Ventilator-associated pneumonia (VAP) is the most frequent infection in patients admitted to intensive care units.
We compared rates of VAP, days on mechanical ventilation (MV), and cost of ...antimicrobial agents before and during implementation.
We collected data from 401 patients before the intervention and from 1,534 patients during the intervention. Both groups were comparable. No significant differences in EuroSCORE were observed between the patients of both periods (6.4 versus 6.3; P = 0.7). The rates of VAP (episodes/1,000 days of ventilation) were, respectively, 23.9 versus 13.5 (P = 0.005). Mean number of days of MV/1,000 days of stay was 507 versus 375 (P = 0.001), and the cost of antimicrobial therapy (Euros/1,000 days of stay) was €70,612 versus €52,775 (P = 0.10). The main effect of sequential application of preventive measures in time achieved a relative-rate reduction of VAP of 41% (IRR, 0.41; 95% CI, 0.28 to 0.62). The mortality rate before and during the intervention was 13.0% and 10.2%, respectively.
A sequentially applied bundle of four preventive measures reduces VAP rates, days of MV, and the cost of antimicrobial therapy in patients admitted to the major heart surgery ICU.
Clinical Trials.gov: NCT02060045. Registered 4 February 2014.
To determine the frequency, etiology, and risk factors of ventilator-associated pneumonia (VAP) and purulent tracheobronchitis (TBX) in patients who have undergone heart surgery. To study the ...predictive role of systematic surveillance cultures.
Prospective study.
Heart surgery intensive care unit.
Intubated heart surgical patients.
Systematic tracheal aspirate and protected brush catheter cultures of all intubated patients.
Studied were the frequency of lower respiratory tract infection in ventilated patients and the role of surveillance cultures. The frequency of VAP was 7.87% (34.5 per 1,000 days of mechanical ventilation), and the criteria for purulent tracheobronchitis was fulfilled by 8.15% of patients (31.13 per 1,000 days of mechanical ventilation). After multivariate analysis, the variables independently associated with the development of respiratory tract infection were central nervous system disorder (relative risk RR = 4.7), ulcer disease (RR = 3.6), New York Heart Association score >/=3 (RR = 4), need for mechanical circulatory support (RR = 6.8), duration of mechanical ventilation >96 hrs (RR = 12.3), and reintubation (RR = 63.7). Mortality in our study was as follows: VAP patients, 57.1%; purulent tracheobronchitis patients, 20.7%; colonized patients, 11.5%; and noncolonized patients, 1.6%. Regular surveillance cultures were taken from all ventilated patients to assess the anticipative value of the cultures in predicting respiratory tract infection. A total of 1,626 respiratory surveillance samples were obtained. Surveillance cultures effectively predicted only one episode of VAP and one of tracheobronchitis.
Patients undergoing heart surgery have a high frequency of VAP. VAP is associated with a poor prognosis. In this study, surveillance cultures failed as an anticipative diagnostic method.
Survey of intravascular catheter management is an essential step in the control and prevention of catheter-related infection. In recent years, most surveillance studies only included catheters from ...intensive care units (ICUs). Data regarding the level of care and adherence to international guidelines in a whole general institution are scarce. Our objective was to evaluate the care situation of intravascular catheters in our adult units of a General Hospital.
We surveyed adults hospitalized in non-psychiatric/maternity wards. In a week, a nurse visited all the adult hospitalized patients. Data were registered in a protocol that included variables, such as no. of catheters, location of catheter, type of catheter, date of placement and the need of an indication of each catheter in the visit day.
We included in the study a total of 753 adult patients. Of them, 653 (86.7%) had one or more inserted catheters at the moment of the study visit (total: 797 catheters). Of all the catheters, 144 (18.0%) were central venous catheters and 653 (81.9%) were peripheral lines. The hospitalization units where the patients were admitted were ICU, 52 (6.9%); and non-ICU, 601 (92.0%). There were 183 (22.9%) catheters with no need to remain in place in the day of the study. Overall, we found 464 (71.0%) patients with one or more opportunities for catheter care improvement.
A rapid survey of the care situation of intravascular catheters is feasible and easy to do with our methodology. The data show great opportunity for improvement, mainly in the non-ICU areas.
Problemática: tras la implementación del marco normativo de las NIIF para pymes en Colombia, las empresas hoteleras del sector ecoturismo han demostrado incrementos económicos relevantes, lo que ha ...aumentado su competitividad y productividad empresarial; sin embargo, son escasas las referencias bibliográficas que permiten analizar dichos efectos. Objetivos: se pretende analizar la forma que emplean estas empresas para reconocer, medir y revelar los ingresos de actividades ordinarias por los servicios de alojamiento de huéspedes. Materiales y métodos: se emplea una metodología dinámica que incluye la revisión documental del marco legal y normativo contable, repositorios académicos y el análisis de informes oficiales, aplicando una investigación exploratoria y explicativa del marco técnico normativo vigente, mediante un enfoque mixto cuantitativo y cualitativo en la investigación. Resultados: los ingresos por servicios hoteleros se realizan conforme a los Decretos 2706 de 2012 y 3022 de 2013. Son reconocidos cuando se puede realizar una medición fiable y se traslada el control, los riesgos y las ventajas del bien o servicio al cliente. Su medición se fundamenta en el valor razonable aplicando el método de mercado activo. Discusión: la aplicación de la sección 23 de las NIIF para pymes no ha afectado el rendimiento económico de las pymes del sector ecoturismo; por el contrario, han generado mayor inversión extranjera y flujos de capital. Conclusiones: las empresas del grupo dos y tres aplican NIIF para pymes, las cuales pueden incorporar la sección 23 a sus políticas individuales. Contribución/originalidad: se espera formular una guía de implementación de la norma contable para el reconocimiento, medición y revelación de ingresos por servicios para las empresas hoteleras del sector ecoturismo que cumplan las exigencias para aplicar las NIIF del grupo dos y, en el caso de las microempresas del grupo tres, si quisieran incorporar la sección 23 a sus políticas individuales.
Patients undergoing heart surgery show a high risk of catheter colonization and catheter-related bloodstream infections. We evaluated whether skin insertion site and catheter hub surveillance ...cultures ("surface cultures") could predict catheter colonization and help establish the origin of bloodstream infections.
: Prospective cohort study.
An 11-bed heart surgery intensive care unit in a tertiary university hospital.
Heart surgery patients spending >4 days in intensive care over an 11-month period.
All catheters were surveyed. Cultures were obtained from the skin insertion site and all hubs on day 5 after surgery, every 72 hrs thereafter, and on catheter removal. Swabs were processed semiquantitatively by streaking the surface of a Columbia agar plate. Catheters were processed using Maki's method. The observation of > or = 15 colonies/plate was taken to indicate a positive skin or catheter colonization culture result.
Over the study period, 561 catheters were inserted in 130 patients. The median time a catheter was in place was 6 days (interquartile range 3-11), and 3,712 surface cultures were obtained (median four per patient). Catheter colonization occurred in 133 catheters, and there were 15 episodes of catheter-related bloodstream infection (incidence density of colonization 29.3 and of catheter-related bloodstream infection 8.8 per 1,000 catheter-days). Validity indexes for the capacity of surface cultures to predict catheter colonization and catheter-related bloodstream infection, respectively, were as follows: accuracy, 71.4, 65.6; sensitivity, 83.5%, 100%; specificity, 67.1%, 64.7%; positive predictive value, 47.6%, 7.2%; negative predictive value, 91.9%, 100%; positive likelihood ratio, 2.5, 2.83; and negative likelihood ratio, 0.2, 0. Surface cultures correctly predicted 77.4% of all bacteremia episodes (catheter-related and non-catheter-related).
Systematic surveillance cultures of catheter hub and skin insertion sites in patients admitted to a heart surgery intensive care unit could help identify patients who would benefit from decontamination and preventive measures and establish whether catheters are the portal of entry of bloodstream infection.
Objectives
Information on the recently COVID‐19‐associated pulmonary aspergillosis (CAPA) entity is scarce. We describe eight CAPA patients, compare them to colonised ICU patients with coronavirus ...disease 2019 (COVID‐19), and review the published literature from Western countries.
Methods
Prospective study (March to May, 2020) that included all COVID‐19 patients admitted to a tertiary hospital. Modified AspICU and European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria were used.
Results
COVID‐19‐associated pulmonary aspergillosis was diagnosed in eight patients (3.3% of 239 ICU patients), mostly affected non‐immunocompromised patients (75%) with severe acute respiratory distress syndrome (ARDS) receiving corticosteroids. Diagnosis was established after a median of 15 days under mechanical ventilation. Bronchoalveolar lavage was performed in two patients with positive Aspergillus fumigatus cultures and galactomannan (GM) index. Serum GM was positive in 4/8 (50%). Thoracic CT scan findings fulfilled EORTC/MSG criteria in one case. Isavuconazole was used in 4/8 cases. CAPA‐related mortality was 100% (8/8). Compared with colonised patients, CAPA subjects were administered tocilizumab more often (100% vs. 40%, p = .04), underwent longer courses of antibacterial therapy (13 vs. 5 days, p = .008), and had a higher all‐cause mortality (100% vs. 40%, p = .04). We reviewed 96 similar cases from recent publications: 59 probable CAPA (also putative according modified AspICU), 56 putative cases and 13 colonisations according AspICU algorithm; according EORTC/MSG six proven and two probable. Overall, mortality in the reviewed series was 56.3%.
Conclusions
COVID‐19‐associated pulmonary aspergillosis must be considered a serious and potentially life‐threatening complication in patients with severe COVID‐19 receiving immunosuppressive treatment.
There is a paucity of knowledge on the long-term outcome in patients diagnosed with COVID-19. We describe a cohort of patients with a constellation of symptoms occurring four weeks after diagnosis ...causing different degrees of reduced functional capacity. Although different hypothesis have been proposed to explain this condition like persistent immune activation or immunological dysfunction, to date, no physiopathological mechanism has been identified. Consequently, there are no therapeutic options besides symptomatic treatment and rehabilitation.
We evaluated patients with symptoms that persisted for at least 4 weeks after COVID-19. Epidemiological and clinical data were collected. Blood tests, including inflammatory markers, were conducted, and imaging studies made if deemed necessary. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) in plasma, stool, and urine were performed. Patients were offered antiviral treatment (compassionate use).
We evaluated 29 patients who reported fatigue, muscle pain, dyspnea, inappropriate tachycardia, and low-grade fever. Median number of days from COVID-19 to positive RT-PCR in extra-respiratory samples was 55 (39-67). Previous COVID-19 was mild in 55% of the cases. Thirteen patients (45%) had positive plasma RT-PCR results and 51% were positive in at least one RT-PCR sample (plasma, urine, or stool). Functional status was severely reduced in 48% of the subjects. Eighteen patients (62%) received antiviral treatment. Improvement was seen in most patients (p = 0.000) and patients in the treatment group achieved better outcomes with significant differences (p = 0.01).
In a cohort of COVID-19 patients with persistent symptoms, 45% of them have detectable plasma SARS-CoV-2 RNA. Our results indicate possible systemic viral persistence in these patients, who may benefit of antiviral treatment strategies.
Fourteen fungal entomopathogenic strains were isolated from soil samples and infected field-collected fall armyworm larvae, in Guanajuato, Mexico. Isolates were identified by morphology and internal ...transcribed spacers sequencing. Isolates Ma22, Ma41, and Mr8 showed 99% identity with reference strains (RS) of Metarhizium anisopliae. Isolates Bb9, Bb19, Bb21, Bb40, Bb27, Bb23, and Bb39 showed identity between 99 and 100% with RS of Beauveria bassiana. Isolates Nr1, Nr2, Nr3, and Nr4 showed identity between 98 and 100% with RS of Nomuraea rileyi. Qualitative selection used one concentration (1 × 108 conidia/ml) on fall armyworm eggs and neonate larvae. Strains Ma22, Ma41, and Mr8 showed 100%, and strains Bb39, Bb23, Bb9, Bb40, Bb19, and Bb21 showed 92, 89.2, 87.6, 82.8, 58, and 38% egg mortality, respectively. Bioassays on neonate larvae showed 100% mortality with strains Ma22, Ma41, Mr8, and Bb9. Strains Bb39, Bb19, Bb27, Bb23, Bb21, and Bb40 showed 74, 60, 54, 53, 28, and 19% mortality, respectively. Bioassay estimated LC50s for strains Ma41 at 7.4 × 104, Mr8 at 8.9 × 104, and Ma22 at 10 × 104 conidia/ml, on fall armyworm eggs. LC50s on neonate larvae were estimated at 2.8 × 105, 16 × 105, 26 × 105, and 36 × 105 conidia/ml for strains Ma41, Bb9, Ma22, and Mr8, respectively. Virulence genes mad1 and mad2 were found in Mr8, Ma22, and Ma41, whereas the gen gmact was found only in the strain Ma22. Genes hyd1 and hyd2 were identified in Bb9, Bb19, Bb21, and Bb27. No correlation was observed between the virulence gene detection and the estimated LC50s. Strain Ma41 showed the highest potential to be developed as a bioinsecticide.
PDF
