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

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Radiotherapy of brain metastases from non-small cell lung cancer

Brain metastases risk at the time of diagnosis or during the course of disease is high in non-small cell lung cancer (NSCLC). Even the incidence of brain metastases has increased in recent years, due to detection of smaller asymptomatic lesions with MRI screening as well as improved survival as a consequence of developments in systemic therapies. In the last decade, there have been many trials in the management of NSCLC patients with brain metastases, questioning the role of adjuvant whole brain radiotherapy (WBRT) after surgery or stereotactic radiosurgery (SRS), WBRT, compared to best supportive care in patients not amenable to surgery, aggressive local therapies in solitary brain metastases, postsurgical cavity SRS, SRS in non-oligometastatic patients, cranial radiotherapy in patients with driver mutations, thyrosine kinase inhibitors, immune check point inhibitors and the impact of therapies on neurocognitive functions and quality of life. The main objective of this review is to provide an update on current trends in radiotherapy in the management of newly diagnosed brain metastases from NSCLC

Flow cytometric analysis of depletion and recovery kinetics of T cell subsets in rats after total-body-irradiation: Footprints of treg-augmented immunosuppression

OBJECTIVE Total-body-irradiation (TBI) causes significant immunosuppression, but different lymphocyte subsets have various radiosensitivities. Regulatory T (Treg) cells, which are crucial for self-tolerance and are potent sup-pressors of antitumor immunity are found to be resistant to radiotherapy (RT) compared with T helper (Th) cells and Cytotoxic-T lymphocytes (CTL) in both in-vivo and in-vitro studies, but the data on this subject is relatively scarce. Besides, recent developments in the context of combination of immunotherapy with RT compelled us to revisit the concept of radiation-induced quantitative and functional changes in lymphocyte subsets by flow cytometry using animal models with the aim of transitioning the findings to clinical studies. METHODS Twenty-three Swiss albino rats were exposed to TBI at a single fraction of 5 Gy. Immediately prior to irradiation, at time points of 1 day and 7 and 14 days post-TBI, flow cytometric analyses were performed. RESULTS There has been statistically significant decrease in all T lymphocyte subsets at 1, 7 and 14 days post-TBI. The decrease in Th subset was more pronounced compared to CTL. Baseline CD4+/CD8+ ratio was 0.85 which significantly decreased to 0.29 1 day post-TBI, then increased steadily in subsequent measurements and reached near normal. The number of Treg cells markedly declined to 6.5% of baseline value one day after TBI, and then steadily increased during the follow-up. By the end of 14 days, it reached half of its baseline value. CONCLUSION Radiation-induced immunosuppression may be explained not only by the decrease in lymphocyte cell number but also by the relative increase in Treg cell number because the higher regenerative capacity may present an additional role. © 2018, Turkish Society for Radiation Oncology