLUSIONS Pro-, pre- and synbiotics can prevent VAP and the use of probiotics for patients who are critically ill should be supported.
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Affiliation(s)
- Shao-Huan Lan
- School of Pharmaceutical Sciences and Medical Technology, Putian University, Putian, Fujian, China
| | - Shun-Hsing Hung
- Division of Urology, Department of Surgery, Chi-Mei Hospital, Chia Li, Taiwan
| | | | - Li-Chin Lu
- School of Management, Putian University, Putian, Fujian, China
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Taiwan
| | - Wei-Ting Lin
- Department of Orthopedic, Chi Mei Medical Center, Tainan Taiwan.,Department of Mechanical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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Song H, Hu W, Zhou X, Tao J, Zhang S, Su X, Wu W. Clinical Benefits From Administering Probiotics to Mechanical Ventilated Patients in Intensive Care Unit: A PRISMA-Guided Meta-Analysis. Front Nutr 2022; 8:798827. [PMID: 35155520 PMCID: PMC8829544 DOI: 10.3389/fnut.2021.798827] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background The use of probiotics has been considered as a new intervention for ventilator-associated pneumonia (VAP) prevention in the intensive care unit (ICU). The aim of this meta-analysis was to evaluate the effect of probiotics on mechanical-ventilated patients in ICU. Methods PubMed, Embase, Scopus, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) from their respective inception through October 10, 2021. All studies meeting the inclusion criteria were selected to evaluate the effect of probiotics on patients receiving mechanical ventilation in ICU. Results A total of 15 studies involving 4,693 participants met our inclusion criterion and were included in this meta-analysis. The incidence of VAP in the probiotic group was significantly lower (odds ratio [OR] 0.58, 95% CI 0.41 to 0.81; p = 0.002; I2 = 71%). However, a publication bias may be present as the test of asymmetry was significant (p = 0.007). The probiotic administration was associated with a significant reduction in the duration of mechanical ventilation (mean difference [MD] −1.57, 95% CI −3.12 to −0.03; p = 0.05; inconsistency [I]2 = 80%), length of ICU stay (MD −1.87, 95% CI −3.45 to −0.28; p = 0.02; I2 = 76%), and incidence of bacterial colonization (OR 0.59, 95% CI 0.45 to 0.78; p = 0.0001; I2 = 34%). Moreover, no statistically significant differences were observed regarding the incidence of diarrhea (OR 0.90, 95% CI 0.65 to 1.25; p = 0.54; I2 = 12%) and mortality (OR 0.91, 95% CI 0.80 to 1.05; p = 0.19; I2 = 0%) between probiotics group and control group. Conclusion Our meta-analysis shows that probiotics are associated with a reduction in VAP, as well as the duration of mechanical ventilation, ICU length of stay, and bacterial colonization, but no significant effects on ICU mortality and occurrence of diarrhea. However, in consideration of the significant heterogeneity and publication bias, our findings need to be further validated. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42020150770.
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Affiliation(s)
- Hongzhuan Song
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Wenqing Hu
- Department of Emergency, Haining People's Hospital, Haining, China
| | - Xiujie Zhou
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Jiaping Tao
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Siyi Zhang
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Xuhong Su
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Wenjun Wu
- Department of Hematology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Wenjun Wu
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Jung YJ, Kim EJ, Choi YH. Aerosolized antibiotics in the treatment of hospital-acquired pneumonia/ventilator-associated pneumonia. Korean J Intern Med 2022; 37:1-12. [PMID: 34666432 PMCID: PMC8747925 DOI: 10.3904/kjim.2021.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/22/2021] [Indexed: 01/02/2023] Open
Abstract
Aerosolized antibiotics are being increasingly used to treat respiratory infections, especially those caused by drug-resistant pathogens. Their use in the treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in critically ill patients is especially significant. They are also used as an efficient alternative to overcome the issues caused by systemic administration of antibiotics, including the occurrence of drug-resistant strains, drug toxicity, and insufficient drug concentration at the target site. However, the rationale for the use of aerosolized antibiotics is limited owing to their insufficient efficacy and the potential for underestimated risks of developing side effects. Despite the lack of availability of high-quality evidence, the use of aerosolized antibiotics is considered as an attractive alternative treatment approach, especially in patients with multidrug-resistant pathogens. In this review, we have discussed the effectiveness and side effects of aerosolized antibiotics as well as the latest advancements in this field and usage in the Republic of Korea.
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Affiliation(s)
- Yun Jung Jung
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Eun Jin Kim
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon,
Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon,
Korea
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7
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Zhao J, Li LQ, Chen CY, Zhang GS, Cui W, Tian BP. Do probiotics help prevent ventilator-associated pneumonia in critically ill patients? A systematic review with meta-analysis. ERJ Open Res 2021; 7:00302-2020. [PMID: 33532460 PMCID: PMC7836470 DOI: 10.1183/23120541.00302-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022] Open
Abstract
Background Probiotic treatments might contribute to the prevention of ventilator-associated pneumonia (VAP). Due to its unclear clinical effects, here we intend to assess the preventive effect and safety of probiotics on intensive care unit (ICU) patients. Methods Eligible randomised controlled trials were selected in databases until 30 September 2019. The characteristics of the studies were extracted, including study design, definition of VAP, probiotics intervention, category of included patients, incidence of VAP, mortality, duration of mechanical ventilation (MV) and ICU stay. Heterogeneity was evaluated by Chi-squared and I2 tests. Results 15 studies involving 2039 patients were identified for analysis. The pooled analysis suggests significant reduction on VAP (risk ratio, 0.68; 95% Cl, 0.60 to 0.77; p<0.00001) in a fixed-effects model. Subgroup analyses performed on the category of clinical and microbiological criteria both support the above conclusion; however, there were no significant differences in duration of MV or length of ICU stay in a random-effects model. Also, no significant differences in total mortality, overall mortality, 28-day mortality or 90-day mortality were found in the fixed-effects model. Conclusions The probiotics helped to prevent VAP without impacting the duration of MV, length of ICU stay or mortality.
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Affiliation(s)
- Jie Zhao
- Dept of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China
| | - Lei-Qing Li
- Dept of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China
| | - Cheng-Yang Chen
- Dept of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China
| | - Gen-Sheng Zhang
- Dept of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China
| | - Wei Cui
- Dept of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China
| | - Bao-Ping Tian
- Dept of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China
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Zhao X, Xu L, Yang Z, Sun B, Wang Y, Li G, Feng C, Pan T, Yu T, Feng X. Significance of sTREM-1 in early prediction of ventilator-associated pneumonia in neonates: a single-center, prospective, observational study. BMC Infect Dis 2020; 20:542. [PMID: 32711473 PMCID: PMC7381866 DOI: 10.1186/s12879-020-05196-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 06/24/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To evaluate whether soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) can be used as an early predictor of ventilator-associated pneumonia (VAP). METHODS Ventilated neonatal patients admitted into the neonatology department between January 2017 and January 2018 were divided into VAP (n = 30) and non-VAP (n = 30) groups. Serum sTREM, procalcitonin (PCT), C-reactive protein and interleukin-6 levels were measured at 0, 24, 72, and 120 h after initiation of mechanical ventilation (MV). Correlations between blood biomarker concentrations and VAP occurrence were analyzed. Predictive factors for VAP were identified by logistic regression analysis and Hosmer-Lemeshow test, and the predictive value of sTREM-1 and biomarker combinations for VAP was determined by receiver operating characteristic curve analysis. RESULTS The serum sTREM-1 concentration was significantly higher in the VAP group than in the non-VAP group after 72 and 120 h of MV (72 h: 289.5 (179.6-427.0) vs 202.9 (154.8-279.6) pg/ml, P < 0.001; 120 h: 183.9 (119.8-232.1) vs 141.3 (99.8-179.1) pg/ml, P = 0.042). The area under the curve (AUC) for sTREM-1 at 72 h was 0.902 with a sensitivity of 90% and specificity of 77% for the optimal cut-off value of 165.05 pg/ml. Addition of PCT to sTERM-1 at 72 h further improved the predictive value, with this combination having an AUC of 0.971 (95% confidence interval: 0.938-1.000), sensitivity of 0.96, specificity of 0.88, and Youden index of 0.84. CONCLUSION sTREM-1 is a reliable predictor of VAP in neonates, and combined measurement of serum levels of sTREM-1 and PCT after 72 h of MV provided the most accurate prediction of VAP in neonatal patients.
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Affiliation(s)
- Xingxing Zhao
- Department of Neonatology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215000, China
| | - Lixiao Xu
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Zuming Yang
- Department of Neonatology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215000, China
| | - Bin Sun
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Ying Wang
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Gen Li
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Chenxi Feng
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Tao Pan
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Tian Yu
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Xing Feng
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China.
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Aloush SM, Al-Rawajfa OM. Prevention of ventilator-associated pneumonia in intensive care units: Barriers and compliance. Int J Nurs Pract 2020; 26:e12838. [PMID: 32293064 DOI: 10.1111/ijn.12838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/22/2020] [Indexed: 12/27/2022]
Abstract
AIM The purpose of this study was to evaluate the compliance of Jordanian nurses with ventilator-associated pneumonia prevention guidelines and the barriers to compliance. METHOD A descriptive, cross-sectional design was used. A convenience sample of 294 nurses from nine hospitals in Jordan completed a self-reported questionnaire. RESULTS According to the study compliance categories, 45.6% of the participants reported 'insufficient compliance,' 24.8% 'weak compliance' and 29.6% 'sufficient compliance.' Nurses with more experience and previous education on ventilator-associated pneumonia reported higher compliance scores than their counterparts with less experience and no previous education. Nurses reported several barriers that limited their own compliance, such as lack of education, lack of policies and protocols, lack of resources and the shortage of staff. CONCLUSION The compliance of nursing staff with the prevention guidelines was poor. Applying tailored educational programs may help improve their level of compliance. These programs must target new graduate nurses and be conducted in those hospitals with limited resources.
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Affiliation(s)
- Sami M Aloush
- School of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Omar M Al-Rawajfa
- School of Nursing, Al al-Bayt University, Mafraq, Jordan.,College of Nursing, , Sultan Qaboos University, AlKhoud, Oman
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Abstract
PURPOSE OF REVIEW To describe recent developments in trials exploring inhaled antibiotics for treating severe pneumonia. RECENT FINDINGS Three recent randomized studies investigated the potential role for aerosolized antibiotics for gram-negative pneumonia in ventilated patients. One single center, nonblinded investigation suggested a benefit with inhaled amikacin for resistant gram-negative infections. However, two multicenter, blinded trials found no benefit to adjunctive nebulized amikacin for severe gram-negative pneumonia. SUMMARY Well done clinical trials do not support the routine use of inhaled amikacin for pneumonia in ventilated patients. There may be a potential role for aerosolized antibiotics when other options are limited.
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Yao J, Guan S, Liu Z, Li X, Zhou Q. Changes in immune indicators and bacteriologic profile were associated with patients with ventilator-associated pneumonia. Medicine (Baltimore) 2020; 99:e19716. [PMID: 32311958 PMCID: PMC7440178 DOI: 10.1097/md.0000000000019716] [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] [Indexed: 12/04/2022] Open
Abstract
The aim of this study is to explore and identify ventilator-associated pneumonia (VAP)-related prognostic immune factors and further detect the drug-resistant pathogens to establish the theoretical guidance for clinical prevention and treatment strategies of VAP. A total of 478 patients using ventilator who were hospitalized in July 2014 to November 2016 in our hospital were enrolled in this study. About 103 patients with VAP (21.5%, 103/478) among 478 cases of patients using ventilator. Among the 103 patients with VAP, the distribution of pathogenic bacteria and drug resistance in patients with VAP were detected and analyzed. In the VAP group, 35 patients died and 43 patients had simultaneous sepsis. Compared with those of non-VAP group, the proportion of CD3 (P = .012), CD3CD4 (P = .024) and CD8CD28 ( P = .017) T cells in VAP group increased significantly, which indicated more severe immune response. Multivariate regression model analysis revealed that tracheotomy of mechanical ventilation (P = .013), mechanical ventilation time ≥7 days (P = .02) and aspiration and reflux (P = .011) were independent risk factors associated with VAP. According to the results of bacterial culture and drug sensitivity test, rational selection of antibiotics and monitoring of patients within intensive care unit can effectively control the incidence of VAP and improve the prognosis of patients.
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12
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Hu Y, Guo Y, Wang X, Li Y, Sun D, Cui D. Effects of the Incidence Density of Fever (IDF) on Patients Resuscitated From In-Hospital Cardiac Arrest: A Mediation Analysis. Front Med (Lausanne) 2020; 7:86. [PMID: 32269996 PMCID: PMC7109405 DOI: 10.3389/fmed.2020.00086] [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: 11/19/2019] [Accepted: 03/02/2020] [Indexed: 12/05/2022] Open
Abstract
Objective: The aim of this research was to study the factors contributing to the survival rate of in-hospital cardiac arrest (IHCA) and to determine whether the incidence density of fever (IDF) acts as a mediator. Methods: Data from patients with IHCA who survived more than 48 h were collected from 2011 to 2017. IDF was defined as the fever duration divided by the hospitalization duration, prolonged fever was defined as fever lasting for more than 5 days, and early fever was defined as an initial onset within the first 2 days of IHCA. Possible clinical variables associated with IDF were examined by linear regression, and possible clinical variables associated with survival rate were examined by univariate and multivariate analyses. IDF was investigated as a mediator of the indirect effects of the risk factors on survival. Results: In our retrospective study, the median IDF was 0, with an interquartile range from 0 to 0.42. Prolonged fever was noted in 16% (97/605) of the total, and early fever was noted in 17.2% (104/605) of the total. Linear regression results showed that positive chest X-ray, central venous catheter and Glasgow Coma Score (GCS) ≤ 8 were related to IDF. The IDF (OR: 0.36, 95% CI, 0.13–0.97, P = 0.04), prolonged fever (adjusted OR = 0.13, 95% CI, 0.06–0.29, P < 0.001), positive chest X-ray (OR: 0.67, 95% CI, 0.46–0.98, P = 0.04), central venous catheter placement (OR: 0.54, 95% CI, 0.34–0.89, P = 0.01), and endotracheal intubation (OR: 0.47, 95% CI, 0.33–0.69, P < 0.001) were also related to the negative outcome of hospital discharge after adjustment. Additionally, positive chest X-ray had a 19% effect on survival outcome through IDF as a mediator, and the indirect effect of central venous catheter mediated by IDF accounted for 10% of the total. Conclusions: A higher IDF, prolonged fever, a positive chest X-ray, the use of a central venous catheter and endotracheal intubation reduced the survival rate of these patients, and the detrimental impacts of a positive chest X-ray and the use of a central venous catheter on survival outcomes were partially mediated by IDF.
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Affiliation(s)
- Yue Hu
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yong Guo
- Department of Critical Care Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xintao Wang
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Li
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Dawei Sun
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Derong Cui
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
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Costa Magacho C, Guerra Pinto J, Müller Nunes Souza B, Correia Pereira AH, Ferreira-Strixino J. Comparison of photodynamic therapy with methylene blue associated with ceftriaxone in gram-negative bacteria; an in vitro study. Photodiagnosis Photodyn Ther 2020; 30:101691. [PMID: 32109621 DOI: 10.1016/j.pdpdt.2020.101691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/22/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022]
Abstract
The resistance of microorganisms increases the need for new antimicrobial therapies. The aim of this study was to evaluate the in vitro action of photodynamic therapy and its combination with ceftriaxone in third generation cephalosporin resistant gram-negative bacteria. Clinical strains of Klebsiella pneumoniae, Enterobacter aerogenes and Escherichia coli were obtained, incubated with MB for 15 min combined or not with ceftriaxone and irradiated with fluence of 10 and 25 J/cm². MB internalization was evaluated by confocal microscopy. Cell viability was assessed by counting colony forming units and bacterian metabolism by the resazurin test. MB has been observed within cells, although not in all bacteria. PDT-MB alone and combined with Ceftriaxone reduced bacterial growth by approximately 1 log at 10 J/cm² of fluence and 4 logs by 25 J/cm², with a significant difference from the control group. The reduction in bacterial growth between the treated groups was similar, without significant difference between them. The Resazurin test showed lower bacterial metabolic activity in the treated groups, but it did not allow to observe difference between fluences. It was concluded with this study that the internalization of MB was not observed in all cells of K. pneumoniae, E. aerogenes and E. coli strains. There was less bacterial metabolic activity in the treated groups, with no variation between different fluences. PDT-MB 25 J/cm² alone and combined with Ceftriaxone showed antimicrobial action, but the PDT-MB/Ceftriaxone combination had no potentiating effect.
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Affiliation(s)
- Christiane Costa Magacho
- Laboratório de Fotobiologia Aplicada à Saúde (FOTOBIOS), Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraíba, São José dos Campos, São Paulo, Brazil
| | - Juliana Guerra Pinto
- Laboratório de Fotobiologia Aplicada à Saúde (FOTOBIOS), Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraíba, São José dos Campos, São Paulo, Brazil
| | - Beatriz Müller Nunes Souza
- Laboratório de Fotobiologia Aplicada à Saúde (FOTOBIOS), Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraíba, São José dos Campos, São Paulo, Brazil
| | - André Henrique Correia Pereira
- Laboratório de Fotobiologia Aplicada à Saúde (FOTOBIOS), Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraíba, São José dos Campos, São Paulo, Brazil
| | - Juliana Ferreira-Strixino
- Laboratório de Fotobiologia Aplicada à Saúde (FOTOBIOS), Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraíba, São José dos Campos, São Paulo, Brazil.
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14
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Nebulized Antibiotics for Multidrug-Resistant Ventilator-Associated Pseudomonas aeruginosa Pneumonia*. Crit Care Med 2019; 47:880-881. [DOI: 10.1097/ccm.0000000000003751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Xie X, Lyu J, Hussain T, Li M. Drug Prevention and Control of Ventilator-Associated Pneumonia. Front Pharmacol 2019; 10:298. [PMID: 31001116 PMCID: PMC6455059 DOI: 10.3389/fphar.2019.00298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/11/2019] [Indexed: 01/10/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is one of the most prevalent and serious complications of mechanical ventilation, which is considered a common nosocomial infection in critically ill patients. There are some great options for the prevention of VAP: (i) minimize ventilator exposure; (ii) intensive oral care; (iii) aspiration of subglottic secretions; (iv) maintain optimal positioning and encourage mobility; and (v) prophylactic probiotics. Furthermore, clinical management of VAP depends on appropriate antimicrobial therapy, which needs to be selected based on individual patient factors, such as previous antibacterial therapy, history of hospitalization or mechanical ventilation, and bacterial pathogens and antibiotic resistance patterns. In fact, antibiotic resistance has exponentially increased over the last decade, and the isolation of a multidrug-resistant (MDR) pathogen has been identified as an independent predictor of inadequate initial antibiotic therapy and which is significantly associated with increased mortality. Multiple attempts were used in the treatment of VAP, such as novel antibacterial agents, inhaled antibiotics and monoclonal antibodies. In this review, we summarize the current therapeutic options for the prevention and treatment of VAP, aiming to better management of VAP in clinical practice.
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Affiliation(s)
- Xinming Xie
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Tafseel Hussain
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Manxiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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Almansa R, Nogales L, Martín-Fernández M, Batlle M, Villareal E, Rico L, Ortega A, López-Campos G, Andaluz-Ojeda D, Ramírez P, Socias L, Tamayo L, Vallés J, Bermejo-Martín JF, Martín-Loeches I. Transcriptomic depression of immunological synapse as a signature of ventilator-associated pneumonia. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:415. [PMID: 30581823 DOI: 10.21037/atm.2018.05.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Ventilator-associated pneumonia (VAP) is one of the most commonly encountered intensive care unit (ICU) acquired infections worldwide. The objective of the study was to identify the immune alteration occurring in patients suffering from VAP at the transcriptomic level and explore its potential use for clinical diagnoses of this disease. Methods We performed a prospective observational study in five medical ICUs. Immunological gene expression profiles in the blood of VAP patients were compared with those of controls by using whole transcriptome microarrays and droplet digital polymerase chain reaction (ddPCR) in the first 24 hours following diagnosis. Results VAP patients showed significantly lower expression levels of HLA-DOA, HLA-DMA, HLA-DMB, ICOS, ICOSLG, IL2RA, CD1, CD3, CD28 and CD40LG. The molecules coded by these genes participate of the immunological synapse. CD1C, CD40LG and ICOS showed the highest values of area under the receiver operating characteristic curve (AUROC) with a good balance between sensibility and specificity. Conclusions Patients with VAP show a transcriptomic depression of genes participating of the immunological synapse. It takes a commonplace event, namely VAP, and highlights a quite significant underlying immune suppressive state. In effect this small study will change how we regard VAP, and proposes that we regard it as an infection in an immune compromised host, and that immunity has a central role for ICU acquired infections. This may in time change clinical practice, as it has profound implications for the role of protocolised care, or bundles, in the prevention of VAP. Quantifying the expression in blood of this genes using ddPCR could be a useful approach for the diagnosis of VAP.
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Affiliation(s)
- Raquel Almansa
- Laboratory of Biomedical Research in Sepsis (Bio.Sepsis), Hospital Clínico Universitario de Valladolid, SACYL/IECSCYL, España
| | - Leonor Nogales
- Intensive Care Medicine, Hospital Clínico Universitario de Valladolid, SACYL, España
| | - Marta Martín-Fernández
- Laboratory of Biomedical Research in Sepsis (Bio.Sepsis), Hospital Clínico Universitario de Valladolid, SACYL/IECSCYL, España
| | - Montse Batlle
- Intensive Care Medicine, Hospital Parc Taulí-Sabadell, Barcelona, España
| | - Esther Villareal
- Intensive Care Medicine, Hospital Universitario y Politecnico la Fe, Valencia, España
| | - Lucia Rico
- Laboratory of Biomedical Research in Sepsis (Bio.Sepsis), Hospital Clínico Universitario de Valladolid, SACYL/IECSCYL, España
| | - Alicia Ortega
- Laboratory of Biomedical Research in Sepsis (Bio.Sepsis), Hospital Clínico Universitario de Valladolid, SACYL/IECSCYL, España
| | | | - David Andaluz-Ojeda
- Intensive Care Medicine, Hospital Clínico Universitario de Valladolid, SACYL, España
| | - Paula Ramírez
- Intensive Care Medicine, Hospital Universitario y Politecnico la Fe, Valencia, España
| | - Lorenzo Socias
- Intensive Care Medicine, Hospital Son Llatzer, Palma de Mallorca, España
| | - Luis Tamayo
- Intensive Care Medicine, Hospital Universitario Rio Hortega, Valladolid, España
| | - Jordi Vallés
- Intensive Care Medicine, Hospital Parc Taulí-Sabadell, Barcelona, España
| | - Jesús F Bermejo-Martín
- Laboratory of Biomedical Research in Sepsis (Bio.Sepsis), Hospital Clínico Universitario de Valladolid, SACYL/IECSCYL, España
| | - Ignacio Martín-Loeches
- Intensive Care Medicine, Trinity Centre for Health Sciences, St James's University Hospital, Dublin, Ireland
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17
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Antibacterial Activity of Human Simulated Epithelial Lining Fluid Concentrations of Ceftazidime-Avibactam Alone or in Combination with Amikacin Inhale (BAY41-6551) against Carbapenem-Resistant Pseudomonas aeruginosa and Klebsiella pneumoniae. Antimicrob Agents Chemother 2018; 62:AAC.00113-18. [PMID: 29914950 DOI: 10.1128/aac.00113-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/03/2018] [Indexed: 12/28/2022] Open
Abstract
The role of inhalational combination therapy when treating carbapenem-resistant Pseudomonas aeruginosa and Klebsiella pneumoniae with newer beta-lactam/beta-lactamase inhibitors has not been established. Using a 72-h in vitro pharmacodynamic chemostat model, we simulated the human exposures achieved in epithelial lining fluid (ELF) following intravenous treatment with ceftazidime-avibactam (CZA) 2.5 g every 8 h (q8h) alone and in combination with inhaled amikacin (AMK-I) 400 mg q12h, a reformulated aminoglycoside designed for inhalational administration, against three P. aeruginosa isolates (CZA [ceftazidime/avibactam] MICs, 4/4 to 8/4 μg/ml; AMK-I MICs, 8 to 64 μg/ml) and three K. pneumoniae isolates (CZA MICs, 1/4 to 8/4 μg/ml; AMK-I MICs, 32 to 64 μg/ml). Combination therapy resulted in a significant reduction in 72-h CFU compared with that of CZA monotherapy against two of three P. aeruginosa isolates (-4.14 log10 CFU/ml, P = 0.027; -1.42 log10 CFU/ml, P = 0.020; and -0.4 log10 CFU/ml, P = 0.298) and two of three K. pneumoniae isolates (0.04 log10 CFU/ml, P = 0.963; -4.34 log10 CFU/ml, P < 0.001; and -2.34 log10 CFU/ml, P = 0.021). When measured by the area under the bacterial growth curve (AUBC) over 72 h, significant reductions were observed in favor of the combination regimen against all six isolates tested. AMK-I combination therapy successfully suppressed CZA resistance development in one K. pneumoniae isolate harboring blaKPC-3 that was observed during CZA monotherapy. These studies suggest a beneficial role for combination therapy with intravenous CZA and inhaled AMK when treating pneumonia caused by carbapenem-resistant Gram-negative bacteria.
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18
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Kuti JL, Wang Q, Chen H, Li H, Wang H, Nicolau DP. Defining the potency of amikacin against Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii derived from Chinese hospitals using CLSI and inhalation-based breakpoints. Infect Drug Resist 2018; 11:783-790. [PMID: 29872328 PMCID: PMC5975598 DOI: 10.2147/idr.s161636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We report the in vitro activity of amikacin and comparators against Gram-negative bacteria collected from blood and respiratory specimens in China during a 1-year period between December 2015 and December 2016. MATERIALS AND METHODS Minimum inhibitory concentrations (MICs) were determined by agar dilution methods using Clinical and Laboratory Standards Institute (CLSI) guidelines, and susceptibility was assessed using CLSI breakpoints, except for tigecycline against Enterobacteriaceae. A pharmacodynamic threshold MIC ≤ 256 mg/L was also applied for amikacin since its inhalation formulation has demonstrated activity up to these MICs. RESULTS For Escherichia coli, including extended-spectrum beta-lactamase (ESBL)-producing isolates (45.7% of population), amikacin demonstrated excellent activity (93.0%-94.7% susceptible) similar to tigecycline, piperacillin/tazobactam, and the carbapenems. Against Klebsiella pneumoniae, only tigecycline retained susceptibility >90%; amikacin inhibited 83.7% and 71.1% of the total and ESBL-producing (24.2%) populations at its breakpoint, respectively. Amikacin susceptibility against Pseudomonas aeruginosa was 91.1%, and only polymyxin B (100%) achieved higher susceptibility rates. Susceptibility declined to 80.9% and 54.5% against carbapenem- and multidrug-resistant (MDR) isolates, respectively. Finally, MDR was very common (84.0%) among Acinetobacter baumannii, with amikacin susceptibility at 30.5% for all isolates and 17.3% for MDR isolates. Since the majority of the amikacin-resistant isolates had amikacin MICs > 256 mg/L, the use of the inhalation pharmacodynamic threshold did not substantially improve the CLSI susceptible value. CONCLUSION Amikacin portrayed comparable or better susceptibility rates to most of the tested antibiotics against E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii in China. As few isolates had MICs of 32-256 mg/L, use of the CLSI breakpoint and inhalation pharmacodynamic threshold yielded similar overall susceptibilities.
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Affiliation(s)
- Joseph L Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
| | - Qi Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Hongbin Chen
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Henan Li
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
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19
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Shorr AF, Fisher K, Micek ST, Kollef MH. The Burden of Viruses in Pneumonia Associated With Acute Respiratory Failure: An Underappreciated Issue. Chest 2017; 154:84-90. [PMID: 29274318 DOI: 10.1016/j.chest.2017.12.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/08/2017] [Accepted: 12/01/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pneumonia associated with mechanical ventilation (MV) results in substantial mortality and represents a leading reason for the use of antibiotics. The role of viruses in this setting is unclear. Identifying a viral cause in such instances could facilitate antibiotic stewardship. METHODS We performed a secondary analysis of a prospective cohort with pneumonia requiring MV. We included both cases occurring in the community and hospital-onset cases and classified patients according to the cause of the pneumonia. The prevalence of viral pathogens represented the primary end point. We identified variables independently associated with isolation of a viral organism as the sole pathogen. RESULTS The cohort included 364 patients, and a virus was the sole pathogen in 79 cases (21.7%). The most common viruses included rhinovirus/enterovirus (n = 20), influenza A (n = 12), and respiratory syncytial virus (n = 11). The rate of in-hospital death was high (37.2%) and did not differ from that seen in other patients (36.5%). The duration of MV, hospital length of stay, and 30-day readmission rates also did not differ based on the cause of pneumonia. Two variables were independently associated with recovery of a virus: an Acute Physiology and Health Evaluation II score of < 26 (adjusted odds ratio [AOR], 0.51; 95% CI, 0.28-0.93; P = .027) and stem cell transplantation (SCT) (AOR, 4.39; 95% CI, 2.03-9.50; P = .001). A sensitivity analysis excluding patients who underwent SCT did not substantially alter our observations. CONCLUSIONS Viruses represent a major cause of pneumonia in critically ill patients requiring MV. Identifying such subjects presents an opportunity for discontinuing antibiotics. Clinicians should consider systematically evaluating patients with pneumonia requiring MV for viral pathogens.
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Affiliation(s)
- Andrew F Shorr
- Department of Medicine, Medstar Washington Hospital Center, Washington, DC; Pulmonary and Critical Care Medicine Section, Medstar Washington Hospital Center, Washington, DC.
| | - Kristen Fisher
- CardioPulmonary Associates of St. Lukes Hospital, Chesterfield, MO
| | - Scott T Micek
- St. Louis College of Pharmacy, Barnes Jewish Christian Hospital, St. Louis, MO
| | - Marin H Kollef
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Barnes Jewish Christian Hospital, St. Louis, MO
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Aloush SM. Nurses' implementation of ventilator-associated pneumonia prevention guidelines: an observational study in Jordan. Nurs Crit Care 2017; 23:147-151. [PMID: 29143487 DOI: 10.1111/nicc.12323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/21/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia prevention guidelines from the Center for Disease Control and Prevention, the American Thoracic Society, and the Institute for Health Care and Improvement have been published to reduce the rate of ventilator-associated pneumonia in the clinical settings; however, nurses' compliance with these guidelines is still questionable. AIMS The purpose of this study was to assess nurses' compliance with ventilator-associated pneumonia prevention guidelines and the factors that influence their compliance. DESIGN A structured observational design with a non-participant approach. METHOD One hundred nurses were observed during their care for patients on mechanical ventilator. The observers documented nurses' implementation of ventilator-associated pneumonia prevention guidelines using a structured observational sheet. RESULTS Compliance of nurses was found to be unsatisfactory. Of the participants, 63% showed 'insufficient compliance'. Nurses working in units with a 1:1 nurse:patient ratio and lower beds' capacity demonstrated higher compliance and their intensive care units had a lower rate of ventilator-associated pneumonia and shorter intensive care unit stay in comparison with their counterparts working with a 1:2 nurse:patient ratio and higher beds' capacity. CONCLUSION Nurses' compliance with ventilator-associated pneumonia prevention guidelines was insufficient. Low nurse-patient ratio and large intensive care unit beds capacity were found to affect nurses' compliance and patients' outcomes. This study expanded knowledge about important aspects of nursing care; nurses' compliance with ventilator-associated pneumonia prevention guidelines and the factors that affect their compliance. This knowledge can be used by health professional to guide the clinical practice and to improve the quality of care.
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Affiliation(s)
- Sami M Aloush
- School of Nursing, Al Al-Bayt University, Mafraq, Jordan
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21
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Roberts KL, Micek ST, Juang P, Kollef MH. Controversies and advances in the management of ventilator associated pneumonia. Expert Rev Respir Med 2017; 11:875-884. [PMID: 28891372 DOI: 10.1080/17476348.2017.1378574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Although national surveillance data suggests that the incidence of ventilator associated pneumonia (VAP) is down-trending, it remains one of the most commonly encountered hospital acquired infections in the United States and worldwide. Its association with increased healthcare costs and worsened patient outcomes warrants continued effort to improve the care of patients with VAP. Areas covered: The increasing prevalence of multi-drug resistant bacteria further drives the need to explore advances in diagnostic and treatment options. In this review, controversies pertaining to the definition and diagnosis of VAP as well as empiric treatment strategies will be discussed along with several developments related to rapid microbiologic testing methods and the use of non-traditional antimicrobial agents. Expert commentary: The application of rapid diagnostic techniques to identify microbial pathogens is perhaps one of the most impactful advancements in the treatment of serious nosocomial infections. This technology has the potential to reduce inappropriate initial antimicrobial therapy, unnecessary antimicrobial exposure, and mortality in patients with VAP. In addition, the anticipated approval of new antimicrobial agents within the next several years will provide a much-needed expansion of available treatment options in an era of growing antimicrobial resistance.
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Affiliation(s)
| | - Scott T Micek
- b Division of Pharmacy Practice , St Louis College of Pharmacy , St Louis , MO , USA
| | - Paul Juang
- b Division of Pharmacy Practice , St Louis College of Pharmacy , St Louis , MO , USA
| | - Marin H Kollef
- c Division of Pulmonary and Critical Care Medicine , Washington University School of Medicine , St Louis , MO , USA
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22
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Metersky ML, Kalil AC. Letter to the editor: 'challenges and opportunities in the treatment of ventilator-associated pneumonia'. Expert Rev Anti Infect Ther 2017; 15:191-192. [PMID: 28117609 DOI: 10.1080/14787210.2017.1286981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mark L Metersky
- a Department of Medicine, Division of Pulmonary and Critical Care , University of Connecticut School of Medicine , Farmington , CT , USA
| | - Andre C Kalil
- b Department of Medicine, Division of Infectious Diseases , University of Nebraska Medical Center , Omaha , NE , USA
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23
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Schreiber MP, Shorr AF. Response to: 'letter to the editor: "Challenges and opportunities in the treatment of ventilator-associated pneumonia"'. Expert Rev Anti Infect Ther 2017; 15:193. [PMID: 28118759 DOI: 10.1080/14787210.2017.1286982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Matthew P Schreiber
- a Department of Internal Medicine , Section of Pulmonary Disease Critical Care , Washington , DC , USA
| | - Andrew F Shorr
- a Department of Internal Medicine , Section of Pulmonary Disease Critical Care , Washington , DC , USA
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