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Pneumonia associated with mechanical ventilation

Aušra Čiginskienė, Asta Dambrauskienė, Jordi Rello, Dalia Adukauskienė
Background and objectives: High mortality and healthcare costs area associated with ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii ( A. baumannii ). The data concerning the link between multidrug-resistance of A. baumannii strains and outcomes remains controversial. Therefore, we aimed to identify the relation of risk factors for ventilator-associated pneumonia (VAP) and mortality with the drug resistance profiles of Acinetobacter baumannii ( A. baumannii ) and independent predictors of in-hospital mortality...
February 13, 2019: Medicina
Dominique Hope Limoli, Lucas R Hoffman
Recent studies of human respiratory secretions using culture-independent techniques have found a surprisingly diverse array of microbes. Interactions among these community members can profoundly impact microbial survival, persistence and antibiotic susceptibility and, consequently, disease progression. Studies of polymicrobial interactions in the human microbiota have shown that the taxonomic and structural compositions, and resulting behaviours, of microbial communities differ substantially from those of the individual constituent species and in ways of clinical importance...
February 18, 2019: Thorax
H Eylül Bozkurt Yılmaz, Elif Küpeli, Nazan Şen, İlker Arer, Kenan Çalışkan, Şule Akçay, Mehmet Haberal
OBJECTIVES: We evaluated the frequency and cause of acute respiratory failure in renal transplant recipients. MATERIALS AND METHODS: Our single-center retrospective observational study included consecutive renal transplant recipients who were admitted to an intensive care unit for acute respiratory failure between 2011 and 2017. Acute respiratory failure was defined as oxygen saturation < 92% or partial pressure of oxygen in arterial blood < 60 mm Hg on room air and/or requirement of noninvasive or invasive mechanical ventilation...
January 2019: Experimental and Clinical Transplantation
Otavio T Ranzani, Tarek Senussi, Francesco Idone, Adrian Ceccato, Gianluigi Li Bassi, Miquel Ferrer, Antoni Torres
BACKGROUND: Data on the methods used for microbiological diagnosis of hospital-acquired pneumonia (HAP) are mainly extrapolated from ventilator-associated pneumonia. HAP poses additional challenges for respiratory sampling, and the utility of sputum or distal sampling in HAP has not been comprehensively evaluated, particularly in HAP admitted to the ICU. METHODS: We analyzed 200 patients with HAP from six ICUs in a teaching hospital in Barcelona, Spain. The respiratory sampling methods used were divided into non-invasive [sputum and endotracheal aspirate (EAT)] and invasive [fiberoptic-bronchoscopy aspirate (FBAS), and bronchoalveolar lavage (BAL)]...
February 18, 2019: Critical Care: the Official Journal of the Critical Care Forum
Martin Wolkewitz, Mercedes Palomar-Martinez, Francisco Alvarez-Lerma, Pedro Olaechea-Astigarraga, Martin Schumacher
OBJECTIVE: To study the impact of duration of mechanical ventilation, hospitalization and multiple ventilation episodes on the development of pneumonia while accounting for extubation as a competing event. DESIGN: A multicenter data base from a Spanish surveillance network was used to conduct a retrospective analysis of prospectively collected intensive care patients followed from admission to discharge. SETTING: Spanish intensive care units (ICUs)...
February 18, 2019: Infection Control and Hospital Epidemiology
James C Hurley
PURPOSE: The objective here is to define the extent and possible reasons for geographic variation in Pseudomonas aeruginosa associated with Ventilator Associated Pneumonia (VAP). METHODS: A random effects meta-regression model of Pseudomonas associated VAP incidence within the published literature was undertaken incorporating group level factors such trauma admission, year of publication and use of bronchoscopic sampling towards VAP diagnosis. RESULTS: Pseudomonas associated VAP incidence was reported in 162 studies from seven worldwide regions published over 30 years...
February 6, 2019: Journal of Critical Care
Peera Hemarajata, Romney M Humphries
Objectives: Ceftazidime/avibactam resistance due to mutation in the omega loop of KPC-2 has been documented in vitro and in vivo. This study evaluated the mechanism of ceftazidime/avibactam resistance in a KPC-2-expressing Klebsiella pneumoniae isolated from a patient following ceftazidime/avibactam combination therapy with gentamicin for the treatment of ventilator-associated pneumonia. Methods: Ceftazidime/avibactam-susceptible and -resistant isolates of K. pneumoniae were evaluated by broth microdilution and WGS...
February 7, 2019: Journal of Antimicrobial Chemotherapy
Astrid Pérez, Eva Gato, José Pérez-Llarena, Felipe Fernández-Cuenca, María José Gude, Marina Oviaño, María Eugenia Pachón, José Garnacho, Verónica González, Álvaro Pascual, José Miguel Cisneros, Germán Bou
Objectives: To characterize the antimicrobial susceptibility, molecular epidemiology and carbapenem resistance mechanisms in Pseudomonas aeruginosa isolates recovered from respiratory tract samples from patients with ventilator-associated pneumonia enrolled in the MagicBullet clinical trial. Methods: Isolates were collected from 53 patients from 12 hospitals in Spain, Italy and Greece. Susceptibility was determined using broth microdilution and Etest. MALDI-TOF MS was used to detect carbapenemase activity and carbapenemases were identified by PCR and sequencing...
February 8, 2019: Journal of Antimicrobial Chemotherapy
Kartik K Venkatesh, Wesley Jackson, Brenna L Hughes, Mathew M Laughon, John M Thorp, David M Stamilio
OBJECTIVE: To investigate the association of chorioamnionitis, and secondarily its duration, on neonatal adverse outcomes for infants born <34 weeks vs. ≥34 weeks. STUDY DESIGN: A secondary analyss from the observational U.S. Consortium on Safe Labor Study. The exposure was chorioamnionitis, and secondarily, its estimated duration. The composite outcome included pneumonia, seizure, necrotizing enterocolitis, sepsis, periventricular/intraventricular/cerebral hemorrhage, mechanical ventilation, and neonatal death...
February 5, 2019: Journal of Perinatology: Official Journal of the California Perinatal Association
Ahmed El-Nawawy, Magdy A-F Ramadan, Manal A-M Antonios, Shams A-F Arafa, Eman Hamza
PURPOSE: Therapy of severe pneumonia is very challenging in view of the current widespread bacterial resistance to many antibiotics especially extended spectrum ß-lactams, carbapenems, and anti-pseudomonal drugs. The current study aimed at assessing antimicrobial sensitivity pattern and optimization of the antibiotic stewardship program applied in a university affiliated pediatric intensive care unit (PICU). SUBJECTS AND METHODS: This prospective cohort study included all patients aged 1 month to 12 years, admitted to the PICU with severe pneumonia episodes indicated for mechanical ventilation, and were followed up and investigated...
January 30, 2019: Journal of Global Antimicrobial Resistance
Jianan Ren, Jiashuo Zheng
The published clinical research in 2018 in surgical infection are changing current opinions in the management of acute appendicitis, antibiotics usage, resuscitation of septic shock, and choice of nutritional therapy in critically ill patients. In the management of uncomplicated acute appendicitis, antibiotic therapy can be successful in selected patients who wish to avoid surgery. Delayed primary wound closure can not reduce superficial surgical site infection rates compared to primary wound closure for complicated appendicitis...
January 25, 2019: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
James C Borders, Daniel Fink, Joseph E Levitt, Jeffrey McKeehan, Edel McNally, Alix Rubio, Rebecca Scheel, Jonathan M Siner, Stephanie Gomez Taborda, Rosemary Vojnik, Heather Warner, S David White, Susan E Langmore, Marc Moss, Gintas P Krisciunas
Dysphagia is common in hospitalized patients post-extubation and associated with poor outcomes. Laryngeal sensation is critical for airway protection and safe swallowing. However, current understanding of the relationship between laryngeal sensation and aspiration in post-extubation populations is limited. Acute respiratory failure patients requiring intensive care unit admission and mechanical ventilation received a Flexible Endoscopic Evaluation of Swallowing (FEES) within 72 h of extubation. Univariate and multivariable analyses were performed to examine the relationship between laryngeal sensation, length of intubation, and aspiration...
January 29, 2019: Dysphagia
G Li Bassi, T Comaru, D Martí, E A Xiol, C Chiurazzi, C Travierso, M Carbonara, O T Ranzani, R Amaro, G Frigola, C Fuster, M A Saco, A Zanella, F De Rosa, M Rigol, L Fernandez, N Luque, J Ramirez, F Blasi, J Suen, J Fraser, A Torres
BACKGROUND: Recruitment manoeuvres generate a transient increase in trans-pulmonary pressure that could open collapsed alveoli. Recruitment manoeuvres might generate very high inspiratory airflows. We evaluated whether recruitment manoeuvres could displace respiratory secretions towards the distal airways and impair gas exchange in a porcine model of bacterial pneumonia. METHODS: We conducted a prospective randomised study in 10 mechanically ventilated pigs. Pneumonia was produced by direct intra-bronchial introduction of Pseudomonas aeruginosa...
February 2019: British Journal of Anaesthesia
Chastity Warren, Mary Kathryn Medei, Brooke Wood, Debra Schutte
: Purpose: The purpose of this evidence-based quality improvement (QI) project was to implement an oral care protocol in the adult in-patient care areas of a level 1 trauma hospital and to evaluate its impact on the incidence of hospital-acquired pneumonia (HAP). METHODS: A standardized, evidence-based oral care protocol was implemented depending on the level of care required by each ventilated, at-risk, or short-term care patient. The QI project included the introduction of a new suction toothbrush kit for at-risk patients and, for short-term patients, a new short-term oral care kit that featured a more ergonomically appropriate toothbrush, a baking soda toothpaste, and an alcohol-free antiseptic mouthwash; the project also supported the continued use of the then current suction toothbrush kit for patients receiving mechanical ventilation...
February 2019: American Journal of Nursing
Despoina Koulenti, Francesca Romana Parisella, Elena Xu, Jeffrey Lipman, Jordi Rello
Chronic obstructive pulmonary disease (COPD) affects approximately 65 million people from which > 25% will require intensive care unit (ICU) admission. Ventilator-associated pneumonia (VAP) is the commonest ICU infection and results in increased morbidity/mortality and costs. The literature on the interaction between COPD and VAP is scarce and controversial. The project aimed to search the literature in order to address the following: (i) Is COPD a risk factor for VAP development? (ii) Does COPD impact the outcome of patients with VAP? (iii) Does VAP development impact the outcome of COPD patients? (iv) Does COPD impact the aetiology of VAP? Current evidence on the topic is controversial...
January 24, 2019: European Journal of Clinical Microbiology & Infectious Diseases
Qinyuan Li, Yuanyuan Li, Qian Yi, Fengtao Suo, Yuan Tang, Siying Luo, Xiaoyin Tian, Guangli Zhang, Dapeng Chen, Zhengxiu Luo
We aimed to investigate the relationship between time to positivity (TTP) of blood cultures and clinical outcomes in children with S. pneumoniae bacteremia. Children with S. pneumoniae bacteremia hospitalized in Children's Hospital of Chongqing Medical University from May 2011 to December 2017 were enrolled retrospectively. Overall, 136 children with S. pneumoniae bacteremia were enrolled. The standard cutoff TTP was 12 h. We stated that in-hospital mortality is significantly higher in the early TTP (≤ 12 h) group than that in the late TTP (> 12 h) group (41...
January 24, 2019: European Journal of Clinical Microbiology & Infectious Diseases
Moon Seong Baek, Sojung Park, Jeong-Hee Choi, Cheol-Hong Kim, In Gyu Hyun
INTRODUCTION: Although prognostic prediction scores for pneumonia such as CURB-65 score or pneumonia severity index (PSI) are widely used, there were a few studies in very elderly patients. The aim of the study was to validate prognostic prediction scores for severe pneumonia and investigate risk factors associated with in-hospital mortality of severe pneumonia in very elderly patients. METHODS: During the 6-year study period (from October 2012 to May 2018), 160 patients aged 80 or older admitted to medical intensive unit were analyzed retrospectively...
January 24, 2019: Journal of Intensive Care Medicine
Zhuo Wang, Wei Ding, Qi Fang, Lulu Zhang, Xueyun Liu, Zaixiang Tang
BACKGROUND: Monitoring gastric residual volume has been a common practice in intensive care patients receiving enteral feeding worldwide. Recent studies though, have challenged the reliability and necessity of this routine monitoring process. Several studies even reported improvements in the delivery of enteral feeding without monitoring gastric residual volume, while incurring no additional adverse events. However, the benefit of monitoring gastric residual volume remains controversial in intensive care patients...
January 3, 2019: International Journal of Nursing Studies
Inès Bendib, Luc de Chaisemartin, Vanessa Granger, Frédéric Schlemmer, Bernard Maitre, Sophie Hüe, Mathieu Surenaud, Asma Beldi-Ferchiou, Guillaume Carteaux, Keyvan Razazi, Sylvie Chollet-Martin, Armand Mekontso Dessap, Nicolas de Prost
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Neutrophil extracellular traps are increasingly recognized as pathogenic in acute injury, but their role in sepsis-related acute respiratory distress syndrome is unknown WHAT THIS ARTICLE TELLS US THAT IS NEW:: In 35 patients with acute respiratory distress syndrome secondary to pneumonia, neutrophil extracellular traps were elevated in the blood and bronchoalveolar fluid, and associated with interleukin-8 and neutrophil levels; however, higher (vs...
January 22, 2019: Anesthesiology
José Luis Bonilla García, Manuel Cortiñas Sáenz, Esperanza Del Pozo Gavilán
INTRODUCTION: Healthcare associated infections (HAI) are the most frequent complication of hospitalized patients. The aim of this study was to describe the clinical and epidemiological characteristics of critically ill post-surgical patients with a diagnosis of healthcare associated infections, after a pattern of sedoanalgesia of at least 4 days. METHODS: All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology where sedation was based as analgesic the opioid remifentanil for at least 96 hours in continuous perfusion...
August 2018: Revista da Associação Médica Brasileira
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