• Salmonella enterica Serovar Infantis
• bacterial resistance
• blaKPC
• carbapenemase
• genetic determinant
• whole-genome sequencing

• Ecuador
• Anti-Bacterial Agents/pharmacology
• beta-Lactamases/genetics
• Salmonella enterica/drug effects
• Salmonella enterica/genetics
• Humans
• Microbial Sensitivity Tests
• Plasmids
• Whole Genome Sequencing
• Serogroup
• Salmonella Infections/microbiology
• Salmonella Infections/drug therapy
• Gene Transfer, Horizontal
• Drug Resistance, Multiple, Bacterial/genetics

• COVID-19
• Economic evaluation
• Hospital-acquired infections
• Intensive care unit
• Medical costs
• Serbia

• multidrug-resistant pathogens
• nosocomial pneumonia
• risk factors

• catecholamine inotropes
• catheter-related infection
• continuous renal replacement therapy
• dialysis catheter

• hypertension
• intracerebral hemorrhage
• neurosurgery
• pulmonary infection
• risk

• Adult
• Diabetes Mellitus/epidemiology
• Glasgow Coma Scale
• Humans
• Hypoalbuminemia/epidemiology
• Incidence
• Intracranial Hemorrhage, Hypertensive/surgery
• Logistic Models
• Middle Aged
• Postoperative Complications/epidemiology
• Respiration, Artificial/statistics & numerical data
• Respiratory Tract Infections/epidemiology
• Respiratory Tract Infections/microbiology
• Retrospective Studies
• Risk Factors

• JCYJ20190806150005453 Science and Technology Innovation Foundation of Shenzhen

Immunological dysfunction is common in critically ill patients but its clinical significance and the optimal method to measure it are unknown. The level of tumor necrosis factor alpha (TNF-α) after ex-vivo whole blood stimulation with lipopolysaccharide (LPS) has been proposed as a possible method to quantify immunological function. We hypothesized that in a cohort of critically ill patients, those with a lower post-stimulation TNF-α level would have increased rates of nosocomial infections (NIs) and worse clinical outcomes.

A secondary analysis of a phase 2 randomized, multi-centre, double-blinded placebo-controlled trial. As there was no difference between treatment and control arms in outcomes and NI rate, all the patients were analyzed as one cohort. On enrolment, day 4, 7, and weekly until day 28, whole blood was incubated with LPS ex-vivo and subsequent TNF-α level was measured. Patients were grouped in tertiles according to delta and peak TNF-α level. The primary outcome was the association between NIs and tertiles of TNF-α level post LPS stimulation; secondary outcomes included ICU and 90-day mortality, and ICU and hospital length of stay.

Data was available for 201 patients. Neither the post LPS stimulation delta TNF-α group nor the peak TNF-α post-stimulation group were associated with the development of NIs or clinical outcomes. Patients in the highest tertile for post LPS stimulation delta TNF-α compared to the lowest tertile were younger [61.1 years ± 15.7 vs. 68.6 years ± 12.8 standard deviations (SD) in the lowest tertile], had lower acuity of illness (APACHE II 25.0 ± 9.7 vs. 26.7 ± 6.1) and had lower baseline TNF-α (9.9 pg/mL ± 19.0 vs. 31.0 pg/mL ± 68.5). When grouped according to peak post-stimulation TNF-α levels, patients in the highest tertile had higher serum TNF-α at baseline (21.3 pg/mL ± 66.7 compared to 6.5 pg/mL ± 9.0 in the lowest tertile).

In this prospective multicenter study, ex-vivo stimulated TNF-α level was not associated with the occurrence of NIs or clinical outcomes. Further study is required to better ascertain whether TNF levels and ex-vivo stimulation can be used to characterize immune function in critical illness and if other assays might be better suited to this task.

• Immune dysfunction
• TNF- α
• critically ill
• nosocomial infections

• bacteremia
• hospital-acquired pneumonia
• mortality
• propensity score
• surgical site infection

• CAUTI
• Catheter
• NeuroICU
• Urinary tract infection

• Acinetobacter spp.
• Aseer Central Hospital
• Hydrogen peroxide–silver cations
• ICU
• Interventions

• HAI
• Healthcare quality
• JCI accreditation
• children hospital
• mortality committee
• mortality index.

• Cavoatrial junction
• Central venous catheters
• Extravascular catheters
• Intra-arterial catheters
• Left-sided venous catheters
• Malpositioned catheters
• Right-sided venous catheters

• Healthcare-associated infections
• Healthcare-associated meningitis and ventriculitis
• Infections in brain injury

• Brain Injuries/immunology
• Central Nervous System Infections/complications
• Central Nervous System Infections/diagnosis
• Central Nervous System Infections/therapy
• Cross Infection/complications
• Cross Infection/diagnosis
• Cross Infection/therapy
• Encephalitis/diagnosis
• Humans
• Infection Control
• Meningitis/diagnosis
• Neuroimmunomodulation

• Ventilator-associated pneumonia
• chlorhexidine
• healthcare-associated infection surveillance
• subglottic endotracheal tubes
• tracheostomy

• Video-assisted thoracoscopic surgery (VATS)
• lobectomy
• lung cancer
• postoperative care

• ALEA score
• HAI claims
• Healthcare-associated infections
• cost analysis
• litigation management
• patient safety
• quality of health care
• technical estimates.

• Cross Infection/economics
• Cross Infection/epidemiology
• Cross Infection/prevention & control
• Delivery of Health Care/standards
• Humans
• Incidence
• Infection Control/economics
• Infection Control/organization & administration
• Infection Control/standards
• Practice Guidelines as Topic/standards
• Quality Improvement
• Rome

The intensive care unit (ICU) admits critically ill patients requiring advanced airway, respiratory, cardiac and renal support. Despite the highly-specialized interventions, the mortality and morbidity is still high due to a number of reasons including nosocomial infections, which are the most likely complications in hospitalized patients with the rates being highest among ICU patients.

In this cross-sectional study of 111 adult patients admitted to 2 of the ICUs in Uganda, we set out to describe the commonest bacterial infections, their antimicrobial susceptibility patterns and factors associated with development of a nosocomial infection.

Klebsiella pneumoniae (30%), Acinetobacter species (22%) and Staphylococcus aureus (14%) were the most frequently isolated bacteria. The prevalence of multidrug resistant bacterial species was 58%; 50% Escherichia coli and 33.3% Klebsiella pneumoniae were extended spectrum beta lactamase or AmpC beta lactamase producers and 9.1% Acinetobacter species were extensive drug resistant. Imipenem was the antibiotic with the highest susceptibility rates across most bacterial species. Institution of ventilator support (P 0.003) and severe traumatic brain injury (P 0.035) were highly associated with the development of nosocomial infections.

Due to the high prevalence of multi drug resistant (MDR) and extensive drug resistant bacterial species, there is a need for development of strong policies on antibiotic stewardship, antimicrobial surveillance and infection control to help guide empirical antibiotic therapy and prevent the spread of MDR bacteria and antibiotic drug resistance.

The online version of this article (doi:10.1186/s13104-017-2695-5) contains supplementary material, which is available to authorized users.

• Drug resistance
• Intensive care unit
• Mechanical ventilation
• Nosocomial infections
• Traumatic brain injury

Introduction: The reported incidence of ventilator-associated pneumonia (VAP) in Wales is low compared with surveillance data from other European regions. It is unclear whether this reflects success of the Welsh healthcare-associated infection prevention measures or limitations in the application of European VAP surveillance methods. Our primary aim was to investigate episodes of ventilator-associated respiratory tract infection (VARTI), to identify episodes that met established criteria for VAP, and to explore reasons why others did not, according to the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) definitions.

Materials and Methods: During two 14-day study periods 2012–2014, investigators reviewed all invasively ventilated patients in all 14 Welsh Intensive Care Units (ICUs). Episodes were identified in which the clinical team had commenced antibiotic therapy because of suspected VARTI. Probability of pneumonia was estimated using a modified Clinical Pulmonary Infection Score (mCPIS). Episodes meeting HELICS definitions of VAP were identified, and reasons for other episodes not meeting definitions examined. In the second period, each patient was also assessed with regards to the development of a ventilator-associated event (VAE), according to recent US definitions.

Results: The study included 306 invasively ventilated patients; 282 were admitted to ICU for 48 h or more. 32 (11.3%) patients were commenced on antibiotics for suspected VARTI. Ten of these episodes met HELICS definitions of VAP, an incidence of 4.2 per 1000 intubation days. In 48% VARTI episodes, concurrent chest radiography was not performed, precluding the diagnosis of VAP. Mechanical ventilation (16.0 vs. 8.0 days; p = 0.01) and ICU stay (25.0 vs. 11.0 days; p = 0.01) were significantly longer in patients treated for VARTI compared to those not treated. There was no overlap between episodes of VARTI and of VAE.

Discussion: HELICS VAP surveillance definitions identified less than one-third of cases in which antibiotics were commenced for suspected ventilator-associated RTI. Lack of chest radiography precluded nearly 50% cases from meeting the surveillance definition of VAP, and as a consequence we are almost certainly underestimating the incidence of VAP in Wales.

• respiratory tract infection
• surveillance
• ventilator-associated complication
• ventilator-associated event
• ventilator-associated pneumonia
• ventilator-associated tracheobronchitis

AIM: To assess the rate of infection, appropriateness of antimicrobial-therapy and mortality on intensive care unit (ICU). Special focus was drawn on patients with liver cirrhosis.

METHODS: The study was approved by the local ethical committee. All patients admitted to the Internal Medicine-ICU between April 1, 2007 and December 31, 2009 were included. Data were extracted retrospectively from all patients using patient charts and electronic documentations on infection, microbiological laboratory reports, diagnosis and therapy. Due to the large hepatology department and liver transplantation center, special interest was on the subgroup of patients with liver cirrhosis. The primary statistical-endpoint was the evaluation of the influence of appropriate versus inappropriate antimicrobial-therapy on in-hospital-mortality.

RESULTS: Charts of 1979 patients were available. The overall infection-rate was 53%. Multiresistant-bacteria were present in 23% of patients with infection and were associated with increased mortality (P < 0.000001). Patients with infection had significantly increased in-hospital-mortality (34% vs 17%, P < 0.000001). Only 9% of patients with infection received inappropriate initial antimicrobial-therapy, no influence on mortality was observed. Independent risk-factors for in-hospital-mortality were the presence of septic-shock, prior chemotherapy for malignoma and infection with Pseudomonas spp. Infection and mortality-rate among 175 patients with liver-cirrhosis was significantly higher than in patients without liver-cirrhosis. Infection increased mortality 2.24-fold in patients with cirrhosis. Patients with liver cirrhosis were at an increased risk to receive inappropriate initial antimicrobial therapy.

CONCLUSION: The results of the present study report the successful implementation of early-goal-directed therapy. Liver cirrhosis patients are at increased risk of infection, mortality and to receive inappropriate therapy. Increasing burden are multiresistant-bacteria.

• Intensive care unit
• Sepsis-bundle
• Early goal-directed therapy
• Liver cirrhosis
• Mortality

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents/therapeutic use
• Bacterial Infections/diagnosis
• Bacterial Infections/drug therapy
• Bacterial Infections/microbiology
• Bacterial Infections/mortality
• Drug Resistance, Multiple, Bacterial
• Female
• Germany
• Guideline Adherence
• Hospital Mortality
• Humans
• Inappropriate Prescribing
• Intensive Care Units
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/mortality
• Liver Cirrhosis/therapy
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Patient Selection
• Practice Guidelines as Topic
• Practice Patterns, Physicians'
• Predictive Value of Tests
• Process Assessment, Health Care
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Young Adult

• HAP
• VAP
• antibiotic therapy
• hospital-acquired pneumonia
• mortality

• Adult
• Anti-Bacterial Agents/administration & dosage
• Critical Illness
• Cross Infection/drug therapy
• Drug Administration Schedule
• Humans
• Intensive Care Units
• Pneumonia/drug therapy
• Pneumonia/microbiology
• Pneumonia, Ventilator-Associated/drug therapy
• Pneumonia, Ventilator-Associated/microbiology
• Randomized Controlled Trials as Topic
• Time Factors

• BSI = bloodstream infection
• CDC = Centers for Disease Control and Prevention
• CLABSI = central line–associated BSI
• EVD = external ventricular drain
• IV = intravenous
• MIC = minimum inhibitory concentration
• NNICU = neurology-neurosurgical intensive care unit
• VAP = ventilator-associated pneumonia
• ac = antibiotic-coated
• antibiotics
• external ventricular drains
• infection
• ventriculitis

Infection is a common complication seen in ICU patients. Given the correlation between infection and mortality in these patients, a rapid etiological diagnosis and the determination of antimicrobial resistance markers are of paramount importance, especially in view of today's globally spread of multi drug resistance microorganisms. This paper reviews some of the rapid diagnostic techniques available for ICU patients with infections.

A narrative review of recent peer-reviewed literature (published between 1995 and 2014) was performed using as the search terms: Intensive care medicine, Microbiological techniques, Clinical laboratory techniques, Diagnosis, and Rapid diagnosis, with no language restrictions.

The most developed microbiology fields for a rapid diagnosis of infection in critically ill patients are those related to the diagnosis of bloodstream infection, pneumonia -both ventilator associated and non-ventilator associated-, urinary tract infection, skin and soft tissue infections, viral infections and tuberculosis.

New developments in the field of microbiology have served to shorten turnaround times and optimize the treatment of many types of infection. Although there are still some unresolved limitations of the use of molecular techniques for a rapid diagnosis of infection in the ICU patient, this approach holds much promise for the future.

•

Aberrant LM levels contribute to immune dysfunction in CI.

Sepsis, trauma, burns, and major surgical procedures activate common systemic inflammatory pathways. Nosocomial infection, organ failure, and mortality in this patient population are associated with a quantitatively different reprioritization of the circulating leukocyte transcriptome to the initial inflammatory insult, greater in both magnitude and duration, and secondary to multiple observed defects in innate and adaptive immune function. Dysregulation of inflammatory resolution processes and associated bioactive lipid mediators (LMs) mechanistically contribute to this phenotype. Recent data indicate the potential efficacy of therapeutic interventions that either reduce immunosuppressive prostaglandins (PGs) or increase specialized proresolving LMs. Here, we reassess the potential for pharmacological manipulation of these LMs as therapeutic approaches for the treatment of critical illness (CI).

• cyclooxygenase
• eicosanoids
• immunosuppression
• prostaglandins
• resolution of inflammation
• sepsis

• PGE2
• T-regulatory cell
• apoptosis
• critical illness
• efferocytosis
• lipid mediators
• macrophage
• myeloid-derived suppressor cell
• resolution of inflammation
• sepsis

• Antibiotic resistance
• Critically ill
• Inappropriate antibiotic
• Mortality
• Pneumonia

• Cost-Benefit Analysis/economics
• Cost-Benefit Analysis/methods
• Critical Care/economics
• Critical Care/methods
• Critical Illness/economics
• Critical Illness/therapy
• Cross Infection/economics
• Cross Infection/prevention & control
• Humans
• Infection Control/economics
• Infection Control/methods
• Intensive Care Units/economics
• Treatment Outcome