MDR colonization: what \u301s the matter in the perioperative setting?

INTRODUCTION. Multi-Drug-Resistant (MDR) colonization is an actual major issue in intensive care units (ICUs) and perioperative medicine, frequently resulting in life-threatening infections. OBJECTIVES. The aim of this study was to evaluate the post- operative course of patients requiring ICU admission after surgery and to compare MDR colonized patients (pts) undergoing abdominal surgery to non colonized ones. METHODS. We retrospectively analyzed all consecutive patients undergoing surgery in our hospital for a three-month period (July- September 2017) who required admission to our 12-bed-medico- surgical ICU on post-operative day (POD) 0 (Dept Anesthesia and Intensive Care B, Policlinico GB Rossi). We then compared MDR col- onized (rectal and/or pharyngeal swab) patients (MDR+) to non col- onized patients (MDR-) for post operative complications, ICU and hospital length of stay (LOS) and mortality. We also investigated the impact of administered targeted perioperative antibiotic ther- apy compared to empiric antibiotic prophylaxis. RESULTS. 70 pts were included in the study (47 men), median age 67(55-79) years; they underwent either elective (n=57, 81.4%) or emergency (n= 13, 18.6%) surgery; 33 pts (47.1%) were submitted to pancreatic surgery, 15 (21.4%) to intestinal resection, 13 (18.6%) to hepato-biliary surgery, and the rest to other kind of abdominal sur- gery; they were admitted to ICU on POD 0 for scheduled (n =52, 74,3%) or unscheduled (n= 18, 25,7%) intensive PO monitoring. These latter were admitted because of surgical length (10, 4.9%), sep- tic episode (4, 5.7%), intraoperative hypotension (2, 2.9%) , intraoper- ative hemorrage (2, 2.9%). 11 pts were MDR+ pre operatively (15,7%), 4 of whom were either Klebsiella Pneumoniae Carbapenemasis Producer or Vancomycin Re- sistant Enterococcus (VRE) colonized and 7 pts were Extended Spectrum Beta Lactamase (ESBL) Escherichia Coli colonized. Both ICU and hospital LOS were significantly higher in MDR+ compared to MDR- (16\ub123 vs 2\ub13 and 37\ub125 vs 22\ub116, respectively, p < 0.05). Hospital mortality occured in 4 patients, all MDR+ (p< 0.001). Postop- erative complication incidence and type did not significantly differ between the two groups. 4 MDR+ patients (5.7%) received targeted pre-operative antibiotic therapy compared to standard prophylaxis but this did not influence their outcome (small number). CONCLUSIONS. Pre-operative surveillance swab positivity correlates with both ICU and hospital LOS and post-operative mortality, no matter swap and surgical sites. Targeted antibiotic therapy may be routinely used to improve patients' outcome. More studies are needed to further investigate the possibile therapeutic options in MDR+ patients undergoing surgery

Analysis of P(v-a)CO2/C(a-v)O2 Ratio and Other Perfusion Markers in a Population of 98 Pediatric Patients Undergoing Cardiac Surgery

Background: The so-called Low Cardiac Output Syndrome (LCOS) is one of the most common complications in pediatric patients with congenital heart disease undergoing corrective surgery. LCOS requires high concentrations of inotropes to support cardiac contractility and improve cardiac output, allowing for better systemic perfusion. To date, serum lactate concentrations and central venous oxygen saturation (ScVO2) are the most commonly used perfusion markers, but they are not completely reliable in identifying a state of global tissue hypoxia. The study aims to evaluate whether the venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio [P(v-a)CO2/C(a-v)O-2] can be a good index to predict the development of LCOS in the aforementioned patients, so as to treat it promptly. Methods: This study followed a population of 98 children undergoing corrective cardiac surgery from June 2018 to October 2020 at the Department of Cardiac Surgery of University Hospital Integrated Trust and their subsequent admission at the Postoperative Cardiothoracic Surgery Intensive Care Unit. During the study, central arterial and venous blood gas analyses were carried out before and after cardiopulmonary bypass (CPB) (pre-CPB and post-CPB), at admission to the intensive care unit, before and after extubation, and at any time of instability or modification of the patient's clinical and therapeutic conditions. Results: The data analysis shows that 46.9% of the children developed LCOS (in line with the current literature) but that there is no statistically significant association between the P(v-a)CO2/C(a-v)O-2 ratio and LCOS onset. Despite the limits of statistical significance, however, a 31% increase in the ratio emerged from the pre-CPB phase to the post-CPB phase when LCOS is present. Conclusions: This study confirms a statistically significant association between the most used markers in adult patients (serum lactate concentration, ScVO2, and oxygen extraction ratio-ERO2) measured in the pre-CPB phase and the incidence of LCOS onset, especially in patients with hemodynamic instability before surgery