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1.
Ann Intensive Care ; 14(1): 98, 2024 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-38916830

RESUMEN

BACKGROUND: Current guidelines recommend using antifungals for selected patients with health care-associated intra-abdominal infection (HC-IAI), but this recommendation is based on a weak evidence. This study aimed to assess the association between early empirical use of antifungals and outcomes in intensive care unit (ICU) adult patients requiring re-intervention after abdominal surgery. METHODS: A retrospective, multicentre cohort study with overlap propensity score weighting was conducted in three ICUs located in three medical institutions in France. Patients treated with early empirical antifungals for HC-IAI after abdominal surgery were compared with controls who did not receive such antifungals. The primary endpoint was the death rate at 90 days, and the secondary endpoints were the death rate at 1 year and composite criteria evaluated at 30 days following the HC-IAI diagnosis, including the need for re-intervention, inappropriate antimicrobial therapy and death, whichever occurred first. RESULTS: At 90 days, the death rate was significantly decreased in the patients treated with empirical antifungals compared with the control group (11.4% and 20.7%, respectively, p = 0.02). No differences were reported for the secondary outcomes. CONCLUSION: The use of early empirical antifungal therapy was associated with a decreased death rate at 90 days, with no effect on the death rate at 1 year, the death rate at 30 days, the rate of re-intervention, the need for drainage, and empirical antibiotic and antifungal therapy failure at 30 days.

2.
Adv Ther ; 39(11): 5058-5071, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-36050614

RESUMEN

INTRODUCTION: Sepsis is a heterogeneous syndrome that results in life-threatening organ dysfunction. Our goal was to determine the relevant variables and patient phenotypes to use in predicting sepsis outcomes. METHODS: We performed an ancillary study concerning 119 patients with septic shock at intensive care unit (ICU) admittance (T0). We defined clinical worsening as having an increased sequential organ failure assessment (SOFA) score of ≥ 1, 48 h after admission (ΔSOFA ≥ 1). We performed univariate and multivariate analyses based on the 28-day mortality rate and ΔSOFA ≥ 1 and determined three patient phenotypes: safe, intermediate and unsafe. The persistence of the intermediate and unsafe phenotypes after T0 was defined as a poor outcome. RESULTS: At T0, the multivariate analysis showed two variables associated with 28-day mortality rate: norepinephrine dose and serum lactate concentration. Regarding ΔSOFA ≥ 1, we identified three variables at T0: norepinephrine dose, lactate concentration and venous-to-arterial carbon dioxide difference (P(v-a)CO2). At T0, the three phenotypes (safe, intermediate and unsafe) were found in 28 (24%), 70 (59%) and 21 (18%) patients, respectively. We thus suggested using an algorithm featuring norepinephrine dose, lactate concentration and P(v-a)CO2 to predict patient outcomes and obtained an area under the curve (AUC) of 74% (63-85%). CONCLUSION: Our findings highlight the fact that identifying relevant variables and phenotypes may help physicians predict patient outcomes.


Asunto(s)
Sepsis , Choque Séptico , Dióxido de Carbono , Humanos , Unidades de Cuidados Intensivos , Ácido Láctico , Norepinefrina/uso terapéutico , Fenotipo , Pronóstico , Curva ROC , Estudios Retrospectivos , Sepsis/complicaciones , Sepsis/tratamiento farmacológico , Choque Séptico/tratamiento farmacológico
3.
Sci Rep ; 11(1): 16497, 2021 08 13.
Artículo en Inglés | MEDLINE | ID: mdl-34389761

RESUMEN

Data on the relationship between antimicrobial resistance and mortality remain scarce, and this relationship needs to be investigated in intensive care units (ICUs). The aim of this study was to compare the ICU mortality rates between patients with ICU-acquired pneumonia due to highly antimicrobial-resistant (HAMR) bacteria and those with ICU-acquired pneumonia due to non-HAMR bacteria. We conducted a multicenter, retrospective cohort study using the French National Surveillance Network for Healthcare Associated Infection in ICUs ("REA-Raisin") database, gathering data from 200 ICUs from January 2007 to December 2016. We assessed all adult patients who were hospitalized for at least 48 h and presented with ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii. The association between pneumonia caused by HAMR bacteria and ICU mortality was analyzed using the whole sample and using a 1:2 matched sample. Among the 18,497 patients with at least one documented case of ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii, 3081 (16.4%) had HAMR bacteria. The HAMR group was associated with increased ICU mortality (40.3% vs. 30%, odds ratio (OR) 95%, CI 1.57 [1.45-1.70], P < 0.001). This association was confirmed in the matched sample (3006 HAMR and 5640 non-HAMR, OR 95%, CI 1.39 [1.27-1.52], P < 0.001) and after adjusting for confounding factors (OR ranged from 1.34 to 1.39, all P < 0.001). Our findings suggest that ICU-acquired pneumonia due to HAMR bacteria is associated with an increased ICU mortality rate, ICU length of stay, and mechanical ventilation duration.


Asunto(s)
Neumonía Asociada a la Atención Médica/mortalidad , Unidades de Cuidados Intensivos , Neumonía Bacteriana/mortalidad , Infecciones por Acinetobacter/tratamiento farmacológico , Infecciones por Acinetobacter/microbiología , Infecciones por Acinetobacter/mortalidad , Factores de Edad , Anciano , Farmacorresistencia Bacteriana , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/microbiología , Infecciones por Enterobacteriaceae/mortalidad , Femenino , Neumonía Asociada a la Atención Médica/tratamiento farmacológico , Neumonía Asociada a la Atención Médica/microbiología , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/microbiología , Neumonía Estafilocócica/tratamiento farmacológico , Neumonía Estafilocócica/microbiología , Neumonía Estafilocócica/mortalidad , Prohibitinas , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Infecciones por Pseudomonas/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales
4.
Shock ; 53(6): 710-716, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-31490355

RESUMEN

This study aimed to assess the viability of using the venous-to-arterial carbon dioxide partial pressure difference (P(v-a)CO2) to predict clinical worsening of septic shock, depending on central venous oxygen saturation (ScvO2). The prospective, observational, multicentric study conducted in three intensive care units (ICUs) included all patients with a septic shock episode during the first 6 h, with 122 patients assessed. Clinical worsening was defined as an increase of sequential organ failure assessment (SOFA) scores ≥1 (ΔSOFA ≥1) within 2 days. To assess the ability of P(v-a)CO2 to predict clinical worsening, univariate and multivariate analyses were performed according to ΔSOFA. A receiver-operating characteristic (ROC) analysis was used to confirm model predictions. Associations between P(v-a)CO2 and mortality were explored using correlations. Using multivariate analyses, two independent factors associated with ΔSOFA at least 1 were identified: an averaged 6-h value of lactate concentration (Lac [1-6]) (odds ratios [ORs], 2.43 [95% confidence interval, CI, 1.20-4.89]; P = 0.013) and an averaged 6-h value of P(v-a)CO2 (P(v-a)CO2 [1-6]) (OR, 1.49 [95% CI, 1.04-2.15]; P = 0.029). ROC analysis confirmed that Lac [1-6] and P(v-a)CO2 [1-6] were significantly associated with ΔSOFA at least 1, whereas ScvO2 [1-6] was not. Finally, ΔSOFA at least 1 was associated with higher 28-day (76% vs. 10%, P = 0.001) and ICU (83% vs. 12%, P = 0.001) mortality rates, which were higher in patients with P(v-a)CO2 [1-6] more than 5.8 mmHg (57% vs. 33%; P = 0.012). In conclusion, P(v-a)CO2 may help predict outcomes for septic shock patients regardless of ScvO2 values.


Asunto(s)
Dióxido de Carbono/sangre , Oxígeno/sangre , Choque Séptico/diagnóstico , Anciano , Arterias , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Masculino , Puntuaciones en la Disfunción de Órganos , Presión Parcial , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Choque Séptico/sangre , Choque Séptico/mortalidad , Venas
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