Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60\u20131.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14\u20131.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely

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

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

The importance of radiology in detection of complications associated with central venous catheter insertion: case report

Abstract Background & aim: One of the goals of central venous catheter (CVC) insertion is monitoring of fluid therapy, but the catheter insertion can be associated with several complications. The objective of this study was to determine the role of radiology in central venous catheter complications. Case presentation: 77-year-old woman, a known case of chronic lymphocytic leukemia due to deep vein thrombosis treated with warfarin and due to peritonitis is undergoing emergency surgery. After insertion of central venous catheters and receiving fresh frozen plasma to correct the clotting dysfunction, the candidate is transferred to the operating room. Once during Intraoperative and again immediately after entering the ICU were involved with ventricular arrhythmia. Chest x-ray showed massive unilateral hydrothorax. Conclusion: Most complications of central venous catheter is diagnosed on chest radiograph and appropriate treatment of these complications is tsaving. Key words: Central Venous Catheter, Hydrothorax, Radiograph

Electrostatic Interactions Affect Nanoparticle-Mediated Toxicity to Gram-Negative Bacterium \u3cem\u3ePseudomonas aeruginosa\u3c/em\u3e PAO1

Nanoscale materials can have cytotoxic effects. Here we present the first combined empirical and theoretical investigation of the influence of electrostatic attraction on nanoparticle cytotoxicity. Modeling electrostatic interactions between cells and 13 nm spheres of zinc oxide nanoparticles provided insight into empirically determined variations of the minimum inhibitory concentrations between four differently charged isogenic strains of Pseudomonas aeruginosa PAO1. We conclude that controlling the electrostatic attraction between nanoparticles and their cellular targets may permit the modulation of nanoparticle cytotoxicity

The Pacific-Antarctic Ridge–Foundation Hotspot Interaction: a Case Study of a Ridge Approaching a Hotspot

The Foundation hotspot–Pacific-Antarctic Ridge (PAR) system is the best documented case of a fast spreading ridge approaching a hotspot and interacting with it. The morphology, crustal structure inferred from gravity anomalies and the chemical composition of the lavas of the axial area of the PAR show evidence of the influence of the hotspot, that is presently located roughly 35 km west of the spreading ridge axis. Along-axis variation in the Mantle Bouguer anomaly is about 28 mGal, corresponding to a crustal thickening of 1.5 km where the hotspot is nearer to the PAR. Anomalous ridge elevation is 650 m and the along-axis width of the chemical anomaly is 200 km. A comparison of these axial parameters with those derived for other ridge–hotspot systems, suggests that the amount of plume material reaching the ridge axis is smaller for the Foundation–PAR system. This implies a weaker connection between the plume and the ridge. Cumulative effects of a fast spreading rate and of a fast ridge–hotspot relative motion can be responsible for this weak plume–ridge flow. The flow from the hotspot may be less efficiently channelled towards the ridge axis when a fast ridge is rapidly moving towards a hotspot