Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Venous thromboembolism in centenarians: Findings from the RIETE registry

BACKGROUND: The balance between the efficacy and safety of anticoagulant therapy in patients aged ≥100years receiving anticoagulant therapy for venous thromboembolism (VTE) is uncertain. METHODS: We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the rate of VTE recurrences, bleeding events, and mortality appearing during the course of anticoagulant therapy in VTE patients aged ≥100years. RESULTS: Of 61,173 patients enrolled in RIETE as of January 2016, 47 (0.08%) were aged ≥100years. Of these, 10 (21%) were men, 21 (45%) presented with pulmonary embolism (PE), and 26 with deep vein thrombosis alone. Overall, 35 patients (74%) had severe renal insufficiency, 14 (30%) chronic heart failure, 30 (64%) anemia, 16 (34%) were taking antiplatelets, and 6 (13%) corticosteroids or non-steroidal anti-inflammatory drugs. Most patients (95%) were treated initially with low-molecular-weight heparin (LMWH) (mean daily dose, 168±42IU/kg). Then, 14 (30%) switched to vitamin K antagonists and 29 (62%) kept receiving long-term LMWH therapy (mean, 148±51IU/kg/day). During the course of anticoagulant therapy (mean duration, 139days), mortality was high (15/47; 32%). Two patients died of PE (initial PE one, recurrent PE one) and 5 (11%) had minor bleeding, but no major bleeding was reported. CONCLUSIONS: Among patients with acute VTE aged ≥100years, the risk of VTE recurrences during the course of anticoagulation outweighed the risk of bleeding. Our data suggest the use of standard anticoagulant therapy in this patient population, even if they have severe renal insufficiency.publisher: Elsevier articletitle: Venous thromboembolism in centenarians: Findings from the RIETE registry journaltitle: European Journal of Internal Medicine articlelink: http://dx.doi.org/10.1016/j.ejim.2016.07.025 content_type: article copyright: © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.status: publishe

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ExCITE Project : A Review of Forty-Two Months of Robotic Telepresence Technology

This article reports on the EU project ExCITE with specific focus on the technical development of the telepresence platform over a period of 42 months. The aim of the project was to assess the robustness and validity of the mobile robotic telepresence (MRP) system Giraff as a means to support elderly people and to foster their social interaction and participation. Embracing the idea of user-centered product refinement, the robot was tested over long periods of time in real homes. As such, the system development was driven by a strong involvement of elderly people and their caregivers but also by technical challenges associated with deploying the robot in real-world contexts. The results of the 42-months’ long evaluation is a system suitable for use in homes rather than a generic system suitable, for example, in office environments.Funding Agency:EU AAL-2009-2-125ExCIT

ExCITE project: A review of forty-two months of robotic telepresence technology evolution

This article reports on the EU project ExCITE with specific focus on the technical development of the telepresence platform over a period of 42 months. The aim of the project was to assess the robustness and validity of the mobile robotic telepresence (MRP) system Giraff as a means to support elderly people and to foster their social interaction and participation. Embracing the idea of user-centered product refinement, the robot was tested over long periods of time in real homes. As such, the system development was driven by a strong involvement of elderly people and their caregivers but also by technical challenges associated with deploying the robot in real-world contexts. The results of the 42-months’ long evaluation is a system suitable for use in homes rather than a generic system suitable, for example, in office environments