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https://www.readbyqxmd.com/read/29156858/risk-factors-for-colistin-associated-nephrotoxicity-and-mortality-in-critically-ill-patients
#1
Hüseyin Özkarakaş, Işıl Köse, Çiler Zincircioğlu, Sibel Ersan, Gürsel Ersan, Nimet Şenoğlu, Şükran Köse, Rıza Hakan Erbay
Background/aim: Colistin is gaining popularity against multidrug-resistant bacteria. The primary concern with colistin is its nephrotoxicity (NT). The aim of this study was to evaluate the incidence and risk factors for NT and to evaluate the risk factors for mortality in the toxicity group. Materials and methods: NT was defined according to the RIFLE criteria. Data of patients who did or did not develop NT were compared. Positive and negative predictive values, risk ratio, and correlation coefficients were calculated...
August 23, 2017: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/29154111/pten-expression-and-its-association-with-glucose-control-and-calorie-supplementation-in-critically-ill-patients
#2
Alessio Molfino, Francesco Alessandri, Paola Mosillo, Donatella Dell'Utri, Alessio Farcomeni, Maria Ida Amabile, Alessandro Laviano
BACKGROUND & AIM: Phosphatase and tensin homologue (PTEN) reduces insulin sensitivity. Since critically ill patients present insulin resistance, we aimed at assessing the role of PTEN expression on glucose homeostasis and clinical outcome in patients admitted to an intensive care unit (ICU) and receiving artificial nutrition. METHODS: Observational, single-center study conducted in one ICU in Rome, Italy on adult patients hospitalized for trauma. Plasma glucose levels and its variability were recorded in patients receiving artificial nutrition...
November 4, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/29142756/usefulness-of-central-venous-saturation-as-a-predictor-of-thiamine-deficiency-in-critically-ill-patients-a-case-report
#3
Genri Numata, Satoshi Kodera, Hiroyuki Kiriyama, Atsuko Nakayama, Eisuke Amiya, Arihiro Kiyosue, Masaru Hatano, Eiki Takimoto, Masafumi Watanabe, Issei Komuro
Background: Central venous oxygen saturation (ScvO2) reflects the balance of oxygen delivery and consumption. Low ScvO2 indicates the presence of inadequate oxygen delivery, while high ScvO2 indicates reduced oxygen consumption and is sometimes associated with a high mortality rate in critically ill patients from dysoxia. Thiamine is an essential cofactor in cellular aerobic metabolism. Thiamine deficiency is more prevalent than was previously thought, and underlies severe conditions in critically ill patients...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/29142383/assessment-of-doripenem-meropenem-and-imipenem-against-respiratory-isolates-of-pseudomonas-aeroginosa-in-a-tertiary-care-hospital-of-north-india
#4
Arti Negi, Mridu Anand, Avinash Singh, Awadhesh Kumar, Chinmoy Sahu, Kashi Nath Prasad
Objective: Pseudomonas aeruginosa is one of the leading pathogen causing healthcare-associated infections, particularly in immunocompromised and critically ill patients. The development of carbapenem resistance in P. aeruginosa infections is worrisome. Data specifically comparing the susceptibility of the three available carbapenems are lacking in the Indian subcontinent. Materials and Methods: We evaluated the minimum inhibitory concentrations (MICs) of the three commonly used carbapenems- imipenem, meropenem, and doripenem against, 435 P...
October 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29130725/-eighth-jes%C3%A3%C2%BAs-culebras-lecture-critical-care-nutrition-and-hyperglycemia-a-close-relationship
#5
Alfonso Mesejo
Critically ill patients show a metabolic response to injury that affects carbohydrate metabolism, causing hyperglycemia and an increase in glycemic variability that makes the critically ill patient susceptible to infection, resulting in morbidity and mortality increase. Also, severe hypoglycemia was detected as a consequence of intensive insulin treatment that provokes deleterious effects in their clinical evolution, so a correct monitoring of plasma glucose would contribute to reduce morbidity and mortality...
October 24, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
https://www.readbyqxmd.com/read/29108947/antibiotic-strategies-and-clinical-outcomes-in-critically-ill-patients-with-pneumonia-caused-by-carbapenem-resistant-acinetobacter-baumannii
#6
Chun-An Liang, Ying-Chi Lin, Po-Liang Lu, Huang-Chi Chen, Hsu-Liang Chang, Chau-Chyun Sheu
OBJECTIVES: This study aimed to investigate antibiotic prescribing patterns and effectiveness of different anti-carbapenem-resistant Acinetobacter baumannii (CRAB) strategies for CRAB pneumonia. METHODS: We conducted a multicenter, retrospective study in three hospitals. During 2010-2015, adult ICU patients with CRAB pneumonia treated with at least one antimicrobial agent covering the CRAB isolate in vitro for more than two days were included. We used multivariate logistic regression to analyze the associations of anti-CRAB strategies with ICU mortality and other clinical outcomes...
November 3, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/29099239/physician-approaches-to-conflict-with-families-surrounding-end-of-life-decision-making-in-the-icu-a-qualitative-study
#7
Hashim M Mehter, Jessica B McCannon, Jack A Clark, Renda Soylemez Wiener
RATIONALE: Families of critically ill patients are often asked to make difficult decisions to pursue, withhold or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care. OBJECTIVES: To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making...
November 3, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29098423/hypoglycemia-reduction-strategies-in-the-icu
#8
REVIEW
Susan Shapiro Braithwaite, Dharmesh B Bavda, Thaer Idrees, Faisal Qureshi, Oluwakemi T Soetan
PURPOSE OF REVIEW: We reviewed the strategies associated with hypoglycemia risk reduction among critically ill non-pregnant adult patients. RECENT FINDINGS: Hypoglycemia in the ICU has been associated with increased mortality in a number of studies. Insulin dosing and glucose monitoring rules, response to impending hypoglycemia, use of computerization, and attention to modifiable factors extrinsic to insulin algorithms may affect the risk for hypoglycemia. Recurring use of intravenous (IV) bolus doses of insulin in insulin-resistant cases may reduce reliance upon higher IV infusion rates...
November 2, 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/29097442/a-p190brhogap-mutation-and-prolonged-rhob-activation-in-fatal-systemic-capillary-leak-syndrome
#9
Richard W Pierce, Jonathan Merola, John Paul Lavik, Martin S Kluger, Anita Huttner, Mustafa K Khokha, Jordan S Pober
We describe a fatal case of pediatric systemic capillary leak (Clarkson's disease) associated with a point mutation in p190BRhoGAP. Dermal microvascular endothelial cells (ECs) isolated from this patient form monolayers with similar levels and distribution of junctional proteins and transendothelial electrical resistance compared with normal human dermal microvascular ECs. However, patient-derived ECs demonstrate a greater increase in permeability and impaired recovery of barrier function in response to tumor necrosis factor (TNF) compared with normal donor EC cultures...
November 2, 2017: Journal of Experimental Medicine
https://www.readbyqxmd.com/read/29081854/toxic-shock-in-children-with-bone-and-joint-infections-a-review-of-seven-years-of-patients-admitted-to-one-intensive-care-unit
#10
D L Kerr, E K Loraas, A C Links, T V Brogan, G A Schmale
PURPOSE: The objective of this study was to compare the frequency of severe systemic, multi-organ involvement and toxic shock syndrome (TSS) in patients with Staphylococcus aureus (SA) and Group A β-haemolytic Streptococcus pyogenes (GABS) bone and joint infections. METHODS: We retrospectively reviewed patients treated for septic arthritis or osteomyelitis at one children's hospital between 2002 and 2009. The rates of intensive care unit (ICU) admission for methicillin-sensitive SA (MSSA), methicillin-resistant SA (MRSA) and GABS infections were compared, as were the lengths of stay, number of surgeries, operative procedures and cases of TSS...
October 1, 2017: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/29080413/a-uhplc-ms-ms-method-for-the-simultaneous-determination-of-piperacillin-and-tazobactam-in-plasma-total-and-unbound-urine-and-renal-replacement-therapy-effluent
#11
Saiyuri Naicker, Yarmarly C Guerra Valero, Jenny L Ordenez Meija, Jeffrey Lipman, Jason A Roberts, Steven C Wallis, Suzanne L Parker
Piperacillin-tazobactam is a beta-lactam/beta-lactamase combination antibiotic used in patients with moderate to severe infection. Dosing of piperacillin-tazobactam requires an understanding of this patient group to maximise the effectiveness of this antibiotic and limit a further emergence of resistant pathogens. This is the first method that measures piperacillin and tazobactam simultaneously, across this range of clinically-relevant biological matrices. The calibration line was linear across the concentration range of 0...
October 25, 2017: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/29075247/salmonella-enterica-serovar-typhimurium-strategies-for-host-adaptation
#12
REVIEW
Christopher J Anderson, Melissa M Kendall
Bacterial pathogens must sense and respond to newly encountered host environments to regulate the expression of critical virulence factors that allow for niche adaptation and successful colonization. Among bacterial pathogens, non-typhoidal serovars of Salmonella enterica, such as serovar Typhimurium (S. Tm), are a primary cause of foodborne illnesses that lead to hospitalizations and deaths worldwide. S. Tm causes acute inflammatory diarrhea that can progress to invasive systemic disease in susceptible patients...
2017: Frontiers in Microbiology
https://www.readbyqxmd.com/read/29063877/optimisation-of-antimicrobial-dosing-based-on-pharmacokinetic-and-pharmacodynamic-principles
#13
REVIEW
Grace Si Ru Hoo, Yi Xin Liew, Andrea Lay-Hoon Kwa
While suboptimal dosing of antimicrobials has been attributed to poorer clinical outcomes, clinical cure and mortality advantages have been demonstrated when target pharmacokinetic (PK) and pharmacodynamic (PD) indices for various classes of antimicrobials were achieved to maximise antibiotic activity. Dosing optimisation requires a good knowledge of PK/PD principles. This review serves to provide a foundation in PK/PD principles for the commonly prescribed antibiotics (β-lactams, vancomycin, fluoroquinolones and aminoglycosides), as well as dosing considerations in special populations (critically ill and obese patients)...
July 2017: Indian Journal of Medical Microbiology
https://www.readbyqxmd.com/read/29044341/the-use-of-antimicrobials-in-septic-patients-with-acute-kidney-injury
#14
Fernanda Moreira de Freitas, Welder Zamoner, Durval Sampaio de Souza Garms, Mariele Gobo de Oliveira, André Luis Balbi, Daniela Ponce
Sepsis is the most common cause of death in critically ill patients and it may be associated with multiorgan failure, including acute kidney injury (AKI). This situation can require acute renal support and increase mortality. Therefore, it is essential to administrate antimicrobials in dosis to achieve adequate serum levels, preventing overdosis and drug toxicity or underdosing and risk for resistance to antibiotics and higher mortality. To date, there aren't validated guidelines on antibiotic dosis adjustment in septic patients with AKI and the recommendations are extrapolated from studies conducted in non-critical patients with chronic kidney disease in end stage receiving chronic renal replacement therapy...
July 2017: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/29038248/lipopolysaccharide-potentiates-insulin-driven-hypoglycemic-shock
#15
Jon A Hagar, Matthew L Edin, Fred B Lih, Lance R Thurlow, Beverly H Koller, Bruce A Cairns, Darryl C Zeldin, Edward A Miao
Critically ill patients typically present with hyperglycemia. Treatment with conventional insulin therapy (targeting 144-180 mg/dl) improves patient survival; however, intensive insulin therapy (IIT) targeting normal blood glucose levels (81-108 mg/dl) increases the incidence of moderate and severe hypoglycemia, and increases mortality. Septic patients are especially prone to IIT-induced hypoglycemia, but the mechanism remains unknown. Here, we show that codelivery of insulin with otherwise sublethal doses of LPS induced hypoglycemic shock in mice within 1-2 h...
November 15, 2017: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/29029712/advanced-cardiopulmonary-support-for-pulmonary-embolism
#16
REVIEW
Oren Friedman, James M Horowitz, Danny Ramzy
Management of high-risk pulmonary embolism (PE) requires an understanding of the pathophysiology of PE, options for rapid clot reduction, critical care interventions, and advanced cardiopulmonary support. PE can lead to rapid respiratory and hemodynamic collapse via a complex sequence of events leading to acute right ventricular failure. Importantly, reduction in pulmonary vascular resistance must be accomplished either by systemic thrombolytics, catheter directed thrombolytics, endovascular clot extraction, or surgical embolectomy...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29027128/continuous-infusion-versus-intermittent-bolus-of-beta-lactams-in-critically-ill-patients-with-respiratory-infections-a-systematic-review-and-meta-analysis
#17
REVIEW
Young R Lee, Pamela D Miller, Saeed K Alzghari, Delilah D Blanco, Jackson D Hager, Kailey S Kuntz
BACKGROUND: Critically ill patients display altered pharmacokinetics and pharmacodynamics and are more likely to be infected with more resistant pathogens. Beta-lactam antibiotics exhibit time-dependent pharmacodynamics; therefore, it is postulated that continuous infusion (CI) may optimize these parameters. OBJECTIVE: To perform a systematic review and meta-analysis of the available literature comparing CI versus intermittent bolus (IB) of beta-lactam antibiotics in critically ill adult patients with respiratory infections to determine if clinical benefits exist...
October 12, 2017: European Journal of Drug Metabolism and Pharmacokinetics
https://www.readbyqxmd.com/read/29023567/carbapenem-resistant-enterobacteriaceae-colonization-cre-and-subsequent-risk-of-infection-and-90-day-mortality-in-critically-ill-patients-an-observational-study
#18
COMPARATIVE STUDY
Thomas Howe McConville, Sean Berger Sullivan, Angela Gomez-Simmonds, Susan Whittier, Anne-Catrin Uhlemann
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as an urgent public health threat. Intestinal colonization with CRE has been identified as a risk factor for the development of systemic CRE infection, but has not been compared to colonization with third and/or fourth generation cephalosporin-resistant (Ceph-R) Enterobacteriaceae. Moreover, the risk conferred by colonization on adverse outcomes is less clear, particularly in critically ill patients admitted to the intensive care unit (ICU)...
2017: PloS One
https://www.readbyqxmd.com/read/29017888/impact-of-amikacin-pharmacokinetic-pharmacodynamics-ratio-on-treatment-response-in-critically-ill-patient
#19
Jesus Ruiz, Paula Ramirez, María José Company, Mónica Gordon, Esther Villarreal, Pablo Concha, María Aroca, Juan Frasquet, María Remedios Marqués, Álvaro Castellanos-Ortega
OBJECTIVE: To evaluate the association between pharmacokinetic and pharmacodynamic ratio and treatment response to amikacin in critically ill patients. MATERIAL AND METHODS: An observational prospective study was designed. Critically ill adult patients with an infection due to amikacin-sensitive gram-negative bacteria treated with amikacin were included. Amikacin maximum (Cmax) and minimum (Cmin) concentration samples were taken during the first 48h and 96h after the beginning of the treatment...
October 7, 2017: Journal of Global Antimicrobial Resistance
https://www.readbyqxmd.com/read/28991829/sepsis-reduces-bone-strength-before-morphologic-changes-are-identifiable
#20
Zudin A Puthucheary, Yao Sun, Kaiyang Zeng, Lien Hong Vu, Zhi Wei Zhang, Ryan Z L Lim, Nicholas S Y Chew, Matthew E Cove
OBJECTIVES: Survivors of critical illness have an increased prevalence of bone fractures. However, early changes in bone strength, and their relationship to structural changes, have not been described. We aimed to characterize early changes in bone functional properties in critical illness and their relationship to changes in bone structure, using a sepsis rodent model. DESIGN: Experimental study. SETTING: Animal research laboratory. SUBJECTS: Adult Sprague-Dawley rats...
December 2017: Critical Care Medicine
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