Introduction
We evaluated the diagnostic reliability of serum polymerase chain reaction (PCR) versus blood culture, abdominal fluid or both (composite measure) in patients receiving empirical ...antifungal treatment for suspected invasive candidiasis.
Methods
This observational, prospective, non-interventional, multicentre study in Spain enrolled 176 critically ill patients admitted to the intensive care unit. Separate blood samples for culture and serum PCR were taken before the start of antifungal therapy. Patient assessment was performed according to each site’s usual clinical practice. The primary end point was concordance between serum PCR and blood culture. Secondary end points were concordance between serum PCR and a positive abdominal fluid sample or the composite measure. Quality indices included sensitivity, specificity, positive/negative predictive values (PPV/NPV) and kappa indices.
Results
Among 175 evaluable patients, rates of
Candida
detection were similar for serum PCR (
n
= 16/175, 9.1%) versus blood culture (
n
= 14/175, 8.0%). Quality indices for serum PCR relative to blood culture were: sensitivity 21.4%; specificity 91.9%; PPV 18.8%; NPV 93.1%; kappa index 0.125. Thirty-two abdominal fluid samples were positive. Quality indices for serum PCR versus abdominal fluid were: sensitivity 31.3%; specificity 83.0%; PPV 15.6%; NPV 92.3%; kappa index 0.100. Quality indices for serum PCR versus the composite measure were: sensitivity 15.8%; specificity 92.7%; PPV 37.5%; NPV 79.9%; kappa index 0.107.
Conclusion
The sensitivity of serum PCR for
Candida
detection was low and the rate of concordance was low between serum PCR and the other diagnostic techniques used to identify
Candida
infections. Hospital-based diagnostic tests need optimising to improve outcomes in patients with suspected invasive candidiasis.
Funding
Astellas Pharma Inc.
The aim is to describe our experience with Cefiderocol as a rescue treatment for critical care patients with severe infections due to multi-resistant GNB.
Observational, retrospective study. We ...included every patient admitted to the department of Critical Care Medicine who received treatment with Cefiderocol. We collected demographical data, ICU length of stay, APACHE-II score, reason for being admitted, and the need of invasive mechanical ventilation or continuous renal replacement therapy. We defined clinical success as a combination of survival, improvement of signs and symptoms of infection and absence of recurrent infection due to the same bacterial species >7 days after finishing treatment with Cefiderocol. Our standard dose of cefiderocol was a prolonged infusion (3 h) of 2 g of Cefiderocol diluted in 100 cc of saline solution.
We have treated a total of 8 patients with cefiderocol. All of them were males (100%), with a median age of 63.5 years (IQR 58–68.5) Median APACHE-II was 22.5 (IQR 15.5–25). The cause of admission was bilateral pneumonia due to SARS-CoV2 in two of them (25%), septic shock in one of them (12.5%), pneumonia in one of them (12.5%), cardiac arrest in 3 of them (37.5%), and complication post-surgery in one of them (12.5%). Most of them experienced a prolonged stay in intensive care describe by a mean of days between admission and isolation of the multi-resistant bacteria of 36.25 (+/− 19.17). The standard duration of treatment was 14 days. In one patient the treatment continued after hospital discharge due to the finding of endocarditis. Clinical success was accomplished in 5 (62.5%) patients. All of these 5 patients were successfully discharged from ICU and eventually from hospital with the exception of one due to limitation of life support therapies because of brain damage detected by cerebral MRI. Reasons for not achieving clinical success: continuous isolation of the pathogen despite improvement of signs and symptoms, transfer to his country and reatment for 2 days before switching to other antibiotic following sensibilities.
WE have limited experience with Cefiderocol. It has been used in difficult patients, with a prolonged length of stay and several risk factors. In patients who were able to complete 14 days of treatment, clinical success was achieved in all of them, and microbiological success only failed in one of them.
Summary Objectives To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. Methods A secondary ...analysis from a prospective, multicentre, observational study (2009–2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the binominal distributions of the true (+) and true (−) results. Results Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT <0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT <0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. Conclusion PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock.
There is a lack of evidence in the efficacy of the coupled plasma filtration adsorption (CPFA) to reduce the mortality rate in septic shock. To fill this gap, we have designed the ROMPA study ...(Mortality Reduction in Septic Shock by Plasma Adsorption) to confirm whether treatment with an adequate dose of treated plasma by CPFA could confer a clinical benefit.
Our study is a multicentric randomised clinical trial with a 28-day and 90-day follow-up and allocation ratio 1:1. Its aim is to clarify whether the application of high doses of CPFA (treated plasma ≥0.20 L/kg/day) in the first 3 days after randomisation, in addition to the current clinical practice, is able to reduce hospital mortality in patients with septic shock in intensive care units (ICUs) at 28 and 90 days after initiation of the therapy. The study will be performed in 10 ICUs in the Southeast of Spain which follow the same protocol in this disease (based on the Surviving Sepsis Campaign). Our trial is designed to be able to demonstrate an absolute mortality reduction of 20% (α=0.05; 1-β=0.8; n=190(95×2)). The severity of the process, ensuring the recruitment of patients with a high probability of death (50% in the control group), will be achieved through an adequate stratification by using both severity scores and classical definitions of severe sepsis/septic shock and dynamic parameters. Our centres are fully aware of the many pitfalls associated with previous medical device trials. Trying to reduce these problems, we have developed a training programme to improve the CPFA use (especially clotting problems).
The protocol was approved by the Ethics Committees of all the participant centres. The findings of the trial will be disseminated through peer-reviewed journals, as well as national and international conference presentations.
NCT02357433; Pre-results.
Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the ...impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU.
A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis.
In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001).
Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.
Although there is ample evidence on the importance of having good protocols for Trauma patient care, a teaching system for the personnel involved in this care is needed.
The aim is to describe how we ...have organised the care for this type of patient in Torrevieja Hospital by creating a Trauma Surgery Unit, a Trauma Committee and a Trauma Team. We also describe how we have developed training in order to ensure personnel get the knowledge and skills to care for these patients correctly (Trauma Surgery Course).
We prospectively describe the results. Seventy-nine patients were attended to and 38% had sustained combined multiple injuries, 35% isolated thoracic trauma, 15% combined thorax and abdomen, and 12% abdomen. The most frequent cause of trauma was traffic accident, closely followed by stab wounds. Trauma team activation was made in 27 cases. Overall mortality rate was 8.8%. During this period of time, 5 editions of the course have been given and 29.5% of the target personnel have already participated in them.
We conclude by highlighting the importance of having adequate protocols for treating these patients and the correct means for teaching the personnel.
Abstract Introduction Although there is ample evidence on the importance of having good protocols for Trauma patient care, a teaching system for the personnel involved in this care is needed. Methods ...The aim is to describe how we have organised the care for this type of patient in Hospital Torrevieja by creating a Trauma Surgery Unit, a Trauma Committee, and a Trauma Team. We also describe how we have developed training in order to ensure personnel get the knowledge and skills to care for these patients correctly (Trauma Surgery Course). Results We prospectively describe the results. Seventy-nine patients were attended to and 38% had sustained combined multiple injuries, 35% isolated thoracic trauma, 15% combined thorax and abdomen, and 12% abdomen. The most frequent cause of trauma was traffic accident, closely followed by stab wounds. Trauma team activation was made in 27 cases. Overall mortality rate was 8.8%. During this period of time, 5 editions of the course have been given and 29.5% of the target personnel have already participated in them. Conclusions We conclude by highlighting the importance of having adequate protocols for treating these patients and the correct means for teaching the personnel.
Tracing Orpheus Miguel Herrero de Jáuregui, Ana Isabel Jiménez San Cristóbal, Eugenio R. Luján Martínez, Raquel Martín Hernández, Marco Antonio Santamaría Álvarez, Sofía Torallas Tovar / Miguel Herrero de Jáuregui, Ana Isabel Jiménez San Cristóbal, Eugenio R. Luján Martínez, Raquel Martín Hernández, Marco Antonio Santamaría Álvarez, Sofía Torallas Tovar
2011
eBook
There is hardly a more controversial issue in the study of ancient religion than Orphism. More than two centuries of debate have not closed the subject, since new evidence and divergent approaches ...have kept appearing regularly. This volume sheds light on the most relevant pieces of evidence for ancient Orphism, collected in the recent edition by Alberto Bernabé. It contains 65 short new studies on Orphic fragments by leading international scholars who comment one of the most controversial phenomena in Antiquity from a plurality of perspectives. Readers will acquire a global vision of the multiple dimensions of the Orphic tradition, as well as many new insights into particular Orphic fragments.
According to the current literature, the term "du Bois sign" characterizes the condition of a shortened fifth finger as a symptom of congenital syphilis, Down syndrome, dyscrania, and encephalic ...malformation. After a stint with the 32nd Regiment of Pennsylvania Volunteers in the American Civil War, Duhring enrolled at the University of Penn's Medical School. In the same year Dutton undertook his next expedition to the Gambia alone and first recognised the presence of trypanosomes in human blood which would eventually lead to the discovery of the cause of sleeping sickness.
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