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Doudakmanis C, Makris D. Ventilator-Associated Pneumonia in Patients With Increased Intra-abdominal Pressure. Cureus 2025; 17:e81370. [PMID: 40291219 PMCID: PMC12034327 DOI: 10.7759/cureus.81370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2025] [Indexed: 04/30/2025] Open
Abstract
Increased intra-abdominal pressure (IAP) is a significant clinical concern, which has been proven to cause significant adverse events in patients. Respiratory infections are a high-yield problem in the intensive care unit (ICU). In this study, we reviewed available literature regarding the relationship between elevated IAP and the development of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Patients with prolonged mechanical ventilation are prone to develop VAP. Longer hospitalization, prior use of antibiotics, and comorbidities make these patients more susceptible to infections. Multidrug-resistant VAP poses a vast threat to critically ill patients, as it is characterized by a shift in the microbiological profile of the disease, as well as difficulties in its treatment options. Elevated IAP could adversely affect mechanically ventilated patients, as it is associated with an elevated risk of microaspirations and altered patency of the intestinal barrier, thus comprising an important factor for developing VAP. In addition, elevated IAP can deteriorate pulmonary function and hemodynamic condition of the patient, adding an extra risk for developing VAP. In such frail conditions, these patients have compromised immune function and are at risk of developing systematic infection, even resulting in the failure of multiple organs. As the microbiologic profile shifts toward multidrug-resistant bacteria, there is a need for comprehensive strategies in ICU settings to mitigate the risks associated with both elevated IAP and multidrug-resistant VAP. Timely intervention and proper management can prevent the risk of difficult-to-treat infections and life-threatening adverse events for patients.
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Affiliation(s)
- Christos Doudakmanis
- Department of Critical Care Medicine, University Hospital of Larissa, Larissa, GRC
- Second Propaedeutic Department of Surgery, Laiko General Hospital of Athens, Athens, GRC
| | - Demosthenes Makris
- Department of Critical Care Medicine, University Hospital of Larissa, Larissa, GRC
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Sheng H, Wang L, Fei Y, Zhu Z, Wang P. Application of double-sleeve endotracheal tube in infection control for icu patients: a randomized controlled trial. Head Face Med 2025; 21:12. [PMID: 40011996 PMCID: PMC11863518 DOI: 10.1186/s13005-025-00488-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Accepted: 02/06/2025] [Indexed: 02/28/2025] Open
Abstract
BACKGROUND Poor oral hygiene in patients with tracheal intubation will increase the occurrence of dental plaque and mucosal inflammation, resulting in oral barrier dysfunction. This study aimed to design and evaluate a novel double-lumen endotracheal tube (DETT) and explore its role in infection control, particularly its effects on the oral microenvironment and ventilator-associated pneumonia (VAP). METHODS This was a prospective, non-blinded, randomized parallel-controlled trial conducted from July 2024 to September 2024. A total of 115 patients who had been intubated for more than 3 days in a tertiary hospital ICU were enrolled and randomly assigned to either the DETT group (n = 58) or the conventional endotracheal tube (ETT) group (n = 57). Both groups received the same oral care protocols. The DETT group was intubated with the double-lumen endotracheal tube, which included a built-in bite block, while the ETT group used a standard endotracheal tube with a bite block. The primary outcome was the incidence of VAP, while secondary outcomes included oral bacterial colony counts, biofilm formation, BOAS oral health scores, and plaque index. RESULTS Compared to the ETT group, the DETT group showed a significant reduction in VAP incidence (χ²=4.382, p < 0.05). The DETT group also had significantly lower oral bacterial colony counts (Z=-7.362, P < 0.05) and biofilm formation (χ²=5.472, p < 0.05), as well as better BOAS scores (Z=-2.774, p < 0.05). However, there were no significant differences between the two groups in pathogenic bacterial presence or plaque index (p > 0.05). CONCLUSIONS The novel double-lumen endotracheal tube effectively reduces the total bacterial load in the oral cavity, inhibits biofilm formation, and lowers the incidence of VAP. It also improves oral function and hygiene, contributing to infection control, and holds significant clinical value.
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Affiliation(s)
- Han Sheng
- ICU, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Linyan Wang
- ICU, The Affiliated Hospital of Jiaxing University, Jiaxing, China.
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China.
| | - Yeping Fei
- ICU, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhihong Zhu
- ICU, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ping Wang
- ICU, The Affiliated Hospital of Jiaxing University, Jiaxing, China
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Meng H, Shi Y, Xue K, Liu D, Cao X, Wu Y, Fan Y, Gao F, Zhu M, Xiong L. Prediction model, risk factor score and ventilator-associated pneumonia: A two-stage case-control study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2025; 58:94-102. [PMID: 39578166 DOI: 10.1016/j.jmii.2024.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 09/21/2024] [Accepted: 11/12/2024] [Indexed: 11/24/2024]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is one of the most important hospital acquired infections in patients requiring mechanical ventilation (MV) in the intensive care unit, but the effective and robust predictable tools for VAP prevention were relatively lacked. METHODS This study aimed to establish a weighted risk scoring system to examine VAP risk among a two-stage VAP case-control study, and to evaluate the diagnostic performance of risk factor score (RFS) for VAP. We constructed a prediction model by least absolute shrinkage and selection operator (LASSO), random forest (RF), and extreme gradient boosting (XGBoost) models in 363 patients and 363 controls, and weighted RFS was calculated based on significant predictors. Finally, the diagnostic performance of the RFS was testified and further validated in another 177 pairs of VAP case-control study. RESULTS LASSO, RF and XGBoost consistently revealed significant associations of length of stay before MV, MV time, surgery, tracheotomy, multiple drug resistant organism infection, C-reactive protein, PaO2, and APACHE II score with VAP. RFS was significantly linearly associated with VAP risk [odds ratio and 95 % confidence interval = 2.699 (2.347, 3.135)], and showed good discriminations for VAP both in discovery stage [area under the curve (AUC) = 0.857] and validation stage (AUC = 0.879). CONCLUSIONS Results of this study revealed co-occurrence of multiple predictors for VAP risk. The risk factor scoring system proposed is a potentially useful predictive tool for clinical targets for VAP prevention.
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Affiliation(s)
- Hua Meng
- Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuxin Shi
- Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaming Xue
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Liu
- Interventional Diagnostic and Therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiongjing Cao
- Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanyan Wu
- Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunzhou Fan
- Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Gao
- Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Zhu
- Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lijuan Xiong
- Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Codru IR, Vintilă BI, Sava M, Bereanu AS, Neamțu SI, Bădilă RM, Bîrluțiu V. Optimizing Diagnosis and Management of Ventilator-Associated Pneumonia: A Systematic Evaluation of Biofilm Detection Methods and Bacterial Colonization on Endotracheal Tubes. Microorganisms 2024; 12:1966. [PMID: 39458275 PMCID: PMC11509713 DOI: 10.3390/microorganisms12101966] [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: 09/02/2024] [Revised: 09/25/2024] [Accepted: 09/26/2024] [Indexed: 10/28/2024] Open
Abstract
Healthcare-associated infections, such as ventilator-associated pneumonia and biofilm formation on intubation cannulas, impose significant burdens on hospitals, affecting staffing, finances, and patient wellbeing, while also increasing the risk of patient mortality. We propose a research study aimed at exploring various methodologies for detecting these infections, discovered in the biofilm on medical devices, particularly tracheal cannulas, and understanding the role of each method in comprehending these infections from an etiological perspective. Our investigation also involves an analysis of the types of endotracheal tubes utilized in each case, the bacteria species identified, and strategies for combating biofilm-associated infections. The potential impact of our research is the substantial improvement of patient care through enhanced diagnosis and management of these infections.
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Affiliation(s)
- Ioana Roxana Codru
- Faculty of Medicine, Lucian Blaga University of Sibiu,550169 Sibiu, Romania; (I.R.C.); (A.S.B.); (V.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (S.I.N.); (R.M.B.)
| | - Bogdan Ioan Vintilă
- Faculty of Medicine, Lucian Blaga University of Sibiu,550169 Sibiu, Romania; (I.R.C.); (A.S.B.); (V.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (S.I.N.); (R.M.B.)
| | - Mihai Sava
- Faculty of Medicine, Lucian Blaga University of Sibiu,550169 Sibiu, Romania; (I.R.C.); (A.S.B.); (V.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (S.I.N.); (R.M.B.)
| | - Alina Simona Bereanu
- Faculty of Medicine, Lucian Blaga University of Sibiu,550169 Sibiu, Romania; (I.R.C.); (A.S.B.); (V.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (S.I.N.); (R.M.B.)
| | - Sandra Ioana Neamțu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (S.I.N.); (R.M.B.)
| | - Raluca Maria Bădilă
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (S.I.N.); (R.M.B.)
| | - Victoria Bîrluțiu
- Faculty of Medicine, Lucian Blaga University of Sibiu,550169 Sibiu, Romania; (I.R.C.); (A.S.B.); (V.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (S.I.N.); (R.M.B.)
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Fois M, De Vito A, Cherchi F, Ricci E, Pontolillo M, Falasca K, Corti N, Comelli A, Bandera A, Molteni C, Piconi S, Colucci F, Maggi P, Boscia V, Fugooah A, Benedetti S, De Socio GV, Bonfanti P, Madeddu G. Efficacy and Safety of Ceftazidime-Avibactam Alone versus Ceftazidime-Avibactam Plus Fosfomycin for the Treatment of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia: A Multicentric Retrospective Study from the SUSANA Cohort. Antibiotics (Basel) 2024; 13:616. [PMID: 39061297 PMCID: PMC11273729 DOI: 10.3390/antibiotics13070616] [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: 05/17/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024] Open
Abstract
Hospital-acquired pneumonia (HAP) and ventilation-associated pneumonia (VAP) are challenging clinical conditions due to the challenging tissue penetrability of the lung. This study aims to evaluate the potential role of fosfomycin (FOS) associated with ceftazidime/avibactam (CZA) in improving the outcome in this setting. We performed a retrospective study including people with HAP or VAP treated with CZA or CZA+FOS for at least 72 h. Clinical data were collected from the SUSANA study, a multicentric cohort to monitor the efficacy and safety of the newer antimicrobial agents. A total of 75 nosocomial pneumonia episodes were included in the analysis. Of these, 34 received CZA alone and 41 in combination with FOS (CZA+FOS). People treated with CZA alone were older, more frequently male, received a prolonged infusion more frequently, and were less frequently affected by carbapenem-resistant infections (p = 0.01, p = 0.06, p < 0.001, p = 0.03, respectively). No difference was found in terms of survival at 28 days from treatment start between CZA and CZA+FOS at the multivariate analysis (HR = 0.32; 95% CI = 0.07-1.39; p = 0.128), while prolonged infusion showed a lower mortality rate at 28 days (HR = 0.34; 95% CI = 0.14-0.96; p = 0.04). Regarding safety, three adverse events (one acute kidney failure, one multiorgan failure, and one urticaria) were reported. Our study found no significant association between combination therapy and mortality. Further investigations, with larger and more homogeneous samples, are needed to evaluate the role of combination therapy in this setting.
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Affiliation(s)
- Marco Fois
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.F.); (F.C.)
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.F.); (F.C.)
| | - Francesca Cherchi
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.F.); (F.C.)
| | - Elena Ricci
- Fondazione ASIA Onlus, 20090 Buccinasco, Italy;
| | - Michela Pontolillo
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. D’Annunzio University, Chieti-Pescara, 66100 Chieti, Italy (K.F.)
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. D’Annunzio University, Chieti-Pescara, 66100 Chieti, Italy (K.F.)
| | - Nicolò Corti
- Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (N.C.); (P.B.)
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Agnese Comelli
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (A.B.)
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (A.B.)
| | - Chiara Molteni
- Unit of Infectious Diseases, “A. Manzoni” Hospital, 23900 Lecco, Italy; (C.M.); (S.P.)
| | - Stefania Piconi
- Unit of Infectious Diseases, “A. Manzoni” Hospital, 23900 Lecco, Italy; (C.M.); (S.P.)
| | - Francesca Colucci
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.C.); (P.M.)
| | - Paolo Maggi
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.C.); (P.M.)
| | - Vincenzo Boscia
- Unit of Infectious Diseases, Garibaldi Hospital, 95124 Catania, Italy; (V.B.)
| | - Aakash Fugooah
- Unit of Infectious Diseases, Garibaldi Hospital, 95124 Catania, Italy; (V.B.)
| | - Sara Benedetti
- Unit of Infectious Diseases, Santa Maria Hospital, 06129 Perugia, Italy; (S.B.); (G.V.D.S.)
| | | | - Paolo Bonfanti
- Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (N.C.); (P.B.)
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.F.); (F.C.)
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Fally M, Haseeb F, Kouta A, Hansel J, Robey RC, Williams T, Welte T, Felton T, Mathioudakis AG. Unravelling the complexity of ventilator-associated pneumonia: a systematic methodological literature review of diagnostic criteria and definitions used in clinical research. Crit Care 2024; 28:214. [PMID: 38956655 PMCID: PMC11221085 DOI: 10.1186/s13054-024-04991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/15/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a prevalent and grave hospital-acquired infection that affects mechanically ventilated patients. Diverse diagnostic criteria can significantly affect VAP research by complicating the identification and management of the condition, which may also impact clinical management. OBJECTIVES We conducted this review to assess the diagnostic criteria and the definitions of the term "ventilator-associated" used in randomised controlled trials (RCTs) of VAP management. SEARCH METHODS Based on the protocol (PROSPERO 2019 CRD42019147411), we conducted a systematic search on MEDLINE/PubMed and Cochrane CENTRAL for RCTs, published or registered between 2010 and 2024. SELECTION CRITERIA We included completed and ongoing RCTs that assessed pharmacological or non-pharmacological interventions in adults with VAP. DATA COLLECTION AND SYNTHESIS Data were collected using a tested extraction sheet, as endorsed by the Cochrane Collaboration. After cross-checking, data were summarised in a narrative and tabular form. RESULTS In total, 7,173 records were identified through the literature search. Following the exclusion of records that did not meet the eligibility criteria, 119 studies were included. Diagnostic criteria were provided in 51.2% of studies, and the term "ventilator-associated" was defined in 52.1% of studies. The most frequently included diagnostic criteria were pulmonary infiltrates (96.7%), fever (86.9%), hypothermia (49.1%), sputum (70.5%), and hypoxia (32.8%). The different criteria were used in 38 combinations across studies. The term "ventilator-associated" was defined in nine different ways. CONCLUSIONS When provided, diagnostic criteria and definitions of VAP in RCTs display notable variability. Continuous efforts to harmonise VAP diagnostic criteria in future clinical trials are crucial to improve quality of care, enable accurate epidemiological assessments, and guide effective antimicrobial stewardship.
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Affiliation(s)
- Markus Fally
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - Faiuna Haseeb
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Ahmed Kouta
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Jan Hansel
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West School of Intensive Care Medicine, Health Education England North West, Manchester, UK
| | - Rebecca C Robey
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Thomas Williams
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Timothy Felton
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alexander G Mathioudakis
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
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Abarca-Coloma L, Puga-Tejada M, Nuñez-Quezada T, Gómez-Cruz O, Mawyin-Muñoz C, Barungi S, Perán M. Risk Factors Associated with Mortality in Acinetobacter baumannii Infections: Results of a Prospective Cohort Study in a Tertiary Public Hospital in Guayaquil, Ecuador. Antibiotics (Basel) 2024; 13:213. [PMID: 38534648 DOI: 10.3390/antibiotics13030213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Antibiotic overuse and the resulting antimicrobial resistance pose significant global public health challenges, providing an avenue for opportunistic pathogens like Acinetobacter baumannii to thrive. This study will report the trends of Acinetobacter baumannii antimicrobial resistance patterns at the Hospital Teodoro Maldonado Carbo, Ecuador. An observational, analytical, longitudinal, and prospective study was conducted involving patients diagnosed with hospital-acquired infections. Antimicrobial susceptibility testing was performed, followed by molecular analysis of carbapenemase genes in Acinetobacter baumannii isolates. We included 180 patients aged from 16 to 93 years. The hospital mortality rate was 63/180 (35%). Invasive mechanical ventilation (IMV) was indicated in 91/180 patients (50.4%). The overall survival (OS) rate in patients on IMV was 49.5% (45/91), with a median survival of 65 days. The OS rate in patients not on IMV was 80.9% (72/89), with a median survival of 106 days (HR 2.094; 95% CI 1.174-3.737; p = 0.012). From multivariate analysis, we conclude that ventilator-associated pneumonia is the most related factor to OS.
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Affiliation(s)
- Luz Abarca-Coloma
- Critical Care Unit Hospital Teodoro Maldonado Carbo, Catholic University Santiago of Guayaquil, Guayaquil 090203, Ecuador
| | - Miguel Puga-Tejada
- Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil 090505, Ecuador
| | - Tamara Nuñez-Quezada
- Department of Medical Microbiology Hospital Teodoro Maldonado Carbo, Catholic University Santiago of Guayaquil, Guayaquil 090203, Ecuador
| | - Otilia Gómez-Cruz
- Infection Prevention and Control Program, Hospital Teodoro Maldonado Carbo, Guayaquil 090203, Ecuador
| | - Carlos Mawyin-Muñoz
- Critical Care Unit Hospital Teodoro Maldonado Carbo, Catholic University Santiago of Guayaquil, Guayaquil 090203, Ecuador
| | - Shivan Barungi
- Department of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - Macarena Perán
- Department of Health Sciences, University of Jaén, 23071 Jaén, Spain
- Excellence Research Unit "Modeling Nature" (MNat), University of Granada, 18010 Granada, Spain
- Biopathology and Regenerative Medicine Institute (IBIMER), University of Granada, 18010 Granada, Spain
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8
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Rangel K, De-Simone SG. Treatment and Management of Acinetobacter Pneumonia: Lessons Learned from Recent World Event. Infect Drug Resist 2024; 17:507-529. [PMID: 38348231 PMCID: PMC10860873 DOI: 10.2147/idr.s431525] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
Acinetobacter pneumonia is a significant healthcare-associated infection that poses a considerable challenge to clinicians due to its multidrug-resistant nature. Recent world events, such as the COVID-19 pandemic, have highlighted the need for effective treatment and management strategies for Acinetobacter pneumonia. In this review, we discuss lessons learned from recent world events, particularly the COVID-19 pandemic, in the context of the treatment and management of Acinetobacter pneumonia. We performed an extensive literature review to uncover studies and information pertinent to the topic. The COVID-19 pandemic underscored the importance of infection control measures in healthcare settings, including proper hand hygiene, isolation protocols, and personal protective equipment use, to prevent the spread of multidrug-resistant pathogens like Acinetobacter. Additionally, the pandemic highlighted the crucial role of antimicrobial stewardship programs in optimizing antibiotic use and curbing the emergence of resistance. Advances in diagnostic techniques, such as rapid molecular testing, have also proven valuable in identifying Acinetobacter infections promptly. Furthermore, due to the limited availability of antibiotics for treating infections caused A. baumannii, alternative strategies are needed like the use of antimicrobial peptides, bacteriophages and their enzymes, nanoparticles, photodynamic and chelate therapy. Recent world events, particularly the COVID-19 pandemic, have provided valuable insights into the treatment and management of Acinetobacter pneumonia. These lessons emphasize the significance of infection control, antimicrobial stewardship, and early diagnostics in combating this challenging infection.
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Affiliation(s)
- Karyne Rangel
- Center for Technological Development in Health (CDTS)/National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, 21040-900, Brazil
- Epidemiology and Molecular Systematics Laboratory (LEMS), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, 21040-900, Brazil
| | - Salvatore Giovanni De-Simone
- Center for Technological Development in Health (CDTS)/National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, 21040-900, Brazil
- Epidemiology and Molecular Systematics Laboratory (LEMS), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, 21040-900, Brazil
- Program of Post-Graduation on Science and Biotechnology, Department of Molecular and Cellular Biology, Biology Institute, Federal Fluminense University, Niterói, RJ, 22040-036, Brazil
- Program of Post-Graduation on Parasitic Biology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, 21040-900, Brazil
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Forsberg G, Taxbro K, Elander L, Hanberger H, Berg S, Idh J, Berkius J, Ekman A, Hammarskjöld F, Niward K, Balkhed ÅÖ. Risk factors for ventilator-associated lower respiratory tract infection in COVID-19, a retrospective multicenter cohort study in Sweden. Acta Anaesthesiol Scand 2024; 68:226-235. [PMID: 37751991 DOI: 10.1111/aas.14338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Ventilator-associated lower respiratory tract infections (VA-LRTI) increase morbidity and mortality in intensive care unit (ICU) patients. Higher incidences of VA-LRTI have been reported among COVID-19 patients requiring invasive mechanical ventilation (IMV). The primary objectives of this study were to describe clinical characteristics, incidence, and risk factors comparing patients who developed VA-LRTI to patients who did not, in a cohort of Swedish ICU patients with acute hypoxemic respiratory failure due to COVID-19. Secondary objectives were to decipher changes over the three initial pandemic waves, common microbiology and the effect of VA-LTRI on morbidity and mortality. METHODS We conducted a multicenter, retrospective cohort study of all patients admitted to 10 ICUs in southeast Sweden between March 1, 2020 and May 31, 2021 because of acute hypoxemic respiratory failure due to COVID-19 and were mechanically ventilated for at least 48 h. The primary outcome was culture verified VA-LRTI. Patient characteristics, ICU management, clinical course, treatments, microbiological findings, and mortality were registered. Logistic regression analysis was conducted to determine risk factors for first VA-LRTI. RESULTS Of a total of 536 included patients, 153 (28.5%) developed VA-LRTI. Incidence rate of first VA-LRTI was 20.8 per 1000 days of IMV. Comparing patients with VA-LRTI to those without, no differences in mortality, age, sex, or number of comorbidities were found. Patients with VA-LRTI had fewer ventilator-free days, longer ICU stay, were more frequently ventilated in prone position, received corticosteroids more often and were more frequently on antibiotics at intubation. Regression analysis revealed increased adjusted odds-ratio (aOR) for first VA-LRTI in patients treated with corticosteroids (aOR 2.64 [95% confidence interval [CI]] [1.31-5.74]), antibiotics at intubation (aOR 2.01 95% CI [1.14-3.66]), and days of IMV (aOR 1.05 per day of IMV, 95% CI [1.03-1.07]). Few multidrug-resistant pathogens were identified. Incidence of VA-LRTI increased from 14.5 per 1000 days of IMV during the first wave to 24.8 per 1000 days of IMV during the subsequent waves. CONCLUSION We report a high incidence of culture-verified VA-LRTI in a cohort of critically ill COVID-19 patients from the first three pandemic waves. VA-LRTI was associated with increased morbidity but not 30-, 60-, or 90-day mortality. Corticosteroid treatment, antibiotics at intubation and time on IMV were associated with increased aOR of first VA-LRTI.
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Affiliation(s)
- Gustaf Forsberg
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Knut Taxbro
- Department of Anaesthesiology and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Louise Elander
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Anaesthesiology and Intensive Care, Vrinnevi Hospital, Norrköping, Sweden
- Department of Anaesthesiology and Intensive Care, Centre for Clinical Research, Sörmland, Nyköping Hospital, Nyköping, Sweden
- Department of Anaesthesiology and Intensive care, Linköping University Hospital, Linköping, Sweden
| | - Håkan Hanberger
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Sören Berg
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jonna Idh
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Anaesthesiology and Intensive Care, Västervik Hospital, Västervik, Sweden
| | - Johan Berkius
- Department of Anaesthesiology and Intensive Care, Västervik Hospital, Västervik, Sweden
| | - Andreas Ekman
- Department of Anaesthesiology and Intensive Care, Kalmar Hospital, Kalmar, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesiology and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Katarina Niward
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Åse Östholm Balkhed
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
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10
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Noorizadeh M, Geetha M, Bensaali F, Meskin N, Sadasivuni KK, Zughaier SM, Elgamal M, Ait Hssain A. A Path towards Timely VAP Diagnosis: Proof-of-Concept Study on Pyocyanin Sensing with Cu-Mg Doped Graphene Oxide. BIOSENSORS 2024; 14:48. [PMID: 38248425 PMCID: PMC11154305 DOI: 10.3390/bios14010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024]
Abstract
In response to the urgent requirement for rapid, precise, and cost-effective detection in intensive care units (ICUs) for ventilated patients, as well as the need to overcome the limitations of traditional detection methods, researchers have turned their attention towards advancing novel technologies. Among these, biosensors have emerged as a reliable platform for achieving accurate and early diagnoses. In this study, we explore the possibility of using Pyocyanin analysis for early detection of pathogens in ventilator-associated pneumonia (VAP) and lower respiratory tract infections in ventilated patients. To achieve this, we developed an electrochemical sensor utilizing a graphene oxide-copper oxide-doped MgO (GO - Cu - Mgo) (GCM) catalyst for Pyocyanin detection. Pyocyanin is a virulence factor in the phenazine group that is produced by Pseudomonas aeruginosa strains, leading to infections such as pneumonia, urinary tract infections, and cystic fibrosis. We additionally investigated the use of DNA aptamers for detecting Pyocyanin as a biomarker of Pseudomonas aeruginosa, a common causative agent of VAP. The results of this study indicated that electrochemical detection of Pyocyanin using a GCM catalyst shows promising potential for various applications, including clinical diagnostics and drug discovery.
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Affiliation(s)
- Mohammad Noorizadeh
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar;
| | - Mithra Geetha
- Department of Mechanical and Industrial Engineering, Centre for Advanced Materials, Qatar University, Doha 2713, Qatar; (M.G.); (K.K.S.)
| | - Faycal Bensaali
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar;
| | - Nader Meskin
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar;
| | - Kishor K. Sadasivuni
- Department of Mechanical and Industrial Engineering, Centre for Advanced Materials, Qatar University, Doha 2713, Qatar; (M.G.); (K.K.S.)
| | - Susu M. Zughaier
- College of Medicine, QU Health, Qatar University, Doha 2713, Qatar; (S.M.Z.); (M.E.)
| | - Mahmoud Elgamal
- College of Medicine, QU Health, Qatar University, Doha 2713, Qatar; (S.M.Z.); (M.E.)
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hamad Medical Corporation, Doha 3050, Qatar;
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11
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Ho UC, Hsieh CJ, Lu HY, Huang APH, Kuo LT. Predictors of extubation failure and prolonged mechanical ventilation among patients with intracerebral hemorrhage after surgery. Respir Res 2024; 25:19. [PMID: 38178114 PMCID: PMC10765847 DOI: 10.1186/s12931-023-02638-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) is a condition associated with high mortality and morbidity. Survivors may require prolonged intubation with mechanical ventilation (MV). The aim of this study was to analyze the predictors of extubation failure and prolonged MV in patients who undergo surgical evacuation. METHODS This retrospective study was conducted on adult patients with ICH who underwent MV for at least 48 h and survived > 14 days after surgery. The demographics, clinical characteristics, laboratory tests, and Glasgow Coma Scale score were analyzed. RESULTS A total of 134 patients with ICH were included in the study. The average age of the patients was 60.34 ± 15.59 years, and 79.9% (n = 107) were extubated after satisfying the weaning parameters. Extubation failure occurred in 11.2% (n = 12) and prolonged MV in 48.5% (n = 65) patients. Multivariable regression analysis revealed that a white blood cell count > 10,000/mm3 at the time of extubation was an independent predictor of reintubation. Meanwhile, age and initial Glasgow Coma Scale scores were predictors of prolonged MV. CONCLUSIONS This study provided the first comprehensive characterization and analysis of the predictors of extubation failure and prolonged MV in patients with ICH after surgery. Knowledge of potential predictors is essential to improve the strategies for early initiation of adequate treatment and prognosis assessment in the early stages of the disease.
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Affiliation(s)
- Ue-Cheung Ho
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yunlin Branch No. 579, Sec. 2, Yunlin Rd, Yunlin, 640, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Chia-Jung Hsieh
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, 640, Taiwan
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei, 100, Taiwan
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yunlin Branch No. 579, Sec. 2, Yunlin Rd, Yunlin, 640, Taiwan.
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan.
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12
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Chen Q, Wang M, Han M, Xu L, Zhang H. Molecular basis of Klebsiella pneumoniae colonization in host. Microb Pathog 2023; 177:106026. [PMID: 36773942 DOI: 10.1016/j.micpath.2023.106026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/12/2023]
Abstract
Klebsiella pneumoniae (K. pneumoniae) is a common cause of nosocomial infection, which causing disseminated infections such as cystitis, pneumonia and sepsis. K. pneumoniae is intrinsic resistant to penicillin, and members of the population usually have acquired resistance to a variety of antibiotics, which makes it a major threat to clinical and public health. Bacteria can colonize on or within the hosts, accompanied by growth and reproduction of the organisms, but no clinical symptoms are presented. As the "first step" of bacterial infection, colonization in the hosts is of great importance. Colonization of bacteria can last from days to years, with resolution influenced by immune response to the organism, competition at the site from other organisms and, sometimes, use of antimicrobials. Colonized pathogenic bacteria cause healthcare-associated infections at times of reduced host immunity, which is an important cause of clinical occurrence of postoperative complications and increased mortality in ICU patients. Though, K. pneumoniae is one of the most common conditional pathogens of hospital-acquired infections, the mechanisms of K. pneumoniae colonization in humans are not completely clear. In this review, we made a brief summary of the molecular basis of K. pneumoniae colonization in the upper respiratory tract and intestinal niche, and provided new insights for understanding the pathogenesis of K. pneumoniae.
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Affiliation(s)
- Qi Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Wang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Mingxiao Han
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Leyi Xu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Haifang Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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13
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Hoellinger B, Deboscker S, Danion F, Lavigne T, Severac F, Ruch Y, Ursenbach A, Lefebvre N, Boyer P, Hansmann Y. Incidence and Time-to-Onset of Carbapenemase-Producing Enterobacterales (CPE) Infections in CPE Carriers: a Retrospective Cohort Study. Microbiol Spectr 2022; 10:e0186822. [PMID: 36321906 PMCID: PMC9769894 DOI: 10.1128/spectrum.01868-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022] Open
Abstract
This study aimed to assess the proportion of carbapenemase-producing Enterobacterales (CPE) infections among all infectious episodes in CPE carriers, compare the time-to-onset of CPE infections with that of other infections, assess the mortality of patients with CPE infections, and identify risk factors for CPE infections in CPE carriers. A retrospective cohort study was performed over a 10-year period in our University Hospital, and 274 CPE carriers were identified. All infectious episodes within the first 6 months following the diagnosis of CPE rectal carriage were considered. Risk factor analysis for CPE infections in CPE carriers was performed by univariate and multivariate analyses. This study revealed an incidence of 24.1% (66/274) of CPE infection within 6 months of CPE carriage diagnosis. The 28-day all-cause mortality due to CPE infections was 25.7%. CPE infections represented 52.6% (70/133) of all infectious episodes in CPE carriers in the first 6 months following CPE carriage detection, and these significantly occurred earlier than non-CPE infections, with a median time of 15 versus 51 days, respectively (P < 0.01). Based on the multivariate analysis, prior neurological disease was the only risk factor associated with CPE infections in CPE carriers. CPE infections have an early onset, accounting for a large proportion of infections in CPE carriers, and are associated with high mortality. IMPORTANCE Carbapenemase-producing Enterobacterales (CPE) infections are emerging infections and may represent a therapeutic challenge, while effective antibiotic therapy is likely to be delayed. We aimed to assess the proportion of CPE infections in CPE carriers and to identify risk factors of CPE infections among this population that could guide empirical antibiotic therapy. We showed that CPE infections are frequent in CPE carriers, have an early onset after CPE carriage diagnosis, and represent a significant proportion of all infectious episodes in CPE carriers. No significant risk factors for CPE infections could be identified. Overall, this study suggests that empirical antibiotic treatment covering CPE might be initiated in CPE carriers at least in the first month after its diagnosis and in severe infections due to the high frequency and early occurrence of CPE infections in these patients.
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Affiliation(s)
- B. Hoellinger
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S. Deboscker
- Service d’Hygiène Hospitalière, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - F. Danion
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - T. Lavigne
- Service d’Hygiène Hospitalière, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Service de Réanimation Médicale de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - F. Severac
- Groupe Méthodes en Recherche Clinique (GMRC), Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Y. Ruch
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - A. Ursenbach
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - N. Lefebvre
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - P. Boyer
- Department of Bacteriology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Y. Hansmann
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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KIŞLAK DEMİRCAN S, NAZİK S, GÜLER S, CİNGÖZ E. Ventilatör İlişkili Pnömonili Hastaların Retrospektif Olarak Değerlendirilmesi: Altı Yıllık Veri. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1172690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Amaç: Bu çalışmada yoğun bakım ünitesinde takip edilen ventilatör ilişkili pnömoni (VİP) olgularının demografik özelliklerinin, VİP etkenlerinin ve prognozunun değerlendirilmesi ve bu özelliklerin mortalite ile olan ilişkisinin ortaya konulması amaçlanmıştır.
Gereç ve Yöntem: Çalışma retrospektif ve tek merkezli olarak Ocak 2012-Aralık 2017 tarihleri arasında yapılmıştır. Hastanemizde VİP tanısı ile yatan ≥18 yaş hastalar ve 48 saatten uzun süre mekanik ventilasyon altında olan 533 hasta çalışmaya dahil edilmiştir. Veriler, hastane veri sistemi ve hasta dosyaları incelenerek değerlendirildi. Hastalara ait yaş, cinsiyet, yattığı klinik, kültür antibiyogram sonuçları, komorbidite durumu, hastanede kalış süresi ve hastanın son durumu (taburcu/eksitus) gibi veriler kaydedildi.
Bulgular: Çalışmaya dahil edilen olguların 337’si (%63.2) erkek, 196’sı (%36.8) kadın cinsiyette olup yaş ortalaması 63.8±20.4 yıldı. Hastaların %93.1’inde Gram negatif bakteri, %6.4’ünde Gram pozitif bakteri ve %0.6’sında mantar üremesi saptandı. En sık saptanan etkenler Acinetobacter baumannii (%42.2), Pseudomonas aeruginosa (%19.3), Klebsiella pneumoniae (%12.2) idi. VİP olgularının % 66.2’si mortalite ile sonuçlandı. Prognozu etkileyen risk faktörleri ve eşlik eden hastalıklardan; serebrovasküler hastalıklar, koroner arter hastalığı, malignite, bilinç kapalılığı, peptik ülser profilaksisi, hemodiyalize girme, immünsupresyon varlığı, kardiyopulmoner resusitasyon ve santral venöz kateter varlığının (sırasıyla OR:1.20, 0.38, 0.15, 0.96, 0.76, 0.25, 1.67, 0.19, 0.62) mortaliteyi arttırdığı saptanmıştır. Hastaların tanı anındaki C-reaktif protein (AUC:0.588 p=0,001), prokalsitonin (AUC:0.658 p
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15
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Serra Mitjà P, Centeno C, Garcia-Olivé I, Antuori A, Casadellà M, Tazi R, Armestar F, Fernández E, Andreo F, Rosell A. Bronchoscopy in Critically Ill COVID-19 Patients: Findings, Microbiological Profile, and Coinfection. J Bronchology Interv Pulmonol 2022; 29:186-190. [PMID: 35730778 DOI: 10.1097/lbr.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bronchoscopy is a widely use technique in critically ill patients. Nosocomial coinfections are a cause of morbidity and mortality in intensive care units. OBJECTIVES Our aim was to describe bronchoscopy findings and analyze microbiological profile and probably coinfection through bronchial aspirate (BA) samples in patients with coronavirus disease 2019 pneumonia requiring intensive care unit admission. METHODS Retrospective observational study analyzing the BA samples collected from intubated patients with coronavirus disease 2019 in a referral Hospital (Spain). RESULTS One hundred fifty-five consecutive BA samples were collected from 75 patients. Ninety (58%) were positive cultures for different microorganisms, 11 (7.1%) were polymicrobial, and 37 (23.7%) contained resistant microorganisms. There was a statistically significant association between increased days of orotracheal intubation and positive BA (18.9 vs. 10.9 d, P<0.01), polymicrobial infection (22.11 vs. 13.54, P<0.01) and isolation of resistant microorganisms (18.88 vs. 10.94, P<0.01). In 88% of the cases a new antibiotic or change in antibiotic treatment was made. CONCLUSION Bronchoscopy in critically ill patient was safe and could be useful to manage these patients and conduct the microbiological study, that seems to be higher and different than in nonepidemic periods. The longer the intubation period, the greater the probability of coinfection, isolation of resistant microorganisms and polymicrobial infection.
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Affiliation(s)
- Pere Serra Mitjà
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
| | - Carmen Centeno
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
| | - Ignasi Garcia-Olivé
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
| | | | | | - Rachid Tazi
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
| | - Fernando Armestar
- Servei de Medicina Intensiva
- Department of Medicine, Autonomous University of Barcelona, Barcelona
| | - Ester Fernández
- Thoracic Surgery Unit, Germans Trias i Pujol University Hospital
- Department of Medicine, Autonomous University of Barcelona, Barcelona
| | - Felipe Andreo
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- Department of Medicine, Autonomous University of Barcelona, Barcelona
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
| | - Antoni Rosell
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- Department of Medicine, Autonomous University of Barcelona, Barcelona
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
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Li HY, Wang HS, Wang YL, Wang J, Huo XC, Zhao Q. Management of Ventilator-Associated Pneumonia: Quality Assessment of Clinical Practice Guidelines and Variations in Recommendations on Drug Therapy for Prevention and Treatment. Front Pharmacol 2022; 13:903378. [PMID: 35668946 PMCID: PMC9163435 DOI: 10.3389/fphar.2022.903378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/29/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: To assess the quality of clinical practice guidelines (CPGs) related to drug therapy for prevention and control of ventilator-associated pneumonia (VAP) and compare the differences and similarities between recommendations. Methods: Electronic databases (including PubMed, Cochrane library, Embase, Web of Science), guideline development organizations, and professional societies were searched to identify CPGs for VAP from 20 January 2012 to 20 January 2022. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. The recommendations on drug therapy for prevention and treatment for each guideline were extracted, and then a descriptive synthesis was performed to analyze the scope/topic, and consistency of the recommendations. Results: Thirteen CPGs were included. The median score and interquartile range (IQR) in each domain are shown below: scope and purpose 72.22% (63.89%,83.33%); stakeholder involvement 44.44% (38.89%,52.78%); rigor of development 43.75% (31.25%,57.29%); clarity and presentation 94.44% (77.78%,94.44%); applicability 20.83 (8.34%,33.34%) and editorial independence 50% (33.33%,66.67%). We extracted 21 recommendations on drug therapy for prevention of VAP and 51 recommendations on drugs used for treatment. Some controversies remained among the included guidelines. Conclusion: There is considerable variability in the development processes and reporting of VAP guidelines. Despite many similarities, the recommendations still had some inconsistencies in the details. For the prevention and treatment of VAP, local microbial epidemiology and antibiotic sensitivity must be considered, and recommendations should be regularly revised as new evidence emerges.
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Affiliation(s)
- Hong-Yan Li
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Hai-Shan Wang
- Department of Intensive Care Unit, Yantai YEDA Hospital, Yantai, China
| | - Ying-Lin Wang
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Jing Wang
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Xue-Chen Huo
- Department of Hepatobiliary Surgery, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
- *Correspondence: Xue-Chen Huo, ; Quan Zhao,
| | - Quan Zhao
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
- *Correspondence: Xue-Chen Huo, ; Quan Zhao,
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17
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Xu Y, Han D, Xu F, Shen S, Zheng X, Wang H, Lyu J. Using Restricted Cubic Splines to Study the Duration of Antibiotic Use in the Prognosis of Ventilator-Associated Pneumonia. Front Pharmacol 2022; 13:898630. [PMID: 35571078 PMCID: PMC9099062 DOI: 10.3389/fphar.2022.898630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Ventilator-associated pneumonia (VAP) is the most widespread and life-threatening nosocomial infection in intensive care units (ICUs). The duration of antibiotic use is a good predictor of prognosis in patients with VAP, but the ideal duration of antibiotic therapy for VAP in critically ill patients has not been confirmed. Research is therefore needed into the optimal duration of antibiotic use and its impact on VAP. Methods: The Medical Information Mart for Intensive Care database included 1,609 patients with VAP. Chi-square or Student's t-tests were used to compare groups, and Cox regression analysis was used to investigate the factors influencing the prognoses of patients with VAP. Nonlinear tests were performed on antibiotic use lasting <7, 7-10, and >10 days. Significant factors were included in the model for sensitivity analysis. For the subgroup analyses, the body mass indexes (BMIs) of patients were separated into BMI <30 kg/m2 and BMI ≥30 kg/m2, with the criterion of statistical significance set at p < 0.05. Restricted cubic splines were used to analyze the relationship between antibiotic use duration and mortality risk in patients with VAP. Results: In patients with VAP, the effects of antibiotic use duration on the outcomes were nonlinear. Antibiotic use for 7-10 days in models 1-3 increased the risk of antibiotic use by 2.6020-, 2.1642-, and 2.3263-fold relative to for >10 days, respectively. The risks in models 1-3 for <7 days were 2.6510-, 1.9933-, and 2.5151-fold higher than those in models with >10 days of antibiotic use, respectively. These results were robust across the analyses. Conclusions: The duration of antibiotic treatment had a nonlinear effect on the prognosis of patients with VAP. Antibiotic use durations of <7 days and 7-10 days both presented risks, and the appropriate duration of antibiotic use can ensure the good prognosis of patients with VAP.
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Affiliation(s)
- Yixian Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Didi Han
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Fengshuo Xu
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Si Shen
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xinkai Zheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hao Wang
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
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18
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Zhao J, Li LQ, Zhen NX, Du LL, Shan H, Yu Y, Zhang ZC, Cui W, Tian BP. Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study. Front Microbiol 2021; 12:720051. [PMID: 34925251 PMCID: PMC8678279 DOI: 10.3389/fmicb.2021.720051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
Background: The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent. Purpose: To determine the microbiology and outcomes of SAP in the lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV). Methods: In this observational study, included patients were divided into SAP and non-SAP based on a comprehensive analysis of symptom, imaging, and laboratory results. Baseline characteristics, clinical characteristics, microbiology, and outcomes were recorded and evaluated. Results: Of 200 patients, 42.5% developed SAP after the onset of stroke, and they had a lower proportion of non-smokers (p = 0.002), lower GCS score (p < 0.001), higher serum CRP (p < 0.001) at ICU admission, and a higher proportion of males (p < 0.001) and hypertension (p = 0.039) than patients with non-SAP. Gram-negative aerobic bacilli were the predominant organisms isolated (78.8%), followed by Gram-positive aerobic cocci (29.4%). The main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogenes, Serratia marcescens, and Burkholderia cepacia. SAP prolonged length of MV (p < 0.001), duration of ICU stay (p < 0.001) and hospital stay (p = 0.027), shortened MV-free days by 28 (p < 0.001), and caused elevated vasopressor application (p = 0.001) and 60-day mortality (p = 0.001). Logistic regression analysis suggested that patients with coma (p < 0.001) have a higher risk of developing SAP. Conclusion: The microbiology of SAP is similar to early phase of HAP and VAP. SAP prolongs the duration of MV and length of ICU and hospital stays, but also markedly increases 60-day mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bao-ping Tian
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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19
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Ceccato A, Dominedò C, Ferrer M, Martin-Loeches I, Barbeta E, Gabarrús A, Cillóniz C, Ranzani OT, De Pascale G, Nogas S, Di Giannatale P, Antonelli M, Torres A. Prediction of ventilator-associated pneumonia outcomes according to the early microbiological response: a retrospective observational study. Eur Respir J 2021; 59:13993003.00620-2021. [PMID: 34475230 DOI: 10.1183/13993003.00620-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/12/2021] [Indexed: 11/05/2022]
Abstract
Ventilator-associated pneumonia is a leading infectious cause of morbidity in critically ill patients; yet current guidelines offer no indications for follow-up cultures.We aimed to evaluate the role of follow-up cultures and microbiological response 3 days after diagnosing ventilator-associated pneumonia as predictors of short- and long-term outcomes.We performed a retrospective analysis of a cohort prospectively collected from 2004 to 2017. Ventilator-associated pneumonia was diagnosed based on clinical, radiographic, and microbiological criteria. For microbiological identification, a tracheobronchial aspirate was performed at diagnosis and repeated after 72 h. We defined three groups when comparing the two tracheobronchial aspirate results: persistence, superinfection, and eradication of causative pathogens.One-hundred-fifty-seven patients were enrolled in the study, among whom microbiological persistence, superinfection, and eradication was present in 67 (48%), 25 (16%), and 65 (41%), respectively, after 72hs. Those with superinfection had the highest mortalities in the intensive care unit (p=0.015) and at 90 days (p=0.036), while also having the fewest ventilation-free days (p=0.024). Multivariable analysis revealed shock at VAP diagnosis (odds ratios [OR] 3.43; 95% confidence interval [CI] 1.25 to 9.40), Staphylococcus aureus isolation at VAP diagnosis (OR 2.87; 95%CI 1.06 to 7.75), and hypothermia at VAP diagnosis (OR 0.67; 95%CI 0.48 to 0.95, per +1°C) to be associated with superinfection.Our retrospective analysis suggests that ventilator-associated pneumonia short-term and long-term outcomes may be associated with superinfection in follow-up cultures. Follow-up cultures may help guiding antibiotic therapy and its duration. Further prospective studies are necessary to verify our findings.
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Affiliation(s)
- Adrian Ceccato
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain.,Intensive Care Unit, Hospital Universitari Sagrat Cor, Barcelona, Spain.,Equal Contribution
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.,Equal Contribution
| | - Miquel Ferrer
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain.,Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ignacio Martin-Loeches
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain.,Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Enric Barbeta
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain.,Intensive Care Unit, Hospital Universitari Sagrat Cor, Barcelona, Spain.,Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Albert Gabarrús
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain.,Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Catia Cillóniz
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain.,Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Otavio T Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain.,Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gennaro De Pascale
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Nogas
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Pierluigi Di Giannatale
- University of Chieti-Pescara 'Gabriele D'Annunzio', Hospital of Chieti 'SS. Annunziata', Chieti, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antoni Torres
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain .,Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
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20
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Aretha D, Kiekkas P. Obesity and the Incidence of Ventilator-Associated Pneumonia in Critically Ill Patients With Shock: The Paradox Persists. Chest 2021; 159:2135-2136. [PMID: 34099118 DOI: 10.1016/j.chest.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Diamanto Aretha
- Anesthesiology and Intensive Care Medicine, University General Hospital of Patras, Patras, Greece.
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21
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Caméléna F, Poncin T, Dudoignon E, Salmona M, Le Goff J, Donay JL, Lafaurie M, Darmon M, Azoulay E, Plaud B, Mebazaa A, Dépret F, Jacquier H, Berçot B. Rapid identification of bacteria from respiratory samples of patients hospitalized in intensive care units, with FilmArray Pneumonia Panel Plus. Int J Infect Dis 2021; 108:568-573. [PMID: 34087488 DOI: 10.1016/j.ijid.2021.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the performance of FilmArray Pneumonia Panel Plus (FA-PP) for the detection of typical bacterial pathogens in respiratory samples from patients hospitalized in intensive care units (ICUs). METHODS FA-PP was implemented for clinical use in the microbiology laboratory in March 2020. A retrospective analysis on a consecutive cohort of adult patients hospitalized in ICUs between March 2020 and May 2020 was undertaken. The respiratory samples included sputum, blind bronchoalveolar lavage (BBAL) and protected specimen brush (PSB). Conventional culture and FA-PP were performed in parallel. RESULTS In total, 147 samples from 92 patients were analysed; 88% had coronavirus disease 2019 (COVID-19). At least one pathogen was detected in 46% (68/147) of samples by FA-PP and 39% (57/147) of samples by culture. The overall percentage agreement between FA-PP and culture results was 98% (93-100%). Bacteria with semi-quantitative FA-PP results ≥105 copies/mL for PSB samples, ≥106 copies/mL for BBAL samples and ≥107 copies/mL for sputum samples reached clinically significant thresholds for growth in 90%, 100% and 91% of cultures, respectively. FA-PP detected resistance markers, including mecA/C, blaCTX-M and blaVIM. The median turnaround time was significantly shorter for FA-PP than for culture. CONCLUSIONS FA-PP may constitute a faster approach to the diagnosis of bacterial pneumonia in patients hospitalized in ICUs.
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Affiliation(s)
- François Caméléna
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Thibaut Poncin
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Emmanuel Dudoignon
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - Maud Salmona
- University of Paris, Inserm U976, Insight team, F-75010, Paris France; Department of Virology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérôme Le Goff
- University of Paris, Inserm U976, Insight team, F-75010, Paris France; Department of Virology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Luc Donay
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Disease, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1153, Centre of Epidemiology and Biostatistics, ECSTRA Team, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1153, Centre of Epidemiology and Biostatistics, ECSTRA Team, Paris, France
| | - Benoît Plaud
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - François Dépret
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - Hervé Jacquier
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Béatrice Berçot
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France.
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22
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Nseir S, Martin-Loeches I, Povoa P, Metzelard M, Du Cheyron D, Lambiotte F, Tamion F, Labruyere M, Makris D, Boulle Geronimi C, Pinetonde Chambrun M, Nyunga M, Pouly O, Mégarbane B, Saade A, Gomà G, Magira E, Llitjos JF, Torres A, Ioannidou I, Pierre A, Coelho L, Reignier J, Garot D, Kreitmann L, Baudel JL, Voiriot G, Contou D, Beurton A, Asfar P, Boyer A, Thille AW, Mekontso-Dessap A, Tsolaki V, Vinsonneau C, Floch PE, Le Guennec L, Ceccato A, Artigas A, Bouchereau M, Labreuche J, Duhamel A, Rouzé A. Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:177. [PMID: 34034777 PMCID: PMC8146175 DOI: 10.1186/s13054-021-03588-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022]
Abstract
Background Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. Methods Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox’s regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event.
Findings Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 group (adjusted HR 1.65 (95% CI 1.11–2.46), p = 0.013), but not in influenza (1.74 (0.99–3.06), p = 0.052), or no viral infection groups (1.13 (0.68–1.86), p = 0.63). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. Interpretation VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality.
Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03588-4.
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Affiliation(s)
- Saad Nseir
- Médecine Intensive-Réanimation, CHU de Lille, F-59000, Lille, France. .,Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Univ. Lille, Lille, France.
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, St. James Street, Dublin 8, Dublin, Eire, Ireland.,Hospital Clinic, IDIBAPS, Universided de Barcelona, CIBERes, Barcelona, Spain
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, and NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | | | - Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France
| | - Fabien Lambiotte
- Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Fabienne Tamion
- Medical Intensive Care Unit, Rouen University Hospital, Normandie Université, UNIROUEN, Inserm U1096, FHU-REMOD-VHF, 76000, Rouen, France
| | - Marie Labruyere
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Demosthenes Makris
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly, 41110, Biopolis Larissa, Greece
| | - Claire Boulle Geronimi
- Service de Réanimation Et de Soins Intensifs, Centre Hospitalier de Douai, Route de Cambrai, Douai, France
| | - Marc Pinetonde Chambrun
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | | | - Olivier Pouly
- Médecine Intensive Réanimation, Hôpital Saint Philibert GHICL, Université Catholique, Lille, France
| | - Bruno Mégarbane
- Réanimation Médicale Et Toxicologique, Hôpital Lariboisière, Université de Paris, INSERM UMRS-1144, Paris, France
| | - Anastasia Saade
- Service de Médecine Intensive Et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Gemma Gomà
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Eleni Magira
- 1St Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos Hospital, Athens, Greece
| | - Jean-François Llitjos
- Medical Intensive Care Unit, Cochin Hospital, AP-HP. Centre, Université de Paris, Paris, France
| | - Antoni Torres
- Department of Pulmonology, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERES, ICREA, Barcelona, Spain
| | - Iliana Ioannidou
- 1St Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, "Sotiria" Chest Hospital, Athens, Greece
| | | | - Luis Coelho
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, and NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France
| | - Denis Garot
- Service de Médecine Intensive Réanimation, CHU de Tours, Hôpital Bretonneau, 2 Bd Tonnellé, 37000, Tours, France
| | - Louis Kreitmann
- Service de Médecine Intensive - Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5, place d'Arsonval, 69437, Lyon Cedex 03, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Guillaume Voiriot
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Damien Contou
- Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France
| | - Alexandra Beurton
- Service de Pneumologie, Médecine Intensive - Réanimation (Département "R3S"), AP-HP, Sorbonne Université, Groupe Hospitalier Universitaire Pitié-Salpêtrière Charles Foix, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France
| | - Pierre Asfar
- Département de Médecine Intensive-Réanimation, CHU D'Angers, Université D'Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Alexandre Boyer
- Intensive Care Unit, Pellegrin-Tripode Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Arnaud W Thille
- CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Armand Mekontso-Dessap
- APHP, CHU Henri Mondor, Service de Médecine Intensive RéanimationUniversité Paris Est-Créteil, Faculté de Santé, Groupe de Recherche Clinique CARMASINSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
| | - Vassiliki Tsolaki
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly, 41110, Biopolis Larissa, Greece
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Réseau de Recherche Boréal, 62408, Béthune, France
| | - Pierre-Edouard Floch
- Service de Réanimation, Hôpital Duchenne, Rue Monod, 62200, Boulogne-sur-Mer, France
| | - Loïc Le Guennec
- Sorbonne Université, AP-HP, Hôpital de La Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Paris, France
| | - Adrian Ceccato
- Intensive Care Unit, Hospital Universitari Sagrat Cor, and Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028)-Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Artigas
- Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Parc Tauli 1, 08028, Sabadell, Spain
| | | | - Julien Labreuche
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Anahita Rouzé
- Médecine Intensive-Réanimation, CHU de Lille, F-59000, Lille, France.,Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Univ. Lille, Lille, France
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23
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Mojtahedzadeh M, Mashhadi Akbar Boojar M, Habtemariam S, Nabavi SM, Najafi A, Ghahremanian A, Baktash M, Aghaabdollahian S, Sureda A, Bagheri M. Systematic review: Effectiveness of herbal oral care products on ventilator-associated pneumonia. Phytother Res 2021; 35:3665-3672. [PMID: 33891776 DOI: 10.1002/ptr.7060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022]
Abstract
Ventilator-associated pneumonia (VAP) resulting from bacterial infection is a prevalent medical problem in intensive care units (ICUs). The purpose of this study was to systematically review available studies on oral products employed to control and reduce VAP in patients undergoing tracheal intubation. This study was based on a systematic review of clinical trial data from science databases such as PubMed, Cochrane, Scopus, and Web of science. Articles were reviewed and selected according to defined criteria and assessed by the primary evaluation checklist. After a critical review of 3,143 search hits, only 18 relevant articles were finally selected for discussion. Our assessment revealed that chlorhexidine and some other oral herbal medications are beneficial in preventing VAP. Chlorhexidine oral dosage forms provide a remarkable role in oral health and prevention of VAP by decreasing the microbial flora in the mouth. Because of similar benefits and comparable effects, some herbal medicines can be suggested as a practical alternative to chlorhexidine.
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Affiliation(s)
- Mojtaba Mojtahedzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Mashhadi Akbar Boojar
- Nanobiotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Solomon Habtemariam
- Pharmacognosy Research Laboratories and Herbal Analysis Services, The University of Greenwich, London, UK
| | | | - Atabak Najafi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhosein Ghahremanian
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Poisoning Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Baktash
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Poisoning Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Safieh Aghaabdollahian
- Department of Nanobiotechnology, New Technologies Research Group, Pasteur Institute of Iran, Tehran, Iran
| | - Antoni Sureda
- Research Group on Community Nutrition and Oxidative Stress, Department of Fundamental Biology and Health Sciences, University of Balearic Islands, Palma, Spain
| | - Mahdi Bagheri
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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24
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Wicky PH, Niedermann MS, Timsit JF. Ventilator-associated pneumonia in the era of COVID-19 pandemic: How common and what is the impact? Crit Care 2021; 25:153. [PMID: 33882991 PMCID: PMC8059113 DOI: 10.1186/s13054-021-03571-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 12/20/2022] Open
Abstract
We reviewed similarities and differences of ventilator associated pneumonia in Sars-Cov2 infection and with other ARDS. The differences in epidemiology and outcome will be detailed. Possible explanations of differences in pathophysiology of VAP in Sarscov2 infections will be cited and discussed.
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Affiliation(s)
- Paul-Henri Wicky
- Medical and Infectious Diseases ICU (MI2), AP-HP, Bichat Hospital, 75018, Paris, France
| | - Michael S Niedermann
- Department of Medicine, Weill Cornell Medicine, New York, USA
- Pulmonary and Critical Care Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, USA
| | - Jean-François Timsit
- Medical and Infectious Diseases ICU (MI2), AP-HP, Bichat Hospital, 75018, Paris, France.
- IAME, INSERM, University of Paris, 75018, Paris, France.
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25
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Early prediction of extubation failure in patients with severe pneumonia: a retrospective cohort study. Biosci Rep 2021; 40:221958. [PMID: 31990295 PMCID: PMC7007404 DOI: 10.1042/bsr20192435] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/03/2020] [Accepted: 01/28/2020] [Indexed: 02/05/2023] Open
Abstract
Backgroud: Severe pneumonia is one of the most common causes for mechanical ventilation. We aimed to early identify severe pneumonia patients with high risk of extubation failure in order to improve prognosis. Methods: From April 2014 to December 2015, medical records of intubated patients with severe pneumonia in intensive care unit were retrieved from database. Patients were divided into extubation success and failure groups, and multivariate logistic regressions were performed to identify independent predictors for extubation failure. Results: A total of 125 eligible patients were included, of which 82 and 43 patients had extubation success and failure, respectively. APACHE II score (odds ratio (OR) 1.141, 95% confident interval (CI) 1.022–1.273, P = 0.019, cutoff at 17.5), blood glucose (OR 1.122, 95%CI 1.008–1.249, P = 0.035, cutoff at 9.87 mmol/l), dose of fentanyl (OR 3.010, 95%CI 1.100–8.237, P = 0.032, cutoff at 1.135 mg/d), and the need for red blood cell (RBC) transfusion (OR 2.774, 95%CI 1.062–7.252, P = 0.037) were independent risk factors for extubation failure. Conclusion: In patients with severe pneumonia, APACHE II score > 17.5, blood glucose > 9.87 mmol/l, fentanyl usage > 1.135 mg/d, and the need for RBC transfusion might be associated with higher risk of extubation failure.
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26
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Koulenti D, Armaganidis A, Arvaniti K, Blot S, Brun-Buisson C, Deja M, De Waele J, Du B, Dulhunty JM, Garcia-Diaz J, Judd M, Paterson DL, Putensen C, Reina R, Rello J, Restrepo MI, Roberts JA, Sjovall F, Timsit JF, Tsiodras S, Zahar JR, Zhang Y, Lipman J. Protocol for an international, multicentre, prospective, observational study of nosocomial pneumonia in intensive care units: the PneumoINSPIRE study. CRIT CARE RESUSC 2021; 23:59-66. [PMID: 38046390 PMCID: PMC10692553 DOI: 10.51893/2021.1.oa5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Nosocomial pneumonia in the critical care setting is associated with increased morbidity, significant crude mortality rates and high health care costs. Ventilator-associated pneumonia represents about 80% of nosocomial pneumonia cases in intensive care units (ICUs). Wide variance in incidence of nosocomial pneumonia and diagnostic techniques used has been reported, while successful treatment remains complex and a matter of debate. Objective: To describe the epidemiology, diagnostic strategies and treatment modalities for nosocomial pneumonia in contemporary ICU settings across multiple countries around the world. Design, setting and patients: PneumoINSPIRE is a large, multinational, prospective cohort study of adult ICU patients diagnosed with nosocomial pneumonia. Participating ICUs from at least 20 countries will collect data on 10 or more consecutive ICU patients with nosocomial pneumonia. Site-specific information, including hospital policies on antibiotic therapy, will be recorded along with patient-specific data. Variables that will be explored include: aetiology and antimicrobial resistance patterns, treatment-related parameters (including time to initiation of antibiotic therapy, and empirical antibiotic choice, dose and escalation or de-escalation), pneumonia resolution, ICU and hospital mortality, and risk factors for unfavourable outcomes. The concordance of ventilator-associated pneumonia diagnosis with accepted definitions will also be assessed. Results and conclusions: PneumoINSPIRE will provide valuable information on current diagnostic and management practices relating to ICU nosocomial pneumonia, and identify research priorities in the field. Trial registration:ClinicalTrials.gov identifier NCT02793141.
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Affiliation(s)
- Despoina Koulenti
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Second Critical Care Department, Attikon University Hospital, Medical School, University of Athens, Athens, Greece
| | - Apostolos Armaganidis
- Second Critical Care Department, Attikon University Hospital, Medical School, University of Athens, Athens, Greece
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Stijn Blot
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Christian Brun-Buisson
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Mixed Research Unit (French Institute for Medical Research [INSERM], Université de Versailles Saint Quentin Medical School and Institut Pasteur), Paris-Saclay University, Montigny-Le-Bretonneux, France
| | - Maria Deja
- Lumbeck Klinik für Anästhesiologie und Intensivmedizin, Sektion Interdisziplinäre Operative Intensivmedizin, Universitatsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Lübeck, Germany
| | - Jan De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Bin Du
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | - Joel M. Dulhunty
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Research and Medical Education, Redcliffe Hospital, Brisbane, QLD, Australia
| | - Julia Garcia-Diaz
- Infectious Diseases Department, Ochsner Clinic Foundation, New Orleans, LA, USA
- Ochsner Clinical School, The University of Queensland, New Orleans, LA, USA
| | - Matthew Judd
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - David L. Paterson
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital,Brisbane, QLD, Australia
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Rosa Reina
- Critical Care Department, Hospital San Martin de la Plata, Buenos Aires, Argentina
| | - Jordi Rello
- Clinical Research/Innovation in Pneumonia and Sepsis Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Efermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Clinical Research Department, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Marcos I. Restrepo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- Pulmonary and Critical Care Fellowship Program, University of Texas Health Science Center, San Antonio, TX, USA
- Medical Intensive Care Unit, South Texas Veterans Health Care System, Audie L Murphy Division, San Antonio, TX, USA
- INnovation Science in Pulmonary Infections REsearch Network, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jason A. Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Fredrik Sjovall
- Department of Intensive Care and Perioperative Medicine, Skane University Hospital, Malmö, Sweden
| | - Jean-Francois Timsit
- Infection, Antimicrobials, Modelling, Evolution Research Centre, French Institute for Medical Research (INSERM), Université de Paris, Paris, France
- Medical and Infectious Diseases Intensive Care Unit (MI2), Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Jean-Ralph Zahar
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, Assistance Publique — Hôpitaux de Paris, Bobigny, France
- Infection, Antimicrobials, Modelling, Evolution Research Centre, Unité Mixte de Recherche 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - Yuchi Zhang
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jeffrey Lipman
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Anesthesiology and Critical Care Department, Centre Hospitalier Universitaire de Nîmes, University of Montpellier, Nîmes, France
| | - On behalf of the Working Group on Pneumonia of the European Society of Intensive Care Medicine
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Second Critical Care Department, Attikon University Hospital, Medical School, University of Athens, Athens, Greece
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
- Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Mixed Research Unit (French Institute for Medical Research [INSERM], Université de Versailles Saint Quentin Medical School and Institut Pasteur), Paris-Saclay University, Montigny-Le-Bretonneux, France
- Lumbeck Klinik für Anästhesiologie und Intensivmedizin, Sektion Interdisziplinäre Operative Intensivmedizin, Universitatsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Lübeck, Germany
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Research and Medical Education, Redcliffe Hospital, Brisbane, QLD, Australia
- Infectious Diseases Department, Ochsner Clinic Foundation, New Orleans, LA, USA
- Ochsner Clinical School, The University of Queensland, New Orleans, LA, USA
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital,Brisbane, QLD, Australia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Critical Care Department, Hospital San Martin de la Plata, Buenos Aires, Argentina
- Clinical Research/Innovation in Pneumonia and Sepsis Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Efermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Clinical Research Department, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- Pulmonary and Critical Care Fellowship Program, University of Texas Health Science Center, San Antonio, TX, USA
- Medical Intensive Care Unit, South Texas Veterans Health Care System, Audie L Murphy Division, San Antonio, TX, USA
- INnovation Science in Pulmonary Infections REsearch Network, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Department of Intensive Care and Perioperative Medicine, Skane University Hospital, Malmö, Sweden
- Infection, Antimicrobials, Modelling, Evolution Research Centre, French Institute for Medical Research (INSERM), Université de Paris, Paris, France
- Medical and Infectious Diseases Intensive Care Unit (MI2), Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, Assistance Publique — Hôpitaux de Paris, Bobigny, France
- Infection, Antimicrobials, Modelling, Evolution Research Centre, Unité Mixte de Recherche 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Anesthesiology and Critical Care Department, Centre Hospitalier Universitaire de Nîmes, University of Montpellier, Nîmes, France
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27
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Schmalstig AA, Freidy S, Hanafin PO, Braunstein M, Rao GG. Reapproaching Old Treatments: Considerations for PK/PD Studies on Phage Therapy for Bacterial Respiratory Infections. Clin Pharmacol Ther 2021; 109:1443-1456. [PMID: 33615463 DOI: 10.1002/cpt.2214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
Antibiotic resistant bacterial respiratory infections are a significant global health burden, and new therapeutic strategies are needed to control the problem. For bacterial respiratory infections, this need is emphasized by the rise in antibiotic resistance and a lean drug development pipeline. Bacteriophage (phage) therapy is a promising alternative to antibiotics. Phage are viruses that infect and kill bacteria. Because phage and antibiotics differ in their bactericidal mechanisms, phage are a treatment option for antibiotic-resistant bacteria. Here, we review the history of phage therapy and highlight recent preclinical and clinical case reports of its use for treating antibiotic-resistant respiratory infections. The ability of phage to replicate while killing the bacteria is both a benefit for treatment and a challenge for pharmacokinetic (PK) and pharmacodynamic (PD) studies. In this review, we will discuss how the phage lifecycle and associated bidirectional interactions between phage and bacteria can impact treatment. We will also highlight PK/PD considerations for designing studies of phage therapy to optimize the efficacy and feasibility of the approach.
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Affiliation(s)
- Alan A Schmalstig
- Department of Microbiology and Immunology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Soha Freidy
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Patrick O Hanafin
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Miriam Braunstein
- Department of Microbiology and Immunology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gauri G Rao
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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28
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Nseir S, Le Gouge A, Pouly O, Lascarrou JB, Lacherade JC, Mira JP, Mercier E, Declercq PL, Sirodot M, Piton G, Tinturier F, Coupez E, Gaudry S, Djibré M, Thevenin D, Balduyck M, Reignier J. Relationship Between Obesity and Ventilator-Associated Pneumonia: A Post Hoc Analysis of the NUTRIREA2 Trial. Chest 2021; 159:2309-2317. [PMID: 33561455 DOI: 10.1016/j.chest.2021.01.081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/05/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with obesity are at higher risk for community-acquired and nosocomial infections. However, no study has specifically evaluated the relationship between obesity and ventilator-associated pneumonia (VAP). RESEARCH QUESTION Is obesity associated with an increased incidence of VAP? STUDY DESIGN AND METHODS This study was a post hoc analysis of the Impact of Early Enteral vs Parenteral Nutrition on Mortality in Patients Requiring Mechanical Ventilation and Catecholamines (NUTRIREA2) open-label, randomized controlled trial performed in 44 French ICUs. Adults receiving invasive mechanical ventilation and vasopressor support for shock and parenteral nutrition or enteral nutrition were included. Obesity was defined as BMI ≥ 30 kg/m2 at ICU admission. VAP diagnosis was adjudicated by an independent blinded committee, based on all available clinical, radiologic, and microbiologic data. Only first VAP episodes were taken into account. Incidence of VAP was analyzed by using the Fine and Gray model, with extubation and death as competing risks. RESULTS A total of 699 (30%) of the 2,325 included patients had obesity; 224 first VAP episodes were diagnosed (60 and 164 in obese and nonobese groups, respectively). The incidence of VAP at day 28 was 8.6% vs 10.1% in the two groups (hazard ratio, 0.85; 95% CI 0.63-1.14; P = .26). After adjustment on sex, McCabe score, age, antiulcer treatment, and Sequential Organ Failure Assessment at randomization, the incidence of VAP remained nonsignificant between obese and nonobese patients (hazard ratio, 0.893; 95% CI, 0.66-1.2; P = .46). Although no significant difference was found in duration of mechanical ventilation and ICU length of stay, 90-day mortality was significantly lower in obese than in nonobese patients (272 of 692 [39.3%] patients vs 718 of 1,605 [44.7%]; P = .02). In a subgroup of patients (n = 123) with available pepsin and alpha-amylase measurements, no significant difference was found in rate of abundant microaspiration of gastric contents, or oropharyngeal secretions between obese and nonobese patients. INTERPRETATION Our results suggest that obesity has no significant impact on the incidence of VAP.
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Affiliation(s)
- Saad Nseir
- Médecine Intensive-Réanimation, CHU Lille, Lille, France; Inserm U1285, Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France.
| | | | - Olivier Pouly
- Médecine Intensive-Réanimation, CHU Lille, Lille, France
| | - Jean-Baptiste Lascarrou
- Medecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Université de Nantes, Nantes, France
| | - Jean-Claude Lacherade
- Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche-sur-Yon, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emmanuelle Mercier
- Médecine Intensive Réanimation, Hôpital Bretonneau, CHU Tours, Tours, France
| | | | - Michel Sirodot
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France
| | - Gaël Piton
- Medical Intensive Care Unit, CHRU Besançon, Besançon, France; EA3920, Université de Franche Comté, Besançon, France
| | | | - Elisabeth Coupez
- Intensive Care Unit, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Stéphane Gaudry
- Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France; INSERM, UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Paris, Paris, France
| | - Michel Djibré
- Service de Médecine intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Didier Thevenin
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Docteur Schaffner, Lens, France
| | | | - Jean Reignier
- Medecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Université de Nantes, Nantes, France
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29
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Silveira GGOS, Torres MDT, Ribeiro CFA, Meneguetti BT, Carvalho CME, de la Fuente-Nunez C, Franco OL, Cardoso MH. Antibiofilm Peptides: Relevant Preclinical Animal Infection Models and Translational Potential. ACS Pharmacol Transl Sci 2021; 4:55-73. [PMID: 33615161 DOI: 10.1021/acsptsci.0c00191] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Indexed: 12/21/2022]
Abstract
Biofilm-forming bacteria may be 10-1000 times more resistant to antibiotics than planktonic bacteria and represent about 75% of bacterial infections in humans. Antibiofilm treatments are scarce, and no effective therapies have been reported so far. In this context, antibiofilm peptides (ABPs) represent an exciting class of agents with potent activity against biofilms both in vitro and in vivo. Moreover, murine models of bacterial biofilm infections have been used to evaluate the in vivo effectiveness of ABPs. Therefore, here we highlight the translational potential of ABPs and provide an overview of the different clinically relevant murine models to assess ABP efficacy, including wound, foreign body, chronic lung, and oral models of infection. We discuss key challenges to translate ABPs to the clinic and the pros and cons of the existing murine biofilm models for reliable assessment of the efficacy of ABPs.
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Affiliation(s)
- Gislaine G O S Silveira
- S-Inova Biotech, Programa de Pós-Graduação Stricto Sensu em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul 79117-010, Brazil
| | - Marcelo D T Torres
- Machine Biology Group, Departments of Psychiatry and Microbiology, Institute for Biomedical Informatics, Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States.,Departments of Bioengineering and Chemical and Biomolecular Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States.,Penn Institute for Computational Science, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Camila F A Ribeiro
- S-Inova Biotech, Programa de Pós-Graduação Stricto Sensu em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul 79117-010, Brazil
| | - Beatriz T Meneguetti
- S-Inova Biotech, Programa de Pós-Graduação Stricto Sensu em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul 79117-010, Brazil
| | - Cristiano M E Carvalho
- S-Inova Biotech, Programa de Pós-Graduação Stricto Sensu em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul 79117-010, Brazil
| | - Cesar de la Fuente-Nunez
- Machine Biology Group, Departments of Psychiatry and Microbiology, Institute for Biomedical Informatics, Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States.,Departments of Bioengineering and Chemical and Biomolecular Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States.,Penn Institute for Computational Science, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Octávio L Franco
- S-Inova Biotech, Programa de Pós-Graduação Stricto Sensu em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul 79117-010, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal 71966-700, Brazil
| | - Marlon H Cardoso
- S-Inova Biotech, Programa de Pós-Graduação Stricto Sensu em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul 79117-010, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal 71966-700, Brazil
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Degroote T, Jaillette E, Reignier J, Zerimech F, Girault C, Brunin G, Chiche A, Lacherade JC, Mira JP, Maboudou P, Balduyck M, Nseir S. Is COPD associated with increased risk for microaspiration in intubated critically ill patients? Ann Intensive Care 2021; 11:7. [PMID: 33428002 PMCID: PMC7798009 DOI: 10.1186/s13613-020-00794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although COPD patients are at higher risk for aspiration when breathing spontaneously, no information is available on the risk for microaspiration in invasively ventilated COPD patients. The aim of our study was to determine the relationship between COPD and abundant microaspiration in intubated critically ill patients. Methods This was a retrospective analysis of prospectively collected data, provided by 3 randomized controlled trials on microaspiration in critically ill patients receiving invasive mechanical ventilation for more than 48 h. Abundant microaspiration was defined as the presence of pepsin and or alpha-amylase at significant levels in tracheal aspirates. In all study patients, pepsin and alpha-amylase were quantitatively measured in all tracheal aspirates collected during a 48-h period. COPD was defined using spirometry criteria. Results Among the 515 included patients, 70 (14%) had proven COPD. Pepsin and alpha-amylase were quantitatively measured in 3873 and 3764 tracheal aspirates, respectively. No significant difference was found in abundant microaspiration rate between COPD and non-COPD patients (62 of 70 patients (89%) vs 366 of 445 (82%) patients, p = 0.25). Similarly, no significant difference was found in abundant microaspiration of gastric contents (53% vs 45%, p = 0.28), oropharyngeal secretions (71% vs 71%, p = 0.99), or VAP (19% vs 22%, p = 0.65) rates between the two groups. No significant difference was found between COPD and non-COPD patients in duration of mechanical ventilation, ICU length of stay, or ICU mortality. Conclusions Our results suggest that COPD is not associated with increased risk for abundant microaspiration in intubated critically ill patients.
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Affiliation(s)
- Thècle Degroote
- Service de Médecine Intensive et Réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | | | - Jean Reignier
- Medecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - Farid Zerimech
- Centre de Biologie Et de Pathologie, CHU Lille, 59000, Lille, France
| | - Christophe Girault
- Normandie Univ, UNIROUEN, EA 3830, Rouen University Hospital, Medical Intensive Care Unit, 76000, Rouen, France
| | - Guillaume Brunin
- Intensive Care Unit, Boulogne Sur Mer Hospital, Boulogne-sur-Mer, France
| | - Arnaud Chiche
- Intensive Care Unit, Tourcoing Hospital, Tourcoing, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de La Vendée, La Roche sur Yon, France
| | - Jean-Paul Mira
- Groupe Hospitalier Paris Centre-Université de Paris, Cochin University Hospital, Medical Intensive Care Unit, Paris, France
| | - Patrice Maboudou
- Centre de Biologie Et de Pathologie, CHU Lille, 59000, Lille, France
| | - Malika Balduyck
- Centre de Biologie Et de Pathologie, CHU Lille, 59000, Lille, France
| | - Saad Nseir
- Critical Care Center, CHU Lille, 59000, Lille, France. .,INSERM U995, Lille Inflammation Research International Center E2, Lille University, Lille, France.
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Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study. Intensive Care Med 2021; 47:188-198. [PMID: 33388794 PMCID: PMC7778569 DOI: 10.1007/s00134-020-06323-9] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Although patients with SARS-CoV-2 infection have several risk factors for ventilator-associated lower respiratory tract infections (VA-LRTI), the reported incidence of hospital-acquired infections is low. We aimed to determine the relationship between SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, and the incidence of VA-LRTI. METHODS Multicenter retrospective European cohort performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation > 48 h were eligible if they had: SARS-CoV-2 pneumonia, influenza pneumonia, or no viral infection at ICU admission. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. All VA-LRTI were prospectively identified, and chest-X rays were analyzed by at least two physicians. Cumulative incidence of first episodes of VA-LRTI was estimated using the Kalbfleisch and Prentice method, and compared using Fine-and Gray models. RESULTS 1576 patients were included (568 in SARS-CoV-2, 482 in influenza, and 526 in no viral infection groups). VA-LRTI incidence was significantly higher in SARS-CoV-2 patients (287, 50.5%), as compared to influenza patients (146, 30.3%, adjusted sub hazard ratio (sHR) 1.60 (95% confidence interval (CI) 1.26 to 2.04)) or patients with no viral infection (133, 25.3%, adjusted sHR 1.7 (95% CI 1.2 to 2.39)). Gram-negative bacilli were responsible for a large proportion (82% to 89.7%) of VA-LRTI, mainly Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp. CONCLUSIONS The incidence of VA-LRTI is significantly higher in patients with SARS-CoV-2 infection, as compared to patients with influenza pneumonia, or no viral infection after statistical adjustment, but residual confounding may still play a role in the effect estimates.
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Altinsoy S, Catalca S, Sayin MM, Tutuncu EE. The risk factors of Ventilator Associated Pneumonia and relationship with type of tracheostomy. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020. [DOI: 10.1016/j.tacc.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Zhou B, Guo M, Hao X, Lou B, Liu J, She J. Altered exosomal microRNA profiles in bronchoalveolar lavage fluid can mediate metabolism in patients with Acinetobacter baumannii ventilator-associated pneumonia. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1561. [PMID: 33437760 PMCID: PMC7791224 DOI: 10.21037/atm-20-2375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Ventilator-associated pneumonia (VAP) is a major public health problem and is most commonly caused by Acinetobacter baumannii (Ab) infection. In our study, we investigated the profiles of exosomal microRNAs (miRNAs) extracted from the bronchoalveolar lavage fluid (BALF) and serum of patients with Acinetobacter baumannii ventilator-associated pneumonia (Ab-VAP). We also examined the serum metabolomic profiles of these patients. Our aim was to study the associations between lung tissue-derived exosomal miRNAs and changes in global metabolism in patients with Ab-VAP. Methods Consecutively sampled patients admitted to an intensive care unit (ICU) for pulmonary infection treatment were enrolled in this study. Demographic information and biochemical measurements were collected. Serum samples were obtained following overnight fasting on admission. Bronchoscopies were performed and BALF samples were collected from each patient. Exosomes were extracted using kits from System Biosciences (SBI) and miRNA sequencing was performed. Non-targeted metabolomics were used to express metabolic profiles. Results We found significant changes in the miRNA profiles of patients with Ab-VAP; these changes occurred in both BALF exosomal miRNA and serum exosomal miRNA. Gene Ontology analysis further identified the function of miRNA in system metabolism. Serum metabolomic profiles and ratios of biological significance were found to be differentially regulated in Ab-VAP patients. This differential regulation was correlated with the differential expression of miRNAs. Conclusions Our data summarizes the dysregulation of serum metabolism and exosomal miRNA excretion that occurs in Ab-VAP patients. The correlation found between BALF exosomal miRNA and dysregulated metabolism, as indicated by the irregular expression of metabolites in the cellular metabolic pathway, highlights potential biomarkers for the diagnosis and treatment of Ab infection.
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Affiliation(s)
- Bo Zhou
- Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Manyun Guo
- Cardiovascular Department, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiang Hao
- Cardiovascular Department, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bowen Lou
- Cardiovascular Department, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junhui Liu
- Diagnostic Department, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianqing She
- Cardiovascular Department, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Miller LS, Fowler VG, Shukla SK, Rose WE, Proctor RA. Development of a vaccine against Staphylococcus aureus invasive infections: Evidence based on human immunity, genetics and bacterial evasion mechanisms. FEMS Microbiol Rev 2020; 44:123-153. [PMID: 31841134 PMCID: PMC7053580 DOI: 10.1093/femsre/fuz030] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022] Open
Abstract
Invasive Staphylococcus aureus infections are a leading cause of morbidity and mortality in both hospital and community settings, especially with the widespread emergence of virulent and multi-drug resistant methicillin-resistant S. aureus strains. There is an urgent and unmet clinical need for non-antibiotic immune-based approaches to treat these infections as the increasing antibiotic resistance is creating a serious threat to public health. However, all vaccination attempts aimed at preventing S. aureus invasive infections have failed in human trials, especially all vaccines aimed at generating high titers of opsonic antibodies against S. aureus surface antigens to facilitate antibody-mediated bacterial clearance. In this review, we summarize the data from humans regarding the immune responses that protect against invasive S. aureus infections as well as host genetic factors and bacterial evasion mechanisms, which are important to consider for the future development of effective and successful vaccines and immunotherapies against invasive S. aureus infections in humans. The evidence presented form the basis for a hypothesis that staphylococcal toxins (including superantigens and pore-forming toxins) are important virulence factors, and targeting the neutralization of these toxins are more likely to provide a therapeutic benefit in contrast to prior vaccine attempts to generate antibodies to facilitate opsonophagocytosis.
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Affiliation(s)
- Lloyd S Miller
- Immunology, Janssen Research and Development, 1400 McKean Road, Spring House, PA, 19477, USA.,Department of Dermatology, Johns Hopkins University School of Medicine, 1550 Orleans Street, Cancer Research Building 2, Suite 209, Baltimore, MD, 21231, USA.,Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD, 21287, USA.,Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.,Department of Materials Science and Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
| | - Vance G Fowler
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, 315 Trent Drive, Hanes House, Durham, NC, 27710, USA.,Duke Clinical Research Institute, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Sanjay K Shukla
- Center for Precision Medicine Research, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, WI, 54449, USA.,Computation and Informatics in Biology and Medicine, University of Wisconsin, 425 Henry Mall, Room 3445, Madison, WI, 53706, USA
| | - Warren E Rose
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, USA.,Pharmacy Practice Division, University of Wisconsin-Madison, 777 Highland Avenue, 4123 Rennebohm Hall, Madison, WI, 53705 USA
| | - Richard A Proctor
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, USA.,Department of Medical Microbiology and Immunology, University of Wisconsin-Madison School of Medicine and Public Health, 1550 Linden Drive, Microbial Sciences Building, Room 1334, Madison, WI, 53705, USA
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Caméléna F, Moy AC, Dudoignon E, Poncin T, Deniau B, Guillemet L, Le Goff J, Budoo M, Benyamina M, Chaussard M, Coutrot M, Lafaurie M, Plaud B, Mebazaa A, Depret F, Berçot B. Performance of a multiplex polymerase chain reaction panel for identifying bacterial pathogens causing pneumonia in critically ill patients with COVID-19. Diagn Microbiol Infect Dis 2020; 99:115183. [PMID: 33069002 PMCID: PMC7441025 DOI: 10.1016/j.diagmicrobio.2020.115183] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 12/16/2022]
Abstract
The FilmArray® Pneumonia Plus (FA-PP) panel can provide rapid identifications and semiquantitative results for many pathogens. We performed a prospective single-center study in 43 critically ill patients with coronavirus disease 2019 (COVID-19) in which we performed 96 FA-PP tests and cultures of blind bronchoalveolar lavage (BBAL). FA-PP detected 1 or more pathogens in 32% (31/96 of samples), whereas culture methods detected at least 1 pathogen in 35% (34/96 of samples). The most prevalent bacteria detected were Pseudomonas aeruginosa (n = 14) and Staphylococcus aureus (n = 11) on both FA-PP and culture. The FA-PP results from BBAL in critically ill patients with COVID-19 were consistent with bacterial culture findings for bacteria present in the FA-PP panel, showing sensitivity, specificity, and positive and negative predictive value of 95%, 99%, 82%, and 100%, respectively. Median turnaround time for FA-PP was 5.5 h, which was significantly shorter than for standard culture (26 h) and antimicrobial susceptibility testing results (57 h).
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Affiliation(s)
- François Caméléna
- Department of Microbiology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Anne-Clotilde Moy
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Dudoignon
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 942, INI-CRCT network, Paris, France
| | - Thibaut Poncin
- Department of Microbiology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Benjamin Deniau
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 942, INI-CRCT network, Paris, France
| | - Lucie Guillemet
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérôme Le Goff
- Department of Microbiology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mélissa Budoo
- Department of Microbiology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mourad Benyamina
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maïté Chaussard
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maxime Coutrot
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Disease, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoît Plaud
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 942, INI-CRCT network, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 942, INI-CRCT network, Paris, France
| | - François Depret
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 942, INI-CRCT network, Paris, France
| | - Béatrice Berçot
- Department of Microbiology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France.
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Cornejo-Juárez P, González-Oros I, Mota-Castañeda P, Vilar-Compte D, Volkow-Fernández P. Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria. World J Crit Care Med 2020; 9:43-53. [PMID: 32844090 PMCID: PMC7416360 DOI: 10.5492/wjccm.v9.i3.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/22/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation (MV). The emergence of multidrug resistant bacteria (MDRB) has become a public health problem, creating a new burden on medical care in hospitals, particularly for patients admitted to the intensive care unit (ICU).
AIM To describe risk factors for ventilator-acquired pneumonia (VAP) in patients with cancer and to evaluate the impact of MDRB.
METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City, which included all patients who were admitted to the ICU and required MV ≥ 48 h. They were classified as those who developed VAP versus those who did not; pathogens isolated, including MDRB. Clinical evolution at 60-d was assessed. Descriptive analysis was carried out; comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.
RESULTS Two hundred sixty-three patients were included in the study; mean age was 51.9 years; 52.1% were male; 68.4% had solid tumors. There were 32 episodes of VAP with a rate of 12.2%; 11.5 episodes/1000 ventilation-days. The most frequent bacteria isolated were the following: Klebsiella spp. [n = 9, four were Extended-Spectrum Beta-Lactamase (ESBL) producers, one was Carbapenem-resistant (CR)]; Escherichia coli (n = 5, one was ESBL), and Pseudomonas aeruginosa (n = 8, two were CR). One Methicillin-susceptible Staphylococcus aureus was identified. In multivariate analysis, the sole risk factor associated for VAP was length of ICU stay (OR = 1.1; 95%CI: 1.03-1.17; P = 0.003). Sixty-day mortality was 53% in VAP and 43% without VAP (P = 0.342). There was not higher mortality in those patients with MDRB.
CONCLUSION This study highlights the high percentage of Gram-negative bacteria, which allows the initiation of empiric antibiotic coverage for these pathogens. In this retrospective, single center, observational study, MDRB VAP was not directly linked to increased mortality at 60 days.
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Affiliation(s)
- Patricia Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Ivan González-Oros
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Paola Mota-Castañeda
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Diana Vilar-Compte
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
| | - Patricia Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City 14080, Mexico
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Cornejo-Juárez P, González-Oros I, Mota-Castañeda P, Vilar-Compte D, Volkow-Fernández P. Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria. World J Crit Care Med 2020. [DOI: 10.5492/wjccm.v9.i3.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Lind LA, Andel EM, McCall AL, Dhindsa JS, Johnson KA, Stricklin OE, Mueller C, ElMallah MK, Lever TE, Nichols NL. Intralingual Administration of AAVrh10-miR SOD1 Improves Respiratory But Not Swallowing Function in a Superoxide Dismutase-1 Mouse Model of Amyotrophic Lateral Sclerosis. Hum Gene Ther 2020; 31:828-838. [PMID: 32498636 DOI: 10.1089/hum.2020.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal disease characterized by degeneration of motor neurons and muscles, and death is usually a result of impaired respiratory function due to loss of motor neurons that control upper airway muscles and/or the diaphragm. Currently, no cure for ALS exists and treatments to date do not significantly improve respiratory or swallowing function. One cause of ALS is a mutation in the superoxide dismutase-1 (SOD1) gene; thus, reducing expression of the mutated gene may slow the progression of the disease. Our group has been studying the SOD1G93A transgenic mouse model of ALS that develops progressive respiratory deficits and dysphagia. We hypothesize that solely treating the tongue in SOD1 mice will preserve respiratory and swallowing function, and it will prolong survival. At 6 weeks of age, 11 SOD1G93A mice (both sexes) received a single intralingual injection of gene therapy (AAVrh10-miRSOD1). Another 29 mice (both sexes) were divided into two control groups: (1) 12 SOD1G93A mice that received a single intralingual vehicle injection (saline); and (2) 17 non-transgenic littermates. Starting at 13 weeks of age, plethysmography (respiratory parameters) at baseline and in response to hypoxia (11% O2) + hypercapnia (7% CO2) were recorded and videofluoroscopic swallow study testing were performed twice monthly until end-stage disease. Minute ventilation during hypoxia + hypercapnia and mean inspiratory flow at baseline were significantly reduced (p < 0.05) in vehicle-injected, but not AAVrh10-miRSOD1-injected SOD1G93A mice as compared with wild-type mice. In contrast, swallowing function was unchanged by AAVrh10-miRSOD1 treatment (p > 0.05). AAVrh10-miRSOD1 injections also significantly extended survival in females by ∼1 week. In conclusion, this study indicates that intralingual AAVrh10-miRSOD1 treatment preserved respiratory (but not swallowing) function potentially via increasing upper airway patency, and it is worthy of further exploration as a possible therapy to preserve respiratory capacity in ALS patients.
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Affiliation(s)
- Lori A Lind
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Ellyn M Andel
- Department of Otolaryngology, University of Missouri, Columbia, Missouri, USA
| | - Angela L McCall
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Justin S Dhindsa
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Katherine A Johnson
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Olivia E Stricklin
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Christian Mueller
- Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester Massachusetts, USA
| | - Mai K ElMallah
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Teresa E Lever
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri, USA.,Department of Otolaryngology, University of Missouri, Columbia, Missouri, USA
| | - Nicole L Nichols
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri, USA.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri, USA
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Zhang L, Valizadeh H, Alipourfard I, Bidares R, Aghebati-Maleki L, Ahmadi M. Epigenetic Modifications and Therapy in Chronic Obstructive Pulmonary Disease (COPD): An Update Review. COPD 2020; 17:333-342. [PMID: 32558592 DOI: 10.1080/15412555.2020.1780576] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) that is one of the most prevalent chronic adult diseases and the third leading cause of fatality until 2020. Elastase/anti-elastase hypothesis, chronic inflammation, apoptosis, oxidant-antioxidant balance and infective repair cause pathogenesis of COPD are among the factors at play. Epigenetic changes are post-translational modifications in histone proteins and DNA such as methylation and acetylation as well as dysregulation of miRNAs expression. In this update review, we have examined recent studies on the upregulation or downregulation of methylation in different genes associated with COPD. Dysregulation of HDAC activity which is caused by some factors and miRNAs plays a key role in the suppression and reduction of COPD development. Also, some therapeutic approaches are proposed against COPD by targeting HDAC2 and miRNAs, which have therapeutic effects.
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Affiliation(s)
- Lingzhi Zhang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hamed Valizadeh
- Department of Internal Medicine and Pulmonology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.,Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Iraj Alipourfard
- Faculty of Life Sciences, Center of pharmaceutical sciences, University of Vienna, Vienna, Austria.,Faculty of Sciences, School of Pharmacy, University of Rome Tor Vergata, Roma, Italy
| | - Ramtin Bidares
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Majid Ahmadi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
PURPOSE OF REVIEW In the last 2 years, two major guidelines for the management of nosocomial pneumonia have been published: The International European Respiratory Society/European Society of Intensive Care Medicine/European Society of Clinical Microbiology and Infectious Diseases/Asociación Latinoamericana de Toráx guidelines for the management of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) and the American guidelines for management of adults with HAP and VAP; both the guidelines made important clinical recommendations for the management of patients. RECENT FINDINGS With the increasing emergence of multidrug resistant (MDR) organisms, paired with a relative reduction in new antibiotic development, nosocomial infections have become one of the most significant issues affecting global healthcare today. Despite several stark differences between the European and American guidelines, they are in agreement about many aspects of nosocomial pneumonia management. SUMMARY American and European guidelines promote prompt and appropriate empiric treatment which is immediately guided by local microbiological data, followed by an adequate de-escalation protocol based on culture results with a 1-week course of treatment. Both also questioned the use of biomarkers in HAP/VAP, whether as part of the diagnosis or daily assessment of patients. On the contrary, they have conflicting views in regards to the optimum method of diagnosis, the risk factors used to stratify patients, the use of clinical scoring systems and the various antibiotic classes used. All were presented with varying levels of evidence to support these differences in opinion, indicating that further research into these areas is required before a consensus can be agreed upon.
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Yao J, Guan S, Liu Z, Li X, Zhou Q. Changes in immune indicators and bacteriologic profile were associated with patients with ventilator-associated pneumonia. Medicine (Baltimore) 2020; 99:e19716. [PMID: 32311958 PMCID: PMC7440178 DOI: 10.1097/md.0000000000019716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The aim of this study is to explore and identify ventilator-associated pneumonia (VAP)-related prognostic immune factors and further detect the drug-resistant pathogens to establish the theoretical guidance for clinical prevention and treatment strategies of VAP. A total of 478 patients using ventilator who were hospitalized in July 2014 to November 2016 in our hospital were enrolled in this study. About 103 patients with VAP (21.5%, 103/478) among 478 cases of patients using ventilator. Among the 103 patients with VAP, the distribution of pathogenic bacteria and drug resistance in patients with VAP were detected and analyzed. In the VAP group, 35 patients died and 43 patients had simultaneous sepsis. Compared with those of non-VAP group, the proportion of CD3 (P = .012), CD3CD4 (P = .024) and CD8CD28 ( P = .017) T cells in VAP group increased significantly, which indicated more severe immune response. Multivariate regression model analysis revealed that tracheotomy of mechanical ventilation (P = .013), mechanical ventilation time ≥7 days (P = .02) and aspiration and reflux (P = .011) were independent risk factors associated with VAP. According to the results of bacterial culture and drug sensitivity test, rational selection of antibiotics and monitoring of patients within intensive care unit can effectively control the incidence of VAP and improve the prognosis of patients.
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Pre-admission air pollution exposure prolongs the duration of ventilation in intensive care patients. Intensive Care Med 2020; 46:1204-1212. [PMID: 32185459 PMCID: PMC7224020 DOI: 10.1007/s00134-020-05999-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/03/2020] [Indexed: 12/15/2022]
Abstract
Purpose Air pollutant exposure constitutes a serious risk factor for the emergence or aggravation of (existing) pulmonary disease. The impact of pre-intensive care ambient air pollutant exposure on the duration of artificial ventilation was, however, not yet established. Methods The medical records of 2003 patients, admitted to the intensive care unit (ICU) of the Antwerp University Hospital (Flanders, Belgium), who were artificially ventilated on ICU admission or within 48 h after admission, for the duration of at least 48 h, were analyzed. For each patient’s home address, daily air pollutant exposure [particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5) and ≤ 10 µm (PM10), nitrogen dioxide (NO2) and black carbon (BC)] up to 10 days prior to hospital admission was modeled using a high-resolution spatial–temporal model. The association between duration of artificial ventilation and air pollution exposure during the last 10 days before ICU admission was assessed using distributed lag models with a negative binomial regression fit. Results Controlling for pre-specified confounders, an IQR increment in BC (1.2 µg/m3) up to 10 days before admission was associated with an estimated cumulative increase of 12.4% in ventilation duration (95% CI 4.7–20.7). Significant associations were also observed for PM2.5, PM10 and NO2, with cumulative estimates ranging from 7.8 to 8.0%. Conclusion Short-term ambient air pollution exposure prior to ICU admission represents an unrecognized environmental risk factor for the duration of artificial ventilation in the ICU. Electronic supplementary material The online version of this article (10.1007/s00134-020-05999-3) contains supplementary material, which is available to authorized users.
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Cai Y, Zhang W, Zhang R, Cui X, Fang J. Combined Use of Three Machine Learning Modeling Methods to Develop a Ten-Gene Signature for the Diagnosis of Ventilator-Associated Pneumonia. Med Sci Monit 2020; 26:e919035. [PMID: 32031163 PMCID: PMC7020762 DOI: 10.12659/msm.919035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study aimed to use three modeling methods, logistic regression analysis, random forest analysis, and fully-connected neural network analysis, to develop a diagnostic gene signature for the diagnosis of ventilator-associated pneumonia (VAP). MATERIAL AND METHODS GSE30385 from the Gene Expression Omnibus (GEO) database identified differentially expressed genes (DEGs) associated with patients with VAP. Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment identified the molecular functions of the DEGs. The least absolute shrinkage and selection operator (LASSO) regression analysis algorithm was used to select key genes. Three modeling methods, including logistic regression analysis, random forest analysis, and fully-connected neural network analysis, also known as also known as the feed-forward multi-layer perceptron (MLP), were used to identify the diagnostic gene signature for patients with VAP. RESULTS Sixty-six DEGs were identified for patients who had VAP (VAP+) and who did not have VAP (VAP-). Ten essential or feature genes were identified. Upregulated genes included matrix metallopeptidase 8 (MMP8), arginase 1 (ARG1), haptoglobin (HP), interleukin 18 receptor 1 (IL18R1), and NLR family apoptosis inhibitory protein (NAIP). Down-regulated genes included complement factor D (CFD), pleckstrin homology-like domain family A member 2 (PHLDA2), plasminogen activator, urokinase (PLAU), laminin subunit beta 3 (LAMB3), and dual-specificity phosphatase 2 (DUSP2). Logistic regression, random forest, and MLP analysis showed receiver operating characteristic (ROC) curve area under the curve (AUC) values of 0.85, 0.86, and 0.87, respectively. CONCLUSIONS Logistic regression analysis, random forest analysis, and MLP analysis identified a ten-gene signature for the diagnosis of VAP.
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Affiliation(s)
- Yunfang Cai
- Department of Anesthesia, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Wen Zhang
- Department of Anesthesia, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Runze Zhang
- Department of Anesthesia, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Xiaoying Cui
- Department of Anesthesia, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Jun Fang
- Department of Anesthesia, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
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Impact of Chronic Obstructive Pulmonary Disease on Incidence, Microbiology and Outcome of Ventilator-Associated Lower Respiratory Tract Infections. Microorganisms 2020; 8:microorganisms8020165. [PMID: 31979375 PMCID: PMC7074722 DOI: 10.3390/microorganisms8020165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the impact of chronic obstructive pulmonary disease (COPD) on incidence, microbiology, and outcomes of ventilator-associated lower respiratory tract infections (VA-LRTI). Methods: Planned ancillary analysis of TAVeM study, including 2960 consecutive adult patients who received invasive mechanical ventilation (MV) > 48 h. COPD patients (n = 494) were compared to non-COPD patients (n = 2466). The diagnosis of ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) was based on clinical, radiological and quantitative microbiological criteria. Results: No significant difference was found in VAP (12% versus 13%, p = 0.931), or VAT incidence (13% versus 10%, p = 0.093) between COPD and non-COPD patients. Among patients with VA-LRTI, Escherichia coli and Stenotrophomonas maltophilia were significantly more frequent in COPD patients as compared with non-COPD patients. However, COPD had no significant impact on multidrug-resistant bacteria incidence. Appropriate antibiotic treatment was not significantly associated with progression from VAT to VAP among COPD patients who developed VAT, unlike non-COPD patients. Among COPD patients, patients who developed VAT or VAP had significantly longer MV duration (17 days (9–30) or 15 (8–27) versus 7 (4–12), p < 0.001) and intensive care unit (ICU) length of stay (24 (17–39) or 21 (14–40) versus 12 (8–19), p < 0.001) than patients without VA-LRTI. ICU mortality was also higher in COPD patients who developed VAP (44%), but not VAT(38%), as compared to no VA-LRTI (26%, p = 0.006). These worse outcomes associated with VA-LRTI were similar among non-COPD patients. Conclusions: COPD had no significant impact on incidence or outcomes of patients who developed VAP or VAT.
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Pouly O, Lecailtel S, Six S, Préau S, Wallet F, Nseir S, Rouzé A. Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections. Ann Intensive Care 2020; 10:6. [PMID: 31932982 PMCID: PMC6957592 DOI: 10.1186/s13613-020-0624-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 01/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to investigate the concordance between ventilator-associated events (VAE) and ventilator-associated lower respiratory tract infections (VA-LRTI), and their impact on outcome. Methods This retrospective study was performed in five 10-bed ICUs of a teaching hospital, during a 2-year period. Ventilator-associated lower respiratory tract infections (VA-LRTI), including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) were prospectively diagnosed. The agreement between VAE, VAT and VAP was assessed by k statistics. Results A total of 1059 patients (15,029 ventilator-days) were included. 268 VAP (17.8 per 1000 ventilator-days), 127 VAT (8.5 per 1000 ventilator-days) and 262 VAE (17.4 per 1000 ventilator-days) were diagnosed. There was no agreement between VAT and VAE, and the agreement was poor between VAP and VAE (k = 0.12, 95% CI 0.03–0.20). VAE and VA-LRTI were associated with significantly longer duration of mechanical ventilation, ICU and hospital length of stay. VAP, VAT and VAE were not significantly associated with mortality in multivariate analysis. Conclusions The agreement was poor between VAE and VAP. No agreement was found between VAE and VAT. VAE episodes were significantly associated with longer duration of mechanical ventilation and length of stay, but not with ICU mortality.
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Affiliation(s)
- Olivier Pouly
- Critical Care Center, CHU Lille, 59000, Lille, France.,Medicine Faculty, Lille University, 59000, Lille, France
| | | | - Sophie Six
- Critical Care Center, CHU Lille, 59000, Lille, France
| | | | - Frédéric Wallet
- Centre de Biologie et de Pathologie, CHU Lille, 59000, Lille, France
| | - Saad Nseir
- Critical Care Center, CHU Lille, 59000, Lille, France. .,Medicine Faculty, Lille University, 59000, Lille, France.
| | - Anahita Rouzé
- Critical Care Center, CHU Lille, 59000, Lille, France
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Hindman BJ, Dexter F. Anesthetic Management of Emergency Endovascular Thrombectomy for Acute Ischemic Stroke, Part 2: Integrating and Applying Observational Reports and Randomized Clinical Trials. Anesth Analg 2019; 128:706-717. [PMID: 30883416 DOI: 10.1213/ane.0000000000004045] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The 2018 American Heart Association stroke care guidelines consider endovascular thrombectomy to be the standard of care for patients who have acute ischemic stroke in the anterior circulation when arterial puncture can be made: (1) within 6 h of symptom onset; or (2) within 6-24 h of symptom onset when specific eligibility criteria are satisfied. The aim of this 2-part review is to provide practical perspective on the clinical literature regarding anesthesia care of endovascular thrombectomy patients. In the preceding companion article (part 1), the rationale for rapid workflow and maintenance of blood pressure before reperfusion were reviewed. Also in part 1, the key patient and procedural factors determining endovascular thrombectomy effectiveness were identified. In this article (part 2), the observational literature regarding anesthesia for endovascular thrombectomy is summarized briefly, largely to identify its numerous biases, but also to develop hypotheses regarding sedation versus general anesthesia pertaining to workflow, hemodynamic management, and intra- and post-endovascular thrombectomy adverse events. These hypotheses underlie the conduct and outcome measures of 3 recent randomized clinical trials of sedation versus general anesthesia for endovascular thrombectomy. A meta-analysis of functional outcomes from these 3 trials show, when managed according to trial protocols, sedation and general anesthesia result in outcomes that are not significantly different. Details regarding anesthesia and hemodynamic management from these 3 trials are provided. This article concludes with a pragmatic approach to real-time anesthesia decision-making (sedation versus general anesthesia) and the goals and methods of acute phase anesthesia management of endovascular thrombectomy patients.
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Affiliation(s)
- Bradley J Hindman
- From the Department of Anesthesia, The University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
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François B, Cariou A, Clere-Jehl R, Dequin PF, Renon-Carron F, Daix T, Guitton C, Deye N, Legriel S, Plantefève G, Quenot JP, Desachy A, Kamel T, Bedon-Carte S, Diehl JL, Chudeau N, Karam E, Durand-Zaleski I, Giraudeau B, Vignon P, Le Gouge A. Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest. N Engl J Med 2019; 381:1831-1842. [PMID: 31693806 DOI: 10.1056/nejmoa1812379] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients who are treated with targeted temperature management after out-of-hospital cardiac arrest with shockable rhythm are at increased risk for ventilator-associated pneumonia. The benefit of preventive short-term antibiotic therapy has not been shown. METHODS We conducted a multicenter, double-blind, randomized, placebo-controlled trial involving adult patients (>18 years of age) in intensive care units (ICUs) who were being mechanically ventilated after out-of-hospital cardiac arrest related to initial shockable rhythm and treated with targeted temperature management at 32 to 34°C. Patients with ongoing antibiotic therapy, chronic colonization with multidrug-resistant bacteria, or moribund status were excluded. Either intravenous amoxicillin-clavulanate (at doses of 1 g and 200 mg, respectively) or placebo was administered three times a day for 2 days, starting less than 6 hours after the cardiac arrest. The primary outcome was early ventilator-associated pneumonia (during the first 7 days of hospitalization). An independent adjudication committee determined diagnoses of ventilator-associated pneumonia. RESULTS A total of 198 patients underwent randomization, and 194 were included in the analysis. After adjudication, 60 cases of ventilator-associated pneumonia were confirmed, including 51 of early ventilator-associated pneumonia. The incidence of early ventilator-associated pneumonia was lower with antibiotic prophylaxis than with placebo (19 patients [19%] vs. 32 [34%]; hazard ratio, 0.53; 95% confidence interval, 0.31 to 0.92; P = 0.03). No significant differences between the antibiotic group and the control group were observed with respect to the incidence of late ventilator-associated pneumonia (4% and 5%, respectively), the number of ventilator-free days (21 days and 19 days), ICU length of stay (5 days and 8 days if patients were discharged and 7 days and 7 days if patients had died), and mortality at day 28 (41% and 37%). At day 7, no increase in resistant bacteria was identified. Serious adverse events did not differ significantly between the two groups. CONCLUSIONS A 2-day course of antibiotic therapy with amoxicillin-clavulanate in patients receiving a 32-to-34°C targeted temperature management strategy after out-of-hospital cardiac arrest with initial shockable rhythm resulted in a lower incidence of early ventilator-associated pneumonia than placebo. No significant between-group differences were observed for other key clinical variables, such as ventilator-free days and mortality at day 28. (Funded by the French Ministry of Health; ANTHARTIC ClinicalTrials.gov number, NCT02186951.).
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Affiliation(s)
- Bruno François
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Alain Cariou
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Raphaël Clere-Jehl
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Pierre-François Dequin
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Françoise Renon-Carron
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Thomas Daix
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Christophe Guitton
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Nicolas Deye
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Stéphane Legriel
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Gaëtan Plantefève
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Jean-Pierre Quenot
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Arnaud Desachy
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Toufik Kamel
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Sandrine Bedon-Carte
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Jean-Luc Diehl
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Nicolas Chudeau
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Elias Karam
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Isabelle Durand-Zaleski
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Bruno Giraudeau
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Philippe Vignon
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
| | - Amélie Le Gouge
- From Réanimation Polyvalente (B.F., T.D., P.V.), INSERM Centre d'Investigation Clinique (CIC) 1435 (B.F., T.D., P.V.), and Unité des Essais Cliniques, Pharmacie à Usage Intérieur (F.R.-C.), Centre Hospitalier Universitaire (CHU) Dupuytren, and INSERM Unité Mixte de Recherche (UMR) 1092, Faculté de Médecine, Université de Limoges (B.F., T.D., P.V.), Limoges, Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre (site Cochin), Assistance Publique-Hôpitaux de Paris (AP-HP) (A.C.), Université Paris Descartes (A.C.), Réanimation Médicale, CHU Lariboisière, AP-HP (N.D.), INSERM UMR S942, Université Paris Diderot (N.D.), Réanimation Médicale, Hôpital Européen Georges-Pompidou, AP-HP (J.-L.D.), INSERM UMR S1140, Université Paris Descartes (J.-L.D.), and AP-HP, Unité de Recherche Clinique en Économie de la Santé d'Ile de France and Hôpital Henri Mondor (I.D.-Z.), Paris, Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg (R.C.-J.), Médecine Intensive-Réanimation (P.-F.D.) and INSERM Unité 1100 (P.-F.D.), CHU Bretonneau, and INSERM CIC 1415, CHU de Tours (B.G., A.L.G.), Tours, Médecine Intensive et Réanimation, CHU de Nantes, and Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes (C.G.), Réanimation Médico-chirurgicale, Centre Hospitalier du Mans, Le Mans (C.G., N.C.), Réanimation Médico-chirurgicale, Centre Hospitalier André Mignot, Versailles (S.L.), Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil (G.P.), Médecine Intensive et Réanimation, CHU François Mitterrand, Lipness Team, Centre de Recherche INSERM Lipides, Nutrition, Cancer-UMR 1231, and INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon (J.-P.Q.), Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angoulême (A.D.), Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans (T.K.), Réanimation Polyvalente, Centre Hospitalier de Périgueux, Périgueux (S.B.-C.), and Réanimation Polyvalente, Centre Hospitalier, Brive la Gaillarde (E.K.) - all in France
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48
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Zhang J, Deng R, Jia H, Li X. Risk factors and peripheral blood lymphocyte subset analysis of patients with ventilator-associated pneumonia: a Chinese population-based study. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:3830-3838. [PMID: 31933771 PMCID: PMC6949756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study is to analyze and identify ventilator-associated pneumonia (VAP) risk factors related to pathogens and drug resistance, and explore the theoretical guidance for clinical prevention and treatment strategies of VAP. 478 cases using a ventilator who were hospitalized in July 2014 to November 2016 in our hospital were analyzed in this study. Among them there were 103 patients with VAP. The distribution of pathogenic bacteria and drug resistance in VAP patients was detected and analyzed. 103 patients had VAP (21.5%, 103/478) among 478 cases of patients using a ventilator. Among the 103 patients with VAP, 35 patients died and 43 had simultaneous sepsis. Compared with those of the non-VAP group, the proportion of CD3+ (p = 0.012), CD3+ CD4+ (P = 0.024) and CD8+ CD28+ (P = 0.017) T cells in VAP group increased significantly, which showed a more severe immune response. Multivariate regression model analysis revealed that tracheotomy for mechanical ventilation (P = 0.013), mechanical ventilation time ≥ 7 days (P = 0.02) and aspiration and reflux (P = 0.011) were independent risk factors associated with VAP. Multi-drugs resistance was observed in this study. Modality of mechanical ventilation, mechanical ventilation ≥ 7 days, and aspiration and reflux were independent risk factors associated with VAP. According to the results of bacterial culture and drug sensitivity test, rational selection of antibiotics and monitoring of patients in the ICU can effectively control the incidence of VAP and improve prognosis.
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Affiliation(s)
- Jiefang Zhang
- Department of Critical Care Medicine, Heze City Hospital Heze, Shandong Province, China
| | - Rong Deng
- Department of Critical Care Medicine, Heze City Hospital Heze, Shandong Province, China
| | - Huijuan Jia
- Department of Critical Care Medicine, Heze City Hospital Heze, Shandong Province, China
| | - Xiuxian Li
- Department of Critical Care Medicine, Heze City Hospital Heze, Shandong Province, China
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49
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Guilhen C, Miquel S, Charbonnel N, Joseph L, Carrier G, Forestier C, Balestrino D. Colonization and immune modulation properties of Klebsiella pneumoniae biofilm-dispersed cells. NPJ Biofilms Microbiomes 2019; 5:25. [PMID: 31583108 PMCID: PMC6760147 DOI: 10.1038/s41522-019-0098-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 08/12/2019] [Indexed: 02/07/2023] Open
Abstract
Biofilm-dispersal is a key determinant for further dissemination of biofilm-embedded bacteria. Recent evidence indicates that biofilm-dispersed bacteria have transcriptional features different from those of both biofilm and planktonic bacteria. In this study, the in vitro and in vivo phenotypic properties of Klebsiella pneumoniae cells spontaneously dispersed from biofilm were compared with those of planktonic and sessile cells. Biofilm-dispersed cells, whose growth rate was the same as that of exponential planktonic bacteria but significantly higher than those of sessile and stationary planktonic forms, colonized both abiotic and biotic surfaces more efficiently than their planktonic counterparts regardless of their initial adhesion capabilities. Microscopy studies suggested that dispersed bacteria initiate formation of microcolonies more rapidly than planktonic bacteria. In addition, dispersed cells have both a higher engulfment rate and better survival/multiplication inside macrophages than planktonic cells and sessile cells. In an in vivo murine pneumonia model, the bacterial load in mice lungs infected with biofilm-dispersed bacteria was similar at 6, 24 and 48 h after infection to that of mice lungs infected with planktonic or sessile bacteria. However, biofilm-dispersed and sessile bacteria trend to elicit innate immune response in lungs to a lesser extent than planktonic bacteria. Collectively, the findings from this study suggest that the greater ability of K. pneumoniae biofilm-dispersed cells to efficiently achieve surface colonization and to subvert the host immune response confers them substantial advantages in the first steps of the infection process over planktonic bacteria.
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Affiliation(s)
- Cyril Guilhen
- 1Université Clermont Auvergne, CNRS 6023, LMGE, Clermont-Ferrand, France.,3Present Address: Université de Genève, Centre Médical Universitaire, Département de Physiologie Cellulaire et Métabolisme, Genève, Suisse
| | - Sylvie Miquel
- 1Université Clermont Auvergne, CNRS 6023, LMGE, Clermont-Ferrand, France
| | - Nicolas Charbonnel
- 1Université Clermont Auvergne, CNRS 6023, LMGE, Clermont-Ferrand, France
| | - Laura Joseph
- 1Université Clermont Auvergne, CNRS 6023, LMGE, Clermont-Ferrand, France
| | - Guillaume Carrier
- 2Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand, France.,4Present Address: Department of Surgical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | | | - Damien Balestrino
- 1Université Clermont Auvergne, CNRS 6023, LMGE, Clermont-Ferrand, France
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New guidelines for hospital-acquired pneumonia/ventilator-associated pneumonia: USA vs. Europe. Curr Opin Crit Care 2019; 24:347-352. [PMID: 30063491 DOI: 10.1097/mcc.0000000000000535] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia were published in 2017 whilst the American guidelines for Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia were launched in 2016 by the Infectious Diseases Society of America/ATS. Both guidelines made updated recommendations based on the most recent evidence sharing not only some parallelisms but also important conceptual differences. RECENT FINDINGS Contemporary therapy for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) emphasizes the importance of prompt and appropriate antimicrobial therapy. There is an implicit risk, when appropriate means broad spectrum, that liberal use of antimicrobial combinations will encourage the emergence of multidrug resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant bacteria (PDR) and generate untreatable infections, including carbapenemase resistant infections. SUMMARY American and European guidelines have many areas of common agreement such as limiting antibiotic duration. Both guidelines were in favour of a close clinical assessment. Neither recommended a regular use of biomarkers but only in specific circumstances such as dealing with MDR and treatment failure. Risk factor prediction for MDR differed and whilst American guidelines focus on organ failure, the European ones did it in local ecology and septic shock.
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