scholarly journals The Impact of Carbapenem-Resistant Enterobacteriaceae Type on Clinical Outcomes After the Recovery of This Organism From Urine of Critically Ill Patients

2016 ◽  
Vol 37 (10) ◽  
pp. 1257-1258 ◽  
Author(s):  
Leandro Reus Rodrigues Perez
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Carbapenem Resistant ◽  
The Impact ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals Efficacy and safety of vancomycin loading doses in critically ill patients with methicillin-resistant Staphylococcus aureus infection

2021 ◽  
Vol 8 ◽  
pp. 204993612110059
Author(s):  
Alexander H. Flannery ◽  
Katie L. Wallace ◽  
Christian N. Rhudy ◽  
Allison S. Olmsted ◽  
Rachel C. Minrath ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Loading Dose ◽  
Clinical Failure ◽  
Methicillin Resistant ◽  
Mrsa Infection ◽  
The Impact

Background: While vancomycin loading doses may facilitate earlier pharmacokinetic–pharmacodynamic target attainment, the impact of loading doses on clinical outcomes remains understudied. Critically ill patients are at highest risk of morbidity and mortality from methicillin resistant Staphylococcus aureus (MRSA) infection and hypothesized to most likely benefit from a loading dose. We sought to determine the association between receipt of a vancomycin loading dose and clinical outcomes in a cohort of critically ill adults. Methods: Four hundred and forty-nine critically ill patients with MRSA cultures isolated from blood or respiratory specimens were eligible for the study. Cohorts were established by receipt of a loading dose (⩾20 mg/kg actual body weight) or not. The primary outcome was clinical failure, a composite outcome of death within 30 days of first MRSA culture, blood cultures positive ⩾7 days, white blood cell count up to 5 days from vancomycin initiation, temperature up to 5 days from vancomycin initiation, or substitution (or addition) of another MRSA agent. Results: There was no difference in the percentage of patients experiencing clinical failure between the loading dose and no loading dose groups (74.8% versus 72.8%; p = 0.698). Secondary outcomes were also similar between groups, including mortality and acute kidney injury, as was subgroup analysis based on site of infection. Exploratory analyses, including assessment of loading dose based on quartiles and a multivariable logistic regression model showed no differences. Conclusion: Use of vancomycin loading doses was not associated with improved clinical outcomes in critically ill patients with MRSA infection.

scholarly journals Incidence, Predictors and Outcomes of Delirium in Critically Ill Patients With COVID-19

2021 ◽  
pp. 194187442110348
Author(s):  
Craig A. Williamson ◽  
Laura Faiver ◽  
Andrew M. Nguyen ◽  
Lauren Ottenhoff ◽  
Venkatakrishna Rajajee
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Functional Outcomes ◽  
Respiratory Illness ◽  
Lengths Of Stay ◽  
Mechanical Ventilation Duration ◽  
The Impact ◽  
To Receive

Background and Purpose: A variety of neurological manifestations have been attributed to COVID-19, but there is currently limited evidence regarding risk factors and outcomes for delirium in critically ill patients with COVID-19. The purpose of this study was to identify delirium in a large cohort of ICU patients with COVID-19, and to identify associated features and clinical outcomes at the time of hospital discharge. Methods: This is an observational cohort study of 213 consecutive patients admitted to an ICU for COVID-19 respiratory illness. Delirium was diagnosed by trained abstractors using the CHART-DEL instrument. The associations between key clinical features, sedation and delirium were examined, as were the impacts of delirium on clinical outcomes. Results: Delirium was identified in 57.3% of subjects. Delirious patients were more likely to receive mechanical ventilation, had lower P: F ratios, higher rates of renal replacement therapy and ECMO, and were more likely to receive enteral benzodiazepines. Only mechanical ventilation remained a significant predictor of delirium in a logistic regression model. Mortality was not significantly different, but delirious patients experienced greater mechanical ventilation duration, ICU/hospital lengths of stay, worse functional outcomes at discharge, and were less likely to be discharged home. Conclusions: Delirium is common in critically ill patients with COVID-19 and appears to be associated with greater disease severity. When present, delirium is associated with worse functional status at discharge, but not increased mortality. Additional studies are necessary to determine the generalizability of these results and the impact of delirium on longer-term cognitive and functional outcomes.

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