Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).[Background] Data on risk factors for carbapenem-resistant Enterobacterales (CRE) with wider applicability are needed to inform preventive measures and efficient design of randomised trials.[Methods] An international matched case-control-control study was performed in 50 hospitals with high CRE incidence from March 2016 to November 2018 to investigate different aspects of infections caused by CRE (NCT02709408). Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors.[Findings] Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-β-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74–15.53; <0.001), urinary catheter (1.78; 1.03–3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25–3.88; 0.006) and time-dependent (1.04 per day; 1.00–1.07; 0.014); chronic renal failure (2.81; 1.40–5.64; 0.004) and admission from home (0.44; 0.23–0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results.[Interpretation] The main risk factors for CRE infections in hospitals with high incidence included previous colonization, urinary catheter and exposure to broad spectrum antibiotics.The study was funded by the Innovative Medicines Initiative Joint Undertaking (https://www.imi.europa.eu/) under Grant Agreement No. 115620 (COMBACTE-CARE).Peer reviewe

Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

Safety and Effectiveness of Thrombolytic Therapy Compared with Standard Anticoagulation in Subjects with Submassive Pulmonary Embolism

Objective: Thrombolytic and anticoagulation therapy modalities are the possible treatment for submassive pulmonary embolism (PE). However, the indications are still the subject of debate. The aim of the present study was to compare the efficacies of thrombolytic and standard anticoagulation treatment modalities on mortality and also to determine the safety of thrombolytic treatment in subjects with submassive PE. Materials and Methods: Subjects with submassive PE were recruited from the intensive care unit (ICU). Demographic data, comorbidity, bedside echocardiography (ECHO) findings, treatment procedure, treatment-related side effects, and total length of stay in the hospital and ICU were collected. Control ECHO was performed 48 h after the initiation of treatment. Short-term and 1-year mortality rates were recorded. The correlation between the increased risk for major bleeding and thrombolytic treatment was assessed. Results: A total of 54 subjects were enrolled during the study period. The median age of the subjects was 66 (54-73) years. Of the 54 subjects, 18 (33.3%) underwent thrombolytic treatment, and 36 (66.7%) received standard anticoagulation therapy. Short-term and 1-year mortality rates were statistically lower in subjects who received thrombolytic therapy (p=0.02 and p=0.04, respectively). The reduction in mean pulmonary arterial pressure was significantly higher in the thrombolytic treatment group (p< 0.001). Risk for major bleeding was similar between the two. Conclusion: Thrombolytic therapy may reduce the mortality rates in subjects with submassive PE without an increase in the risk of major bleeding

Maximum Inspiratory Pressure: Can it Be A Helpful Parameter for Predicting Successful Weaning in Chronic Obstructive Pulmonary Disease Patients?

Objective: To evaluate the predictive value of maximum inspiratory pressure (MIP) besides rapid and shallow breathing index (RSBI) in the weaning of chronic obstructive pulmonary disease (COPD) patients. Material and Methods: Fifty-six COPD patients with acute exacerbation and type II respiratory failure requiring invasive mechanical ventilation for more than 24 hours were enrolled in this study. Extubation was planned if the patients tolerated pressure support mode for at least two hours and spontaneous breathing during a 30 minutes T-piece trial. Breathing frequency, exhaled tidal volume, rapid and shallow breathing index (RSBI), minute ventilation (Vmin), MIP and vital capacity measurements were recorded prior to extubation. Patients were divided into two groups according to weaning success (WS) and failure. WS was defined as 48 hours of independence from mechanical ventilation after extubation. Results: Although RSBI values between two groups were not significantly different, there were statistically significant differences between the two groups in terms of MIP (30 vs 18 cmH2O; p= 0.008) and Vmin (10.40 vs 8.25; p= 0.032). Patients with a MIP value greater than or equal to 25 cm H2O had greater WS when compared to those with values lower than 25 cm H2O. Conclusion: RSBI alone seems not reliable enough to predict weaning outcome in COPD patients with type II respiratory failure due to acute exacerbation. Supported with MIP, better results may be achieved to predict weaning outcome

Pleural complications and chest tube follow-up in patients with COVID-19

[Abstract Not Available

Turkish translation, cross-cultural adaptation, and assessment of psychometric properties of the Ottawa sitting scale for the intensive care unit survivors

To translate and cross-culturally adapt the Ottawa Sitting Scale (OSS) developed for acute care patients into Turkish and to examine its psychometric properties in intensive care unit (ICU) survivors. After translation process the Turkish version of the scale was adminstered to eighty-one patients aged 39–82 years after discharge from the ICU and videotape was recorded. Two physiotherapists watched the videotaped records during the evaluation and scored. Test-retest reliability was assesed by scoring the same video recordings 15 days after the initial scoring. Correlations of the OSS with Berg Balance Scale (BBS), Functional Independence Measurement (FIM), the ICU length of stay and, total mechanical ventilation duration were assessed for convergent validity. The intra-class correlation coefficient for inter and intra-rater reliability was 0.989–0.994 and 0.998 respectively. The internal consistency was excellent (Cronbach’s α = 0.998). The OSS score was highly correlated with the BBS total score (r = 0.716), the BBS unsupported sitting item score (r = 0.863), and moderately correlated with the total score of the FIM (r = 0.602), the number of days in ICU (r= −0.545), and total mechanical ventilation duration (r = −0.518). The Turkish version of OSS has been found to be valid and reliable in assessment of sitting balance in patients discharged from intensive care unit.Implications For RehabilitationPhysiotherapeutic measurements are crucial and necessary to determine the functional status of the patients.Ottawa Sitting Scale was translated and culturally adapted to Turkish and showed good psychometric propertiesOttawa Sitting Scale is valid and reliable tool to evaluate sitting balance in intensive care unit survivors.Ottawa Sitting Scale can guide clinicians in establishing evaluation and rehabilitation programs for patients discharged from intensive care unit. Physiotherapeutic measurements are crucial and necessary to determine the functional status of the patients. Ottawa Sitting Scale was translated and culturally adapted to Turkish and showed good psychometric properties Ottawa Sitting Scale is valid and reliable tool to evaluate sitting balance in intensive care unit survivors. Ottawa Sitting Scale can guide clinicians in establishing evaluation and rehabilitation programs for patients discharged from intensive care unit.</p