Incremento da depuração renal em pacientes gravemente enfermos: Incidência, fatores associados e efeitos no tratamento com vancomicina

Objective: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the efects on vancomycin concentrations and dosing in a series of intensive care unit patients. Methods: We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m2), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered. Results: Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p>0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations. Conclusions: In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.Facultad de Ciencias Médica

Incremento da depuração renal em pacientes gravemente enfermos: Incidência, fatores associados e efeitos no tratamento com vancomicina

Objective: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the efects on vancomycin concentrations and dosing in a series of intensive care unit patients. Methods: We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m2), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered. Results: Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p>0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations. Conclusions: In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.Facultad de Ciencias Médica

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Incremento da depuração renal em pacientes gravemente enfermos: incidência, fatores associados e efeitos no tratamento com vancomicina

Objetivo: Foi descrito um incremento da depura&#231;&#227;o renal em alguns grupos de pacientes gravemente enfermos, o qual pode induzir &#224; elimina&#231;&#227;o de concentra&#231;&#245;es de f&#225;rmacos por filtra&#231;&#227;o glomerular aqu&#233;m do ideal, principalmente no caso de antibi&#243;ticos. Sua ocorr&#234;ncia e os fatores determinantes t&#234;m sido pouco estudados. Nossos objetivos foram determinar a incid&#234;ncia e os fatores associados ao incremento da depura&#231;&#227;o renal, bem como seus efeitos nas concentra&#231;&#245;es e na posologia de vancomicina em uma s&#233;rie de pacientes em unidade de terapia intensiva. M&#233;todos: Estudamos, de forma prospectiva, 363 pacientes admitidos durante 1 ano em uma unidade de terapia intensiva cl&#237;nico-cir&#250;rgica. Foram exclu&#237;dos pacientes que tivessem n&#237;vel de creatinina s&#233;rica >1,3mg/dL. A depura&#231;&#227;o de creatinina foi calculada a partir da coleta de urina de 24 horas. Os pacientes foram agrupados segundo a presen&#231;a de incremento da depura&#231;&#227;o renal (depura&#231;&#227;o de creatinina >120mL/min/1,73m2), e os poss&#237;veis fatores de risco foram analisados por meio de an&#225;lise bivariada e log&#237;stica. Em pacientes tratados com vancomicina, foram registradas a posologia e as concentra&#231;&#245;es plasm&#225;ticas. Resultados: O incremento da depura&#231;&#227;o renal esteve presente em 103 pacientes (28%), os quais eram mais jovens (48&#177;15 versus 65&#177;17 anos; p<0,0001), tinham mais frequentemente admiss&#245;es obst&#233;tricas (16 versus 7%; p=0,0006) e por trauma (10 versus 3%; p=0,016), e menos comorbidades. Os &#250;nicos determinantes independentes para o desenvolvimento de incremento da depura&#231;&#227;o renal foram idade (OR=0,95; IC95%=0,93-0,96; p<0,0001;) e aus&#234;ncia de diabetes (OR 0,34; IC95% 0,12-0,92; p=0,03). Doze dos 46 pacientes que receberam vancomicina tinham incremento da depura&#231;&#227;o renal e, apesar das doses elevadas, tinham concentra&#231;&#245;es plasm&#225;ticas de vancomicina mais baixas. Conclus&#245;es: Nessa coorte de pacientes gravemente enfermos, foi frequente o achado de incremento da depura&#231;&#227;o renal. Idade e aus&#234;ncia de diabetes foram os &#250;nicos determinantes independentes. Assim, pacientes jovens e previamente saud&#225;veis podem necessitar de doses mais elevadas de vancomicina

Field and classroom initiatives for portable sequence-based monitoring of dengue virus in Brazil

This work was supported by Decit, SCTIE, Brazilian Ministry of Health, Conselho Nacional de Desenvolvimento Científico - CNPq (440685/ 2016-8, 440856/2016-7 and 421598/2018-2), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES - (88887.130716/2016-00), European Union’s Horizon 2020 Research and Innovation Programme under ZIKAlliance Grant Agreement (734548), STARBIOS (709517), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ (E-26/2002.930/2016), International Development Research Centre (IDRC) Canada (108411-001), European Union’s Horizon 2020 under grant agreements ZIKACTION (734857) and ZIKAPLAN (734548).Fundação Ezequiel Dias. Laboratório Central de Saúde Pública do Estado de Minas Gerais. Belo Horizonte, MG, Brazil / Latin American Genomic Surveillance Arboviral Network.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil / Latin American Genomic Surveillance Arboviral Network.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil Latin American Genomic Surveillance Arboviral Network.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Leônidas e Maria Deane. Laboratório de Ecologia de Doenças Transmissíveis na Amazônia. Manaus, AM, Brazil.Secretaria de Saúde do Estado de Mato Grosso do Sul. Laboratório Central de Saúde Pública. Campo Grande, MS, Brazil.Fundação Ezequiel Dias. Laboratório Central de Saúde Pública do Estado de Minas Gerais. Belo Horizonte, MG, Brazil.Laboratório Central de Saúde Pública Dr. Giovanni Cysneiros. Goiânia, GO, Brazil.Laboratório Central de Saúde Pública Professor Gonçalo Moniz. Salvador, BA, Brazil.Secretaria de Saúde do Estado da Bahia. Salvador, BA, Brazil.Laboratório Central de Saúde Pública Dr. Milton Bezerra Sobral. Recife, PE, Brazil.Laboratório Central de Saúde Pública do Estado de Mato Grosso. Cuiabá, MT, Brazil.Laboratório Central de Saúde Pública do Distrito Federal. Brasília, DF, Brazil.Fundação Ezequiel Dias. Laboratório Central de Saúde Pública do Estado de Minas Gerais. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Coordenação Geral dos Laboratórios de Saúde Pública. Brasília, DF, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Coordenação Geral dos Laboratórios de Saúde Pública. Brasília, DF, Brazil.Organização Pan-Americana da Saúde / Organização Mundial da Saúde. Brasília, DF, Brazil.Organização Pan-Americana da Saúde / Organização Mundial da Saúde. Brasília, DF, Brazil.Organização Pan-Americana da Saúde / Organização Mundial da Saúde. Brasília, DF, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde Coordenação Geral das Arboviroses. Brasília, DF, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde Coordenação Geral das Arboviroses. Brasília, DF, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde Coordenação Geral das Arboviroses. Brasília, DF, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde Coordenação Geral das Arboviroses. Brasília, DF, Brazil.Fundação Hemocentro de Ribeirão Preto. Ribeirão Preto, SP, Brazil.Gorgas Memorial Institute for Health Studies. Panama, Panama.Universidade Federal da Bahia. Vitória da Conquista, BA, Brazil.Laboratorio Central de Salud Pública. Asunción, Paraguay.Fundação Oswaldo Cruz. Bio-Manguinhos. Rio de Janeiro, RJ, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Coordenação Geral dos Laboratórios de Saúde Pública. Brasília, DF, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, BrazilFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, BrazilMinistério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Laboratório Central de Saúde Pública do Estado de Mato Grosso do Sul. Campo Grande, MS, Brazil.Laboratório Central de Saúde Pública do Estado de Mato Grosso do Sul. Campo Grande, MS, Brazil.Instituto de Investigaciones en Ciencias de la Salud. San Lorenzo, Paraguay.Secretaria de Estado de Saúde de Mato Grosso do Sul. Campo Grande, MS, Brazil.Fundação Oswaldo Cruz. Campo Grande, MS, Brazil.Fundação Hemocentro de Ribeirão Preto. Ribeirão Preto, SP, Brazil.Laboratório Central de Saúde Pública Dr. Giovanni Cysneiros. Goiânia, GO, Brazil.Laboratório Central de Saúde Pública Dr. Giovanni Cysneiros. Goiânia, GO, Brazil.Laboratório Central de Saúde Pública Professor Gonçalo Moniz. Salvador, BA, Brazil.Laboratório Central de Saúde Pública Dr. Milton Bezerra Sobral. Recife, PE, Brazil.Laboratório Central de Saúde Pública do Distrito Federal. Brasília, DF, Brazil.Secretaria de Saúde de Feira de Santana. Feira de Santana, Ba, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Secretaria de Saúde do Estado de Minas Gerais. Belo Horizonte, MG, Brazil.Hospital das Forças Armadas. Brasília, DF, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brazil.Universidade Nova de Lisboa. Instituto de Higiene e Medicina Tropical. Lisboa, Portugal.University of Sydney. School of Life and Environmental Sciences and School of Medical Sciences. Marie Bashir Institute for Infectious Diseases and Biosecurity. Sydney, NSW, Australia.University of KwaZulu-Natal. College of Health Sciences. KwaZulu-Natal Research Innovation and Sequencing Platform. Durban, South Africa.University of Oxford. Peter Medawar Building. Department of Zoology. Oxford, UK.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Universidade Estadual de Feira de Santana. Salvador, BA, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brazil.Universidade de Brasília. Brasília, DF, Brazil.Universidade Salvador. Salvador, BA, Brazil.Fundação Ezequiel Dias. Belo Horizonte, MG, Brazil.Fundação Ezequiel Dias. Belo Horizonte, MG, Brazil.Fundação Ezequiel Dias. Belo Horizonte, MG, Brazil.Fundação Ezequiel Dias. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Hantaviroses e Rickettsioses. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Leônidas e Maria Deane. Laboratório de Ecologia de Doenças Transmissíveis na Amazônia. Manaus, AM, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Faculdade de Medicina Veterinária. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Faculdade de Medicina Veterinária. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brazil.Laboratório Central de Saúde Pública do Estado do Paraná. Curitiba, PR, Brazil.Laboratório Central de Saúde Pública do Estado de Rondônia. Porto Velho, RO, Brazil.Laboratório Central de Saúde Pública do Estado do Amazonas. Manaus, AM, Brazil.Laboratório Central de Saúde Pública do Estado do Rio Grande do Norte. Natal, RN, Brazil.Laboratório Central de Saúde Pública do Estado de Mato Grosso. Cuiabá, MT, Brazil.Laboratório Central de Saúde Pública Professor Gonçalo Moniz. Salvador, BA, Brazil.Laboratório Central de Saúde Pública Professor Gonçalo Moniz. Salvador, BA, Brazil.Laboratório Central de Saúde Pública Noel Nutels. Rio de Janeiro, RJ, Brazil.Instituto Adolfo Lutz. São Paulo, SP, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Universidade de São Paulo. Instituto de Medicina Tropical. São Paulo, SP, Brazil.Universidade de São Paulo. Instituto de Medicina Tropical. São Paulo, SP, Brazil.Universidade de São Paulo. Instituto de Medicina Tropical. São Paulo, SP, Brazil.University of Oxford. Peter Medawar Building. Department of Zoology. Oxford, UK.Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui. Pergamino, Argentina.Gorgas Memorial Institute for Health Studies. Panama, Panama.Gorgas Memorial Institute for Health Studies. Panama, Panama.Gorgas Memorial Institute for Health Studies. Panama, Panama.Instituto de Salud Pública de Chile. Santiago, Chile.Instituto de Diagnóstico y Referencia Epidemiológicos Dr. Manuel Martínez Báez. Ciudad de México, México.Instituto Nacional de Enfermedades Infecciosas Dr Carlos G Malbrán. Buenos Aires, Argentina.Ministerio de Salud Pública de Uruguay. Montevideo, Uruguay.Instituto Costarricense de Investigación y Enseñanza em Nutrición y Salud. Tres Ríos, Costa Rica.Instituto Nacional de Investigacion en Salud Publica Dr Leopoldo Izquieta Pérez. Guayaquil, Ecuador.Instituto Nacional de Investigacion en Salud Publica Dr Leopoldo Izquieta Pérez. Guayaquil, Ecuador.Universidade Federal de Pernambuco. Recife, PE, Brazil.Secretaria de Saúde do Estado de Minas Gerais. Belo Horizonte. MG, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brazil.Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brazil.Universidade Federal de Ouro Preto. Ouro Preto, MG, Brazil.Universidade Federal de Ouro Preto. Ouro Preto, MG, Brazil.Universidade Federal de Ouro Preto. Ouro Preto, MG, Brazil.Universidade Federal de Ouro Preto. Ouro Preto, MG, Brazil.Fundação Hemocentro de Ribeirão Preto. Ribeirão Preto, SP, Brazil.Secretaria de Saúde de Feira de Santana. Feira de Santana, BA, Brazil.Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Belo Horizonte, MG, Brazil.Brazil experienced a large dengue virus (DENV) epidemic in 2019, highlighting a continuous struggle with effective control and public health preparedness. Using Oxford Nanopore sequencing, we led field and classroom initiatives for the monitoring of DENV in Brazil, generating 227 novel genome sequences of DENV1-2 from 85 municipalities (2015–2019). This equated to an over 50% increase in the number of DENV genomes from Brazil available in public databases. Using both phylogenetic and epidemiological models we retrospectively reconstructed the recent transmission history of DENV1-2. Phylogenetic analysis revealed complex patterns of transmission, with both lineage co-circulation and replacement. We identified two lineages within the DENV2 BR-4 clade, for which we estimated the effective reproduction number and pattern of seasonality. Overall, the surveillance outputs and training initiative described here serve as a proof-of-concept for the utility of real-time portable sequencing for research and local capacity building in the genomic surveillance of emerging viruses

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study (Intensive Care Medicine, (2021), 47, 2, (160-169), 10.1007/s00134-020-06234-9)

The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected