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排序方式: 共有10000条查询结果,搜索用时 31 毫秒
831.
François Barbier Sébastien Bailly Carole Schwebel Laurent Papazian Élie Azoulay Hatem Kallel Shidasp Siami Laurent Argaud Guillaume Marcotte Benoît Misset Jean Reignier Michaël Darmon Jean-Ralph Zahar Dany Goldgran-Toledano Étienne de Montmollin Bertrand Souweine Bruno Mourvillier Jean-François Timsit for the OUTCOMEREA Study Group 《Intensive care medicine》2018,44(5):616-626
Purpose
To investigate the clinical significance of infection-related ventilator-associated complications (IVAC) and their impact on carbapenem consumption in mechanically ventilated (MV) patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE).Methods
Inception cohort study from the French prospective multicenter OUTCOMEREA database (17 ICUs, 1997–2015) including all ESBLE carriers (systematic rectal swabbing at admission then weekly and/or urinary or superficial surgical site colonisation) with MV duration?>?48 h and?≥?1 episode of IVAC after carriage documentation. All ICU-acquired infections were microbiologically documented.Results
The 318 enrolled ESBLE carriers (median age 68 years; males 67%; medical admission 68%; imported carriage 53%) experienced a total of 576 IVAC comprising 361 episodes (63%) without documented infection, 124 (21%) related to infections other than ventilator-associated pneumonia (VAP), 73 (13%) related to non-ESBLE VAP and 18 (3%) related to ESBLE VAP. Overall, ESBLE infections accounted for only 43 episodes (7%). Carbapenem exposure within the preceding 3 days was the sole independent predictor of ESBLE infection as the causative event of IVAC, with a protective effect (adjusted odds ratio 0.2, 95% confidence interval 0.05–0.6; P?<?0.01). Carbapenems were initiated in 9% of IVAC without infection, 15% of IVAC related to non-VAP infections, 42% of IVAC related to non-ESBLE VAP, and 56% of IVAC related to ESBLE VAP (ESBLE VAP versus non-ESBLE VAP: P?=?0.43).Conclusions
IVAC in ESBLE carriers mostly reflect noninfectious events but act as a strong driver of empirical carbapenem consumption. ESBLE infections are scarce yet hard to predict, strengthening the need for novel diagnostic approaches and carbapenem-sparing alternatives.832.
Manu Shankar-Hari Deepankar Datta Julie Wilson Valentina Assi Jacqueline Stephen Christopher J. Weir Jillian Rennie Jean Antonelli Anthony Bateman Jennifer M. Felton Noel Warner Kevin Judge Jim Keenan Alice Wang Tony Burpee Alun K. Brown Sion M. Lewis Tracey Mare Alistair I. Roy John Wright Gillian Hulme Ian Dimmick Alasdair Gray Adriano G. Rossi A. John Simpson Andrew Conway Morris Timothy S. Walsh 《Intensive care medicine》2018,44(11):1836-1848
Purpose
Reliable biomarkers for predicting subsequent sepsis among patients with suspected acute infection are lacking. In patients presenting to emergency departments (EDs) with suspected acute infection, we aimed to evaluate the reliability and discriminant ability of 47 leukocyte biomarkers as predictors of sepsis (Sequential Organ Failure Assessment score?≥?2 at 24 h and/or 72 h following ED presentation).Methods
In a multi-centre cohort study in four EDs and intensive care units (ICUs), we standardised flow-cytometric leukocyte biomarker measurement and compared patients with suspected acute infection (cohort-1) with two comparator cohorts: ICU patients with established sepsis (cohort-2), and ED patients without infection or systemic inflammation but requiring hospitalization (cohort-3).Results
Between January 2014 and February 2016, we recruited 272, 59 and 75 patients to cohorts 1, 2, and 3, respectively. Of 47 leukocyte biomarkers, 14 were non-reliable, and 17 did not discriminate between the three cohorts. Discriminant analyses for predicting sepsis within cohort-1 were undertaken for eight neutrophil (cluster of differentiation antigens (CD) CD15; CD24; CD35; CD64; CD312; CD11b; CD274; CD279), seven monocyte (CD35; CD64; CD312; CD11b; HLA-DR; CD274; CD279) and a CD8 T-lymphocyte biomarker (CD279). Individually, only higher neutrophil CD279 [OR 1.78 (95% CI 1.23–2.57); P?=?0.002], higher monocyte CD279 [1.32 (1.03–1.70); P?=?0.03], and lower monocyte HLA-DR [0.73 (0.55–0.97); P?=?0.03] expression were associated with subsequent sepsis. With logistic regression the optimum biomarker combination was increased neutrophil CD24 and neutrophil CD279, and reduced monocyte HLA-DR expression, but no combination had clinically relevant predictive validity.Conclusions
From a large panel of leukocyte biomarkers, immunosuppression biomarkers were associated with subsequent sepsis in ED patients with suspected acute infection.Clinical trial registration
NCT02188992.833.
Jean-François Timsit Mark Rupp Emilio Bouza Vineet Chopra Tarja Kärpänen Kevin Laupland Thiago Lisboa Leonard Mermel Olivier Mimoz Jean-Jacques Parienti Garyphalia Poulakou Bertrand Souweine Walter Zingg 《Intensive care medicine》2018,44(6):742-759
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU. It discusses the optimal therapy of catheter-related infections and thrombosis. Prevention of complications is a multidisciplinary task that combines both improvement of the process of care and introduction of new technologies. We emphasize the main component of the prevention strategies that should be used in critical care and propose areas of future investigation in this field. 相似文献
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Po-Lan Su Wei-Chieh Lin Yen-Fen Ko Pei-Fang Su Chang-Wen Chen 《Intensive care medicine》2018,44(3):389-391
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