scholarly journals Clinical Utility of Rapid Pathogen Identification for Detecting the Causative Organisms in Sepsis: A Single-Center Study in Korea

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Won-Young Kim ◽  
Eun Suk Jeong ◽  
Insu Kim ◽  
Kwangha Lee
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Intensive Care Unit Admission ◽  
Antimicrobial Therapy ◽  
Odds Ratio ◽  
Pathogen Identification ◽  
Maldi Tof Ms ◽  
Maldi Tof ◽  
Tof Ms

Purpose. The aim of this pre- and postintervention cohort study was evaluating how effectively rapid pathogen identification with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) detected the causative organisms in sepsis.Methods. All consecutive adult patients who had bacteremia within 72 h of intensive care unit admission and met ≥2 quick Sequential Organ Failure Assessment criteria at intensive care unit admission were analyzed. The patients whose microorganisms were identified via MALDI-TOF MS between March 2014 and February 2016 formed the postintervention group. The patients whose microorganisms were identified by using conventional methods between March 2011 and February 2013 formed the preintervention group.Results. The postintervention group (n=58) had a shorter mean time from blood draw to receiving the antimicrobial susceptibility results than the preintervention group (n=40) (90.2 ± 32.1 vs. 108.7 ± 43.1 h;p=0.02). The postintervention group was also more likely to have received active antimicrobial therapy by the time the susceptibility report became available (77% vs. 47%;p=0.005). Its 28-day mortality was also lower (40% vs. 70%;p=0.003). Univariate analysis showed that identification via MALDI-TOF MS (odds ratio, 0.28; 95% confidence interval, 0.12–0.66;p=0.004) and active therapy (odds ratio, 0.38; 95% confidence interval, 0.16–0.95;p=0.04) were associated with lower 28-day mortality.Conclusion. Rapid microorganism identification via MALDI-TOF MS followed by appropriate antimicrobial therapy may improve the clinical outcomes of patients with sepsis.

scholarly journals The utility of MALDI-TOF MS for outbreak investigation in the neonatal intensive care unit

2020 ◽  
Vol 179 (12) ◽  
pp. 1843-1849
Author(s):  
Maskit Bar-Meir ◽  
Elihay Berliner ◽  
Livnat Kashat ◽  
David A. Zeevi ◽  
Marc V. Assous
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Outbreak Investigation ◽  
Maldi Tof Ms ◽  
Maldi Tof ◽  
Tof Ms

scholarly journals Whole-genome sequence-informed MALDI-TOF MS diagnostics reveal importance of Klebsiella oxytoca group in invasive infections: a retrospective clinical study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Aline Cuénod ◽  
Daniel Wüthrich ◽  
Helena M. B. Seth-Smith ◽  
Chantal Ott ◽  
Christian Gehringer ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Clinical Impact ◽  
Whole Genome Sequence ◽  
Specific Marker ◽  
Invasive Infection ◽  
Maldi Tof Ms ◽  
Maldi Tof ◽  
Species Specific ◽  
Tof Ms

Abstract Background Klebsiella spp. are opportunistic pathogens which can cause severe infections, are often multi-drug resistant and are a common cause of hospital-acquired infections. Multiple new Klebsiella species have recently been described, yet their clinical impact and antibiotic resistance profiles are largely unknown. We aimed to explore Klebsiella group- and species-specific clinical impact, antimicrobial resistance (AMR) and virulence. Methods We analysed whole-genome sequence data of a diverse selection of Klebsiella spp. isolates and identified resistance and virulence factors. Using the genomes of 3594 Klebsiella isolates, we predicted the masses of 56 ribosomal subunit proteins and identified species-specific marker masses. We then re-analysed over 22,000 Matrix-Assisted Laser Desorption Ionization - Time Of Flight (MALDI-TOF) mass spectra routinely acquired at eight healthcare institutions in four countries looking for these species-specific markers. Analyses of clinical and microbiological endpoints from a subset of 957 patients with infections from Klebsiella species were performed using generalized linear mixed-effects models. Results Our comparative genomic analysis shows group- and species-specific trends in accessory genome composition. With the identified species-specific marker masses, eight Klebsiella species can be distinguished using MALDI-TOF MS. We identified K. pneumoniae (71.2%; n = 12,523), K. quasipneumoniae (3.3%; n = 575), K. variicola (9.8%; n = 1717), “K. quasivariicola” (0.3%; n = 52), K. oxytoca (8.2%; n = 1445), K. michiganensis (4.8%; n = 836), K. grimontii (2.4%; n = 425) and K. huaxensis (0.1%; n = 12). Isolates belonging to the K. oxytoca group, which includes the species K. oxytoca, K. michiganensis and K. grimontii, were less often resistant to 4th-generation cephalosporins than isolates of the K. pneumoniae group, which includes the species K. pneumoniae, K. quasipneumoniae, K. variicola and “K. quasivariicola” (odds ratio = 0.17, p < 0.001, 95% confidence interval [0.09,0.28]). Within the K. pneumoniae group, isolates identified as K. pneumoniae were more often resistant to 4th-generation cephalosporins than K. variicola isolates (odds ratio = 2.61, p = 0.003, 95% confidence interval [1.38,5.06]). K. oxytoca group isolates were found to be more likely associated with invasive infection to primary sterile sites than K. pneumoniae group isolates (odds ratio = 2.39, p = 0.0044, 95% confidence interval [1.05,5.53]). Conclusions Currently misdiagnosed Klebsiella spp. can be distinguished using a ribosomal marker-based approach for MALDI-TOF MS. Klebsiella groups and species differed in AMR profiles, and in their association with invasive infection, highlighting the importance for species identification to enable effective treatment options.

scholarly journals Hemorrhage and venous thromboembolism in critically ill patients with COVID-19

2021 ◽  
Vol 9 ◽  
pp. 205031212110201
Author(s):  
Chenyang Qiu ◽  
Tong Li ◽  
Guoqing Wei ◽  
Jun Xu ◽  
Wenqiao Yu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Blood Transfusion ◽  
Confidence Interval ◽  
Intensive Care Unit Admission ◽  
Extracorporeal Membrane Oxygenation ◽  
Odds Ratio ◽  
Community Acquired Pneumonia ◽  
Bleeding Events

Objective: The majority of patients with COVID-19 showed mild symptoms. However, approximately 5% of them were critically ill and require intensive care unit admission for advanced life supports. Patients in the intensive care unit were high risk for venous thromboembolism and hemorrhage due to the immobility and anticoagulants used during advanced life supports. The aim of the study was to report the incidence and treatments of the two complications in such patients. Method: Patients with COVID-19 (Group 1) and patients with community-acquired pneumonia (Group 2) that required intensive care unit admission were enrolled in this retrospective study. Their demographics, laboratory results, ultrasound findings and complications such as venous thromboembolism and hemorrhage were collected and compared. Results: Thirty-four patients with COVID-19 and 51 patients with community-acquired pneumonia were included. The mean ages were 66 and 63 years in Groups 1 and 2, respectively. Venous thromboembolism was detected in 6 (18%) patients with COVID-19 and 18 (35%) patients with community-acquired pneumonia (P = 0.09). The major type was distal deep venous thrombosis. Twenty-one bleeding events occurred in 12 (35%) patients with COVID-19 and 5 bleeding events occurred in 5 (10%) patients with community-acquired pneumonia, respectively (P = 0.01). Gastrointestinal system was the most common source of bleeding. With the exception of one death due to intracranial bleeding, blood transfusion with or without surgical/endoscopic treatments was able to manage the bleeding in the remaining patients. Multivariable logistic regression showed increasing odds of hemorrhage with extracorporeal membrane oxygenation (odds ratio: 13.9, 95% confidence interval: 4.0–48.1) and COVID-19 (odds ratio: 4.7, 95% confidence interval: 1.2–17.9). Conclusion: Venous thromboembolism and hemorrhage were common in both groups. The predominant type of venous thromboembolism was distal deep venous thrombosis, which presented a low risk of progression. COVID-19 and extracorporeal membrane oxygenation were risk factors for hemorrhage. Blood transfusion with or without surgical/endoscopic treatments was able to manage it in most cases.

MALDI-TOF MS typing of a nosocomial methicillin-resistantStaphylococcus aureusoutbreak in a neonatal intensive care unit

2016 ◽  
Vol 72 (4) ◽  
pp. 219-225 ◽  
Author(s):  
Deborah Steensels ◽  
Ariane Deplano ◽  
Olivier Denis ◽  
Anne Simon ◽  
Alexia Verroken
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Maldi Tof Ms ◽  
Maldi Tof ◽  
Tof Ms

Māori health outcomes in an intensive care unit in Aotearoa New Zealand

2021 ◽  
pp. 0310057X2198971
Author(s):  
M Atif Mohd Slim ◽  
Hamish M Lala ◽  
Nicholas Barnes ◽  
Robert A Martynoga
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Renal Replacement Therapy ◽  
Confidence Interval ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
One Year ◽  
Maori Health

Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand’s Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. Our study aimed to describe Māori health outcomes in our intensive care unit and identify inequities. We performed a retrospective audit of prospectively entered data in the Australian and New Zealand Intensive Care Society database for all general intensive care unit admissions over 15 years of age to Waikato Hospital from 2014 to 2018 ( n = 3009). Primary outcomes were in–intensive care unit and in-hospital mortality. The secondary outcome was one-year mortality. In our study, Māori were over-represented relative to the general population. Compared to non-Māori, Māori patients were younger (51 versus 61 years, P < 0.001), and were more likely to reside outside of the Waikato region (37.2% versus 28.0%, P < 0.001) and in areas of higher deprivation ( P < 0.001). Māori had higher admission rates for trauma and sepsis ( P < 0.001 overall) and required more renal replacement therapy ( P < 0.001). There was no difference in crude and adjusted mortality in–intensive care unit (16.8% versus 16.5%, P = 0.853; adjusted odds ratio 0.98 (95% confidence interval 0.68 to 1.40)) or in-hospital (23.7% versus 25.7%, P = 0.269; adjusted odds ratio 0.84 (95% confidence interval 0.60 to 1.18)). One-year mortality was similar (26.1% versus 27.1%, P=0.6823). Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.

Rapid Pathogen Identification With Direct Application of MALDI-TOF Mass Spectrometry on an Endophthalmitis Vitreous Sample Without Prior Culture

2019 ◽  
Vol 3 (4) ◽  
pp. 255-259 ◽  
Author(s):  
Lindsay Y. Chun ◽  
Laura Dolle Molle ◽  
Olaf Schneewind ◽  
Dominique Missiakas ◽  
Kathleen G. Beavis ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Direct Analysis ◽  
Causative Organism ◽  
Pathogen Identification ◽  
Maldi Tof Ms ◽  
Hand Motion ◽  
Maldi Tof ◽  
Microbiological Methods ◽  
Vitreous Sample ◽  
Tof Ms

Purpose:We report a case of a 72-year-old man with bleb-related endophthalmitis (BRE) whose vitreous samples were directly analyzed with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) to rapidly identify the causative organism, whereas the results from conventional microbiological techniques were negative.Methods:We analyzed BRE vitreous samples with MALDI-TOF MS (Vitek MS, bioMérieux) for rapid pathogen identification without prior culture. Samples were also analyzed with standard microbiological methods.Results:Within 1 hour of sample acquisition, MALDI-TOF MS identified Gemella sanguinis from the undiluted vitreous sample from vitrectomy without prior culture with a confidence value of 99.7%. Gram stain and cultures from aqueous and vitreous samples were negative for 28 days after acquisition. The patient’s right-eye vision improved from hand motion to 20/50 2 months later.Conclusions:Our findings suggest that the direct analysis of intraocular samples with MALDI-TOF MS could be a novel, promising adjuvant method of rapid endophthalmitis diagnosis.

scholarly journals The clinical implications of sinus tachycardia in mild COVID-19 infection: A retrospective cohort study

2021 ◽  
Vol 9 ◽  
pp. 205031212110549
Author(s):  
Jenny Yi Chen Hsieh ◽  
Juliana Yin Li Kan ◽  
Shaikh Abdul Matin Mattar ◽  
Yan Qin
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Sinus Tachycardia ◽  
High Dependency ◽  
General Wards

Objectives: This study aims to estimate the prevalence of sinus tachycardia in hospitalized patients with mild COVID-19 infection and to identify the clinical, radiological, and biological characteristics associated with sinus tachycardia. Methods: A retrospective cohort study was conducted on patients with mild COVID-19 infection and sinus tachycardia during hospitalization. Outcomes measured included incidences of venous thromboembolism, high-dependency/intensive care unit admission, laboratory parameters, and radiological findings. Results: A total of 236 COVID-19 positive patients admitted to Singapore General Hospital isolation general wards from 1 June 2020 to 30 June 2020 were included in this study. Ninety-seven (41.1%) patients had sinus tachycardia on or during their admission. All patients were monitored in general wards and discharged to community quarantine facilities. None required oxygen support or high-dependency/intensive care unit admission. Sinus tachycardia was associated with increased C-reactive protein level (odds ratio = 1.033, 95% confidence interval = 1.002–1.066), abnormal chest X-ray findings (odds ratio = 3.142, 95% confidence interval = 1.390–7.104), and longer hospitalization (odds ratio = 1.117, 95% confidence interval = 1.010–1.236). There was no significant statistical association between sinus tachycardia and incidences of venous thromboembolism. Conclusion: This study suggests that patients with mild COVID-19 infection and concurrent sinus tachycardia are more likely to have higher inflammatory marker levels, abnormal imaging, and prolonged hospitalization. However, no significant association between sinus tachycardia and thromboembolism is identified in mild COVID-19 infection.

scholarly journals Direct Rapid Identification from Positive Blood Cultures by MALDI-TOF MS: Specific Focus on Turnaround Times

2021 ◽  
Author(s):  
Hazan Zengin Canalp ◽  
Banu Bayraktar
Keyword(s):  
Blood Culture ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Pathogen Identification ◽  
Short Term ◽  
Maldi Tof Ms ◽  
Maldi Tof ◽  
Solid Media ◽  
Time Required ◽  
Tof Ms

Using MALDI-TOF MS directly from blood culture bottles reduces the time required for pathogen identification, and the turnaround times for final identification have been compared with overnight incubation from solid media in previous studies. However, identification from a short incubation of agar plates has been increasingly accepted and successfully implemented in routine laboratories, but there is no data comparing direct MALDI-TOF MS with the short-term, incubated agar plates.

scholarly journals Factors associated with cerebral edema in children under 5 years of age admitted in an intensive care unit and their outcome

2019 ◽  
Vol 7 ◽  
pp. 205031211987462
Author(s):  
Shamin Islam ◽  
Monira Sarmin ◽  
Tahmeed Ahmed ◽  
Farzana Afroze ◽  
Mohammod Jobayer Chisti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Cerebral Edema ◽  
Odds Ratio ◽  
Fatal Outcome ◽  
Severe Malnutrition ◽  
Clinical Predictors ◽  
Record System ◽  
Children Under 5

Objective: We aimed to evaluate risk factors and outcome of cerebral edema in children with diarrhea. Methods: In this retrospective chart analysis, data of all diarrheal children under 5 years of age having convulsion and admitted in intensive care unit were retrieved from an electronic medical record system of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh, from 1st January 2011 to 31st December 2016. Comparison of clinical and laboratory characteristics was made between children with (cases = 22) and without cerebral edema (controls = 66). Results: Cases more often had a fatal outcome than controls (36% vs 8%, p = 0.003). In logistic regression analysis, after adjusting for potential confounders, the cases were independently associated with respiratory distress (odds ratio = 5.5, confidence interval = 1.55–19.62, p = 0.008), severe sepsis (odds ratio = 4.6, confidence interval = 1.24–16.77, p = 0.022), and severe malnutrition (odds ratio = 0.16, confidence interval = 0.04–0.74, p = 0.019). A rapid drop (>0.5 mmol/L per hour) in serum sodium did not have any impact on developing cerebral edema (p = 0.090). Conclusion: Identification of simple clinical predictors may help in the early treatment of cerebral edema that may further help in reducing deaths in such children especially in resource-poor settings. However, further research with prospective design is needed to consolidate our observation.

Arrhythmias in the paediatric intensive care unit: a prospective study of the rates and predictors of arrhythmias in children without underlying cardiac disease

2014 ◽  
Vol 25 (7) ◽  
pp. 1281-1289 ◽  
Author(s):  
Gina N. Cassel-Choudhury ◽  
Scott I. Aydin ◽  
Iris Toedt-Pingel ◽  
H. Michael Ushay ◽  
James S. Killinger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ventricular Tachycardia ◽  
Confidence Interval ◽  
Supraventricular Tachycardia ◽  
Cardiac Disease ◽  
Odds Ratio ◽  
Paediatric Intensive Care Unit ◽  
Paediatric Intensive Care ◽  
Central Venous

AbstractObjectiveArrhythmias are common in patients admitted to the paediatric intensive care unit. We sought to identify the rates of occurrence and types of arrhythmias, and determine whether an arrhythmia was associated with illness severity and paediatric intensive care unit length of stay.DesignThis is a prospective, observational study of all patients admitted to the paediatric intensive care unit at the Children’s Hospital at Montefiore from March to June 2012. Patients with cardiac disease or admitted for the treatment of primary arrhythmias were excluded. Clinical and laboratory data were collected and telemetry was reviewed daily. Tachyarrhythmias were identified as supraventricular tachycardia, ventricular tachycardia, and arrhythmias causing haemodynamic compromise or for which an intervention was performed.ResultsA total of 278 patients met the inclusion criteria and were analysed. There were 97 incidences of arrhythmia in 53 patients (19%) and six tachyarrhythmias (2%). The most common types of arrhythmias were junctional rhythm (38%), premature atrial contractions (24%), and premature ventricular contractions (22%). Tachyarrhythmias included three supraventricular tachycardia (50%) and three ventricular tachycardia (50%). Of the six tachyarrhythmias, four were related to placement or migration of central venous lines and two occurred during aminophylline infusion. Patients with an arrhythmia had longer duration of mechanical ventilation and paediatric intensive care unit stay (p<0.001). In multivariate analysis, central venous lines (odds ratio 3.1; 95% confidence interval 1.3–7.2, p=0.009) and aminophylline use (odds ratio 5.1; 95% confidence interval 1.7–14.9, p=0.003) were independent predictors for arrhythmias.ConclusionsArrhythmias were common in paediatric intensive care unit patients (19%), although tachyarrhythmias occurred rarely (2%). Central venous lines and use of aminophylline were identified as two clinical factors that may be associated with development of an arrhythmia.

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