Nosocomial Bacterial Pneumonia Research Articles

Machine learning to identify risk factors associated with the development of ventilated hospital-acquired pneumonia and mortality: implications for antibiotic therapy selection.

Among patients with nosocomial bacterial pneumonia, those who decompensated to requiring mechanical ventilation (vHABP) faced the highest mortality followed by ventilator-associated pneumonia (VABP) and non-ventilated hospital-acquired pneumonia (nvHABP). The objectives of this study were to identify risk factors associated with the development and mortality of vHABP and to evaluate antibiotic management. A multicenter retrospective cohort study of adult inpatients with nosocomial pneumonia during 2014-2019 was performed. Groups were stratified by vHABP, nvHABP, and VABP and compared on demographics, clinical characteristics, treatment, and outcomes. Multivariable models were generated via machine learning to identify risk factors for progression to vHABP as well as pneumonia-associated mortality for each cohort. 457 patients (32% nvHABP, 37% vHABP, and 31% VABP) were evaluated. The vHABP and nvHABP groups were similar in age (median age 66.4 years) with 77% having multiple comorbidities but more vHABP patients had liver disease (18.2% vs. 7.7% p = 0.005), alcohol use disorder (27% vs. 7.1%, p < 0.0001), and were hospitalized within the past 30 days (30.4% vs. 19.5%, p = 0.02). An immediate need for ventilatory support occurred in 70% of vHABP patients on the day of diagnosis. Mortality was the highest in vHABP followed by VABP and nvHABP groups (44.6% vs. 36% vs. 14.3%, p < 0.0001). Nearly all (96%) vHABP patients had positive cultures, with Gram-negative pathogens accounting for 58.8% whereby 33.0% were resistant to extended-spectrum β-lactams (ESBLs), ceftriaxone (17.5%), fluoroquinolones (20.6%), and carbapenems (12.4%). Up to half of the vHABP patients with ESBL-Enterobacterales or P. aeruginosa did not receive an effective empiric regimen; over 50% increase in mortality rate was observed among patients whom effective therapy was initiated past the day of pneumonia diagnosis. Risk factors associated with vHABP development were alcohol use disorder, APACHE II score, vasopressor therapy prior to infection, and culture positive for ESBL-Enterobacterales whereas history of hospitalization in the past 30 days, active malignancy, isolation of ceftriaxone-resistant pathogens or Pseudomonas aeruginosa, and vasopressor therapy were risk factors for vHABP-associated mortality. Patients with vHABP experienced an acute and severe decompensation upon diagnosis. The risk factors identified in this study could provide actionable data for clinicians to identify those at risk for vHABP at the onset of pneumonia and to target antimicrobial stewardship efforts to improve treatment success.

Respiratory Viruses in Nosocomial Pneumonia: An Evolving Paradigm.

Nosocomial pneumonia (NP) represents a leading cause of morbidity and mortality in hospitalized patients. Historically, clinicians have considered hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), which comprise NP, to be essentially bacterial processes. As such, patients suspected of having either HAP or VAP are initially treated with broad-spectrum antibiotics, and few clinicians search for a possible culprit virus. Recent reports which build on earlier studies, however, indicate that viruses likely play an important role in NP. Studies employing viral diagnostics as part of the evaluation for NP indicate that common respiratory viruses can spread nosocomially and lead to HAP and VAP. Similarly, studies of the general epidemiology of respiratory viral infections, such as influenza, respiratory syncytial virus, adenovirus, and rhinovirus, confirm that these pathogens are important causes of NP, especially among immunosuppressed and pediatric patients. More importantly, these more contemporary analyses reveal that one cannot, based on clinical characteristics, distinguish a viral from a bacterial cause of NP. Additionally, viral HAP and VAP result in crude mortality rates that rival or exceed those reported in bacterial NP. Rigorous prospective, multicenter trials are needed to confirm the significance of respiratory viruses in NP, as are studies of novel therapeutics for these viral infections.

Antibiotic treatment of community-acquired and hospital-acquired pneumonia

Community-acquired and nosocomial bacterial pneumonia are among the most common infectious diseases in Germany. Knowledge of possible pathogens and therapeutic implications thereof are essential to be able to provide adequate, differentiated antimicrobial therapy with the appropriate drugs, form of application, dose, and duration. New diagnostics that include multiplex polymerase chain reaction, correct interpretation of the biomarker procalcitonin, and treatment of multidrug-resistant bacteria are becoming increasingly import.

Clinical Outcomes and Prolonged SARS-CoV-2 Viral Shedding in ICU Patients with Severe COVID-19 Infection and Nosocomial Bacterial Pneumonia: A Retrospective Cohort Study.

This study explored the clinical outcomes and association of prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding in patients with severe coronavirus disease 2019 (COVID-19) infection who developed nosocomial pneumonia. This was a retrospective study conducted in a medical center in Taiwan. From May to September 2021, patients from four intensive care units were enrolled after SARS-CoV-2 was confirmed through quantitative polymerase chain reaction and all cases were compatible with the definitions of severe COVID-19 infection. Baseline characteristics, disease severity, clinical outcomes, and times of viral shedding were recorded. A total of 72 patients were diagnosed as having severe COVID-19 infection and 30 developed nosocomial pneumonia, comprising hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). The patients with severe COVID-19 infection and concomitant HAP/VAP had longer intensive care unit (ICU) stays and fewer ventilator-free days at Day 28. An independent risk factor for nosocomial pneumonia was a greater SOFA score at admission. Furthermore, the patients with severe COVID-19 infection who developed HAP/VAP had a significantly longer duration of SARS-CoV-2 shedding (19.50 days vs. 15.00 days, p = 0.006). Patients with severe COVID-19 infection who developed nosocomial pneumonia had longer SARS-CoV-2 shedding days, more complications, and worse outcomes.

Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study.

PurposeAlthough there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19.MethodsMulticentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated.ResultsBetween February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65–0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58–0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14–1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61–0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia.ConclusionCorticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00134-022-06726-w.

Linezolid as Potent Inhibitor of SARS-CoV-2 Nsp13 Helicase: Grid Based Docking Approach

Abstract: A diversified originator in humans and wildlife, the corona virus (COVID-19) is an enveloped RNA virus. Six different species have been shown to be the root of human sickness. Human diseases are greatly influenced by viral infections, and one of the most recent global epidemics is the appearance of the new corona. The SARS (Severe Acute Respiratory Syndrome) virus, a potentially fatal viral infection, was caused by the SS-RNA virus from the enveloped corona virus family. In many nations around the world, disease is rapidly expanding. 462,684 confirmed cases and 20,834 fatalities had been reported as of March 26, 2020, internationally. On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization (WHO). There are numerous medication trials ongoing, and some of the outcomes are encouraging. However, since there is no vaccine, the only approach to fight the virus is through preventative measures. Patients with bacterial nosocomial pneumonia were successfully treated with the antibiotic "Linezolid" by receiving an intravenous dose of 600 mg of linezolid every 12 hours for 7 to 10 days. All of the patients made a full recovery and were allowed to leave the hospital. Additionally, previous studies have shown that linezolid is more clinically and microbiologically effective than other antibiotics (vancomycin). The goal of the current study was to use a molecular docking approach to evaluate linezolid's potential against SAR-CoV-2 infection.

Linezolid as Potent Inhibitor of SARS-CoV-2 Nsp13 Helicase: Grid Based Docking Approach

A diversified originator in humans and wildlife, the corona virus (COVID-19) is an enveloped RNA virus. Six different species have been shown to be the root of human sickness. Human diseases are greatly influenced by viral infections, and one of the most recent global epidemics is the appearance of the new corona. The SARS (Severe Acute Respiratory Syndrome) virus, a potentially fatal viral infection, was caused by the SS-RNA virus from the enveloped corona virus family. In many nations around the world, disease is rapidly expanding. 462,684 confirmed cases and 20,834 fatalities had been reported as of March 26, 2020, internationally. On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization (WHO). There are numerous medication trials ongoing, and some of the outcomes are encouraging. However, since there is no vaccine, the only approach to fight the virus is through preventative measures. Patients with bacterial nosocomial pneumonia were successfully treated with the antibiotic "Linezolid" by receiving an intravenous dose of 600 mg of linezolid every 12 hours for 7 to 10 days. All of the patients made a full recovery and were allowed to leave the hospital. Additionally, previous studies have shown that linezolid is more clinically and microbiologically effective than other antibiotics (vancomycin). The goal of the current study was to use a molecular docking approach to evaluate linezolid's potential against SAR-CoV-2 infection.

Inappropriate Empiric Therapy Impacts Complications and Hospital Resource Utilization Differentially Among Different Types of Bacterial Nosocomial Pneumonia: A Cohort Study, United States, 2014-2019.

OBJECTIVES:Nosocomial pneumonia (NP) remains a costly complication of hospitalization fraught with subsequent complications and augmented resource utilization. Consisting of ventilated hospital-acquired bacterial pneumonia (vHABP), nonventilated hospital-acquired bacterial pneumonia (nvHABP), and ventilator-associated bacterial pneumonia (VABP), each may respond differently to inappropriate empiric treatment (IET). We explored whether IET affects the three pneumonia types differently.DESIGN:A multicenter, retrospective cohort study within the Premier Research database.SETTING:Acute care hospitals in the United States.PATIENTS:Patients with three types of NP were identified based on a previously published International Classification of Diseases, 9th Edition/International Classification of Diseases, 10th Edition Clinical Modification algorithm.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:We compared the impact of IET on hospital costs, length of stay (LOS), and development of Clostridium difficile infection (CDI), extubation failure (EF), and reintubation (RT). Marginal effects were derived from multivariable regression analyses. IET was present if no drug covering the organism recovered from the index culture was administered within 2 days of the culture date. Among 17,819 patients who met the enrollment criteria, 26.5% had nvHABP, 25.6% vHABP, and 47.9% VABP. Compared with non-IET, IET was associated with increased mean unadjusted hospital LOS across all NP types: nvHABP 12.5 versus 21.1, vHABP 16.7 versus 19.2, and VABP 18.6 versus 21.4 days. The adjusted marginal hospital LOS (4.9 d) and costs ($13,147) with IET were the highest in nvHABP. Incident CDI was rare and similar across NP types (2.4% nvHABP to 3.6% VABP). Both EF and RT were more common with IET in VABP (EF, 15.4% vs 19.2%; RT, 6.2% vs 10.4%), but not vHABP (EF, 15.1% vs 17.7%; RT, 8.1% vs 9.1%).CONCLUSIONS:Although IET is relatively uncommon, it affects resource utilization and the risk of complications differently across NP types. The impact of IET is greatest on both LOS and costs in nvHABP and is greater on VABP than vHABP in terms of EF and RT.

1314. Descriptive Epidemiology of 30-day Readmissions among Survivors of Hospitalization with Bacterial Nosocomial Pneumonia in the US, 2012-2019

BackgroundNosocomial pneumonia (NP) remains associated with excess morbidity and mortality. The effect of NP on other measures of outcome and quality, such as re-admission at 30 days, remains unclear. Moreover, differing types of NP may have varying impacts on re-admissions.MethodsWe conducted a multicenter retrospective cohort study within the Premier Research database, a source containing administrative, pharmacy, and microbiology data. The rate of rehospitalization at 30 days following the index discharge served as our primary endpoint. We compared NP patients readmitted with pneumonia (RaP) as the principal diagnosis to those readmitted for other reasons (RaO). We also compared readmission rates as function of the type of NP: ventilator-associated bacterial pneumonia (VABP), ventilated hospital-acquired bacterial pneumonia (vHABP), and non-ventilated HABP (nvHABP).ResultsAmong 17,819 patients with NP, 14,123 (79.3%) survived to discharge, of whom 2,151 (15.2%) required an acute readmission within 30 days of index discharge. Of these, 106 (4.9%) were RaP, and the remainder were RaO. At index hospitalization, RaP patients were older (mean age (SD) 67.4 (13.9] vs. 63.0 (15.2) years), more likely medical (44.3% vs. 36.7%), and less chronically ill (median [IQR] Charlson scores (3 [2-5] vs. 4 [2-5]) than persons with RaO. Bacteremia (10.4% vs. 17.5%), need for vasopressors (15.1% vs. 20.0%), dialysis (9.4% vs. 16.5%), and/or sepsis (9.4% vs. 16.5%) or septic shock 14.2% vs. 17.1%) occurred less frequently in the RaP group. With respect to NP type, nvHABP was most common in RaP (47.2%) and VABP in RaO (38.1%). ConclusionOne in seven survivors of a hospitalization complicated by NP requires an acute rehospitalization within 30 days. However, few of these readmissions had a principal diagnosis of pneumonia, irrespective of NP type. This suggests that short-term readmission does not capture the quality of care initially delivered to patients for their NP. Of the 5% of NP subjects with RaP, the plurality initially suffered from nvHABP. Disclosures Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee) Andrew F. Shorr, MD, MPH, MBA, Merck (Consultant)

1322. Complications and Hospital Resource Utilization among Patients with Bacterial Nosocomial Pneumonia in the US, 2012-2019

Abstract Background Nosocomial pneumonia (NP) remains a costly complication of hospitalization. Consisting of hospital-acquired ventilated (vHABP) and non-ventilated (nvHABP), and ventilator-associated (VABP) bacterial pneumonia, these conditions themselves are fraught with further complications. We examined hospital resource utilization (HRU) and the rates of important complications in these three groups in a large US database. Methods We conducted a multicenter retrospective cohort study within Premier Research database, a source containing administrative, pharmacy, and microbiology data. The three types of NP were identified based on a slightly modified, previously published ICD-9/10-CM algorithm,1 and compared with respect to hospital costs, length of stay (LOS) and development of C. difficile infection (CDI), extubation failure (EF), and reintubation (RT). CDI was identified by its treatment with metronidazole, vancomycin, or fidaxomicin. Marginal effects were derived from multivariable regression analyses. Results Among 17,819 patients who met the enrollment criteria, 26.5% had nvHABP, 25.6% vHAPB, and 47.9% VABP. Patients with nvHABP were oldest (mean 66.7+/-15.1 years) and those with VABP were youngest (59.7+/-16.6 years). vHABP was associated with the highest chronic disease burden (mean Charlson score 4.1+/-2.8) and VABP with lowest (3.2+/-2.5). Patients with nvHABP had lowest severity of acute illness (ICU 58.0%, vasopressors 7.7%), and those with vHABP were most likely to require vasopressors (38.8%). The adjusted EF and RT in vHABP and VABP, and CDI rates, and adjusted post-infection onset hospital LOS across all groups were similar. The adjusted marginal post-infection onset ICU LOS and total hospital costs relative to nvHABP were 5.9 (95% CI 5.4, 6.3) days and &amp;6,814 (95% CI &amp;3,637, &amp;9,991) in vHABP, and 6.5 (95% CI 6.0, 6.9) days and &amp;16,782 (95% CI &amp;13,446, &amp;20,118) in VABP. Conclusion Both HABP and VABP remain associated with significant morbidity and HRU in the US. VABP was associated with the longest post-infection ICU LOS and highest hospital costs. Reference 1. Zilberberg et al. Chest 2019;155:1119-30 Disclosures Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&amp;J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Laura A. Puzniak, PhD, Merck &amp; Co., Inc. (Employee) Andrew F. Shorr, MD, MPH, MBA, Merck (Consultant)

Efficacy of adjunctive nebulized colistin in critically ill patients with nosocomial carbapenem-resistant Gram-negative bacterial pneumonia: a multi-centre observational study

ObjectivesTo investigate the association between adjunctive nebulized colistin and treatment outcomes in critically ill patients with nosocomial carbapenem-resistant Gram-negative bacterial (CR-GNB) pneumonia. MethodsThis retrospective, multi-centre, cohort study included individuals admitted to the intensive care unit with nosocomial pneumonia caused by colistin-susceptible CR-GNB. Enrolled patients were divided into groups with/without nebulized colistin as adjunct to at least one effective intravenous antibiotic. Propensity score matching was performed in the original cohort (model 1) and a time-window bias-adjusted cohort (model 2). The association between adjunctive nebulized colistin and treatment outcomes was analysed. ResultsIn total, 181 and 326 patients treated with and without nebulized colistin, respectively, were enrolled for analysis. The day 14 clinical failure rate and mortality rate were 41.4% (75/181) versus 46% (150/326), and 14.9% (27/181) versus 21.8% (71/326), respectively. In the propensity score-matching analysis, patients with nebulized colistin had lower day 14 clinical failure rates (model 1: 41% (68/166) versus 54.2% (90/166), p 0.016; model 2: 35.3% (41/116) versus 56.9% (66/116), p 0.001). On multivariate analysis, nebulized colistin was an independent factor associated with fewer day 14 clinical failures (model 1: adjusted odds ratio (aOR) 0.59, 95% CI 0.37–0.92; model 2: aOR 0.37, 95% CI 0.21–0.65). Nebulized colistin was not associated independently with a lower 14-day mortality rate in the time-dependent analysis in both models 1 and 2. ConclusionsAdjunctive nebulized colistin was associated with lower day 14 clinical failure rate, but not lower 14-day mortality rate, in critically ill patients with nosocomial pneumonia caused by colistin-susceptible CR-GNB.

Phage Therapy to Prevent Nosocomial Bacterial Pneumo-nia in Patients with Severe COVID-19 in 2020

The COVID-19 was reported to be a pandemic, according to the World Health Organization (WHO). Secondary bacterial pneumonia exacerbates respiratory problems and increases mortality in patients with COVID-19. Recently, 50% of the causes of death in these patients have been reported as nosocomial pneumonia in these cases. These bacteria have become multidrug-resistant. Phage production is a cost-benefit. Inhalation of phage cocktail with mesh nebulizer can be suitable to prevent secondary bacterial pulmonary infection in patients with severe COVID-19. To prevent secondary bacterial pneumonia and reduce mortality in patients with severe type COVID-19 and patients who are under a ventilator for a long time, the use of phage cocktail product by inhalation with mesh nebulizer device is recommended.

Epidemiology, Treatment, and Prevention of Nosocomial Bacterial Pneumonia.

Septicaemia likely results in high case-fatality rates in the present multidrug-resistant (MDR) era. Amongst them are hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), two frequent fatal septicaemic entities amongst hospitalised patients. We reviewed the PubMed database to identify the common organisms implicated in HAP/VAP, to explore the respective risk factors, and to find the appropriate antibiotic choice. Apart from methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, extended-spectrum β-lactamase-producing Enterobacteriaceae spp., MDR or extensively drug-resistant (XDR)-Acinetobacter baumannii complex spp., followed by Stenotrophomonas maltophilia, Chryseobacterium indologenes, and Elizabethkingia meningoseptica are ranked as the top Gram-negative bacteria (GNB) implicated in HAP/VAP. Carbapenem-resistant Enterobacteriaceae notably emerged as an important concern in HAP/VAP. The above-mentioned pathogens have respective risk factors involved in their acquisition. In the present XDR era, tigecycline, colistin, and ceftazidime-avibactam are antibiotics effective against the Klebsiella pneumoniae carbapenemase and oxacillinase producers amongst the Enterobacteriaceae isolates implicated in HAP/VAP. Antibiotic combination regimens are recommended in the treatment of MDR/XDR-P. aeruginosa or A. baumannii complex isolates. Some special patient populations need prolonged courses (>7-day) and/or a combination regimen of antibiotic therapy. Implementation of an antibiotic stewardship policy and the measures recommended by the United States (US) Institute for Healthcare were shown to decrease the incidence rates of HAP/VAP substantially.

Bacterial Nosocomial Pneumonia in Respiratory Intensive Care Unit of Assiut University Hospital

Bacterial Nosocomial Pneumonia in Respiratory Intensive Care Unit of Assiut University Hospital

Development of the Immune Response in Pneumonia Caused Pseudomonas aeruginosa (Part 1)

Nosocomial bacterial pneumonia associated with Gram-negative pathogens, characterized by severe, high risk of complications and death. This article describes the immune response to infection with gram-negative bacterium Pseudomonas aeruginosa respiratory tract, which provide an effective clearance of the pathogen. The mechanisms of the respiratory tract showcased that an image-recognition receptors cells inducing pathogen-associated molecular structures Pseudomonas aeruginosa.

Telavancin for Hospital-Acquired Pneumonia: Clinical Response and 28-Day Survival

U.S. Food and Drug Administration draft guidance for future antibiotic clinical trials of bacterial nosocomial pneumonia recommends the use of diagnostic criteria according to American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines and the use of a primary endpoint of 28-day all-cause mortality. The effect of applying these guidelines on outcomes of phase III nosocomial pneumonia studies of telavancin was evaluated in a post hoc analysis. ATS/IDSA criteria were applied in a blind fashion to the original all-treated (AT) group. Clinical cure rates at final follow-up were determined in the refined AT and clinically evaluable (CE) groups (ATS/IDSA-AT and ATS/IDSA-CE, respectively). The exploratory endpoint of 28-day survival was evaluated for the ATS/IDSA-AT group. Noninferiority of telavancin versus vancomycin was demonstrated, with similar cure rates in the ATS/IDSA-AT (59% versus 59%) and ATS/IDSA-CE (83% versus 80%) groups. Cure rates favored telavancin in ATS/IDSA-CE patients where Staphylococcus aureus was the sole pathogen (86% versus 75%). Overall, 28-day survival rates were similar in the telavancin (76%) and vancomycin (77%) groups but lower in telavancin-treated patients with preexisting moderate-to-severe renal impairment (creatinine clearance [CLCR] of <50 ml/min). Telavancin should be administered to patients with moderate-to-severe renal impairment only if treatment benefit outweighs the risk or if no suitable alternatives are available.

Selective digestive decontamination and bacterial resistance

1 van der Meer JW, Vandenbroucke-Grauls CM, Vincent JL. Resistance to selective decontamination: the jury is still out. Lancet Infect Dis 2013; 13: 282–83. 2 Daneman N, Sarwar S, Fowler RA, Cuthbertson BH; for SuDDICU Canadian Study Group. Eff ect of selective decontamination on antimicrobial resistance in intensive care units: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13: 328–41. 3 Vincent JL. Prevention of nosocomial bacterial pneumonia. Thorax 1999; 54: 544–549. 4 van Saene HKF, Stoutenbeek CP. Selective decontamination. J Antimicrob Chemother 1987; 20: 462–65. 5 Silvestri L, de la Cal MA, van Saene HKF. Selective decontamination of the digestive tract: the mechanism of action is control of gut overgrowth. Intensive Care Med 2012; 38: 1738–50. 6 Stoutenbeek CP, Miranda DR, van Saene HKF. A new technique for infection prevention in the intensive care unit. Proceedings of the 6th European Congress of Anaesthesiology. Anaesthesia 1982; 56: 98 (abstr). patients treated in an intensivecare unit for longer than 5 days. A 2% chlorhexidine rinse was used for throat decontamination. This regimen was given to 55 patients: 18 had abnormal fl ora in the throat and gut, particularly Pseudomonas spp and Acinetobacter spp. These isolates were sensitive to colistin, but resistant to co-trimoxazole. 12 patients developed pneumonia. Co-trimoxazole is absorbable and caused side-eff ects including thrombo cytopenia and allergy, so was replaced by parenteral cefotaxime and enteral, non-absorbable tobramycin. This combination, used in 35 RCTs, was analysed by the authors of the meta-analysis. van der Meer JW and VandenbrouckeGrauls make two statements: that benefi t with SDD is controversial and that the long-term eff ects of SDD on resistance are unknown. They say that decades are required to assess the eff ect of SDD on the development of resistance, particularly on the noncultivable species in the digestive tract. We strongly disagree with these statements. SDD reduces morbidity and mortality, and the Surviving Sepsis Campaign has recommended SDD as an infection control measure. van der Meer JW and Vandenbroucke-Grauls’ demands for further research into SDD and resistance, in particular in non-cultivable species, do not make sense because these organisms have no clinical impact. We ask whether the contributors have applied similar requirements for their traditional use of parenteral antibiotics with regards to the emergence of resistance?

Oral Health and the Stroke Survivor

Abstract This module includes a narrated PowerPoint with embedded video clips, as well as a non-narrated PowerPoint presentation, both of which provide a review of the numerous effects a cerebrovas...

Epidemiological analysis of critically ill adult patients with pandemic influenza A(H1N1) in South Korea

A total of 245 patients with confirmed 2009 H1N1 influenza were admitted to the intensive-care units of 28 hospitals (South Korea). Their mean age was 55.3 years with 68.6% aged >50 years, and 54.7% male. Nine were obese and three were pregnant. One or more comorbidities were present in 83.7%, and nosocomial acquisition occurred in 14.3%. In total, 107 (43.7%) patients received corticosteroids and 66.1% required mechanical ventilation. Eighty (32.7%) patients died within 30 days after onset of symptoms and 99 (40.4%) within 90 days. Multivariate logistic regression analysis showed that the clinician's decision to prescribe corticosteroids, older age, Sequential Organ Failure Assessment score and nosocomial bacterial pneumonia were independent risk factors for 90-day mortality. In contrast with Western countries, critical illness in Korea in relation to 2009 H1N1 was most common in older patients with chronic comorbidities; nosocomial acquisition occurred occasionally but disease in obese or pregnant patients was uncommon.

Diagnosis of Nosocomial Bacterial Pneumonia in Mechanically Ventilated Patients of Intensive Care unit

Diagnosis of Nosocomial Bacterial Pneumonia in Mechanically Ventilated Patients of Intensive Care unit