Pathogens in Early-Onset and Late-Onset Intensive Care Unit–Acquired Pneumonia

2007 ◽  
Vol 28 (4) ◽  
pp. 389-397 ◽  
Author(s):  
K. M. C. Verhamme ◽  
W. De Coster ◽  
L. De Roo ◽  
H. De Beenhouwer ◽  
G. Nollet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Onset ◽  
Late Onset ◽  
Clinical Signs ◽  
Positive Culture ◽  
Signs And Symptoms ◽  
Positive Culture Result ◽  
Multiple Drugs

Objectives.To compare the type of pathogens isolated from patients with early-onset intensive care unit (ICU)-acquired pneumonia with those isolated from patients with late-onset ICU-acquired pneumonia and to study risk factors for the isolation of pathogens that are potentially resistant to multiple drugs.Design.Prospective cohort study.Setting.Patients admitted to the ICU of a 677-bed, university-affiliated teaching hospital in Belgium during 1997-2002.Methods.ICU-acquired pneumonia was defined as a case of pneumonia that occurred 2 days or more after admission to the ICU in combination with a positive results of radiologic analysis, clinical signs and symptoms, and a positive culture result. All cases of pneumonia were categorized as either early onset (within 7 days after admission) and late onset (7 days or more after admission), with or without previous antibiotic treatment, and the corresponding pathogens were analyzed. Risk factors for the isolation of pathogens potentially resistant to multiple drugs (ie, Pseudomonas aeruginosa, Serratia marcescens, Enterobacter species, Morganella morganii, methicillin-resistant Stapylococcus aureus, Citrobacter species, Acinetobacter species, Burkholderia species, extended-spectrum β-lactamase–producing pathogens, and Stenotrophomonas maltophilia) were analyzed using logistic regression analysis.Results.A total of 4,200 patients stayed at the ICU for 2 or more days, 298 of whom developed ICU-acquired pneumonia, for an overall incidence of 13 cases (95% confidence interval [CI], 11-14 cases) per 1,000 ICU-days. Pathogens potentially resistant to multiple drugs were isolated from 52% of patients with early-onset pneumonia. Risk factors for the isolation of these pathogens were greater age and previous receipt of antibiotic prophylaxis (adjusted odds ratio [aOR], 4.6 [95% CI, 1.6-13.0]) or antibiotic therapy (aOR, 8.2 [95% CI, 2.8-23.8]). The length of ICU admission and hospital stay were weaker risk factors for the isolation of these pathogens.Conclusions.Pathogens potentially resistant to multiple drugs were isolated in 52% of cases of early-onset ICU-acquired pneumonia. Previous antibiotic use (both prophylactic and therapeutic) is the main risk factor for the isolation of these pathogens.

NEONATAL SEPSIS AND IDENTIFICATION OF RISK FACTORS: STUDY IN AVBRH HOSPITAL SAWANGI

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Pramod P. Singhavi
Keyword(s):  
Risk Factors ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Signs And Symptoms ◽  
Premature Rupture ◽  
Maternal Risk ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Meconium Stained Amniotic Fluid

Introduction: India has the highest incidence of clinical sepsis i.e.17,000/ 1,00,000 live births. In Neonatal sepsis septicaemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections can be included. Mortality in the neonatal period each year account for 41% (3.6 million) of all deaths in children under 5 years and most of these deaths occur in low income countries and about one million of these deaths are due to infectious causes including neonatal sepsis, meningitis, and pneumonia. In early onset neonatal sepsis (EOS) Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis. Culture results take up to 48 hours and may give false-positive or low-yield results because of the antenatal antibiotic exposure. Reviews of risk factors has been used globally to guide the development of management guidelines for neonatal sepsis, and it is similarly recommended that such evidence be used to inform guideline development for management of neonatal sepsis. Material and Methods: This study was carried out using institution based cross section study . The total number neonates admitted in the hospital in given study period was 644, of which 234 were diagnosed for neonatal sepsis by the treating pediatrician based on the signs and symptoms during admission. The data was collected: Sociodemographic characteristics; maternal information; and neonatal information for neonatal sepsis like neonatal age on admission, sex, gestational age, birth weight, crying immediately at birth, and resuscitation at birth. Results: Out of 644 neonates admitted 234 (36.34%) were diagnosed for neonatal sepsis by the paediatrician based on the signs and symptoms during admission. Of the 234 neonates, 189 (80.77%) infants were in the age range of 0 to 7 days (Early onset sepsis) while 45 (19.23%) were aged between 8 and 28 days (Late onset sepsis). Male to female ratio in our study was 53.8% and 46% respectively. Out of total 126 male neonates 91(72.2%) were having early onset sepsis while 35 (27.8%) were late onset type. Out of total 108 female neonates 89(82.4%) were having early onset sepsis while 19 (17.6%) were late onset type. Maternal risk factors were identified in 103(57.2%) of early onset sepsis cases while in late onset sepsis cases were 11(20.4%). Foul smelling liquor in early onset sepsis and in late onset sepsis was 10(5.56%) and 2 (3.70%) respectively. In early onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 21(11.67%), 19 (10.56%), 20(11.11%) and 33 (18.33%) cases respectively. In late onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 2 (3.70%), 1(1.85%), 3 (5.56%) and 3 (5.56%) cases respectively. Conclusion: Maternal risk identification may help in the early identification and empirical antibiotic treatment in neonatal sepsis and thus mortality and morbidity can be reduced.

Early- and late-onset ventilator-associated pneumonia acquired in the intensive care unit: comparison of risk factors

2008 ◽  
Vol 23 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Marine Giard ◽  
Alain Lepape ◽  
Bernard Allaouchiche ◽  
Claude Guerin ◽  
Jean-Jacques Lehot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Late Onset ◽  
Ventilator Associated Pneumonia

scholarly journals Myxedema Coma in a Hypothermic, Obtunded Patient with Post-renal Acute Kidney Injury and Bacteremia in the Intensive Care Unit

2019 ◽  
Vol 14 (2) ◽  
pp. 38-41
Author(s):  
Hernan Dario Franco Lopez ◽  
Sameer Sharif ◽  
John Centofanti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Obstructive Uropathy ◽  
Clinical Signs ◽  
Kidney Injury ◽  
Signs And Symptoms ◽  
Initial Diagnosis ◽  
Hypothyroid Patient ◽  
Profound Hypothermia ◽  
Myxedema Coma

We present a case of a hypothermic, unconscious patient transferred to our Intensive Care Unit with sepsis requiring mechanical ventilation. The absence of any known past medical history as well as concurrent obstructive uropathy and bacteremia made initial diagnosis challenging. He was eventually found to be in myxedema coma in light of evolving signs and laboratory investigations. This case emphasizes the need to consider myxedema coma in the differential diagnosis of profound hypothermia, especially when other clinical signs and symptoms may obscure its initial diagnosis, and lead clinicians to focus on the triggering event in isolation rather than concurrently managing hypothyroidism. This case highlights a challenging presentation of an uncommon, but life-threatening condition. We discuss the signs and symptoms present in the hypothyroid patient with myxedema coma; emphasize the pathophysiology of myxedema coma as well as the evidence-based acute management of this condition.

Treatment Outcomes Of Patients With Early-Onset And Late-Onset Intensive Care Unit (ICU) Pneumonia

2011 ◽  
Author(s):  
Kimbal D. Ford ◽  
Ernesto G. Scerpella ◽  
Paula Peyrani ◽  
Nadia Z. Haque ◽  
Verna L. Welch ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Treatment Outcomes ◽  
Early Onset ◽  
Late Onset
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