Bacterial and fungal co-infection has been reported in patients with COVID-19, but there is limited experience on these infections in critically ill patients. The objective of this study was to ...assess the characteristics and ouctome of ICU-acquired infections in COVID-19 patients. We conducted a retrospective single-centre, case-control study including 140 patients with severe COVID-19 admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical, and microbiological features, and outcome of ICU-acquired infections. Fifty-seven patients (40.7%) developed a bacterial or fungal nosocomial infection during ICU stay. Infection occurred after a median of 9 days (IQR 5–11) of admission and was significantly associated with the APACHE II score (
p
= 0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia (23%), tracheobronchitis (10%), and urinary tract infection (8%) that were produced by a wide spectrum of Gram-positive (55%) and Gram-negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death (OR 2.7, 95% CI 1.2–5.9,
p
= 0.015) and a longer ICU stay (
p
< 0.001). Bacterial and fungal nosocomial infection is a common complication of ICU admission in patients with COVID-19. It usually presents as a severe form of infection, and it is associated with a high mortality and longer course of ICU stay.
The aim of this study was to examine the impacts on blood lactate concentration, measured heart rate and assessment of perceived exertion during split sessions of equal relative load, as also their ...relationship to the specific sport practised. Nineteen regional-level athletes (nine middle and long-distance runners (cyclic group) and ten field-sport team players (acyclic group)) performed four high-intensity interval training (HIIT) sessions with work-interval durations of 10 s, 50 s, 90 s and 130 s. The sessions were carried out at their usual training sites with a separation of at least 48 hours. Blood lactate concentration was measured at rest and 3 min after the completion of each protocol. Heart rate was measured continuously during all sessions with a sampling rate of 1 s, and rating of perceived exertion (RPE) was requested at the end of the trial. The results showed an increase in blood lactate concentration, peak heart rate and rating of perceived exertion during long protocols as compared with short ones. No differences were observed in dependent variables between cyclic and acyclic groups. Significant but moderate correlations were observed between post-exercise blood lactate concentration, peak heart rate and RPE.
Fecal carriage of extended-spectrum-β-lactamase (ESBL)-producing organisms was detected in 70% of index cases of patients (n = 40) with community-acquired infections due to ESBL producers and reached ...16.7% in household contacts (n = 54). A total of 66% of ESBL-producing organisms from index cases were indistinguishable from isolates from household contacts by pulsed-field gel electrophoresis. Patients with community infections and members of their households represent a reservoir for ESBL producers, increasing dispersal of resistance in healthy people.
The availability of highly sensitive molecular tests for the detection of
in feces leads to overtreatment of patients who are probably only colonized. In this prospective study, the usefulness of ...fecal calprotectin (fCP) is evaluated in a cohort of patients with detection of toxigenic
in feces. Patients were classified by an infectious diseases consultant blinded to fCP results into three groups-group I, presumed
infection (CDI); group II, doubtful but treated CDI; and group III, presumed
colonization or self-limited CDI not needing treatment. One hundred and thirty-four patients were included. The median fCP concentrations were 410 (138-815) μg/g in group I, 188 (57-524) μg/g in group II, and 51 (26-97) μg/g in group III (26 cases);
< 0.05 for all comparisons. In forty-five out of 134 cases (33.5%), the fCP concentrations were below 100 µg/g. In conclusion, fCP is low in most patients who do not need treatment against
, and should be investigated as a potentially useful test in the management of patients with detected toxigenic
.
Colistimethate sodium (CMS) treatment has increased over the last years, being acute kidney injury (AKI) its main drug-related adverse event. Therefore, this study aimed to evaluate the incidence and ...risk factors associated with AKI, as well as identifying the factors that determine renal function (RF) outcomes at six months after discharge.
This retrospective study included adult septic patients receiving intravenous CMS for at least 48h (January 2007–December 2014). AKI was assessed using KDIGO criteria. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD equation. Logistic and linear models were performed to evaluate the risk factors for AKI and chronic kidney disease (CKD).
Among 126 patients treated with CMS; the incidence of AKI was 48.4%. Sepsis–severe sepsis (OR 8.07, P=0.001), sepsis–septic shock (OR 42.9, P<0.001), and serum creatinine (SCr) at admission (OR 6.20, P=0.009) were independent predictors.
Eighty-four patients survived; the main factors for RF evolution at the 6-month follow-up was baseline eGFR (0.58, P<0.001) and at discharge (0.34, P<0.001). Fifty-six percent (34/61) of the patients that developed AKI survived. At six months, 32% had CKD.
The development of AKI in septic patients with CMS treatment was associated with sepsis severity and SCr at admission. Baseline eGFR and eGFR at discharge were and important determinant of the RF at the 6-month follow-up. These predictors may assist in clinical decision making for this patient population.
El tratamiento con colistimetato de sodio (CMS) se ha incrementado, siendo su principal complicación el fracaso renal agudo (FRA). El objetivo de este estudio fue determinar la incidencia de FRA y los factores de riesgo asociados, así como identificar los factores que determinan la función renal (FR) a los 6 meses del alta hospitalaria.
Estudio retrospectivo que incluyó pacientes adultos sépticos que recibieron CMS intravenoso durante al menos 48h (enero 2007-diciembre 2014). El diagnóstico de FRA se realizó según los criterios KDIGO. Se estimó el filtrado glomerular (FG) mediante la ecuación del MDRD-4. Se realizaron modelos logísticos y lineales para evaluar los factores de riesgo para el desarrollo de FRA y enfermedad renal crónica (ERC).
Ciento veintiséis pacientes fueron incluidos; la incidencia de FRA fue del 48,4%. Sepsis-sepsis severa (OR: 8,07; p=0,001), sepsis-shock séptico (OR: 42,9; p<0,001) y la creatinina sérica (CRs) al ingreso (OR: 6,20; p=0,009) fueron predictores independientes de FRA. Ochenta y cuatro pacientes sobrevivieron; el determinante principal de la evolución de la FR a los 6 meses de seguimiento fue el FGe basal (0,58; p<0,001) y al alta (0,34; p<0,001). El 56% (34/61) de los pacientes que desarrollaron FRA sobrevivieron. A los 6 meses, el 32% desarrollo ERC.
El desarrollo de FRA asociado al tratamiento con CMS se asoció con el grado de severidad de la sepsis y la CRs al ingreso. El FGe basal y al alta hospitalaria fueron predictores independientes de la FR a los 6 meses de seguimiento.
Summary Objective To assess the efficacy and toxicity of intravenous colistin in the treatment of infections due to multidrug-resistant gram-negative bacteria. Methods Retrospective cohort study. ...Results Sixty patients received colistin sulphomethate sodium (mean dose, 4.4 mg/kg/day; median duration, 20 days). The main infections were pneumonia or tracheobronchitis (63.3%), intra-abdominal (10%), urinary tract (8.3%), and surgical site infection (6.6%), primary bacteremia (5%), catheter infection (3.3%), meningitis (1.6%), and soft-tissue infection (1.6%). The responsible bacteria were Acinetobacter spp. (50%), P. aeruginosa (23.3%), K. pneumoniae (13.3%), Enterobacter spp. (10%), E. coli (1.6%), and S. maltophilia (1.6%). Eight patients (13%) received colistin monotherapy, and 52 (87%) received combination therapy with other antibiotics such as beta-lactams (15 cases), aminoglycosides (14), beta-lactams and aminoglycosides (15), or ciprofloxacin (8). A favourable response was observed in 43 cases (71.7%). Overall mortality was 26.7%. Despite the common use of combination therapy with aminoglycosides (48%), nephrotoxicity during colistin therapy was observed in only 10.9% of patients; most of them had previous renal failure. Conclusion Colistin appears to be an effective and safe drug for therapy of severe infections due to multidrug-resistant gram-negative bacteria. Despite the concomitant use of aminoglycosides in a high proportion of patients, renal toxicity was an uncommon adverse event.
The lack of new antibiotics for multidrug-resistant bacteria is a matter of concern in microorganisms such as Pseudomonas aeruginosa, ESBL- and carbapenemase-producing Enterobacteriaceae, ...Acinetobacter baumannii, methicillin-resistant Staphylococcous aureus and vancomycin-resistant Enterococcus faecium. This situation has conditioned the reuse of "old" antibiotics (colistin, fosfomycin), the use of more recent antibiotics with new indications or dosage regimens (tigecycline, meropenem) and the introduction of "new" antibiotics (β-lactams, lipoglycopeptides, oxazolidinones) that are the subject of this review.
The spread of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We ...investigated whether β-lactam/β-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval CI) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.).
Abstract
Background
Infections caused by carbapenemase-producing Enterobacterales (CPE) are not well represented in pivotal trials with ceftazidime/avibactam. The best strategy for the treatment of ...these infections is unknown.
Methods
We conducted a multicentre retrospective observational study of patients who received ≥48 h of ceftazidime/avibactam or best available therapy (BAT) for documented CPE infections. The primary outcome was 30 day crude mortality. Secondary outcomes were 21 day clinical response and microbiological response. A multivariate logistic regression model was used to identify factors predictive of 30 day crude mortality. A propensity score to receive treatment with ceftazidime/avibactam was used as a covariate in the analysis.
Results
The cohort included 339 patients with CPE infections. Ceftazidime/avibactam treatment was used in 189 (55.8%) patients and 150 (44.2%) received BAT at a median of 2 days after diagnosis of infection. In multivariate analysis, ceftazidime/avibactam treatment was associated with survival (OR 0.41, 95% CI 0.20–0.80; P = 0.01), whereas INCREMENT-CPE scores of >7 points (OR 2.57, 95% CI 1.18–1.5.58; P = 0.01) and SOFA score (OR 1.20, 95% CI 1.08–1.34; P = 0.001) were associated with higher mortality. In patients with INCREMENT-CPE scores of >7 points, ceftazidime/avibactam treatment was associated with lower mortality compared with BAT (16/73, 21.9% versus 23/49, 46.9%; P = 0.004). Ceftazidime/avibactam was also an independent factor of 21 day clinical response (OR 2.43, 95% CI 1.16–5.12; P = 0.02) and microbiological eradication (OR 0.40, 95% CI 0.18–0.85; P = 0.02).
Conclusions
Ceftazidime/avibactam is an effective alternative for the treatment of CPE infections, especially in patients with INCREMENT-CPE scores of >7 points. A randomized controlled trial should confirm these findings.
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