Morbidity In Intensive Care Unit Research Articles

Brain-Specific Serum Biomarkers Predict Neurological Morbidity in Diagnostically Diverse Pediatric Intensive Care Unit Patients.

Unexpected neurological morbidity in Pediatric Intensive Care Units (PICUs) remains high and is difficult to detect proactively. Brain-specific biomarkers represent a novel approach for early detection of neurological injury. We sought to determine whether serum concentrations of neuron-specific enolase (NSE), myelin basic protein (MBP), and S100B, specific for neurons, oligodendrocytes, and glia, respectively, were predictive of neurological morbidity in critically ill children. Serum was prospectively collected on days 1-7 from diagnostically diverse PICU patients (n=103). Unfavorable neurological outcome at hospital discharge was defined as Pediatric Cerebral Performance Category (PCPC) score of 3-6 with a deterioration from baseline. NSE, MBP, and S100B concentrations were measured by enzyme-linked immunosorbent assay. Peak biomarker levels were greater in patients with unfavorable versus favorable neurological outcome [NSE 39.4±44.1 vs. 12.2±22.9ng/ml (P=0.005), MBP 9.1±11.5 vs. 0.6±1.3ng/ml (P=0.003), S100B 130±232 vs. 34±70pg/ml (P=0.04), respectively; mean±SD]. Peak levels were each independently associated with unfavorable neurological outcome when controlling for presence of primary neurologic admission diagnosis and poor baseline PCPC using logistic regression analysis (NSE, P=0.04; MBP, P=0.004; S100B, P=0.04), and had the following receiver operating characteristics: NSE 0.75 (0.58, 0.92), MBP 0.81 (0.66, 0.94), and S100B 0.80 (0.67, 0.93) (area under the curve [95% confidence intervals]). Prospectively collected brain-specific serum biomarkers predict unfavorable neurological outcome in critically ill children. Serum biomarkers used in conjunction with clinical data could be used to generate models predicting early detection of neurological injury, allowing for more timely diagnostic and therapeutic interventions, potentially reducing neurological morbidity in the PICU.

Actualización en sepsis y choque séptico: nuevas definiciones y evaluación clínica

Sepsis is the result of inadequate and deleterious host response caused by infection, which requires the prompt identification, diagnosis and treatment. Sepsis causes a large percentage of the mortality and morbidity in intensive care units. The definition of sepsis and its diagnostic and therapeutic approach has been evolving for over a decade due to the large number of studies on this topic. This article provides a comprehensive review of sepsis, covering new definitions, pathophysiology, and recommendations on its diagnosis and treatment.

Reduced nosocomial infection rate in a neonatal intensive care unit during a 4-year surveillance period

BackgroundHospital-acquired infections are a leading cause of morbidity and mortality in neonatal intensive care units (NICU). The aim of the study was to investigate the change of nosocomial infection rate in a NICU during a 4-year surveillance period. MethodsWe investigated the changes in nosocomial infection rates, infection sites, and microorganism species in a NICU before and after the unit was moved to a new location, extending from November 2008 to October 2012.The new facility was opened on November 1, 2010 and the old NICU was closed on the same day. In the meantime, three catheter-based bundles were implemented in the new NICU and all intensive care units in our hospital due to the new policy. Data collection was performed by independent, experienced infection control nurses. ResultsA total of 512 neonates were admitted to the NICU and enrolled in this study. There were 242 infants who were admitted to the old NICU, and 270 infants in the new facility. During the study period, the rate of infection episodes decreased from 19.0% to 11.1% (P = 0.01). Additionally, the average hospital-acquired infection rate decreased from 6.26 cases per 1000 patient-days to 4.09 cases per 1000 patient-days (P = 0.03). The most common infection site was blood stream infection, which decreased from 8.3% to 3.7% (P = 0.03). The total catheter-related infection rates of the blood stream, lower respiratory tract, and urinary tract decreased from 13.6% to 5.9% (P = 0.003). Klebsiella pneumonia, E. coli, Methicillin-resistant Staphylococcus aureus (MRSA), and Coagulase-negative Staphylococci (CoNS) were the most frequently found pathogens in the old NICU, whereas MRSA, CoNS, E. faecalis, and A. baumannii were the most frequently found pathogens in the new NICU. ConclusionThe change in the environment and implementation of device bundles in the NICU might be associated with the nosocomial infection rate.

Health care providers' perspectives for providing quality infection control measures at the neonatal intensive care unit, Cairo University Hospital

Health care-associated infections are one of the major causes of morbidity and mortality in neonatal intensive care units (NICUs). This study identified health care providers' perspectives for providing quality infection control measures at a NICU. A qualitative approach was adopted. Participants were selected via a purposive sampling technique. The study group was composed of 3 medical staff who held leadership positions and 10 nurses working in the NICU at Cairo University Hospital. Data were collected using semi-structured interviews. Responses were analyzed using a thematic content analysis. The priorities identified by thematic analysis were suggestions and barriers for providing quality infection control measures, from the perspectives of health care providers. All interviewees cited shortage in staffing, especially nurses, lack of time to apply infection control standards, limited opportunities for infection control training, and work overload as the main barriers. All interviewees recommended on-going training and the introduction of audiovisual aids and case study approaches. Lack of time to apply infection control standards, limited opportunities for infection control training, and work overload are the most commonly perceived barriers. The current infection control system in the NICU is likely to remain ineffective unless these underlying barriers are adequately addressed.

Strategies to reduce infections and antibiotic use and its effects in a neonatal care unit

Late onset sepsis (LOS) remains an important cause of morbidity and mortality in neonatal intensive care units (NICU). The empirical use of vancomycin and other broad spectrum antibiotics is very frequent and is associated with the emergence of resistant agents, infection by gram-negative bacilli (GNB), fungal infections and increased morbidity and mortality. To evaluate the impact of 5 intervention protocols designed to reduce infections and promote the rational use of antibiotics (AB) in a single NICU. Retrospective analysis included all hospitalized patients before (year 2012) and after interventions (August 2013 through July 2014). All episodes of positive cultures (blood, urine, tracheal and spinal fluid) were considered as late onset infections. After intervention, a significant decrease of late onset infections was observed from 14.3 to 8.5 per 1,000 live births (p < 0.01); with a decrease in LOS from 5.7 to 2.9 per 1,000 live births, although no significant. There was a decrease in vancomycin and 3rd generation cephalosporin use without Candida spp infections in the intervention period. Mortality rates and length of hospital stay were similar in both study periods. After interventions, there was an important reduction in overall late onset infections and AB related costs.

Quorum sensing network in clinical strains of A. baumannii: AidA is a new quorum quenching enzyme.

Acinetobacter baumannii is an important pathogen that causes nosocomial infections generally associated with high mortality and morbidity in Intensive Care Units (ICUs). Currently, little is known about the Quorum Sensing (QS)/Quorum Quenching (QQ) systems of this pathogen. We analyzed these mechanisms in seven clinical isolates of A. baumannii. Microarray analysis of one of these clinical isolates, Ab1 (A. baumannii ST-2_clon_2010), previously cultured in the presence of 3-oxo-C12-HSL (a QS signalling molecule) revealed a putative QQ enzyme (α/ß hydrolase gene, AidA). This QQ enzyme was present in all non-motile clinical isolates (67% of which were isolated from the respiratory tract) cultured in nutrient depleted LB medium. Interestingly, this gene was not located in the genome of the only motile clinical strain growing in this medium (A. baumannii strain Ab421_GEIH-2010 [Ab7], isolated from a blood sample). The AidA protein expressed in E. coli showed QQ activity. Finally, we observed downregulation of the AidA protein (QQ system attenuation) in the presence of H2O2 (ROS stress). In conclusion, most of the A. baumannii clinical strains were not surface motile (84%) and were of respiratory origin (67%). Only the pilT gene was involved in surface motility and related to the QS system. Finally, a new QQ enzyme (α/ß hydrolase gene, AidA protein) was detected in these strains.

Risk factors for hospital acquired bloodstream infections in neonatal intensive care unit of B.P. Koirala Institute of Health Sciences, Nepal

Introduction : With the development of advanced technologies in neonatal intensive care worldwide, survival rates of newborns, particularly low birth weight and premature babies are higher. This has led to longer duration of hospital stay predisposing these babies to hospital-acquired infections (HAIs). Hence it is one of the main cause of morbidity and mortality in the neonatal intensive care unit (NICU). Objective: To determine the risk factors for HAI in NICU of B.P. Koirala Institute of Health Sciences (BPKIHS), Nepal Method: A prospective cohort study was conducted in a seven bedded teaching and referral NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. HAI was diagnosed according to the CDC criteria. Risk factors for HAI were analyzed with Chi-square test and Logistic regression model. A p -value of Results: The incidence rate and density of HAI were 47% and 39.3 infections per 1000 patient-days respectively. Blood stream infection (BSI) was observed as the most common form of HAI (60.2%). Low birth weight and mechanical ventilation were found to be related to hospital acquired infection (p Conclusions : Low birth weight and mechanical ventilation were the most important risk factors for HAI in NICU of BPKIHS, Nepal Sri Lanka Journal of Child Health , 2016; 46 (1): 16-22

Deep Vein Thrombosis among Intensive Care Unit Patients; an Epidemiologic Study.

Deep vein thrombosis (DVT) is a major cause of morbidity and mortality in intensive care unit (ICU) patients despite use of prophylactic anticoagulant therapy. The aim of the present study was to determine the incidence of DVT among medical and surgical ICU patients. In this cross sectional study, patients older than 18 years who were hospitalized in the ICU of Imam Hossein educational Hospital, Tehran, Iran, for ≥ 2 days, during August 2008 to July 2011 were evaluated regarding DVT incidence. Demographic data, comorbidities, acute physiology and chronic health evaluation (APACHE) II scores, ICU length of stay, type of DVT prophylaxis, and patient outcomes were analyzed using SPSS 19. Out of the 1387 reviewed patient files, 500 (36.04%) patients had been classified as potential DVT cases. DVT occurred in 3.5% of them with the mean age of 60 ± 18 years (62.5% male) and mortality rate of 27.1%. Significant independent risk factors of DVT incidence were age (p = 0.02) and length of ICU stay (p = 0.01). The results of this study showed the 3.5% incidence of DVT in ICU admitted patients. Longer ICU stay and older age were independent risk factors of DVT development.

Prevalence of healthcare-associated infections in Polish adult intensive care units: summary data from the ECDC European Point Prevalence Survey of Hospital-associated Infections and Antimicrobial Use in Poland 2012–2014

Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. Local epidemiological studies need to be conducted to set the priorities for surveillance and prevention programmes. To investigate the epidemiology of hospital-acquired infections (HAIs) among patients admitted to Polish adult ICUs over a three-year period. Data were collected according to the European Centre for Disease Prevention and Control (ECDC) European Union Point Prevalence Survey of Healthcare-associated Infections and Antimicrobial Use in European Acute Care Hospitals (EU-PPS HAI & AU) protocol for 39,318 patients within 160 acute care hospitals. From this initial database, data for adult ICU patients (N=945) were filtered for further analyses. HAIs were present in 370 patients (39%) and 430 HAI episodes were recorded. The most common HAIs were respiratory tract infections (45%), usually caused by Enterobacteriaceae and Gram-negative non-fermenters. The majority (87%) of these infections were likely to be device associated. Out of 61 cases of bloodstream infection, 51% were catheter associated. These bloodstream infections were mainly caused by coagulase-negative staphylococci. Among 57 cases of surgical site infection, 42% were classified as organ/space, 33% were classified as deep incisional, and 25% were classified as superficial. The predominant micro-organisms were Enterobacteriaceae and Staphylococcus aureus. Out of 50 cases of urinary tract infection, 96% were device associated. The prevalence of HAI among Polish adult ICU patients is higher than described in similar studies, but may be partially affected by methodological differences. The proportion of device-associated infections was very high, so there is an urgent need to introduce countrywide, targeted surveillance and prevention programmes.

Invasive candidiasis in a neonatal intensive care unit in Lagos, Nigeria.

Invasive candidiasis has been identified globally as a major cause of morbidity and mortality in neonatal intensive care units (NICU). Systemic candidiasis presents like bacterial sepsis and can involve multiple organs. The objective of this study was to determine the prevalence of Candida infection in a NICU at a tertiary hospital in Nigeria and to identify its associated risk factors. The study was a retrospective descriptive study of all cases of culture-proven invasive Candida infection (ICI) in neonates admitted to the NICU over a 4-year period. The study participants were identified from microbiology records of all neonates with a positive Candida culture. Medical records of identified neonates were also reviewed, and relevant information obtained. Over the 4 years, 2712 newborns were admitted to the NICU. From these, 1182 various clinical samples were collected from babies with features of sepsis and processed in the medical microbiology laboratory. Twenty-seven (2.3%) of the cultures yielded Candida organisms; fifteen of the Candida cultures were from male infants with a male:female ratio of 1.3:1. Bloodstream infection was the most frequent ICI seen in preterm babies (seven [58.3%] out of 12 babies with ICI). Nearly, all (91.7%) affected preterm infants with ICI were <1500 g in weight. All were exposed to invasive procedures and broad-spectrum antibiotics. The case fatality rate among those with ICI was 18.5%. There was a significant prevalence of invasive candidiasis in high-risk newborns and the incidence increases with increased practices in risk factors such as invasive procedures and antibiotic use and lower gestational age babies with very low birth weight.

The burden of Candida species colonization in NICU patients: a colonization surveillance study

Fungal infections are an important cause of morbidity and mortality in neonatal intensive care units (NICUs). The identifi-cation of specific risk factors supports pre-vention of candidemia in neonates. Effec-tive prophylactic strategies have recently become available, but the identification and adequate management of high-risk in-fants is still a priority. Prior colonization is a key risk factor for candidemia. For this reason, surveillance studies to monitor in-cidence, species distribution, and antifun-gal susceptibility profiles, are mandatory. Among 520 infants admitted to our NICU between January 2013 and December 2014, 472 (90.77%) were included in the study. Forty-eight out of 472 (10.17%) pa-tients tested positive for Candida spp. (C.), at least on one occasion. All the colonized patients tested positive for the rectal swab, whereas 7 patients also tested positive for the nasal swab. Fifteen out of 472 patients (3.18%) had more than one positive rec-tal or nasal swab during their NICU stay. Moreover, 9 out of 15 patients tested nega-tive at the first sampling, suggesting they acquired Candida spp. during their stay. Twenty-five of forty-eight (52.1%) colo-nized patients carried C.albicans and 15/48 (31.25%) C.parapsilosis. We identified as risk factors for Candida spp. colonization: antibiotic therapy, parenteral nutrition, the use of a central venous catheter, and nasogastric tube. Our experience suggests that effective microbiological surveillance can allow for implementing proper, effec-tive and timely control measures in a high-risk setting.

Hospital-acquired Hyponatremia in Pediatric Intensive Care Unit.

Objective:The objective of the study was to evaluate the etiology of hospital-acquired hyponatremia (HAH) and its effects on morbidity and mortality in the Pediatric Intensive Care Unit (PICU) patients.Design:This study design was a prospective observational case–control study.Setting:this study was conducted at tertiary care PICU.Materials and Methods:All consecutive cases admitted with at least one measured serum sodium (PNa) value were evaluated. Those with normal admission PNa were followed till they develop hyponatremia (PNa < 35 mEq/L) 7 days or PICU discharge whichever was earlier.Results:During the study period, 123 (19.6%) cases developed HAH and 126 patients remained isonatremic (control group). The admission PNa 138.8 ± 3.03 mEq/L decreased to 132 ± 2.58 mEq/L (drop of 6.68 ± 3.39 mEq/L, P < 0.001) in HAH cases. The use of antidiuretic hormone (ADH)-stimulating drugs (odds ratio [OR]: 2.83, P = 0.01), postsurgical status (OR: 2.95, P = 0.006), and fluid intake ml/kg (OR: 1.0, P = 0.001) were found to be significant risk factors in HAH group on multivariate analysis. HAH cases had prolonged PICU stay (P = 0.000) and mechanical ventilation (P = 0.01), but no difference in the mortality when compared to controls.Conclusions:HAH is associated with increased fluid intake, presence of ADH-stimulating drugs or conditions, and postsurgical status and has an adverse effect on the outcome of PICU patients.

Fluid overload in children undergoing mechanical ventilation.

Patients admitted to an intensive care unit are prone to cumulated fluid overload and receive intravenous volumes through the aggressive resuscitation recommended for septic shock treatment, as well as other fluid sources related to medications and nutritional support. The liberal liquid supply strategy has been associated with higher morbidity and mortality. Although there are few prospective pediatric studies, new strategies are being proposed. This non-systematic review discusses the pathophysiology of fluid overload, its consequences, and the available therapeutic strategies. During systemic inflammatory response syndrome, the endothelial glycocalyx is damaged, favoring fluid extravasation and resulting in interstitial edema. Extravasation to the third space results in longer mechanical ventilation, a greater need for renal replacement therapy, and longer intensive care unit and hospital stays, among other changes. Proper hemodynamic monitoring, as well as cautious infusion of fluids, can minimize these damages. Once cumulative fluid overload is established, treatment with long-term use of loop diuretics may lead to resistance to these medications. Strategies that can reduce intensive care unit morbidity and mortality include the early use of vasopressors (norepinephrine) to improve cardiac output and renal perfusion, the use of a combination of diuretics and aminophylline to induce diuresis, and the use of sedation and early mobilization protocols.

Culture and Sensitivity Pattern of Sepsis in Ventilated Newborns

Introduction: Neonatal sepsis is a major cause of mortality and morbidity in modern neonatal intensive care units (NICU). Increasing trend of antibiotic resistance makes this problem more difficult to tackle, at present. Haemodynamically compromised neonates, particularly those requiring ventilator support, often suffer from multidrug resistant sepsis. The objectives of this study were to determine micro-organisms causing sepsis in those neonates requiring ventilator support and the sensitivity patterns of those micro-organisms.Material and Method: During 18 months of study period, 48 neonates, who had fulfilled the chosen inclusion criteria were included in this study. They were investigated with blood culture, urine culture, CSF culture, and endotracheal tube tip culture (taken within 48 hours of starting ventilation), as per relevance. Those who were found positive to any micro-organism, were also explored. They were studied further for antimicrobial sensitivity pattern. Data obtained from this study were analysed using SPSS-20.0.Results: 15(31.3%) neonates were found to be culture positive. Klebsiella sp. was most common (33.3%) organism isolated, followed by Pseudomonas aeruginosa (20%). Most common antibiotic found to be sensitive was Meropenem (86.67%), followed by Colistin and Tigecycline (80% each).Conclusion: Nowadays, all NICUs throughout the world face a common problem of multidrug resistant sepsis. There is always a doubt regarding choice of second line antibiotics, when one considers for upgradation. As per this study, authors considered Meropenem as second line antibiotic of choice, as other sensitive antibiotics like Colistin, Tigecycline wield more adverse effects on neonates.J Nepal Paediatr Soc 2016;36(1):34-37

Bacterial profile and their antibiotic resistance in an ICU of Bangladesh: Comparison of four studies from 2004 to 2011

Antimicrobial resistance plays a vital role in determining the outcome of the critically ill patients with infections in intensive care unit (ICU).Aim: The objective of this study was to evaluate the frequencies of isolated pathogens and their resistance pattern in an ICU of Bangladesh. The study also aimed to analyze and compare the trends of bacterial population and their resistance pattern in the same ICU between 2004 and 2011 in four different studies.Materials and Method: A cross sectional study was carried out in a 10 bed adult ICU of a tertiary care hospital of Bangladesh over a period of 10-month, from January 2011 to October 2011. Blood, respiratory secretions and urine from patients with clinically suspected infections were included in the study. Findings were compared with previous three studies done in 2004, 20006-07, and 2008-09 in same ICU.Results: In 2011, a total of 1408 samples were analyzed. Six hundred eighty-four micro-organisms were isolated from 597 samples. Maximum growth was obtained from respiratory secretions (71.7%). Organisms isolated were Acinetobacter sp. (46.4%), Pseudomonas sp. (21.4%), Candida sp. (11.5%), Klebsiella sp. (9.9%), Eschericia coli (4.1%) and Staphylococcus aureus (2.9%). Major gram negative organisms were highly resistant to 3rd generation cephalosporins (&gt;70%). All Acinetobacter sp. were extremely resistant (&gt;85%) to all antibiotics except colistin. Resistance of isolated Pseudomonas sp. was &gt;65% to ciprofloxacin, &gt;70% to aminoglycosides, and &gt;85% to imipenem. About 72% of the isolated Staphylococcus aureus was methicillin resistant with variable resistant to other antibiotics. Comparing the findings of this study with previous three studies done in same ICU, it has been found that rate of isolation of Acinetobacter sp., was increased significantly (p&lt;0.05) in this ICU population with decrease in rate of Pseudomonas sp., Eschericia coli, Staphylococcus aureus, Enterococci sp., and Candida sp. Resistances pattern of two commonest gram negative organisms, eg Acinetobacter sp. and Pseudomonas sp., to the available antibiotics showed gradual increase in resistance from 2004 to 2011.Conclusion: It is recommended that strict infection control policies and antibiotic stewardship program must be implemented to solve this emerging drug resistance problem which might cause high morbidity and mortality in ICU patients.Bangladesh Crit Care J September 2016; 4 (2): 79-85

Protein phosphatase 2A activation attenuates inflammation in murine models of acute lung injury.

Acute respiratory distress syndrome (ARDS) remains a leading cause of morbidity and mortality in both adult and pediatric intensive care units. A key event in the development of ARDS is neutrophil recruitment into the lungs leading to tissue damage and destruction. Interleukin-8 (IL-8) is the major human chemokine responsible for neutrophil recruitment into the lungs. Protein phosphatase 2A (PP2A) has been shown to be a key regulator of the mitogen-activated protein kinase (MAPK) cascades, which control the production of IL-8. Previously, our laboratory employed an in vitro model to show that inhibition of PP2A results in an increase in IL-8 production in human alveolar epithelial cells. The objective of this study was to determine whether PP2A regulated this response in vivo by investigating the impact of pharmacologic activation of PP2A on chemokine production and activation of the MAPK cascade and lung injury using endotoxin- and bacterial-challenge models of ARDS in mice. N6-cyclopentyladenosine (N6-CPA) increased PP2A activity and inhibited endotoxin-induced cytokine production in a murine alveolar macrophage cell line. N6-CPA pretreatment in mice challenged with intratracheal endotoxin decreased chemokine production, reduced neutrophil infiltration, and attenuated lung injury. Following initiation of lung injury with live Pseudomonas aeruginosa, mice that received N6-CPA 4 h following bacterial challenge showed attenuated chemokine production and reduced neutrophil infiltration compared with control mice. Pharmacologic PP2A activation both limited and prevented inflammation and tissue injury in two direct injury models of ARDS. These results suggest modulation of PP2A activity as a therapeutic target in ARDS.

Severe maternal morbidity in a general intensive care unit in Nigeria: clinical profiles and outcomes

BackgroundData on outcomes of obstetric admissions to intensive care units can serve as useful markers for assessing the quality of maternal care. We evaluated the intensive care unit utilization rate, diagnoses, case-fatality rate, mortality rate and associated factors among obstetric patients. MethodsA prospective observational study of obstetric patients admitted to the general intensive care unit was performed. Women at 24 or more weeks of gestation, or within six weeks postpartum, who were admitted to the intensive care unit constituted the study population. ResultsA total of 101 obstetric patients were admitted to the intensive care unit. Obstetric patients accounted for approximately 12% of all intensive care unit admissions. Over 90% of admissions were from direct obstetric morbidity such as hypertensive disorders (41.6%), major obstetric haemorrhage (37.6%) and sepsis (11.9%). Forty-three women (42.6%) died, giving an overall mortality rate of 1 in 2.4. Sepsis had the highest case-fatality rate (1 in 1.7) followed by obstetric haemorrhage (1 in 2.1) and hypertensive disorders (1 in 3.6). In univariable logistic regression analysis, abdominal delivery and/or peripartum hysterectomy, had 2.7-fold (95% CI 1.1 to 6.5) increased risk of maternal death as compared to vaginal delivery. ConclusionDirect obstetric morbidities constituted the leading reasons for obstetric admissions to the intensive care unit, with sepsis accounting for the highest case-fatality rate. Abdominal delivery and/or peripartum hysterectomy increased risk of death among obstetric admissions.

Risk Factors for Health Care-Associated Bloodstream Infections in a Neonatal Intensive Care Unit.

BackgroundHealthcare-associated bloodstream infections (HCA-BSI) are a major cause of morbidity and mortality in neonatal intensive care units (NICUs).ObjectivesWe aimed to determine the causative organisms and risk factors of HCA-BSIs in NICUs.MethodsThis study was performed between January 2011 and December 2014 in the neonatal intensive care unit of Dicle university, Turkey. The study consisted of 126 patients (infected group) with positive blood culture and 126 randomly selected patients (uninfected control group) with negative blood culture after four days of hospitalization.ResultsWe found that the most common causative agents isolated from nosocomial infections (NIs) were 20.7% Staphylococcus epidermidis, 26.7% Klebsiella spp., and 13.3% Acinetobacter spp. Incidences of low gestational age, low birth weight, vaginal birth type, and long length of hospitalization were higher in the infected neonates than in the uninfected neonates. In the univariate analysis, surgical operation, ventriculoperitoneal shunt, use of umbilical catheter, nasogastric or orogastric tube, urinary catheter, mechanical ventilation, surfactant treatment, erythrocyte transfusion, plasma transfusion, thrombocyte transfusion, total parenteral nutrition infusion, intracranial hemorrhage, length of hospital stay, fifth-minute Apgar score, and total parenteral nutrition time were significantly associated with NIs. In the multiple logistic regression analysis, fifth-minute Apgar, use of erythrocyte transfusion and surgical operation were found as the independent risk factors for HCA-BSI.ConclusionsThis study determined the causative organisms and risk factors of HCA-BSIs in NICUs.

Serum and Urinary Malondialdehyde (MDA), Uric acid, and Protein as markers of perinatal asphyxia.

IntroductionPerinatal asphyxia (PA) is among the leading causes of neonatal morbidity and death in neonatal intensive care units (NICUs). The aims of this research were to determine the concentrations of malondialdehyde (MDA), urine MDA, uric acid, and protein in the cord blood of neonates with perinatal asphyxia and to determine their relationship with the severity of perinatal asphyxia.MethodsThis matched case-control study was conducted from October 2012 to March 2013. All of the cases and controls were selected from the Gynecology & Obstetrics Department and the NICUs, at Qous Central Hospital in Qena, Egypt. We allocated 20 full-term neonates who had perinatal asphyxia to the case group. Also, we selected 20 healthy neonates for the control group. The subjects were matched with respect to age and gender. At birth and 48 hours later, measurements were made of MDA in cord blood and urine, and uric acid, protein, and creatinine also were measured in both groups. The data were analyzed by SPSS, version 17, using the independent-samples t-test, ANOVA, Tukey’s test, and Spearman’s correlation coefficient.ResultsAt birth and 48 hr later, the newborns’ with PA had significantly higher levels of MDA in the cord blood, mean urinary uric acid/creatinine (UUA:Cr), protein/creatinine (UP:Cr), and MDA/creatinine ratio (UMDA:Cr) than the controls; their PA levels were correlated with the degree of hypoxic-ischemic encephalopathy (HIE). The babies who died due to PA had significantly higher levels of cord blood MDA, and they also had higher UUA:Cr, UP:Cr, and UMDA:Cr ratios than the babies who survived.ConclusionThe concentration of MDA in cord blood can be used as a diagnostic marker of oxidative stress in asphyxiated neonates. The ratios of the urinary excretion rates of uric acid, protein, and MDA to creatinine increased as the severity of perinatal asphyxia and associated brain damage increased.

Clinical Outcomes of Inadequate Calorie Delivery and Protein Deficit in Surgical Intensive Care Patients.

Adequate nutritional therapy in critically ill patients is integral to optimal outcome. To evaluate the association between cumulative macronutrient deficit and overall morbidity in surgical intensive care unit patients. Adult patients receiving enteral nutrition for more than 72 hours were included if they had no previous admission to the surgical intensive care unit, had received no enteral feedings before admission, had no intestinal obstruction or ileus, and survived 72 hours or more after admission. Data on demographics, outcomes, and nutritional intake during the unit stay were collected for up to 14 days until oral intake began, discharge, or death. Outcome variables included lengths of stay in the hospital and intensive care unit, days with no mechanical ventilation, complications, and mortality. Of 94 participants, 71% were men, mean age was 63 years, and mean score on the Acute Physiology and Chronic Health Evaluation II was 14. Patients with high cumulative calorie deficit (≥ 6000 cal) and high protein deficit (≥ 300 g) had significantly fewer days with no mechanical ventilation (P < .001), longer unit stays (P < .001), longer hospital stays (P = .007), more total complications (P = .007), and more infectious complications (P = .009) than other participants. These associations remained significant in multivariable models after adjustments for age, sex, reason for admission, and propensity score of deficit. In-hospital and 30-day mortality did not differ. Cumulative macronutrient deficits have important clinical outcomes in surgical intensive care patients.