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1.
Diagnostics (Basel) ; 13(6)2023 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-36980354

RESUMEN

Acute kidney injury (AKI) is common after pediatric cardiac surgery (CS). Several urine biomarkers have been validated to detect AKI earlier. The objective of this study was to evaluate urine CHI3L1, NGAL, TIMP-2, IGFBP7, and NephroCheck® as predictors for AKI ≥ 1 in pediatric CS after 48 h and AKI ≥ 2 after 12 h. Pediatric patients (age < 18 year; body weight ≥ 2 kg) requiring CS were prospectively included. Urine CHI3L1, NGAL, TIMP-2, IGFBP7, and NephroCheck® were measured during surgery and intensive care unit (ICU) stay and corrected for urine dilution. One hundred and one pediatric patients were included. AKI ≥ 1 within 48 h after ICU admission occurred in 62.4% and AKI ≥ 2 within 12 h in 30.7%. All damage biomarkers predicted AKI ≥ 1 within 48 h after ICU admission, when corrected for urine dilution: CHI3L1 (AUC-ROC: 0.642 (95% CI, 0.535-0.741)), NGAL (0.765 (0.664-0.848)), TIMP-2 (0.778 (0.662-0.868)), IGFBP7 (0.796 (0.682-0.883)), NephroCheck® (0.734 (0.614-0.832)). Similarly, AKI ≥ 2 within 12 h was predicted by all damage biomarkers when corrected for urine dilution: uCHI3L1 (AUC-ROC: 0.686 (95% CI, 0.580-0.780)), NGAL (0.714 (0.609-0.804)), TIMP-2 (0.830 (0.722-0.909)), IGFBP7 (0.834 (0.725-0.912)), NephroCheck® (0.774 (0.658-0.865)). After pediatric cardiac surgery, the damage biomarkers urine CHI3L1, NGAL, TIMP-2, IGFBP7, and NephroCheck® reliably predict AKI after correction for urine dilution.

2.
Infect Control Hosp Epidemiol ; 26(6): 575-9, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-16018434

RESUMEN

OBJECTIVE: Timely initiation of antibiotic therapy is crucial for severe infection. Appropriate antibiotic therapy is often delayed for nosocomial infections caused by antibiotic-resistant bacteria. The relationship between knowledge of colonization caused by antibiotic-resistant gram-negative bacteria (ABR-GNB) and rate of appropriate initial antibiotic therapy for subsequent bacteremia was evaluated. DESIGN: Retrospective cohort study. SETTING: Fifty-four-bed intensive care unit (ICU) of a university hospital. In this unit, colonization surveillance is performed through routine site-specific surveillance cultures (urine, mouth, trachea, and anus). Additional cultures are performed when presumed clinically relevant. PATIENTS: ICU patients with nosocomial bacteremia caused by ABR-GNB. RESULTS: Infectious and microbiological characteristics and rates of appropriate antibiotic therapy were compared between patients with and without colonization prior to bacteremia. Prior colonization was defined as the presence (detected > or = 2 days before the onset of bacteremia) of the same ABR-GNB in colonization and subsequent blood cultures. During the study period, 157 episodes of bacteremia caused by ABR-GNB were suitable for evaluation. One hundred seventeen episodes of bacteremia (74.5%) were preceded by colonization. Appropriate empiric antibiotic therapy (started within 24 hours) was administered for 74.4% of these episodes versus 55.0% of the episodes that occurred without prior colonization. Appropriate therapy was administered within 48 hours for all episodes preceded by colonization versus 90.0% of episodes without prior colonization. CONCLUSION: Knowledge of colonization status prior to infection is associated with higher rates of appropriate therapy for patients with bacteremia caused by ABR-GNB.


Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia , Infección Hospitalaria , Infecciones por Bacterias Gramnegativas , Selección de Paciente , Canal Anal/microbiología , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Bacteriemia/microbiología , Bélgica/epidemiología , Protocolos Clínicos/normas , Análisis Costo-Beneficio , Cuidados Críticos/economía , Cuidados Críticos/métodos , Cuidados Críticos/normas , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Hospitales Universitarios , Humanos , Incidencia , Control de Infecciones/economía , Control de Infecciones/métodos , Control de Infecciones/normas , Tiempo de Internación/estadística & datos numéricos , Pruebas de Sensibilidad Microbiana , Boca/microbiología , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Manejo de Especímenes/economía , Manejo de Especímenes/métodos , Manejo de Especímenes/normas , Factores de Tiempo , Tráquea/microbiología , Orina/microbiología
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