Medical Intensive Care Unit Patients Research Articles (Page 1)

Introduction: The Charlson Comorbidity Index (CCI) is a validated tool for estimating mortality risk based on comorbid conditions in the general medicine population. Whether CCI has predictive power for in-hospital mortality among patients admitted to the Cardiac Intensive Care Unit (CICU) or Medical Intensive Care Unit (MICU) after undergoing a rapid response (RRT) within 24 hours of admission has yet to be evaluated. Hypothesis: We aimed to assess whether CCI correlates with in-hospital mortality among patients admitted to CICU or MICU following a RRT within 24 hours of admission. Methods: We conducted a multicenter retrospective cohort study of 763 patients requiring RRT activation within 24 hours of admission. The patients were grouped by level of care required following RRT (MICU, CICU, or medicine floor). Demographic and clinical variables were analyzed using analysis of variance and chi-square test, as appropriate. CCI, which was calculated at the time of RRT, and mortality were plotted as a simple logistic regression. Results: Of the 763 patients, 183 (24.0) were admitted to MICU, 61 (8.0) to CICU, and 519 (68.0) remained on the general medicine floor. The average age was 68.6 years, with 52% being male and 48% being female. A total of 164 deaths were recorded, 69 (42%) occurring in the MICU, 13 (7.9%) occurring in the CICU, and 82 (50%) with patients on the medical floor. CCI was significantly associated with in-hospital mortality in the CICU with a moderate predictive relationship (p = 0.01, R-squared = 0.115) (Figure 1). CCI also correlated with inpatient mortality for patients who remained on floors (p<0.0001), with a notably weaker correlation of 0.056. In contrast, CCI did not correlate with mortality among patients admitted to MICU (p = 0.102). Conclusion: While the Charlson Comorbidity Index (CCI) demonstrated moderate predictive value for in-hospital mortality among CICU patients, it showed limited utility for those on the general medicine floor and no significant association in MICU patients. Our findings suggest that CCI may aid prognostication at the time of CICU admission, but it appears less effective in predicting outcomes for MICU and floor patients. Further studies are required to assess which risk calculator may correlate best with mortality across different inpatient care settings.

Advanced neuromonitoring techniques for medical and neurological ICU patients.

Background: Admission screening for CRO carriage may prevent transmission, but there is a lack of consensus on the best targeted approach. Using a well-characterized cohort of medical intensive care unit (MICU) patients prospectively screened for CRO carriage at time of admission (MAriMbA cohort), we compared the effectiveness of common targeted strategies (singly and in combination) available to hospitals in Illinois to identify MICU patients at risk for CRO carriage, including: (a) screening patients transferred from external facilities (e.g., short- and long-term acute care hospitals); (b) screening patients with a tracheostomy or pressure ulcer; or (c) querying the Illinois XDRO registry for prior CRO history. Methods: Results of rectal swab samples collected within 48 hours of MICU admission during 1/2017-1/2018 and cultured for CROs (carbapenem-resistant Enterobacterales [CRE], CR Pseudomonas aeruginosa [CRPA], and CR Acinetobacter baumannii [CRAB]) were used as the reference standard. Patients’ status as direct transfer from an external healthcare facility and presence of tracheostomy or pressure ulcer were collected prospectively during the MAriMbA study. History of CRO colonization before MICU admission was queried retrospectively from the Illinois XDRO Registry (xdro.org), with the limitation that most reports available during the study period were restricted to CRE. We evaluated each predictors’ independent association with admission CRO status and combined variables in a planned logistic regression modeling approach. Results: CRO colonization was detected in 37 (2.6%; including 26 CRE, 10 CRPA, and 1 patient co-colonized with CRE and CRAB) of 1,423 unique MICU admissions. For univariate analyses, presence of a tracheostomy (OR 9.32, 95% CI 4.29-20.27), presence of pressure ulcer (OR 3.07, 95% CI 1.42-6.64), transfer from an external healthcare facility (OR 1.97, 95% CI 1.02-3.82), and prior CRO history reported to the Illinois XDRO Registry (OR 72.96, 95% CI 25.83-206.07) were associated with higher odds of CRO colonization. A model combining these variables improved the predictive capability (AUC 0.73) (Table). Prior CRO history reported to the Illinois XDRO Registry identified 27% of CRO cases, with number needed to screen (NNS) of only 2 patients. Adding tracheostomy, pressure ulcer, and external facility transfer together improved detection of admission CRO cases to 68%, with NNS of 20 patients (Figure). Conclusion: In a region with well-established inter-facility communication of CRO history via the Illinois XDRO Registry, the addition of screening patients with a tracheostomy, transfer from an external facility, or pressure ulcer may improve early identification of CRO carriage at time of MICU admission.

Background: Central line-associated bloodstream infections (CLABSIs) are preventable infections associated with poor outcomes. Nationally, the CLABSI standardized infection ratio (SIR) decreased from 2018 to 2019, but those positive results were derailed by the COVID-19 pandemic. From FY21 to FY22, the CLABSI SIR in our facility’s medical intensive care unit (MICU) more than doubled. In March 2021, we created a multidisciplinary central venous access device (CVAD) rounding team to decrease CLABSI in the MICU. Method: We conducted a prospective pre-post quality improvement study in an academic, quaternary care hospital with a 30-bed MICU. The decision to implement a multidisciplinary CVAD rounding process was based on a review of published best practices. The study was approved by the UNC Institutional Review Board.Our team included MICU clinicians, registered nurses, an infection preventionist, a vascular access registered nurse and a “CVAD Liaison”. The CVAD liaison role is a registered nurse trained maintaining aseptic technique during CVAD insertions and educating staff on CVAD maintenance. Each teammate had assigned responsibilities (Fig. 1).The team rounded weekly on every MICU patient with a CVAD. Components of the rounding process were compliance audits of all CVADs; evaluation of line necessity; targeted education and process improvement. Result: This study evaluated the intervention’s impact on CLABSI, CVAD utilization, and maintenance bundle compliance rates. Data were collected for five fiscal years (FY19 to FY23). Following the intervention, the MICU experienced a 57% decrease in CLABSI rates between FY21 and FY22. This reduction was meaningful for patient care, although not statistically significant. Infection rates rose slightly in FY23 but remained lower than from FY19-21 (Table 1). There was no statistically significant difference in the CVAD utilization rate between FY21 and FY22. There was an improvement in the percentage of intact dressings (Fig.2). Conclusion: Following the implementation of a multidisciplinary CVAD rounding team, there was a 57% decrease in the MICU’s FY22 CLABSI infection rate from the prior fiscal year. This decrease in CLABSI was sustained with a similar CLABSI rate in FY23. One potential explanation for the CLABSI reduction was increased awareness of the importance of maintaining CVAD dressings (Fig. 2). The primary challenge for this team has been sustaining staff availability. Staff shortages and burnout have made it challenging to find coverage for rounds. Our team began addressing staffing challenges by expanding the pool of interested staff. Sustainment of rounding and CLABSI reduction will require continued monitoring and recruitment.

BackgroundRed cell distribution width (RDW) has been investigated as a clinical predictor in different study populations. However, its prognostic usefulness in medical and surgical intensive care units remains unknown. This study investigates the role of RDW as a prognostic factor in this specific patient population.ObjectiveThis study examined the relationship between red cell distribution width and other blood parameters as a prognostic indicator among patients treated in medical and surgical ICU.MethodsThis study is observational in type and its sample consisted of n = 197 patients treated in the medical and surgical ICU (msICU) of a public hospital of Istanbul and during 2023. In this study, personal characteristics (age, gender etc.), clinical characteristics (comorbidity, presence of catheters, length of stay etc.) and clinical/laboratory blood parameters (the RDW coefficient of variation (CV), C reactive protein (CRP), albumin, platelet (PLT) etc.) of msICU patients were analyzed. The relationship between clinical/laboratory parameters was examined using the Pearson correlation test, and changes in RDW values according to patient characteristics were examined using ANOVA and independent sample t-tests.ResultsIn this study a positive, strong and statistically significant relationship existed between RDW and lactate (r = 0.704, p = 0.004) and CRP (r = 0.759, p = 0.026), and creatinine (r = 0.729, p = 0.001). It was reported that a negative, weak and statistically significant relationship existed between RDW and albumin (r = −0.172, p = 0.015) and PLT (p = −0.169, p = 0.011). The patient characteristics such as inotropic and vasopressor use, multiple comorbidities, APACHE II score, and surgical experience were factors that increased RDW levels (p < 0.05). Patients in the postoperative period and patients with pressure sores had higher RDW values and these differences were statistically significant (p < 0.05).ConclusionAs a result of this study, RDW level was associated with levels of lactate, CRP, albumin, platelet and creatinine among patients in the medical and surgical ICU. The patients with chronic wounds, comorbidities, and/or certain medications and in deceased patients, were associated with increased RDW. RDW may be a useful marker as a prognostic criterion to validate clinical status.

Hepcidin vs Procalcitonin: Which biomarker best predicts bacteremia in the medical ICU?

BackgroundPlatelet transfusions are frequent in the Intensive Care Unit (ICU), either as prophylaxis against bleeding complications or as treatment for bleeding. The European Society of Intensive Care Medicine guidelines for ICU patients generally recommend not using prophylactic platelet transfusions unless the platelet count falls below 10 × 109 cells/L in non-bleeding patients and make no recommendation for platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia. Therefore, the decision to transfuse platelets is often left to clinical assessment by the treating physician. This study aims to describe current platelet transfusion preferences among ICU physicians.MethodsAn online, anonymous survey consisting of 43 items was produced in two languages (French and English) and distributed by investigators in the Nine-I research network to ICU physicians in Europe and the United States of America. The survey evaluated platelet transfusion practices in ICU patients with and without bleeding, the presence of local guidelines, and factors influencing the decisions to transfuse platelets. Only completed surveys were analysed.ResultsWe received 997 surveys completed by ICU physicians. Overall, there was large heterogeneity in platelet transfusion practices between and within countries. In non-bleeding, thrombocytopenic medical ICU patients, most would transfuse prophylactic platelets at a platelet count threshold of 10 × 109 cells/L. Thirty percent would change their strategy in patients with bone marrow failure and either be more liberal (60%; 95% Confidence Limits 0.54, 0.66), more restrictive (31%; 0.26,0.36) or seek assistance. Higher thresholds were preferred in surgical patients, prior to procedures and in patients with bleeding. Only 173 (17%; 0.15,0.19) responded that they were confident about the clinical indications every time they prescribed a platelet transfusion. As for existing guidelines, only 123 (12%; 0.10,0.15) responded that they always read them. Colleagues' attitudes and departmental culture were important influencers on transfusion practice.ConclusionPlatelet transfusion practice in the ICU is heterogeneous, both between and within countries; guidelines are often not used, and there is often uncertainty about the clinical indication.

ABSTRACT Simulation training aims to increase exposure to high-stakes low-frequency events like cardiac arrest. However, within our laboratory-based simulation program, we have observed limited buy-in from internal medicine (IM) residents due to competing patient care obligations and a limited fidelity environment. Mirroring patient data within in situ simulation may provide relevance to ongoing resident patient care obligations, increasing buy-in and confidence in management. Clinical data from presently admitted patients in our institution’s medical intensive care unit (MICU) was ‘mirrored’ to create cardiac arrest simulations. Simulations took place in a vacant MICU patient room with resuscitation equipment, including a code cart, saline-substituted medications, and a mannequin capable of endotracheal intubation. The trainee team consisted of one post-graduate year (PGY) 3 IM resident, two PGY-1 residents, and a critical care fellow. A pre- and post-survey was administered to the PGY-3 IM resident to assess confidence in performing technical and non-technical skills. An advanced cardiac life support (ACLS) instructor evaluated PGY-3 IM resident performance using a skills checklist. Eighty-three percent of PGY 3 residents endorsed changes to their practice following the simulation. Confidence increased in skills related to flexible decision-making skills but not for fixed skills such as following ACLS protocol. Qualitative feedback highlighted realism, spontaneity, and debriefing sessions as the most valuable aspects of the program. In situ mirror simulation may be a useful adjunct for IM residency programs suffering similar concerns with learner motivation during laboratory simulation.

Background: Stress hyperglycemia is common among critically ill patients admitted in the intensive care units (ICU), affecting 17-68%of patients within the first 48 hours of admission. Long-term stress hyperglycemia is linked to poor clinical outcomes and increases mortality. The burden and outcomes of stress hyperglycemia in critically ill patients is unknown in Tanzania. Methodology: Prospective short-term cohort study was conducted at Muhimbili National Hospital for 6 months. Adult critically ill patients in medical and surgical ICU were recruited consecutively. On admission, HbA1c and RBG were checked. FBG/RBG was tested daily until discharge or death. Stress hyperglycemia was defined as FBG≥6.1mmol/l or RBG of 140mg/dl (7.8mmol/L) or more observed during ICU admission. Length of stay and ICU mortality in one month of follow-up were recorded. SH proportion is reported as percentages. Predictors of SH were analyzed using logistic regression. P value &lt;0.05 was considered statistically significant. Kaplan Meier’s mortality curves were used to compare the mortality of patients with SH to those without. Results: A total of 270 patients were enrolled, among them 120/270(44.4%) developed SH. These patients were largely male (58.2%) with a mean age of 48.2±17.8years. predictors of SH were having comorbidities and the use of steroids. Stress hyperglycemia increased the risk of staying in the ICU for ≤ 5 days by 2 folds aOR (95%CI), 2.416 (1.261-4.629) P=0.008. Steroid use reduces the risk of SH by 67% aOR (95%CI), 0.326 (0.167-0.636) P=0.001 and by 78% for patients with other comorbidities aOR (95%CI), 0.2196(0.097-0.497) P&lt;0.001. Conclusion: The incidence of stress hyperglycemia is high in ICU patients as evidenced in this study. Duration of ICU stay, comorbidities, and steroid use was significantly associated with stress hyperglycemia. Stress hyperglycemia contributes to a higher mortality rate among critically ill patients.

Background/Objectives: This study aims to investigate ICU mortality rates and to identify predictors of ICU mortality, focusing on clinical and demographic variables, including age, comorbidities, hemoglobin and creatinine values, intubation in the Emergency department, and Glasgow Coma Scale (GCS) and APACHE II scores at presentation in the Emergency department, and how these factors influence patients’ clinical outcomes. Methods: This retrospective observational cross-sectional study analyzed patients admitted to the Jordan University Hospital (JUH) ICU from 1 January 2022 to 31 December 2023. A total of 1323 patients were included, with a mean age of 65 ± 17 years, of whom 442 (34%) died during their ICU stay. Results: A delay of 6 h or more in ICU admission was reported for 77% of the participants. Mortality rates were significantly lower among patients admitted to the ICU through the Emergency department (32%) compared to those transferred from other wards (41%) (p = 0.003). Higher mortality rates were observed among patients on vasopressors and those intubated in the Emergency department, with lower median hemoglobin (Hb) levels, higher APACHE II scores, and pneumonia as the main diagnosis or urosepsis as the secondary diagnosis (p < 0.001). Conclusions: This study identified predictors of mortality in a medical ICU at a tertiary hospital in Jordan.

Objective: To determine the incidence and microbiological profile of healthcare-associated infections (HAIs) in a Medical Intensive Care Unit (MICU) in New Delhi, India. Methods: All patients aged 18 years and above who were admitted to the MICU and suspected of having HAIs by the treating physicians were enrolled in this study. Different samples (pus, blood, urine, and sterile fluid/aspirates) were collected from all patients according to standard protocol. Cultures and microscopy were performed on the samples, and identification of growth was done using biochemical tests and the VITEK-2 system. The antimicrobial susceptibility testing was also conducted according to Clinical and Laboratory Standard Institute guidelines. Results: Among 81 patients with central lines, urinary catheters, and mechanical ventilation, HAIs were observed in 12 (14.8%) patients. Of these 81 patients, ventilator-associated pneumonia (VAP) occurred in 9 patients (11.1%) and central line-associated bloodstream infection was observed in 3 patients (3.7%). The microorganisms isolated from patients with VAP included Klebsiella pneumoniae in 6 cases, Acinetobacter lwoffii in 1 case, Escherichia coli in 1 case and methicillin-resistant Staphylococcus aureus in 1 case. Among the Gram-negative isolates from VAP patients, high resistance was observed in Escherichia coli (83.33%) and Klebsiella pneumoniae (100%) to both imipenem and meropenem. All the isolates were susceptible to colistin. Conclusions: The study highlights the high incidence of HAIs in critically ill MICU patients and the alarming prevalence of carbapenem resistance in the HAI-causing pathogens. HAIs are largely preventable through effective infection prevention and control measures.

While glycemic control is essential in critically ill patients, the optimal insulin regimen for patients receiving continuous enteral nutrition (CEN) is unknown. This study compares glycemic control in basal/correctional vs basal/bolus/correctional insulin regimens in intensive care unit (ICU) patients receiving CEN. This retrospective study included patients ≥18 years old, admitted to the medical critical care service with administration of CEN and ≥20 units of insulin detemir daily for ≥48 hours. Patients receiving non-insulin hypoglycemic agents were excluded. The primary outcome was the comparison of glycemic control, assessed by mean blood glucose and percent of glucose checks in target range. Secondary outcomes included the comparison of hypoglycemia, hyperglycemic emergencies, and glycemic variability between groups. A total of 100 patients were included, with 50 patients per group. Mean blood glucose and percent of blood glucose checks in the target range were similar between basal/correctional and basal/bolus/correctional groups (204.2 vs 194.2 mg/dL, P = 0.2433 and 37.8% vs 43.1%, P = 0.3182, respectively). There were no differences in hypoglycemia or hyperglycemic emergencies. Among patients receiving ≥60 units of insulin daily, the basal/bolus/correctional regimen was associated with lower mean blood glucose (197.1 vs 248.5 mg/dL, P < 0.0001) and increased glucose checks in target range (43.5% vs 9.1%, P = 0.0040) without increased hypoglycemia. Among ICU patients requiring ≥20 units of insulin detemir daily while receiving CEN, basal/correctional and basal/bolus/correctional insulin regimens appear to offer similar glycemic control, but basal/bolus/correctional regimens may improve glycemic control in patients requiring ≥60 units of insulin daily.

Previous investigation into patients' trust in medical providers is largely limited to the outpatient setting, where increased trust is associated with improved adherence, satisfaction, and self-reported quality of life. Contrastingly, in the intensive care unit (ICU), patients are frequently incapacitated, and it is surrogates that engage with clinicians for decision making. This pilot study aims to measure and compare surrogate trust in the healthcare system and ICU physicians. We measured surrogate trust in both the healthcare system and providers by administering two domain-specific trust-measuring surveys (the Healthcare System Distrust Scale and a modified Trust in Physicians Scale) to surrogates of mechanically ventilated medical ICU patients at an urban academic medical center between November 2021 and April 2024. Responses from twenty-seven surrogates were included in the analysis. The overall mean distrust in healthcare system score was 19.29 (SD 5.8). The overall mean trust in individual physician score was 42.4 (SD 6.26). When subdivided into specific domains, surrogates reported higher mean scores for trust in healthcare system and physician competence than values. In our population, surrogates for medical ICU patients are overall more trusting of their medical providers than the healthcare system. Moreover, surrogates are more trusting of a provider's professional competence and knowledge than a provider's values. Our findings may inform trust-building interventions designed specifically for the high-acuity ICU setting to improve quality in communication and family-centered care.

Inaccurate penicillin allergy labels (PALs) results in use of broader, less optimized antibiotics. Studies have shown challenging low-risk PALs is safe and effective. We assessed the proportion of PALs among critically ill patients after a pharmacist driven allergy de-labeling program was implemented in the medical intensive care unit (MICU) between November 2017 and March 2023. There was a notable reduction in the proportion of PALs pre-intervention (14.0%) and post-intervention (12.8%). Persistent reductions in the proportion of PALs among readmitted patients was seen in both MICU (21.4% to 15.9%) and non-MICU patients (13.8% to 11.1%). This study further emphasizes the potential for proactive surveillance and intervention on low-risk PALs by pharmacists to reduce the burden of broad-spectrum antibiotics, which may optimize antibiotic usage and possibly impact institutional antimicrobial spectrum.

SummaryObjective:This study aimed to evaluate whether incorporating albuminuria (Alb) into the Child-Turcotte-Pugh (CTP) score improves the prediction of mortality in patients with hepatic encephalopathy (HE).Methods:This prospective study was conducted between January 2013 and January 2015 at Al-Azhar University, Cairo, Egypt. Patients who were diagnosed with HE at the time of admission to the medical intensive care unit (MICU) were included. Upon admission, patients underwent HE grading, CTP classification, and an albumin-to-creatinine ratio (ACR) assessment. A novel scoring system, CTP-AlbU, was calculated by combining existing CTP scores with the admission degree of ACR. The primary outcome measure was MICU mortality.Results:A total of 78 consecutive cirrhotic patients were included in this study with a mean age of 57.65 ± 12.9 years, with equal male and female distribution. HE grades were categorised as 2, 3, and 4 in 16 (20.5%), 44 (56.4%), and 18 (23.1%) patients, respectively. CTP classifications were B and C in 12 (15.4%) and 66 (84.6%) patients, respectively. The overall mortality rate was 32.1%. Statistical analysis revealed a significant association between increased mortality and both elevated ACR and higher CTP-AlbU scores. Furthermore, the CTP-AlbU score emerged as an independent risk factor for mortality.Conclusion:This study demonstrates that incorporating albuminuria into the CTP score, resulting in the CTP-AlbU score, enhances the prediction of mortality in HE patients. This novel scoring system displayed superior sensitivity compared to the original CTP score, suggesting its potential as a tool for predicting short-term outcomes in this patient population.

IntroductionRenal failure is prevalent among ICU patients, necessitating renal replacement therapy1. This study evaluates the adequacy of hemodialysis among critically ill ICU patients by comparing sustained low-efficiency dialysis (SLED) and intermittent hemodialysis (IHD).ObjectivesTo determine the adequacy of SLED versus IHD in terms of the urea reduction ratio (URR) among critically ill patients in ICU setting.Materials and methodsA prospective observational study was conducted on 84 patients in the multidisciplinary ICU at IQRAA International Hospital, Calicut, from September 2022 to December 2023. Patients, monitored over 28 and 90 days, were assessed for URR as an indicator of dialysis adequacy. Hemodynamic stability and patient outcomes were also evaluated.ResultsThe mean URR achieved was 51% for both SLED and IHD, below the ideal 65% target due to patient instability and frequent treatment interruptions. At follow-up, no significant differences were found between SLED and IHD in terms of URR or renal recovery. SLED was associated with increased hemodynamic instability, especially in critically unstable patients.Discussions/ConclusionsThe study concludes that both SLED and IHD provide comparable dialysis adequacy in critically ill patients, though prolonged or frequent sessions may be required given the high catabolic states and complex conditions of ICU patients. These findings highlight the need for personalized dialysis strategies tailored to patient stability, condition severity, and response to treatment in ICU settings.2

PurposeIntensive care unit-acquired weakness (ICU-AW) is associated with poor functional outcomes and increased healthcare costs. This study aimed to evaluate the diagnostic performance of muscular ultrasound (MUS) measurements in predicting ICU-AW and identify potential predictors.MethodsForty-three surgical and medical ICU patients underwent serial MUS measurements of the femoral cross-sectional area (Fcsa) and femoral + vastus intermedius thickness (F + VIth) on days 1, 3 and 5 post-ICU admission. Patients were categorized as having ICU-AW (Medical Research Council (MRC) sum score < 48 at discharge) or not. Univariate and multivariate logistic regression analyses were performed to identify predictors of ICU-AW. The diagnostic performance of MUS measurements was assessed via receiver operating characteristic (ROC) curves. Clinical outcomes (ICU length of stay, ventilator days, extubation failure) were compared between the groups.ResultsPatients with ICU-AW (n = 12, 28%) showed a significant reduction in the Fcsa from Day 1 to Day 5 (p < 0.001). Univariate analysis revealed significant associations between ICU-AW and the Apache II score (OR 1.12, p = 0.03), SOFA score (OR 1.32, p = 0.008), and Day 1 F + VIth score (OR 0.23, p = 0.05). Multivariate analysis confirmed a significant association with the SOFA score (OR 1.35, p = 0.04) and a trend toward an F + VIth score of Day 1 (OR 0.12, p = 0.09). The day 1 Fcsa and F + VIth demonstrated moderate predictive capabilities for ICU-AW (ROC-AUC values of 0.72 and 0.82, respectively). ICU-AW patients experienced longer ICU stays, more ventilator days, and higher extubation failure rates.ConclusionPreexisting low muscle mass, combined with a high SOFA score, may be a stronger predictor of ICU-acquired weakness than the degree of subsequent muscle loss.

The rapid shallow breathing index (RSBI) as a predictor for extubation success in medical and surgical ICU patients: A retrospective cohort study.

High levels of soluble neuropilin-1 in critically ill multiple trauma/surgical patients.

Urinary tract infections (UTIs) are among the most common nosocomial infections, particularly in elderly patients admitted to the Medical Intensive Care Unit (MICU). These infections, often ascending in nature, can lead to severe complications such as sepsis and multi-organ failure. This study investigates the incidence, risk factors, microbiological profile, and clinical outcomes of ascending UTIs in elderly ICU patients. A retrospective cohort study was conducted on 500 elderly MICU patients over a two-year period (2022–2023). The incidence of ascending UTIs was 28%, with Escherichia coli (55%) and Klebsiella pneumoniae (25%) being the predominant pathogens. Prolonged catheterization, diabetes, and immunosuppression were identified as major risk factors. 32% of affected patients developed sepsis, and the mortality rate was 12%. Our findings highlight the urgent need for improved infection control measures, judicious catheter use, and antibiotic stewardship programs to reduce the burden of UTIs in critically ill elderly patients.