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Critical ill and resistency

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https://www.readbyqxmd.com/read/28619105/patterns-of-antimicrobial-resistance-in-intensive-care-unit-patients-a-study-in-vietnam
#1
Giang M Tran, Thao P Ho-Le, Duc T Ha, Chau H Tran-Nguyen, Tuyet S M Nguyen, Thao T N Pham, Tuyet A Nguyen, Dung A Nguyen, Hoa Q Hoang, Ngoc V Tran, Tuan V Nguyen
BACKGROUND: Antimicrobial resistance has emerged as a major concern in developing countries. The present study sought to define the pattern of antimicrobial resistance in ICU patients with ventilator-associated pneumonia. METHODS: Between November 2014 and September 2015, we enrolled 220 patients (average age ~ 71 yr) who were admitted to ICU in a major tertiary hospital in Ho Chi Minh City, Vietnam. Data concerning demographic characteristics and clinical history were collected from each patient...
June 15, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28616666/the-role-of-psychosomatic-medicine-in-intensive-care-units
#2
REVIEW
Heidemarie Abrahamian, Diana Lebherz-Eichinger
Critically ill patients, their relatives, and intensive care staff are consistently exposed to stress. The principal elements of this exceptional burden are confrontation with a life-threatening disease, specific environmental conditions at the intensive care unit, and the social characteristics of intensive care medicine. The short- and long-term consequences of these stressors include a feeling of helplessness, distress, anxiety, depression, and even posttraumatic stress disorders. Not only the patients, but also their relatives and intensive care staff are at risk of developing such psychopathologies...
June 14, 2017: Wiener Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28614442/skin-and-soft-tissue-infections-in-the-intensive-care-unit-a-retrospective-study-in-a-tertiary-care-center
#3
Luís Filipe Malheiro, Rita Magano, Alcina Ferreira, António Sarmento, Lurdes Santos
Objective: To identify factors that may influence outcomes in patients with severe skin and soft tissue infections in the intensive care unit. Methods: A retrospective observational study was conducted in a cohort of 1,123 critically ill patients admitted to an intensive care unit with a primary or secondary diagnosis of severe skin and soft tissues infection between January 2006 and December 2014. Results: Thirty patients were included, 20 (66...
June 12, 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28607024/population-pharmacokinetics-of-tigecycline-in-critically-ill-patients-with-severe-infections
#4
Jiao Xie, Jason A Roberts, Abdulaziz S Alobaid, Claire Roger, Yan Wang, Qianting Yang, Jinyao Sun, Haiyan Dong, Xue Wang, Jianfeng Xing, Jeffrey Lipman, Yalin Dong
Objectives: We sought to describe the population pharmacokinetics of tigecycline in critically ill patients and describe optimized dosing regimens of tigecycline for different bacterial infections.Methods: This prospective study included ten critically ill patients given a standard dose of tigecycline. Blood samples were collected during one dosing interval and analyzed using validated chromatography. Population pharmacokinetics and Monte Carlo dosing simulations were undertaken using Pmetrics. Three target exposures, ratios of 24h area under the curve to minimum inhibitory concentrations (AUC0-24/MIC), were evaluated (≥17...
June 12, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28584849/carbapenem-resistant-enterobacteriaceae-infections-results-from-a-retrospective-series-and-implications-for-the-design-of-prospective-clinical-trials
#5
Elizabeth L Alexander, Jeffery Loutit, Mario Tumbarello, Richard Wunderink, Tim Felton, George Daikos, Karen Fusaro, Dan White, Shu Zhang, Michael N Dudley
BACKGROUND: The increasing incidence of multidrug-resistant Gram negatives, such as carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a critical need for new antimicrobials. Most studies of new antimicrobials have been performed in patients with nondrug-resistant pathogens. We performed a retrospective analysis of patients with CRE infections to inform the design of phase 3 clinical trials. METHODS: This was a retrospective study at 22 centers in 4 countries...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28584139/genomic-analysis-of-multidrug-resistant-escherichia-coli-from-north-carolina-community-hospitals-ongoing-circulation-of-ctx-m-producing-st131-h30rx-and-st131-h30r1-strains
#6
Hajime Kanamori, Christian M Parobek, Jonathan J Juliano, James R Johnson, Brian D Johnston, Timothy J Johnson, David J Weber, William A Rutala, Deverick J Anderson
Escherichia coli sequence type 131 (ST131) predominates globally among multidrug-resistant (MDR) E. coli We used whole-genome sequencing (WGS) to investigate 63 MDR E. coli isolates from 7 North Carolina community hospitals (2010-2015). Of these, 39 (62%) represented ST131, including 37 (95%) from the ST131-H30R subclone: 10 (27%) from its H30R1 subset, and 27 (69%) from its H30Rx subset. ST131 core genomes differed by a median of 15 single-nucleotide variants (SNVs) overall (range, 0-490), vs. only 7 within H30R1 (range, 3-12 SNVs) and 11 within H30Rx (range, 0-21)...
June 5, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28578555/infections-due-to-acinetobacter-baumannii-in-the-icu-treatment-options
#7
Joseph P Lynch, George G Zhanel, Nina M Clark
Bacteria within the genus Acinetobacter (principally A. baumannii-calcoaceticus complex [ABC]) are gram-negative coccobacilli that may cause nosocomial infections in critically ill or debilitated patients (particularly ventilator-associated pneumonia and infections of the bloodstream, urinary tract, and wounds). Treatment of Acinetobacter infections is difficult, as Acinetobacter spp. are intrinsically resistant to multiple antimicrobial agents, and have a remarkable ability to acquire new resistance determinants via mechanisms that include plasmids, transposons, integrons, and resistance islands...
June 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28578550/ventilator-associated-pneumonia-the-role-of-emerging-diagnostic-technologies
#8
Marin H Kollef, Carey-Ann D Burnham
Antibiotic resistance has emerged as a key determinant of outcome in patients with serious infections along with the virulence of the underlying pathogen. Within the intensive care unit (ICU) setting, ventilator-associated pneumonia (VAP) is a common nosocomial infection that is frequently caused by multidrug-resistant bacteria. Antimicrobial resistance is a growing challenge in the care of critically ill patients. Escalating rates of antibiotic resistance add substantially to the morbidity, mortality, and cost related to infection in the ICU...
June 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28571493/optimizing-%C3%AE-lactams-treatment-in-critically-ill-patients-using-pharmacokinetics-pharmacodynamics-targets-are-first-conventional-doses-effective
#9
Isabelle K Delattre, Fabio S Taccone, Frédérique Jacobs, Maya Hites, Thierry Dugernier, Herbert Spapen, Pierre-François Laterre, Pierre E Wallemacq, Françoise Van Bambeke, Paul M Tulkens
The pharmacokinetic/pharmacodynamic index determining β-lactam activity is the percentage of the dosing interval (%T) during which their free serum concentration remains above a critical threshold over the minimum inhibitory concentration (MIC). Regrettably, neither the value of %T nor that of the threshold are clearly defined for critically-ill patients. Areas covered: We review and assess the targets proposed for β-lactams in critical illness by screening the literature since 1997. Depending on the study intention (clinical cure vs...
June 19, 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28562284/epidemiology-of-methicillin-resistant-staphylococcus-aureus-bacteremia-in-children
#10
Rana F Hamdy, Alice J Hsu, Chris Stockmann, Jared A Olson, Matthew Bryan, Adam L Hersh, Pranita D Tamma, Jeffrey S Gerber
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high rates of treatment failure in adults. The epidemiology, clinical outcomes, and risk factors for treatment failure associated with MRSA bacteremia in children are poorly understood. METHODS: Multicenter, retrospective cohort study of children ≤18 years hospitalized with MRSA bacteremia across 3 tertiary care children's hospitals from 2007 to 2014. Treatment failure was defined as persistent bacteremia >3 days, recurrence of bacteremia within 30 days, or attributable 30-day mortality...
May 5, 2017: Pediatrics
https://www.readbyqxmd.com/read/28555783/implementation-of-a-critical-care-outreach-service-a-qualitative-study
#11
A Jeddian, A Lindenmeyer, T Marshall, A F Howard, L Sayadi, A Rashidian, N Jafari
AIM: The aim of this study was to explore hospital staff perceptions of the perceived challenges and outcomes of implementing a critical care outreach service. BACKGROUND: A nurse-led critical care outreach service was designed and implemented to identify and treat acutely ill patients in a large tertiary care hospital in Iran. METHODS: A qualitative analysis of data from two focus groups and seven interviews was carried out using conventional content analyses techniques...
May 29, 2017: International Nursing Review
https://www.readbyqxmd.com/read/28554937/untargeted-antifungal-therapy-in-adult-patients-with-complicated-intra-abdominal-infection-protocol-for-a-systematic-review-with-meta-analysis
#12
Marie Warrer Petersen, Anders Perner, Fredrik Sjövall, Morten Hylander Møller
INTRODUCTION: Intra-abdominal infections are the second most frequent cause of sepsis. In a recent cohort, fungal specimens were found in 51.9% of all patients with sepsis and peritonitis. Current systematic reviews comparing untargeted antifungal treatment with placebo or no treatment in patients who are critically ill have provided conflicting results, and clinical equipoise exists. Accordingly, we aim to assess patient-important benefits and harms of untargeted antifungal therapy versus placebo or no treatment in adult patients with complicated intra-abdominal infection...
May 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28541510/optimization-of-linezolid-therapy-in-the-critically-ill-the-effect-of-adjusted-infusion-regimens
#13
Max Taubert, Johannes Zander, Sebastian Frechen, Christina Scharf, Lorenz Frey, Michael Vogeser, Uwe Fuhr, Michael Zoller
Objectives: Insufficient linezolid levels, which are associated with a poorer outcome, are often observed in ICU patients who receive standard dosing. Although strategies to overcome these insufficient levels have been discussed, appropriate alternative dosing regimens remain to be identified. Methods: Various infusion regimens (1200-3600 mg/day; q6h, q8h, q12h and continuous) were simulated in 67 000 ICU patients. The probability of attaining pharmacodynamic targets ( T >MIC ≥85%, AUC/MIC ≥100, cumulative fraction of response for Staphylococcus aureus and Enterococcus spp...
May 24, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28525674/continuous-hemoadsorption-with-a-cytokine-adsorber-during-sepsis-a-review-of-the-literature
#14
Khosrow S Houschyar, Malcolm N Pyles, Susanne Rein, Ina Nietzschmann, Dominik Duscher, Zeshaan N Maan, Kristian Weissenberg, Hubertus M Philipps, Catharina Strauss, Beate Reichelt, Frank Siemers
Sepsis is a well-recognized healthcare issue worldwide, ultimately resulting in significant mortality, morbidity and resource utilization during and after critical illness. In its most severe form, sepsis causes multi-organ dysfunction that produces a state of critical illness characterized by severe immune dysfunction and catabolism. Sepsis induces the activation of complement factor via 3 pathways and the release of inflammatory cytokines such as tumor necrosis factor alpha (TNF-α) and interleukin-1beta (IL-1β), resulting in a systemic inflammatory response...
May 29, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28520859/the-role-of-patient-care-items-as-a-fomite-in-healthcare-associated-outbreaks-and-infection-prevention
#15
Hajime Kanamori, William A Rutala, David J Weber
Patient-care items can serve as a source or reservoir for healthcare associated pathogens in hospitals. We reviewed healthcare-associated outbreaks from medical equipment and provided infection prevention recommendations. Multiple healthcare-associated outbreaks via a contaminated patient-care item were identified, including infections with multidrug-resistant organisms. The type of patient-care items implicated as a fomite causing healthcare-associated infections (HAI) has changed over time. Patient populations at risk were most commonly critically ill patients in adult and neonatal ICUs...
May 17, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28501490/colistin-use-in-critically-ill-neonates-a%C3%A2-case-control-study
#16
Mehmet Sah İpek, Fesih Aktar, Nilufer Okur, Muhittin Celik, Erdal Ozbek
BACKGROUND: The aim of this study was to assess the safety and efficacy of colistin use in critically ill neonates. METHODS: This was a case-control study that included newborn infants with proven or suspected nosocomial infections between January 2012 and October 2015, at two centers in Diyarbakir, Turkey. The clinical and laboratory characteristics and outcomes of patients who received colistin therapy were reviewed and compared to patients who were treated with antimicrobial agents other than colistin during the same period...
March 27, 2017: Pediatrics and Neonatology
https://www.readbyqxmd.com/read/28485324/a-novel-porcine-model-of-septic-shock-induced-by-acute-respiratory-distress-syndrome-due-to-methicillin-resistant-staphylococcus-aureus
#17
Shuo Wang, Jun-Yu Wang, Tao Wang, Chen-Chen Hang, Rui Shao, Chun-Sheng Li
BACKGROUND: Sepsis is one of the main causes of mortality in critically ill patients following progression to septic shock. To investigate the pathophysiologic changes of sepsis, we developed a novel porcine model of septic shock induced by acute respiratory distress syndrome (ARDS) due to methicillin-resistant Staphylococcus aureus(MRSA) pneumonia. METHODS: Twenty-six male Landraces (Lvyuanweiye, Beijing, China) weighing 30 ± 2 kg were divided into four groups: sham group (SH; n = 5); cotton smoke inhalation group (SM; n = 6); MRSA pneumonia group (MR; n = 6); and septic shock group with cotton smoke inhalation + MRSA pneumonia (SS; n = 9)...
May 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28478944/theoretical-and-experimental-evaluation-of-the-effects-of-an-argon-gas-mixture-on-the-pressure-drop-through-adult-tracheobronchial-airway-replicas
#18
Patrick D Litwin, Anna Luisa Reis Dib, John Chen, Michelle Noga, Warren H Finlay, Andrew R Martin
Argon has the potential to be a novel inhaled therapeutic agent, owing to the neuroprotective and organoprotective properties demonstrated in preclinical studies. Before human trials are performed, an understanding of varying gas properties on airway resistance during inhalation is essential. This study predicts the effect of an 80% argon/20% oxygen gas mixture on the pressure drop through conducting airways, and by extension the airway resistance, and then verifies these predictions experimentally using 3-D printed adult tracheobronchial airway replicas...
April 18, 2017: Journal of Biomechanics
https://www.readbyqxmd.com/read/28475585/acinetobacter-baumannii-strains-isolated-from-patients-in-intensive-care-units-in-goi%C3%A3-nia-brazil-molecular-and-drug-susceptibility-profiles
#19
Suellen Rocha Araújo Castilho, Cássia Silva de Miranda Godoy, Adriana Oliveira Guilarde, Juliana Lamaro Cardoso, Maria Cláudia Porfirio André, Ana Paula Junqueira-Kipnis, André Kipnis
Resistance to antimicrobial agents is increasing worldwide and imposes significant life-threatening risks to several different populations, especially those in intensive care units (ICUs). Bacteria can quickly develop or acquire resistance to antimicrobial drugs, and combined with their intrinsic potential to cause disease in humans, these bacteria can become deadly. Among Gram-negative bacteria, Acinetobacter baumannii is notorious as a frequent opportunistic pathogen associated with critically ill patients, and understanding the genetic basis of A...
2017: PloS One
https://www.readbyqxmd.com/read/28466147/appropriate-endpoints-for-evaluation-of-new-antibiotic-therapies-for-severe-infections-a-perspective-from-combacte-s-stat-net
#20
Jean-François Timsit, Marlieke E A de Kraker, Harriet Sommer, Emmanuel Weiss, Esther Bettiol, Martin Wolkewitz, Stavros Nikolakopoulos, David Wilson, Stephan Harbarth
PURPOSE: In this era of rising antimicrobial resistance, slowly refilling antibiotic development pipelines, and an aging population, we need to ensure that randomized clinical trials (RCTs) determine the added benefit of new antibiotic agents effectively and in a valid way, especially for severely ill patients. Unfortunately, universally accepted endpoints for the evaluation of new drugs in severe infections are lacking. METHODS: We review and discuss the current practices and challenges regarding endpoints in RCTs in this field and propose novel approaches...
May 2, 2017: Intensive Care Medicine
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