Journal of critical care
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Journal of critical care · Feb 2018
Multicenter StudyRisk of drug resistance in repeat gram-negative infections among patients with multiple hospitalizations.
Drug resistance in gram-negative bacterial hospital-acquired infections (GNB HAIs) has become ubiquitous in recent years. Patients who experience multiple hospitalizations are at high risk of developing repeat GNB HAIs. This study aims to evaluate the relationship between repeat GNB HAIs and antibiotic susceptibility patterns. ⋯ Prevention of repeat infections in high healthcare utilizers may be important in reducing drug resistance in this population.
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Journal of critical care · Feb 2018
Observational StudyCharacteristics and outcomes of critically-ill medical patients admitted to a tertiary medical center with restricted ICU bed capacity.
In the emergency department (ED) critically-ill medical patients are treated in the resuscitation room (RR). No studies described the outcomes of critically-ill RR patients admitted to a hospital with low capacity of intensive care unit (ICU) beds. ⋯ ED critically-ill medical patients who were treated in the RR had high mortality rates in an institute with restricted ICU beds availability. However, those who were admitted to an ICU showed prolonged short and perhaps long term survival compared to those who were not.
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Journal of critical care · Feb 2018
Prior antimicrobial therapy duration influences causative pathogens identification in ventilator-associated pneumonia.
To determine whether prior antimicrobial therapy, divided in recent or current antibiotic treatment, influences the identification rate and/or the type of causative pathogens in patients with suspected episodes of ventilator-acquired pneumonia. ⋯ In patients with a high probability of VAP, current but not recent antibiotic use is associated with a lower rate of positive culture with a higher proportion of MDR pathogens, mostly MDR Pseudomonas aeruginosa.
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Journal of critical care · Feb 2018
Observational StudyImpact of antibiotic therapy in severe community-acquired pneumonia: Data from the Infauci study.
Antibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established. To evaluate the impact of different aspects of AT on the outcome of critically ill patients with CAP, we performed a post hoc analysis of all CAP patients enrolled in a prospective, observational, multicentre study. ⋯ Prolonged AT (>7days) was associated with a longer ICU (14 vs. 7days; p<0.001) and hospital length of stay (LOS) (25 vs. 17days; p<0.001). Combination AT with a macrolide may be the most suitable AT strategy to improve both short and long term outcome of severe CAP patients. AT >7days had no survival benefit and was associated with a longer LOS.
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Journal of critical care · Feb 2018
Observational StudyThiamine in septic shock patients with alcohol use disorders: An observational pilot study.
Alcohol-use disorders (AUDs) have been associated with increased sepsis-related mortality. As patients with AUDs are often thiamine deficient, we investigated practice patterns relating to thiamine administration in patients with AUDs presenting with septic shock and explored the association between receipt of thiamine and mortality. ⋯ A considerable proportion of patients with AUDs admitted for septic shock do not receive thiamine. Thiamine administration in this patient population was associated with decreased mortality.