Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort

Objectives:We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged-infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies.Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries.Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT(> MIC) (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving beta-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of >= 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025].Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infections

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

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

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Kompleksowa ocena zagrożenia środowiska przez eksploatację pojazdów samochodowych

The paper presents authors' views about comprehensive evaluation of the environmental hazard caused by the operation of automotive vehicles. Methods of analysing the emissions of environmental pollutants and the energy input at the stage of production and distribution of energy carriers (from the source of obtaining an energy carrier to the fuel tank, "Well-to-Tank," abbreviated as WtT) and at the stage of vehicle use (from the fuel tank to the vehicle wheel, "Tank-to-Wheel," abbreviated as TtW) have been described. Results of the research carried out in compliance with the Eco-indicator 99 procedures and with the Swiss Ecological Scarcity Method, also known as the Ecoscarcity or UBP.06 method, have been analysed. In the recapitulation, the authors have criticised the existing methods of assessment of the harmful environmental impact of motorisation and proposed an original system of indicators that would characterise, in terms of pollutant emissions, the energy-related and environmental impacts exerted by motor transport at the stages of the production and distribution of energy carriers and the use of automotive vehicles.W pracy przedstawiono poglądy na temat kompleksowej oceny zagrożenia środowiska przez eksploatację pojazdów samochodowych. Przedstawiono metody analizy emisji zanieczyszczeń szkodliwych dla środowiska oraz nakładów energetycznych na etapach wytwarzania i dystrybucji nośników energii (od źródła pozyskiwania nośnika energii do zbiornika paliwa Well-to-Tank, w skrócie WtT) oraz użytkowania pojazdów (od zbiornika paliwa do koła pojazdu Tank-to-Wheel, w skrócie TtW). Przeanalizowano wyniki badań zgodnie z procedurami Eco-inicator 99 oraz szwajcarskiej metody ekologicznego deficytu (ang. Swiss Ecological Scarcity Method), nazywanej inaczej metodą Ecoscarcity lub UBP'06. W podsumowaniu autorzy dokonali krytyki istniejących metod kompleksowej oceny szkodliwości motoryzacji dla środowiska i zaproponowali oryginalny system wskaźników, charakteryzujących efekty energetyczne i ekologiczne ze względu na emisję zanieczyszczeń, związane z motoryzacją na etapach wytwarzania i dystrybucji nośników energii oraz użytkowania pojazdów samochodowych

Correlation investigations into pollutant emission and the operational states of compression-ignition engines in dynamic tests

This study investigates the correlation dependences between pollutant emission intensity and the engine operational states determining these properties, in various conditions, both in relation to measurements of engine operational states and their dynamic nature. The research was carried out in a variety of dynamic tests. Investigations into the correlations of processes occurring in combustion engines make it possible to assess the impact of one process on another and the relationship between the various processes. In general, it was found that similar dependencies occur for carbon monoxide and hydrocarbons, but were often substantially different for nitrogen oxides

Kompleksowa ocena oddziaływania na środowisko procesu przygotowania paliw bioetanolowych pierwszej i drugiej generacji

The paper provides some information regarding comprehensive evaluation of the environmental hazard caused by the operation of automotive vehicles with internal combustion (IC) engines powered by bioethanol fuel. It presents the assumptions made for the life cycle assessment (LCA) of the environmental impact of fuel, carried out according to the Well-to-Wheel (WtW) method, where the fuel preparation stage, including the acquisition of raw materials as well as the production, transport, and distribution processes, and the vehicle operation stage are taken into account. The technologies and raw materials used to make bioethanol of the first and second generation have been presented and compared with each other. Results of research on greenhouse gas (GHG) emissions and non-renewable energy input in the process of preparation of bioethanol fuels of the first and second generation have been analysed. Nine versions of the production process, differing from each other in the process methods used and the types of the biomass processed, have been examined.W pracy przedstawiono informacje na temat kompleksowej oceny zagrożenia środowiska przez eksploatację pojazdów samochodowych z silnikami spalinowymi zasilanymi paliwem bioetanolowym. Przedstawiono założenia analizy ekologicznej cyklu istnienia paliwa według metody Well-to-Wheel, uwzględniającej etap przygotowania paliwa, składający się z pozyskiwania surowców, wytwarzania, transportu i dystrybucji, oraz etap użytkowania pojazdów. Zaprezentowano i porównano technologie oraz surowce stosowane w wytwarzaniu bioetanolu pierwszej i drugiej generacji. Przeanalizowano wyniki badań emisji gazów cieplarnianych oraz zużycia energii ze źródeł nieodnawialnych w procesie przygotowania paliw bioetanolowych pierwszej i drugiej generacji. Rozważono dziewięć wariantów przebiegu procesu wytwarzania, różniących się zastosowaną technologią i rodzajem przetwarzanej biomasy

Ocena cyklu istnienia samochodu z silnikiem o zapłonie samoczynnym ze względu na stosowane paliwa

The paper presents life cycle assessment (LCA) of motor vehicles with compression ignition engines powered with diesel oil, methyl esters of palm, rape, and soybean oils and methyl esters of used vegetable oil. The scope of the analysis included the environmental impact of the processes related to fuel preparation as well as to vehicle manufacturing, operation and disposal when worn out. A balance of the emission of greenhouse gases (GHG) and the consumption of energy obtained from non-renewable sources was compiled. The environmental impact was assessed with the use of the Eco–indicator 99 method. The results obtained have revealed significant differences in environmental loading by specific fuels. In the case of biofuels, a key role is played by the type of the biomass used for the production of fuel, especially by the method of cultivation of the plants to be used as the biomass.W pracy przedstawiono ocenę cyklu istnienia samochodu z silnikiem o zapłonie samoczynnym zasilanym olejem napędowym, estrami metylowymi olejów: palmowego, rzepakowego i sojowego oraz estrami metylowymi zużytego oleju roślinnego. W analizie uwzględniono między innymi oddziaływanie na środowisko procesów związanych z przygotowaniem paliwa, wytwarzaniem samochodu, jego eksploatacją i zagospodarowaniem po zużyciu. Zbilansowano emisję gazów cieplarnianych i zużycie energii ze źródeł nieodnawialnych. Oceny wpływu dokonano metodą Eco–indicator 99. Otrzymane wyniki pozwalają stwierdzić znaczne różnice w obciążeniu środowiska dla poszczególnych paliw. Kluczową rolę w przypadku biopaliw odgrywa rodzaj biomasy wykorzystywanej do wytwarzania paliwa, a w szczególności sposób jej uprawy