scholarly journals Microbiological profile of ventilator-associated pneumonia among intensive care unit patients in tertiary Egyptian hospitals

2020 ◽  
Vol 14 (02) ◽  
pp. 153-161 ◽  
Author(s):  
Alaa M Farag ◽  
Mahmoud M Tawfick ◽  
Mostafa Y Abozeed ◽  
Emad A Shaban ◽  
Maha A Abo-Shadi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Susceptibility ◽  
Genetic Relatedness ◽  
Clinical Manifestations ◽  
Aeromonas Salmonicida ◽  
Common Source ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients ◽  
Causative Agents

Introduction: Ventilator-associated pneumonia (VAP) is one of the common serious infectious diseases encountered in the intensive care unit (ICU), which highly affects the healthcare cost and patient prognosis. VAP is caused by various antimicrobial-resistant aetiological agents and the clinical manifestations lack sensitivity and specificity, making the prompt treatment is a challenge. This study aimed to investigate the microbial profile of VAP causing microorganisms among ICU patients in Egypt, antimicrobial susceptibility patterns and the genetic diversity among the frequently isolated organisms. Methodology: Throughout the period from August 2016 to August 2017, endotracheal aspirate (ETA) specimens were collected from ICU patients with clinically suspected VAP in two tertiary hospitals in Cairo. ETA specimens were investigated for the microbial content. The antimicrobial susceptibility was determined by the Kirby-Bauer method. ERIC-PCR was performed for genotyping. Results: Fifty microbiologically confirmed VAP cases were identified. The most frequently isolated microorganisms were Klebsiella spp., followed by Pseudomonas aeruginosa, Acinetobacter baumannii. Candida spp. was the most isolated fungi. A single isolate of each Cupriavidus pauculus and Aeromonas salmonicida was isolated. Antimicrobial susceptibility profiles indicated 40% of isolates were multidrug-resistant (MDR). ERIC-PCR revealed no genetic relatedness among K. pneumoniae isolates, the most frequently isolated microorganism. Conclusions: Gram-negative bacteria are the main causative agents of VAP cases, which mostly are MDR. Microorganisms like C. pauculus and A. salmonicida should be taken into consideration as VAP causative agents. There was no common source of infection suggesting likely endogenous sources of K. pneumoniae, the main causative agent of VAP in this study.

scholarly journals Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?

2021 ◽  
Vol 9 (7) ◽  
pp. 1505
Author(s):  
Claire Roger ◽  
Benjamin Louart
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Manifestations ◽  
Acute Interstitial Nephritis ◽  
Convulsive Status Epilepticus ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Drug Induced ◽  
Icu Patients

Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10–15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals.

scholarly journals The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenjuan Luo ◽  
Rui Xing ◽  
Canmin Wang
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Information ◽  
Length Of Hospital Stay ◽  
Simplified Acute Physiology Score ◽  
Serum Lactate ◽  
Binary Logistic Regression Analysis ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients

Abstract Background Mechanical ventilation (MV) is often applied in critically ill patients in intensive care unit (ICU) to protect the airway from aspiration, and supplement more oxygen. MV may result in ventilator-associated pneumonia (VAP) in ICU patients. This study was to estimate the 90-day and 180-day mortalities of ICU patients with VAP, and to explore the influence of VAP on the outcomes of ICU patients. Methods Totally, 8182 patients who aged ≥18 years and received mechanical ventilation (MV) in ICU from Medical Information Mart for Intensive Care III (MIMIC III) database were involved in this study. All subjects were divided into the VAP group (n = 537) and the non-VAP group (n = 7626) based on the occurrence of VAP. Clinical data of all participants were collected. The effect of VAP on the prognosis of ICU patients was explored by binary logistic regression analysis. Results The results delineated that the 90-day mortality of VAP patients in ICU was 33.33% and 180-day mortality was 37.62%. The 90-day and 180-day mortality rates were higher in the VAP group than in the non-VAP group. After adjusting the confounders including age, ethnicity, heart failure, septicemia, simplified acute physiology score II (SAPSII) score, sequential organ failure assessment (SOFA) score, serum lactate, white blood cell (WBC), length of ICU stay, length of hospital stay, length of ventilation, antibiotic treatment, Pseudomonas aeruginosa (P.aeruginosa), methicillin-resistant Staphylococcus aureus (MRSA), other pathogens, the risk of 90-day and 180-day mortalities in VAP patients were 1.465 times (OR = 1.465, 95%CI: 1.188–1.807, P < 0.001) and 1.635 times (OR = 1.635, 95%CI: 1.333–2.005, P < 0.001) higher than those in non-VAP patients, respectively. Conclusions Our study revealed that ICU patients with VAP had poorer prognosis than those without VAP. The results of this study might offer a deeper insight into preventing the occurrence of VAP.

scholarly journals Immature granulocytes can help the diagnosis of pulmonary bacterial infections in patients with severe COVID-19 pneumonia

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Thomas Daix ◽  
Robin Jeannet ◽  
Ana Catalina Hernandez Padilla ◽  
Philippe Vignon ◽  
Jean Feuillard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Bacterial Infections ◽  
Distress Syndrome ◽  
Ventilator Associated Pneumonia ◽  
Bacterial Sepsis ◽  
Icu Patients ◽  
Immature Granulocyte ◽  
The Relationship

AbstractDuring COVID-19, immature granulocyte (IG) concentration is heterogeneous with higher concentrations than those found in bacterial sepsis. We investigated the relationship between IG levels at ICU admission and on days 7 (± 2) and 15 (± 2) and associated pulmonary bacterial infections in intensive care unit (ICU) patients hospitalized for an acute respiratory distress syndrome (ARDS) related to SARS-CoV-2. Patients with associated pulmonary bacterial infection had a peak of IGs. IG thresholds of 18% or 2 G/L allowed discriminating patients with ventilator associated pneumonia with 100% sensitivity and specificity. Our study supports that IGs could help identifying pulmonary bacterial infections in this population.

Use of Protocols in Older Intensive Care Unit Patients

2011 ◽  
Vol 22 (2) ◽  
pp. 150-160
Author(s):  
Colleen M. Casey ◽  
Michele C. Balas
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Clinical Practice ◽  
Critical Care Patient ◽  
Care Patient ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients ◽  
Sepsis Bundles

Increasing numbers of older adults are cared for in intensive care units (ICUs) across the country. These patients are disproportionately impacted by illnesses such as sepsis, ventilator-associated pneumonia, and infections. Their care and course of recovery are complicated by myriad factors, including their often-indistinct presentation of illness and issues related to pharmacotherapy. Increasingly, clinical practice guidelines are being used to facilitate the care of patients with select illnesses and presentations. However, these guidelines, protocols, or bundles, as they are known, generally have not been studied in an older population. This article describes the ventilator-associated pneumonia and sepsis bundles relative to the older critical care patient. Although an exhaustive discussion of every intervention within each bundle as it relates to older ICU patients is beyond the scope of this article, selected bundle parameters are presented, with examples of special considerations for the older ICU patient.

Analysis of Risk Factors for Early-onset Ventilator-associated Pneumonia in a Neurosurgical Intensive Care Unit: A Single-center Retrospective Study

2021 ◽  
Author(s):  
guojie teng ◽  
Ning Wang ◽  
Xiuhong Nie ◽  
Lin Zhang ◽  
Hongjun Liu
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Therapeutic Hypothermia ◽  
Early Onset ◽  
Clinical Manifestations ◽  
Older Age ◽  
Resistant Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Hypothermia Treatment

Abstract Background:Ventilator-associated pneumonia (VAP) is a severe infection among patients in the neurosurgery intensive care unit (NICU).Methods:We retrospectively evaluated risk factors for early-onset ventilator-associated pneumonia (EOVAP) from January 2019 to December 2019 at a NICU. A total of 89 NICU patients who were intubated within 48 hours of onset and whose mechanical ventilation time was longer than 7 days were enrolled. The enrolled patients had no history of chronic lung disease and no clinical manifestations of infection before intubation. Clinical data of patients were recorded, and the incidence of and risk factors for EOVAP were analyzed. Patients were also grouped by age (≥65 vs. <65 years) and whether they had received hypothermia treatment or not.Results:Among 89 mechanically ventilated patients (49 men and 40 women; median age 60.1±14.3 years), 40 patients (44.9%) developed EOVAP in 7 days and 14 patients (15.7%) had multidrug resistant bacteria. Binary logistic regression analysis indicated that older age (≥65years) (odds ratio [OR]: 0.267, 95% confidence interval [CI]: 0.101-0.709, P=0.008) and therapeutic hypothermia (OR: 0.235, CI: 0.075-0.738, p=0.013) were independent predictors of EOVAP. Levels of peripheral blood leukocytes, neutrophils and platelets were lower in the therapeutic hypothermia group than those that did not receive hypothermia treatment.Conclusions:This study found that older age (≥65years) and therapeutic hypothermia were independently associated with the risk of EOVAP in NICU patients.

Aspectos Multiprofissionais da atuação na Pneumonia associada a ventilação Mecânica - PAVM

2020 ◽  
Author(s):  
Flávio Marques Lopes ◽  
Lívia Pinheiro Siqueira ◽  
Dayanne Alves Pinheiro Silva ◽  
Liana Lima Vieira ◽  
Luciana Carvalho Silveira ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Lung Disease ◽  
Multidisciplinary Team ◽  
Preventive Measures ◽  
Lung Infection ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients ◽  
Hospital Stays

Ventilator-associated pneumonia (VAP) is the most often lung infection that occurs in the Intensive Care Unit (ICU) and is characterised, specifically, for its development in the first 48 hours after the beginning of Mechanical Ventilation (MV). This kind of lung disease is also associated with longer hospital stays and higher treatment costs. Around 55% of VAPs can be prevented through interventions, scientifically proven, that turns the treatment more viable, effective and at lower costs compared to convencional treatment. The multidisciplinary team is essential in the care of the ICU patient, as it works in the maintenance of patient’s vital organic functions, therefore, in an integrated way, the professionals works to minimize the damage caused by Mechanical Ventilation (MV) in ICU patients, in particular, regarding VAP. The use of measures or bundles are able to decentralize conducts and change the focus of treatment, transforming it into treatment optimised of preventive approaches that avoids complications. Lastly, the preventive measures of VAP should be put into practice, essentially by the multidisciplinary team, aiming at a directly impact on the reduction of the rates of this specific type of pneumonia.

scholarly journals IL-18 haplotype GCAGT and IL-18R1 rs3755276 genotype CC combinatively associated with severity of ventilator associated pneumonia (VAP) in intensive care unit (ICU) patients

2021 ◽  
Author(s):  
Dunfan Chen ◽  
Baijian Chen ◽  
Guowei Li ◽  
Haofei Wang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Real Time Pcr ◽  
Peripheral Blood ◽  
Surgical Patients ◽  
Apache Ii Score ◽  
Ventilator Associated Pneumonia ◽  
Quantitative Real Time Pcr ◽  
Post Injury ◽  
Icu Patients

Abstract Background: IL-18 has been reported as a collaborative biomarker for the development of sepsis surgical patients. IL-18 promoter and IL-18R1 polymorphisms have been reported in the development of post-injury sepsis and other diseases. In this study, we explored the association between IL-18/IL-18R1 polymorphisms and the severity of VAP in sepsis patients. Methods: ELISA was used to measure the abundance of IL-18, TNF-a, IL-6 and PCT in the peripheral blood of VAP patients in distinct groups. Quantitative real-time PCR was carried out to examine the expression of IL-18 and IL-18R1 mRNA under distinct circumstances. APACHEII scoring were performed to assess the APACHEII scores of VAP patients with distinct genotypes. Results: IL-18-GCAGT and IL-18R1-CC were proved to be correlated with the occurrence of SEPSIS in VAP patients. The IL-18 level was remarkably suppressed in the peripheral blood of VAP patients with IL-18-GCAGT, while IL-18R1 polymorphisms showed no impact on IL-18 expression. The expression of IL-18R1 was suppressed in the peripheral blood of VAP patients with IL-18R1-CC genotypes. When combined IL-18 haplotypes and IL-18R1 genotypes together, we found IL-18-GCAGT and IL-18R1-CC were remarkably correlated with decreased APACHE II score and suppressed expression of TNF-a/IL-6/PCT and increased time from ICU admission to VAP. Conclusion: GCAGT significantly reduced the expression of IL-18. And the genotype CC of rs3755276 located in IL-18R1 also reduced expression of IL-18R1 compared with other genotypes. Collectively, both haplotype GCAGT of IL-18 and genotype CC of IL-18R1 were associated with severity of VAP in patients admitted to ICU.

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