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Abstract

Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ® . A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality. Objective It is known that the closed tracheal suction system (CTSS) produces less hemodynamic and gasometric deterioration than an open tracheal suction system (OTSS). Use is limited because no decrease in the incidence of ventilator-associated pneumonia (VAP) was found and also because it is more expensive. But, is daily periodic change of the CTSS necessary? The aim of this study was to analyze the incidence of VAP using a CTSS without periodic change versus an OTSS. Methods It is a prospective study of ICU patients from 1 January 2004 to 31 October 2004. Patients who required mechanical ventilation (MV) were randomized into two groups: one group was suctioned with CTSS without periodic change and another group with OTSS. An aspirate tracheal swab and a throat swab on admission and afterwards twice weekly were taken. VAP was classified based on throat flora in endogenous and exogenous samples. The statistical analysis was performed by chi-square test and Student's t test, and w...

Audit and Feedback to Reduce Broad-Spectrum Antibiotic Use among Intensive Care Unit Patients A Controlled Interrupted Time Series Analysis

“…Earlier studies have detected decreases in extended-spectrum /3-lactamase-producing Enterobacteriaceae 15 " 17 as well as carbapenem, ceftazidime, and ciprofloxacin resistance among Pseudomonas and Acinetobacter species. 16,17 However, our report represents, to our knowledge, the first examination of the impact of critical care antibiotic stewardship on the risk of C. difficile infection. The small reduction in the number of cases of C. difficile infection within our critical care units, which coincided with the introduction of antibiotic stewardship, is intriguing, particularly because a steep increase in the number of cases of C. difficile infection occurred in our nonintervention medical and surgical wards during the same time period.…”

“…15 " 17 A reevaluation of antibiotic therapy at 2 days was associated with a 17% reduction in the number of antibiotic prescriptions, from 1.8 to 1.5 prescriptions per patient. 17 Formal reevaluation at 14 days was associated with a 12% reduction in overall antibiotic use, from 1,265 to 1,112 defined daily doses per 1,000 patient-days. 16 The intervention most similar to our own (with reassessment on days 3, 7, and 10) was credited with a 35% reduction in antibiotic use, from 940 to 610 days of therapy per 1,000 patient days.…”