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Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection
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作者 Marie Dejonckheere Massimo Antonelli +24 位作者 Kostoula Arvaniti Koen blot Ben CreaghBrown Dylan Wde Lange Jan De Waele Mieke Deschepper Yalim Dikmen George Dimopoulos Christian Eckmann Guy Francois Massimo Girardis Despoina Koulenti Sonia Labeau Jeffrey Lipman Fernando Lipovestky Emilio Maseda Philippe Montravers Adam Mikstacki JoseArtur Paiva Cecilia Pereyra Jordi Rello JeanFrancois Timsit Dirk Vogelaers stijn blot the Abdominal Sepsis Study(AbSeS)group on behalf of the Trials Group of the European Society of Intensive Care Medicine 《Journal of Intensive Medicine》 CSCD 2024年第1期81-93,共13页
Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)p... Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)presence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal infection.This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality.Methods:This was a secondary analysis of an international observational study(“AbSeS”)investigating ICU patients with intra-abdominal infection.Only patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU.Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95%confidence interval(CI).Results:The overall mortality was 35.2%(n=58).The independent risk factors for mortality included older age(OR=1.03,95%CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95%CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95%CI:3.8 to 23.9,P<0.001)or after the implementation of additional source control interventions within the first week(OR=4.0,95%CI:1.3 to 12.2,P=0.013).Gramnegative bacteria were most frequently isolated(n=58,49.2%)without clinically relevant differences in microbial etiology between survivors and non-survivors.Conclusions:In pancreatic infection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome.In this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse peritonitis,and severity of disease expression,were not associated with an increased mortality risk. 展开更多
关键词 Pancreatic infection Intensive care unit MORTALITY Intra-abdominal infection SEPSIS
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Severe Candida infections in critically ill patients with COVID-19
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作者 Despoina Koulenti Marios Karvouniaris +5 位作者 Elisabeth Paramythiotou Nikolaos Koliakos Nikolaos Markou Paschalis Paranos Joseph Meletiadis stijn blot 《Journal of Intensive Medicine》 CSCD 2023年第4期291-297,共7页
The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019(COVID-19)during the pandemic.Candidemia was the most frequently re... The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019(COVID-19)during the pandemic.Candidemia was the most frequently reported invasive fungal co-infection.The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients.Additionally,Candida invasive infections in COVID-19 patients were more often linked to invasive procedures(e.g.,invasive mechanical ventilation or renal replacement therapy)during the intensive care stay and the severity of illness rather than more“classic”risk factors present in patients without COVID-19(e.g.,underlying diseases and prior hospitalization).Moreover,apart from the increased incidence of candidemia during the pandemic,a worrying rise in fluconazole-resistant strains was reported,including a rise in the multidrug-resistant Candida auris.Regarding outcomes,the development of invasive Candida co-infection had a negative impact,increasing morbidity and mortality compared to non-co-infected COVID-19 patients.In this narrative review,we present and critically discuss information on the diagnosis and management of invasive fungal infections caused by Candida spp.in critically ill COVID-19 patients. 展开更多
关键词 Critical illness COVID-19 ANTIFUNGALS CANDIDIASIS Candida spp. Candida auris
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Prevention of ventilator-associated pneumonia through care bundles:A systematic review and meta-analysis
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作者 Raquel Martinez-Reviejo Sofia Tejada +7 位作者 Miia Jansson Alfonsina Ruiz-Spinelli Sergio Ramirez-Estrada Duygu Ege Tarsila Vieceli Bert Maertens stijn blot Jordi Rello 《Journal of Intensive Medicine》 CSCD 2023年第4期352-364,共13页
Background Ventilator-associated pneumonia(VAP)represents a common hospital-acquired infection among mechanically ventilated patients.We summarized evidence concerning ventilator care bundles to prevent VAP.Methods A ... Background Ventilator-associated pneumonia(VAP)represents a common hospital-acquired infection among mechanically ventilated patients.We summarized evidence concerning ventilator care bundles to prevent VAP.Methods A systematic review and meta-analysis were performed.Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation(MV)for at least 48 h were considered for inclusion.Outcomes of interest were the number of VAP episodes,duration of MV,hospital and intensive care unit(ICU)length of stay,and mortality.A systematic search was conducted in the MEDLINE,the Cochrane Library,and the Web of Science between 1985 and 2022.Results are reported as odds ratio(OR)or mean difference(MD)with 95%confidence intervals(CI).The PROSPERO registration number is CRD42022341780.Results Thirty-six studies including 116,873 MV participants met the inclusion criteria.A total of 84,031 participants underwent care bundles for VAP prevention.The most reported component of the ventilator bundle was head-of-bed elevation(n=83,146),followed by oral care(n=80,787).A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles,compared with the non-care bundle group(OR=0.42,95%CI:0.33,0.54).Additionally,the implementation of care bundles decreased the duration of MV(MD=−0.59,95%CI:−1.03,−0.15)and hospital length of stay(MD=−1.24,95%CI:−2.30,−0.18)in studies where educational activities were part of the bundle.Data regarding mortality were inconclusive.Conclusions The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs.Their application in combination with educational activities seemed to improve clinical outcomes. 展开更多
关键词 Hospital-acquired pneumonia Ventilator bundle PREVENTION Quality improvement intervention
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