scholarly journals Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2908
Author(s):  
Björn Weiss ◽  
Fridtjof Schiefenhövel ◽  
Julius J. Grunow ◽  
Michael Krüger ◽  
Claudia D. Spies ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Medical Center ◽  
Final Analysis ◽  
Infectious Complications ◽  
Adrenocortical Function ◽  
Secondary Outcome ◽  
Induction Agent ◽  
Postoperative Sepsis ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Background: Etomidate is typically used as an induction agent in cardiac surgery because it has little impact on hemodynamics. It is a known suppressor of adrenocortical function and may increase the risk for post-operative infections, sepsis, and mortality. The aim of this study was to evaluate whether etomidate increases the risk of postoperative sepsis (primary outcome) and infections (secondary outcome) compared to propofol. Methods: This was a retrospective before–after trial (IRB EA1/143/20) performed at a tertiary medical center in Berlin, Germany, between 10/2012 and 01/2015. Patients undergoing cardiac surgery were investigated within two observation intervals, during which etomidate and propofol were the sole induction agents. Results: One-thousand, four-hundred, and sixty-two patients, and 622 matched pairs, after caliper propensity-score matching, were included in the final analysis. Sepsis rates did not differ in the matched cohort (etomidate: 11.5% vs. propofol: 8.2%, p = 0.052). Patients in the etomidate interval were more likely to develop hospital-acquired pneumonia (etomidate: 18.6% vs. propofol: 14.0%, p = 0.031). Conclusion: Our study showed that a single-dose of etomidate is not statistically associated with higher postoperative sepsis rates after cardiac surgery, but is associated with a higher incidence of hospital-acquired pneumonia. However, there is a notable trend towards a higher sepsis rate.

scholarly journals Etiology, incidence and mortality in patients with ventilator-associated pneumonia in adult general surgery and cardiac surgery intensive care units in University Hospital Dubrava

2020 ◽  
Vol 39 (4) ◽  
pp. 124-128
Author(s):  
Andrea Karin ◽  
Andrej Šribar ◽  
Marko Pražetina ◽  
Katerina Bakran ◽  
Jasminka Peršec
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Units ◽  
General Surgery ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Timely Initiation ◽  
Incidence And Mortality ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Ventilator-associated pneumonia (VAP) and hospital acquired pneumonia (HAP) strongly contribute to morbidity and mortality in intensive care units. Hospital acquired pneumonia (HAP) is pneumonia occurring 48 hours upon admission and appears not to be incubating at the time of admission. Ventilator-associated pneumonia (VAP) is a type of HAP developing in intubated patients after more than 48 hours upon mechanical ventilation. HAP and VAP are common and serious complications present in hospitalized patients. Since the diagnosis of VAP and HAP are rarely documented, we wanted to assess the incidence of VAP in General Surgery and Cardiac Surgery Intensive Care Units in 2018 and analyse the patients and procedures related factors. Patients intubated and ventilated more than 96 hours during 2018 were included. Our findings have shown that incidence of VAP in two analysed ICUs in UH Dubrava is in line with VAP incidence found in literature due to successful preventive strategies and timely initiation of antimicrobial therapy and other adjunctive procedures.

scholarly journals 1032. Evaluation of a Multiplex Rapid Diagnostic Panel in Respiratory Specimens from Critically Ill Patients with Hospital-Acquired Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S606-S607
Author(s):  
Bradley J Erich ◽  
Abdullah Kilic ◽  
Elizabeth Palavecino ◽  
John Williamson ◽  
James Johnson ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Diagnostic Tests ◽  
Clinical Decision Making ◽  
Medical Center ◽  
Academic Medical Center ◽  
Rapid Diagnostic Tests ◽  
Treatment Team ◽  
Hospital Acquired Pneumonia ◽  
The Cost ◽  
Hospital Acquired

Abstract Background Rapid diagnostic tests can be a valuable aide in clinical decision-making but often cost more than traditional cultures. Prior to its implementation at our institution, we sought to evaluate the potential clinical and financial impact of using the FilmArray® Pneumonia Panel® (FP panel) in patients with hospital-acquired pneumonia (HAP). Methods This was a retrospective, observational, comparative study conducted at an 885-bed academic medical center. Respiratory samples obtained by bronchoalveolar lavage or tracheal aspiration from adult intensive care unit (ICU) patients with a diagnosis of HAP from Nov 2019 – Feb 2020 were tested by the FP panel in addition to routine cultures. Medical records were reviewed to determine potential changes in antimicrobial therapy if FP panel results were known by the treatment team in real time. A cost analysis was also performed incorporating the cost of the FP panel and the savings associated with the potential avoidance of antibiotics and other rapid diagnostic tests normalized per patient. Results 56 patients met study criteria. FP panel results could have prompted a change in therapy in 36 (64.3%) patients, with a mean reduction in time to optimized therapy of approximately 51 hours. The panel identified 3 cases where the causative pathogen was not treated by empiric therapy and 34 opportunities for antibiotic de-escalation, the most common being the discontinuation of empiric vancomycin. 36 patients had been tested with a Respiratory Virus Panel, which could have been avoided if the FP panel was used. The potential therapy impact based on specific ICU and respiratory culture results is summarized in Table 1. The cost analysis calculated an additional cost of &10 per patient associated with using the FP panel. Table 1. Potential Changes in Therapy Based on Patient Location and Culture Result Conclusion The FP panel could have prompted a change in therapy in about two-thirds of patients studied. Its potential benefits include quicker time to optimized therapy, reduced exposure to and cost of broad-spectrum antimicrobials, and reduced cost of other rapid diagnostic tests. Disclosures James Johnson, PharmD, FLGT (Shareholder) Vera Luther, MD, Nothing to disclose

scholarly journals 2190. Influence of Microbiological Culture Results on Antibiotic Choice for Veterans with Hospital-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S745-S746
Author(s):  
Robbie Lee Anne. Christian ◽  
Sharanie Sims ◽  
Taissa Zappernick ◽  
Brigid Wilson ◽  
Federico Perez ◽  
...  
Keyword(s):  
Antibiotic Susceptibility ◽  
Susceptibility Testing ◽  
Medical Center ◽  
Clinical Signs ◽  
Gram Stain ◽  
Sample Collection ◽  
Specimen Collection ◽  
Therapeutic Decisions ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract Background Respiratory specimens help inform the treatment of hospital-acquired pneumonia (HAP), permitting clinicians to ensure effective and, ideally, narrow-spectrum antibiotic therapy. Here, we examine changes in antibiotic regimens to treat HAP based on the antibiotic susceptibility of pathogens recovered from respiratory samples. Methods At a single Veterans Affairs (VA) Medical Center, we identified veterans hospitalized between October 2014 and September 2018 with HAP, defined as a clinical respiratory sample obtained >48 hours after admission and corresponding clinical signs and symptoms. Exclusion criteria were death, transfer to hospice care or discharge within 48 hours of sample collection or admission from an outside hospital. For each specimen, we assessed timestamps for collection, Gram stain, identification of organisms and results of susceptibility testing. We used the antibiotic spectrum index (ASI) to assess changes in antibiotics given to patients during hospitalization and at discharge. Results Between October 2014 and September 2018, 70 veterans met our inclusion criteria and experienced 73 episodes of HAP. Their mean age was 66.2 years (±9 years) and 47 (67%) had chronic pulmonary disease. All-cause mortality at 30-days after specimen collection was 14%. The median time from specimen collection to Gram stain result was 0.8 days (interquartile range (IQR) 0.1–1.9) and to antibiotic susceptibility results was 2.4 days (IQR 1.5–3.3). The most common bacteria recovered were Enterobacteriaceae (20 isolates), Pseudomonas aeruginosa (11 isolates), Streptococcus spp. and Staphylococcus aureus (8 isolates each); colonization with Candida spp. was frequent (26 isolates). Vancomycin and piperacillin–tazobactam were the most common antibiotics on day 0 (24%, 22%, respectively) and day 3 (21%, 13%, respectively). Compared with the day of sample collection (day 0), the ASI score was lower at day 3 in 23 (32%) and higher in 21 (29%) cases. Conclusion The high proportion of escalation and de-escalation of antibiotics suggests that results of bacteria identification and susceptibility testing influence therapeutic decisions, emphasizing the importance of obtaining respiratory samples to inform treatment of HAP and improve antibiotic stewardship. Disclosures All authors: No reported disclosures.

scholarly journals POLYMIXIN IN ONCOLOGY CLINICAL PRACTICE

2018 ◽  
Vol 17 (3) ◽  
pp. 88-93 ◽  
Author(s):  
N. V. Dmitrieva ◽  
I. N. Petukhova ◽  
Z. V. Grigorievskaya ◽  
N. S. Bagirova ◽  
I. V. Тereshchenko ◽  
...  
Keyword(s):  
Polymyxin B ◽  
Multidrug Resistant ◽  
Infectious Complications ◽  
Cochrane Library ◽  
Clinical Response Rate ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

The purpose of the study was to present data on polymixin-based antibiotics with activity against infections caused by multidrug- resistant Gram-negative bacteria, such as Acinetobacter baumannii,  Klebsiella pneumoniae, and Pseudomonas aeruginosa.Material and methods. The review includes data from clinical as well as in vitro studies for the period 1998–2017. The search for  relevant sources was carried out in the Medline, Cochrane Library, Elibrary and other databases.Results. The analysis of the data showed the presence of synergism and additive activity of polymyxin in combination with  carbapenems, rifampicin and azithromycin. However, experimental  data showed no direct positive correlation between combination of  polymyxim and azithromycin/ rifampicin. In clinical studies, in  hospital-acquired pneumonia, including ventilator-associated  pneumonia, the clinical response rate of polymyxin B combined with  other antibiotics ranged from 38 % to 88 %. High nephro-and  neurotoxicity of polymyxin observed in previous studies can be  explained by a lack of understanding of its toxicodynamics or the use of an incorrect dose.Conclusion. Polymyxin B in combination with other antibiotics is a promising treatment against infectious complications caused by multidrug resistant Gram-negative bacteria.

scholarly journals 1185. Association Between Blood Product Transfusion and Development of Hospital Acquired Infections or Mortality in Patients Admitted to the Hospital Wards. A Retrospective Case-Control Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S617-S617
Author(s):  
Arunmozhi S Aravagiri ◽  
Ayutyanont Napatkamon ◽  
Sabhyata Sharma ◽  
Timothy Collins ◽  
Chimezie Ubbaonu ◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Secondary Outcome ◽  
Blood Products ◽  
Multivariable Model ◽  
Retrospective Case ◽  
Hospital Acquired Infections ◽  
Hospital Acquired ◽  
Hospital Wards ◽  
Control Study

Abstract Background Transfusion of blood products has been shown to be associated with increased mortality and risk of infections in critically ill patients and following cardiac surgery [1-2]. However, there is scarce data evaluating this association in patients admitted to hospital wards. Here we seek to see if transfusion of blood products carries the same risk of infection and mortality in more stable patients. Methods This was a retrospective case-control study of patients admitted to the internal medicine wards who received packed red blood cells (PRBC), fresh frozen plasma (FFP) or platelet transfusions, using data from the HCA Healthcare administrative database from 2016 to 2019. Patients admitted with an infection, on steroids or other immunosuppressant medications were excluded. ICD-10 codes at discharge were used to determine hospital acquired infections (HAI). The presence of HAI was the dependent variable. A multivariable logistic regression was used to determine the effects of the independent variables on development of HAI after adjusting for age and Carlson’s Comorbidity Index. Odds ratios and 95% confidence intervals were calculated. Primary outcome of study was presence of HAI, while secondary outcome was mortality in transfused vs. non-transfused patients. Results A total of 1952 subjects were included in the study analysis. Of these, 653 or 33.4% had a HAI during their admission. Adjusted multivariable model showed transfusion of PRBC (OR 1.14, 95%CI 0.85-1.52), platelets (OR 1.41, 95% CI 0.93-2.10) or FFP (OR 1.27 95%CI 0.90-1.75) was not associated with increased odds of having a HAI. The multivariable model however, did show an increase in odds of mortality in patients who were transfused with PRBC (OR 2.51, 95%CI 1.78-3.54), platelets (OR 3.17, 95%CI 2.01-5.0) or FFP (OR 2.78, 95% CI 1.89-4.08) compared to non-transfused. Conclusion Our data failed to show association between transfusion of blood products and HAI. However, it showed there was significant increase in mortality in patients that had received blood products during their admission. Disclosures All Authors: No reported disclosures

scholarly journals In Vitro Activity of Doripenem, a Carbapenem for the Treatment of Challenging Infections Caused by Gram-Negative Bacteria, against Recent Clinical Isolates from the United States

2008 ◽  
Vol 52 (12) ◽  
pp. 4388-4399 ◽  
Author(s):  
Chris M. Pillar ◽  
Mohana K. Torres ◽  
Nina P. Brown ◽  
Dineshchandra Shah ◽  
Daniel F. Sahm
Keyword(s):  
The United States ◽  
Clinical Isolates ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Coagulase Negative Staphylococci ◽  
Hospital Acquired Pneumonia ◽  
Abdominal Infections ◽  
Hospital Acquired ◽  
Gram Positive Cocci

ABSTRACT Doripenem, a 1β-methylcarbapenem, is a broad-spectrum antibiotic approved for the treatment of complicated urinary tract and complicated intra-abdominal infections. An indication for hospital-acquired pneumonia including ventilator-associated pneumonia is pending. The current study examined the activity of doripenem against recent clinical isolates for the purposes of its ongoing clinical development and future longitudinal analysis. Doripenem and comparators were tested against 12,581 U.S. clinical isolates collected between 2005 and 2006 including isolates of Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus pneumoniae, Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter spp. MICs (μg/ml) were established by broth microdilution. By MIC90, doripenem was comparable to imipenem and meropenem in activity against S. aureus (methicillin susceptible, 0.06; resistant, 8) and S. pneumoniae (penicillin susceptible, ≤0.015; resistant, 1). Against ceftazidime-susceptible Enterobacteriaceae, the MIC90 of doripenem (0.12) was comparable to that of meropenem (0.12) and superior to that of imipenem (2), though susceptibility of isolates exceeded 99% for all evaluated carbapenems. The activity of doripenem was not notably altered against ceftazidime-nonsusceptible or extended-spectrum β-lactamase screen-positive Enterobacteriaceae. Doripenem was the most potent carbapenem tested against P. aeruginosa (MIC90/% susceptibility [%S]: ceftazidime susceptible = 2/92%S, nonsusceptible = 16/61%S; imipenem susceptible = 1/98.5%S, nonsusceptible = 8/56%S). Against imipenem-susceptible Acinetobacter spp., doripenem (MIC90 = 2, 89.1%S) was twice as active by MIC90 as were imipenem and meropenem. Overall, doripenem potency was comparable to those of meropenem and imipenem against gram-positive cocci and doripenem was equal or superior in activity to meropenem and imipenem against Enterobacteriaceae, including β-lactam-nonsusceptible isolates. Doripenem was the most active carbapenem tested against P. aeruginosa regardless of β-lactam resistance.

scholarly journals The Importance of Continued Quality Improvement Efforts in Monitoring Hospital-Acquired Infection Rates: A Cardiac Surgery Experience

2015 ◽  
Vol 99 (6) ◽  
pp. 2061-2069 ◽  
Author(s):  
Valentin Mocanu ◽  
Karen J. Buth ◽  
Lynn B. Johnston ◽  
Ian Davis ◽  
Gregory M. Hirsch ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Infection Rates ◽  
Hospital Acquired Infection ◽  
Hospital Acquired
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