Lyon, France. Introduction ESBL are enzymes mostly found in Enterobacteriaceae and confer resistance to all beta lactams antibiotics except cefoxitin and carbapenems. Notably, very few data are currently available regarding the role of ESBLe colonization on further pneumonia involving the same bacteria .
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Patients and methods This study was conducted retrospectively from January 1st to May 1st , in our intensive care department. Results During the period of the study, stays were associated with an ESBLe colonization in patients. The most common pathogens involved were Escherichia coli , Klebsiella pneumoniae , and Enterobacter cloacae in both groups. Discussion Due to the single center character of our study, results cannot be extrapolated to the whole ICU population.
Nevertheless, the observed incidence of colonizing ESBLe in our study is close enough from others studies. This point consolidates reflection about ICU pneumonia empiric treatment. Alternative associations to carbapenem remain efficient in all cases of pneumonia in our ICU and should probably be kept in mind.
Strategies to reduce curative antibiotic therapy in intensive care units adult and paediatric. Intensive Care Med ;41 7 — Determinants and impact of multidrug antibiotic resistance in pathogens causing ventilator-associated-pneumonia. Crit Care ;12 6 :R Materials and methods Data from a large French national ICU network were explored during a year period — Univariable hierarchical logistic models with two levels random center and region effects were used to select variables associated with resistance using a p value threshold of 0.
Selected variables were further introduced in multivariable analyses using a hierarchical model with two random effects. ICU-based random effect remains significant indicating major impact of local epidemiology. Limitation The absence of information about antibiotic consumption may partly explain the remaining significant center random effect in the final models.
Resistance rates increased over time, especially for 3GC-R Eb and were highly dependent of local previous epidemiology. Introduction Prevalence of Extended-spectrum beta-lactamase-producing Enterobacteriaceae ESBL-PE carriers dramatically increases all over the world with a spread to the community. The increasing prevalence of ESBL-PE carriage at Intensive Care Unit ICU admission raises important questions on empiric therapy strategies in patients presenting with infection, which may include the use of a carbapenem as first-line therapy.
The following data were collected: demographic characteristics, which included sex, age, simplified acute physiology score SAPS II , location before ICU admission, antibiotic exposure, surgery during the previous year, presence of underlying disease, Charlson comorbidity index, presence of indwelling devices and outcomes. Among these patients, patients had sepsis at ICU admission.
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Fifty patients By multivariable analysis, prior urinary tract disease [OR 3. Hosp Infect. Introduction Carbapenemase-producing Enterobacteriaceae CPEc are increasingly reported worldwide and constitutes a real challenge antibiotic for clinicians to preserve the bacterial ecology.
Patients and methods A retrospective and descriptive study conducted in a Tunisian intensive care unit, including all hospitalized patients infected by an Enterobacteriaceae. The global prevalence of CPEc across study period was 4. The overall incidence of CPEc increased from 0. Our study confirms the rapid spread of CPEc in Tunisian hospital and the urgent need for a well-structured and coordinated national surveillance plan in order to limit their dissemination. Carbapenem antibiotic are regarded as the most effective treatment. However numbers of authors suggest that alternatives antibiotics i.
Moreover as far as we know, there are no data in ICU.
Patients and methods Prospective multicentric observational cohort study conducted in volunteers ICU. Demographic datas, empirical and definitive antibiotic therapy ET and DT , clinical evolution, and outcome were recorded. In vitro antimicrobial susceptibility testing was performed by the disk diffusion method or the Vitek 2 system according to the guidelines of the Antibiogram Committee of the French Microbiologic society.
Surprisingly, there were no differences between the 2 groups carbapenems vs alternatives in term of severity. Introduction Multidrug micro-organisms are responsible for longer hospitalisations and poorer outcomes in intensive care unit ICU. The transmission of extended-spectrum beta-lactamase producing enterobacteriaceae ESBL-PE is prevented by the application of additional contact precautions, mainly relying on isolation in a private room and hand hygiene with waterless alcohol-based solution.
Contact isolation cannot be achieved in our bed ICU only composed of two twin bedrooms. Inclusion criteria were: 1 adult patients and 2 a period of hospitalisation allowing the patient to be nursed by at least two paramedical teams. Characteristics of patients at admission age, sex, SAPSII and clinical data during hospital stay duration of mechanical ventilation, duration of ICU stay, outcome were prospectively collected. Microbiological data concerning ESBL-PE imported and acquired carriage were monitored by rectal swabs collected at admission and once weekly every Monday for the whole duration of the ICU stay.
Mechanistic of a potential cross-transmission was studied following a three-step process consisting in 1 identifying patients considered as possible ESBL sources index patients for transmission, 2 classifying each ESBL strain according to the CTXm 1 and 9 groups and 3 diagnosing potential cross-transmission by gene sequencing of remaining cases of possible transmission.
Results From June to April , patients were admitted in the ICU, among which followed the inclusion criteria. The rate of ESBL colonization at admission was Two hundred and twenty-one non-colonized patients were screened at least twice. The incidence of ESBL acquisition was 4. Mortality did not differ between ESBL carriers and non-carriers. The gene sequencing did it for 3 others and confirmed a cross-transmission in only two patients 0. No case of cross-transmission in the same room was observed. Conclusion The rate of Despite the absence of contact isolation, the incidence of ESBL acquisition was 4.
Our results question whether the contact isolation in private rooms plays a major role for the prevention of ESBL cross-transmission in ICU, although the external validity of our results could be questionable. Introduction Bacterial resistance to antibiotics is a common problem worldwide. In South America, this prevalence is reported to be the highest in the world.
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However, in French Guyana, there is no data on the epidemiology of colonization and infection caused by extended spectrum B-lactamase producing enterobacteriaceae ESBL-PE. Our unit, is the sole and the referral one of all French Guiana department. The mean occupancy rate was The most recorded organ failures at admission to ICU were respiratory and hemodynamic ones At admission to ICU, Multidrug resistant MDR bacteria carriage was found in 88 patients During the ICU stay, 98 patients Over the patients carrying MDR bacteria, This finding can help to reduce the inappropriate use of carbapenems in such conditions.
Introduction The implementation of hemofiltration HF as a renal replacement therapy in septic shock patients requires the supply of large quantities of replacement solutions. These solutions are either industrially prepared in autoclaved expensive plastic bags conventional hemofiltration, CHF or continuously provided in unlimited amounts at the dialysis machine directly from the water treatment plant to form the replacing solutions on-line hemofiltration, OLHF. The aim of our study was to evaluate the safety and effectiveness of on-line hemofiltration compared to conventional hemofiltration in septic shock patients.
Patients and methods The investigative protocol was approved by the Institutional Ethics Authorities and all patients or their legally authorized representatives provided written informed consent. It was a prospective, randomized, clinical study, including septic shock patients with acute renal failure.
Conclusion On-line hemofiltration seems to be a safe and reliable method of renal replacement therapy in septic shock patients. It may be associated with attenuated pro-inflammatory cytokine profile C-reactive protein. Introduction Clinical and biological monitoring of efficacy and safety of RRT sessions is thought useful and in many ICUs biological testing at mid RRT session and at its end is routinely performed.
The aim of the present study is to evaluate the impact of laboratory tests performed during RRT session on clinical decision making and treatment alteration. Patients and methods Retrospective study including all consecutive patients hospitalized in the medical ICU of the University Hospital Monastir, Tunisia between January and September , requiring intermittent hemodialysis performed in the ICU.
Based on the patient monitoring records during each RRT session we identified therapeutic interventions started before the end of the RRT session in the light of the results of laboratory tests performed during the session usually in the middle the session : infusion of glucose, potassium, transfusion, extension of the session. Results During the study period, patients were admitted to the ICU.
Of these 24 patients required acute hemodialysis. Anuria, pulmonary oedema, hyperkalemia, and acidosis indicated RRT sessions respectively in Results of laboratory tests performed during RRT sessions prompted a specific attitude in the following rates: infusion of glucose in Conclusion The practice of laboratory tests during the RRT sessions seems useful since it could impact clinical decision making in more than one-third of sessions.
Introduction Therapeutic plasma exchange TPE is crucial for the management of auto-immune diseases like thrombotic thrombocytopenic purpura or myasthenia gravis. TPE is performed either by centrifugation, with specific machines which are not routinely available in ICUs, or by using specific plasma separation membranes with widely spread in ICUs hemofiltration machines.
Regional citrate anticoagulation for TPE is well established with centrifugation but has been seldom described for membrane TPE.
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We are reporting the experience of our ICU in this field. Patients and methods Retrospective study including all patients who received TPE with citrate regional anticoagulation between and in an bed ICU. Results 26 patients were included. Coagulation of the circuit occurred in Minor adverse events have been reported in two patients: one had a rash during the first TPE no recurrence during the 56 next TPEs and the other had paresthesia during the first two TPEs the calcium infusion was increased and there had been no recurrence during the 25 next TPEs.
No serious adverse events related to citrate were observed. Conclusion Regional anticoagulation with citrate allowed us to perform TPE in 26 patients, without significant adverse events. The rate of circuit coagulation was Introduction A reduced incidence of membrane thrombosis after injection of Anti-thrombin AT has been reported in septic patients with acquired deficit in AT undergoing continuous hemofiltration.
As this strategy was routinely performed in our unit until , we investigated its cost-effectiveness. Patients and methods Data about the use of hemofiltration, the consumption of AT and hemofiltration devices during period with routine use of AT and period with use of AT only if a membrane thrombosis occurred were extracted from the administrative database of the institution. A decisional tree was built to modelize the impact of AT on the consumption of hemofiltration devices and blood products. The decisional tree took into account the probability of membrane thrombosis with and without AT and the probability of transfusion after membrane thrombosis.
Costs were obtained from the pharmacy of the institution AT, hemofiltration devices and from the literature blood products.
According to the decisional tree, AT was almost never cost-effective. The only circumstances associated with a benefit for the use of AT was the association of a probability of thrombosis with AT inferior to 0. In these extremely favorable circumstances, AT could decrease the daily cost of hemofiltration of 2. Discussion The model has several limits: the losses of utility related to transfusion and to interruption of hemofiltration due to thrombosis were not taken into account; the cost of AT measurement was not estimated; the work load of changing a membrane and of transfusion after membrane thrombosis was not analyzed.
Conclusion Our results suggest that anti-thrombin is not cost-effective to reduce the costs of hemofiltration related to membrane thrombosis.
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Introduction Several temporary venous catheterizations are sometimes required for acute renal replacement therapy RRT in the intensive care unit ICU. This study compares catheterizations in the femoral and jugular veins in terms of patient safety.