Critical Care Research and Practice最新文献

{"title":"Dyschloremia and Renal Outcomes in Critically Ill Patients With Sepsis: A Prospective Cohort Study: Dyschloremia and Renal Outcomes in Sepsis.","authors":"Saurabh M Thanekar, Vishal Shanbhag, Attur Ravindra Prabhu, Shankar Prasad Nagaraju, Dharshan Rangaswamy, Srinivas Vinayak Shenoy, Mohan Varadarayanahalli Bhojaraja, Indu Ramachandra Rao","doi":"10.1155/2024/8848405","DOIUrl":"https://doi.org/10.1155/2024/8848405","url":null,"abstract":"<p><p><b>Introduction:</b> Chloride is the most abundant extracellular anion; however, abnormalities of serum chloride (dyschloremia) are often overlooked. This study aimed to study the association of dyschloremia with AKI and major adverse kidney events at Day 30 (MAKE30) in critically ill patients with sepsis. <b>Materials and Methods:</b> This prospective single-center cohort study included adult patients with sepsis admitted in a tertiary care hospital in India. Patients with advanced chronic kidney disease, requiring dialysis at admission, or with hospital stay of less than 72 h were excluded. Hyperchloremia and hypochloremia were defined as chloride levels of > 110 mEq/L and < 95 mEq/L, respectively. The primary outcome measure was MAKE30-a composite of death, need for dialysis, or sustained loss of kidney function at Day 30. <b>Results:</b> In a cohort of 400 patients with a mean age of 60 (±15) years, AKI was seen in 301 (75.2%) and MAKE30 in 171 (42.8%). Hyperchloremia and hypochloremia were seen in 19.3% (<i>n</i> = 77) and 32.3% (<i>n</i> = 129), respectively, in the first 72 h of ICU stay. Hypochloremia, but not hyperchloremia, was independently associated with both MAKE30 (OR: 2.56, 95% CI: 1.13-5.79; <i>p</i>=0.024) and new-onset or worsening AKI (OR: 2.52, 95% CI: 1.17-5.41; <i>p</i>=0.019). There was no association between hyperchloremia and either MAKE30 (OR: 1.07, 95% CI: 0.43-2.69; <i>p</i>=0.882) or new-onset/worsening AKI (OR: 0.89, 95% CI: 0.38-2.09; <i>p</i>=0.781). <b>Conclusion:</b> Hypochloremia, but not hyperchloremia, was associated with MAKE30 in this cohort of critically ill patients with sepsis. <b>Trial Registration:</b> Clinical Trial Registry identifier: CTRI//2022/02/040519.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"8848405"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548237","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}

{"title":"Consensus for the Development of a New Early Warning Score for Predicting Patients' Clinical Deterioration in Angola: A Delphi Study.","authors":"Esmael Tomás, Ana Escoval, Maria Lina Antunes","doi":"10.1155/2024/9070807","DOIUrl":"10.1155/2024/9070807","url":null,"abstract":"<p><p><b>Background:</b> Nearly 30 years since its inception, the early warning scores (EWSs) remain pivotal, yet variations have emerged for hospital and prehospital use. Aggregated scores, reflecting multiple physiological parameters, outperform single-parameter systems in assessing acute illness severity, though consensus on optimal approaches is lacking. Resource-limited countries, including Angola, lack adapted EWSs, emphasizing the need for cost-effective and adaptable solutions to enhance patient care. <b>Objective:</b> To explore the perspectives of Angolan experts to identify physiological parameters suitable for incorporation into existing EWSs, allowing the development of a new tool adjusted to the healthcare context in Angola. <b>Methods:</b> We conducted a three-round Delphi survey, engaging a national expert panel comprising twenty-five physicians and nurses with expertise in internal medicine, surgery, emergency rooms, intensive care units, and/or teachers at universities or at teaching courses in these fields. Participants were asked to rate items using a five-point Likert scale. Consensus was achieved if the items received a rating ≥ 80% from the panel. <b>Results:</b> Consensus was evident for the inclusion of standard physiological parameters, such as systolic blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, neurological status, and the presence or absence of supplemental oxygen. Furthermore, there was consensus for the consideration of specific items, namely, seizures, jaundice, cyanosis, capillary refill time, and pain-typically not included in the current EWSs. Consensus was reached regarding the exclusion of both oxygen saturation and temperature measurements in healthcare settings where oximeters and thermometers might not be readily available. <b>Conclusion:</b> Angolan experts were able to identify the physiological parameters suitable for incorporation into the basic EWSs. Further study must be conducted to test and validate the impact of the newly suggested vital parameters on the discriminant and predictive capability of a new aggregated model specifically adjusted to the Angolan healthcare setting.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"9070807"},"PeriodicalIF":1.8,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356158","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}

{"title":"The Impact of the Critical Care Resuscitation Unit on Quaternary Care Accessibility for Rural Patients: A Comparative Analysis.","authors":"Quincy K Tran, Anastasia Ternovskaia, Jessica V Downing, Minahil Cheema, Taylor Kowansky, Isha Vashee, Jasjot Sayal, Jasmine Wu, Aditi Singh, Daniel J Haase","doi":"10.1155/2024/9599855","DOIUrl":"10.1155/2024/9599855","url":null,"abstract":"<p><strong>Background: </strong>Previous research suggests that patients from rural areas who are critically ill with complex medical needs or require time-sensitive subspecialty interventions face worse healthcare outcomes and delays in care when compared to those from urban areas. The critical care resuscitation unit (CCRU) at our quaternary care center was established to expedite the transfer of critically ill patients or those who need time-sensitive intervention. This study investigates if disparities exist in treatments and outcomes among patients transferred to the CCRU from rural versus urban hospitals.</p><p><strong>Methods: </strong>This is a retrospective study of adult, nontrauma patients admitted to the CCRU via interhospital transfer from outside facilities from January 1 to December 31, 2018. Patients transferred from within our institution or with missing clinical data were excluded. Multivariable logistic regressions were performed to measure the association between patients' demographic and clinical factors with in-hospital mortality.</p><p><strong>Results: </strong>We analyzed 1381 nontrauma patients, and 484 (35%) were from rural areas. Median age was 59 [47-69], and 629 (46%) were female. Median sequential organ failure assessment was 3 ([1-6], <i>p</i>=0.062) for both patients transferred from urban and rural hospitals. There was no significant difference between groups with respect to most demographic and clinical factors, as well as types of interventions after CCRU arrival, including emergent surgical interventions within 12 hours of arrival at the CCRU. Rural patients were more likely to be transferred for care by the acute care emergency surgery service than were patients from urban areas and were transferred over a significantly greater distance (difference of 53 kilometers (km), 95% CI: -58.9-51.7 km, <i>P</i> < 0.001). Transfer from rural areas was not associated with increased odds of in-hospital mortality (OR: 0.90, 95% CI: 0.60, 1.36; <i>P</i>=0.63).</p><p><strong>Conclusion: </strong>Thirty-five percent of patients transferred to the CCRU came from rural areas, which house 25% of the state population of Maryland. Patients transferred from rural counties to the CCRU faced greater transport distances, but they received the same level of care upon arrival at the CCRU and had the same odds of in-hospital mortality as patients transferred from urban hospitals.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"9599855"},"PeriodicalIF":1.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113311","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}

{"title":"Predictive Value of Red Cell Distribution Width-to-Platelet Ratio Combined with Procalcitonin in 28-day Mortality for Patients with Sepsis.","authors":"Ying Si, Bo Sun, Yongmao Huang, Ke Xiao","doi":"10.1155/2024/9964992","DOIUrl":"10.1155/2024/9964992","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to investigate the predictive value of erythrocyte distribution width-to-platelet ratio (RPR) combined with procalcitonin (PCT) on 28-day mortality in patients with sepsis.</p><p><strong>Methods: </strong>A total of 193 patients with sepsis admitted to the Affiliated Hospital of Southwest Medical University from January 2013 to January 2018 were selected as the study objects. Univariate and multivariate analyses were used to understand the indicators related to the 28-day prognosis of patients, and the ROC curve was further drawn. The Kaplan-Meier curve was used to evaluate the prognosis of patients.</p><p><strong>Results: </strong>A total of 193 patients were enrolled and divided into the survivor group (=156) and nonsurvivor group (=37) according to the prognosis within 28 days. The median age was 62.5 years, and 64.7% were males. Multivariate analysis showed that PCT and RPR were independent risk factors for 28-day prognosis in sepsis patients. The area under the ROC curve of PCT and RPR were 0.894 and 0.861, respectively, and the cutoff values were 27.04 and 0.12, respectively. Survival curve analysis showed that PCT and RPR were associated with the 28-day prognosis of patients, and the combination of PCT and RPR had a better predictive effect.</p><p><strong>Conclusions: </strong>PCT and RPR are independent predictors of sepsis prognosis. The combined application of PCT and RPR (PCT-RPR) can further improve the predictive performance and provide a reference for the clinical diagnosis, treatment, and prognosis evaluation of sepsis patients.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"9964992"},"PeriodicalIF":1.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005519","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}

{"title":"Burden of Respiratory Disease in Pediatric Intensive Care Unit: Experience from a PICU of a Tertiary Care Center in Pakistan.","authors":"Sidra Ishaque, Nazia Bibi, Zaiba Shafik Dawood, Janeeta Hamid, Quratulain Maha, Syeda Asma Sherazi, Ali Faisal Saleem, Qalab Abbas, Naveed Ur Rehman Siddiqui, Anwar Ul Haque","doi":"10.1155/2024/6704727","DOIUrl":"10.1155/2024/6704727","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to determine the burden of respiratory disease by examining clinical profiles and associated predictors of morbidity and mortality of patients admitted to a Pediatric Intensive Care Unit (PICU) in Pakistan, a resource limited country. We also stratified the respiratory diseases as defined by the Pediatric Advanced Life Support (PALS) Classification.</p><p><strong>Methods: </strong>A retrospective study was conducted on children aged 1 month to 18 years who were diagnosed with respiratory illness at the PICU in a tertiary hospital in Karachi, Pakistan. Demographics, essential clinical details including immunization status, and the outcome in terms of mortality or survival were recorded. Predictors of mortality and morbidity including prolonged intubation and mechanical ventilation in the PICU were analyzed using the chi-square test or Fischer's exact test as appropriate.</p><p><strong>Results: </strong>279 (63.8% male; median age 9 months, IQR 4-36 months) patients were evaluated of which 44.2% were malnourished and 23.3% were incompletely immunized. The median length of stay in the PICU was 3 days (IQR 2-5 days). Pneumonia was the principal diagnosis in 170 patients (62%) and accounted for most deaths. 76/279 (27.2%) were ventilated, and 67/279(24.0%) needed inotropic support. A high Pediatric Risk of Mortality (PRISM) III score, pneumothorax, and lower airway disease were significantly associated with ventilation support. The mortality rate of patients was 14.3%. Predictors of mortality were a high PRISM III score (OR 1.179; 95% CI 1.024-1.358, <i>P</i>=0.022) and a positive blood culture (OR 4.305; 95% CI 1.062-17.448, <i>P</i>=0.041).</p><p><strong>Conclusion: </strong>Pneumonia is a significant contributor of respiratory diseases in the PICU in Pakistan and is the leading cause of morbidity and mortality. A high PRISM III score, pneumothorax, and lower airway disease were predictors for ventilation support. A high PRISM III score and a positive blood culture were predictors of patient mortality in our study.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"6704727"},"PeriodicalIF":1.8,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976851","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}

{"title":"Characteristics and Cluster Analysis of 18,030 Sepsis Patients Who Were Admitted to Thailand's Largest National Tertiary Referral Center during 2014-2020 to Identify Distinct Subtypes of Sepsis in Thai Population.","authors":"Phuwanat Sakornsakolpat, Surat Tongyoo, Chairat Permpikul","doi":"10.1155/2024/6699274","DOIUrl":"10.1155/2024/6699274","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the demographic, clinical, and laboratory characteristics of sepsis patients who were admitted to our center during 2014-2020 and to employ cluster analysis, which is a type of machine learning, to identify distinct types of sepsis in Thai population.</p><p><strong>Methods: </strong>Demographic, clinical, laboratory, medicine, and source of infection data of patients admitted to medical wards of Siriraj Hospital (Bangkok, Thailand) during 2014-2020 were collected. Sepsis was diagnosed according to the Sepsis-3 criteria. Nineteen demographic, clinical, and laboratory variables were analyzed using hierarchical clustering to identify sepsis subtypes.</p><p><strong>Results: </strong>Of 98,359 admissions, 18,030 (18.3%) had sepsis. Respiratory tract was the most common site of infection. The mean Sequential Organ Failure Assessment (SOFA) score was 4.21 ± 2.24, and the median serum lactate level was 2.7 mmol/L [range: 0.4-27.5]. Twenty percent of admissions required vasopressor. In-hospital mortality was 19.6%. Ten sepsis subtypes were identified using hierarchical clustering. Three clusters (clusters L1-L3) were considered low risk, and seven clusters (clusters H1-H7) were considered high risk for in-hospital mortality. Cluster H1 had prominent hematologic abnormalities. Clusters H3 and H5 had younger ages and significant hepatic dysfunction. Cluster H5 had multiple organ dysfunctions, and a higher proportion of cluster H5 patients required vasopressor, mechanical ventilation, and renal replacement therapy. Cluster H6 had more respiratory tract infection and acute respiratory failure and a lower SpO₂/FiO₂ value.</p><p><strong>Conclusions: </strong>Cluster analysis revealed 10 distinct subtypes of sepsis in Thai population. Furthermore, the study is needed to investigate the value of these sepsis subtypes in clinical practice.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"6699274"},"PeriodicalIF":1.8,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11303049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898622","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}

{"title":"Association between Red Blood Cell Distribution Width and In-Hospital Mortality among Congestive Heart Failure Patients with Diabetes among Patients in the Intensive Care Unit: A Retrospective Cohort Study.","authors":"Kai Zhang, Yu Han, Yu Xuan Gao, Fang Ming Gu, Tianyi Cai, Rui Hu, Zhao Xuan Gu, Jia Ying Liang, Jia Yu Zhao, Min Gao, Bo Li, Dan Cui","doi":"10.1155/2024/9562200","DOIUrl":"10.1155/2024/9562200","url":null,"abstract":"<p><strong>Background: </strong>Elevated red blood cell distribution width (RDW) levels are strongly associated with an increased risk of mortality in patients with congestive heart failure (CHF). Additionally, heart failure has been closely linked to diabetes. Nevertheless, the relationship between RDW and in-hospital mortality in the intensive care unit (ICU) among patients with both congestive heart failure (CHF) and diabetes mellitus (DM) remains uncertain.</p><p><strong>Methods: </strong>This retrospective study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, a comprehensive critical care repository. RDW was assessed as both continuous and categorical variables. The primary outcome of the study was in-hospital mortality at the time of hospital discharge. We examined the association between RDW on ICU admission and in-hospital mortality using multivariable logistic regression models, restricted cubic spline analysis, and subgroup analysis.</p><p><strong>Results: </strong>The cohort consisted of 7,063 patients with both DM and CHF (3,135 females and 3,928 males). After adjusting for potential confounders, we found an association between a 9% increase in mortality rate and a 1 g/L increase in RDW level (OR = 1.09; 95% CI, 1.05∼1.13), which was associated with 11 and 58% increases in mortality rates in Q2 (OR = 1.11, 95% CI: 0.87∼1.43) and Q3 (OR = 1.58, 95% CI: 1.22∼2.04), respectively, compared with that in Q1. Moreover, we observed a significant linear association between RDW and in-hospital mortality, along with strong stratified analyses to support the findings.</p><p><strong>Conclusions: </strong>Our findings establish a positive association between RDW and in-hospital mortality in patients with DM and CHF.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"9562200"},"PeriodicalIF":1.8,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894588","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}

{"title":"Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study).","authors":"Christine M Groth, Christopher A Droege, Preeyaporn Sarangarm, Michaelia D Cucci, Kyle A Gustafson, Kathryn A Connor, Kimberly Kaukeinen, Nicole M Acquisto, Sai Ho J Chui, Deepali Dixit, Alexander H Flannery, Nina E Glass, Helen Horng, Mojdeh S Heavner, Justin Kinney, William J Peppard, Andrea Sikora, Brian L Erstad","doi":"10.1155/2024/6626899","DOIUrl":"10.1155/2024/6626899","url":null,"abstract":"<p><strong>Objective: </strong>Describe continuous infusion (CI) ketamine practices in pediatric intensive care units (PICUs) and evaluate its effect on pain/sedation scores, exposure to analgesics/sedatives, and adverse effects (AEs).</p><p><strong>Methods: </strong>Multicenter, retrospective, observational study in children <18 years who received CI ketamine between 2014 and 2017. Time spent in goal pain/sedation score range and daily cumulative doses of analgesics/sedatives were compared from the 24 hours (H) prior to CI ketamine to the first 24H and 25-48H of the CI. Adverse effects were collected over the first 7 days of CI ketamine.</p><p><strong>Results: </strong>Twenty-four patients from 4 PICUs were included; median (IQR) age 7 (1-13.25) years, 54% female (<i>n</i> = 13), 92% intubated (<i>n</i> = 22), 25% on CI vasopressors (<i>n</i> = 6), and 33% on CI paralytics (<i>n</i> = 8). Ketamine indications were analgesia/sedation (<i>n</i> = 21, 87.5%) and status epilepticus (<i>n</i> = 3, 12.5%). Median starting dose was 0.5 (0.48-0.70) mg/kg/hr and continued for a median of 2.4 (1.3-4.4) days. There was a significant difference in mean proportion of time spent within goal pain score range (24H prior: 74% ± 14%, 0-24H: 85% ± 10%, and 25-48H: 72% ± 20%; <i>p</i>=0.014). A significant reduction in median morphine milligram equivalents (MME) was seen (24H prior: 58 (8-195) mg vs. 0-24H: 4 (0-69) mg and <i>p</i>=0.01), but this was not sustained (25-48H: 24 (2-246) mg and <i>p</i>=0.29). Common AEs were tachycardia (63%), hypotension (54%), secretions/suctioning (29%), and emergence reactions (13%).</p><p><strong>Conclusions: </strong>Ketamine CI improved time in goal pain score range and significantly reduced MME, but this was not sustained. Larger prospective studies are needed in the pediatric population.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"6626899"},"PeriodicalIF":1.8,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894589","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}

{"title":"Incidence of Carbapenem-Resistant Gram-Negative Bacterial Infections in Critically Ill Patients with COVID-19 as Compared to Non-COVID-19 Patients: A Prospective Case-Control Study.","authors":"Diamanto Aretha, Sotiria Rizopoulou, Leonidia Leonidou, Sotiria Kefala, Vasilios Karamouzos, Maria Lagadinou, Anastasia Spiliopoulou, Markos Marangos, Fotini Fligou, Fevronia Kolonitsiou, Fotini Paliogianni, Stelios F Assimakopoulos","doi":"10.1155/2024/7102082","DOIUrl":"10.1155/2024/7102082","url":null,"abstract":"<p><strong>Introduction: </strong>Critically ill COVID-19 patients hospitalized in intensive care units (ICU) are immunosuppressed due to SARSCoV-2-related immunological effects and are administered immunomodulatory drugs. This study aimed to determine whether these patients carry an increased risk of multi-drug resistant (MDR) and especially carbapenem-resistant Gram-negative (CRGN) bacterial infections compared to other critically ill patients without COVID-19.</p><p><strong>Materials and methods: </strong>A prospective case-control study was conducted between January 2022 and August 2023. The ICU patients were divided into two groups (COVID-19 and non-COVID-19). Differences in the incidence of CRGN infections from <i>Klebsiella pneumonia</i>e, <i>Acinetobacter</i> spp., and <i>Pseudomonas aeruginosa</i> were investigated. In addition, an indicator of the infection rate of the patients during their ICU stay was calculated. Factors independently related to mortality risk were studied.</p><p><strong>Results: </strong>Forty-two COVID-19 and 36 non-COVID-19 patients were analyzed. There was no statistically significant difference in the incidence of CRGN between COVID-19 and non-COVID-19 patients. The infection rate was similar in the two groups. Regarding the aetiological agents of CRGN infections, <i>Pseudomonas aeruginosa</i> was significantly more common in non-COVID-19 patients (<i>p</i>=0.007). COVID-19 patients had longer hospitalisation before ICU admission (<i>p</i>=0.003) and shorter ICU length of stay (LOS) (<i>p</i>=0.005). ICU COVID-19 patients had significantly higher mortality (<i>p</i> < 0.001) and sequential organ failure assessment (SOFA) score (<i>p</i> < 0.001) compared to non-COVID-19 patients. Μortality secondary to CRGN infections was also higher in COVID-19 patients compared to non-COVID-19 patients (<i>p</i>=0.033). Male gender, age, ICU LOS, and hospital LOS before ICU admission were independent risk factors for developing CRGN infections. Independent risk factors for patients' mortality were COVID-19 infection, obesity, SOFA score, total number of comorbidities, WBC count, and CRP, but not infection from CRGN pathogens.</p><p><strong>Conclusions: </strong>The incidence of CRGN infections in critically ill COVID-19 patients is not different from that of non-COVID-19 ICU patients. The higher mortality of COVID-19 patients in the ICU is associated with higher disease severity scores, a higher incidence of obesity, and multiple underlying comorbidities, but not with CRGN infections.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"7102082"},"PeriodicalIF":1.8,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11214592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471506","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}

{"title":"Retrospective Tertiary Care-Based Cohort Study on Clinical Characteristics and Outcomes of Ceftazidime-Avibactam-Resistant Carbapenem-Resistant <i>Klebsiella pneumoniae</i> Infections.","authors":"Fatema Ahmed, Betsy Abraham, Nermin Kamal Saeed, Hasan Mohamed Naser, Kannan Sridharan","doi":"10.1155/2024/3427972","DOIUrl":"10.1155/2024/3427972","url":null,"abstract":"<p><strong>Introduction: </strong>The advent of ceftazidime-avibactam (CAZ-AVI)-resistant carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) isolates has been steadily documented in recent years. We aimed to identify risk factors of CAZ-AVI-resistant CRKP infection and assess clinical outcomes of patients.</p><p><strong>Methods: </strong>The study retrospectively examined the clinical and microbiological data of patients with ceftazidime avibactam susceptible and ceftazidime avibactam-resistant <i>Klebsiella pneumonia</i> carbapenem-resistant enterobacteriaceae infection to identify risk factors, clinical features, and outcomes using multivariate logistic regression analysis.</p><p><strong>Results: </strong>A total of 152 patients with CRKP infection were enrolled in this study. Patients with CAZ-AVI-resistant CRKP isolates (20/34 = 58.8%) had prior exposure to carbapenems (<i>p</i>=0.003) and had more tracheostomies (16/34 = 47.1%) (<i>p</i>=0.001). Only 8/28 (28.6%) patients with CAZ-AVI susceptible CRKP isolates died amongst those administered ceftazidime-avibactam compared to 49/90 (54.4%) who did not receive the same (<i>p</i>=0.016). 1/9 (11.1%) patients with CAZ-AVI-resistant CRKP isolates who received colistin died compared to 13/25 (52%) who did not receive colistin (<i>p</i>=0.03). There was no association between presence of CAZ-AVI-resistant CRKP isolates and overall mortality (odds ratio: 0.7; 95% CI: 0.3, 1.6), and no independent predictors of risk factors to overall mortality in the group with CAZ-AVI-resistant CRKP isolates were noted.</p><p><strong>Conclusion: </strong>Early advent of CAZ-AVI resistance in CRE isolates highlights the dynamic necessity of routine CAZ-AVI resistance laboratory testing and antimicrobial stewardship programmes focusing on the utilization of all antibiotics. Consolidating the hospital infection control of tracheostomies may help to prevent CAZ resistance in CRKP. Colistin may aid in decreasing of mortality rates among patients with CAZ-AVI CRKP isolates.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2024 ","pages":"3427972"},"PeriodicalIF":1.7,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11168800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311989","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}