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Review Article
Infection
Microbial infections in burn patients
Souvik Roy, Preeti Mukherjee, Sutrisha Kundu, Debashrita Majumder, Vivek Raychaudhuri, Lopamudra Choudhury
Acute Crit Care. 2024;39(2):214-225.   Published online May 24, 2024
DOI: https://doi.org/10.4266/acc.2023.01571
  • 1,833 View
  • 177 Download
  • 1 Crossref
AbstractAbstract PDF
Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.

Citations

Citations to this article as recorded by  
  • Enhancing clinical outcomes in burn and surgical intensive care units patients
    Mahta Moghaddam Ahmadi, Moein Moghaddam Ahmadi
    Burns.2024;[Epub]     CrossRef
Original Articles
Infection
Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes
Ahlem Trifi, Selim Sellaouti, Asma Mehdi, Lynda Messaoud, Eya Seghir, Badis Tlili, Sami Abdellatif
Acute Crit Care. 2023;38(4):425-434.   Published online November 28, 2023
DOI: https://doi.org/10.4266/acc.2023.00773
  • 1,808 View
  • 52 Download
AbstractAbstract PDFSupplementary Material
Background
Coronavirus disease 2019 (COVID-19) pandemic disrupted adherences to healthcare-associated infection (HAI) prevention protocols. Herein, we studied the characteristics of all HAIs occurring in critically ill COVID-19 patients.
Methods
A retrospective, single-center cohort of critical COVID-19 patients during 2021. Microbiological samples were collected if HAI was suspected. We analyzed all factors that could potentially induce HAI, using septic shock and mortality as endpoints.
Results
Sixty-four among 161 included patients (39.7%) presented a total of 117 HAIs with an incidence density of 69.2 per 1,000 hospitalization days. Compared to the prior COVID-19 period (2013–2019), the identification of HAI increased in 2021. HAIs were classified into ventilator-associated pneumonia (VAP; n=38), bloodstream infection (n=32), urinary tract infection (n=24), catheter-related infection (n=12), and fungal infection (n=11). All HAIs occurred significantly earlier in the post–COVID-19 period (VAP: 6 vs. 10 days, P=0.045, in 2017 and 2021). Acinetobacter baumannii (39.5%) and Klebsiella pneumoniae (27%) were the most commonly isolated pathogens that exhibited a multidrug-resistant (MDR) profile, observed in 89% and 64.5%, respectively. The HAI factors were laboratory abnormalities (odds ratio [OR], 6.4; 95% confidence interval [CI], 2.3–26.0), cumulative steroid dose (OR, 1.9; 95% CI, 1.3–4.0), and invasive procedures (OR, 20.7; 95% CI, 5.3–64.0). HAI was an independent factor of mortality (OR, 8.5; P=0.004).
Conclusions
During the COVID-19 era, the incidence of HAIs increased and MDR isolates remained frequent. A severe biological inflammatory syndrome, invasive devices, and elevated cumulative steroid dosages were related to HAIs. HAI was a significant death factor.
Infection
Evaluating the use of the respiratory-rate oxygenation index as a predictor of high-flow nasal cannula oxygen failure in COVID-19
Scott Weerasuriya, Savvas Vlachos, Ahmed Bobo, Namitha Birur Jayaprabhu, Lauren Matthews, Adam R Blackstock, Victoria Metaxa
Acute Crit Care. 2023;38(1):31-40.   Published online February 27, 2023
DOI: https://doi.org/10.4266/acc.2022.01081
  • 2,027 View
  • 116 Download
AbstractAbstract PDFSupplementary Material
Background
It can be challenging for clinicians to predict which patients with respiratory failure secondary to coronavirus disease 2019 (COVID-19) will fail on high-flow nasal cannula (HFNC) oxygen and require escalation of therapy. This study set out to evaluate the association between the respiratory rate-oxygenation index (ROX) and HFNC failure in such patients and to assess whether ROX trajectory correlates with treatment failure.
Methods
This was a single-centre, retrospective, observational study of patients with COVID-19 requiring HFNC, conducted over a 3-month period. ROX was calculated as “pulse-oximetry oxygen saturation (SpO2) over the fractional inspired oxygen concentration (FiO2)/respiratory rate” for each patient at 2, 4, and 12 hours from starting HFNC. HFNC failure was defined as escalation to continuous positive airway pressure ventilation or invasive mechanical ventilation (IMV). Time-to-event analyses were performed to account for the longitudinal data set and time-dependent variables.
Results
We included 146 patients. Ninety-three (63.7%) experienced HFNC failure, with 53 (36.3%) requiring IMV. Higher ROX values were associated with a lower subhazard of HFNC failure on time-to-HFNC failure analysis (subhazard ratio, 0.29; 95% confidence interval [CI], 0.18–0.46; P<0.001). This remained true after controlling for informative censoring. Median ROX values changed differentially over time, increasing in the HFNC success group (0.06 per hour; 95% CI, 0.05–0.08; P<0.001) but not in the HFNC failure group (0.004 per hour; 95% CI, –0.05 to 0.08; P=0.890).
Conclusions
A higher ROX is associated with a lower risk of HFNC failure. Monitoring ROX trajectory over time may help identify patients at risk of treatment failure. This has potential clinical applications; however, future prospective studies are required.
Infection
Study of the gut microbiome as a novel target for prevention of hospital-associated infections in intensive care unit patients
Suzan Ahmed Elfiky, Shwikar Mahmoud Ahmed, Ahmed Mostafa Elmenshawy, Gehad Mahmoud Sultan, Sara Lotfy Asser
Acute Crit Care. 2023;38(1):76-85.   Published online February 23, 2023
DOI: https://doi.org/10.4266/acc.2022.01116
  • 2,439 View
  • 94 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
Hospital-acquired infections (HAIs) are increasing due to the spread of multi-drugresistant organisms. Gut dysbiosis in an intensive care unit (ICU) patients at admission showed an altered abundance of some bacterial genera associated with the occurrence of HAIs and mortality. In the present study, we investigated the pattern of the gut microbiome in ICU patients at admission to correlate it with the development of HAIs during ICU stay. Methods: Twenty patients admitted to an ICU with a cross-matched control group of 30 healthy subjects of matched age and sex. Quantitative SYBR green real-time polymerase chain reaction was done for the identification and quantitation of selected bacteria. Results: Out of those twenty patients, 35% developed ventilator-associated pneumonia during their ICU stay. Gut microbiome analysis showed a significant decrease in Firmicutes and Firmicutes to Bacteroidetes ratio in ICU patients in comparison to the control and in patients who developed HAIs in comparison to the control group and patients who did not develop HAIs. There was a statistically significant increase in Bacteroides in comparison to the control group. There was a statistically significant decrease in Bifidobacterium and Faecalibacterium prausnitzii and an increase in Lactobacilli in comparison to the control group with a negative correlation between Acute Physiology and Chronic Health Evaluation (APACHE) II score and Firmicutes to Bacteroidetes and Prevotella to Bacteroides ratios. Conclusions: Gut dysbiosis of patients at the time of admission highlights the importance of identification of the microbiome of patients admitted to the ICU as a target for preventing of HAIs

Citations

Citations to this article as recorded by  
  • Safety, feasibility, and impact on the gut microbiome of kefir administration in critically ill adults
    Vinod K. Gupta, Sanu Rajendraprasad, Mahmut Ozkan, Dhanya Ramachandran, Sumera Ahmad, Johan S. Bakken, Krzysztof Laudanski, Ognjen Gajic, Brent Bauer, Simon Zec, David W. Freeman, Sahil Khanna, Aditya Shah, Joseph H. Skalski, Jaeyun Sung, Lioudmila V. Kar
    BMC Medicine.2024;[Epub]     CrossRef
  • Bringing gut microbiota into the spotlight of clinical research and medical practice
    Efstathia Davoutis, Zoi Gkiafi, Panagis M Lykoudis
    World Journal of Clinical Cases.2024; 12(14): 2293.     CrossRef
  • Antimicrobial Peptides and Their Assemblies
    Ana Maria Carmona-Ribeiro
    Future Pharmacology.2023; 3(4): 763.     CrossRef
Review Article
Neurology
Transient splenial lesions of the corpus callosum and infectious diseases
Kyu Sun Yum, Dong-Ick Shin
Acute Crit Care. 2022;37(3):269-275.   Published online August 17, 2022
DOI: https://doi.org/10.4266/acc.2022.00864
  • 6,231 View
  • 324 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDF
comTransient splenial lesion of the corpus callosum can be observed in various diseases such as cancer, drug use, metabolic disorders, and cerebrovascular disorders, as well as in patients with infectious diseases. During the coronavirus disease 2019 (COVID-19) pandemic, there were increasing reports of these lesions being detected on brain imaging tests performed in patients with neurological symptoms. On brain magnetic resonance imaging, findings suggestive of cytotoxic edema are observed in the splenium; these are known to disappear with improvement of clinical symptoms. Cytokinopathy caused by infection increases the permeability of the blood–brain barrier and activates the glial cells of the brain to induce cytotoxic edema. Most patients have a good prognosis. The causes, mechanism, diagnosis, treatment and prognosis of transient splenial lesions of the corpus callosum will be summarized in this review.

Citations

Citations to this article as recorded by  
  • A 10-year-old girl with meningitis retention syndrome and reversible splenial lesion: A case report
    Chung-Hao Wang, Chi-Nan Huang, Pei-Wei Wang
    Pediatrics & Neonatology.2024; 65(2): 204.     CrossRef
  • Legionella‐induced dysarthria and rhabdomyolysis with acute renal failure achieving recovery
    Husam El Sharu, Soban Ahmad, Hunter Coore
    Clinical Case Reports.2024;[Epub]     CrossRef
  • Rickettsial infection causing non-aneurysmal subarachnoid hemorrhage with transient corpus callosum lesion
    Zahraa Noureddine El Moussaoui, Zahraa Saker, Hasan Rahhal, Ali Nasserdine, Mahmoud Younes
    Journal of Medicine, Surgery, and Public Health.2024; 2: 100093.     CrossRef
Original Articles
Infection
Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review
Sofia R. Valdoleiros, Cristina Torrão, Laura S. Freitas, Diana Mano, Celina Gonçalves, Carla Teixeira
Acute Crit Care. 2022;37(1):61-70.   Published online January 26, 2022
DOI: https://doi.org/10.4266/acc.2021.01151
  • 6,594 View
  • 277 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract PDFSupplementary Material
Background
Nosocomial meningitis is a medical emergency that requires early diagnosis, prompt initiation of therapy, and frequent admission to the intensive care unit (ICU). Methods: A retrospective study was conducted in adult patients diagnosed with nosocomial meningitis who required admission to the ICU between April 2010 and March 2020. Meningitis/ventriculitis and intracranial infection were defined according to Centers for Disease Control and Prevention guidelines. Results: An incidence of 0.75% of nosocomial meningitis was observed among 70 patients. The mean patient age was 59 years and 34% were ≥65 years. Twenty-two percent of patients were in an immunocompromised state. A clear predisposing factor for nosocomial meningitis (traumatic brain injury, basal skull fracture, brain hemorrhage, central nervous system [CNS] invasive procedure or device) was present in 93% of patients. Fever was the most frequent clinical feature. A microbiological agent was identified in 30% of cases, of which 27% were bacteria, with a predominance of Gram-negative over Gram-positive. Complications developed in 47% of cases, 24% of patients were discharged with a Glasgow coma scale <14, and 37% died. There were no clear clinical predictors of complications. Advanced age (≥65 years old) and the presence of complications were associated with higher hospital mortality. Conclusions: Nosocomial meningitis in critical care has a low incidence rate but high mortality and morbidity. In critical care patients with CNS-related risk factors, a high level of suspicion for meningitis is warranted, but diagnosis can be hindered by several confounding factors.

Citations

Citations to this article as recorded by  
  • Procalcitonin As Diagnostic Tool for CNS Infections—Overall, Not Good Enough (Yet?)*
    Michael A. Pizzi, Katharina M. Busl
    Critical Care Medicine.2024; 52(1): 163.     CrossRef
  • A retrospective analysis of 20,178 adult neurological infection admissions to United Kingdom critical care units from 2001 to 2020
    Joseph Donovan, Abena Glover, John Gregson, Andrew W. Hitchings, Emma C. Wall, Robert S. Heyderman
    BMC Infectious Diseases.2024;[Epub]     CrossRef
  • Clinical Characteristics, Treatment, and Outcomes of Veterans with Cerebrospinal Fluid Culture Positive for Gram-Negative Rod Bacteria: A Retrospective Analysis over 18 Years in 125 Veterans Health Administration Hospitals
    Shinya Hasegawa, Eiyu Matsumoto, Jennifer R. Carlson, Hiroyuki Suzuki
    Current Microbiology.2024;[Epub]     CrossRef
  • Confronting multidrug-resistantKlebsiellameningitis after mid-clival Cerebrospinal Fluid leak repair: a therapeutic odyssey
    Anbarasi Madoure, Dharanya Gopalakrishnan Srinivasan, Tejaswi Mishra, Lokesh Kumar Penubarthi
    BMJ Case Reports.2024; 17(6): e257872.     CrossRef
  • Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland
    Sakke Niemelä, Laura Lempinen, Eliisa Löyttyniemi, Jarmo Oksi, Jussi Jero
    BMC Infectious Diseases.2023;[Epub]     CrossRef
  • Bacterial meningitis in children with an abnormal craniocerebral structure
    Jiali Pan, Wei Xu, Wenliang Song, Tao Zhang
    Frontiers in Pediatrics.2023;[Epub]     CrossRef
  • Fieber in der Intensivmedizin
    Jan-Hendrik Naendrup, Boris Böll, Jorge Garcia Borrega
    Intensivmedizin up2date.2023; 19(01): 17.     CrossRef
  • Neurosurgical management of penetrating brain injury during World War I: A historical cohort
    Rayan Fawaz, Mathilde Schmitt, Philémon Robert, Nathan Beucler, Jean-Marc Delmas, Nicolas Desse, Aurore Sellier, Arnaud Dagain
    Neurochirurgie.2023; 69(3): 101439.     CrossRef
  • Etiology and Outcomes of Healthcare-Associated Meningitis and Ventriculitis—A Single Center Cohort Study
    Hana Panic, Branimir Gjurasin, Marija Santini, Marko Kutlesa, Neven Papic
    Infectious Disease Reports.2022; 14(3): 420.     CrossRef
  • Healthcare-associated central nervous system infections
    Mariachiara Ippolito, Antonino Giarratano, Andrea Cortegiani
    Current Opinion in Anaesthesiology.2022; 35(5): 549.     CrossRef
Thoracic Surgery
Outcome of External Ventricular Drainage according to the Operating Place: the Intensive Care Unit versus Operating Room
Si On Kim, Won Jun Song, Yu Sam Won, Jae Young Yang, Chun Sik Choi
Korean J Crit Care Med. 2016;31(1):10-16.   Published online February 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.1.10
  • 5,753 View
  • 94 Download
AbstractAbstract PDF
Background:
External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups.
Methods
We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015.
Results
A total of 75 patients (45 men and 30 women, mean age: 58.7 ± 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 ± 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group.
Conclusions
If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.
Infection
Extended-Spectrum beta-Lactamase and Multidrug Resistance in Urinary Sepsis Patients Admitted to the Intensive Care Unit
Bumjoon Kim, Sung Gyun Kim, Seung Soon Lee, Tae Seok Kim, Yong Il Hwang, Seung Hun Jang, Joo Hee Kim, Ki Suck Jung, Sunghoon Park
Korean J Crit Care Med. 2014;29(4):257-265.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.257
  • 6,160 View
  • 67 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
The role of extended-spectrum beta-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting.
METHODS
Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome.
RESULTS
In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95micro confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production.
CONCLUSIONS
Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.

Citations

Citations to this article as recorded by  
  • Worrisome high frequency of extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired urinary tract infections: a case–control study
    Franco Castillo-Tokumori, Claudia Irey-Salgado, Germán Málaga
    International Journal of Infectious Diseases.2017; 55: 16.     CrossRef
Randomized Controlled Trial
Central Venous Catheter-related Infection in Major Burn Patients: Comparison of Subclavian Vein and Femoral Vein
Young Ho Jang, Yong Hoon Son, Sang Kyu Kim, Joon Mo Park, Mi Young Lee, Jin Mo Kim
Korean J Crit Care Med. 2011;26(4):245-249.
DOI: https://doi.org/10.4266/kjccm.2011.26.4.245
  • 4,103 View
  • 72 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
A central venous catheter (CVC) is usually inserted in patients with severe burns and the selection of the CVC is often difficult due to widespread burned skin. We investigated the incidences of colonization and catheter-related blood stream infection (CRBSI) according to the insertion site of the CVC in major burn patients METHODS: In 63 adult massive burn patients in the intensive care unit, 93 CVCs (47 polyurethane standard CVCs and 46 Oligon anti-mocrobial CVCs) were randomly inserted via the subclavian vein (SCV group, n = 66) or femoral vein (FEV group, n = 27). All catheter tips removed were routinely cultured. Bacterial findings from the burn wound and peripheral blood were also monitored in all patients RESULTS: There was no significant difference in the average insertion length of the CVC (14.3 +/- 6.8 days in SCV and 13.6 +/- 3.8 days in FEV) between the two groups. There were no significant differences in CVC colonization (48.5% in SCV and 63.0% in FEV) and CRBSI (7.6% in SCV and 11.1% in FEV) between the two groups. Logistic analysis found that the use of polyurethane standard CVC is significantly associated with increased risk of CVC colonization (odds ratio = 2.68) CONCLUSIONS: The placement of the CVC via the femoral vein does not increase the incidence of CVC colonization in massive burn patients. The use of Oligon anti-microbial CVC may be helpful to reduce CVC colonization in major burn patients.

Citations

Citations to this article as recorded by  
  • An Ounce of Prevention Saves Tons of Lives: Infection in Burns
    Nishant Merchant, Karen Smith, Marc G. Jeschke
    Surgical Infections.2015; 16(4): 380.     CrossRef

ACC : Acute and Critical Care