Pub Date : 2024-04-01DOI: 10.1016/j.jointm.2023.09.005
Yu Wu , Guosheng Wu , Minyu Li , Yongqing Chang , Miao Yu , Yan Meng , Xiaojian Wan
Background
Prolonged length of stay (LOS) of sepsis can drain a hospital's material and human resources. This study investigated the correlations between T helper type 17 (Th17) and regulatory T (Treg) balance with LOS in sepsis.
Methods
A prospective clinical observational study was designed in Changhai Hospital affiliated to Naval Medical University in Shanghai, China, from January to October 2020. The patients diagnosed with sepsis and who met the inclusion and exclusion criteria were recruited and whether the levels of cytokines, procalcitonin, subtypes, and biomarkers of T cells in the peripheral blood were detected. We analyzed the correlation between these and LOS.
Results
Sixty septic patients were classified into two groups according to whether their intensive care unit (ICU) stay exceeded 14 days. The patients with LOS ≥14 days were older ([72.6±7.5] years vs. [63.3±10.4] years, P=0.015) and had higher Sequential Organ Failure Assessment (SOFA) (median [interquartile range]: 6.5 [5.0–11.0] vs. 4.0 [3.0–6.0], P=0.001) and higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (16.0 [13.0–21.0] vs. 8.5 [7.0–14.0], P=0.001). There was no difference in other demographic characteristics and cytokines, interleukin-6, tumor necrosis factor-α, and interleukin-10 between the two groups. The Th17/Treg ratio of sepsis with LOS <14 days was considerably lower (0.48 [0.38–0.56] vs. 0.69 [0.51–0.98], P=0.001). For patients with LOS ≥14 days, the area under the receiver operating characteristic curve for the Th17/Treg ratio was 0.766. It improved to 0.840 and 0.850 when combined with the SOFA and APACHE II scores, respectively.
Conclusions
The Th17/Treg ratio was proportional to septic severity and can be used as a potential predictor of ICU stay in sepsis, presenting a new option for ICU practitioners to better care for patients with sepsis.
背景脓毒症患者住院时间（LOS）的延长会耗费医院的物力和人力。本研究探讨了脓毒症患者T辅助细胞17型（Th17）和调节性T（Treg）平衡与住院时间的相关性。方法于2020年1月至10月在中国上海海军军医大学附属长海医院设计了一项前瞻性临床观察研究。招募符合纳入和排除标准的脓毒症患者，检测其外周血中细胞因子、降钙素原、亚型和 T 细胞生物标志物的水平。结果根据脓毒症患者在重症监护室（ICU）的住院时间是否超过 14 天，将其分为两组。LOS≥14天的患者年龄较大（[72.6±7.5] 岁 vs. [63.3±10.4]岁，P=0.015），序贯器官功能衰竭评估（SOFA）较高（中位数[四分位间范围]：6.5[5.0-11.0]对 4.0 [3.0-6.0]，P=0.001），急性生理学和慢性健康评估（APACHE）II 评分更高（16.0 [13.0-21.0] 对 8.5 [7.0-14.0]，P=0.001）。两组患者的其他人口统计学特征和细胞因子、白细胞介素-6、肿瘤坏死因子-α和白细胞介素-10均无差异。LOS<14天的脓毒症患者的Th17/Treg比值要低得多（0.48 [0.38-0.56] vs. 0.69 [0.51-0.98]，P=0.001）。对于LOS≥14天的患者，Th17/Treg比值的接收者操作特征曲线下面积为0.766。结论 Th17/Treg 比值与脓毒症严重程度成正比，可作为脓毒症患者入住 ICU 的潜在预测指标，为 ICU 医生更好地护理脓毒症患者提供了新的选择。
{"title":"Prediction of Th17/Treg cell balance on length of stay in intensive care units of patients with sepsis","authors":"Yu Wu , Guosheng Wu , Minyu Li , Yongqing Chang , Miao Yu , Yan Meng , Xiaojian Wan","doi":"10.1016/j.jointm.2023.09.005","DOIUrl":"10.1016/j.jointm.2023.09.005","url":null,"abstract":"<div><h3>Background</h3><p>Prolonged length of stay (LOS) of sepsis can drain a hospital's material and human resources. This study investigated the correlations between T helper type 17 (Th17) and regulatory T (Treg) balance with LOS in sepsis.</p></div><div><h3>Methods</h3><p>A prospective clinical observational study was designed in Changhai Hospital affiliated to Naval Medical University in Shanghai, China, from January to October 2020. The patients diagnosed with sepsis and who met the inclusion and exclusion criteria were recruited and whether the levels of cytokines, procalcitonin, subtypes, and biomarkers of T cells in the peripheral blood were detected. We analyzed the correlation between these and LOS.</p></div><div><h3>Results</h3><p>Sixty septic patients were classified into two groups according to whether their intensive care unit (ICU) stay exceeded 14 days. The patients with LOS ≥14 days were older ([72.6±7.5] years <em>vs</em>. [63.3±10.4] years, <em>P</em>=0.015) and had higher Sequential Organ Failure Assessment (SOFA) (median [interquartile range]: 6.5 [5.0–11.0] <em>vs</em>. 4.0 [3.0–6.0], <em>P</em>=0.001) and higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (16.0 [13.0–21.0] <em>vs</em>. 8.5 [7.0–14.0], <em>P</em>=0.001). There was no difference in other demographic characteristics and cytokines, interleukin-6, tumor necrosis factor-α, and interleukin-10 between the two groups. The Th17/Treg ratio of sepsis with LOS <14 days was considerably lower (0.48 [0.38–0.56] <em>vs</em>. 0.69 [0.51–0.98], <em>P</em>=0.001). For patients with LOS ≥14 days, the area under the receiver operating characteristic curve for the Th17/Treg ratio was 0.766. It improved to 0.840 and 0.850 when combined with the SOFA and APACHE II scores, respectively.</p></div><div><h3>Conclusions</h3><p>The Th17/Treg ratio was proportional to septic severity and can be used as a potential predictor of ICU stay in sepsis, presenting a new option for ICU practitioners to better care for patients with sepsis.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 240-246"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000853/pdfft?md5=321ab9d2b5242e0e171ec49293fa0b44&pid=1-s2.0-S2667100X23000853-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138993281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.jointm.2023.08.002
Lianlian Jiang , Hui Chen , Jianfeng Xie , Ling Liu , Yi Yang
Background
The dead space fraction (VD/VT) has proven to be a powerful predictor of higher mortality in acute respiratory distress syndrome (ARDS). However, its measurement relies on expired carbon dioxide, limiting its widespread application in clinical practice. Several estimates employing routine variables have been found to be reliable substitutes for direct measurement of VD/VT. In this study, we evaluated the prognostic value of these dead space estimates obtained in the first 7 days following the initiation of ventilation.
Methods
This retrospective observational study was conducted using data from the Chinese database in intensive care (CDIC). Eligible participants were adult ARDS patients receiving invasive mechanical ventilation while in the intensive care unit between 1st January 2014 and 31st March 2021. We collected data during the first 7 days of ventilation to calculate various dead space estimates, including ventilatory ratio (VR), corrected minute ventilation (), VD/VT (Harris–Benedict), VD/VT (Siddiki estimate), and VD/VT (Penn State estimate) longitudinally. A time-dependent Cox model was used to handle these time-varying estimates.
Results
A total of 392 patients (median age 66 [interquartile range: 55–77] years, median SOFA score 9 [interquartile range: 7–12]) were finally included in our analysis, among whom 132 (33.7%) patients died within 28 days of admission. VR (hazard ratio [HR]=1.04 per 0.1 increase, 95% confidence interval [CI]: 1.01 to 1.06; P=0.013), (HR=1.08 per 1 increase, 95% CI: 1.04 to 1.12; P < 0.001), VD/VT (Harris–Benedict) (HR=1.25 per 0.1 increase, 95% CI: 1.06 to 1.47; P=0.006), and VD/VT (Penn State estimate) (HR=1.22 per 0.1 increase, 95% CI: 1.04 to 1.44; P=0.017) remained significant after adjustment, while VD/VT (Siddiki estimate) (HR=1.10 per 0.1 increase, 95% CI: 1.00 to 1.20; P=0.058) did not. Given a large number of negative values, VD/VT (Siddiki estimate) and VD/VT (Penn State estimate) were not recommended as reliable substitutes. Long-term exposure to VR >1.3, >7.53, and VD/VT (Harris–Benedict) >0.59 was independently associated with an increased risk of mortality in ARDS patients. These findings were validated in the fluid and catheter treatment trial (FACTT) database.
{"title":"Prognostic value of time-varying dead space estimates in mechanically ventilated patients with acute respiratory distress syndrome","authors":"Lianlian Jiang , Hui Chen , Jianfeng Xie , Ling Liu , Yi Yang","doi":"10.1016/j.jointm.2023.08.002","DOIUrl":"10.1016/j.jointm.2023.08.002","url":null,"abstract":"<div><h3>Background</h3><p>The dead space fraction (V<sub>D</sub>/V<sub>T</sub>) has proven to be a powerful predictor of higher mortality in acute respiratory distress syndrome (ARDS). However, its measurement relies on expired carbon dioxide, limiting its widespread application in clinical practice. Several estimates employing routine variables have been found to be reliable substitutes for direct measurement of V<sub>D</sub>/V<sub>T</sub>. In this study, we evaluated the prognostic value of these dead space estimates obtained in the first 7 days following the initiation of ventilation.</p></div><div><h3>Methods</h3><p>This retrospective observational study was conducted using data from the Chinese database in intensive care (CDIC). Eligible participants were adult ARDS patients receiving invasive mechanical ventilation while in the intensive care unit between 1st January 2014 and 31st March 2021. We collected data during the first 7 days of ventilation to calculate various dead space estimates, including ventilatory ratio (VR), corrected minute ventilation (<span><math><msub><mover><mi>V</mi><mo>˙</mo></mover><mtext>Ecorr</mtext></msub></math></span>), V<sub>D</sub>/V<sub>T</sub> (Harris–Benedict), V<sub>D</sub>/V<sub>T</sub> (Siddiki estimate), and V<sub>D</sub>/V<sub>T</sub> (Penn State estimate) longitudinally. A time-dependent Cox model was used to handle these time-varying estimates.</p></div><div><h3>Results</h3><p>A total of 392 patients (median age 66 [interquartile range: 55–77] years, median SOFA score 9 [interquartile range: 7–12]) were finally included in our analysis, among whom 132 (33.7%) patients died within 28 days of admission. VR (hazard ratio [HR]=1.04 per 0.1 increase, 95% confidence interval [CI]: 1.01 to 1.06; <em>P</em>=0.013), <span><math><msub><mover><mi>V</mi><mo>˙</mo></mover><mtext>Ecorr</mtext></msub></math></span> (HR=1.08 per 1 increase, 95% CI: 1.04 to 1.12; <em>P</em> < 0.001), V<sub>D</sub>/V<sub>T</sub> (Harris–Benedict) (HR=1.25 per 0.1 increase, 95% CI: 1.06 to 1.47; <em>P</em>=0.006), and V<sub>D</sub>/V<sub>T</sub> (Penn State estimate) (HR=1.22 per 0.1 increase, 95% CI: 1.04 to 1.44; <em>P</em>=0.017) remained significant after adjustment, while V<sub>D</sub>/V<sub>T</sub> (Siddiki estimate) (HR=1.10 per 0.1 increase, 95% CI: 1.00 to 1.20; <em>P</em>=0.058) did not. Given a large number of negative values, V<sub>D</sub>/V<sub>T</sub> (Siddiki estimate) and V<sub>D</sub>/V<sub>T</sub> (Penn State estimate) were not recommended as reliable substitutes. Long-term exposure to VR >1.3, <span><math><msub><mover><mi>V</mi><mo>˙</mo></mover><mtext>Ecorr</mtext></msub></math></span> >7.53, and V<sub>D</sub>/V<sub>T</sub> (Harris–Benedict) >0.59 was independently associated with an increased risk of mortality in ARDS patients. These findings were validated in the fluid and catheter treatment trial (FACTT) database.</p></div><div><h3>Conclusions</h3><p>In cases where V<sub>D</sub>/V<sub>T</sub> cannot ","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 187-193"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000579/pdfft?md5=0ac9da0cfca8c02b622234d8102decc2&pid=1-s2.0-S2667100X23000579-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135607151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.jointm.2023.09.004
Sylvain Le Pape , Florent Joly , François Arrivé , Jean-Pierre Frat , Maeva Rodriguez , Maïa Joos , Laura Marchasson , Mathilde Wairy , Arnaud W. Thille , Rémi Coudroy
Background
Extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) is systematically associated with decreased respiratory system compliance (CRS). It remains unclear whether transportation to the referral ECMO center, changes in ventilatory mode or settings to achieve ultra-protective ventilation, or the natural evolution of ARDS drives this change in respiratory mechanics. Herein, we assessed the precise moment when CRS decreases after ECMO cannulation and identified factors associated with decreased CRS.
Methods
To rule out the effect of transportation and the different modes of ventilation on CRS, we conducted a retrospective, single-center, observational cohort study from January 2013 to May 2020, on 22 patients with severe ARDS requiring on-site ECMO and ventilated in pressure-controlled mode to achieve ultra-protective ventilation. CRS was assessed at different time points ranging from 12 h before ECMO cannulation to 72 h after ECMO cannulation. The primary outcome was the relative change in CRS between 3 h before and 3 h after ECMO cannulation. The secondary outcomes included variables associated with the relative changes in CRS within the first 3 h after ECMO cannulation and the relative changes in CRS at each time point.
Results
CRS decreased within the first 3 h after ECMO cannulation (−28.3%, 95% confidence interval [CI]: −38.8 to −17.9, P<0.001), while the decrease was mild before and after these first 3 h after ECMO cannulation. To achieve ultra-protective ventilation, respiratory rate decreased in the mean by –13 breaths/min (95% CI: −15 to −11) and driving pressure by −8.3 cmH2O (95% CI: −11.2 to −5.3), resulting in decreased tidal volume by −3.3 mL/kg of predicted body weight (95% CI: −3.9 to −2.6) as compared to before ECMO cannulation (P <0.001 for all). Plateau pressure reduction, driving pressure reduction, and tidal volume reduction were significantly associated with decreased CRS after ECMO cannulation, whereas neither respiratory rate, positive end-expiratory pressure, inspired fraction of oxygen, fluid balance, nor mean airway pressure was associated with decreased CRS.
Conclusions
Decreased driving pressure resulting in lower tidal volume to achieve ultra-protective ventilation after ECMO cannulation was associated with a marked decrease in CRS in ARDS patients with on-site ECMO cannulation.
{"title":"Factors associated with decreased compliance after on-site extracorporeal membrane oxygenation cannulation for acute respiratory distress syndrome: A retrospective, observational cohort study","authors":"Sylvain Le Pape , Florent Joly , François Arrivé , Jean-Pierre Frat , Maeva Rodriguez , Maïa Joos , Laura Marchasson , Mathilde Wairy , Arnaud W. Thille , Rémi Coudroy","doi":"10.1016/j.jointm.2023.09.004","DOIUrl":"10.1016/j.jointm.2023.09.004","url":null,"abstract":"<div><h3>Background</h3><p>Extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) is systematically associated with decreased respiratory system compliance (CRS). It remains unclear whether transportation to the referral ECMO center, changes in ventilatory mode or settings to achieve ultra-protective ventilation, or the natural evolution of ARDS drives this change in respiratory mechanics. Herein, we assessed the precise moment when CRS decreases after ECMO cannulation and identified factors associated with decreased CRS.</p></div><div><h3>Methods</h3><p>To rule out the effect of transportation and the different modes of ventilation on CRS, we conducted a retrospective, single-center, observational cohort study from January 2013 to May 2020, on 22 patients with severe ARDS requiring on-site ECMO and ventilated in pressure-controlled mode to achieve ultra-protective ventilation. CRS was assessed at different time points ranging from 12 h before ECMO cannulation to 72 h after ECMO cannulation. The primary outcome was the relative change in CRS between 3 h before and 3 h after ECMO cannulation. The secondary outcomes included variables associated with the relative changes in CRS within the first 3 h after ECMO cannulation and the relative changes in CRS at each time point.</p></div><div><h3>Results</h3><p>CRS decreased within the first 3 h after ECMO cannulation (−28.3%, 95% confidence interval [CI]: −38.8 to −17.9, <em>P</em><0.001), while the decrease was mild before and after these first 3 h after ECMO cannulation. To achieve ultra-protective ventilation, respiratory rate decreased in the mean by –13 breaths/min (95% CI: −15 to −11) and driving pressure by −8.3 cmH<sub>2</sub>O (95% CI: −11.2 to −5.3), resulting in decreased tidal volume by −3.3 mL/kg of predicted body weight (95% CI: −3.9 to −2.6) as compared to before ECMO cannulation (<em>P</em> <0.001 for all). Plateau pressure reduction, driving pressure reduction, and tidal volume reduction were significantly associated with decreased CRS after ECMO cannulation, whereas neither respiratory rate, positive end-expiratory pressure, inspired fraction of oxygen, fluid balance, nor mean airway pressure was associated with decreased CRS.</p></div><div><h3>Conclusions</h3><p>Decreased driving pressure resulting in lower tidal volume to achieve ultra-protective ventilation after ECMO cannulation was associated with a marked decrease in CRS in ARDS patients with on-site ECMO cannulation.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 194-201"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000841/pdfft?md5=61183c699b866e26d06227c467462980&pid=1-s2.0-S2667100X23000841-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139023674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acinetobacter baumannii is a clinically significant pathogen with a high incidence of multidrug resistance that is associated with life-threatening nosocomial infections. Here, we aimed to provide an insight into the clinical characteristics and outcomes of a unique group of A. baumannii infections in which the isolates were resistant to carbapenems and most other antibiotic groups in a tertiary-care intensive care unit (ICU).
Methods
We performed a retrospective observational study in which records of patients hospitalized in the ICU between June 1, 2021 and June 1, 2023 were reviewed. We checked the clinical, laboratory, and microbiological records of all adult patients who had carbapenem-resistant A. baumannii (CRAB) infections. Prior antibiotic treatments and definitive antibiotic treatments after culture positivity and susceptibility test results were recorded. C-reactive protein (CRP) and procalcitonin levels and leukocyte counts were noted. Length of ICU stay and 30-day mortality were defined as the outcome parameters.
Results
During the study period, 57 patients were diagnosed with CRAB infections. The respiratory tract was the leading infection site (80.7%). In non-survivors, bloodstream infections (21.9% vs. 4.0% P=0.05) and colistin-resistant (col-R) CRAB infections (43.8% vs. 24.0%, P=0.12) were more common than in survivors, but these parameters were not statistically significant. The length of ICU stay was not different between survivors and non-survivors. Overall, the rate of col-R among CRAB clinical isolates was 35.1%. The 30-day mortality in all patients with CRAB infection was 56.1%. Mortality in col-R CRAB and colistin-susceptible (col-S) CRAB infections was 70.0% and 48.6%, respectively (P=0.12). Prior carbapenem use was 56.1%. Prior colistin use before col-R and col-S CRAB infections was not significant (35.0% vs. 27.0%, P=0.53).
Conclusions
Our study provides real-world data on highly resistant A. baumannii infections and shares the characteristics of infections with such resistant strains. Unfortunately, carbapenem resistance in A. baumannii is a challenge for intensive care specialists who are faced with few treatment options, and colistin resistance further complicates the problem.
{"title":"A retrospective analysis of carbapenem-resistant Acinetobacter baumannii infections in critically ill patients: Experience at a tertiary-care teaching hospital ICU","authors":"Leyla Ferlicolak , Neriman Defne Altintas , Fugen Yoruk","doi":"10.1016/j.jointm.2023.11.004","DOIUrl":"10.1016/j.jointm.2023.11.004","url":null,"abstract":"<div><h3>Background</h3><p><em>Acinetobacter baumannii</em> is a clinically significant pathogen with a high incidence of multidrug resistance that is associated with life-threatening nosocomial infections. Here, we aimed to provide an insight into the clinical characteristics and outcomes of a unique group of <em>A. baumannii</em> infections in which the isolates were resistant to carbapenems and most other antibiotic groups in a tertiary-care intensive care unit (ICU).</p></div><div><h3>Methods</h3><p>We performed a retrospective observational study in which records of patients hospitalized in the ICU between June 1, 2021 and June 1, 2023 were reviewed. We checked the clinical, laboratory, and microbiological records of all adult patients who had carbapenem-resistant <em>A. baumannii</em> (CRAB) infections. Prior antibiotic treatments and definitive antibiotic treatments after culture positivity and susceptibility test results were recorded<strong>.</strong> C-reactive protein (CRP) and procalcitonin levels and leukocyte counts were noted. Length of ICU stay and 30-day mortality were defined as the outcome parameters.</p></div><div><h3>Results</h3><p>During the study period, 57 patients were diagnosed with CRAB infections. The respiratory tract was the leading infection site (80.7%). In non-survivors, bloodstream infections (21.9% <em>vs.</em> 4.0% <em>P</em>=0.05) and colistin-resistant (col-R) CRAB infections (43.8% <em>vs.</em> 24.0%, <em>P</em>=0.12) were more common than in survivors, but these parameters were not statistically significant. The length of ICU stay was not different between survivors and non-survivors. Overall, the rate of col-R among CRAB clinical isolates was 35.1%. The 30-day mortality in all patients with CRAB infection was 56.1%. Mortality in col-R CRAB and colistin-susceptible (col-S) CRAB infections was 70.0% and 48.6%, respectively (<em>P</em>=0.12). Prior carbapenem use was 56.1%. Prior colistin use before col-R and col-S CRAB infections was not significant (35.0% <em>vs.</em> 27.0%, <em>P</em>=0.53).</p></div><div><h3>Conclusions</h3><p>Our study provides real-world data on highly resistant <em>A. baumannii</em> infections and shares the characteristics of infections with such resistant strains. Unfortunately, carbapenem resistance in <em>A. baumannii</em> is a challenge for intensive care specialists who are faced with few treatment options, and colistin resistance further complicates the problem.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 181-186"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000907/pdfft?md5=86f94941361c491c86f93b2100f0145d&pid=1-s2.0-S2667100X23000907-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139393743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.jointm.2023.08.003
Josephine Braunsteiner, Stephanie Siedler, Dominik Jarczak, Stefan Kluge, Axel Nierhaus
{"title":"Septic shock due to Capnocytophaga canimorsus treated with IgM-enriched immunoglobulin as adjuvant therapy in an immunocompetent woman","authors":"Josephine Braunsteiner, Stephanie Siedler, Dominik Jarczak, Stefan Kluge, Axel Nierhaus","doi":"10.1016/j.jointm.2023.08.003","DOIUrl":"10.1016/j.jointm.2023.08.003","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 265-268"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000592/pdfft?md5=849d3111cbff4d5246b41b4617c81be1&pid=1-s2.0-S2667100X23000592-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134917363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.jointm.2023.09.003
Omar E. Ramadan , Ahmed F. Mady , Mohammed A. Al-Odat , Ahmed N. Balshi , Ahmed W. Aletreby , Taisy J. Stephen , Sheena R. Diolaso , Jennifer Q. Gano , Waleed Th. Aletreby
Background
Resuscitation can sometimes be futile and making a do-not-resuscitate (DNR) decision is in the best interest of the patient. The electronic poor outcome screening (ePOS) score was developed to predict 6-month poor outcomes of critically ill patients. We explored the diagnostic accuracy of the ePOS score in predicting DNR decisions in the intensive care unit (ICU).
Methods
This study was conducted at the ICU of a tertiary referral hospital in Saudi Arabia between March and May 2023. Prospectively, we calculated ePOS scores for all eligible consecutive admissions after 48 h in the ICU and recorded the DNR orders. The ability of the score to predict DNR was explored using logistic regression. Youden's ideal cut-off value was calculated using the DeLong method, and different diagnostic accuracy measures were generated with corresponding 95 % confidence intervals (CIs).
Results
We enrolled 857 patients, 125 received a DNR order and 732 did not. The average ePOS score of DNR and non-DNR patients was 28.2±10.7 and 15.2±9.7, respectively. ePOS score, as a predictor of DNR order, had an area under receiver operator characteristic (AUROC) curve of 81.8 % (95% CI: 79.0 to 84.3, P <0.001). Youden's ideal cut-off value >17 was associated with a sensitivity of 87.2 (95% CI: 80.0 to 92.5, P <0.001), specificity of 63.9 (95% CI: 60.3 to 67.4, P <0.001), positive predictive value of 29.2 (95% CI: 24.6 to 33.8, P <0.001), negative predictive value of 96.7 (95% CI: 95.1 to 98.3, P <0.001), and diagnostic odds ratio 12.1 (95% CI: 7.0 to 20.8, P <0.001).
Conclusions
In this study, the ePOS score performed well as a diagnostic test for patients who will be labeled as DNR during their ICU stay. A cut-off score >17 may help guide clinical decisions to withhold or commence resuscitative measures.
背景复苏有时可能是徒劳的，做出不进行复苏（DNR）的决定符合患者的最佳利益。电子不良预后筛查（ePOS）评分是为了预测重症患者 6 个月的不良预后而开发的。我们探讨了 ePOS 评分在预测重症监护病房（ICU）DNR 决定方面的诊断准确性。方法这项研究于 2023 年 3 月至 5 月期间在沙特阿拉伯一家三级转诊医院的重症监护病房进行。我们前瞻性地计算了重症监护室 48 小时后所有符合条件的连续入院患者的 ePOS 分数，并记录了 DNR 命令。我们使用逻辑回归法探讨了该评分预测 DNR 的能力。使用 DeLong 方法计算了尤登理想临界值，并得出了不同的诊断准确性测量值及相应的 95 % 置信区间 (CI)。DNR 和非 DNR 患者的平均 ePOS 评分分别为（28.2±10.7）分和（15.2±9.7）分。ePOS 评分作为 DNR 命令的预测指标，其接收者操作特征曲线下面积（AUROC）为 81.8 %（95% CI：79.0 至 84.3，P <0.001）。Youden理想截断值>17的灵敏度为87.2 (95% CI: 80.0 to 92.5, P <0.001)，特异度为63.9 (95% CI: 60.3 to 67.4, P <0.001)，阳性预测值为29.2 (95% CI: 24.6 to 33.8, P <0.001)，阴性预测值为96.7 (95% CI: 95.1 to 98.3, P <0.001)，诊断几率比12.1 (95% CI: 7.0 to 20.8, P <0.001)。结论在这项研究中，ePOS评分作为ICU住院期间将被标记为DNR患者的诊断测试表现良好。截断分数>17可能有助于指导临床决定暂停或开始复苏措施。
{"title":"Diagnostic accuracy of ePOS score in predicting DNR labeling after ICU admission: A prospective observational study (ePOS-DNR)","authors":"Omar E. Ramadan , Ahmed F. Mady , Mohammed A. Al-Odat , Ahmed N. Balshi , Ahmed W. Aletreby , Taisy J. Stephen , Sheena R. Diolaso , Jennifer Q. Gano , Waleed Th. Aletreby","doi":"10.1016/j.jointm.2023.09.003","DOIUrl":"10.1016/j.jointm.2023.09.003","url":null,"abstract":"<div><h3>Background</h3><p>Resuscitation can sometimes be futile and making a do-not-resuscitate (DNR) decision is in the best interest of the patient. The electronic poor outcome screening (ePOS) score was developed to predict 6-month poor outcomes of critically ill patients. We explored the diagnostic accuracy of the ePOS score in predicting DNR decisions in the intensive care unit (ICU).</p></div><div><h3>Methods</h3><p>This study was conducted at the ICU of a tertiary referral hospital in Saudi Arabia between March and May 2023. Prospectively, we calculated ePOS scores for all eligible consecutive admissions after 48 h in the ICU and recorded the DNR orders. The ability of the score to predict DNR was explored using logistic regression. Youden's ideal cut-off value was calculated using the DeLong method, and different diagnostic accuracy measures were generated with corresponding 95 % confidence intervals (CIs).</p></div><div><h3>Results</h3><p>We enrolled 857 patients, 125 received a DNR order and 732 did not. The average ePOS score of DNR and non-DNR patients was 28.2±10.7 and 15.2±9.7, respectively. ePOS score, as a predictor of DNR order, had an area under receiver operator characteristic (AUROC) curve of 81.8 % (95% CI: 79.0 to 84.3, <em>P</em> <0.001). Youden's ideal cut-off value >17 was associated with a sensitivity of 87.2 (95% CI: 80.0 to 92.5, <em>P</em> <0.001), specificity of 63.9 (95% CI: 60.3 to 67.4, <em>P</em> <0.001), positive predictive value of 29.2 (95% CI: 24.6 to 33.8, <em>P</em> <0.001), negative predictive value of 96.7 (95% CI: 95.1 to 98.3, <em>P</em> <0.001), and diagnostic odds ratio 12.1 (95% CI: 7.0 to 20.8, <em>P</em> <0.001).</p></div><div><h3>Conclusions</h3><p>In this study, the ePOS score performed well as a diagnostic test for patients who will be labeled as DNR during their ICU stay. A cut-off score >17 may help guide clinical decisions to withhold or commence resuscitative measures.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 216-221"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000798/pdfft?md5=1c3da08ab34201aa2f3d09d3325a9bef&pid=1-s2.0-S2667100X23000798-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135455062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.jointm.2023.08.004
Junfeng Su , Ying Wang , Jing Xie , Long Chen , Xinxin Lin , Jiandong Lin , Xiongjian Xiao
Background
Acute kidney injury (AKI) is a primary feature of renal complications in patients with sepsis. MicroRNA (miRNA/miR)-30a is an essential regulator of cardiovascular diseases, tumors, phagocytosis, and other physical processes, but whether it participates in sepsis-induced AKI (sepsis-AKI) is unknown. We aimed to elucidate the functions and molecular mechanism underlying miR-30a activity in sepsis-AKI.
Methods
The classical cecal ligation and puncture (CLP) method and lipopolysaccharide (LPS)-induced Human Kidney 2 (HK-2) cells were used to establish in vivo and in vitro sepsis-AKI models. Specific pathogen-free and mature male Sprague-Dawley (SD) rats, aged 6–8 weeks (weight 200–250 g), were randomly divided into five-time phase subgroups. Fluid resuscitation with 30 mL/kg 37 °C saline was administered after the operation, without antibiotics. Formalin-fixed, paraffin-embedded kidney sections were stained with hematoxylin and eosin. SD rat kidney tissue samples were collected for analysis by real-time quantitative polymerase chain reaction and enzyme-linked immunosorbent assay. HK-2 cells were transfected with hsa-miR-30a-3p mimics or inhibitors, and compared with untreated normal controls. RNA, protein, and cell viability were evaluated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR), western blot, and cell counting kit-8 methods. A Dual-Luciferase Assay Kit (Promega) was used to measure luciferase activity 48 h after transfection with miR-30a-3p mimics.
Results
Expression levels of miR-30a-3p and miR-30a-5p in renal tissues of the sepsis group were significantly reduced at 12 h and 24 h (P <0.05). Tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were significantly increased in renal tissue 3 h after the operation in rats (P <0.05), and gradually decreased 6 h, 12 h, and 24 h after CLP. Levels of miR-30a-5p and miR-30a-3p were significantly down-regulated at 3 h after LPS treatment (P <0.05), and gradually decreased in HK-2 cells. One hour after LPS (10 µg/mL) treatment, TNF-α and IL-1β levels in HK-2 cells were significantly up-regulated (P < 0.05), and they were markedly down-regulated after 3 h (P <0.05). IL-6 expression levels began to rise after LPS treatment of cells, peaked at 6 h (P <0.05), and then decreased to the initial level within a few hours. Stimulation with 10 µg/mL LPS promoted HK-2 cells proliferation, which was inhibited after miR-30a-3p-mimic transfection. Bioinformatics prediction identified 37 potential miR-30a-3p target genes, including transcriptional enhanced associate domain 1 (TEAD1). After transfection of HK-2 cells with miR-30a-3p mimics and miR-30a-3p inhibitor, TEAD1 transcript was significantly up- and down-regulated, respectively (both P <0.05). After LPS treatment (24 h), expression
{"title":"MicroRNA-30a inhibits cell proliferation in a sepsis-induced acute kidney injury model by targeting the YAP-TEAD complex","authors":"Junfeng Su , Ying Wang , Jing Xie , Long Chen , Xinxin Lin , Jiandong Lin , Xiongjian Xiao","doi":"10.1016/j.jointm.2023.08.004","DOIUrl":"10.1016/j.jointm.2023.08.004","url":null,"abstract":"<div><h3>Background</h3><p>Acute kidney injury (AKI) is a primary feature of renal complications in patients with sepsis. MicroRNA (miRNA/miR)-30a is an essential regulator of cardiovascular diseases, tumors, phagocytosis, and other physical processes, but whether it participates in sepsis-induced AKI (sepsis-AKI) is unknown. We aimed to elucidate the functions and molecular mechanism underlying miR-30a activity in sepsis-AKI.</p></div><div><h3>Methods</h3><p>The classical cecal ligation and puncture (CLP) method and lipopolysaccharide (LPS)-induced Human Kidney 2 (HK-2) cells were used to establish <em>in vivo</em> and <em>in vitro</em> sepsis-AKI models. Specific pathogen-free and mature male Sprague-Dawley (SD) rats, aged 6–8 weeks (weight 200–250 g), were randomly divided into five-time phase subgroups. Fluid resuscitation with 30 mL/kg 37 °C saline was administered after the operation, without antibiotics. Formalin-fixed, paraffin-embedded kidney sections were stained with hematoxylin and eosin. SD rat kidney tissue samples were collected for analysis by real-time quantitative polymerase chain reaction and enzyme-linked immunosorbent assay. HK-2 cells were transfected with hsa-miR-30a-3p mimics or inhibitors, and compared with untreated normal controls. RNA, protein, and cell viability were evaluated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR), western blot, and cell counting kit-8 methods. A Dual-Luciferase Assay Kit (Promega) was used to measure luciferase activity 48 h after transfection with miR-30a-3p mimics.</p></div><div><h3>Results</h3><p>Expression levels of miR-30a-3p and miR-30a-5p in renal tissues of the sepsis group were significantly reduced at 12 h and 24 h (<em>P</em> <0.05). Tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were significantly increased in renal tissue 3 h after the operation in rats (<em>P</em> <0.05), and gradually decreased 6 h, 12 h, and 24 h after CLP. Levels of miR-30a-5p and miR-30a-3p were significantly down-regulated at 3 h after LPS treatment (<em>P</em> <0.05), and gradually decreased in HK-2 cells. One hour after LPS (10 µg/mL) treatment, TNF-α and IL-1β levels in HK-2 cells were significantly up-regulated (<em>P</em> < 0.05), and they were markedly down-regulated after 3 h (<em>P</em> <0.05). IL-6 expression levels began to rise after LPS treatment of cells, peaked at 6 h (<em>P</em> <0.05), and then decreased to the initial level within a few hours. Stimulation with 10 µg/mL LPS promoted HK-2 cells proliferation, which was inhibited after miR-30a-3p-mimic transfection. Bioinformatics prediction identified 37 potential miR-30a-3p target genes, including transcriptional enhanced associate domain 1 (<em>TEAD1</em>). After transfection of HK-2 cells with miR-30a-3p mimics and miR-30a-3p inhibitor, <em>TEAD1</em> transcript was significantly up- and down-regulated, respectively (both <em>P</em> <0.05). After LPS treatment (24 h), expression ","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 231-239"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000609/pdfft?md5=59eb5345e21f729473bb2f9d369d6a63&pid=1-s2.0-S2667100X23000609-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135663637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1016/j.jointm.2024.01.006
Background
Elevated anxiety levels are common in patients on mechanical ventilation (MV) and may challenge recovery. Research suggests music-based interventions may reduce anxiety during MV. However, studies investigating specific music therapy techniques, addressing psychological and physiological well-being in patients on MV, are scarce.
Methods
This three-arm randomized clinical pilot study was conducted with MV patients admitted to the intensive care unit (ICU) of Hospital San José in Bogotá, Colombia between March 7, 2022, and July 11, 2022. Patients were divided into three groups: intervention group 1 (IG1), music-assisted relaxation; intervention group 2 (IG2), patient-preferred therapeutic music listening; and control group (CG), standard care. The main outcome measure was the 6-item State-Anxiety Inventory. Secondary outcomes were: pain (measured with a visual analog scale), resilience (measured with the Brief Resilience Scale), agitation/sedation (measured with the Richmond Agitation–Sedation Scale), vital signs (including heart rate, blood pressure, oxygen saturation, and respiratory rate), days of MV, extubation success, and days in the ICU. Additionally, three patients underwent electroencephalography during the interventions.
Results
Data from 23 patients were analyzed in this study. The age range of the patients was 24.0–84.0 years, with a median age of 66.0 years (interquartile range: 57.0–74.0). Of the 23 patients, 19 were female (82.6%). No statistically significant differences between the groups were observed for anxiety (P=0.330), pain (P=0.624), resilience (P=0.916), agitation/sedation (P=0.273), length of ICU stay (P=0.785), or vital signs. A statistically significant difference between the groups was found for days of MV (P=0.019). Electroencephalography measurements showed a trend toward delta and theta band power decrease for two patients and a power increase on both beta frequencies (slow and fast) in the frontal areas of the brain for one patient.
Conclusions
In this pilot study, music therapy did not significantly affect the anxiety levels in patients on MV. However, the interventions were widely accepted by the staff, patients, and caregivers and were safe, considering the critical medical status of the participants. Further large-scale randomized controlled trials are needed to investigate the potential benefits of music therapeutic interventions in this population.
{"title":"Effect of music therapy on short-term psychological and physiological outcomes in mechanically ventilated patients: A randomized clinical pilot study","authors":"","doi":"10.1016/j.jointm.2024.01.006","DOIUrl":"10.1016/j.jointm.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><p>Elevated anxiety levels are common in patients on mechanical ventilation (MV) and may challenge recovery. Research suggests music-based interventions may reduce anxiety during MV. However, studies investigating specific music therapy techniques, addressing psychological and physiological well-being in patients on MV, are scarce.</p></div><div><h3>Methods</h3><p>This three-arm randomized clinical pilot study was conducted with MV patients admitted to the intensive care unit (ICU) of Hospital San José in Bogotá, Colombia between March 7, 2022, and July 11, 2022. Patients were divided into three groups: intervention group 1 (IG1), music-assisted relaxation; intervention group 2 (IG2), patient-preferred therapeutic music listening; and control group (CG), standard care. The main outcome measure was the 6-item State-Anxiety Inventory. Secondary outcomes were: pain (measured with a visual analog scale), resilience (measured with the Brief Resilience Scale), agitation/sedation (measured with the Richmond Agitation–Sedation Scale), vital signs (including heart rate, blood pressure, oxygen saturation, and respiratory rate), days of MV, extubation success, and days in the ICU. Additionally, three patients underwent electroencephalography during the interventions.</p></div><div><h3>Results</h3><p>Data from 23 patients were analyzed in this study. The age range of the patients was 24.0–84.0 years, with a median age of 66.0 years (interquartile range: 57.0–74.0). Of the 23 patients, 19 were female (82.6%). No statistically significant differences between the groups were observed for anxiety (<em>P</em>=0.330), pain (<em>P</em>=0.624), resilience (<em>P</em>=0.916), agitation/sedation (<em>P</em>=0.273), length of ICU stay (<em>P</em>=0.785), or vital signs. A statistically significant difference between the groups was found for days of MV (<em>P</em>=0.019). Electroencephalography measurements showed a trend toward delta and theta band power decrease for two patients and a power increase on both beta frequencies (slow and fast) in the frontal areas of the brain for one patient.</p></div><div><h3>Conclusions</h3><p>In this pilot study, music therapy did not significantly affect the anxiety levels in patients on MV. However, the interventions were widely accepted by the staff, patients, and caregivers and were safe, considering the critical medical status of the participants. Further large-scale randomized controlled trials are needed to investigate the potential benefits of music therapeutic interventions in this population.</p><p><strong>Trial Registration</strong> ISRCTN trial registry identifier: ISRCTN16964680</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 515-525"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000161/pdfft?md5=9bf738c306eba37149375a60ce5fb945&pid=1-s2.0-S2667100X24000161-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1016/j.jointm.2023.12.004
Fotinie Ntziora, Efthymia Giannitsioti
The Coronavirus disease 2019 (COVID-19) pandemic increased the burden of critically ill patients who required hospitalization in the intensive care unit (ICU). Bacterial and fungal co-infections, including bloodstream infections (BSIs), increased significantly in ICU patients with COVID-19; this had a significant negative impact on patient outcomes. Reported data pertaining to BSI episodes from the ICU setting during the COVID-19 pandemic were collected and analyzed for this narrative review. We searched the PubMed database for articles published between March 2020 and October 2023; the terms “COVID-19” AND “bloodstream infections” AND “ICU” were used for the search. A total of 778 articles were retrieved; however, only 27 were exclusively related to BSIs in ICU patients with COVID-19. Data pertaining to the epidemiological characteristics, risk factors, characteristics of bacterial and fungal BSIs, patterns of antimicrobial resistance, and comparisons between ICU and non-ICU patients during and before the COVID-19 pandemic were obtained. Data on antimicrobial stewardship and infection-control policies were also included. The rates of BSI were found to have increased among ICU patients with COVID-19 than in non-COVID-19 patients and those admitted during the pre-pandemic period. Male gender, 60–70 years of age, increased body mass index, high Sequential Organ Failure Assessment scores at admission, prolonged hospital and ICU stay, use of central lines, invasive ventilation, and receipt of extracorporeal membrane oxygenation were all defined as risk factors for BSI. The use of immune modulators for COVID-19 appeared to increase the risk of BSI; however, the available data are conflicting. Overall, Enterococci, Acinetobacter baumannii, and Candida spp. emerged as prominent infecting organisms during the pandemic; along with Enterobacterales and Pseudomonas aeruginosa they had a significant impact on mortality. Multidrug-resistant organisms prevailed in the ICU, especially if antimicrobial resistance was established before the COVID-19 pandemic and were significantly associated with increased mortality rates. The unnecessary and widespread use of antibiotics further increased the prevalence of multidrug-resistant organisms during COVID-19. Notably, the data indicated a significant increase in contaminants in blood cultures; this highlighted the decline in compliance with infection-control measures, especially during the initial waves of the pandemic. The implementation of infection-control policies along with antibiotic stewardship succeeded in significantly reducing the rates of blood contamination and BSI pathogens. BSIs considerably worsened outcomes in patients with COVID-19 who were admitted to ICUs. Further studies are needed to evaluate adequate preventive and control measures that may increase preparedness for the future.
{"title":"Bloodstream infections in the era of the COVID-19 pandemic: Changing epidemiology of antimicrobial resistance in the intensive care unit","authors":"Fotinie Ntziora, Efthymia Giannitsioti","doi":"10.1016/j.jointm.2023.12.004","DOIUrl":"10.1016/j.jointm.2023.12.004","url":null,"abstract":"<div><p>The Coronavirus disease 2019 (COVID-19) pandemic increased the burden of critically ill patients who required hospitalization in the intensive care unit (ICU). Bacterial and fungal co-infections, including bloodstream infections (BSIs), increased significantly in ICU patients with COVID-19; this had a significant negative impact on patient outcomes. Reported data pertaining to BSI episodes from the ICU setting during the COVID-19 pandemic were collected and analyzed for this narrative review. We searched the PubMed database for articles published between March 2020 and October 2023; the terms “COVID-19” AND “bloodstream infections” AND “ICU” were used for the search. A total of 778 articles were retrieved; however, only 27 were exclusively related to BSIs in ICU patients with COVID-19. Data pertaining to the epidemiological characteristics, risk factors, characteristics of bacterial and fungal BSIs, patterns of antimicrobial resistance, and comparisons between ICU and non-ICU patients during and before the COVID-19 pandemic were obtained. Data on antimicrobial stewardship and infection-control policies were also included. The rates of BSI were found to have increased among ICU patients with COVID-19 than in non-COVID-19 patients and those admitted during the pre-pandemic period. Male gender, 60–70 years of age, increased body mass index, high Sequential Organ Failure Assessment scores at admission, prolonged hospital and ICU stay, use of central lines, invasive ventilation, and receipt of extracorporeal membrane oxygenation were all defined as risk factors for BSI. The use of immune modulators for COVID-19 appeared to increase the risk of BSI; however, the available data are conflicting. Overall, <em>Enterococci, Acinetobacter baumannii</em>, and <em>Candida</em> spp. emerged as prominent infecting organisms during the pandemic; along with <em>Enterobacterales</em> and <em>Pseudomonas aeruginosa</em> they had a significant impact on mortality. Multidrug-resistant organisms prevailed in the ICU, especially if antimicrobial resistance was established before the COVID-19 pandemic and were significantly associated with increased mortality rates. The unnecessary and widespread use of antibiotics further increased the prevalence of multidrug-resistant organisms during COVID-19. Notably, the data indicated a significant increase in contaminants in blood cultures; this highlighted the decline in compliance with infection-control measures, especially during the initial waves of the pandemic. The implementation of infection-control policies along with antibiotic stewardship succeeded in significantly reducing the rates of blood contamination and BSI pathogens. BSIs considerably worsened outcomes in patients with COVID-19 who were admitted to ICUs. Further studies are needed to evaluate adequate preventive and control measures that may increase preparedness for the future.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 3","pages":"Pages 269-280"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000057/pdfft?md5=848e5bd6aed77c0f723e4656794b0573&pid=1-s2.0-S2667100X24000057-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21DOI: 10.1016/j.jointm.2024.02.001
{"title":"The causal role of immune cells in susceptibility and severity of COVID-19: A bidirectional Mendelian randomization study","authors":"","doi":"10.1016/j.jointm.2024.02.001","DOIUrl":"10.1016/j.jointm.2024.02.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 537-538"},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000148/pdfft?md5=c5e592c7e70ab6e88cbe11d7720ce27f&pid=1-s2.0-S2667100X24000148-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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