Impact of chronic obstructive pulmonary disease on incidence, microbiology and outcome of ventilator-associated lower respiratory tract infections

Objectives: To determine the impact of chronic obstructive pulmonary disease (COPD) on incidence, microbiology, and outcomes of ventilator-associated lower respiratory tract infections (VA-LRTI). Methods: Planned ancillary analysis of TAVeM study, including 2960 consecutive adult patients who received invasive mechanical ventilation (MV) > 48 h. COPD patients (n = 494) were compared to non-COPD patients (n = 2466). The diagnosis of ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) was based on clinical, radiological and quantitative microbiological criteria. Results: No significant difference was found in VAP (12% versus 13%, p = 0.931), or VAT incidence (13% versus 10%, p = 0.093) between COPD and non-COPD patients. Among patients with VA-LRTI, Escherichia coli and Stenotrophomonas maltophilia were significantly more frequent in COPD patients as compared with non-COPD patients. However, COPD had no significant impact on multidrug-resistant bacteria incidence. Appropriate antibiotic treatment was not significantly associated with progression from VAT to VAP among COPD patients who developed VAT, unlike non-COPD patients. Among COPD patients, patients who developed VAT or VAP had significantly longer MV duration (17 days (9–30) or 15 (8–27) versus 7 (4–12), p < 0.001) and intensive care unit (ICU) length of stay (24 (17–39) or 21 (14–40) versus 12 (8– 19), p < 0.001) than patients without VA-LRTI. ICU mortality was also higher in COPD patients who developed VAP (44%), but not VAT(38%), as compared to no VA-LRTI (26%, p = 0.006). These worse outcomes associated with VA-LRTI were similar among non-COPD patients. Conclusions: COPD had no significant impact on incidence or outcomes of patients who developed VAP or VAT.publishersversionpublishe

Intérêt de l'utilisation du bas débit ("low flow") en anesthésie volatile chez le chien

L'anesthésie volatile peut être pratiquée en bas débit, en appliquant un débit de gaz frais compris entre 4 et 22 ml/kg/min. La première partie est une revue de la pratique de l'anesthésie volatile vétérinaire. Elle débute par un rappel historique, puis par la description des différents agents anesthésiques volatils, et rappelle le fonctionnement des appareils d'anesthésie et des différents circuits patients. L'anesthésie volatile peut être pratiquée en bas débit, en appliquant un débit de gaz frais compris entre 4 et 22 mL/kg/min. Cette technique particulière est développée en seconde partie, en précisant tout d'abord son principe, puis en s'attardant sur les avantages et inconvénients qu'elle implique. Enfin, l'exercice clinique du bas débit sera détaillé.NANTES-Ecole Nat.Vétérinaire (441092302) / SudocSudocFranceF

Législatives 2022 : bilan sévère pour les dissidents

Les candidats sans coalition ont pu, par la dispersion des voix, empêcher leur camp de se qualifier au second tour du scrutin

Législatives 2022 : bilan sévère pour les dissidents

Les candidats sans coalition ont pu, par la dispersion des voix, empêcher leur camp de se qualifier au second tour du scrutin

Législatives 2022 : bilan sévère pour les dissidents

Les candidats sans coalition ont pu, par la dispersion des voix, empêcher leur camp de se qualifier au second tour du scrutin

Antibiotic Prescriptions in Critically Ill Patients with Bloodstream Infection Due to ESBL-Producing Enterobacteriaceae: Compliance with the French Guidelines for the Treatment of Infections with Third-Generation Cephalosporin-Resistant Enterobacteriaceae—A Multicentric Retrospective Cohort Study

National and international guidelines were recently published regarding the treatment of Enterobacteriaceae resistant to third-generation cephalosporins infections. We aimed to assess the implementation of the French guidelines in critically ill patients suffering from extended-spectrum β-lactamase-producing Enterobacteriaceae bloodstream infection (ESBL-E BSI). We conducted a retrospective observational cohort study in the ICU of three French hospitals. Patients treated between 2018 and 2022 for ESBL-E BSI were included. The primary assessment criterion was the proportion of adequate empirical carbapenem prescriptions, defined as prescriptions consistent with the French guidelines. Among the 185 included patients, 175 received an empirical anti-biotherapy within 24 h of ESBL-E BSI onset, with a carbapenem for 100 of them. The proportion of carbapenem prescriptions consistent with the guidelines was 81%. Inconsistent prescriptions were due to a lack of prescriptions of a carbapenem, while it was recommended in 25% of cases. The only factor independently associated with adequate empirical carbapenem prescription was ESBL-E colonization (OR: 107.921 [9.303–1251.910], p = 0.0002). The initial empirical anti-biotherapy was found to be appropriate in 83/98 patients (85%) receiving anti-biotherapy in line with the guidelines and in 56/77 (73%) patients receiving inadequate anti-biotherapy (p = 0.06). Our results illustrate the willingness of intensivists to spare carbapenems. Promoting implementation of the guidelines could improve the proportion of initial appropriate anti-biotherapy in critically ill patients with ESBL-E BSI

Microorganisms isolated in patients with ventilator-associated pneumonia.

<p>Microorganisms isolated in patients with ventilator-associated pneumonia.</p

Patient characteristics at ICU admission.

<p>Patient characteristics at ICU admission.</p

Patient outcomes.

<p>Patient outcomes.</p