Abstract:
BACKGROUND:Empirical antimicrobial therapy (EAT) is a challenge for community-acquired, hospital-acquired and ventilator-associated pneumonia, particularly in the context of the increasing occurrence of third-generation cephalosporin-resistant Enterobacterales (3GCR-E), including extended-spectrum beta-lactamase Enterobacterales (ESBL-E) and high-level expressed AmpC cephalosporinase-producing Enterobacterales (HLAC-E). To prevent the overuse of broad-spectrum antimicrobial therapies, such as carbapenems, we assessed the performance of screening for intestinal carriage of HLAC-E in addition to ESBL-E to predict 3GCR-E (ESBL-E and/or HLAC-E) presence or absence in respiratory samples in ICU, and to evaluate its potential impact on carbapenem prescription. MATERIALS AND METHODS:This monocentric retrospective observational study was performed in a surgical ICU during a 4-year period (January 2013-December 2016). Patients were included if they had a positive culture on a respiratory sample and a previous intestinal carriage screening performed by rectal swabbing within 21 days. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and likelihood ratios were calculated for the screening for intestinal carriage of ESBL-E, HLAC-E and 3GCR-E (ESBL-E and/or HLAC-E) as predictor of their absence/presence in respiratory samples. Impact of HLAC-E and ESBL-E reporting on EAT was also studied. RESULTS:765 respiratory samples, retrieved from 468 patients, were analyzed. ESBL-E prevalence was 23.8% in rectal swab and 4.4% in respiratory samples. HLAC-E prevalence was 9.0% in rectal swabs and 3.7% in respiratory samples. Overall, the 3GCR-E prevalence was 31.8% in rectal swabs and 7.7% in respiratory samples. NPVs were 98.8%, 98.0% and 96.6% for ESBL-E, HLAC-E and 3GCR-E, respectively. Over the study period, empirical antimicrobial therapy was initiated for 315 episodes of respiratory infections: 228/315 (72.4%) were associated with negative intestinal carriage screening for both HLAC-E and ESBL-E, of whom 28/228 (12.3%) were treated with carbapenems. Of 23/315 (7.3%) cases with screening for positive intestinal carriage with HLAC-E alone, 10/23 (43.5%) were treated with carbapenems. CONCLUSION:Systematic screening and reporting of HLAC-E in addition to ESBL-E in intestinal carriage screening could help to predict the absence of 3GCR-E in respiratory samples of severe surgical ICU patients. This could improve the appropriateness of EAT in ICU patients with HAP and may prevent the overuse of carbapenems.
journal_name
Ann Intensive Carejournal_title
Annals of intensive careauthors
Elsa M,Matthieu LD,De Ponfilly Gauthier P,Hanaa B,Rishma A,Emmanuelle C,Benjamin S,Glenn CB,Hervé Jdoi
10.1186/s13613-020-00754-9subject
Has Abstractpub_date
2020-10-29 00:00:00pages
149issue
1issn
2110-5820pii
10.1186/s13613-020-00754-9journal_volume
10pub_type
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journal_title:Annals of intensive care
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journal_title:Annals of intensive care
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journal_title:Annals of intensive care
pub_type: 已发布勘误
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abstract:BACKGROUND:The value of goal-directed fluid therapy in neurosurgical patients, where brain swelling is a major concern, is unknown. The aim of our study was to evaluate the effect of an intraoperative goal-directed fluid restriction (GDFR) strategy on the postoperative outcome of high-risk patients undergoing brain sur...
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journal_title:Annals of intensive care
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abstract:BACKGROUND:Despite improvements in intermittent hemodialysis management, intradialytic hemodynamic instability (IHI) remains a common issue that could account for increased mortality and delayed renal recovery. However, predictive factors of IHI remain poorly explored. The objective of this study was to evaluate the re...
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abstract:BACKGROUND:Assessment of maximum respiratory pressures is a common practice in intensive care because it can predict the success of weaning from ventilation. However, the reliability of measurements through an intubation catheter has not been compared with standard measurements. The aim of this study was to compare max...
journal_title:Annals of intensive care
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doi:10.1186/s13613-018-0362-1
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journal_title:Annals of intensive care
pub_type: 杂志文章
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journal_title:Annals of intensive care
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pub_type: 杂志文章
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更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Preliminary reports have described significant procoagulant events in patients with coronavirus disease-2019 (COVID-19), including life-threatening pulmonary embolism (PE). MAIN TEXT:We review the current data on the epidemiology, the possible underlying pathophysiologic mechanisms, and the therapeutic impl...
journal_title:Annals of intensive care
pub_type: 杂志文章,评审
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更新日期:2020-09-16 00:00:00
abstract:BACKGROUND:Middle East respiratory syndrome coronavirus (MERS-CoV) has caused several hospital outbreaks, including a major outbreak at King Abdulaziz Medical City, a 940-bed tertiary-care hospital in Riyadh, Saudi Arabia (August-September 2015). To learn from our experience, we described the critical care response to ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-016-0203-z
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Hypoxic hepatitis (HH) is a type of acute hepatic injury that is histologically characterized by centrilobular liver cell necrosis and that is caused by insufficient oxygen delivery to the hepatocytes. Typical for HH is the sudden and significant increase of aspartate aminotransferase (AST) in response to ca...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0356-z
更新日期:2018-01-30 00:00:00
abstract::The death of a loved one is often an ordeal and a tragedy for those who witness it, as death is not merely the end of a life, but also the end of an existence, the loss of a unique individual who is special and irreplaceable. In some situations, end-of-life signs, such as agonal gasps, can be an almost unbearable "sig...
journal_title:Annals of intensive care
pub_type: 杂志文章,评审
doi:10.1186/2110-5820-4-23
更新日期:2014-07-08 00:00:00
abstract:BACKGROUND:SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in SARS-CoV-2+ pati...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-020-00798-x
更新日期:2021-01-13 00:00:00
abstract:BACKGROUND:Optimal anti-bacterial activity of meropenem requires maintenance of its plasma concentration (Cp) above the minimum inhibitory concentration (MIC) of the pathogen for at least 40% of the dosing interval (fT > MIC > 40). We aimed to determine whether a 3-h extended infusion (EI) of meropenem achieves fT > MI...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-019-0622-8
更新日期:2020-01-10 00:00:00
abstract:BACKGROUND:Knowledge of patients' height is essential for daily practice in the intensive care unit. However, actual height measurements are unavailable on a daily routine in the ICU and measured height in the supine position and/or visual estimates may lack consistency. Clinicians do need simple and rapid methods to e...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-016-0154-4
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:The consequences of the ageing population concerning ICU hospitalisation need to be adequately described. We believe that this discussion should be disease specific. A focus on respiratory infections is of particular interest, because it is strongly associated with old age. Our objective was to assess trends...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0430-6
更新日期:2018-08-15 00:00:00
abstract:BACKGROUND:The choice of empirical antimicrobial therapy for pneumonia in intensive care unit (ICU) is a challenge, since pneumonia is often related to multidrug-resistant pathogens, particularly extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E). To prevent the overuse of broad-spectrum antimicrobial ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0237-x
更新日期:2017-12-01 00:00:00
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journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0415-5
更新日期:2018-06-04 00:00:00
abstract:BACKGROUND:Ultrafast cooling by total liquid ventilation (TLV) provides potent cardio- and neuroprotection after experimental cardiac arrest. However, this was evaluated in animals with no initial lung injury, whereas out-of-hospital cardiac arrest is frequently associated with early-onset pneumonia, which may lead to ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0404-8
更新日期:2018-05-02 00:00:00
abstract:: Critically ill adult patients often require multiple examinations in the hospital and need transport from one department to another, or even between hospitals. However, to date, no guidelines exist regarding optimum practices for transport of these fragile patients. We present recommendations for intrahospital transp...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-2-1
更新日期:2012-02-03 00:00:00
abstract:BACKGROUND:Acute kidney injury (AKI) occurs in up to 50% of all critically ill patients and hemodynamic abnormalities are assumed to contribute, but their nature and share is still unclear. We explored the associations between hemodynamic variables, including cardiac index and right ventricular function, and the occurr...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-019-0513-z
更新日期:2019-03-13 00:00:00
abstract::Although improving, the mortality from septic shock still remains high despite increased international awareness. As a consequence, much effort has focused on alternative treatment strategies in an effort to improve outcomes. The application of blood purification therapies to improve immune homeostasis has been sugges...
journal_title:Annals of intensive care
pub_type: 杂志文章,评审
doi:10.1186/s13613-019-0530-y
更新日期:2019-05-14 00:00:00
abstract:: Red blood cells (RBC) storage facilitates the supply of RBC to meet the clinical demand for transfusion and to avoid wastage. However, RBC storage is associated with adverse changes in erythrocytes and their preservation medium. These changes are responsible for functional alterations and for the accumulation of pote...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-3-2
更新日期:2013-01-15 00:00:00
abstract:: Cancer is a leading cause of death in children. In the past decades, there has been a marked increase in overall survival of children with cancer. However, children whose treatment includes hematopoietic stem cell transplantation still represent a subpopulation with a higher risk of mortality. These improvements in m...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-2-14
更新日期:2012-06-12 00:00:00
abstract:BACKGROUND:The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). The present study investigated the association between ultrasound guidance (US) during AC insertion and major catheter-related infections (MCRI), catheter-related bloodstream infect...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-020-00705-4
更新日期:2020-07-08 00:00:00
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journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-3-25
更新日期:2013-08-11 00:00:00