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Critical ill and resistency

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https://www.readbyqxmd.com/read/28301890/kasuistik-late-onset-small-fiber-neuropathie-nach-kritischer-erkrankung
#1
Susanne Koch, Rabih Moshourab, Tobias Wollersheim, Claudia Spies, Thomas Fritzsche, Steffen Weber-Carstens
A 42-year-old patient presented with acute allodynia and hyperalgesia in her distal limbs, most severe in the innervation area of the ulnar nerve. The patient developed critical illness myopathy/polyneuropathy after septic shock 5 months prior to her presentation. After exclusion of differential diagnosis, "late onset small fiber neuropathy" after critical illness was diagnosed. Recent studies showed small fiber lesions during critical illness and in follow-up exams, where additionally neuropathic pain were proved...
March 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28299183/challenges-in-microbiological-diagnosis-of-invasive-aspergillus-infections
#2
REVIEW
Alexandre Alanio, Stéphane Bretagne
Invasive aspergillosis (IA) has been increasingly reported in populations other than the historical hematology patients and there are new questions about the performance of microbiological tools. Microscopy and culture have been completed by biomarkers, either antigens or DNA, and in blood or respiratory specimens or both. First studied in hematology, the antigen galactomannan performance in serum is low in other patient populations where the pathophysiology of the infection can be different and the prevalence of IA is much lower...
2017: F1000Research
https://www.readbyqxmd.com/read/28298480/antimicrobial-stewardship-programmes-bedside-rationing-by-another-name
#3
Simon Oczkowski
Antimicrobial therapy is a cornerstone of therapy in critically ill patients; however, the wide use of antibiotics has resulted in increased antimicrobial resistance and outbreaks of resistant disease. To counter this, many hospitals have instituted antimicrobial stewardship programmes as a way to reduce the inappropriate use of antibiotics. However, uptake of antimicrobial stewardship programmes has been variable, as many clinicians fear that they may put individual patients at risk of treatment failure. In this paper, I argue that antimicrobial stewardship programmes are indeed a form of bedside rationing, and explore the risks and benefits of such programmes for individual patients in the intensive care unit, and the critically ill population in general...
March 15, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28297594/the-role-of-staging-in-planning-psychotherapeutic-interventions-in-depression
#4
Jenny Guidi, Elena Tomba, Fiammetta Cosci, Seung K Park, Giovanni A Fava
CONTEXT: The purpose of this critical review is to examine the role of staging in planning a psychotherapeutic intervention in depressive disorders. EVIDENCE ACQUISITION: English-language studies concerned with staging in depressive disorders were identified in MEDLINE, PsycINFO, and Web of Science and by manual search of the literature. Selection of articles was based on their methodological quality and implications for clinical practice. RESULTS: Staging may allow clinicians to apply a psychotherapeutic intervention to specific phases of the development of depressive disorders: certain psychotherapeutic approaches, such as well-being therapy and mindfulness-based cognitive therapy, appear to be uniquely suited for addressing the residual phase of depression, whereas interpersonal psychotherapy has been mainly tested in the acute phase...
March 14, 2017: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28295469/assessing-new-peptides-that-may-be-involved-in-the-physiological-regulation-of-the-gonadal-axis-in-humans-gonadotropin-inhibitory-hormone
#5
Peter Y Liu
The hypothalamo-pituitary-testicular (HPT) and hypothalamo-pituitary-ovarian (HPO) axes are integrated networks that regulate androgenization or estrogenization (including embryonic, infantile, pubertal and adult sexual maturation), male or female sexual behavior, and spermatogenesis or ovulation, respectively. Dysregulation of the HPT axis, for example, results in pubertal delay, eunuchism, impaired spermatogenesis, and reduced systemic androgen exposure; and may also contribute to some of the features of male aging, impair recovery from protracted critical illness, and induce visceral adiposity, sarcopenia, osteopenia, and insulin resistance...
March 13, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28293420/candidemia-in-a-major-regional-tertiary-referral-hospital-epidemiology-practice-patterns-and-outcomes
#6
Jocelyn Qi-Min Teo, Samuel Rocky Candra, Shannon Jing-Yi Lee, Shannon Yu-Hng Chia, Hui Leck, Ai-Ling Tan, Hui-Peng Neo, Kenneth Wei-Liang Leow, Yiying Cai, Rachel Pui-Lai Ee, Tze-Peng Lim, Winnie Lee, Andrea Lay-Hoon Kwa
BACKGROUND: Candidemia is a common cause of nosocomial bloodstream infections, resulting in high morbidity and mortality. This study was conducted to describe the epidemiology, species distribution, antifungal susceptibility patterns and outcomes of candidemia in a large regional tertiary referral hospital. METHODS: A retrospective surveillance study of patients with candidemia was conducted at Singapore General Hospital between July 2012 and December 2015. In addition, incidence densities and species distribution of candidemia episodes were analysed from 2008 to 2015...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28275139/the-cytokine-response-to-lipopolysaccharide-does-not-predict-the-host-response-to-infection
#7
Benjamin A Fensterheim, Yin Guo, Edward R Sherwood, Julia K Bohannon
The magnitude of the LPS-elicited cytokine response is commonly used to assess immune function in critically ill patients. A suppressed response, known as endotoxin tolerance, is associated with worse outcomes, yet endotoxin tolerance-inducing TLR4 ligands are known to protect animals from infection. Thus, it remains unknown whether the magnitude of the LPS-elicited cytokine response provides an accurate assessment of antimicrobial immunity. To address this, the ability of diverse TLR ligands to modify the LPS-elicited cytokine response and resistance to infection were assessed...
March 8, 2017: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/28273381/role-of-combination-antimicrobial-therapy-for-vancomycin-resistant-enterococcus-faecium-infections-review-of-the-current-evidence
#8
Juwon Yim, Jordan R Smith, Michael J Rybak
Enterococcus species are the second most common cause of nosocomial infections in the United States and are particularly concerning in critically ill patients with preexisting comorbid conditions. Rising resistance to antimicrobials that were historically used as front-line agents for treatment of enterococcal infections, such as ampicillin, vancomycin, and aminoglycosides, further complicates the treatment of these infections. Of particular concern are Enterococcus faecium strains that are associated with the highest rate of vancomycin resistance...
March 8, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28267670/selective-digestive-decontamination-in-critically-ill-children-a-survey-of-canadian-providers
#9
Srinivas Murthy, Nazima Pathan, Brian H Cuthbertson
BACKGROUND: Selective digestive decontamination of the digestive tract involves the routine administration of oral, gastric, and intravenous antibiotics to mechanically ventilated children to prevent hospital-acquired infections. It has a strong evidence base in adults, with limited pediatric evidence. Current utilization of this intervention among pediatric physicians in North America is unknown. METHODS: An electronic survey administered to pediatric critical care and pediatric infectious disease providers in Canada...
February 20, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28264846/substantial-impact-of-altered-pharmacokinetics-in-critically-ill-patients-on-the-antibacterial-effects-of-meropenem-evaluated-via-the-dynamic-hollow-fiber-infection-model
#10
Phillip J Bergen, Jürgen B Bulitta, Carl M J Kirkpatrick, Kate E Rogers, Megan J McGregor, Steven C Wallis, David L Paterson, Roger L Nation, Jeffrey Lipman, Jason A Roberts, Cornelia B Landersdorfer
Critically ill patients frequently have substantially altered pharmacokinetics compared to non-critically ill patients. We investigated the impact of pharmacokinetic alterations on bacterial killing and resistance for commonly used meropenem dosing regimens. A Pseudomonas aeruginosa isolate (MICmeropenem 0.25 mg/L) was studied in the hollow-fiber infection model (inoculum ∼10(7.5) CFU/mL; 10 days). Pharmacokinetic profiles representing critically ill patients with augmented renal clearance (ARC), normal, or impaired renal function (creatinine clearances of 285, 120 or ∼10 mL/min, respectively) were generated for three meropenem regimens (2g, 1g and 0...
March 6, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28264613/pharmacokinetic-drug-evaluation-of-ceftobiprole-for-the-treatment-of-mrsa
#11
Karolyn S Horn, Larry H Danziger, Keith A Rodvold, Robert C Glowacki
Methicillin-resistant Staphylococcus aureus (MRSA), while decreasing in overall incidence, is still a prominent concern world-wide. New agents coming to market in the last 10 years allow practitioners to optimize treatment for MRSA infections. Ceftobiprole is a cephalosporin agent with MRSA activity, currently approved in selected countries for the treatment of community-acquired pneumonia and hospital-acquired pneumonia. Areas covered: Relevant literature regarding spectrum of activity, pharmacokinetics, pharmacodynamics, and clinical trials will be discussed...
March 17, 2017: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/28257317/pulmonary-infections-in-critical-intensive-care-rapid-diagnosis-and-optimizing-antimicrobial-usage
#12
Ivor S Douglas
PURPOSE OF REVIEW: Diagnosis of pulmonary infection, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in the critically ill patient remains a common and therapeutically challenging diagnosis with significant attributable morbidity, mortality, and cost. Current clinical approaches to surveillance, early detection and, conventional culture-based microbiology are inadequate for optimal targeted antibiotic treatment and stewardship. Efforts to enhance diagnosis of HAP and VAP and the impact of these novel approaches on rational antimicrobial selection and stewardship are the focus of recent studies reviewed here...
March 2, 2017: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/28248714/nebulization-of-antiinfective-agents-in-invasively-mechanically-ventilated-adults-a-systematic-review-and-meta-analysis
#13
Candela Solé-Lleonart, Jean-Jacques Rouby, Stijn Blot, Garyfallia Poulakou, Jean Chastre, Lucy B Palmer, Matteo Bassetti, Charles-Edouard Luyt, Jose M Pereira, Jordi Riera, Tim Felton, Jayesh Dhanani, Tobias Welte, Jose M Garcia-Alamino, Jason A Roberts, Jordi Rello
BACKGROUND: Nebulization of antiinfective agents is a common but unstandardized practice in critically ill patients. METHODS: A systematic review of 1,435 studies was performed in adults receiving invasive mechanical ventilation. Two different administration strategies (adjunctive and substitute) were considered clinically relevant. Inclusion was restricted to studies using jet, ultrasonic, and vibrating-mesh nebulizers. Studies involving children, colonized-but-not-infected adults, and cystic fibrosis patients were excluded...
March 1, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28248705/antibiotic-therapy-in-the-critically-ill-expert-opinion-of-the-intensive-care-medicine-scientific-subcommittee-of-the-european-society-of-anaesthesiology
#14
Ignacio Martin-Loeches, Marc Leone, Krisztina Madách, Claude Martin, Sharon Einav
Antimicrobial treatment is the cornerstone of infection treatment, and the selection of appropriate antibiotic treatment for critically ill patients is challenging. Clinicians working with critically ill patients usually feel a greater obligation towards their patient than towards maintenance of the delicate ecological balance of prevalent microbiological threats and their resistance patterns. Although antibiotic overtreatment is a frequent phenomenon, patient outcomes need not be compromised when antibiotic treatment is driven by informed decision-making...
April 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28236797/community-acquired-pneumonia-caused-by-methicillin-resistant-staphylococcus-aureus-in-critically-ill-patients-systematic-review
#15
Nuria Carballo, Marta De Antonio-Cuscó, Daniel Echeverría-Esnal, Sonia Luque, Esther Salas, Santiago Grau
INTRODUCTION: Community-acquired pneumonia (CAP) is associated with high morbidity and mortality rates. Despite methicillin-resistant Staphylococcus aureus (MRSA) having often been associated with nosocomial pneumonia, the condition of some MRSA CAP patients is severe enough to warrant their being admitted to ICU. OBJECTIVE: The purpose of this study is to conduct a systematic review of the literature on antibiotic treatment of MRSA CAP in critically-ill patients...
March 1, 2017: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/28228057/intravenous-chlorothiazide-versus-enteral-metolazone-to-augment-loop-diuretic-therapy-in-the-intensive-care-unit
#16
Christopher J Michaud, Kendall C Mintus
BACKGROUND: In cases of loop diuretic resistance in the intensive care unit (ICU), recommendations for a specific second-line thiazide agent are lacking. OBJECTIVE: To compare the effects of intravenous chlorothiazide (CTZ) and enteral metolazone (MET) on urine output (UOP) when added to furosemide monotherapy therapy in critically ill adults. METHODS: This was a retrospective cohort study conducted in the medical, surgical, and cardiothoracic ICUs of a quaternary medical center...
April 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28222811/recurring-septic-shock-in-a-patient-with-blunt-abdominal-and-pelvic-trauma-how-mandatory-is-source-control-surgery-a-case-report
#17
Antonella Frattari, Giustino Parruti, Rocco Erasmo, Luigi Guerra, Ennio Polilli, Rosamaria Zocaro, Giuliano Iervese, Paolo Fazii, Tullio Spina
BACKGROUND: In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control. CASE PRESENTATION: A 42-year-old white man presented with traumatic hemorrhagic shock. Unstable pelvic fractures led to emergency stabilization surgery. Fever ensued with diarrhea, followed by septic shock...
February 22, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28222699/suspicion-of-respiratory-tract-infection-with-multidrug-resistant-enterobacteriaceae-epidemiology-and-risk-factors-from-a-paediatric-intensive-care-unit
#18
Hanna Renk, Lenja Stoll, Felix Neunhoeffer, Florian Hölzl, Matthias Kumpf, Michael Hofbeck, Dominik Hartl
BACKGROUND: Multidrug-resistant (MDR) infections are a serious concern for children admitted to the Paediatric Intensive Care Unit (PICU). Tracheal colonization with MDR Enterobacteriaceae predisposes to respiratory infection, but underlying risk factors are poorly understood. This study aims to determine the incidence of children with suspected infection during mechanical ventilation and analyses risk factors for the finding of MDR Enterobacteriaceae in tracheal aspirates. METHODS: A retrospective single-centre analysis of Enterobacteriaceae isolates from the lower respiratory tract of ventilated PICU patients from 2005 to 2014 was performed...
February 21, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28215131/angiotensin-ii-for-the-treatment-of-high-output-shock-3-athos-3-protocol-for-a-phase-iii-double-blind-randomised-controlled-trial
#19
Lakhmir S Chawla, James A Russell, Sean M Bagshaw, Andrew D Shaw, Stuart L Goldstein, Mitchell P Fink, George F Tidmarsh
OBJECTIVE: Catecholamine-resistant hypotension (CRH) is characterised by inadequate response to standard doses of vasopressors, and increased mortality. Our Angiotensin II for the Treatment of High-Output Shock 3 (ATHOS-3) trial compares the efficacy and safety of angiotensin II (ANGII) versus placebo in CRH. DESIGN, SETTING AND PARTICIPANTS: A phase III, multicentre, randomised, placebo-controlled trial of LJPC-501 (synthetic ANGII) for CRH in up to 120 intensive care units...
March 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28198203/enteral-administration-of-twice-daily-dolutegravir-and-rilpivirine-as-a-part-of-a-triple-therapy-regimen-in-a-critically-ill-patient-with-hiv
#20
Sarah Lynn Turley, Patricia Pecora Fulco
The administration of antiretroviral therapy (ART) in intubated critically ill patients may be challenging. Limited pharmacokinetic data exist characterizing the effects of crushed ART with subsequent enteral administration on antiretroviral drug concentrations or the clinical impact on HIV virologic suppression. We report a case of a 27-year-old HIV-positive male with presumed multidrug-resistant HIV and a diagnosis of lymphoma who required enteral ART administration after intensive care unit admission. Crushed twice-daily dolutegravir (separated from enteral nutrition by 2 hours) and rilpivirine (concurrently with a bolus feed) were administered via an orogastric tube...
January 1, 2017: Journal of the International Association of Providers of AIDS Care
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