Pneumonia In Intensive Care Unit Research Articles

Impact of Pseudomonas aeruginosa carriage on intensive care unit-acquired pneumonia: a European multicentre prospective cohort study

ObjectivesPseudomonas aeruginosa (PA) is a common causative pathogen of pneumonia acquired in the intensive care unit (ICU). The aim of this study was to determine the incidence of PA ICU pneumonia (PAIP) and to quantify its independent association with PA colonization at different body sites. MethodsAdult patients on mechanical ventilation at ICU admission were prospectively enrolled across 30 European ICUs. PA colonization in the perianal area and in the lower respiratory tract was assessed within 72 hours after ICU admission and twice weekly until ICU discharge. PAIP development was evaluated daily. Competing risk models with colonization as a time-varying exposure and ICU death and discharge as competing events were fitted and adjusted for confounders to investigate the association between PA carriage and PAIP. ResultsA total of 1971 subjects were enrolled. The colonization prevalence with PA in the first 72 hours of ICU admission was 10.4% (179 perianal and 51 respiratory), whereas the acquisition incidence during the ICU stay was 7.0% (158 perianal and 47 respiratory). Of the 43 (1.8%) patients who developed PAIP, 11 (25.6%) were PA colonized on admission and 9 (20.9%) acquired colonization before PAIP onset. Both perianal (adjusted subdistribution hazard ratio, 4.4; 95% CI, 1.7–11.6) and respiratory colonization (adjusted subdistribution hazard ratio: 4.6, 95% CI, 1.9–11.1) were independently associated with PAIP development. DiscussionPAIP incidence was higher in PA colonized vs. non-colonized patients. Colonization of both the rectum and of the respiratory tract was associated with development of PAIP. The increased risk of PA colonization for subsequent infection provides an opportunity for targeted preventive interventions.

Evaluation of ventilator-associated pneumonia care practice in the intensive care units of a comprehensive specialized hospital in Northwest Ethiopia: a 1.5-year prospective observational study.

Nosocomial infections pose a global health threat, with Ventilator-Associated Pneumonia (VAP) emerging as a prominent hospital-acquired infection, particularly in intensive care units (ICU).VAP is the commonest form of pneumonia in ICUs, contributing significantly to morbidity and mortality rates, which can reach around 30%. Despite the substantial impact of VAP on healthcare, there is a lack of data on adherence to VAP prevention protocols in our hospital. Consequently, this study aims to assess the adherence to ventilator-associated pneumonia care bundles in critical care units at a comprehensive specialized hospital in northwest Ethiopia. A hospital-based prospective observational study was conducted from July 3, 2022, to January 7, 2024. All adult patients who were on mechanical ventilators for more than 48h during the study period were included. Data were collected using the Institute of Healthcare Improvement VAP prevention standards as checklists via direct observation and chart review. The data were entered and analyzed using SPSS version 20. A total of 300 surgical and medical ICU patients were observed. Among the patients, 66.3% were from the medical ICU. In terms of admission reasons, 22.3%, 15.7% and, 12% were attributed to infections excluding respiratory origin, respiratory disorders, and other causes, respectively. The rate of compliance with all components of the bundle was 70%. A 100% adherence rate was observed for the prophylaxis for peptic ulcer and deep vein thrombosis (DVT). The lowest adherence rate was observed in the practice of oral hygiene with 0.5% chlorhexidine solution (0%) followed by humidification with heat and moisture exchangers (23.3%). Endotracheal tube cuff pressure measurement and use of endotracheal tubes with subglottic suction were not applicable. The study revealed suboptimal compliance with the VAP care bundle, indicating unsatisfactory overall practice. Specific attention is warranted for subglottic suction, cuff pressure measurement, humidification, oral care with chlorhexidine, and sedation vacation.

Effects of nursing team communication and collaboration on treatment outcomes in intensive care unit patients with severe pneumonia.

Severe pneumonia is a common severe respiratory infection worldwide, and its treatment is challenging, especially for patients in the intensive care unit (ICU). To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU. We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1, 2021 and December 31, 2023. We compared and analyzed the respiratory mechanical indexes [airway resistance (Raw), mean airway pressure (mPaw), peak pressure (PIP)], blood gas analysis indexes (arterial oxygen saturation, arterial oxygen partial pressure, and oxygenation index), and serum inflammatory factor levels [C-reactive protein (CRP), procalcitonin (PCT), cortisol (COR), and high mobility group protein B1 (HMGB1)] of all patients before and after treatment. Before treatment, there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups (P > 0.05). However, after treatment, the respiratory mechanical indexes of patients in both groups were significantly improved, and the improvement of Raw, mPaw, plateau pressure, PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group (P < 0.05). The serum CRP and PCT levels of patients were significantly decreased, and the difference was statistically significant compared with that of nursing group alone (P < 0.05). The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups. The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators, blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.

Bidirectional association between pneumonia and intestinal infection: an analysis of the MIMIC-IV database.

The purpose is to analyze the prevalence of intestinal infection in patients with pneumonia in intensive care units (ICU) and the impact of intestinal infection on the prognosis of patients with pneumonia, so as to explore the bidirectional association between pneumonia and intestinal infection. The study aims to investigate the correlation between the occurrence of pneumonia and intestinal infection among patients in the ICU, utilizing the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, as well as the impact of intestinal infection on the prognosis of pneumonia patients. The enrolled patients were first divided into pneumonia group and non-pneumonia group, and the primary outcome was that patients developed intestinal infection. Multivariate logistic regression was used to elucidate the association between pneumonia and the prevalence of intestinal infection, and propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) were used to validate our findings. We then divided patients with pneumonia into two groups according to whether they were complicated by intestinal infection, and analyzed the effect of intestinal infection on 28-day mortality, length of ICU stay, and length of hospital stay in patients with pneumonia. This study included 50,920 patients, of which 7493 were diagnosed with pneumonia. Compared with non-pneumonia patients, the incidence of intestinal infection in pneumonia patients was significantly increased [OR 1.58 (95% CI 1.34-1.85; P < 0.001)]. Cox proportional hazards regression model showed no significant effect of co-infection on 28-day mortality in patients with pneumonia (P = 0.223). Patients in the intestinal infection group exhibited a longer length stay in ICU and hospital than those without intestinal infection (P < 0.001). In the ICU, patients with pneumonia were more likely linked to intestinal infection. In addition, the presence of concurrent intestinal infections can prolong both ICU and hospital stays for pneumonia patients.

Application and significance of prone position in the treatment of patients with severe pneumonia in intensive care unit

To investigate the effect of prone position on the prognosis of patients with severe pneumonia in intensive care unit (ICU). A retrospective cohort study was conducted. The patients with severe pneumonia admitted to the ICU of Qingdao Municipal Hospital from May 2022 to August 2023 were enrolled. The general information, etiology, underlying diseases, vital signs and laboratory indicators at ICU admission, clinical treatment and prognosis during ICU hospitalization were collected. The above clinical data of patients with different prognosis were compared. Multifactorial Logistic regression analysis was used to screen the related factors affecting survival during ICU in patients with severe pneumonia. The change in oxygenation index (PaO2/FiO2) of patients with severe pneumonia were observed at 1 hour before the first prone position, 1 hour after the first prone position, and 1 hour after the end of the first prone position. The effect of prone position on oxygenation in patients with severe pneumonia was analyzed. Spearman correlation analysis was used to investigate the correlation between the duration to first prone position and the change in the PaO2/FiO2 before and after prone position in patients with severe pneumonia. Finally, a total of 144 patients with severe pneumonia were enrolled, 45 survived and 99 died during ICU hospitalization, with a mortality of 68.8%. Compared with the survival group, the patients in the death group were older [years old: 81.00 (70.75, 86.00) vs. 71.00 (60.50, 81.50), P < 0.01], the proportion of pre-existing lung disease, heart rate (HR), respiratory rate (RR), blood lactic acid (Lac) and the ratio of continuous renal replacement therapy (CRRT) were higher [ratio of pre-existing lung disease: 23.2% (23/99) vs. 8.9% (4/45), HR (bpm): 99.61±22.47 vs. 91.49±18.76, RR (times/min): 22.50 (19.75, 29.25) vs. 20.00 (17.50, 24.50), Lac (mmol/L): 2.00 (1.55 , 3.25) vs. 1.60 (1.20, 1.95), CRRT ratio: 25.3% (25/99) vs. 6.7% (3/45), all P < 0.05], and the proportion of prone position was lower [41.4% (41/99) vs. 68.9% (31/45), P < 0.01]. Multifactorial Logistic regression analysis showed that age [odds ratio (OR) = 0.946, 95% confidence interval (95%CI) was 0.912-0.980, P = 0.002] and Lac (OR = 0.563, 95%CI was 0.340-0.930, P = 0.025) were negatively correlated with survival during ICU hospitalization in severe pneumonia patients, while prone position was positively correlated with survival (OR = 2.551, 95%CI was 1.067-6.095, P = 0.035), indicating that prone position was beneficial for improving ICU prognosis in severe pneumonia patients. The results of PaO2/FiO2 at different time points in prone position showed that PaO2/FiO2 at 1 hour of the first prone position in the patients with severe pneumonia was significantly higher than that at 1 hour before the first prone position [mmHg (1 mmHg ≈ 0.133 kPa): 146.69 (113.92, 257.25) vs. 111.75 (70.15, 212.20), P < 0.01], indicating that the prone position had a relevant effect on the improvement of oxygenation in patients. Spearman correlation analysis showed that the duration of the first prone position in patients with severe pneumonia was significantly and positively correlated with the improvement of oxygenation at 1 hour of the first prone position (r = 0.565, P < 0.001). The prone position is a therapeutic measure that can independently influence the prognosis of patients with severe pneumonia during ICU hospitalization. The prone position effectively improves oxygenation in patients with severe pneumonia and the first change in oxygenation in patients is related to the duration of the prone position.

Application of a multiplex molecular pneumonia panel and real-world impact on antimicrobial stewardship among patients with hospital-acquired and ventilator-associated pneumonia in intensive care units

BackgroundThe optimal timing for applying the BioFire FilmArray Pneumonia Panel (FAPP) in intensive care unit (ICU) patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) remains undefined, and there are limited data on its impact on antimicrobial stewardship. MethodsThis retrospective study was conducted at a referral hospital in Taiwan from November 2019 to October 2022. Adult ICU patients with HAP/VAP who underwent FAPP testing were enrolled. Patient data, FAPP results, conventional microbiological testing results, and the real-world impact of FAPP results on antimicrobial therapy adjustments were assessed. Logistic regression was used to determine the predictive factors for bacterial detection by FAPP. ResultsAmong 592 respiratory specimens, including 564 (95.3%) endotracheal aspirate specimens, 19 (3.2%) expectorated sputum specimens and 9 (1.5%) bronchoalveolar lavage specimens, from 467 patients with HAP/VAP, FAPP testing yielded 368 (62.2%) positive results. Independent predictors for positive bacterial detection by FAPP included prolonged hospital stay (odds ratio [OR], 3.14), recent admissions (OR, 1.59), elevated C-reactive protein levels (OR, 1.85), Acute Physiology and Chronic Health Evaluation II scores (OR, 1.58), and septic shock (OR, 1.79). Approximately 50% of antimicrobial therapy for infections caused by Gram-negative bacteria and 58.4% for Gram-positive bacteria were adjusted or confirmed after obtaining FAPP results. ConclusionsThis study identified several factors predicting bacterial detection by FAPP in critically ill patients with HAP/VAP. More than 50% real-world clinical practices were adjusted or confirmed based on the FAPP results. Clinical algorithms for the use of FAPP and antimicrobial stewardship guidelines may further enhance its benefits.

Effectiveness of Ceftazidime-Avibactam in Gram-Negative Nosocomial Pneumonia: A Real-World Study in India.

The incidences of nosocomial pneumonia in intensive care units (ICUs) in India have been reported to range from 9% to 58% and are associated with a mortality rate of 30-70%. Ceftazidime-avibactam has activity against OXA-48-like carbapenem-resistant Enterobacterales (CRE) and has a safer adverse effect profile as compared to the nephrotoxic colistin. The current study aimed to assess the effectiveness and usage pattern of ceftazidime-avibactam in gram-negative hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in real-world settings in India. Electronic medical records of hospitalized patients in three prominent medical centers in India (Fortis Memorial Research Centre, Gurugram, S L Raheja Hospital, Mumbai, and Fortis Hospital, Anandapur, Kolkata)with nosocomial pneumonia and documented gram-negative Klebsiella pneumoniae (KP)-confirmed infection were collected. This study assessed the effectiveness, usage pattern of ceftazidime-avibactam, and clinical and microbiological cure rates. Among the 116 patients included, 78.45% (91/116) showed clinical cure. Microbiological cure was observed in nine out of 13 (69.23%) patients. In the subset analysis, a clinical cure rate of 84.85% (28/33) and microbiological recovery rate of 62.50% (5/8) were observed when ceftazidime-avibactam was initiated within 72 hours of diagnosis. Ceftazidime-avibactam was administered for a mean (±SD) duration of 7.79 ± 4.43 days, with improvement in signs and symptoms reported among 91.38% (106/116). Ceftazidime-avibactam showed a susceptibility of 56% (28/56) in the study. The current study showed a better clinical and microbiological cure rate with a safer tolerability profile of ceftazidime-avibactam in carbapenem-resistant KP nosocomial pneumonia and VAP. This study has further demonstrated that ceftazidime-avibactam may be used as one of the viable treatment choices in carbapenem-resistant KP with favorable clinical outcomes.

Comparison of the Distribution of Healthcare-Associated Infections and Causative Agents Between Intensive Care Units and Other Clinics.

To compare the trends in the distribution of healthcare associated infectious (HAIs) and causative agents in intensive care units (ICUs) and other clinics. Descriptive study. Place and Duration of the Study: Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkiye, from 2015 to 2022. The study included patients who were diagnosed with HAIs and admitted to both the ICUs and the clinics. The data of HAIs identified between 2015-2022 were accessed and analysed retrospectively from the surveillance records of the IPC committee between 28.05.2023-07.08.2023. There was a decreasing trend observed in both ICU and clinics regarding the ratio of patients developing HAIs and the overall HAI rate (all p-values <0.001). These two measures were found to be significantly lower in the years 2019-2022 compared to the years 2015-2018. Over the years, particularly after 2020, a significant increasing trend in carbapenem resistance was observed in E. coli, K. pneumoniae, and P. aeruginosa (p=0.009, p<0.001, and p<0.001, respectively). The ratio of patients developing HAIs in the ICUs was higher than in the clinics (p<0.001). There was an increasing trend in the ratio of pneumonia and bloodstream infection (BSI) in ICUs. The increasing ratio of BSI and pneumonia in ICUs highlighted the need to review infection control bundles. Carbapenem resistance has been increasing over the years, suggesting that antimicrobial description and consumption practices should be re-evaluated, especially in the context of the COVID-19 pandemic. Intensive Care Unit, Healthcare-Associated Infections, Surveillance, Infection prevention and control, Antibiotic resistance.

Development and validation of a predictive model for 30-day mortality in patients with severe community-acquired pneumonia in intensive care units.

Based on the high prevalence and fatality rates associated with severe community-acquired pneumonia (SCAP), this study endeavored to construct an innovative nomogram for early identification of individuals at high risk of all-cause death within a 30-day period among SCAP patients receiving intensive care units (ICU) treatment. In this single-center, retrospective study, 718 SCAP patients were screened from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database for the development of a predictive model. A total of 97 patients eligible for inclusion were included from Chongqing General Hospital, China between January 2020 and July 2023 for external validation. Clinical data and short-term prognosis were collected. Risk factors were determined using the least absolute shrinkage and selection operator (LASSO) and multiple logistic regression analysis. The model's performance was evaluated through area under the curve (AUC), calibration curve, and decision curve analysis (DCA). Eight risk predictors, including age, presence of malignant cancer, heart rate, mean arterial pressure, albumin, blood urea nitrogen, prothrombin time, and lactate levels were adopted in a nomogram. The nomogram exhibited high predictive accuracy, with an AUC of 0.803 (95% CI: 0.756-0.845) in the training set, 0.756 (95% CI: 0.693-0.816) in the internal validation set, 0.778 (95% CI: 0.594-0.893) in the external validation set concerning 30-day mortality. Meanwhile, the nomogram demonstrated effective calibration through well-fitted calibration curves. DCA confirmed the clinical application value of the nomogram. This simple and reliable nomogram can help physicians assess the short-term prognosis of patients with SCAP quickly and effectively, and could potentially be adopted widely in clinical settings after more external validations.

Difficulties in choosing antibacterial therapy regimen for nosocomial pneumonia in intensive care units: clinical observations

Nosocomial pneumonia is one of the most common healthcare-associated infections and the most frequent in intensive care unit (ICU) patients. The clinical and economic consequences of nosocomial pneumonia are very significant, especially for ventilated patients. In this article we present several clinical observations that demonstrate the difficulties of antibacterial therapy of nosocomial pneumonia and ventilator-associated pneumonia in adults in multidisciplinary hospitals in Moscow, which are due to both patient characteristics and profile of circulating pathogens.

Heparin-binding protein as a predictor of mortality in patients with diabetes mellitus and community-acquired pneumonia in intensive care unit : a propensity score matched study.

Patients with diabetes mellitus (DM) are vulnerable to community-acquired pneumonia (CAP), which have a high mortality rate. We aimed to investigate the value of heparin-binding protein (HBP) as a prognostic marker of mortality in patients with DM and CAP. This retrospective study included CAP patients who were tested for HBP at intensive care unit (ICU) admission from January 2019 to April 2020. Patients were allocated to the DM or non-DM group and paired with propensity score matching. Baseline characteristics and clinical outcomes up to 90 days were evaluated. The primary outcome was the 10-day mortality. Receiver operating characteristic (ROC) curves, Kaplan-Meier analysis, and Cox regression were used for statistical analysis. Among 152 enrolled patients, 60 pairs were successfully matched. There was no significant difference in 10-day mortality, while more patients in the DM group died within 28 d (P=0.024) and 90 d (P=0.008). In the DM group, HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors (median 182.21 [IQR: 55.43-300] ng/ml vs. median 66.40 [IQR: 34.13-107.85] ng/mL, P=0.019), and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747. The cut-off value, sensitivity, and specificity were 160.6 ng/mL, 66.7%, and 90.2%, respectively. Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day (HR 7.196, 95%CI: 1.596-32.455, P=0.01), 28-day (HR 4.381, 95%CI: 1.449-13.245, P=0.009), and 90-day mortality (HR 4.581, 95%CI: 1.637-12.819, P=0.004) in patients with DM. Plasma HBP at ICU admission was associated with the 10-day, 28-day, and 90-day mortality, and might be a prognostic factor in patients with DM and CAP.

Exploring the intersection of obesity and gender in COVID-19 outcomes in hospitalized Mexican patients: a comparative analysis of risk profiles using unsupervised machine learning.

Obesity and gender play a critical role in shaping the outcomes of COVID-19 disease. These two factors have a dynamic relationship with each other, as well as other risk factors, which hinders interpretation of how they influence severity and disease progression. This work aimed to study differences in COVID-19 disease outcomes through analysis of risk profiles stratified by gender and obesity status. This study employed an unsupervised clustering analysis, using Mexico's national COVID-19 hospitalization dataset, which contains demographic information and health outcomes of patients hospitalized due to COVID-19. Patients were segmented into four groups by obesity and gender, with participants' attributes and clinical outcome data described for each. Then, Consensus and PAM clustering methods were used to identify distinct risk profiles based on underlying patient characteristics. Risk profile discovery was completed on 70% of records, with the remaining 30% available for validation. Data from 88,536 hospitalized patients were analyzed. Obesity, regardless of gender, was linked with higher odds of hypertension, diabetes, cardiovascular diseases, pneumonia, and Intensive Care Unit (ICU) admissions. Men tended to have higher frequencies of ICU admissions and pneumonia and higher mortality rates than women. Within each of the four analysis groups (divided based on gender and obesity status), clustering analyses identified four to five distinct risk profiles. For example, among women with obesity, there were four profiles; those with a hypertensive profile were more likely to have pneumonia, and those with a diabetic profile were most likely to be admitted to the ICU. Our analysis emphasizes the complex interplay between obesity, gender, and health outcomes in COVID-19 hospitalizations. The identified risk profiles highlight the need for personalized treatment strategies for COVID-19 patients and can assist in planning for patterns of deterioration in future waves of SARS-CoV-2 virus transmission. This research underscores the importance of tackling obesity as a major public health concern, given its interplay with many other health conditions, including infectious diseases such as COVID-19.

Clinical efficacy and safety of tigecycline based on therapeutic drug monitoring for carbapenem-resistant Gram-negative bacterium pneumonia in intensive care units

BackgroundWe investigated the associations between the different doses of tigecycline, its efficacy and safety, and the role of tigecycline therapeutic drug monitoring for patients in the intensive care unit.MethodsThis study was a single-center cohort including patients infected with multidrug-resistant Acinetobacter baumannii (MDR-AB) and multidrug-resistant Klebsiella pneumoniae (MDR-KP) causing pulmonary infections. The steady-state plasma concentration after tigecycline administration was determined by High-Performance Liquid Chromatography (HPLC) in patients admitted to the ICU between October 2020 and December 2021. Multivariate analyses of tigecycline’s clinical efficacy and safety were performed to control confounding factors.ResultsFor this study, we included 45 patients and 45 blood samples to determine steady-state trough concentrations of tigecycline. All patients were divided into the High Dose (HD) and Standard Dose (SD) groups. The median trough concentration of tigecycline was 0.56 μg/mL in the HD group, which was higher than in the SD group (0,21 μg/mL), p = 0.000. There was no significant difference between the two groups of patients in terms of bacterial eradication rate, mortality rate, and clinical efficacy. Multiple regression analysis showed that the ICU days were correlated with mortality OR 1.030(1.005–1.056), p = 0.017. APACHE II was significantly associated with clinical efficacy OR 0.870(0.755–1.002), p = 0.045. The level of fibrinogen decline in the HD group was significantly higher than in the SD group (-3.05 ± 1.67 vs -1.75 ± 1.90), p = 0.038. We identified that age and tigecycline treatment duration influenced fibrinogen decline.ConclusionsTigecycline plasma concentrations are significantly increased when using a high dose. However, the plasma concentration of tigecycline is not correlated with clinical efficacy and adverse reactions. Fibrinogen decline appears to be related to the patient’s age and days of tigecycline. Large sample data are still needed to confirm the clinical guidance significance of tigecycline TDM.

Risk factors for mortality in intensive care unit patients with Stenotrophomonas maltophilia pneumonia in South Korea.

Stenotrophomonas maltophilia has been increasingly recognized as an opportunistic pathogen associated with high morbidity and mortality. Data on the prognostic factors associated with S. maltophilia pneumonia in patients admitted to intensive care unit (ICU) are lacking. We conducted a retrospective analysis of data from 117 patients with S. maltophilia pneumonia admitted to the ICUs of two tertiary referral hospitals in South Korea between January 2011 and December 2022. To assess risk factors associated with in-hospital mortality, multivariable logistic regression analyses were performed. The median age of the study population was 71 years. Ventilator-associated pneumonia was 76.1% of cases, and the median length of ICU stay before the first isolation of S. maltophilia was 15 days. The overall in-hospital mortality rate was 82.1%, and factors independently associated with mortality were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00-1.09; P=0.046), Sequential Organ Failure Assessment (SOFA) score (OR, 1.21; 95%; CI, 1.02-1.43; P=0.025), corticosteroid use (OR, 4.19; 95% CI, 1.26-13.91; P=0.019), and polymicrobial infection (OR, 95% CI 0.07-0.69). However, the impact of appropriate antibiotic therapy on mortality was insignificant. In a subgroup of patients who received appropriate antibiotic therapy (n=58), antibiotic treatment modality-related variables, including combination or empirical therapy, also showed no significant association with survival. Patients with S. maltophilia pneumonia in ICU have high mortality rates. Older age, higher SOFA score, and corticosteroid use were independently associated with increased in-hospital mortality, whereas polymicrobial infection was associated with lower mortality. The effect of appropriate antibiotic therapy on prognosis was insignificant.

Pneumocystis jirovecii pneumonia in intensive care units: a multicenter study by ESGCIP and EFISG.

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic, life-threatening disease commonly affecting immunocompromised patients. The distribution of predisposing diseases or conditions in critically ill patients admitted to intensive care unit (ICU) and subjected to diagnostic work-up for PJP has seldom been explored. The primary objective of the study was to describe the characteristics of ICU patients subjected to diagnostic workup for PJP. The secondary objectives were: (i) to assess demographic and clinical variables associated with PJP; (ii) to assess the performance of Pneumocystis PCR on respiratory specimens and serum BDG for the diagnosis of PJP; (iii) to describe 30-day and 90-day mortality in the study population. Overall, 600 patients were included in the study, of whom 115 had presumptive/proven PJP (19.2%). Only 8.8% of ICU patients subjected to diagnostic workup for PJP had HIV infection, whereas hematological malignancy, solid tumor, inflammatory diseases, and solid organ transplants were present in 23.2%, 16.2%, 15.5%, and 10.0% of tested patients, respectively. In multivariable analysis, AIDS (odds ratio [OR] 3.31; 95% confidence interval [CI] 1.13-9.64, p = 0.029), non-Hodgkin lymphoma (OR 3.71; 95% CI 1.23-11.18, p = 0.020), vasculitis (OR 5.95; 95% CI 1.07-33.22, p = 0.042), metastatic solid tumor (OR 4.31; 95% CI 1.76-10.53, p = 0.001), and bilateral ground glass on CT scan (OR 2.19; 95% CI 1.01-4.78, p = 0.048) were associated with PJP, whereas an inverse association was observed for increasing lymphocyte cell count (OR 0.64; 95% CI 0.42-1.00, p = 0.049). For the diagnosis of PJP, higher positive predictive value (PPV) was observed when both respiratory Pneumocystis PCR and serum BDG were positive compared to individual assay positivity (72% for the combination vs. 63% for PCR and 39% for BDG). Cumulative 30-day mortality and 90-day mortality in patients with presumptive/proven PJP were 52% and 67%, respectively. PJP in critically ill patients admitted to ICU is nowadays most encountered in non-HIV patients. Serum BDG when used in combination with respiratory Pneumocystis PCR could help improve the certainty of PJP diagnosis.

The Effects of Early Rehabilitation and Diaphragm Kinesiotaping on Diaphragm Muscle Thickness in Patients with Severe COVID-19 Pneumonia in the Intensive Care Unit

Objective The efficacy of early rehabilitation in patients in the intensive care unit is apparent. However, it is still unclear in COVID-19 patients. Also, the effects of diaphragm kinesiotaping on outcomes and muscle thickness were not shown previously. Thus, we aimed to investigate the efficacy of rehabilitation and diaphragm kinesiotaping in patients with severe COVID-19 pneumonia by evaluating with the ultrasonography of the diaphragm.&#x0D; Methods Patients with severe COVID-19 pneumonia in intensive care unit requiring high flow oxygen therapy included in the study. Patients with severe COVID-19 pneumonia in intensive care unit requiring high flow oxygen therapy were divided into three groups: Group 1 (n = 22) rehabilitation, group 2 (n = 26) rehabilitation and diaphragm kinesiotaping, Group 3 (n = 24) control group-only standard intensive care unit care. Ultrasonographic measurements of diaphragm thickness and thickening fraction were recorded repeatedly.&#x0D; Results The demographic characteristics, mortality, and length of stay were not different between groups. However, invasive mechanic ventilation requirement and the decrease in diaphragm thickness and thickening fraction values were significantly lower in the diaphragm kinesiotaping group. Baseline diaphragm thickness and thickening fraction values were found to impact invasive mechanic ventilation requirement. Cut-off values for these parameters are 2.85 mm and 37.95%, respectively.&#x0D; Conclusion Baseline diaphragm thickness can be used to predict noninvasive ventilation failure. By the way, the patients who are more likely to develop respiratory failure should receive inspiratory muscle training exercises combined with general rehabilitation principles. Also, diaphragm kinesiotaping should be included in the rehabilitation protocol.

Role of basic infection control practices to curtail the outbreak of ventilator-associated pneumonia caused by Klebsiella pneumoniae in a tertiary care hospital’s trauma intensive care unit

Abstract Background: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care units (ICUs), with high mortality and morbidity rates. Multidrug-resistant pathogens such as Klebsiella pneumoniae and Acinetobacter spp. generally cause VAP. Following an outbreak of VAP due to Klebsiella pneumonia in the trauma ICU (TICU), aggressive infection control practices and effective interventions were instituted to reduce the infection. We summarize the timely implementation and changes in infection control practices that helped reduce VAP incidence in an ICU. Materials and Methods: An intervention was done in the form of the implementation of infection control practices, training of healthcare workers (HCWs), and auditing of practices. Data were collected, and VAP rates were calculated pre- and postintervention. Results: Twenty-four VAP cases/1000 ventilator days due to multidrug-resistant Klebsiella pneumoniae were identified in April–May 2019. After the intervention in the form of training and auditing, there was a change in the behavior of healthcare workers. The hand hygiene compliance rate improved from 33% to 74%. Overall bundle adherence rate in the study period was 62.5%, with semirecumbent position (head end elevation) achieved in 95%, administration of deep vein thrombosis prophylaxis in 56%, peptic ulcer prophylaxis in more than 90% of patients, and daily oral care was achieved in 96% patients. Their VAP rate decreased to 8 cases/1000 ventilator days in June and July 2019 from 24/1000 ventilator days in April–May 2019. The difference was statistically significant (P &lt; 0.05). Conclusions: The VAP rates in TICUs were reduced by strengthening basic infection control practices.

Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain: Prevalence and antibiotics susceptibility pattern.

Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that. It is the most common infection encountered among intubated patients. VAP incidence showed wide variability between countries. To define the VAP incidence in the intensive care unit (ICU) in the central government hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern. The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020. It included adult and adolescent patients (> 14 years old) admitted to the ICU and required intubation and mechanical ventilation. VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score, which considers the clinical, laboratory, microbiological, and radiographic evidence. The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155. Forty-six patients developed VAP during their ICU stay (29.7%). The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period, with a mean age of 52 years ± 20. Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96 ± 6.55. Gram-negative contributed to most VAP cases in our unit, with multidrug-resistant Acinetobacter being the most identified pathogen. The reported VAP rate in our ICU was relatively high compared to the international benchmark, which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

Comparative study of Ultrasound and chest X-ray in diagnosis of pneumonia in Intensive Care Unit

Comparative study of Ultrasound and chest X-ray in diagnosis of pneumonia in Intensive Care Unit

Prevention of pneumonia associated with invasive mechanical ventilation in an intensive care unit

Introduction: ventilator-associated pneumonia represents between 30 % and 70 % of morbidity and mortality rates; its incidence is reflected in increased hospital stay and health care costs for health care institutions. Objective: to determine the nursing care to be applied in adult patients for the prevention of ventilator-associated pneumonia in Intensive Care Units. Methods: the study was carried out by means of a research strategy applied in the search engines and databases Google Scholar, Pubmed, Lilacs, SciELO, Cochrane, CINAHL. After the search, 143040 records were identified; 86 articles that met the search criteria: Healthcare - Associated Pneumoniae, Respiration Artificial associated with nursing care; and inclusion criteria were annexed to the study. Results: the following main activities focused on the prevention of ventilator-associated pneumonia were determined: Strict hand hygiene with alcohol-based products (ABP) before handling the airway. Control and maintenance of pneumotap pressure (&gt; 20 cm H2O). Avoid supine decubitus at 0°, whenever possible. Aspiration of subglottic secretions. Promote the process of early weaning, in a safe manner. Oral hygiene with chlorhexidine (0,12 – 0,2 %). Conclusions: nursing activities decrease the incidence of pneumonia in mechanical ventilation. Continuous training should be promoted in order to provide care validated under scientific evidence