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Martin-Loeches I, Reyes LF, Nseir S, Ranzani O, Povoa P, Diaz E, Schultz MJ, Rodríguez AH, Serrano-Mayorga CC, De Pascale G, Navalesi P, Panigada M, Coelho LM, Skoczynski S, Esperatti M, Cortegiani A, Aliberti S, Caricato A, Salzer HJF, Ceccato A, Civljak R, Soave PM, Luyt CE, Ekren PK, Rios F, Masclans JR, Marin J, Iglesias-Moles S, Nava S, Chiumello D, Bos LD, Artigas A, Froes F, Grimaldi D, Taccone FS, Antonelli M, Torres A. European Network for ICU-Related Respiratory Infections (ENIRRIs): a multinational, prospective, cohort study of nosocomial LRTI. Intensive Care Med 2023; 49:1212-1222. [PMID: 37812242 PMCID: PMC10562498 DOI: 10.1007/s00134-023-07210-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Lower respiratory tract infections (LRTI) are the most frequent infectious complication in patients admitted to the intensive care unit (ICU). We aim to report the clinical characteristics of ICU-admitted patients due to nosocomial LRTI and to describe their microbiology and clinical outcomes. METHODS A prospective observational study was conducted in 13 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), ICU hospital-acquired pneumonia (ICU-HAP), HAP that required invasive ventilation (VHAP), and HAP in patients transferred to the ICU without invasive mechanical ventilation were collected. The clinical diagnosis and treatments were per clinical practice and not per protocol. Descriptive statistics were used to compare the study groups. RESULTS 1060 patients with LRTI (72.5% male sex, median age 64 [50-74] years) were included in the study; 160 (15.1%) developed VAT, 556 (52.5%) VAP, 98 (9.2%) ICU-HAP, 152 (14.3%) HAP, and 94 (8.9%) VHAP. Patients with VHAP had higher serum procalcitonin (PCT) and Sequential Organ Failure Assessment (SOFA) scores. Patients with VAP or VHAP developed acute kidney injury, acute respiratory distress syndrome, multiple organ failure, or septic shock more often. One thousand eight patients had microbiological samples, and 711 (70.5%) had etiological microbiology identified. The most common microorganisms were Pseudomonas aeruginosa (18.4%) and Klebsiella spp (14.4%). In 382 patients (36%), the causative pathogen shows some antimicrobial resistance pattern. ICU, hospital and 28-day mortality were 30.8%, 37.5% and 27.5%, respectively. Patients with VHAP had the highest ICU, in-hospital and 28-day mortality rates. CONCLUSION VHAP patients presented the highest mortality among those admitted to the ICU. Multidrug-resistant pathogens frequently cause nosocomial LRTI in this multinational cohort study.
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Affiliation(s)
- Ignacio Martin-Loeches
- St James's University Hospital, Trinity College, Dublin 8, D08 NHY, Ireland.
- Universidad de Barcelona, CIBERes, Barcelona, Spain.
| | - Luis Felipe Reyes
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia
- Clinica Universidad de La Sabana, Chia, Colombia
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Saad Nseir
- University Hospital of Lille, Lille, France
| | | | - Pedro Povoa
- Hospital de Sao Francisco Xavier, Lisbon, Portugal
| | - Emili Diaz
- Corporacio Sanitaria Parc Tauli, Sabadell, Spain
| | - Marcus J Schultz
- Academic Medical Center, Amsterdam, The Netherlands
- Department of Intensive Care Laboratory for Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | | | - Cristian C Serrano-Mayorga
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia
- Clinica Universidad de La Sabana, Chia, Colombia
| | | | - Paolo Navalesi
- Magna Graecia University, Catanzaro, Italy
- Sant'Andrea (ASL VC), Vercelli, Italy
| | - Mauro Panigada
- Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | - Stefano Aliberti
- Medical University of Silesia, Katowice, Poland
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
| | | | - Helmut J F Salzer
- Department of Internal Medicine 4-Pneumology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Division of Infectious Diseases and Tropical Medicine, Kepler University Hospital, Linz, Austria
| | | | - Rok Civljak
- "Dr. Fran Mihaljevic" University Hospital for Infectious Diseases, Zagreb, Croatia
| | | | | | | | - Fernando Rios
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - Joan Ramon Masclans
- Hospital del Mar, Barcelona, Spain
- Intensive Care Medicine, Hospital del Mar & IMIM, Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Judith Marin
- Intensive Care Medicine, Hospital del Mar & IMIM, Barcelona, Spain
| | | | - Stefano Nava
- S. Orsola-Malpighi Hospital, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Lieuwe D Bos
- Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - David Grimaldi
- Hospital Erasme Universit Libre de Bruxelles, Brussels, Belgium
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2
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Garofalo E, Rovida S, Cammarota G, Biamonte E, Troisi L, Cosenza L, Pelaia C, Navalesi P, Longhini F, Bruni A. Benefits of secretion clearance with high frequency percussive ventilation in tracheostomized critically ill patients: a pilot study. J Clin Monit Comput 2023; 37:911-918. [PMID: 36607533 PMCID: PMC10175357 DOI: 10.1007/s10877-022-00970-7] [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: 07/11/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
Clearance of secretions remains a challenge in ventilated patients. Despite high-frequency percussive ventilation (HFPV) showing benefits in patients with cystic fibrosis and neuromuscular disorders, very little is known about its effects on other patient categories. Therefore, we designed a physiological pilot study investigating the effects on lung aeration and gas exchange of short HFPV cycles in tracheostomized patients undergoing mechanical ventilation. Electrical impedance tomography (EIT) was recorded at baseline (T0) by a belt wrapped around the patient's chest, followed by the HFPV cycle lasting 10 min. EIT data was collected again after the HFPV cycle (T1) as well as after 1 h (T2) and 3 h (T3) from T0. Variation from baseline of end-expiratory lung impedance (∆EELI), tidal variation (TIV) and global inhomogeneity index (GI) were computed. Arterial blood was also taken for gas analysis. HFPV cycle significantly improved the ∆EELI at T1, T2 and T3 when compared to baseline (p < 0.05 for all comparisons). The ratio between arterial partial pressure and inspired fraction of oxygen (PaO2/FiO2) also increased after the treatment (p < 0.001 for all comparison) whereas TIV (p = 0.132) and GI (p = 0.114) remained unchanged. Short cycles of HFPV superimposed to mechanical ventilation promoted alveolar recruitment, as suggested by improved ∆EELI, and improved oxygenation in tracheostomized patients with high load of secretion.Trial Registration Prospectively registered on www.clinicaltrials.gov (NCT05200507; dated 6th January 2022).
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Affiliation(s)
- Eugenio Garofalo
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Serena Rovida
- Department of Intensive Care Medicine, St George's University Hospital, London, UK
| | - Gianmaria Cammarota
- Department of Anaesthesia and Intensive Care Medicine, University of Perugia, Perugia, Italy
| | - Eugenio Biamonte
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Letizia Troisi
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Leonardo Cosenza
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Corrado Pelaia
- Pulmonary Medicine Unit, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Paolo Navalesi
- Anaesthesia and Intensive Care, Department of Medicine-DIMED, Padua Hospital, University of Padua, Padua, Italy
| | - Federico Longhini
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. .,Intensive Care Unit, Department of Medical and Surgical Sciences, Mater Domini University Hospital, Magna Graecia University, Viale Europa, 88100, Catanzaro, Italy.
| | - Andrea Bruni
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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3
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Duszynska W, Idziak M, Smardz K, Burkot A, Grotowska M, Rojek S. Frequency, Etiology, Mortality, Cost, and Prevention of Respiratory Tract Infections—Prospective, One Center Study. J Clin Med 2022; 11:jcm11133764. [PMID: 35807049 PMCID: PMC9267472 DOI: 10.3390/jcm11133764] [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: 04/27/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Ventilator-associated pneumonia (VAP) is the most monitored form of respiratory tract infections (RTIs). A small number of epidemiological studies have monitored community-acquired pneumonia (CAP), non-ventilator hospital-acquired pneumonia (NV-HAP) and ventilator-associated tracheobronchitis (VAT) in intensive care units (ICUs). The objective of this study was to assess the frequency, etiology, mortality, and additional costs of RTIs. Methods: One-year prospective RTI surveillance at a 30-bed ICU. The study assessed the rates and microbiological profiles of CAP, VAP, NV-HAP, VAT, and VAP prevention factors, the impact of VAP and NV-HAP on the length of ICU stays, and the additional costs of RTI treatment and mortality. Results: Among 578 patients, RTIs were found in 30%. The CAP, NV-HAP, VAP, and VAT rates/100 admissions were 5.9, 9.0, 8.65, and 6.05, respectively. The VAP incidence density/1000 MV-days was 10.8. The most common pathogen of RTI was Acinetobacter baumannii MDR. ICU stays were extended by VAP and NV-HAP for 17.8 and 3.7 days, respectively, and these RTIs increased the cost of therapy by 13,029 and 2708 EUR per patient, respectively. The mortality rate was higher by 11.55% in patients with VAP than those without device-associated and healthcare-associated infections (p = 0.0861). Conclusions: RTIs are a serious epidemiological problem in patients who are admitted and treated in ICU, as they may affect one-third of patients. Hospital-acquired RTIs extend hospitalization time, increase the cost of treatment, and worsen outcomes.
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Affiliation(s)
- Wieslawa Duszynska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (M.I.); (M.G.)
- Correspondence: ; Tel.: +48-717332302
| | - Marta Idziak
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (M.I.); (M.G.)
| | - Klaudia Smardz
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (K.S.); (A.B.)
| | - Anna Burkot
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (K.S.); (A.B.)
| | - Malgorzata Grotowska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (M.I.); (M.G.)
| | - Stanislaw Rojek
- Department of Anaesthesiology and Intensive Therapy, Specialist Hospital in Walbrzych, A. Sokolowskiego Street 4, 58-309 Walbrzych, Poland;
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Bruni A, Garofalo E, Procopio D, Corrado S, Caroleo A, Biamonte E, Pelaia C, Longhini F. Current Practice of High Flow through Nasal Cannula in Exacerbated COPD Patients. Healthcare (Basel) 2022; 10:536. [PMID: 35327014 PMCID: PMC8954797 DOI: 10.3390/healthcare10030536] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Acute Exacerbation of Chronic Obstructive Pulmonary Disease is a form of severe Acute Respiratory Failure (ARF) requiring Conventional Oxygen Therapy (COT) in the case of absence of acidosis or the application of Non-Invasive Ventilation (NIV) in case of respiratory acidosis. In the last decade, High Flow through Nasal Cannula (HFNC) has been increasingly used, mainly in patients with hypoxemic ARF. However, some studies were also published in AECOPD patients, and some evidence emerged. In this review, after describing the mechanism underlying potential clinical benefits, we analyzed the possible clinical application of HFNC to AECOPD patients. In the case of respiratory acidosis, the gold-standard treatment remains NIV, supported by strong evidence in favor. However, HFNC may be considered as an alternative to NIV if the latter fails for intolerance. HFNC should also be considered and preferred to COT at NIV breaks and weaning. Finally, HFNC should also be preferred to COT as first-line oxygen treatment in AECOPD patients without respiratory acidosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (A.B.); (E.G.); (D.P.); (S.C.); (A.C.); (E.B.); (C.P.)
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5
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Wicky PH, Martin-Loeches I, Timsit JF. "HAP and VAP after Guidelines". Semin Respir Crit Care Med 2022; 43:248-254. [PMID: 35042265 DOI: 10.1055/s-0041-1740246] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Nosocomial pneumonia is associated with worsened prognosis when diagnosed in intensive care unit (ICU), ranging from 12 to 48% mortality. The incidence rate of ventilation-acquired pneumonia tends to decrease below 15/1,000 intubation-day. Still, international guidelines are heterogeneous about diagnostic criteria because of inaccuracy of available methods. New entities have thus emerged concerning lower respiratory tract infection, namely ventilation-acquired tracheobronchitis (VAT), or ICU-acquired pneumonia (ICUAP), eventually requiring invasive ventilation (v-ICUAP), according to the type of ventilation support. The potential discrepancy with non-invasive methods could finally lead to underdiagnosis in almost two-thirds of non-intubated patients. Delayed diagnostic could explain in part the 2-fold increase in mortality of penumonia when invasive ventilation is initiated. Here we discuss the rationale underlying this new classification.Many situations can lead to misdiagnosis, even more when the invasive mechanical ventilation is initiated. The chest radiography lacks sntivity and specificity for diagnosing pneumonia. The place of chest computed tomography and lung ultrasonography for routine diagnostic of new plumonary infiltrate remain to be evaluated.Microbiological methods used to confirm the diagnostic can be heterogeneous. The development of molecular diagnostic tools may improve the adequacy of antimicrobial therapies of ventilated patients with pneumonia, but we need to further assess its impact in non-ventilated pneumonia.In this review we introduce distinction between hospital-acquired pneumonia according to the localization in the hospital and the oxygenation/ventilation mode. A clarification of definition is the first step to develop more accurate diagnostic strategies and to improve the patients' prognosis.
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Affiliation(s)
- Paul-Henri Wicky
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Diderot University, Paris, France
| | - Ignacio Martin-Loeches
- Department of Anaesthesia and Critical Care Medicine, St. James's Hospital, Dublin, Ireland.,Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, Dublin, Ireland
| | - Jean-François Timsit
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Diderot University, Paris, France.,UMR 1137, IAME, Université Paris Diderot, Paris, France
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6
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Cutuli SL, Grieco DL, Menga LS, De Pascale G, Antonelli M. Noninvasive ventilation and high-flow oxygen therapy for severe community-acquired pneumonia. Curr Opin Infect Dis 2021; 34:142-150. [PMID: 33470666 PMCID: PMC9698117 DOI: 10.1097/qco.0000000000000715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We review the evidence on the use of noninvasive respiratory supports (noninvasive ventilation and high-flow nasal cannula oxygen therapy) in patients with acute respiratory failure because of severe community-acquired pneumonia. RECENT FINDINGS Noninvasive ventilation is strongly advised for the treatment of hypercapnic respiratory failure and recent evidence justifies its use in patients with hypoxemic respiratory failure when delivered by helmet. Indeed, such interface allows alveolar recruitment by providing high level of positive end-expiratory pressure, which improves hypoxemia. On the other hand, high-flow nasal cannula oxygen therapy is effective in patients with hypoxemic respiratory failure and some articles support its use in patients with hypercapnia. However, early identification of noninvasive respiratory supports treatment failure is crucial to prevent delayed orotracheal intubation and protective invasive mechanical ventilation. SUMMARY Noninvasive ventilation is the first-line therapy in patients with acute hypercapnic respiratory failure because of pneumonia. Although an increasing amount of evidence investigated the application of noninvasive respiratory support to hypoxemic respiratory failure, the optimal ventilatory strategy in this setting is uncertain. Noninvasive mechanical ventilation delivered by helmet and high-flow nasal cannula oxygen therapy appear as promising tools but their role needs to be confirmed by future research.
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Affiliation(s)
- Salvatore Lucio Cutuli
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Domenico Luca Grieco
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Luca Salvatore Menga
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - Massimo Antonelli
- Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8
- Facoltà di Medicina e Chirurgia ‘Agostino Gemelli’, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
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Abstract
Supplemental Digital Content is available in the text. Objective: Bacterial infections caused by antibiotic-resistant pathogens are a major problem for patients requiring critical care. An approach to combat resistance is the use of bacterial viruses known as “phage therapy.” This review provides a brief “clinicians guide” to phage biology and discusses recent applications in the context of common infections encountered in ICUs. Data Sources: Research articles were sourced from PubMed using search term combinations of “bacteriophages” or “phage therapy” with either “lung,” “pneumonia,” “bloodstream,” “abdominal,” “urinary tract,” or “burn wound.” Study Selection: Preclinical trials using animal models, case studies detailing compassionate use of phage therapy in humans, and randomized controlled trials were included. Data Extraction: We systematically extracted: 1) the infection setting, 2) the causative bacterial pathogen and its antibiotic resistance profile, 3) the nature of the phage therapeutic and how it was administered, 4) outcomes of the therapy, and 5) adverse events. Data Synthesis: Phage therapy for the treatment of experimental infections in animal models and in cases of compassionate use in humans has been associated with largely positive outcomes. These findings, however, have failed to translate into positive patient outcomes in the limited number of randomized controlled trails that have been performed to date. Conclusions: Widespread clinical implementation of phage therapy depends on success in randomized controlled trials. Additional translational and reverse translational studies aimed at overcoming phage resistance, exploiting phage-antibiotic synergies, and optimizing phage administration will likely improve the design and outcome of future trials.
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Vallecoccia MS, Dominedò C, Cutuli SL, Martin-Loeches I, Torres A, De Pascale G. Is ventilated hospital-acquired pneumonia a worse entity than ventilator-associated pneumonia? Eur Respir Rev 2020; 29:29/157/200023. [PMID: 32759376 PMCID: PMC9488552 DOI: 10.1183/16000617.0023-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/14/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Nosocomial pneumonia develops after ≥48 h of hospitalisation and is classified as ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP); the latter may require mechanical ventilation (V-HAP) or not (NV-HAP). Main findings VAP and HAP affect a significant proportion of hospitalised patients and are characterised by poor clinical outcomes. Among them, V-HAP has the greatest 28-day mortality rate followed by VAP and NV-HAP (27.8% versus 18% versus 14.5%, respectively). However, no differences in terms of pathophysiology, underlying microbiological pathways and subsequent therapy have been identified. International guidelines suggest specific flow charts to help clinicians in the therapeutic management of such diseases; however, there are no specific recommendations beyond VAP and HAP classification. HAP subtypes are scarcely considered as different entities and the lack of data from the clinical scenario limits any final conclusion. Hopefully, recent understanding of the pathophysiology of such diseases, as well as the discovery of new therapies, will improve the outcome associated with such pulmonary infections. Conclusion Nosocomial pneumonia is a multifaced disease with features of pivotal interest in critical care medicine. Due to the worrisome data on mortality of patients with nosocomial pneumonia, further prospective studies focused on this topic are urgently needed. Due to the different mortality of each subtype of nosocomial pneumonia, including ventilator-associated pneumonia and hospital-acquired pneumonia requiring mechanical ventilation, new prospective studies are urgently neededhttps://bit.ly/3fFoZ6U
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Affiliation(s)
- Maria Sole Vallecoccia
- Dept of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.,Joint first authors
| | - Cristina Dominedò
- Dept of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.,Joint first authors
| | - Salvatore Lucio Cutuli
- Dept of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ignacio Martin-Loeches
- Dept of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, Dublin, Ireland.,Service of Pneumology, Hospital Clinic of Barcelona, University of Barcelona, Institut d'Investigació August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red, Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Antoni Torres
- Service of Pneumology, Hospital Clinic of Barcelona, University of Barcelona, Institut d'Investigació August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red, Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Gennaro De Pascale
- Dept of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy .,Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Salluh JIF, Souza-Dantas VCD, Martin-Loeches I, Lisboa TC, Rabello LSCF, Nseir S, Póvoa P. Ventilator-associated tracheobronchitis: an update. Rev Bras Ter Intensiva 2020; 31:541-547. [PMID: 31967230 PMCID: PMC7008988 DOI: 10.5935/0103-507x.20190079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/22/2019] [Indexed: 11/20/2022] Open
Abstract
Ventilator-associated lower respiratory tract infection is one of the most frequent complications in mechanically ventilated patients. Ventilator-associated tracheobronchitis has been considered a disease that does not warrant antibiotic treatment by the medical community for many years. In the last decade, several studies have shown that tracheobronchitis could be considered an intermediate process that leads to ventilator-associated pneumonia. Furthermore, ventilator-associated tracheobronchitis has a limited impact on overall mortality but shows a significant association with increased patient costs, length of stay, antibiotic use, and duration of mechanical ventilation. Although we still need clear evidence, especially concerning treatment modalities, the present study on ventilator-associated tracheobronchitis highlights that there are important impacts of including this condition in clinical management and epidemiological and infection surveillance.
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Affiliation(s)
- Jorge Ibrain Figueira Salluh
- Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil.,Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | | | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization, Department of Clinical Medicine, Trinity Centre for Health Sciences, St. James's University Hospital -Dublin, Ireland.,CIBER Enfermedades Respiratorias, Critical Care Center, Sabadell Hospital, Corporación Sanitaria Universitaria Parc Taulí, Universitat Autonoma de Barcelona - Sabadell, Spain
| | - Thiago Costa Lisboa
- Rede Institucional de Pesquisa e Inovação em Medicina Intensiva, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil.,Comitê do Departamento de Terapia Intensiva e Controle da Infecção, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Ligia Sarmet Cunha Farah Rabello
- Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil.,Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | - Saad Nseir
- Critical Care Center, Centre Hospitalier Universitaire de Lille - Lille, France.,School of Medicine, University of Lille - Lille, France
| | - Pedro Póvoa
- Unidade Polivalente de Terapia Intensiva, Centro Hospitalar de Lisboa Ocidental, São Francisco Xavier Hospital - Lisboa, Portugal.,NOVA Escola Médica, CEDOC, New Universidade de Lisboa, Campo Mártires da Pátria - Lisboa, Portugal
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Martin-Loeches I. Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients. Antibiotics (Basel) 2020; 9:antibiotics9070380. [PMID: 32635601 PMCID: PMC7399936 DOI: 10.3390/antibiotics9070380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022] Open
Abstract
It is widely known that pneumonia (either community acquired or hospital acquired, as like ventilator associated pneumonia (VAP)), is the most frequent type of severe infection and continues to pose a significant burden on healthcare services worldwide. Despite new diagnostic developments, most pneumonia cases continue to be difficult to diagnose clinically, partly due to acquired antibiotic resistance and the lack of a ‘gold standard’ method of diagnosis. In other words, the lack of a rapid, accurate diagnostic test, as well as the uncertainty of the initial etiologic diagnosis and the risk stratification, results in empirical antibiotic treatments. There are significant changes in the aetiology of patients with ventilator associated lower respiratory tract infections (VA-LRTI), which are characterised by a higher incidence of multi drug resistant organisms. Evidence suggests that when patients with VA-LRTI develop organ failure, the associated mortality can be exceptionally high with frequent complications, including acute respiratory distress syndrome, acute kidney injury, and septic shock. Appropriate antibiotic treatments must consider that the present cardiovascular failure seen in patients has a different association with the patient’s mortality. Unlike patients with less severe clinical presentations, who have a higher chance of survival when the appropriate antibiotics are administered promptly, for patients with a severe subtype of the disease, the appropriateness of antibiotic treatment will impact the patient’s outcome to a lesser extent. The present review highlights certain factors detectable at the time of admission that could indicate patients who are at a high risk of bacteraemia and who, therefore, merit more intense therapy and stratified care.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Anaesthesia and Critical Care Medicine, St James’s Hospital, D08 X4RX Dublin, Ireland;
- Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, D08 X4RX Dublin, Ireland
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, 08036 Barcelona, Spain
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11
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Su G, Jia D. Vitamin D in Acute and Critically Sick Children with a Subgroup of Sepsis and Mortality: A Meta-Analysis. Nutr Cancer 2020; 73:1118-1125. [PMID: 32597305 DOI: 10.1080/01635581.2020.1784964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A meta-analysis study was performed to evaluate the relationship between vitamin D deficiency children and sepsis and acute and critically mortality. Through a systematic literature search up to December 2019, 23 studies with 4451 children, 2500 children with vitamin D deficiency were identified reporting relationships between vitamin D deficiency and sepsis and/or acute and critical care unit mortality (six sepsis only, four acute and critically mortality only and 13 both sepsis and acute and critically mortality). Odd ratio (OR) with 95% confidence intervals (CIs) was calculated comparing vitamin D deficiency children to normal vitamin D children on the bases of sepsis and mortality in acute and critical care units using the dichotomous method with a random effect model. No significant difference was found between males and females in pooled studies all together (OR, 0.72; 95% CI, 0.43-1.22). Vitamin D deficiency children (OR, 2.24; 95% CI, 1.42-3.53) had higher sepsis compared to normal vitamin D children. Also, vitamin D deficiency children (OR, 1.77; 95% CI, 1.26-2.49) had higher acute and critically mortality compared to normal vitamin D children but not as much as that in sepsis. The extent of increased sepsis was higher than that in acute and critically mortality. The impact of vitamin D deficiency in children was observed in all populations. Based on this meta-analysis, vitamin D deficiency in children may have an independent-relationship with up to 2.24 fold risk of sepsis and acute and critical care unit mortality. This relationship forces us to recommend checking vitamin D concentration in all critically ill children.
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Affiliation(s)
- Guiyun Su
- Department of Pediatrics, Jinan Central Hospital Affiliated to Shandong University, Jinan City, China
| | - Daofu Jia
- Department of Orthopedics, Jinan Central Hospital Affiliated to Shandong University, Jinan City, China
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Bruni A, Garofalo E, Cammarota G, Murabito P, Astuto M, Navalesi P, Luzza F, Abenavoli L, Longhini F. High Flow Through Nasal Cannula in Stable and Exacerbated Chronic Obstructive Pulmonary Disease Patients. Rev Recent Clin Trials 2020; 14:247-260. [PMID: 31291880 DOI: 10.2174/1574887114666190710180540] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND High-Flow through Nasal Cannula (HFNC) is a system delivering heated humidified air-oxygen mixture at a flow up to 60 L/min. Despite increasing evidence in hypoxemic acute respiratory failure, a few is currently known in chronic obstructive pulmonary disease (COPD) patients. OBJECTIVE To describe the rationale and physiologic advantages of HFNC in COPD patients, and to systematically review the literature on the use of HFNC in stable and exacerbated COPD patients, separately. METHODS A search strategy was launched on MEDLINE. Two authors separately screened all potential references. All (randomized, non-randomized and quasi-randomized) trials dealing with the use of HFNC in both stable and exacerbated COPD patients in MEDLINE have been included in the review. RESULTS Twenty-six studies have been included. HFNC: 1) provides heated and humidified airoxygen admixture; 2) washes out the anatomical dead space of the upper airway; 3) generates a small positive end-expiratory pressure; 4) guarantees a more stable inspired oxygen fraction, as compared to conventional oxygen therapy (COT); and 5) is more comfortable as compared to both COT and non-invasive ventilation (NIV). In stable COPD patients, HFNC improves gas exchange, the quality of life and dyspnea with a reduced cost of muscle energy expenditure, compared to COT. In exacerbated COPD patients, HFNC may be an alternative to NIV (in case of intolerance) and to COT at extubation or NIV withdrawal. CONCLUSION Though evidence of superiority still lacks and further studies are necessary, HFNC might play a role in the treatment of both stable and exacerbated COPD patients.
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Affiliation(s)
- Andrea Bruni
- Department of Medical and Surgical Sciences, Intensive Care Unit, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, Intensive Care Unit, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Gianmaria Cammarota
- Anesthesia and Intensive Care, "Maggiore della Carita" Hospital, Novara, Italy
| | - Paolo Murabito
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico -Vittorio Emanuele", Catania, Italy
| | - Marinella Astuto
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico -Vittorio Emanuele", Catania, Italy
| | - Paolo Navalesi
- Department of Medical and Surgical Sciences, Intensive Care Unit, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Francesco Luzza
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Viale Europa, 88100 Catanzaro, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Viale Europa, 88100 Catanzaro, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Intensive Care Unit, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
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13
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Mazzitelli M, Garofalo E, Bruni A, Barreca GS, Quirino A, Giancotti A, Serapide F, Indolfi C, Matera G, Navalesi P, Trecarichi EM, Torti C, Longhini F. Severe myocarditis due to influenza A(H1N1)pdm09 viral infection in a young woman successfully treated with intravenous zanamivir: A case report. Clin Case Rep 2019; 7:2336-2340. [PMID: 31893053 PMCID: PMC6935647 DOI: 10.1002/ccr3.2499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/16/2022] Open
Abstract
In patients with influenza-related myocarditis, prompt diagnosis and treatment are important. Intravenous zanamivir can be an alternative to oral oseltamivir, especially in severe cases and when drug intestinal malabsorption is suspected or proven.
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Affiliation(s)
- Maria Mazzitelli
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit“Magna Graecia” UniversityCatanzaroItaly
| | - Eugenio Garofalo
- Department of Medical and Surgical SciencesUnit of Intensive Care, “Magna Graecia” UniversityCatanzaroItaly
| | - Andrea Bruni
- Department of Medical and Surgical SciencesUnit of Intensive Care, “Magna Graecia” UniversityCatanzaroItaly
| | - Giorgio Settimo Barreca
- Department of Health SciencesUnit of Clinical Microbiology“Magna Graecia” UniversityCatanzaroItaly
| | - Angela Quirino
- Department of Health SciencesUnit of Clinical Microbiology“Magna Graecia” UniversityCatanzaroItaly
| | - Aida Giancotti
- Department of Health SciencesUnit of Clinical Microbiology“Magna Graecia” UniversityCatanzaroItaly
| | - Francesca Serapide
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit“Magna Graecia” UniversityCatanzaroItaly
| | - Ciro Indolfi
- Department of Medical and Surgical SciencesDivision of cardiology“Magna Graecia” UniversityCatanzaroItaly
| | - Giovanni Matera
- Department of Health SciencesUnit of Clinical Microbiology“Magna Graecia” UniversityCatanzaroItaly
| | - Paolo Navalesi
- Department of Medical and Surgical SciencesUnit of Intensive Care, “Magna Graecia” UniversityCatanzaroItaly
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit“Magna Graecia” UniversityCatanzaroItaly
| | - Carlo Torti
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit“Magna Graecia” UniversityCatanzaroItaly
| | - Federico Longhini
- Department of Medical and Surgical SciencesUnit of Intensive Care, “Magna Graecia” UniversityCatanzaroItaly
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Pisani L, Astuto M, Prediletto I, Longhini F. High flow through nasal cannula in exacerbated COPD patients: a systematic review. Pulmonology 2019; 25:348-354. [DOI: 10.1016/j.pulmoe.2019.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022] Open
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Trecarichi EM, Quirino A, Scaglione V, Longhini F, Garofalo E, Bruni A, Biamonte E, Lionello R, Serapide F, Mazzitelli M, Marascio N, Matera G, Liberto MC, Navalesi P, Torti C. Successful treatment with cefiderocol for compassionate use in a critically ill patient with XDR Acinetobacter baumannii and KPC-producing Klebsiella pneumoniae: a case report. J Antimicrob Chemother 2019; 74:3399-3401. [PMID: 31369095 DOI: 10.1093/jac/dkz318] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Enrico Maria Trecarichi
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Angela Quirino
- Unit of Clinical Microbiology, Department of Health Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Vincenzo Scaglione
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Federico Longhini
- Unit of Intensive Care, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Eugenio Garofalo
- Unit of Intensive Care, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Andrea Bruni
- Unit of Intensive Care, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Eugenio Biamonte
- Unit of Intensive Care, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Rosaria Lionello
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Francesca Serapide
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Maria Mazzitelli
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Nadia Marascio
- Unit of Clinical Microbiology, Department of Health Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Giovanni Matera
- Unit of Clinical Microbiology, Department of Health Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Maria Carla Liberto
- Unit of Clinical Microbiology, Department of Health Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Paolo Navalesi
- Unit of Intensive Care, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Carlo Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
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Martin-Loeches I, Torres A, Povoa P, Zampieri FG, Salluh J, Nseir S, Ferrer M, Rodriguez A. The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection. Intensive Care Med 2019; 45:1753-1762. [PMID: 31620836 DOI: 10.1007/s00134-019-05797-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/22/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Ventilator associated-lower respiratory tract infections (VA-LRTIs), either ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), accounts for most nosocomial infections in intensive care units (ICU) including. Our aim was to determine if appropriate antibiotic treatment in patients with VA-LRTI will effectively reduce mortality in patients who had cardiovascular failure. METHODS This was a pre-planned subanalysis of a large prospective cohort of mechanically ventilated patients for at least 48 h in eight countries in two continents. Patients with a modified Sequential Organ Failure Assessment (mSOFA) cardiovascular score of 4 (at the time of VA-LRTI diagnosis and needed be present for at least 12 h) were defined as having cardiovascular failure. RESULTS VA-LRTI occurred in 689 (23.2%) out of 2960 patients and 174 (25.3%) developed cardiovascular failure. Patients with cardiovascular failure had significantly higher ICU mortality than those without (58% vs. 26.8%; p < 0.001; OR 3.7; 95% CI 2.6-5.4). A propensity score analysis found that the presence of inappropriate antibiotic treatment was an independent risk factor for ICU mortality in patients without cardiovascular failure, but not in those with cardiovascular failure. When the propensity score analysis was conducted in patients with VA-LRTI, the use of appropriate antibiotic treatment conferred a survival benefit for patients without cardiovascular failure who had only VAP. CONCLUSIONS Patients with VA-LRTI and cardiovascular failure did not show an association to a higher ICU survival with appropriate antibiotic treatment. Additionally, we found that in patients without cardiovascular failure, appropriate antibiotic treatment conferred a survival benefit for patients only with VAP. TRIAL REGISTRY ClinicalTrials.gov, number NCT01791530.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Anaesthesia and Critical Care Medicine, St. James's Hospital, Dublin, Ireland. .,Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, P.O. Box 580, James's Street, Dublin 8, Ireland. .,Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain.
| | - Antoni Torres
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | | | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio De Janeiro, Brazil
| | - Saad Nseir
- Critical Care Center, University Hospital of Lille, Lille University, Lille, France
| | - Miquel Ferrer
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain
| | - Alejandro Rodriguez
- Critical Care Department, Hospital Universitario Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain
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Abstract
PURPOSE OF REVIEW Hospital-acquired pneumonia (HAP) is the leading cause of death from hospital-acquired infection. Little work has been done on strategies for prevention of HAP. This review aims to describe potential HAP prevention strategies and the evidence supporting them. Oral care and aspiration precautions may attenuate some risk for HAP. Oral and digestive decontamination with antibiotics may be effective but could increase risk for resistant organisms. Other preventive measures, including isolation practices, remain theoretical or experimental. RECENT FINDINGS Hospital-acquired pneumonia occurs because of pharyngeal colonization with pathogenic organisms and subsequent aspiration of these pathogens. SUMMARY Most potential HAP prevention strategies remain unproven.
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Cariolou M, Cupp MA, Evangelou E, Tzoulaki I, Berlanga-Taylor AJ. Importance of vitamin D in acute and critically ill children with subgroup analyses of sepsis and respiratory tract infections: a systematic review and meta-analysis. BMJ Open 2019; 9:e027666. [PMID: 31122993 PMCID: PMC6538078 DOI: 10.1136/bmjopen-2018-027666] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To estimate the prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency and investigate its association with mortality in children with acute or critical conditions. DESIGN Systematic review and meta-analysis of observational studies. DATA SOURCES PubMed, OVID, Google Scholar and the Cochrane Library searched until 21 December 2018. ELIGIBILITY CRITERIA Studies of children hospitalised with acute or critical conditions who had blood 25(OH)D levels measured. DATA EXTRACTION AND SYNTHESIS We obtained pooled prevalence estimates of 25(OH)D deficiency and ORs for mortality. We calculated 95% CI and prediction intervals and investigated heterogeneity and evidence of small-study effects. RESULTS Fifty-two studies were included. Of 7434 children, 3473 (47.0%) were 25(OH)D deficient (<50 nmol/L). The pooled prevalence estimate of 25(OH)D deficiency was 54.6% (95% CI 48.5% to 60.6%, I2=95.3%, p<0.0001). Prevalence was similar after excluding smaller studies (51.5%). In children with sepsis (18 studies, 889 total individuals) prevalence was 64.0% (95% CI 52.0% to 74.4%, I2=89.3%, p<0.0001) and 48.7% (95% CI 38.2% to 59.3%; I2=94.3%, p<0.0001) in those with respiratory tract infections (RTI) (25 studies, 2699 total individuals). Overall, meta-analysis of mortality (18 cohort studies, 2463 total individuals) showed increased risk of death in 25(OH)D deficient children (OR 1.81, 95% CI 1.24 to 2.64, p=0.002, I2=25.7%, p=0.153). Four (22.0%) of the 18 studies statistically adjusted for confounders. There were insufficient studies to meta-analyse sepsis and RTI-related mortality. CONCLUSIONS Our results suggest that 25(OH)D deficiency in acute and critically ill children is high and associated with increased mortality. Small-study effects, reverse causation and other biases may have confounded results. Larger, carefully designed studies in homogeneous populations with confounder adjustment are needed to clarify the association between 25(OH)D levels with mortality and other outcomes. PROSPERO REGISTRATION NUMBER CRD42016050638.
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Affiliation(s)
- Margarita Cariolou
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
| | - Meghan A Cupp
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
| | - Evangelos Evangelou
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Ioanna Tzoulaki
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Antonio J Berlanga-Taylor
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
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Martin-Loeches I, Torres A. The European Network for ICU-Related Respiratory Infections (ENIRRIs) ERS Clinical Research Collaboration. Eur Respir J 2019; 53:53/1/1801972. [DOI: 10.1183/13993003.01972-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/12/2018] [Indexed: 11/05/2022]
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