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Montrucchio G, Costamagna A, Pierani T, Petitti A, Sales G, Pivetta E, Corcione S, Curtoni A, Cavallo R, De Rosa FG, Brazzi L. Bloodstream Infections Caused by Carbapenem-Resistant Pathogens in Intensive Care Units: Risk Factors Analysis and Proposal of a Prognostic Score. Pathogens 2022; 11:pathogens11070718. [PMID: 35889963 PMCID: PMC9315650 DOI: 10.3390/pathogens11070718] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 02/06/2023] Open
Abstract
Considering the growing prevalence of carbapenem-resistant Gram-negative bacteria (CR-GNB) bloodstream infection (BSI) in intensive care units (ICUs), the identification of specific risk factors and the development of a predictive model allowing for the early identification of patients at risk for CR-Klebsiella pneumoniae, Acinetobacter baumannii or Pseudomonas aeruginosa are essential. In this retrospective case–control study including all consecutive patients showing an episode of BSI in the ICUs of a university hospital in Italy in the period January–December 2016, patients with blood culture positive for CR-GNB pathogens and for any other bacteria were compared. A total of 106 patients and 158 episodes of BSI were identified. CR-GNBs induced BSI in 49 patients (46%) and 58 episodes (37%). Prognosis score and disease severity at admission, parenteral nutrition, cardiovascular surgery prior to admission to ICU, the presence of sepsis and septic shock, ventilation-associated pneumonia and colonization of the urinary or intestinal tract were statistically significant in the univariate analysis. The duration of ventilation and mortality at 28 days were significantly higher among CR-GNB cases. The prognostic model based on age, presence of sepsis, previous cardiovascular surgery, SAPS II, rectal colonization and invasive respiratory infection from the same pathogen showed a C-index of 89.6%. The identified risk factors are in line with the international literature. The proposal prognostic model seems easy to use and shows excellent performance but requires further studies to be validated.
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Affiliation(s)
- Giorgia Montrucchio
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (A.C.); (T.P.); (A.P.); (G.S.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy
- Correspondence:
| | - Andrea Costamagna
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (A.C.); (T.P.); (A.P.); (G.S.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy
| | - Tommaso Pierani
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (A.C.); (T.P.); (A.P.); (G.S.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy
| | - Alessandra Petitti
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (A.C.); (T.P.); (A.P.); (G.S.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy
| | - Gabriele Sales
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (A.C.); (T.P.); (A.P.); (G.S.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy
| | - Emanuele Pivetta
- Department of General and Specialized Medicine, Division of Emergency Medicine and High Dependency Unit, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy;
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (S.C.); (F.G.D.R.)
- Division of Geographic Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Antonio Curtoni
- Microbiology and Virology Unit, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy; (A.C.); (R.C.)
| | - Rossana Cavallo
- Microbiology and Virology Unit, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy; (A.C.); (R.C.)
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (S.C.); (F.G.D.R.)
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (A.C.); (T.P.); (A.P.); (G.S.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, Italy
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Montrucchio G, Sales G, Catozzi G, Bosso S, Scanu M, Vignola TV, Costamagna A, Corcione S, Urbino R, Filippini C, De Rosa FG, Brazzi L. Effectiveness of an Active and Continuous Surveillance Program for Intensive Care Units Infections Based on the EPIC III (Extended Prevalence of Infection in Intensive Care) Approach. J Clin Med 2022; 11:jcm11092482. [PMID: 35566606 PMCID: PMC9101920 DOI: 10.3390/jcm11092482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/08/2022] [Accepted: 04/27/2022] [Indexed: 11/20/2022] Open
Abstract
We evaluated the effectiveness of the Extended Prevalence of Infection in Intensive Care (EPIC) III data collection protocol as an active surveillance tool in the eight Intensive Care Units (ICUs) of the Intensive and Critical Care Department of the University Hospital of Turin. A total of 435 patients were included in a six-day study over 72 ICU beds. 42% had at least one infection: 69% at one site, 26% at two sites and 5% at three or more sites. ICU-acquired infections were the most common (64%), followed by hospital-associated infections (22%) and community-acquired (20%), considering that each patient may have developed more than one infection type. 72% of patients were receiving at least one antibiotic: 48% for prophylaxis and 52% for treatment. Mortality, the length of ICU and hospital stays were 13%, 14 and 29 days, respectively, being all estimated to be significantly different in patients without and with infection (8% vs. 20%; 4 vs. 20 and 11 vs. 50 (p < 0.001). Our data confirm a high prevalence of infections, sepsis and the use of antimicrobials. The repeated punctual prevalence survey seems an effective method to carry out the surveillance of infections and the use of antimicrobials in the ICU. The use of the European Centre for Disease Prevention and Control (ECDC) definitions and the EPIC III protocol seems strategic to allow comparisons with national and international contexts.
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Affiliation(s)
- Giorgia Montrucchio
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (G.S.); (A.C.); (C.F.); (L.B.)
- Department of Anaesthesia, Critical Care and Emergency, Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (M.S.); (R.U.)
- Correspondence:
| | - Gabriele Sales
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (G.S.); (A.C.); (C.F.); (L.B.)
- Department of Anaesthesia, Critical Care and Emergency, Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (M.S.); (R.U.)
| | - Giulia Catozzi
- Department of Health Sciences, University of Milan, 20122 Milan, Italy;
| | - Stefano Bosso
- Department of Anesthesiology and Critical Care, “Cardinal Massaia” Hospital, 14100 Asti, Italy;
| | - Martina Scanu
- Department of Anaesthesia, Critical Care and Emergency, Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (M.S.); (R.U.)
| | - Titty Vita Vignola
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy;
| | - Andrea Costamagna
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (G.S.); (A.C.); (C.F.); (L.B.)
- Department of Anaesthesia, Critical Care and Emergency, Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (M.S.); (R.U.)
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (S.C.); (F.G.D.R.)
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Rosario Urbino
- Department of Anaesthesia, Critical Care and Emergency, Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (M.S.); (R.U.)
| | - Claudia Filippini
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (G.S.); (A.C.); (C.F.); (L.B.)
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (S.C.); (F.G.D.R.)
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (G.S.); (A.C.); (C.F.); (L.B.)
- Department of Anaesthesia, Critical Care and Emergency, Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (M.S.); (R.U.)
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Montrucchio G, Sales G, Corcione S, De Rosa FG, Brazzi L. Choosing wisely: what is the actual role of antimicrobial stewardship in Intensive Care Units? Minerva Anestesiol 2018; 85:71-82. [PMID: 29991221 DOI: 10.23736/s0375-9393.18.12662-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
More than two-thirds of critically ill patients receive an antimicrobial therapy with a percentage between 30% and 50% of all prescribed antibiotics reported to be unnecessary, inappropriate or misused. Since inappropriate prescription of antibiotic drugs concurs to dissemination of the multidrug resistant organisms, a reasoned antibiotics use is crucial especially in Intensive Care Unit (ICU), where up to 60% of the admitted patients develops an infection during their ICU stay. Even if the concept of antimicrobial stewardship (AS) has been clearly described as a series of coordinated interventions designed to improve antimicrobial agents use, few studies are reporting about its effectiveness to improve outcomes, reduce adverse events and costs and decrease resistance rate spread. Moreover, although it is recognized that AS programs are particularly indicated in the critical setting due to the huge number of antimicrobial drugs used, the optimal characteristics of these interventions and the best system to evaluate their effectiveness are still unclear. Specific interventions, designed tacking into account the peculiarities of the ICU setting, are hence necessary to set-up an "in-ICU-stewardship," including prompt identification of infected patients, selection of appropriate empiric treatments, optimization of dosing and route of administration, improvement of diagnostic techniques, early de-escalation to achieve shorter duration and avoid unnecessary therapies. The present narrative review summarizes the "state of art" about AS programmes and discusses the effects of the interventions possibly applied in ICU setting to optimize the patient's treatment, reduce the micro-organisms resistance and contain the hospital resources utilization.
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Affiliation(s)
| | - Gabriele Sales
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Francesco G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy.,Department of Anaesthesia, Intensive Care and Emergency, "Città della Salute e della Scienza" Hospital, Turin, Italy
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Behera B. A Letter in Response to “Diagnosing Catheter-Associated Urinary Tract Infection in Critically ill Patients: Do the Guidelines Help?”. Indian J Crit Care Med 2018; 22:467-468. [PMID: 29962753 PMCID: PMC6020639 DOI: 10.4103/ijccm.ijccm_225_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Choi YJ, Lee B, Park SA. Epidemiological Study on CandidaSpecies in Patients with Cancer in the Intensive Care Unit. Osong Public Health Res Perspect 2017; 8:384-388. [PMID: 29354396 PMCID: PMC5749485 DOI: 10.24171/j.phrp.2017.8.6.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 10/15/2017] [Accepted: 11/20/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives Although cancer survival rates have increased, serious infection complications can arise in cancer patients. Candida can occur in various tissues and has significant effects on the prognosis of patients with cancer. Thus, we conducted an epidemiological study on Candida infections in patients with cancer admitted to the intensive care unit. Methods A retrospective study was conducted in adult patients with cancer admitted to the intensive care unit between January 1, 2013, and December 31, 2015. Candida infection status and predictive factors for mortality were examined in 634 patients. Results The predictive factors for mortality included the use of steroids, use of a central venous catheter or mechanical ventilator, and identification of Candida in the blood. Patients who stayed in the surgical and intensive care unit for more than 7 days had a lower risk of death than that in those with shorter days. Conclusion The present study shows that invasive procedures, bloodstream infections, and the use of steroids increase the risk of mortality in Candida-infected patients with cancer. To improve the quality of life and reduce mortality, further studies are needed on the factors affecting the risk of mortality associated with Candida infection.
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Affiliation(s)
- Young-ju Choi
- Infection Control Unit, National Cancer Center, Goyang, Korea
| | - Byeongyeo Lee
- Infection Control Unit, National Cancer Center, Goyang, Korea
| | - Sun-A Park
- Division of Nursing Science, University of Suwon, Hwaseong, Korea
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What Is the Most Recent Evidence on the Prevention and Early Treatment of Invasive Fungal Infections in Nonneutropenic Critically Ill Patients? ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2017. [DOI: 10.5812/archcid.12414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cortegiani A, Russotto V, Raineri SM, Gregoretti C, De Rosa FG, Giarratano A. Untargeted Antifungal Treatment Strategies for Invasive Candidiasis in Non-neutropenic Critically Ill Patients: Current Evidence and Insights. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Quesada C, Aceituno J, Suárez R, Mazariegos C. Fungemia Related to Parenteral Nutrition. CURRENT TROPICAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40475-017-0120-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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