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Newey C, Skaar JR, O'Hara M, Miao B, Post A, Kelly T. Systematic Literature Review of the Association of Fever and Elevated Temperature with Outcomes in Critically Ill Adult Patients. Ther Hypothermia Temp Manag 2024; 14:10-23. [PMID: 37158862 DOI: 10.1089/ther.2023.0004] [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: 05/10/2023] Open
Abstract
Although most commonly associated with infection, elevated temperature and fever also occur in a variety of critically ill populations. Prior studies have suggested that fever and elevated temperature may be detrimental to critically ill patients and can lead to poor outcomes, but the evidence surrounding the association of fever with outcomes is rapidly evolving. To broadly assess potential associations of elevated temperature and fever with outcomes in critically ill adult patients, we performed a systematic literature review focusing on traumatic brain injury, stroke (ischemic and hemorrhagic), cardiac arrest, sepsis, and general intensive care unit (ICU) patients. Searches were conducted in Embase® and PubMed® from 2016 to 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including dual-screening of abstracts, full texts, and extracted data. In total, 60 studies assessing traumatic brain injury and stroke (24), cardiac arrest (8), sepsis (22), and general ICU (6) patients were included. Mortality, functional, or neurological status and length of stay were the most frequently reported outcomes. Elevated temperature and fever were associated with poor clinical outcomes in patients with traumatic brain injury, stroke, and cardiac arrest but not in patients with sepsis. Although a causal relationship between elevated temperature and poor outcomes cannot be definitively established, the association observed in this systematic literature review supports the concept that management of elevated temperature may factor in avoidance of detrimental outcomes in multiple critically ill populations. The analysis also highlights gaps in our understanding of fever and elevated temperature in critically ill adult patients.
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Affiliation(s)
- Christopher Newey
- Department of Neurocritical Care, Sanford USD Medical Center, Sioux Falls, South Dakota, USA
| | | | | | | | - Andrew Post
- Trinity Life Sciences, Waltham, Massachusetts, USA
| | - Tim Kelly
- Becton Dickinson, Franklin Lakes, New Jersey, USA
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Análise dos custos de eventos adversos infecciosos em saúde. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao01187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Comas M, Domingo L, Jansana A, Lafuente E, Civit A, García-Pérez L, Lasso de la Vega C, Cots F, Sala M, Castells X. Cost-effectiveness Analysis of Peripherally Inserted Central Catheters Versus Central Venous Catheters for in-Hospital Parenteral Nutrition. J Patient Saf 2022; 18:e1109-e1115. [PMID: 35587883 DOI: 10.1097/pts.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Our objective was to evaluate the cost-effectiveness of the use of peripherally inserted central venous catheters (PICCs) by a vascular access team (VAT) versus central venous catheters (CVCs) for in-hospital total parenteral nutrition (TPN). METHODS The study used a cost-effectiveness analysis based on observational data retrospectively obtained from electronic medical records from 2018 to 2019 in a teaching hospital. We included all interventional procedures requiring PICCs or CVCs with the indication of TPN. We recorded the costs of insertion, maintenance, removal, and complications. The main outcome measure was the incidence rate of catheter-associated bacteremia per 1000 catheter days. Cost-effectiveness analysis was performed from the hospital perspective within the context of the publicly funded Spanish health system. Confidence intervals for costs and effectiveness differences were calculated using bootstrap methods. RESULTS We analyzed 233 CVCs and 292 PICCs from patients receiving TPN. Average duration was longer for PICC (13 versus 9.4 days, P < 0.001). The main reason for complications in both groups was suspected infection (9.77% CVC versus 5.18% PICC). Complication rates due to bacteremia were 2.44% for CVC and 1.15% for PICC. The difference in the incidence of bacteremia per 1000 catheter days was 1.29 (95% confidence interval, -0.89 to 3.90). Overall, costs were lower for PICCs than for CVCs: the difference in mean overall costs was -€559.9 (95% confidence interval, -€919.9 to -€225.4). Uncertainty analysis showed 86.37% of results with lower costs and higher effectiveness for PICC versus CVC. CONCLUSIONS Placement of PICC by VAT compared with CVC for TPN reduces costs and may decrease the rate of bacteremia.
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Affiliation(s)
| | | | | | - Elisabeth Lafuente
- Infusion and Vascular Access Nurse, Nursing Care Research, Hospital del Mar Research Institute (IMIM), Barcelona
| | - Anna Civit
- Infusion and Vascular Access Nurse, Nursing Care Research, Hospital del Mar Research Institute (IMIM), Barcelona
| | | | - Carmen Lasso de la Vega
- Infusion and Vascular Access Nurse, Nursing Care Research, Hospital del Mar Research Institute (IMIM), Barcelona
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Stevens M, Davis T, Munson SH, Shenoy AV, Gricar BLA, Yapici HO, Shaw AD. Short and Mid-Term Economic Impact of Pulmonary Artery Catheter Use in Adult Cardiac Surgery: A Hospital and Integrated Health System Perspective. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:109-119. [PMID: 33574686 PMCID: PMC7872861 DOI: 10.2147/ceor.s282253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
Objective A monitoring pulmonary artery catheter (PAC) is utilized in approximately 34% of the US cardiac surgical procedures. Increased use of PAC has been reported to have an association with complication rates: significant decreases in new-onset heart failure (HF) and respiratory failure (RF), but increases in bacteremia and urinary tract infections. We assessed the impact of increasing PAC adoption on hospital costs among cardiac surgery patients for US-based healthcare systems. Methods An Excel-based economic model calculated annualized savings for a US hospital with various cardiac surgical volumes and PAC adoption rates. A second model, for an integrated payer-provider health system, analyzed outcomes/costs resulting from the cardiac surgical admission and for the treatment of persistent HF and RF complications in the year following surgery. Model inputs were extracted from published literature, and one-way and probabilistic sensitivity analyses were performed. Results For an acute care hospital with 500 procedures/year and 34% PAC adoption, annualized savings equalled $61,806 vs no PAC utilization. An increase in PAC adoption rate led to increased savings of $134,751 for 75% and $170,685 for 95% adoption. Savings ranged from $12,361 to $185,418 at volumes of 100 and 1500 procedures/year, respectively. For an integrated payer-provider health system with the base-case scenario of 3845 procedures/year and 34% PAC adoption, estimated savings were $596,637 for the combined surgical index admission and treatment for related complications over the following year. Conclusion PAC utilization in adult cardiac surgery patients results in reduced costs for both acute care hospitals and payer-provider integrated health systems.
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Affiliation(s)
- Mitali Stevens
- Global Health Economics & Reimbursement, Edwards Lifesciences, Irvine, CA, USA
| | - Todd Davis
- Global Health Economics & Reimbursement, Edwards Lifesciences, Irvine, CA, USA
| | - Sibyl H Munson
- Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, MA, USA
| | - Apeksha V Shenoy
- Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, MA, USA
| | - Boye L A Gricar
- Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, MA, USA
| | - Halit O Yapici
- Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, MA, USA
| | - Andrew D Shaw
- Department of Anaesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
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Serafim MSM, Kronenberger T, Oliveira PR, Poso A, Honório KM, Mota BEF, Maltarollo VG. The application of machine learning techniques to innovative antibacterial discovery and development. Expert Opin Drug Discov 2020; 15:1165-1180. [PMID: 32552005 DOI: 10.1080/17460441.2020.1776696] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION After the initial wave of antibiotic discovery, few novel classes of antibiotics have emerged, with the latest dating back to the 1980's. Furthermore, the pace of antibiotic drug discovery is unable to keep up with the increasing prevalence of antibiotic drug resistance. However, the increasing amount of available data promotes the use of machine learning techniques (MLT) in drug discovery projects (e.g. construction of regression/classification models and ranking/virtual screening of compounds). AREAS COVERED In this review, the authors cover some of the applications of MLT in medicinal chemistry, focusing on the development of new antibiotics, the prediction of resistance and its mechanisms. The aim of this review is to illustrate the main advantages and disadvantages and the major trends from studies over the past 5 years. EXPERT OPINION The application of MLT to antibacterial drug discovery can aid the selection of new and potent lead compounds, with desirable pharmacokinetic and toxic profiles for further optimization. The increasing volume of available data along with the constant improvement in computational power and algorithms has meant that we are experiencing a transition in the way we face modern issues such as drug resistance, where our decisions are data-driven and experiments can be focused by data-suggested hypotheses.
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Affiliation(s)
- Mateus Sá Magalhães Serafim
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte, Brazil
| | - Thales Kronenberger
- Department of Internal Medicine VIII, University Hospital of Tübingen , Tübingen, Germany
| | | | - Antti Poso
- Department of Internal Medicine VIII, University Hospital of Tübingen , Tübingen, Germany.,School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland , Kuopio, Finland
| | - Káthia Maria Honório
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (USP) , São Paulo, Brazil.,Centro de Ciências Naturais e Humanas, Universidade Federal do ABC , Santo André, Brazil
| | - Bruno Eduardo Fernandes Mota
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte, Brazil
| | - Vinícius Gonçalves Maltarollo
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte, Brazil
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Falcao CB, Radis-Baptista G. Crotamine and crotalicidin, membrane active peptides from Crotalus durissus terrificus rattlesnake venom, and their structurally-minimized fragments for applications in medicine and biotechnology. Peptides 2020; 126:170234. [PMID: 31857106 DOI: 10.1016/j.peptides.2019.170234] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 12/11/2022]
Abstract
A global public health crisis has emerged with the extensive dissemination of multidrug-resistant microorganisms. Antimicrobial peptides (AMPs) from plants and animals have represented promising tools to counteract those resistant pathogens due to their multiple pharmacological properties such as antimicrobial, anticancer, immunomodulatory and cell-penetrating activities. In this review, we will focus on crotamine and crotalicidin, which are two interesting examples of membrane active peptides derived from the South America rattlesnake Crotalus durrisus terrificus venom. Their full-sequences and structurally-minimized fragments have potential applications, as anti-infective and anti-proliferative agents and diagnostics in medicine and in pharmaceutical biotechnology.
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Affiliation(s)
- Claudio Borges Falcao
- Laboratory of Biochemistry and Biotechnology, Graduate program in Pharmaceutical Sciences, Federal University of Ceara, Brazil; Peter Pan Association to Fight Childhood Cancer, Fortaleza, CE, 60410-770, Brazil.
| | - Gandhi Radis-Baptista
- Laboratory of Biochemistry and Biotechnology, Graduate program in Pharmaceutical Sciences and Institute for Marine Sciences, Federal University of Ceara, Av da Abolição 3207, Fortaleza, CE, 60165-081, Brazil.
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Sante L, Lecuona M, Jaime AA, Arias Á. [Risk factors to secondary nosocomial bacteremia to UTI in a tertiary hospital]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:311-316. [PMID: 31273970 PMCID: PMC6719644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Nosocomial bacteremia secondary to urinary tract infections (NBS-UTI) occur in 1-4% of episodes and the associated mortality can increase up to 33%. However, very little is known about the epidemiology of these infections. The determination of modifiable risk factors to develop this type of bacteremia could help to control the infection and reduce health costs. METHODS Cases-control study of NBS-UTI diagnosed at the University Hospital of Canary Islands between 2010-2014. The clinical-epidemiological variables and the intrinsic and extrinsic potential risk factors were collected. Logistic regression was used to study the variables associated with the development of NBS-UTI. RESULTS A total of 178 episodes were studied, 85 cases and 93 controls. The average stay was significantly greater in the cases; from admission to bacteremia (p <0.003), as well as from discharge to discharge (p <0.005). Hepatic insufficiency (p <0.091), the use of mechanical ventilation (p <0.001), the central venous catheter (p <0.043) and surgery in the episode (p <0.001) behaved as risk factors for the acquisition of NBS-ITU. CONCLUSIONS Invasive devices, such as central venous catheter and mechanical ventilation, that had not previously been studied; as well as the surgery in the episode, which had not been studied either, suppose risk factors. In addition, NBS-ITU causes a significant increase in hospital stay. Therefore, it is necessary to know the risk factors for the appearance of these infections, and thus prevent their appearance and improve the safety of hospitalized patients.
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Affiliation(s)
- Laura Sante
- Servicio de Microbiología y Control de la Infección, Hospital Universitario de Canarias, Tenerife, España,Correspondencia: Laura Sante Servicio de Microbiología y Control de la Infección, Hospital Universitario de Canarias Ctra. Ofra S/N La Cuesta 38320 La Laguna, Tenerife, España E-mail:
| | - María Lecuona
- Servicio de Microbiología y Control de la Infección, Hospital Universitario de Canarias, Tenerife, España
| | - Armando Aguirre Jaime
- Servicio de apoyo a la investigación. Colegio Oficial de Enfermería de Santa Cruz de Tenerife, España
| | - Ángeles Arias
- Departamento de Medicina Preventiva y Salud Pública de la Universidad de La Laguna, Tenerife, España
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Candel FJ, Borges Sá M, Belda S, Bou G, Del Pozo JL, Estrada O, Ferrer R, González del Castillo J, Julián-Jiménez A, Martín-Loeches I, Maseda E, Matesanz M, Ramírez P, Ramos JT, Rello J, Suberviola B, Suárez de la Rica A, Vidal P. Current aspects in sepsis approach. Turning things around. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2018; 31:298-315. [PMID: 29938972 PMCID: PMC6172679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The incidence and prevalence of sepsis depend on the definitions and records that we use and we may be underestimating their impact. Up to 60% of the cases come from the community and in 30-60% we obtain microbiological information. Sometimes its presentation is ambiguous and there may be a delay in its detection, especially in the fragile population. Procalcitonin is the most validated biomarker for bacterial sepsis and the one that best discriminates the non-infectious cause. Presepsin and pro-adrenomedullin are useful for early diagnosis, risk stratification and prognosis in septic patients. The combination of biomarkers is even more useful to clarify an infectious cause than any isolated biomarker. Resuscitation with artificial colloids has worse results than crystalloids, especially in patients with renal insufficiency. The combination of saline solution and balanced crystalloids is associated with a better prognosis. Albumin is only recommended in patients who require a large volume of fluids. The modern molecular methods on the direct sample or the identification by MALDI-TOF on positive blood culture have helped to shorten the response times in diagnosis, to optimize the antibiotic treatment and to facilitate stewardship programs. The hemodynamic response in neonates and children is different from that in adults. In neonatal sepsis, persistent pulmonary hypertension leads to an increase in right ventricular afterload and heart failure with hepatomegaly. Hypotension, poor cardiac output with elevated systemic vascular resistance (cold shock) is often a terminal sign in septic shock. Developing ultra-fast Point-of-Care tests (less than 30 minutes), implementing technologies based on omics, big data or massive sequencing or restoring "healthy" microbiomes in critical patients after treatment are the main focuses of research in sepsis. The main benefits of establishing a sepsis code are to decrease the time to achieve diagnosis and treatment, improve organization, unify criteria, promote teamwork to achieve common goals, increase participation, motivation and satisfaction among team members, and reduce costs.
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Affiliation(s)
| | - Marcio Borges Sá
- Multidisciplinar Sepsis Unit. Intensive Care Unit. Hospital Son Llatzer. Palma de Mallorca
| | - Sylvia Belda
- Department of Intensive Pediatrics. Maternal and Child Health and Development Network. Hospital 12 de Octubre. Madrid
| | - Germán Bou
- Clinical Microbiology Department. Complejo Hospitalario Universitario. La Coruña
| | - José Luis Del Pozo
- Clinical Microbiology and Infectious Diseases Department. Clinica Universitaria Navarra
| | - Oriol Estrada
- Clinical Innovation Management, Germans Trias i Pujol University Hospital. Barcelona
| | - Ricard Ferrer
- Department of Intensive Care. Shock, Organ Dysfunction and Resuscitation Research Group. CIBERES Instituto de Salud Carlos III. Vall d’Hebron University Hospital. Barcelona
| | | | | | - Ignacio Martín-Loeches
- Multidisciplinary Intensive Care Research Organization. CIBERES Instituto de Salud Carlos III. Department of Intensive Care Medicine. St James’s Hospital. Trinity Centre for Health Sciences. Dublin. Ireland
| | - Emilio Maseda
- Department of Anesthesia and Surgical Intensive Care, Hospital Universitario La Paz. Madrid
| | - Mayra Matesanz
- Department of Internal Medicine. Hospital Clínico San Carlos. Madrid
| | - Paula Ramírez
- Critical Care Department. University Hospital la Fe. Valencia
| | - José Tomás Ramos
- José T. Ramos. Department of Public and Mother-Child Health. Hospital Clínico San Carlos, IdISSC Health Research Institute. Universidad Complutense. Madrid
| | - Jordi Rello
- Clinical Research/epidemiology In Pneumonia & Sepsis (CRIPS). CIBERES Instituto de Salud Carlos III. Vall d’Hebron University Hospital. Barcelona
| | - Borja Suberviola
- Critical Care Department. Hospital Universitario Marqués de Valdecilla. Santander
| | | | - Pablo Vidal
- Intensive Care Unit. Complexo Hospitalario Universitario de Ourense
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