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https://www.readbyqxmd.com/read/29329118/ce-managing-sepsis-and-septic-shock-current-guidelines-and-definitions
#1
Mary Beth Flynn Makic, Elizabeth Bridges
Recent updates emphasize early recognition and prompt intervention. ABSTRACT: Sepsis is a leading cause of critical illness and hospital mortality. Early recognition and intervention are essential for the survival of patients with this syndrome. In 2002, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) launched the Surviving Sepsis Campaign (SSC) to reduce overall patient morbidity and mortality from sepsis and septic shock by driving practice initiatives based on current best evidence...
January 11, 2018: American Journal of Nursing
https://www.readbyqxmd.com/read/29317845/pyomyositis-in-the-setting-of-complicated-diverticulitis-case-report
#2
James Sun, David Leor Kashan, Jolita Marie Auguste, Akella Chendrasekhar
Pyomyositis is typically thought of as a disease of the tropics. However, it is becoming more prevalent in temperate regions, and may be underdiagnosed. Here, pyomyositis is encountered as a complication of perforated diverticulitis, which has not been previously reported. A 61-year-old Caucasian man initially presented in respiratory distress and was diagnosed with respiratory failure due to COPD exacerbation. The patient was taking high-dose prednisone, 60 mg daily for the past 2 years. Initially, he was afebrile, normotensive, tachycardic to 178 beats/minute and tachypneic to 28 breaths/minute, requiring noninvasive ventilation to maintain oxygenation...
2018: International Journal of General Medicine
https://www.readbyqxmd.com/read/29313312/influence-of-single-dose-antibiotic-prophylaxis-for-early-onset-pneumonia-in-high-risk-intubated-patients
#3
Timothy D Lewis, Kelly A Dehne, Kathryn Morbitzer, Denise H Rhoney, Casey Olm-Shipman, J Dedrick Jordan
BACKGROUND: Early-onset pneumonia (EOP) after endotracheal intubation is common among critically ill patients with a neurologic injury and is associated with worse clinical outcomes. METHODS: This retrospective cohort study observed outcomes pre- and post-implementation of an EOP prophylaxis protocol which involved the administration of a single dose of ceftriaxone 2 g around the time of intubation. The study included patients ≥ 18 years who were admitted to the University of North Carolina Medical Center (UNCMC) neuroscience intensive care unit (NSICU) between April 1, 2014, and October 26, 2016, and intubated for ≥ 72 h...
January 8, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29313072/-antibiotic-stewardship-measures-for-optimizing-prescription-of-anti-infective-agents
#4
REVIEW
C Lanckohr, H Bracht
Antibiotic stewardship (ABS) comprises a bundle of different interventions to improve anti-infective treatment in a hospital setting. An important component of ABS interventions is the interdisciplinary approach to infection management. Besides improving infrastructural aspects on a hospital level, including surveillance of the use of anti-infective agents and nosocomial infections, collation and interpretation of statistics on resistance and formulation of local treatment guidelines, ABS teams go to the wards and advise treating physicians on antibiotic therapy...
January 8, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29288367/antimicrobial-resistance-and-antibiotic-stewardship-programs-in-the-icu-insistence-and-persistence-in-the-fight-against-resistance-a-position-statement-from-esicm-escmid-waaar-round-table-on-multi-drug-resistance
#5
Jan J De Waele, Murat Akova, Massimo Antonelli, Rafael Canton, Jean Carlet, Daniel De Backer, George Dimopoulos, José Garnacho-Montero, Jozef Kesecioglu, Jeffrey Lipman, Mervyn Mer, José-Artur Paiva, Mario Poljak, Jason A Roberts, Jesus Rodriguez Bano, Jean-François Timsit, Jean-Ralph Zahar, Matteo Bassetti
Antimicrobial resistance (AMR) is a clear and present danger to patients in any intensive care unit (ICU) around the world. Whereas AMR may affect any patient in the hospital, patients in the ICU are particularly at risk of acquiring AMR infections due to the intensity of the treatment, use of invasive devices, increased risk of transmission and exposure to antibiotics. AMR is present in every ICU, although prevalence is geographically different and AMR pathogens encountered are variable. Intensive care and infectious disease specialists from the European Society of Intensive Care Medicine, European Society of Microbiology and Infectious Diseases and World Alliance Against Antimicrobial Resistance, united in the ANTARCTICA (Antimicrobial Resistance in Critical Care) coalition, call for increased awareness and action among health care professionals to reduce AMR development in critically ill patients, to improve treatment of AMR infections and to coordinate scientific research in this high-risk patient population...
December 29, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/29286945/an-interpretable-machine-learning-model-for-accurate-prediction-of-sepsis-in-the-icu
#6
Shamim Nemati, Andre Holder, Fereshteh Razmi, Matthew D Stanley, Gari D Clifford, Timothy G Buchman
OBJECTIVES: Sepsis is among the leading causes of morbidity, mortality, and cost overruns in critically ill patients. Early intervention with antibiotics improves survival in septic patients. However, no clinically validated system exists for real-time prediction of sepsis onset. We aimed to develop and validate an Artificial Intelligence Sepsis Expert algorithm for early prediction of sepsis. DESIGN: Observational cohort study. SETTING: Academic medical center from January 2013 to December 2015...
December 26, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29277531/population-pharmacokinetics-of-piperacillin-continuous-infusion-in-critically-ill-patients
#7
Sofie A M Dhaese, Jason A Roberts, Mieke Carlier, Alain G Verstraete, Veronique Stove, Jan J De Waele
Dosing recommendations for continuous infusion of piperacillin, a broad-spectrum beta-lactam antibiotic, are mainly guided by outputs from population pharmacokinetic models constructed with intermittent infusion data. However, the probability of target attainment in patients receiving piperacillin by continuous infusion may be overestimated when drug clearance estimates from population pharmacokinetic models based on intermittent infusion data are used, especially when higher doses (e.g. 16g/24h or more) are simulated...
December 22, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/29274318/the-burden-of-viruses-in-pneumonia-associated-with-acute-respiratory-failure-an-underappreciated-issue
#8
Andrew F Shorr, Kristen Fisher, Scott T Micek, Marin H Kollef
BACKGROUND: Pneumonia associated with mechanical ventilation (MV) results in substantial mortality and represents a leading reason for antibiotic utilization. The role of viruses in this setting is unclear. Identifying a viral etiology such instances could facilitate antibiotic stewardship. METHODS: We performed a secondary analysis of a prospective cohort with pneumonia requiring MV. We included both community and hospital-onset cases and classified patients as to the pneumonia's etiology...
December 20, 2017: Chest
https://www.readbyqxmd.com/read/29239831/factors-associated-with-in-hospital-mortality-among-critically-ill-surgical-patients-with-multidrug-resistant-gram-negative-infections
#9
Andrew S Jarrell, Rachel M Kruer, Loredana Diana Berescu, Peter J Pronovost, Julie B Trivedi
PURPOSE: Multidrug-resistant (MDR) Gram-negative infection increases risk of mortality, other complications, and costs. The objective of this study was to determine the prevalence of and identify factors associated with in-hospital mortality among critically ill surgical patients. MATERIALS AND METHODS: This case-control study included critically ill surgical patients from 2011 to 2014 who had a carbapenem-resistant Enterobacteriaceae (CRE), MDR P. aeruginosa, or MDR Acinetobacter spp...
November 24, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29225790/update-on-ventilator-associated-pneumonia
#10
REVIEW
Jean-Francois Timsit, Wafa Esaied, Mathilde Neuville, Lila Bouadma, Bruno Mourvllier
Ventilator-associated pneumonia (VAP) is the most frequent life-threatening nosocomial infection in intensive care units. The diagnostic is difficult because radiological and clinical signs are inaccurate and could be associated with various respiratory diseases. The concept of infection-related ventilator-associated complication has been proposed as a surrogate of VAP to be used as a benchmark indicator of quality of care. Indeed, bundles of prevention measures are effective in decreasing the VAP rate. In case of VAP suspicion, respiratory secretions must be collected for bacteriological secretions before any new antimicrobials...
2017: F1000Research
https://www.readbyqxmd.com/read/29220754/association-of-high-mortality-with-extended-spectrum-%C3%AE-lactamase-esbl-positive-cultures-in-community-acquired-infections
#11
Sumit Ray, Dimple Anand, Sankalp Purwar, Arijit Samanta, Kaustubh V Upadhye, Prasoon Gupta, Debashis Dhar
PURPOSE: Infections due to multidrug resistant organisms have become a serious health concern worldwide. The present study was conducted to investigate the spectrum of microbial resistance pattern in the community and their effects on mortality. METHODS: A retrospective review and analysis of prospectively collected data was done of all patients admitted with diagnosis of sepsis in two tertiary care ICU's for a period of two years. Demographics, culture positivity, microbial spectrum, resistance pattern and outcome data were collected...
October 31, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29219627/non-oncotic-properties-of-albumin-a-multidisciplinary-vision-about-the-implications-for-critically-ill-patients
#12
Ricard Ferrer, Xavier Mateu, Emilio Maseda, Juan Carlos Yébenes, César Aldecoa, Candelaria De Haro, Juan Carlos Ruiz-Rodriguez, José Garnacho-Montero
Effective resuscitation with human albumin solutions is achieved with less fluid than with crystalloid solutions. However, the role of albumin in today's critical care unit is also linked to its multiple pharmacological effects. Areas covered: The potential clinical benefits of albumin in select populations of critically ill patients like sepsis seem related to immunomodulatory and anti-inflammatory effects, antibiotic transportation and endothelial stabilization. Albumin transports many drugs used in critically ill patients...
December 8, 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/29205415/systematic-review-human-gut-dysbiosis-induced-by-non-antibiotic-prescription-medications
#13
REVIEW
Q Le Bastard, G A Al-Ghalith, M Grégoire, G Chapelet, F Javaudin, E Dailly, E Batard, D Knights, E Montassier
BACKGROUND: Global prescription drug use has been increasing continuously for decades. The gut microbiome, a key contributor to health status, can be altered by prescription drug use, as antibiotics have been repeatedly described to have both short-term and long-standing effects on the intestinal microbiome. AIM: To summarise current findings on non-antibiotic prescription-induced gut microbiome changes, focusing on the most frequently prescribed therapeutic drug categories...
December 5, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29201114/once-versus-thrice-daily-colistin-in-critically-ill-ptients-with-multi-drug-resistant-infections
#14
Monireh Ghazaeian, Majid Mokhtari, Mehran Kouchek, MirMohammad Miri, Reza Goharani, Robabeh Ghodssi-Ghassemabadi, Mohammad Sistanizad
The aim of this study was to evaluate the procalcitonin (PCT) changes in two different high-dose colistin regimens in the treatment of multi-drug resistant MDR gram negative infections in ICU patients. This is a prospective study of adult ICU patients with bacteremia and ventilator associated pneumonia (VAP) caused by MDR gram negative pathogens. Patients were assigned to two colistin administration groups. Group A received 9 and group B received 3 million international units every 24 and 8 h respectively. Baseline characteristics and measurements of PCT concentrations at the start, the 3rd and the 5th day of the antibiotic therapy and their trends between the two groups were recorded and compared...
2017: Iranian Journal of Pharmaceutical Research: IJPR
https://www.readbyqxmd.com/read/29194526/bacterial-infections-after-burn-injuries-impact-of-multidrug-resistance
#15
Anne M Lachiewicz, Christopher G Hauck, David J Weber, Bruce A Cairns, David van Duin
Patients who are admitted to the hospital after sustaining a large burn injury are at high risk for developing hospital-associated infections. If patients survive the initial 72 hours after a burn injury, infections are the most common cause of death. Ventilator-associated pneumonia is the most important infection in this patient population. The risk of infections caused by multidrug-resistant bacterial pathogens increases with hospital length of stay in burn patients. In the first days of the postburn hospitalization, more susceptible, Gram-positive organisms predominate, whereas later more resistant Gram-negative organisms are found...
November 29, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29180280/association-between-augmented-renal-clearance-antibiotic-exposure-and-clinical-outcome-in-critically-ill-septic-patients-receiving-high-doses-of-%C3%AE-lactams-administered-by-continuous-infusion-a-prospective-observational-study
#16
Cedric Carrie, Laurent Petit, Nicolas D'houdain, Noemie Sauvage, Vincent Cottenceau, Melanie Lafitte, Cecile Foumenteze, Quentin Hisz, Deborah Menu, Rachel Legeron, Dominique Breilh, Francois Sztark
BACKGROUND: This study aimed to assess whether augmented renal clearance (ARC) impacts negatively on antibiotic concentrations and clinical outcomes in patients treated by high doses of β-lactams administered continuously for a first infection in surgical intensive care unit. METHODS: Over a 9-month period, all critically ill patients treated by one of the monitored β-lactam antibiotics for a documented infection without renal impairment were eligible. During the first three days of antibiotic therapy, every patient underwent 24-hour creatinine clearance (CrCL) measurements and therapeutic drug monitoring...
November 24, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/29171000/applying-pharmacokinetic-pharmacodynamic-principles-for-optimizing-antimicrobial-therapy-during-continuous-renal-replacement-therapy
#17
Patrick M Honore, Rita Jacobs, Elisabeth De Waele, Herbert D Spapen
Continuous renal replacement therapy (CRRT) is progressively supplanting intermittent hemodialysis (IHD) in critically ill patients. CRRT indeed offers more appropriate hemodynamic, fluid, and metabolic stability but concern is rising about its impact on concomitant drug, and in particular antimicrobial, treatment. Antimicrobial dose recommendations have been elaborated to avoid drug accumulation and toxicity in patients undergoing IHD. However, these dosing regimens resulted in significant underdosing in patients undergoing CRRT thereby increasing the risk of treatment failure and development of resistance...
November 24, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29168046/procalcitonin-guided-antibiotic-therapy-in-intensive-care-unit-patients-a-systematic-review-and-meta-analysis
#18
Hui-Bin Huang, Jin-Min Peng, Li Weng, Chun-Yao Wang, Wei Jiang, Bin Du
BACKGROUND: Serum procalcitonin (PCT) concentration is used to guide antibiotic decisions in choice, timing, and duration of anti-infection therapy to avoid antibiotic overuse. Thus, we performed a systematic review and meta-analysis to seek evidence of different PCT-guided antimicrobial strategies for critically ill patients in terms of predefined clinical outcomes. METHODS: We searched for relevant studies in PubMed, Embase, Web of Knowledge, and the Cochrane Library up to 25 February 2017...
November 22, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/29164489/antimicrobial-stewardship-opportunities-in-critically-ill-patients-with-gram-negative-lower-respiratory-tract-infections-a-multicenter-cross-sectional-analysis
#19
Kimberly C Claeys, Evan J Zasowski, Trang D Trinh, Abdalhamid M Lagnf, Susan L Davis, Michael J Rybak
INTRODUCTION: Lower respiratory tract infections (LRTIs) are a major cause of morbidity and death. Because of changes in how LRTIs are defined coupled with the increasing prevalence of drug resistance, there is a gap in knowledge regarding the current burden of antimicrobial use for Centers for Disease Control and Prevention (CDC)-defined LRTIs. We describe the infection characteristics, antibiotic consumption, and clinical and economic outcomes of patients with Gram-negative (GN) LRTIs treated in intensive care units (ICUs)...
November 21, 2017: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/29164144/intensive-care-unit-patients-with-lower-respiratory-tract-nosocomial-infections-the-enirris-project
#20
Gennaro De Pascale, Otavio T Ranzani, Saad Nseir, Jean Chastre, Tobias Welte, Massimo Antonelli, Paolo Navalesi, Eugenio Garofalo, Andrea Bruni, Luis Miguel Coelho, Szymon Skoczynski, Federico Longhini, Fabio Silvio Taccone, David Grimaldi, Helmut J F Salzer, Christoph Lange, Filipe Froes, Antoni Artigas, Emili Díaz, Jordi Vallés, Alejandro Rodríguez, Mauro Panigada, Vittoria Comellini, Luca Fasano, Paolo M Soave, Giorgia Spinazzola, Charles-Edouard Luyt, Francisco Alvarez-Lerma, Judith Marin, Joan Ramon Masclans, Davide Chiumello, Angelo Pezzi, Marcus Schultz, Hafiz Mohamed, Menno Van Der Eerden, Roger A S Hoek, D A M P J Gommers, Marta Di Pasquale, Rok Civljak, Marko Kutleša, Matteo Bassetti, George Dimopoulos, Stefano Nava, Fernando Rios, Fernando G Zampieri, Pedro Povoa, Lieuwe D Bos, Stefano Aliberti, Antoni Torres, Ignacio Martín-Loeches
The clinical course of intensive care unit (ICU) patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by specific epidemiological, clinical and microbiological aspects. A European network for ICU-related respiratory infections (ENIRRIs), supported by the European Respiratory Society, has been recently established, with the aim at studying all respiratory tract infective episodes except community-acquired ones. A multicentre, observational study is in progress, enrolling more than 1000 patients fulfilling the clinical, biochemical and radiological findings consistent with a LRTI...
October 2017: ERJ Open Research
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