RESUMO
Aim: This study investigated the risk factors for the development of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in adult patients in Intensive Care Units (ICUs). Methods: A multicentre case-control study was conducted in ICUs in three tertiary hospitals in Turkey. The cases were patients culture-confirmed CRKP and a condition associated with healthcare-associated infections. Two controls were randomly selected for each case from among all other patients with an ICU stay at least as long as that of the corresponding case-patient. A proportional semiparametric subdistribution hazards regression model was used to assess risk factors for CRKP infection. ICU discharge and non-CRKP-related deaths were treated as competing risks. Results: A total of 120 patients, 44 cases and 76 controls were included in the analysis. Of the controls, 32 were discharged from the ICU and 44 died without acquiring CRKP infection. Endotracheal intubation (hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.00-3.868) and type 2 diabetes mellitus (HR: 1.57, 95% CI: 0.888-2.806) were associated with an increased risk of CRKP infection, whereas carbapenem exposure (HR: 0.47, 95% CI: 0.190-1.1175) and the presence of a nasogastric tube (HR: 0.49, 95% CI: 0.277-0.884) were associated with a decreased risk of CRKP infection. Conclusions: Enteral nutrition support via a nasogastric tube may be associated with a reduced risk of CRKP-resistant infections in ICU patients. This hypothesis should be tested with a well-designed study.
Assuntos
Diabetes Mellitus Tipo 2 , Infecções por Klebsiella , Adulto , Humanos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Klebsiella pneumoniae , Estudos de Casos e Controles , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/epidemiologia , Farmacorresistência Bacteriana , Carbapenêmicos/farmacologia , Carbapenêmicos/uso terapêutico , Fatores de Risco , Unidades de Terapia Intensiva , Estudos RetrospectivosRESUMO
Abstract Background and objectives: This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV) was applied instead of the routine venturi face mask (VM) application after a successful weaning. Methods: Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48 hours were scheduled for this study. 12 patients were excluded because of the weaning failure during T-tube trial. The patients who had optimum weaning criteria after the T-tube trial of 30 minutes were extubated. The patients were kept on VM for 1 hour to observe the hemodynamic and respiratory stability. The group of 50 patients who were successful to wean randomly allocated to have either VM (n = 25), or NIV (n = 25). Systolic arterial pressure (SAP), heart rate (HR), respiratory rate (RR), PaO2, PCO2, and pH values were recorded. Results: The number of patients who developed respiratory failure in the NIV group was significantly less than VM group of patients (3 reintubation vs. 14 NIV + 5 reintubation in the VM group). The length of stay in the ICU was also significantly shorter in NIV group (5.2 ± 4.9 vs. 16.7 ± 7.7 days). Conclusions: The ratio of the respiratory failure and the length of stay in the ICU were lower when non-invasive mechanical ventilation was used after extubation even if the patient is regarded as ‘successfully weaned’. We recommend the use of NIMV in such patients to avoid unexpected ventilator failure.
Resumo Justificativa e objetivos: Este estudo comparou as taxas de insuficiência respiratória aguda, reintubação, tempo de internação em UTI e mortalidade em pacientes sob ventilação mecânica não invasiva (VMNI) em vez da habitual máscara facial de Venturi (MV) após desmame bem-sucedido. Métodos: Após a aprovação do Comitê de Ética do hospital, 62 pacientes que estavam sob ventilação mecânica por no mínimo 48 horas foram inscritos neste estudo. Doze foram excluídos devido à falha de desmame durante o teste de tubo-T. Os que apresentaram critérios de desmame ótimos após o teste de tubo-T de 30 minutos foram extubados. Foram mantidos em MV por uma hora para observação da estabilidade hemodinâmica e respiratória. O grupo de 50 pacientes que obtiveram sucesso no desmame ventilatório foi alocado aleatoriamente para MV (n = 25) ou VNI (n = 25). Os valores de pressão arterial sistólica (PAS), frequência cardíaca (FC), frequência respiratória (FR), PaO2, PCO2 e pH foram registrados. Resultados: O número de pacientes que desenvolveu insuficiência respiratória no grupo VNI foi significativamente menor do que o do grupo MV (3 reintubações vs. 14 VNI + 5 reintubações no grupo MV). O tempo de permanência em UTI também foi significativamente menor no grupo NIV (5,2 ± 4,9 vs. 16,7 ± 7,7 dias). Conclusões: As taxas de insuficiência respiratória e do tempo de permanência em UTI foram menores quando a ventilação mecânica não invasiva foi usada após a extubação, mesmo se o paciente foi considerado como “desmame bem-sucedido”. Recomendamos o uso de VMNI em tais pacientes para evitar a falha inesperada do ventilador.