Bloodstream infections as a marker of community-acquired sepsis severity. Results from the Portuguese community-acquired sepsis study (SACiUCI study)

Funding Information: This work was mostly supported by an unrestricted grant from ASSUCIP (Associação dos Amigos da Unidade de Cuidados Intensivos Polivalente, Hospital Geral de Santo António, Porto, Portugal) as well as by grants from GIS (Grupo de Infecção e Sepsis, Hospital de São João, Porto, Portugal) Merck Sharp & Dohme and Eli Lilly. CL received a grant from Fundação para a Ciência e Tecnologia (PIC/IC/83312/2007). All other authors report that they have no other competing interests to declare related to the topic of this manuscript.Clin Microbiol Infect 2013; 19: 242-248 The impact of bloodstream infection (BSI) on admission to hospital on the outcome of patients with community-acquired sepsis (CAS) admitted to intensive-care units (ICU) is largely unknown. We selected 803 adult patients consecutively admitted with CAS to one of 17 Portuguese ICU, in whom blood cultures were collected before initiation of antibiotic therapy during a 12-month period. A BSI was identified on hospital admission in 160 (19.9%) patients. Those with and without BSI had similar mean Simplified Acute Physiology Score (SAPS) II and age. The presence of BSI was independently associated with mortality in ICU (adjusted odds ratio 1.86; 95% confidence interval 1.20-2.89; p 0.005). On the 4th day in ICU, patients with BSI were found to be significantly more dependent on vasopressor support (p 0.002) but not on ventilatory support. Cumulative ICU mortality was significantly higher in BSI patients from the 9th day onwards. A seasonal variation of BSI isolates was noted: gram-negative BSI were more common in the summer, whereas in the winter, gram-positive infections were more frequent (p 0.024), without mortality differences.publishersversionpublishe

Bloodstream infections as a marker of community-acquired sepsis severity. Results from the Portuguese community-acquired sepsis study (SACiUCI study)

Funding Information: This work was mostly supported by an unrestricted grant from ASSUCIP (Associação dos Amigos da Unidade de Cuidados Intensivos Polivalente, Hospital Geral de Santo António, Porto, Portugal) as well as by grants from GIS (Grupo de Infecção e Sepsis, Hospital de São João, Porto, Portugal) Merck Sharp & Dohme and Eli Lilly. CL received a grant from Fundação para a Ciência e Tecnologia (PIC/IC/83312/2007). All other authors report that they have no other competing interests to declare related to the topic of this manuscript.Clin Microbiol Infect 2013; 19: 242-248 The impact of bloodstream infection (BSI) on admission to hospital on the outcome of patients with community-acquired sepsis (CAS) admitted to intensive-care units (ICU) is largely unknown. We selected 803 adult patients consecutively admitted with CAS to one of 17 Portuguese ICU, in whom blood cultures were collected before initiation of antibiotic therapy during a 12-month period. A BSI was identified on hospital admission in 160 (19.9%) patients. Those with and without BSI had similar mean Simplified Acute Physiology Score (SAPS) II and age. The presence of BSI was independently associated with mortality in ICU (adjusted odds ratio 1.86; 95% confidence interval 1.20-2.89; p 0.005). On the 4th day in ICU, patients with BSI were found to be significantly more dependent on vasopressor support (p 0.002) but not on ventilatory support. Cumulative ICU mortality was significantly higher in BSI patients from the 9th day onwards. A seasonal variation of BSI isolates was noted: gram-negative BSI were more common in the summer, whereas in the winter, gram-positive infections were more frequent (p 0.024), without mortality differences.publishersversionpublishe

Mixed-Integer Linear Programming Approach for Life-Cycle Carpet Profit

This paper proposes an mixed-integer linear programming (MILP) model to accurately represent a product life-cycle design considering profit maximization. The model that takes into account the effects on the demand lev-el and a measure of the customer utility considering recycled raw materials and prices of the traditional and modular products. Demand functions for traditional and modular products are considered. Given the presence of bilinear terms in the formulation (for example due to the multiplication of product price for the demand), the multi-parametric disaggregation technique is used to obtain a line-ar model. The developed model is applied to a company that produces tradition-al carpets and it wants to manufacture carpets based on a new modular design where recycled materials must be incorporated. The objective of the company is to maximize the total profit taking into account the design specifications and the selling prices for traditional and modular carpets. In addition, the amount of square meters of traditional carpets must be determined and the take-back rate must be considered. The practical behavior of the formulation is analyzed through computational experiments exploring the analyzed case-study.Sociedad Argentina de Informática e Investigación Operativ

Mixed-Integer Linear Programming Approach for Life-Cycle Carpet Profit

This paper proposes an mixed-integer linear programming (MILP) model to accurately represent a product life-cycle design considering profit maximization. The model that takes into account the effects on the demand lev-el and a measure of the customer utility considering recycled raw materials and prices of the traditional and modular products. Demand functions for traditional and modular products are considered. Given the presence of bilinear terms in the formulation (for example due to the multiplication of product price for the demand), the multi-parametric disaggregation technique is used to obtain a line-ar model. The developed model is applied to a company that produces tradition-al carpets and it wants to manufacture carpets based on a new modular design where recycled materials must be incorporated. The objective of the company is to maximize the total profit taking into account the design specifications and the selling prices for traditional and modular carpets. In addition, the amount of square meters of traditional carpets must be determined and the take-back rate must be considered. The practical behavior of the formulation is analyzed through computational experiments exploring the analyzed case-study.Sociedad Argentina de Informática e Investigación Operativ

Mixed-Integer Linear Programming Approach for Life-Cycle Carpet Profit

This paper proposes an mixed-integer linear programming (MILP) model to accurately represent a product life-cycle design considering profit maximization. The model that takes into account the effects on the demand lev-el and a measure of the customer utility considering recycled raw materials and prices of the traditional and modular products. Demand functions for traditional and modular products are considered. Given the presence of bilinear terms in the formulation (for example due to the multiplication of product price for the demand), the multi-parametric disaggregation technique is used to obtain a line-ar model. The developed model is applied to a company that produces tradition-al carpets and it wants to manufacture carpets based on a new modular design where recycled materials must be incorporated. The objective of the company is to maximize the total profit taking into account the design specifications and the selling prices for traditional and modular carpets. In addition, the amount of square meters of traditional carpets must be determined and the take-back rate must be considered. The practical behavior of the formulation is analyzed through computational experiments exploring the analyzed case-study.Sociedad Argentina de Informática e Investigación Operativ

Should C-reactive protein concentration at ICU discharge be used as a prognostic marker?

<p>Abstract</p> <p>Background</p> <p>About one third of hospital mortality in critically ill patients occurs after Intensive Care Unit (ICU) discharge. Some authors have recently hypothesized that unresolved or latent inflammation and sepsis may be an important factor that contributes to death following successful discharge from the ICU.</p> <p>Aim</p> <p>The aim of our study was to determine the ability of the clinical and inflammatory markers at ICU discharge to predict post-ICU mortality.</p> <p>Methods</p> <p>A prospective observational cohort study was conducted during a 14-month period in an 8 bed polyvalent ICU. Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA) score, Therapeutic Intervention Scoring System-28 (TISS-28), C-reactive protein (CRP), white cell count (WCC) and body temperature of the day of ICU discharge were collected from patients who survived their first ICU admission.</p> <p>Results</p> <p>During this period 156 patients were discharged alive from the ICU. A total of 29 patients (18.6%) died after ICU discharge. There were no differences in clinical and demographic characteristics between survivors and nonsurvivors. C-reactive protein levels at ICU discharge were not significantly different between survivors and nonsurvivors. The area under receiver operating characteristics curves of APACHE II, SAPS II, SOFA, TISS-28, CRP, WCC and body temperature at ICU discharge as prognostic markers of hospital death were 0.76 (95% confidence interval (CI) 0.67-0.86); 0.75 (95% CI 0.66-0.85); 0.72 (95% CI 0.62-0.83); 0.64 (95% CI 0.52-0.77); 0.55 (95% CI 0.43-0.67); 0.55 (95% CI 0.42-0.66) and 0.54 (95% CI 0.44-0.67) respectively. The hospital mortality rate of the patients with CRP <5, 5-10, >10 mg/dL was 15.1%, 16.1% and 33.3% respectively (p = NS).</p> <p>Conclusions</p> <p>At ICU discharge serum CRP concentration was a poor marker of post-ICU prognosis. Post-ICU death appears to be unrelated to the persistent inflammatory response.</p

The Dynamics of the Pulmonary Microbiome During Mechanical Ventilation in the Intensive Care Unit and the Association with Occurrence of Pneumonia

RATIONALE: Ventilator-associated pneumonia (VAP) is the most common nosocomial infections in patients admitted to the ICU. The adapted island model predicts several changes in the respiratory microbiome during intubation and mechanical ventilation. OBJECTIVES: We hypothesised that mechanical ventilation and antibiotic administration decrease the diversity of the respiratory microbiome and that these changes are more profound in patients who develop VAP. METHODS: Intubated and mechanically ventilated ICU-patients were included. Tracheal aspirates were obtained three times a week. 16S rRNA gene sequencing with the Roche 454 platform was used to measure the composition of the respiratory microbiome. Associations were tested with linear mixed model analysis and principal coordinate analysis. MEASUREMENTS AND MAIN RESULTS: 111 tracheal aspirates were obtained from 35 patients; 11 had VAP, 18 did not have VAP. Six additional patients developed pneumonia within the first 48 hours after intubation. Duration of mechanical ventilation was associated with a decrease in α diversity (Shannon index; fixed-effect regression coefficient (β): -0.03 (95% CI -0.05 to -0.005)), but the administration of antibiotic therapy was not (fixed-effect β: 0.06; 95% CI -0.17 to 0.30). There was a significant difference in change of β diversity between patients who developed VAP and control patients for Bray-Curtis distances (p=0.03) and for Manhattan distances (p=0.04). Burkholderia, Bacillales and, to a lesser extent, Pseudomonadales positively correlated with the change in β diversity. CONCLUSION: Mechanical ventilation, but not antibiotic administration, was associated with changes in the respiratory microbiome. Dysbiosis of microbial communities in the respiratory tract was most profound in patients who developed VAP.info:eu-repo/semantics/publishedVersio