Cost and morbidity associated with antibiotic prophylaxis in the ICU

Namias, Nicholas; Harvill, Sarah; Ball, Suzette; McKenney, Mark; Salomone, Jeffrey P.; Civetta, Joseph M.

doi:10.1016/s1072-7515(98)00287-7

Cited by 67 publications

(24 citation statements)

References 7 publications

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“…[20][21][22][23][24] However, unnecessary antibiotic exposure is associated with increased risk for subsequent infectious complications, colonization, and infection with resistant pathogens, and increased hospital costs. 21,[25][26][27][28][29][30][31] Th us, early identifi cation of patients with pneumonia is necessary to improve outcomes in this population.…”

Section: For Editorial Comment See Page 1448mentioning

confidence: 99%

A Pilot Study of the Noninvasive Assessment of the Lung Microbiota as a Potential Tool for the Early Diagnosis of Ventilator-Associated Pneumonia

May

Brady

Romano-Keeler

et al. 2015

Chest

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BACKGROUND: Ventilator-associated pneumonia (VAP) remains a common complication in critically ill surgical patients, and its diagnosis remains problematic. Exhaled breath contains aerosolized droplets that refl ect the lung microbiota. We hypothesized that exhaled breath condensate fl uid (EBCF) in hygroscopic condenser humidifi er/heat and moisture exchanger (HCH/HME) fi lters would contain bacterial DNA that qualitatively and quantitatively correlate with pathogens isolated from quantitative BAL samples obtained for clinical suspicion of pneumonia.

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Section: For Editorial Comment See Page 1448mentioning

confidence: 99%

A Pilot Study of the Noninvasive Assessment of the Lung Microbiota as a Potential Tool for the Early Diagnosis of Ventilator-Associated Pneumonia

May

Brady

Romano-Keeler

et al. 2015

Chest

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“…The indication is less clear previous to the insertion of a chest tube [168][169][170][171][172][173]. In any case, protracted administration is not indicated, provided that it does not confer additional protection and increases antibioticrelated complications, and in some instances the risk of nosocomial infections [174][175][176]. Randomized clinical trials and comparative nonrandomized studies have proven it [177][178][179][180][181].…”

Section: Other Considerations During the First Daymentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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“…Reduction of translocation of gut microflora might therefore reduce both infections and the need for antibiotics. Although evidence in favor of selective decontamination of the digestive tract (SDD) with antibiotics is mounting [14, 15], the prophylactic use of antibiotics to prevent infectious complications is still controversial [16, 17]. Results of antibiotic prophylaxis are especially conflicting in necrotizing pancreatitis [18, 19].…”

Section: Introductionmentioning

confidence: 99%

Prevention of Infectious Complications in Surgical Patients: Potential Role of Probiotics

Besselink

Timmerman²,

Minnen³

et al. 2005

Dig Surg

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Infectious complications in surgical patients often originate from the intestinal microflora. In the critically ill patient, small bowel motility is disturbed, leading to bacterial overgrowth and subsequent bacterial translocation due to dysfunction of the gut mucosal barrier. The optimal prophylactic strategy should act on all these factors, but such a strategy is not yet available. For several decades, antibiotic prophylaxis to prevent translocation of pathogenic bacteria has been studied with conflicting results. Selective decontamination of the digestive tract has shown good results, but fear for bacterial multiresistance has prevented worldwide implementation. In recent years, probiotics, living bacteria with a potential beneficial effect to their host, have shown promising results in several randomized placebo-controlled trials. Currently, in vitro and experimental research focuses on the effects of probiotics on the microflora responsible for gut-derived infections, structural mucosal barrier function and the immune system.

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Cost and morbidity associated with antibiotic prophylaxis in the ICU

Cited by 67 publications

References 7 publications

A Pilot Study of the Noninvasive Assessment of the Lung Microbiota as a Potential Tool for the Early Diagnosis of Ventilator-Associated Pneumonia

A Pilot Study of the Noninvasive Assessment of the Lung Microbiota as a Potential Tool for the Early Diagnosis of Ventilator-Associated Pneumonia

Critical Care Issues in the Early Management of Severe Trauma

Prevention of Infectious Complications in Surgical Patients: Potential Role of Probiotics

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