Acquisition of Multidrug-Resistant Organisms Among Hospital Patients Hospitalized in Beds Adjacent to Critically Ill Patients

2006 ◽  
Vol 27 (7) ◽  
pp. 675-681 ◽  
Author(s):  
Matan J. Cohen ◽  
Olga Anshelevich ◽  
David Raveh ◽  
Ellen Broide ◽  
Bernard Rudensky ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Multidrug Resistant ◽  
Incidence Rates ◽  
Critically Ill Patient ◽  
Do Not Resuscitate ◽  
Increased Risk ◽  
Multidrug Resistant Pathogens

Objective.To assess whether patients hospitalized in beds physically adjacent to critically ill patients are at increased risk to acquire multidrug-resistant pathogens.Design.Cohort study.Setting.Shaare Zedek Medical Center, a 550-bed medical referral center.Patients.From April to September 2004, we enrolled consecutive newly admitted patients who were hospitalized in beds adjacent to either mechanically ventilated patients or patients designated as “do not resuscitate” (DNR). For each of these patients, we also enrolled a control patient who was not hospitalized in a bed adjacent to a critically ill patient. We collected specimens from the anterior nares, the oral cavity, and the perianal zone at the time of admission and subsequently at 3-day intervals until discharge or death. Specimens were cultured on selective media to detect growth of antibiotic-resistant pathogens, includingAcinetobacter baumannii, methicillin-resistantStaphylococcus aureus(MRSA), extended-spectrum β lactamase (ESBL)–producing Enterobacteriaceae, and vancomycin-resistant enterococci (VRE).Results.We enrolled 46 neighbor-control pairs. Among neighbors and controls, respectively, the incidence rates for isolation ofA. baumanniiwas 8.3 and 4 isolations per 100 patient-days (relative risk [RR], 2.1 [95% confidence interval {CI}, 0.8-5.2];P= .12), the incidence rates for MRSA were 1.4 and 2.6 isolations per 100 patient-days (RR, 0.6 [95% CI, 0.1-2.3];P= .45), the incidence rates for ESBL-producing Enterobacteriaceae were 10.5 and 9 isolations per 100 patient-days (RR, 1.2 [95% CI, 0.6-2.4];P= .84), the incidence rates for VRE were 4.3 and 4.8 isolations per 100 patient-days (RR, 0.9 [95% CI, 0.3-2.4];P= 1), and the composite incidence rate was 21.7 and 16.2 isolations per 100 patient-days (RR, 1.3 [95% CI, 0.8-2.3];P= 0.3).Conclusions.In this pilot study, we did not detect an increased incidence rate of isolation of multidrug-resistant pathogens among patients hospitalized in beds adjacent to critically ill patients. Further studies with larger samples should be conducted in order to generate valid data and provide patients, physicians, and policy makers with a sufficient knowledge base from which decisions can be made.

scholarly journals Elevated serum galectin-1 concentrations are associated with increased risks of mortality and acute kidney injury in critically ill patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257558
Author(s):  
Ruey-Hsing Chou ◽  
Chuan-Tsai Tsai ◽  
Ya-Wen Lu ◽  
Jiun-Yu Guo ◽  
Chi-Ting Lu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Elevated Serum ◽  
Kidney Injury ◽  
The Body ◽  
Icu Admission ◽  
Increased Risk

Background Galectin-1 (Gal-1), a member of the β-galactoside binding protein family, is associated with inflammation and chronic kidney disease. However, the effect of Gal-1 on mortality and acute kidney injury (AKI) in critically-ill patients remain unclear. Methods From May 2018 to March 2020, 350 patients admitted to the medical intensive care unit (ICU) of Taipei Veterans General Hospital, a tertiary medical center, were enrolled in this study. Forty-one patients receiving long-term renal replacement therapy were excluded. Serum Gal-1 levels were determined within 24 h of ICU admission. The patients were divided into tertiles according to their serum Gal-1 levels (low, serum Gal-1 < 39 ng/ml; median, 39–70 ng/ml; high, ≥71 ng/ml). All patients were followed for 90 days or until death. Results Mortality in the ICU and at 90 days was greater among patients with elevated serum Gal-1 levels. In analyses adjusted for the body mass index, malignancy, sepsis, Sequential Organ Failure Assessment (SOFA) score, and serum lactate level, the serum Gal-1 level remained an independent predictor of 90-day mortality [median vs. low: adjusted hazard ratio (aHR) 2.11, 95% confidence interval (CI) 1.24–3.60, p = 0.006; high vs. low: aHR 3.21, 95% CI 1.90–5.42, p < 0.001]. Higher serum Gal-1 levels were also associated with a higher incidence of AKI within 48 h after ICU admission, independent of the SOFA score and renal function (median vs. low: aHR 2.77, 95% CI 1.21–6.34, p = 0.016; high vs. low: aHR 2.88, 95% CI 1.20–6.88, p = 0.017). The results were consistent among different subgroups with high and low Gal-1 levels. Conclusion Serum Gal-1 elevation at the time of ICU admission were associated with an increased risk of mortality at 90 days, and an increased incidence of AKI within 48 h after ICU admission.

scholarly journals Best tigecycline dosing for treatment of infections caused by multidrug-resistant pathogens in critically ill patients with different body weights

2018 ◽  
Vol Volume 12 ◽  
pp. 4171-4179 ◽  
Author(s):  
Mohamed M. Ibrahim ◽  
Abdulla M. Abuelmatty ◽  
Gehan H. Mohamed ◽  
Mohsen A. Nasr ◽  
Amal K. Hussein ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Multidrug Resistant ◽  
Body Weights ◽  
Multidrug Resistant Pathogens

scholarly journals Use of Do-Not-Resuscitate Orders for Critically Ill Patients with ESKD

2020 ◽  
Vol 31 (10) ◽  
pp. 2393-2399 ◽  
Author(s):  
John Danziger ◽  
Miguel Ángel Armengol de la Hoz ◽  
Leo Anthony Celi ◽  
Robert A. Cohen ◽  
Kenneth J. Mukamal
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
The United States ◽  
Chronic Obstructive ◽  
Do Not Resuscitate ◽  
Resuscitation Orders ◽  
Increased Risk ◽  
Major Organ ◽  
Dnr Orders

BackgroundDespite having high comorbidity rates and shortened life expectancy, patients with ESKD may harbor unrealistically optimistic expectations about their prognoses. Whether this affects resuscitation orders is unknown.MethodsTo determine whether do-not-resuscitate (DNR) orders differ among patients with ESKD compared with other critically ill patients, including those with diseases of other major organs, we investigated DNR orders on admission to intensive care units (ICUs) among 106,873 patients in the United States.ResultsMajor organ disease uniformly associated with increased risk of hospital mortality, particularly for cirrhosis (adjusted odds ratio [aOR], 2.67; 95% confidence interval [95% CI], 2.30 to 3.08), and ESKD (aOR, 1.47; 95% CI, 1.31 to 1.65). Compared with critically ill patients without major organ disease, patients with stroke, cancer, heart failure, dementia, chronic obstructive pulmonary disease, and cirrhosis were statistically more likely to have a DNR order on ICU admission; those with ESKD were not. Findings were similar when comparing patients with a single organ disease with those without organ disease. The disconnect between prognosis and DNR use was most notable among Black patients, for whom ESKD (compared with no major organ disease) was associated with a 62% (aOR, 1.62; 95% CI, 1.27 to 2.04) higher odds of hospital mortality, but no appreciable difference in DNR utilization (aOR, 1.06; 95% CI, 0.66 to 1.62).ConclusionsUnlike patients with diseases of other major organs, critically ill patients with ESKD were not more likely to have a DNR order than patients without ESKD. Whether this reflects a greater lack of advance care planning in the nephrology community, as well as a missed opportunity to minimize potentially needless patient suffering, requires further study.

Venous Thromboembolism Prophylaxis: A Narrative Review With a Focus on the High-Risk Critically Ill Patient

2018 ◽  
Vol 34 (11-12) ◽  
pp. 877-888 ◽  
Author(s):  
Tyler C. Lewis ◽  
Jennifer Cortes ◽  
Diana Altshuler ◽  
John Papadopoulos
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Studies ◽  
Health Concern ◽  
Fixed Dose ◽  
Critically Ill Patient ◽  
Increased Risk

Venous thromboembolism (VTE) is a major health concern associated with significant morbidity and mortality. Critically ill patients are at an increased risk of VTE compared to general medical patients due to unique risk factors: prolonged immobilization, invasive lines and devices, certain medications, and acquired thrombophilia. Furthermore, VTE in the critically ill is associated with increased duration of mechanical ventilation, increased length of intensive care unit and hospital stay, and a trend toward increased mortality. Clinical practice guidelines therefore recommend VTE prophylaxis with either subcutaneous heparin or low-molecular-weight heparin for all critically ill patients without contraindication. Yet, many patients will develop VTE despite appropriate pharmacologic prophylaxis, which has led to interest in risk-stratifying critically ill patients for more aggressive prophylaxis strategies. Recent research identified patients at highest risk of failure of thromboprophylaxis and provided insight into the pathophysiologic mechanisms. Obesity and the receipt of vasopressors are 2 risk factors consistently identified in observational studies; further clinical data support decreased absorption of anticoagulant administered via the subcutaneous route as the likely mechanism behind thromboprophylaxis failure in these patient populations. Several studies have investigated novel thromboprophylaxis strategies to circumvent pharmacokinetic limitations in patients who are obese or on vasopressors: increased fixed-dose, weight-based subcutaneous, or continuous intravenous infusion of a prophylactic dose of anticoagulant has shown promise in limited studies; however, the results have yet to demonstrate superiority compared to current standard-of-care. This review discusses observational studies identifying patients at risk of thromboprophylaxis failure and critiques clinical studies evaluating novel thromboprophylaxis strategies in high-risk, critically ill patients with a focus on their limitations. Future studies are currently being conducted that will provide further guidance into the appropriate use of individualized thromboprophylaxis.

scholarly journals Fecal Microbial Transplantation for the Treatment of Persistent Multidrug-Resistant Klebsiella pneumoniae Infection in a Critically Ill Patient

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
V. Ueckermann ◽  
E. Hoosien ◽  
N. De Villiers ◽  
J. Geldenhuys
Keyword(s):  
Clostridium Difficile ◽  
Klebsiella Pneumoniae ◽  
Critically Ill ◽  
Broad Spectrum ◽  
Critically Ill Patients ◽  
Multidrug Resistant ◽  
Common Finding ◽  
Critically Ill Patient ◽  
Organ Support ◽  
Broad Spectrum Antibiotics

Dysbiosis of the microbiome is a common finding in critically ill patients, who receive broad-spectrum antibiotics and various forms of organ support. Multidrug-resistant (MDR) organisms are a growing threat in all areas of medicine, but most markedly in the critically ill, where there is both loss of host defences and widespread use of broad spectrum antibiotics. We present a case of a critically ill patient with persistent MDR Klebsiella pneumoniae infection, successfully treated with fecal microbiota transplantation (FMT), using stool of a rigorously-screened, healthy donor. FMT for Clostridium difficile colitis has been well described in the literature and is an established therapy for recurrent infections with Clostridium difficile. The use of FMT for other multidrug-resistant organisms is less frequently described, particularly in the context of critically ill patients. In our case, we have culture-documented clearance of the MDR Klebsiella pneumoniae form a patient of FMT.

scholarly journals Transmission of Acinetobacter baumannii by Surgical Masks During the COVID-19 Pandemic

2021 ◽  
Vol 1 (S1) ◽  
pp. s51-s51
Author(s):  
Lisa Saidel ◽  
Abraham Borer ◽  
Orli Sagi
Keyword(s):  
Acinetobacter Baumannii ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multidrug Resistant ◽  
Infection Prevention And Control ◽  
Critically Ill Patient ◽  
Surgical Masks ◽  
Great Persistence ◽  
Healthcare Associated ◽  
Hospital Acquired

Background:Acinetobacter baumannii, one of the major causes of nosocomial infections in modern healthcare systems, is characterized by its great persistence in the environment and by its ability to rapidly develop resistance to many antimicrobials. Most A. baumannii infections occur in intubated critically ill patients, causing ventilator-associated pneumonia which is a leading cause of mortality. During the coronavirus disease 19 (COVID-19) pandemic an increase in hospital-acquired carbapenem-resistant A. baumannii (CRAB) infection and colonization in acute-care hospitals has been described. CRAB healthcare-associated infections are often linked to breaches of infection prevention and control (IPC). Beginning in April 2020, our hospital’s IPC unit ordered mandatory universal masking for all healthcare workers (HCWs). Shortages of personal protective equipment during the COVID-19 pandemic led to extended use of surgical face masks by HCWs in our hospital. We investigated whether the extended use of surgical face masks was linked to an increase of CRAB colonization in our intubated critically ill patients. Methods: Surgical masks were collected from doctors, nurses, and housekeeping staff working in 2 internal medicine departments, each including a 4-bed unit for intubated critically ill patients. All surgical masks were worn continuously for 4–5 hours before removal. “Cases“ were defined as HCWs who treated CRAB colonized critically ill patients. “Controls“ were defined as HCWs who did not enter the critically ill patient unit. Surgical masks were incubated with BHI enrichment broth (HyLabs Rehovot, Israel) for 48 hours at 35°C. BHI was seeded on multidrug-resistant (MDR)–selective CHROMagar plates (HyLabs) and incubated overnight at 35°C. Identification was performed using MALDI-ToF mass spectrophotometry (bioMérieux, France). Susceptibility was tested using Vitek 2 (bioMérieux). Results: In total, 55 HCWs participated in the study: 25 cases and 30 controls. Masks from 10 cases (40%) were colonized with Acinetobacter spp versus only 3 masks (10%) from controls (OR, 5.98; 95% CI, 1.42–25; P = .012). Of 13 masks contaminated with Acinetobacter spp, 8 of 10 contaminated masks among cases were colonized with CRAB, whereas only 1 of 3 masks of controls was colonized with CRAB. Conclusions: During the COVID-19 pandemic, extended surgical mask use while treating patients colonized with CRAB increased mask contamination with this bacterium. Surgical masks should be changed after treating a patient colonized with CRAB the same way gown and glove removal and hand hygiene are performed.Funding: NoDisclosures: None

scholarly journals Elevated serum galectin-1 concentrations are associated with increased risks of mortality and acute kidney injury in critically ill patients

2020 ◽  
Author(s):  
Ruey-Hsing Chou ◽  
Chuan-Tsai Tsai ◽  
Ya-Wen Lu ◽  
Jiun-Yu Guo ◽  
Chi-Ting Lu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Elevated Serum ◽  
Kidney Injury ◽  
The Body ◽  
Icu Admission ◽  
Increased Risk

Abstract Background: Galectin-1 (Gal-1), a member of the β-galactoside binding protein family, is associated with inflammation and chronic kidney disease. However, the effect of Gal-1 on mortality and acute kidney injury (AKI) in critically ill patients remains unclear.Methods: From May 2018 to March 2020, 350 patients admitted to the medical intensive care unit (ICU) of Taipei Veterans General Hospital, a tertiary medical center, were enrolled in this study. Forty-one patients receiving long-term renal replacement therapy were excluded. Serum Gal-1 levels were determined within 24 h of ICU admission. The patients were divided into three equally sized groups according to their serum Gal-1 levels (low, serum Gal-1 < 39 ng/ml; median, 39–70 ng/ml; high, >71 ng/ml). All patients were followed for 90 days or until death.Results: Mortality in the ICU and at 90 days was greater among patients with elevated serum Gal-1 levels. In analyses adjusted for the body mass index, malignancy, sepsis, Sequential Organ Failure Assessment (SOFA) score, and serum lactate level, the serum Gal-1 level remained an independent predictor of 90-day mortality [median vs. low: adjusted hazard ratio (aHR) 2.11, 95% confidence interval (CI) 1.24–3.60, p = 0.006; high vs. low: aHR 3.21, 95% CI 1.90–5.42, p < 0.001]. Higher serum Gal-1 levels were also associated with a higher incidence of AKI within 48 h after ICU admission, independent of the SOFA score and renal function (median vs. low: aHR 2.77, 95% CI 1.21–6.34, p = 0.016; high vs. low: aHR 2.88, 95% CI 1.20–6.88, p = 0.017). The results were consistent among different subgroups with high and low Gal-1 levels.Conclusion: Serum Gal-1 elevation at the time of ICU admission were associated with an increased risk of mortality at 90 days, and an increased incidence of AKI within 48 h after ICU admission.

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

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