Recent trends in antibiotic resistance in European ICUs

Duijn, Pleun Joppe van; Dautzenberg, Mirjam J. D.; Oostdijk, Evelien

doi:10.1097/mcc.0b013e32834c9d87

Cited by 81 publications

(57 citation statements)

References 72 publications

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“…The two other studies adopted a more defensive policy: all suspected VAP patients received broad-spectrum antibiotics, and antibiotic deescalation was hardly applied (27,33). These antibiotic strategies were very exceptional in the present study, as they still are in most other Dutch hospitals (34). Furthermore, patients with P. aeruginosa and MRSA colonization or infection were excluded in one study (27), although these microorganisms are well-known causes of VAP.…”

Section: Culturesmentioning

confidence: 83%

Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

et al. 2014

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Authoritative guidelines state that the diagnosis of ventilator-associated pneumonia (VAP) can be established using either endotracheal aspirate (ETA) or bronchoalveolar lavage fluid (BALF) analysis, thereby suggesting that their results are considered to be in accordance. Therefore, the results of ETA Gram staining and semiquantitative cultures were compared to the results from a paired ETA-BALF analysis. Different thresholds for the positivity of ETAs were assessed. This was a prospective study of all patients who underwent bronchoalveolar lavage for suspected VAP in a 27-bed university intensive care unit during an 8-year period. VAP was diagnosed when >2% of the BALF cells contained intracellular organisms and/or when BALF quantitative culture revealed >104 CFU/ml of potentially pathogenic microorganisms. ETA Gram staining and semiquantitative cultures were compared to the results from paired BALF analysis by Cohen's kappa coefficients. VAP was suspected in 311 patients and diagnosed in 122 (39%) patients. In 288 (93%) patients, the results from the ETA analysis were available for comparison. Depending on the threshold used and the diagnostic modality, VAP incidences varied from 15% to 68%. For the diagnosis of VAP, the most accurate threshold for positivity of ETA semiquantitative cultures was moderate or heavy growth, whereas the optimal threshold for BALF Gram staining was >1 microorganisms per high power field. The Cohen's kappa coefficients were 0.22, 0.31, and 0.60 for ETA and paired BALF Gram stains, cultures, and BALF Gram stains, respectively. Since the ETA and BALF Gram stains and cultures agreed only fairly, they are probably not interchangeable for diagnosing VAP.

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Section: Culturesmentioning

confidence: 83%

Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

et al. 2014

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“…Varios estudios de vigilancia a nivel mundial durante la década de 2000 han demostrado que del 20 al 80% de K. pneumoniae aislados fueron resistentes a los antibióticos de primera línea, incluyendo las cefalosporinas, fluoroquinolonas y aminoglucósidos (15,16) .…”

Section: Discussionunclassified

Prevalencia de infecciones intrahospitalarias en el Servicio de Clínica Médica del Hospital Regional de Encarnación 2014-2015

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Almada

2016

Rev. Nac. (Itauguá)

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RESUMENIntroducción: las infecciones asociadas a cuidados de la salud, conocidas también como infecciones nosocomiales (IN), son un problema relevante de salud pública, se asocian con altas tasas de morbilidad y mortalidad, lo que se traduce en un incremento en los días de hospitalización y los costos de atención.Objetivos: determinar los gérmenes intrahospitalarios más frecuentes y su sensibilidad antibiótica en la sala de Clínica Médica del Hospital Regional de Encarnación periodo 2014-2015.Metodología: estudio descriptivo, observacional de corte transversal, prospectivo, de prevalencia y con componente analítico.Resultados: se evaluaron pacientes hospitalizados encontrándose 114 (6%) pacientes con infecciones intrahospitalarias. El perfil epidemiológico se caracterizó por predomino del sexo femenino (53%), con edad media 56,5 ± 22,5 años y una estancia hospitalaria prolongada. Los aislamientos fueron más frecuentes en orina. Las comorbilidades más frecuentes fueron la hipertensión arterial y la diabetes mellitus. El germen más frecuente aislado fue Klebsiella pneumoniae, con una sensibilidad solo a amikacina y cabapenemes, con 64% BLEE(+) y 20% KPC, seguido por Echerichia coli y Staphylococcus aureus con buena sensibilidad a oxacilina. Conclusión

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“…Combination therapy is recommended for neutropenic patients with sepsis, patients with risk factors for multidrug resistance (MDR) pathogen infections and patients with severe pneumonia (16). In the recent years, MDR is a growing problem in ICU worldwide (17)(18)(19). In the era of MDR pathogens, initially appropriate antibiotic therapy is more complicated that causes poor outcome (20)(21)(22)(23).…”

Section: De-escalation Therapymentioning

confidence: 99%

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Alp

2016

Ann. Transl. Med.

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Septic shock is still a lethal disease in intensive care units (ICU). The mortality can exceed 40% even with therapeutic management. The high mortality is clearly associated with the delay of appropriate antimicrobial therapy. Early diagnosis and identification of infectious source is the mainstay of optimal therapeutic management. On the other hand, source control and optimize antibiotic dosing according to pharmacokinetics (PK)/ pharmacodynamics (PD) properties of antibiotics and organ dysfunction of patients are required to get the best clinical outcome.

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Recent trends in antibiotic resistance in European ICUs

Abstract: As the epidemiology of antibiotic resistance in ICUs is rapidly changing toward more frequently occurring epidemics and endemicity of multi and panresistant Gram-negative pathogens, better infection control and improved diagnostics will become even more important than before.

Cited by 81 publications

References 72 publications

Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

Prevalencia de infecciones intrahospitalarias en el Servicio de Clínica Médica del Hospital Regional de Encarnación 2014-2015

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