Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017.
Jean Louis Vincent,Yasser Sakr,Mervyn Singer,Ignacio Martin-Loeches,Flávia Ribeiro Machado,John C. Marshall,Simon Finfer,Paolo Pelosi,Luca Brazzi,Dita Aditianingsih,Jean-François Timsit,Bin Du,Xavier Wittebole,Jan Máca,Santhana Kannan,Luis A. Gorordo-Delsol,Jan J. De Waele,Yatin Mehta,Marc J. M. Bonten,Ashish Khanna,Ashish Khanna,Marin H. Kollef,Mariesa Human,Derek C. Angus +23 more
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TLDR
In a worldwide sample of patients admitted to ICUs in September 2017, the prevalence of suspected or proven infection was high, with a substantial risk of in-hospital mortality, and ICU-acquired infection was independently associated with higher risk of mortality.Abstract:
Importance Infection is frequent among patients in the intensive care unit (ICU). Contemporary information about the types of infections, causative pathogens, and outcomes can aid the development of policies for prevention, diagnosis, treatment, and resource allocation and may assist in the design of interventional studies. Objective To provide information about the prevalence and outcomes of infection and the available resources in ICUs worldwide. Design, Setting, and Participants Observational 24-hour point prevalence study with longitudinal follow-up at 1150 centers in 88 countries. All adult patients (aged ≥18 years) treated at a participating ICU during a 24-hour period commencing at 08:00 on September 13, 2017, were included. The final follow-up date was November 13, 2017. Exposures Infection diagnosis and receipt of antibiotics. Main Outcomes and Measures Prevalence of infection and antibiotic exposure (cross-sectional design) and all-cause in-hospital mortality (longitudinal design). Results Among 15 202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [60.4%]), infection data were available for 15 165 (99.8%); 8135 (54%) had suspected or proven infection, including 1760 (22%) with ICU-acquired infection. A total of 10 640 patients (70%) received at least 1 antibiotic. The proportion of patients with suspected or proven infection ranged from 43% (141/328) in Australasia to 60% (1892/3150) in Asia and the Middle East. Among the 8135 patients with suspected or proven infection, 5259 (65%) had at least 1 positive microbiological culture; gram-negative microorganisms were identified in 67% of these patients (n = 3540), gram-positive microorganisms in 37% (n = 1946), and fungal microorganisms in 16% (n = 864). The in-hospital mortality rate was 30% (2404/7936) in patients with suspected or proven infection. In a multilevel analysis, ICU-acquired infection was independently associated with higher risk of mortality compared with community-acquired infection (odds ratio [OR], 1.32 [95% CI, 1.10-1.60];P = .003). Among antibiotic-resistant microorganisms, infection with vancomycin-resistantEnterococcus(OR, 2.41 [95% CI, 1.43-4.06];P = .001),Klebsiellaresistant to β-lactam antibiotics, including third-generation cephalosporins and carbapenems (OR, 1.29 [95% CI, 1.02-1.63];P = .03), or carbapenem-resistantAcinetobacterspecies (OR, 1.40 [95% CI, 1.08-1.81];P = .01) was independently associated with a higher risk of death vs infection with another microorganism. Conclusions and Relevance In a worldwide sample of patients admitted to ICUs in September 2017, the prevalence of suspected or proven infection was high, with a substantial risk of in-hospital mortality.read more
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Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.
Laura Evans,Andrew Rhodes,Waleed Alhazzani,Massimo Antonelli,Craig M. Coopersmith,Craig French,Flávia Ribeiro Machado,Lauralyn McIntyre,Marlies Ostermann,Hallie C. Prescott,Christa Schorr,Steven Q. Simpson,W. Joost Wiersinga,Fayez Alshamsi,Derek C. Angus,Yaseen M. Arabi,Luciano Cesar Pontes Azevedo,Richard Beale,Gregory J. Beilman,Emilie P. Belley-Côté,Lisa Burry,Maurizio Cecconi,John Centofanti,Angel Coz Yataco,Jan De Waele,R. Phillip Dellinger,Kent Doi,Bin Du,Elisa Estenssoro,Ricard Ferrer,Charles D. Gomersall,Carol L. Hodgson,Morten Hylander Møller,Theodore J. Iwashyna,Shevin T. Jacob,Ruth M. Kleinpell,Michael Klompas,Michael Klompas,Younsuck Koh,Anand Kumar,Arthur Kwizera,Suzana Margareth Lobo,Henry Masur,Steven McGloughlin,Sangeeta Mehta,Yatin Mehta,Mervyn Mer,Mark E. Nunnally,Simon Oczkowski,Tiffany M. Osborn,Elizabeth Papathanassoglou,Anders Perner,Michael A. Puskarich,Jason A. Roberts,William D. Schweickert,Maureen A. Seckel,Jonathan E. Sevransky,Charles L. Sprung,Charles L. Sprung,Tobias Welte,Janice L. Zimmerman,Mitchell M. Levy +61 more
TL;DR: The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications as discussed by the authors, which are either strong or weak, or in the form of best practice statements.
Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Laura Evans,Andrew Rhodes,Waleed Alhazzani,Massimo Antonelli,Craig M. Coopersmith,Craig French,Flávia Ribeiro Machado,Lauralyn McIntyre,Marlies Ostermann,Hallie C. Prescott,Christa Schorr,Steven Q. Simpson,W. Joost Wiersinga,Fayez Alshamsi,Derek C. Angus,Yaseen M. Arabi,Luciano Cesar Pontes Azevedo,Richard Beale,Gregory J. Beilman,Emilie P. Belley-Côté,Lisa Burry,Maurizio Cecconi,John Centofanti,Angel Coz Yataco,Jan De Waele,R. Phillip Dellinger,Kent Doi,Bin Du,Elisa Estenssoro,Ricard Ferrer,Charles D. Gomersall,Carol L. Hodgson,Morten Hylander Møller,Theodore J. Iwashyna,Shevin T. Jacob,Ruth M. Kleinpell,Michael Klompas,Younsuck Koh,Anand Kumar,Arthur Kwizera,Suzana Margareth Lobo,Henry Masur,Steven McGloughlin,Sangeeta Mehta,Yatin Mehta,Mervyn Mer,Mark E. Nunnally,Simon Oczkowski,Tiffany M. Osborn,Elizabeth Papathanassoglou,Anders Perner,Michael A. Puskarich,Jason A. Roberts,William D. Schweickert,Maureen A. Seckel,Jonathan E. Sevransky,Charles L. Sprung,Tobias Welte,Janice L. Zimmerman,Mitchell M. Levy +59 more
TL;DR: The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications as mentioned in this paper, which are either strong or weak, or in the form of best practice statements.
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Tackling antimicrobial resistance in the COVID-19 pandemic.
TL;DR: It is argued that antimicrobial stewardship activities should be integrated into the pandemic response across the broader health system through five measures: ensure the continuity of essential health services and regular supply of quality assured and affordable antimicrobials including antiretroviral and tuberculosis drugs, and vaccines.
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Ventilator-associated pneumonia in critically ill patients with COVID-19.
Mailis Maes,Ellen Higginson,Joana Pereira-Dias,Martin D. Curran,Surendra Parmar,Fahad A Khokhar,Delphine Cuchet-Lourenço,Janine Lux,Sapna Sharma-Hajela,Benjamin Ravenhill,Islam Hamed,Laura Heales,Razeen Mahroof,Amelia Solderholm,Sally Forrest,Sushmita Sridhar,Sushmita Sridhar,Nicholas M. Brown,Stephen Baker,Vilas Navapurkar,Gordon Dougan,Josefin Bartholdson Scott,Andrew Conway Morris,Andrew Conway Morris +23 more
TL;DR: In this article, the authors compared the incidence of VAP and secondary infections using a combination of microbial culture and a TaqMan multi-pathogen array, and determined the lung microbiome composition using 16S RNA analysis in a subset of samples.
References
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Journal ArticleDOI
International Study of the Prevalence and Outcomes of Infection in Intensive Care Units
Jean Louis Vincent,Jordi Rello,John C. Marshall,Eliezer Silva,Antonio Anzueto,Claude Martin,Rui Moreno,Jeffrey Lipman,Charles D. Gomersall,Yasser Sakr,Konrad Reinhart +10 more
TL;DR: In this large cohort, infection was independently associated with an increased risk of hospital death and risk of infection increases with duration of ICU stay.
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Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study
Kristina E. Rudd,Sarah Charlotte Johnson,Kareha M Agesa,Katya Anne Shackelford,Derrick Tsoi,Daniel Kievlan,Danny V. Colombara,Kevin S Ikuta,Kevin S Ikuta,Niranjan Kissoon,Simon Finfer,Carolin Fleischmann-Struzek,Flávia Ribeiro Machado,Konrad Reinhart,Kathryn M Rowan,Christopher W. Seymour,R. Scott Watson,R. Scott Watson,T. Eoin West,Fatima Marinho,Simon I. Hay,Simon I. Hay,Rafael Lozano,Rafael Lozano,Alan D. Lopez,Alan D. Lopez,Derek C. Angus,Christopher J L Murray,Christopher J L Murray,Mohsen Naghavi,Mohsen Naghavi +30 more
TL;DR: Despite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa.
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