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Attributable cost of a nosocomial infection in the intensive care unit: A prospective cohort study

World Journal of Critical Care Medicine 2017年第1期6卷 79-84页

作者： binila chacko Kurien Thomas Thambu David Hema Paul Lakshmanan Jeyaseelan John Victor Peter Medical ICU Division of Critical Care Christian Medical College Department of Medicine Pondicherry Institute of Medical Sciences Department of Medicine Ⅱ Christian Medical College Hospital Infection Control Committee Christian Medical College Department of Biostatistics Christian Medical College

AIM To study the impact of hospital-acquired infections(HAIs) on cost and outcome from intensive care units(ICU) in India. METHODS Adult patients(> 18 years) admitted over 1-year, to a 24-bed medical critical care unit in India, were enrolled prospectively. Treatment cost and outcome data were collected. This cost data was merged with HAI data collected prospectively by the Hospital Infection Control Committee. Only infections occurring during ICU stay were included. The impact of HAI on treatment cost and mortality was assessed. RESULTS The mean(± SD) age of the cohort(n = 499) was42.3 ± 16.5 years. Acute physiology and chronic health evaluation-Ⅱ score was 13.9(95%CI: 13.3-14.5); 86% were ventilated. ICU and hospital length of stay were 7.8 ± 5.5 and 13.9 ± 10 d respectively. Hospital mortality was 27.9%. During ICU stay, 76(15.3%) patients developed an infection(ventilator-associated pneumonia 50; bloodstream infection 35; urinary tract infections 3), translating to 19.7 infections/1000 ICU days. When compared with those who did not develop an infection, an infection occurring during ICU stay was associated with significantly higher treatment cost [median(inter-quartile range, IQR) INR 92893(USD 1523)(IQR 57168-140286) vs INR 180469(USD 2958)(IQR 140030-237525); P < 0.001 and longer duration of ICU(6.7 ± 4.5 d vs 13.4 ± 7.0 d; P < 0.01) and hospital stay(12.4 ± 8.2 d vs 21.8 ± 13.9 d; P < 0.001)]. However ICU acquired infections did not impact hospital mortality(31.6% vs 27.2%; P = 0.49).CONCLUSION An infection acquired during ICU stay was associated with doubling of treatment cost and prolonged hospitalization but did not significantly increase mortality.

关键词： Attributable cost Nosocomial infection Length of stay Mortality Intensive care

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Delayed inflammatory pulmonary syndrome: A distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection?

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世界重症医学杂志 2023年第4期12卷 226-235页

作者： Prithviraj Bose binila chacko Ashwin Oliver Arul Leena Robinson Vimala Balamugesh Thangakunam George M Varghese Mohan Jambugulam Audrin Lenin John Victor Peter Department of Medical Intensive Care Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Radiodiagnosis Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Pulmonary Medicine Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Infectious Disease Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Medicine Christian Medical CollegeVellore 632004Tamil NaduIndia

BACKGROUND During the second wave of the coronavirus disease 2019(COVID-19)pandemic,a subset of critically ill patients developed delayed respiratory deterioration in the absence of new infection,fluid overload or extra-pulmonary organ *** To describe the clinical and laboratory characteristics,outcomes,and management of these patients,and to contrast this entity with other post COVID-19 immune dysregulation related inflammatory *** This was a retrospective observational study of adult patients admitted to the medical intensive care unit of a 2200-bed university affiliated teaching hospital,between May and August 2021,who fulfilled clearly defined inclusion and exclusion *** was assessed by a change in PaO_(2)/FiO_(2) ratio and levels of inflammatory markers before and after immunomodulation,duration of mechanical ventilation after starting treatment,and survival to *** Five patients developed delayed respiratory deterioration in the absence of new infection,fluid overload or extrapulmonary organ dysfunction at a median interquartile range(IQR)duration of 32(23-35)d after the onset of *** patients had elevated inflammatory markers,required mechanical ventilation for 13(IQR 10-23)d,and responded to glucocorticoids and/or intravenous *** patient died(20%).CONCLUSION This delayed respiratory worsening with elevated inflammatory markers and clinical response to immunomodulation appears to contrast the well described Multisystem Inflammatory Syndrome–Adults by the paucity of extrapulmonary organ *** diagnosis can be considered in patients presenting with delayed respiratory worsening,that is not attributable to cardiac dysfunction,fluid overload or ongoing infections,and associated with an increase in systemic inflammatory markers like C-reactive protein,inteleukin-6 and ferritin.A good response to immunomodulation can be *** delayed inflammatory pulmonary syndrome may re

关键词： COVID-19 ARDS Multisystem Inflammatory Syndrome in Adults Long COVID Organizing pneumonia

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