1,721,072 research outputs found
Pharmacokinetics (PK) and tissue penetration of vancomycin (V) in patients undergoing prosthetic mammary surgery
No full textVentilator-associated pneumonia in neuromuscular, tracheostomyzed patients
No full textLower-tract respiratory infections are common events in tracheostomyzed mechanically ventilated patients leading to a 10-fold increase in mortality rate particularly in those patients with severely compromized clinical conditions [1]. Our study aimed to assess epidemiology and risk factors for colonization of respiratory tract and development of ventilator-associated pneumonia (VAP) in home-living, tracheostomyzed and mechanically ventilated patients with neuromuscular disease.
Design
A retrospective study.
Setting
An ICU ambulatorial service for neuromuscular disease.
Patients
Data of 27 patients (20 male) that underwent a routine visit every 6 months, collected from 1995 until 2003, were analyzed. Thirteen had amyotrophic lateral sclerosis (ALS) and one spinal muscular atrophy (ALS-like group); seven had Duchenne's dystrophy (DMP), two congenital dystrophy, three metabolic dystrophy and one supranuclear progressive paralysis (DMP-like group).
The median age was 54 years (interquartile range, 31–63). The median mechanical ventilation period (MVP) was 71 months (30–120).
Thirteen patients had severe dysphagy and ineffective cough reflex, 12 of them were alimentated by percutaneous enteral gastrostomy and one by nasal-gastric tube, ALS-like patients were more frequently dysphagic than DMP-like patients (P < 0.01).
Low respiratory tract infections (LRTI) were defined in the presence of cough or an abnormal increase of bronchial secretions, with or without fever that required antibiotic therapy; pneumonia was defined as LRTI with a new pulmonary infiltrate at thorax radiography [2].
Measurements and main results
VAP incidence was 52 episodes for 100 patients per year of MVP. The median MVP was lower in dysphagic patients (33 months [20.75–70.50]) than in non-dysphagic patients (120 months [80–156]) (P < 0.01) and in ALS-like patients (33 months [24–73]) than in the DMP-like group of patients (96 months [69.5–144]).
Dysphagic patients had an higher colonization incidence (Ci) (P = 0.01), LTRI incidence (LTRIi) (P = not significant), and VAP incidence (VAPi) (P = 0.02) than nondysphagic patients, per month of mechanical ventilation.
ALS-like patients had a higher Ci and VAPi than DMP-like patients (P = not significant).
Bivariate analysis shown a positive correlation between Ci and LTRIi and VAPi (P < 0.01 for both). MVP was negatively correlated with Ci (P < 0.01) and VAPi, although the P value was 0.06. Pseudomonas aeruginosa was the most isolated bacteria in colonization (48%), LTRI (45%) and VAP (52%) episodes.
Conclusion
VAP is a frequent event in our patients. Dysphagic patients, although alimentated by gastrostomy, are more frequently colonized and this enhances the risk to develop VAP more than in nondysphagic patients. Patients ventilated for a long period seem to develop a natural defence from colonization. The longer the MVP, the less the patient is prone to be colonized and, likely, to develop VAP. The risk of developing VAP is no different in ALS-like and DMP-like disease although the dysphagy prevalence differs. A bigger sample is needed to definitively prove this
Pharmacokinetics and tissue penetration of vancomycin in patients undergoing prosthetic mammary surgery
No full textEpidemiologia delle sepsi nosocomiali in un'unità di terapia intensiva
No full textIn a prospective study at a 20-bed intensive care unit, the incidence of nosocomial sepsis was evaluated with causative pathogens and associated risk factors. A total of 182 patients (mean age 56 +/- 17 years), referred from an outpatient setting and admitted for > 48 hr, were enrolled. Over the first 10-month period the incidence of sepsis was high (21.3 per 100 admissions) and most of episodes were central venous catheter (CVC)-associated (47%) and polymicrobial (63%). Increased risk of sepsis was significantly associated with duration of indwelling CVCs and peripheral arterial catheters, mechanical ventilation, and hospital stay. On this ground, mandatory arterial and CVC change every 10 days has been assigned. Over the second 10-month period the incidence of CVC-related (5%) and polymicrobial episodes (9%) was significantly lower than that observed during the first period. However, the routine replacement of vascular catheters failed to show any decrease in the overall incidence of sepsis (22.5 per 100 admissions). As a consequence, other approaches to global infection control need to be developed for this patient population
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Epidemiology of nosocomial sepsis (S) in a medical intensive care unit (ICU)
No full textnosocomial infection prevention and contro
Secular trends in nosocomial candidaemia in non-neutropenic patients in an Italian tertiary hospital.
No full textA retrospective study was performed in an Italian tertiary hospital to evaluate trends in candidaemia
between 1992 and 2001, and to compare the characteristics of episodes of fungaemia between 1992.1997
and 1998.2001. In total, 370 episodes of candidaemia were identified, with an average incidence of 0.99
episodes . 10 000 patient-days . year (range 0.49.1.29 episodes). On an annual trend basis, the overall
incidence was essentially stable in surgical and medical wards, but decreased in intensive care units
(ICUs) (p 0.0065). The average use of fluconazole was 37.9 g . 10 000 patient-days . year (range 21.4.
56.1 g), and did not change significantly during the 10-year period. Nearly two-thirds of patients were in
ICUs at the onset of candidaemia, but none was neutropenic in either study period. Candida albicans
remained the predominant species isolated (53.8% vs. 48.1%), followed by Candida parapsilosis, Candida
glabrata and Candida tropicalis, the distribution of which did not change significantly. The 30-day crude
mortality rate was essentially similar (44% vs. 35%) in both study periods. Thus the incidence of
nosocomial candidaemia, although high in this institution, decreased among critically-ill patients during
the 10-year period. This finding seemed to be related to an improvement in infection control practices,
particularly regarding the prevention of intravascular catheter-related infections in ICUs. Although the
overall use of fluconazole was considerable, no increase in azole-resistant non-albicans Candida spp. was
detected
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