We assessed the impact of 2% daily patient bathing with chlorhexidine gluconate (CHG) washcloths on the incidence of hospital-acquired (HA) and central line-associated (CLA) bloodstream infections ...(BSI) in intensive care units (ICUs). We searched randomised studies in Medline, EMBASE, Cochrane Library (CENTRAL) and Web of Science databases up to April 2015. Primary outcomes were total HABSI, central line, and non-central line-associated BSI rates per patient-days. Secondary outcomes included Gram-negative and Gram-positive BSI rates and adverse events. Four randomised crossover trials involved 25 ICUs and 22,850 patients. Meta-analysis identified a total HABSI rate reduction (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.60-0.90; p = 0.002) with moderate heterogeneity (I
= 36%). Subgroup analysis identified significantly stronger rate reductions (p = 0.01) for CLABSI (OR: 0.50; 95% CI: 0.35-0.71; p < 0.001) than other HABSI (OR: 0.82; 95% CI: 0.70-0.97; p = 0.02) with low heterogeneity (I
= 0%). This effect was evident in the Gram-positive subgroup (OR: 0.55; 95% CI: 0.31-0.99; p = 0.05), but became non-significant after removal of a high-risk-of-bias study. Sensitivity analysis revealed that the intervention effect remained significant for total and central line-associated HABSI. We suggest that use of CHG washcloths prevents HABSI and CLABSI in ICUs, possibly due to the reduction in Gram-positive skin commensals.
The NEMO-3 and SuperNEMO experiments search for neutrino less double beta decay (0vββ). Detection of 0vββ decay would provide direct evidence that neutrinos are Majorana particles and lepton number ...is not conserved. In these experiments, the isotopes of interest are separated from the active detector region, allowing for reconstruction of the full event topology. This aids in background suppression and discrimination between underlying 0vββ decay mechanisms. The NEMO-3 experiment investigated a total of seven 0vββ decay isotopes. The SuperNEMO experiment builds upon the design of NEMO-3. Upgrades to the detector technologies and radiopurity, as well as an increase in isotope mass will allow SuperNEMO to improve 0vββ half-life sensitivities by two orders of magnitude. The latest result from NEMO-3 is summarized, and an overview of the progress in the construction of the SuperNEMO demonstrator module is presented.
The interest in research on oral care in intensive care unit (ICU) patients has emerged largely from the 2000s onward after years of being a rather ignored topic in health science. Since, the focus ...has been on its potential contribution to preventing pneumonia by eliminating contaminated oral pathogens that might invade the lower respiratory tract. Accumulating evidence of the effectiveness of oral care with chlorhexidine gluconate (CHG) in preventing ventilator-associated pneumonia (VAP) or postoperative pneumonia 1, 2 has led to adopting CHG oral care as the gold standard for intubated patients. Recently, however, potential adverse effects of CHG on the oral mucosa 3 and reduced bacterial susceptibility 4 have been reported, as well as an even more alarming potential association of CHG oral care with an increased risk of mortality 5–8. Although the latter association results from retrospective studies or meta-analyses, righteous calls for caution and for a thorough re-evaluation of the established gold standard have been launched 9, 10.
Severe nosocomial infections and multidrug resistance (MDR) are associated with a poor prognosis for patients in intensive care units. This is partly because most of these patients suffer from high ...disease severity and acute illness before the onset of infection. Nevertheless, the mortality attributed directly to infection can also be devastating. However, the attributable mortality can be limited by taking account of a number of key points. General infection prevention measures, prevention of cross-transmission and a policy of restricted antimicrobial use are all important because of their positive influence on the rates of infection and MDR. In turn, this will increase the odds for successful empirical coverage of the causative microorganism. Once infection occurs, benefits are to be expected from early recognition of the septic episode and prompt initiation of empirical antimicrobial therapy. The choice of empirical therapy should be based on the local bacterial ecology and patterns of resistance, the presence of risk-factors for MDR, and the colonisation status of the patient. Attention should also be given to adequate doses of antimicrobial agents and, if possible, elimination of the sources of infection, e.g., contaminated devices or intra-abdominal collections or leakages. In the latter case, timely surgical intervention is essential. In addition, haemodynamic stabilisation and optimisation of tissue oxygenation can save lives.
Purpose
The management of peritonitis in critically ill patients is becoming increasingly complex due to their changing characteristics and the growing prevalence of multidrug-resistant (MDR) ...bacteria.
Methods
A multidisciplinary panel summarizes the latest advances in the therapeutic management of these critically ill patients.
Results
Appendicitis, cholecystitis and bowel perforation represent the majority of all community-acquired infections, while most cases of healthcare-associated infections occur following suture leaks and/or bowel perforation. The micro-organisms involved include a spectrum of Gram-positive and Gram-negative bacteria, as well as anaerobes and fungi. Healthcare-associated infections are associated with an increased likelihood of MDR pathogens. The key elements for success are early and optimal source control and adequate surgery and appropriate antibiotic therapy. Drainage, debridement, abdominal cleansing, irrigation, and control of the source of contamination are the major steps to ensure source control. In life-threatening situations, a "damage control" approach is the safest way to gain time and achieve stability. The initial empirical antiinfective therapy should be prescribed rapidly and must target all of the micro-organisms likely to be involved, including MDR bacteria and fungi, on the basis of the suspected risk factors. Dosage adjustment needs to be based on pharmacokinetic parameters. Supportive care includes pain management, optimization of ventilation, haemodynamic and fluid monitoring, improvement of renal function, nutrition and anticoagulation.
Conclusions
The majority of patients with peritonitis develop complications, including worsening of pre-existing organ dysfunction, surgical complications and healthcare-associated infections. The probability of postoperative complications must be taken into account in the decision-making process prior to surgery.
With an established role in cystic fibrosis and bronchiectasis, nebulized antibiotics are increasingly being used to treat respiratory infections in critically ill invasively mechanically ventilated ...adult patients. Although there is limited evidence describing their efficacy and safety, in an era when there is a need for new strategies to enhance antibiotic effectiveness because of a shortage of new agents and increases in antibiotic resistance, the potential of nebulization of antibiotics to optimize therapy is considered of high interest, particularly in patients infected with multidrug-resistant pathogens. This Position Paper of the European Society of Clinical Microbiology and Infectious Diseases provides recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology regarding the use of nebulized antibiotics in invasively mechanically ventilated adults, based on a systematic review and meta-analysis of the existing literature (last search July 2016). Overall, the panel recommends avoiding the use of nebulized antibiotics in clinical practice, due to a weak level of evidence of their efficacy and the high potential for underestimated risks of adverse events (particularly, respiratory complications). Higher-quality evidence is urgently needed to inform clinical practice. Priorities of future research are detailed in the second part of the Position Paper as guidance for researchers in this field. In particular, the panel identified an urgent need for randomized clinical trials of nebulized antibiotic therapy as part of a substitution approach to treatment of pneumonia due to multidrug-resistant pathogens.
...although types of supporting surfaces vary widely among geographic regions, within countries and even among ICUs in the same hospital, the one and same report form needed to allow reporting of ...every type of supporting surface used worldwide. ...not only for supporting surfaces but for all materials we wanted to collect information about, we had to find then write all-encompassing descriptions that every data collector worldwide could recognise and that allowed them to report the corresponding materials used in the own unit appropriately. ...after a process of several weeks of intensive searches and correspondence with local centres, 15 May 2018 was set as the international data collection day.Challenge #3. The recruitment resulting from that approach however covered a restricted part of the globe only. ...our next step consisted of meticulously screening the PubMed database to identify recent publications in the domain of intensive care, then to invite authors from countries where a national representative for the study was still lacking. ...intended study participation from a number of African countries was prevented by difficulties in obtaining ethical clearance (see below).
Nebulized antibiotics have an established role in patients with cystic fibrosis or bronchiectasis. Their potential benefit to treat respiratory infections in mechanically ventilated patients is ...receiving increasing interest. In this consensus statement of the European Society of Clinical Microbiology and Infectious Diseases, the body of evidence of the therapeutic utility of aerosolized antibiotics in mechanically ventilated patients was reviewed and resulted in the following recommendations: Vibrating-mesh nebulizers should be preferred to jet or ultrasonic nebulizers. To decrease turbulence and limit circuit and tracheobronchial deposition, we recommend: (a) the use of specifically designed respiratory circuits avoiding sharp angles and characterized by smooth inner surfaces, (b) the use of specific ventilator settings during nebulization including use of a volume controlled mode using constant inspiratory flow, tidal volume 8 mL/kg, respiratory frequency 12 to 15 bpm, inspiratory:expiratory ratio 50%, inspiratory pause 20% and positive end-expiratory pressure 5 to 10 cm H2O and (c) the administration of a short-acting sedative agent if coordination between the patient and the ventilator is not obtained, to avoid patient's flow triggering and episodes of peak decelerating inspiratory flow. A filter should be inserted on the expiratory limb to protect the ventilator flow device and changed between each nebulization to avoid expiratory flow obstruction. A heat and moisture exchanger and/or conventional heated humidifier should be stopped during the nebulization period to avoid a massive loss of aerosolized particles through trapping and condensation. If these technical requirements are not followed, there is a high risk of treatment failure and adverse events in mechanically ventilated patients receiving nebulized antibiotics for pneumonia.
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