Acute and Critical Care

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

1,419 View
47 Download

Abstract PDF Supplementary 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

1,749 View
114 Download

Abstract PDF Supplementary 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

2,019 View
90 Download
1 Web of Science
2 Crossref

Abstract 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
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

5,595 View
317 Download
1 Web of Science
3 Crossref

Abstract 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

5,638 View
263 Download
8 Web of Science
9 Crossref

Abstract PDF Supplementary 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
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

5,543 View
91 Download

Abstract 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

6,034 View
67 Download
1 Crossref

Abstract 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

3,947 View
68 Download
1 Crossref

Abstract 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

First
Prev
Page of 1
Next
Last

Search