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Risk factors and mortality rates of carbapenem-resistant Gram-negative bacterial infections in intensive care units

Journal of Intensive Medicine 2024年第3期4卷 347-354页

作者： Tulay Orhan Kuloglu Gamze Kalin Unuvar Fatma Cevahir Aysegul Ulu Kilic Emine Alp Infection Control Committee Faculty of MedicineErciyes UniversityKayseriTurkey Department of Infectious Diseases Faculty of MedicineErciyes UniversityKayseriTurkey Programme of First and Emergency Aid Sakarya UniversitySakaryaTurkey Department of Infectious Diseases Faculty of MedicineYıldırım Beyazıt UniversityAnkaraTurkey

Background The prevalence of hospital-acquired infections caused by carbapenem-resistant gram-negative bacteria(CRGNB)is increasing *** risk factors have been associated with such *** present study aimed to identify risk factors and determine the mortality rates associated with CRGNB infections in intensive care *** This retrospective case-control study was conducted at Erciyes University Hospital(Kayseri,Turkey)between January 2017 and December *** and laboratory data were obtained from the Infection Control Committee data and record *** who had CRGNB infection 48–72 h after hospitalization were assigned to the case group,while those who were not infected with CRGNB during hospitalization formed the control *** factors,comorbidity,demographic data,and mortality rates were compared between the two *** Approximately 1449 patients(8.97%)were monitored during the active follow-up period;of those,1171 patients were included in this *** infection developed in 14 patients(70.00%)who had CRGNB colonization at admission;in 162(78.26%)were colonized during hospitalization,whereas 515(54.56%)were not *** was no significant difference in age,sex(male/female)or *** total length of hospital stay was statistically significantly longer(P=0.001)in the case group(median:24[interquartile range:3–378]days)than the control group(median:16[interquartile range:3–135]days).The rates of colonization at admission(25.5%;vs.10.6%,P=0.001)and mortality(64.4%vs.45.8%,P=0.001)were also significantly higher in the cases than in the control group,*** the univariate analysis,prolonged hospitalization,the time from intensive care unit admission to the development of infection,presence of CRGNB colonization at admission,transfer from other hospitals,previous antibiotic use,enteral nutrition,transfusion,hemodialysis,mechanical ventilation,tracheostomy,reintubation,central veno

关键词： Multidrug resistance Gram-negative bacteria Infection Intensive care units

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Fungal infections in immunocompromised critically ill patients

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Journal of Intensive Medicine 2024年第3期4卷 299-306页

作者： JoséGarnacho-Montero Irene Barrero-García Cristina León-Moya Unidad Clínica de Cuidados Intensivos Hospital Universitario Virgen MacarenaSevillaSpain

Diverse pathogenic fungi can produce severe infections in immunocompromised patients, thereby justifying intensive care unit (ICU) admissions. In some cases, the infections can develop in immunocompromised patients who were previously admitted to the ICU. Aspergillus spp., Pneumocystis jirovecii, Candida spp., and Mucorales are the fungi that are most frequently involved in these infections. Diagnosis continues to be challenging because symptoms and signs are unspecific. Herein, we provide an in-depth review about the diagnosis, with emphasis on recent advances, and treatment of these invasive fungal infections in the ICU setting.

关键词： Invasive aspergillosis Immunocompromised patient Critically ill patient Antifungal Invasive candidiasis Pneumocystis jirovecii

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Latest developments in early diagnosis and specific treatment of severe influenza infection

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Journal of Intensive Medicine 2024年第2期4卷 160-174页

作者： Francisco Valenzuela-Sánchez Blanca Valenzuela-Méndez Juan Francisco Rodríguez-Gutiérrez Ángel Estella Intensive Care Unit University Hospital of JerezRonda de Circunvalación s/nJerez de la FronteraSpain Haematology Department University Hospital of JerezRonda de Circunvalación s/nJerez de la FronteraSpain Centro de Investigación Biomédica en Red Enfermedades respiratoriasCIBERESInstituto de Salud Carlos IIIAv.de Monforte de LemosMadridSpain Department of Oncological Surgery Institut du Cancer de Montpellier(ICM)Parc Euromédecine208 Av.des ApothicairesMontpellierFrance Department of Medicine Faculty of MedicineUniversity of CádizCalle Doctor MarañónCádizSpain Instituto de Investigación e Innovación Biomédica de Cádiz(INIBiCA) Avenida Ana de Viya 21CádizSpain

Influenza pandemics are unpredictable recurrent events with global health,economic,and social *** objective of this review is to provide an update on the latest developments in early diagnosis and specific treatment of the disease and its complications,particularly with regard to respiratory organ *** advances in treatment,the rate of mortality in the intensive care unit remains approximately 30%.Therefore,early identification of potentially severe viral pneumonia is extremely important to optimize treatment in these *** pathogenesis of influenza virus infection depends on viral virulence and host ***,in some patients,it is associated with an excessive systemic response mediated by an authentic cytokine *** process leads to severe primary pneumonia and acute respiratory distress *** prognostication in the emergency department based on comorbidities,vital signs,and biomarkers(e.g.,procalcitonin,ferritin,human leukocyte antigen-DR,mid-regional proadrenomedullin,and lactate)is *** of these biomarkers on admission may facilitate clinical decision-making to determine early admission to the hospital or the intensive care *** decisions are reached considering pathophysiological circumstances that are associated with a poor prognosis(e.g.,bacterial co-infection,hyperinflammation,immune paralysis,severe endothelial damage,organ dysfunction,and septic shock).Moreover,early implementation is important to increase treatment *** on a limited level of evidence,all current guidelines recommend using oseltamivir in this *** possibility of drug resistance should also be *** options include other antiviral drugs and combination therapies with monoclonal ***,it is not recommended to use corticosteroids in the initial treatment of these ***,the implementation of supportive measures for respiratory failure is ***

关键词： Influenza Pandemic Respiratory failure Acute respiratory distress syndrome Intensive care unit admission

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Effects of positive end-expiratory pressure on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in acute brain injury:Friend or foe?A scoping review

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Journal of Intensive Medicine 2024年第2期4卷 247-260页

作者： Greta Zunino Denise Battaglini Daniel Agustin Godoy IRCCS Ospedale Policlinico San Martino GenovaItaly Dipartimento di Scienze Diagnostiche e Chirurgiche Integrate Universitàdegli Studi di GenovaGenovaItaly Neurointensive Care Unit Sanatorio PasteurCatamarcaArgentina

Background Patients with acute brain injury(ABI)are a peculiar population because ABI does not only affect the brain but also other organs such as the lungs,as theorized in brain–lung crosstalk *** patients often require mechanical ventilation(MV)to avoid the complications of impaired respiratory function that can follow ABI;MV should be settled with meticulousness owing to its effects on the intracranial compartment,especially regarding positive end-expiratory pressure(PEEP).This scoping review aimed to(1)describe the physiological basis and mechanisms related to the effects of PEEP in ABI;(2)examine how clinical research is conducted on this topic;(3)identify methods for setting PEEP in ABI;and(4)investigate the impact of the application of PEEP in ABI on the *** The five-stage paradigm devised by Peters et *** expanded by Arksey and O'Malley,Levac et al.,and the Joanna Briggs Institute was used for *** also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)extension *** criteria:we compiled all scientific data from peer-reviewed journals and studies that discussed the application of PEEP and its impact on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in adult patients with *** criteria:studies that only examined a pediatric patient group(those under the age of 18),experiments conducted solely on animals;studies without intracranial pressure and/or cerebral perfusion pressure determinations,and studies with incomplete *** authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online *** were presented in narrative and tubular *** The initial search yielded 330 references on the application of PEEP in ABI,of which 36 met our inclusion *** has recognized beneficial effects on gas exchange,but it produces hemodynamic changes that should be predicted to avoi

关键词： Acute brain injury Mechanical ventilation Positive end-expiratory pressure Intracranial pressure Brain-lung crosstalk Multimodal monitoring

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Diagnostic accuracy of ePOS score in predicting DNR labeling after ICU admission:A prospective observational study(ePOS-DNR)

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Journal of Intensive Medicine 2024年第2期4卷 216-221页

作者： 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 Department of Critical Care King Saud Medical CityRiyadhSaudi Arabia Anesthesia Department Faculty of MedicineAin Shams UniversityCairoEgypt Anesthesia Department Faculty of MedicineTanta UniversityTantaEgypt Faculty of Medicine Alexandria UniversityAlexandriaEgypt Nursing Department King Saud Medical CityRiyadhSaudi Arabia

Background Resuscitation can sometimes be futile and making a do-not-resuscitate(DNR)decision is in the best interest of the *** electronic poor outcome screening(ePOS)score was developed to predict 6-month poor outcomes of critically ill *** 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 ***,we calculated ePOS scores for all eligible consecutive admissions after 48 h in the ICU and recorded the DNR *** ability of the score to predict DNR was explored using logistic ***'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 *** average ePOS score of DNR and non-DNR patients was 28.2±10.7 and 15.2±9.7,*** 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,P17 was associated with a sensitivity of 87.2(95%CI:80.0 to 92.5,P17 may help guide clinical decisions to withhold or commence resuscitative measures.

关键词： Do-not-resuscitate(DNR) Resuscitation Intensive care unit(ICU) Diagnostic accuracy Sensitivity Specificity

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Compartmentalization of the inflammatory response during bacterial sepsis and severe COVID-19

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Journal of Intensive Medicine 2024年第3期4卷 326-340页

作者： Jean-Marc Cavaillon Benjamin G.Chousterman Tomasz Skirecki Institut Pasteur ParisFrance Department of Anesthesia and Critical Care Lariboisière University HospitalDMU ParabolAPHP NordParisFrance Inserm U942 University of ParisParisFrance Department of Translational Immunology and Experimental Intensive Care Centre of Postgraduate Medical EducationWarsawPoland

Acute infections cause local and systemic disorders which can lead in the most severe forms to multi-organ failure and eventually to death. The host response to infection encompasses a large spectrum of reactions with a concomitant activation of the so-called inflammatory response aimed at fighting the infectious agent and removing damaged tissues or cells, and the anti-inflammatory response aimed at controlling inflammation and initiating the healing process. Fine-tuning at the local and systemic levels is key to preventing local and remote injury due to immune system activation. Thus, during bacterial sepsis and Coronavirus disease 2019 (COVID-19), concomitant systemic and compartmentalized pro-inflammatory and compensatory anti-inflammatory responses are occurring. Immune cells (e.g., macrophages, neutrophils, natural killer cells, and T-lymphocytes), as well as endothelial cells, differ from one compartment to another and contribute to specific organ responses to sterile and microbial insult. Furthermore, tissue-specific microbiota influences the local and systemic response. A better understanding of the tissue-specific immune status, the organ immunity crosstalk, and the role of specific mediators during sepsis and COVID-19 can foster the development of more accurate biomarkers for better diagnosis and prognosis and help to define appropriate host-targeted treatments and vaccines in the context of precision medicine.

关键词： Acute respiratory distress syndrome Bone marrow Cytokines Lungs Mucosa Vaccines

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Bloodstream infections in the era of the COVID-19 pandemic: Changing epidemiology of antimicrobial resistance in the intensive care unit

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Journal of Intensive Medicine 2024年第3期4卷 269-280页

作者： Fotinie Ntziora Efthymia Giannitsioti st Department of Propaedeutic Internal Medicine Medical SchoolNational and Kapodistrian University of AthensLaiko General HospitalAthensGreece

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 *** data pertaining to BSI episodes from the ICU setting during the COVID-19 pandemic were collected and analyzed for this narrative *** 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 *** 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 *** on antimicrobial stewardship and infection-control policies were also *** 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 *** 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 *** use of immune modulators for COVID-19 appeared to increase the risk of BSI;however,the available data are ***,Enterococci,Acinetobacter baumannii,and Candida *** as prominent infecting organisms during the pandemic;along with Enterobacterales and Pseudomonas aeruginosa they had a significant impact on ***-resistant organisms prevailed in the ICU,especially if antimicrobial resistance was establish

关键词： COVID-19 Bloodstream infection ICU Antimicr obial resistance Stewardship

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Severe dengue in the intensive care unit

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Journal of Intensive Medicine 2024年第1期4卷 16-33页

作者： Alexandre Mestre Tejo Debora Toshie Hamasaki Letícia Mattos Menezes Yeh-Li Ho Intensive Care Unit Department of Intensive Medicine of the Cancer Institute of the State of São PauloHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil Transfusion Medicine and Cell Therapy Department A.C.Camargo Cancer CenterSão PauloBrazil Intensive Care Unit of Infectious Disease Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil

Dengue fever is considered the most prolific vector-borne disease in the world,with its transmission rate increasing more than eight times in the last two *** most cases present mild to moderate symptoms,5%of patients can develop severe *** the mechanisms are yet not fully comprehended,immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients:increased vascular permeability that may shock and thrombocytopenia,and coagulopathy that can induce *** risk factors of severe disease include previous infection by a different serotype,specific genotypes associated with more efficient replication,certain genetic polymorphisms,and comorbidities such as diabetes,obesity,and cardiovascular *** World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce *** review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.

关键词： Severe dengue Intensive care units Shock Pathogenesis Diagnosis Management

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A hierarchical clustering approach for colorectal cancer molecular subtypes identification from gene expression data

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Intelligent Medicine 2024年第1期4卷 43-51页

作者： Shivangi Raghav Aastha Suri Deepika Kumar Aakansha Aakansha Muskan Rathore Sudipta Roy Department of Computer Science&Engineering Bharati Vidyapeeth’s College of EngineeringNew DelhiIndia Artificial Intelligence&Data Science Jio InstituteNavi Mumbai410206India

Background Colorectal cancer(CRC)is the second leading cause of cancer fatalities and the third most common human *** molecular subgroups of CRC and treating patients accordingly could result in better therapeutic success compared with treating all CRC patients *** have highlighted the significance of CRC as a major cause of mortality worldwide and the potential benefits of identifying molecular subtypes to tailor treatment strategies and improve patient *** This study proposed an unsupervised learning approach using hierarchical clustering and feature selection to identify molecular subtypes and compares its performance with that of conventional *** proposed model contained gene expression data from CRC patients obtained from Kaggle and used dimension reduction techniques followed by Z-score-based outlier *** hierarchy clustering was used to identify molecular subtypes,with a P-value-based approach for feature *** performance of the model was evaluated using various classifiers including multilayer perceptron(MLP).Results The proposed methodology outperformed conventional methods,with the MLP classifier achieving the highest accuracy of 89%after feature *** model successfully identified molecular subtypes of CRC and differentiated between different subtypes based on their gene expression *** This method could aid in developing tailored therapeutic strategies for CRC patients,although there is a need for further validation and evaluation of its clinical significance.

关键词： Machine learning Colorectal cancer Feature selection Classification Clustering

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When to start renal replacement therapy in acute kidney injury: What are we waiting for?

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Journal of Intensive Medicine 2024年第3期4卷 341-346页

作者： Lixia Liu Zhenjie Hu Department of Critical Care Medicine The Fourth Hospital of Hebei Medical UniversityShijiazhuangHebeiChina

Acute kidney injury remains a serious condition with a high mortality risk. In the absence of any new drugs, renal replacement therapy (RRT) is the most important treatment option. Randomized controlled trials have concluded that in critically ill patients without an emergency indication for RRT, a watchful waiting strategy is safe;however, further delays in RRT did not seem to confer any benefit, rather was associated with potential harm. During this process, balancing the risks of complications due to an unnecessary intervention with the risk of not correcting a potentially life-threatening complication remains a challenge. Dynamic renal function assessment, especially dynamic assessment of renal demand-capacity matching, combined with renal biomarkers such as neutrophil gelatinase-associated lipocalin and furosemide stress test, is helpful to identify which patients and when the patients may benefit from RRT.

关键词： Acute kidney injury Renal replacement therapy Initiation timing Dynamic assessment Biomarkers

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