Abstract:
OBJECTIVE:To determine the impact of the rotation of antimicrobial agents on the rates of infection, intestinal colonization, and acquisition with antimicrobial-resistant Gram-negative bacteria. DESIGN:Pre- and postintervention design. SETTING:A 19-bed, medical intensive care unit. PATIENTS:Individuals admitted to the study unit for >48 hrs. INTERVENTIONS:After a 5-month baseline observation period, four classes of antimicrobial agents with Gram-negative activity were cycled at 3- to 4-month intervals for 24 months. MEASUREMENTS AND MAIN RESULTS:The primary outcome was the acquisition rate of antimicrobial resistance among Enterobacteriaceae and Pseudomonas aeruginosa obtained from rectal swab cultures performed on admission, weekly during the patients' stay, and at discharge. Rates and microbiology of nosocomial bloodstream infections and ventilator-associated pneumonia were also compared between baseline and cycling periods. The cycling program resulted in a significant change in prescribing practices; the predominant agent used changed with each cycle. Among study patients who were not already colonized with a resistant organism, the rate of acquisition of enteric colonization with bacteria resistant to any of the target drugs remained stable during the cycling period for P. aeruginosa (relative rate, 0.96; 95% confidence Interval, 0.47-2.16) and Enterobacteriaceae (relative rate, 1.57; 95% confidence interval, 0.80-3.43). Hospital-wide, P. aeruginosa from routine clinical cultures resistant to the target drugs increased during the cycling period. The proportion of Gram-negative bacteria isolated from cases of nosocomial bloodstream infection (29% baseline vs. 26% cycling; p = .11) and ventilator-associated pneumonia (80% vs. 41%; p = .06) did not significantly differ. CONCLUSIONS:In this study, antimicrobial cycling did not result in a significant change in enteric acquisition of resistant Gram-negative bacteria among intensive care unit patients.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Warren DK,Hill HA,Merz LR,Kollef MH,Hayden MK,Fraser VJ,Fridkin SKdoi
10.1097/01.ccm.0000147685.79487.28subject
Has Abstractpub_date
2004-12-01 00:00:00pages
2450-6issue
12eissn
0090-3493issn
1530-0293pii
00003246-200412000-00013journal_volume
32pub_type
杂志文章abstract:OBJECTIVE:To examine the accuracy of brain multimodal monitoring-consisting of intracranial pressure, brain tissue PO2, and cerebral microdialysis--in detecting cerebral hypoperfusion in patients with severe traumatic brain injury. DESIGN:Prospective single-center study. PATIENTS:Patients with severe traumatic brain ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000720
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVES:Vital organ hypoperfusion significantly contributes to the dismal survival rates observed with manual cardiopulmonary resuscitation after cardiac arrest. The impedance threshold device is a valve which reduces air entry into lungs during chest recoil between chest compressions, producing a potentially benefi...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0b013e318170ba80
更新日期:2008-05-01 00:00:00
abstract::In a prospective 30-month study of nosocomial infections in a pediatric ICU (PICU), the incidence, sites, and causes of infection were determined. Factors associated with increased risk of infection were investigated. In 1,388 patients who remained in the PICU for a minimum of 72 h, 116 infections occurred (6.1 infect...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-198803000-00005
更新日期:1988-03-01 00:00:00
abstract::Ten infants with acquired subglottic stenosis were treated successfully using the anterior cricoid split operation. Eight had been preterm infants who required endotracheal intubation and assisted ventilation for the respiratory distress syndrome. Two had been born at term; 1 required mechanical ventilation for aspira...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198404000-00012
更新日期:1984-04-01 00:00:00
abstract:OBJECTIVE:To determine the feasibility of utilizing a scintigraphic technique to differentiate patients with adult respiratory distress syndrome due to sepsis syndrome from control volunteers and patients with congestive heart failure. Gamma scintigraphy was compared with chest roentgenograms to predict mortality rate ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199201000-00012
更新日期:1992-01-01 00:00:00
abstract::In order to determine and analyze the complication rate of the insertion and maintenance of the balloon-tipped, flow-directed pulmonary artery catheter (PAC), the authors prospectively studied the use of 320 catheters in 219 critically ill patients. Mean patient age was 53 +/- 1 years, and 36% had a history of cardiov...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198104000-00006
更新日期:1981-04-01 00:00:00
abstract:OBJECTIVES:To perform a complete immunological characterization of compensatory anti-inflammatory response syndrome in patients with sepsis and to explore the relationship between these changes and clinical outcomes of 28-day mortality and secondary infections. DESIGN:Prospective single-center study conducted between ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000100
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVES:We examined recommendations within critical care guidelines to describe the pairing patterns for strength of recommendation and quality of evidence. We further identified recommendations where the reported strength of recommendation was strong while the reported quality of evidence was not high/moderate and ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003467
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:To describe a severe axonal polyneuropathy that follows acute respiratory failure and, in turn, causes continued ventilator dependence and paralysis after resolution of the primary illness. DESIGN:Retrospective chart review of three patients and prospective analysis of two patients. SETTING:Respiratory and ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199302000-00020
更新日期:1993-02-01 00:00:00
abstract:OBJECTIVE:To investigate if prone position delays the progression of experimental ventilator-induced lung injury, possibly due to a more homogeneous distribution of strain within lung parenchyma. DESIGN:Prospective, randomized, controlled trial. SETTING:Animal laboratory of a university hospital. SUBJECTS:Thirty-fiv...
journal_title:Critical care medicine
pub_type: 评论,杂志文章
doi:10.1097/01.ccm.0000150660.45376.7c
更新日期:2005-02-01 00:00:00
abstract:OBJECTIVES:In the Acute Respiratory Distress Syndrome Network randomized controlled trial, methylprednisolone treatment was associated with increased return to mechanical ventilation with partial loss of early improvements. We hypothesize a causal relationship between protocol-driven rapid discontinuation of methylpred...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0000000000003021
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:The high incidence of lower lobe collapse in adult intensive care patients is well described. We aimed to document the incidence and distribution of acute lobar collapse in the pediatric intensive care setting. The influence of anatomical and pathophysiological differences between the adult and pediatric resp...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199908000-00035
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVES:To perform a scoping literature review of cognitive, psychiatric, and quality of life outcomes in adults undergoing extracorporeal membrane oxygenation for any indication. DATA SOURCES:We searched PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO from inception to June 2019. STUDY SELE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004488
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:To investigate pharmacokinetics and metabolism of sodium citrate in critically ill patients. To determine the risk of citrate accumulation in the setting of liver dysfunction (cirrhosis, hepatorenal syndrome). DESIGN:Prospective cohort study. SETTING:Intensive Care Unit, Department of Medicine IV, Universi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000084871.76568.E6
更新日期:2003-10-01 00:00:00
abstract:OBJECTIVES:To determine plasma aluminum concentrations and 24-hr urine aluminum excretion rate in long-term mechanically ventilated patients treated with 6 g of sucralfate daily for stress ulcer prophylaxis. DESIGN:Prospective study in long-term mechanically ventilated critically ill patients. SETTING:A surgical inte...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:
更新日期:1994-11-01 00:00:00
abstract:OBJECTIVE:To define a biomarker panel to predict organ dysfunction, shock, and in-hospital mortality in emergency department (ED) patients with suspected sepsis. DESIGN:Prospective observational study. SETTING:EDs of ten academic medical centers. PATIENTS:There were 971 patients enrolled. INCLUSION CRITERIA:1) ED p...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318192fd9d
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVES:Augmented renal clearance might lead to subtherapeutic plasma levels of drugs with predominant renal clearance. Early identification of augmented renal clearance remains challenging for the ICU physician. We developed and validated our augmented renal clearance predictor, a clinical prediction model for augm...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004667
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:To examine the longitudinal outcome of a cohort of mechanically ventilated patients admitted to an acute care respiratory unit after critical illness. DESIGN, SETTING, AND PATIENTS:Prospective, observational study of 210 consecutive patients admitted to a respiratory unit of an acute, tertiary care universit...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000287589.16724.B2
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:We have previously described a method for the precise delivery of inhaled nitric oxide (iNO) via a conventional, continuous-flow, pressure-limited, time-cycled ventilator. Because of the augmented effect of iNO decreasing pulmonary vascular resistance with high-frequency oscillatory ventilation (HFOV), we de...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00038
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVE:Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent hemodialysis. There is no difference in mortality, although patients treated with CRRT may have a higher rate of renal recovery. Given these considerations, an estimate of the costs by modality may help in choo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000045182.90302.B3
更新日期:2003-02-01 00:00:00
abstract::Previously, we determined that a colloid concentration of about 3% was optimal for resuscitation of lethal ischemic intestinal shock model in rats. Maximal volumes of lactated Ringer's solution (RL) alone only expanded plasma volume (PV) to 80% of preshock level, while increasing volumes of 3% albumin (ALB) in RL line...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199001000-00014
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:During pressure support ventilation, ventilator inspiration ends when inspiratory flow drops to a given percentage of the peak inspiratory flow cycling-off criteria. This study evaluated the effect of two different cycling-off criteria on breathing pattern, respiratory effort, and gas exchange in patients wit...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000287594.80110.34
更新日期:2007-11-01 00:00:00
abstract:OBJECTIVES:To evaluate the preload dependence of femoral maximal change in pressure over time (dP/dtmax) during volume expansion in preload dependent and independent critically ill patients. DESIGN:Retrospective database analysis. SETTING:Two adult polyvalent ICUs. PATIENTS:Twenty-five critically ill patients with a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004515
更新日期:2020-10-01 00:00:00
abstract::The applicability of continuous arteriovenous hemofiltration (CAVH) for renal replacement therapy was evaluated in three infants and two young children with catastrophic medical and surgical illnesses. In the first four patients, CAVH was used in conjunction with either peritoneal or hemodialysis. In the fifth patient...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198612000-00014
更新日期:1986-12-01 00:00:00
abstract::Flow rates and pressure recording accuracy were compared for Argyle 14-, 16-, and 18-ga double-lumen and Edwards 7-Fr triple-lumen CVP catheters. Physiologic saline solution was pressure-infused into dogs through one lumen and CVP was measured via the other lumen. CVP accuracy was unaltered by simultaneous rapid infus...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198507000-00017
更新日期:1985-07-01 00:00:00
abstract:OBJECTIVES:Hepatic ischemia-reperfusion is a major clinical problem with limited treatment options. The pathophysiology of hepatic ischemia-reperfusion is characterized by mitochondrial dysfunction and cellular energy deficits. Sirtuin 1 is an energy-sensing enzyme known to modulate mitochondrial biogenesis. We hypothe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001637
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:Oxygenation measured 24 hours after acute respiratory distress syndrome onset more accurately stratifies risk, relative to oxygenation at onset, in both children and adults. However, waiting 24 hours is problematic, especially for interventions that are more efficacious early in the disease course. We aimed t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002958
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:To determine whether blood lactate, base deficit, or oxygen-derived hemodynamic variables correlate with morbidity and mortality rates in a clinically-relevant LD50 model of penetrating trauma. DESIGN:Prospective, controlled study. SETTING:University research laboratory. SUBJECTS:Anesthetized, mechanically...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199901000-00044
更新日期:1999-01-01 00:00:00
abstract:OBJECTIVE:The successful management of an influenza pandemic will be reliant on the expertise of healthcare workers at high risk for occupationally acquired influenza. Recommended infection control measures for healthcare workers include surgical masks to protect against droplet-spread respiratory transmissible infecti...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/ccm.0b013e3181b9e8b3
更新日期:2010-02-01 00:00:00
abstract::Vecuronium's short half-life and minimal cardiopulmonary side-effects make it a suitable drug for continuous infusion. Vecuronium is used frequently in critically ill patients to increase their total compliance and to minimize the adverse effects of mechanical ventilation. This crossover, prospective study evaluates t...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198910000-00004
更新日期:1989-10-01 00:00:00