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1. Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project

Author

Matteo Bassetti, Daniele R. Giacobbe, Antonio Vena, Cecilia Trucchi, Filippo Ansaldi, Massimo Antonelli, Vaclava Adamkova, Cristiano Alicino, Maria-Panagiota Almyroudi, Enora Atchade, Anna M. Azzini, Novella Carannante, Alessia Carnelutti, Silvia Corcione, Andrea Cortegiani, George Dimopoulos, Simon Dubler, José L. García-Garmendia, Massimo Girardis, Oliver A. Cornely, Stefano Ianniruberto, Bart Jan Kullberg, Katrien Lagrou, Clement Le Bihan, Roberto Luzzati, Manu L. N. G. Malbrain, Maria Merelli, Ana J. Marques, Ignacio Martin-Loeches, Alessio Mesini, José-Artur Paiva, Maddalena Peghin, Santi Maurizio Raineri, Riina Rautemaa-Richardson, Jeroen Schouten, Pierluigi Brugnaro, Herbert Spapen, Polychronis Tasioudis, Jean-François Timsit, Valentino Tisa, Mario Tumbarello, Charlotte H. S. B. van den Berg, Benoit Veber, Mario Venditti, Guillaume Voiriot, Joost Wauters, and Philippe Montravers

Subjects
ICU, Candidemia, Candidiasis, Candida, Abdominal candidiasis, Incidence, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe. Methods A multinational, multicenter, retrospective study was conducted in 23 ICUs in 9 European countries, representing the first phase of the candidemia/intra-abdominal candidiasis in European ICU project (EUCANDICU). Results During the study period, 570 episodes of ICU-acquired IC were observed, with a cumulative incidence of 7.07 episodes per 1000 ICU admissions, with important between-center variability. Separated, non-mutually exclusive cumulative incidences of candidemia and IAC were 5.52 and 1.84 episodes per 1000 ICU admissions, respectively. Crude 30-day mortality was 42%. Age (odds ratio [OR] 1.04 per year, 95% CI 1.02–1.06, p

Published
2019
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2. Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project

Author

Herbert D. Spapen, Massimo Girardis, Polychronis Tasioudis, Santi Maurizio Raineri, Jose Luis Garcia-Garmendia, Philippe Montravers, Valentino Tisa, Alessio Mesini, Massimo Antonelli, Novella Carannante, Stefano Ianniruberto, Jean-François Timsit, Mario Venditti, Filippo Ansaldi, Joost Wauters, Mario Tumbarello, Cecilia Trucchi, Matteo Bassetti, Manu L N G Malbrain, Katrien Lagrou, Silvia Corcione, Enora Atchade, Bart Jan Kullberg, Alessia Carnelutti, Cristiano Alicino, Pierluigi Brugnaro, José Artur Paiva, Riina Rautemaa-Richardson, Ana J Marques, Maria-Panagiota Almyroudi, George Dimopoulos, Clément Le Bihan, Andrea Cortegiani, Maria Merelli, Anna Maria Azzini, Simon Dubler, Daniele Roberto Giacobbe, Charlotte H S B van den Berg, Maddalena Peghin, Benoit Veber, Jeroen Schouten, Roberto Luzzati, Antonio Vena, Guillaume Voiriot, Oliver A. Cornely, Vaclava Adamkova, Ignacio Martin-Loeches, Bassetti M., Giacobbe D.R., Vena A., Trucchi C., Ansaldi F., Antonelli M., Adamkova V., Alicino C., Almyroudi M.-P., Atchade E., Azzini A.M., Carannante N., Carnelutti A., Corcione S., Cortegiani A., Dimopoulos G., Dubler S., Garcia-Garmendia J.L., Girardis M., Cornely O.A., Ianniruberto S., Kullberg B.J., Lagrou K., Le Bihan C., Luzzati R., Malbrain M.L.N.G., Merelli M., Marques A.J., Martin-Loeches I., Mesini A., Paiva J.-A., Peghin M., Raineri S.M., Rautemaa-Richardson R., Schouten J., Brugnaro P., Spapen H., Tasioudis P., Timsit J.-F., Tisa V., Tumbarello M., Van Den Berg C.H.S.B., Veber B., Venditti M., Voiriot G., Wauters J., Montravers P., Bassetti, M., Giacobbe, D. R., Vena, A., Trucchi, C., Ansaldi, F., Antonelli, M., Adamkova, V., Alicino, C., Almyroudi, M. -P., Atchade, E., Azzini, A. M., Carannante, N., Carnelutti, A., Corcione, S., Cortegiani, A., Dimopoulos, G., Dubler, S., Garcia-Garmendia, J. L., Girardis, M., Cornely, O. A., Ianniruberto, S., Kullberg, B. J., Lagrou, K., Le Bihan, C., Luzzati, R., Malbrain, M. L. N. G., Merelli, M., Marques, A. J., Martin-Loeches, I., Mesini, A., Paiva, J. -A., Peghin, M., Raineri, S. M., Rautemaa-Richardson, R., Schouten, J., Brugnaro, P., Spapen, H., Tasioudis, P., Timsit, J. -F., Tisa, V., Tumbarello, M., Van Den Berg, C. H. S. B., Veber, B., Venditti, M., Voiriot, G., Wauters, J., Montravers, P., Faculty of Psychology and Educational Sciences, Supporting clinical sciences, Intensive Care, and Internal Medicine Specializations

Subjects
Male, Outcome Assessment, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], MULTICENTER, Critical Care and Intensive Care Medicine, law.invention, 610 Medical sciences Medicine, 0302 clinical medicine, Retrospective Studie, Risk Factors, law, Outcome Assessment, Health Care, EPIDEMIOLOGY, Medicine, Cumulative incidence, PREDICTORS, Candida, Medicine(all), Cross Infection, Incidence, Incidence (epidemiology), lcsh:Medical emergencies. Critical care. Intensive care. First aid, Candidiasis, Middle Aged, Intensive care unit, Europe, Intensive Care Units, Abdominal candidiasis, Candidemia, ICU, Aged, Candidiasis, Invasive, Female, Humans, Retrospective Studies, Candidiasi, SOFA score, Life Sciences & Biomedicine, Human, medicine.medical_specialty, Invasive, Intensive Care Unit, Abdominal candidiasis, Candida, Candidemia, Candidiasis, ICU, Incidence, 03 medical and health sciences, Critical Care Medicine, General & Internal Medicine, Intensive care, Settore MED/41 - ANESTESIOLOGIA, MANAGEMENT, Science & Technology, business.industry, Septic shock, INTRAABDOMINAL CANDIDIASIS, Research, 030208 emergency & critical care medicine, Retrospective cohort study, lcsh:RC86-88.9, Odds ratio, medicine.disease, Health Care, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], Emergency medicine, Abdominal candidiasi, business
Abstract

Contains fulltext : 206779.pdf (Publisher’s version ) (Open Access) BACKGROUND: The objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe. METHODS: A multinational, multicenter, retrospective study was conducted in 23 ICUs in 9 European countries, representing the first phase of the candidemia/intra-abdominal candidiasis in European ICU project (EUCANDICU). RESULTS: During the study period, 570 episodes of ICU-acquired IC were observed, with a cumulative incidence of 7.07 episodes per 1000 ICU admissions, with important between-center variability. Separated, non-mutually exclusive cumulative incidences of candidemia and IAC were 5.52 and 1.84 episodes per 1000 ICU admissions, respectively. Crude 30-day mortality was 42%. Age (odds ratio [OR] 1.04 per year, 95% CI 1.02-1.06, p < 0.001), severe hepatic failure (OR 3.25, 95% 1.31-8.08, p 0.011), SOFA score at the onset of IC (OR 1.11 per point, 95% CI 1.04-1.17, p 0.001), and septic shock (OR 2.12, 95% CI 1.24-3.63, p 0.006) were associated with increased 30-day mortality in a secondary, exploratory analysis. CONCLUSIONS: The cumulative incidence of IC in 23 European ICUs was 7.07 episodes per 1000 ICU admissions. Future in-depth analyses will allow explaining part of the observed between-center variability, with the ultimate aim of helping to improve local infection control and antifungal stewardship projects and interventions.

Published
2019

3. Increased plasma levels of endozepines, endogenous ligands of benzodiazepine receptors, during systemic inflammation: a prospective observational study

Author

Vincent Compère, Emmanuel Besnier, Hélène Castel, Thomas Clavier, Bertrand Dureuil, Fabrice Morin, Pierrick Gandolfo, Anne Foutel, Marie-Christine Tonon, Antoine Lefevre-Scelles, Muriel Quillard, Jean-Jacques Tuech, Benoit Veber, Différenciation et communication neuronale et neuroendocrine (DC2N), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Anesthésie et soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Service de chirurgie digestive [CHU Rouen], Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Medical Biochemistry, Institute of Clinical Biology, Rouen University Hospita, Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, CASTEL, Hélène, Hôpital Charles Nicolle [Rouen], and Normandie Université (NU)-Normandie Université (NU)-CHU Rouen

Subjects
Male, [SDV]Life Sciences [q-bio], Endogeny, Pharmacology, Ligands, Critical Care and Intensive Care Medicine, Systemic inflammation, Rats, Sprague-Dawley, chemistry.chemical_compound, 0302 clinical medicine, Prospective Studies, ComputingMilieux_MISCELLANEOUS, Diazepam Binding Inhibitor, 0303 health sciences, GABAA receptor, Radioimmunoassay, Middle Aged, Systemic Inflammatory Response Syndrome, 3. Good health, [SDV] Life Sciences [q-bio], Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Inflammation Mediators, medicine.symptom, Adult, medicine.medical_specialty, Endozepine, Inflammation, [SDV.BC]Life Sciences [q-bio]/Cellular Biology, Sepsis, 03 medical and health sciences, Immune system, Species Specificity, Internal medicine, medicine, Animals, Humans, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], [SDV.BC] Life Sciences [q-bio]/Cellular Biology, 030304 developmental biology, business.industry, Research, Receptors, GABA-A, medicine.disease, Rats, Endocrinology, chemistry, business, 030217 neurology & neurosurgery
Abstract

Introduction Recent work has shown that benzodiazepines interact with the immune system and exhibit anti-inflammatory effects. By using in vitro models, researchers in several studies have shown that the peptidergic endogenous ligands of benzodiazepine receptors, named endozepines, are involved in the immune response. All endozepines identified so far derive from diazepam-binding inhibitor (DBI), which generates several biologically active fragments. The aim of the present study was to measure plasma levels of DBI-like immunoreactivity (DBI-LI) in a rat model of sepsis and in patients with systemic inflammation from septic or non-septic origin. Methods Cecal ligation and puncture (CLP) or sham surgery was performed in rats. Blood samples were taken from animals, patients hospitalized for digestive surgery with inflammatory diseases, and healthy volunteers. Measurements of plasma DBI-related peptides were carried out by radioimmunoassay in animal and human samples. Results In the rats, CLP provoked an increase of plasma DBI-LI (+37%) 6 hours postsurgery. In humans, DBI-LI levels were significantly higher in the systemic inflammation group than in the healthy volunteer group (48.6 (32.7 to 77.7) pg/ml versus 11.1 (5.9 to 35.3) pg/ml, P

Published
2014

4. Strategies of initiation and streamlining of antibiotic therapy in 41 French intensive care units

Author

Philippe Montravers, Herve Dupont, Remy Gauzit, Benoit Veber, Jean-Pierre Bedos, Alain Lepape, The CIAR Study Group, Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pôle d'Anesthésie Réanimation, CHU Amiens-Picardie, Affectations Mineralisantes du Systeme Cardiovasculaire : Calcifications Arterielles et Valvulaires Aortiques, Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel-Dieu [Paris], Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de réanimation [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), Service d'anesthésie-réanimation [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), This research was supported by Wyeth Pharmaceuticals France, CIAR (Club d'infectiologie en Anesthésie-Réanimation) Study Group, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Université de Picardie Jules Verne ( UPJV ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Hôtel-Dieu [Paris], Service de réanimation médicale [Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Service de Reanimation Polyvalente, Centre Hospitalier de Versailles (CHV), Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, and BMC, Ed.

Subjects
Male, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], MESH : Prospective Studies, MESH : Aged, Bacteremia, Critical Care and Intensive Care Medicine, MESH : Intensive Care, MESH : Intraabdominal Infections, law.invention, MESH: Clinical Protocols, MESH : Physician's Practice Patterns, 0302 clinical medicine, Clinical Protocols, law, MESH: Risk Factors, Risk Factors, MESH : Female, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, MESH : Anti-Bacterial Agents, Practice Patterns, Physicians', Prospective cohort study, MESH: Bacteremia, MESH: Aged, MESH: Intraabdominal Infections, MESH: Middle Aged, [ SDV.MHEP.PHY ] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], MESH : After-Hours Care, MESH : Adult, Middle Aged, MESH : Risk Factors, Intensive care unit, 3. Good health, Anti-Bacterial Agents, Intensive Care Units, SAPS II, Cohort, SOFA score, Female, France, MESH : Intensive Care Units, MESH: After-Hours Care, Adult, medicine.medical_specialty, MESH: Pneumonia, Critical Care, MESH : Male, MESH : Drug Administration Schedule, MESH: Drug Administration Schedule, Drug Administration Schedule, MESH : Hospital Mortality, 03 medical and health sciences, After-Hours Care, Intensive care, MESH: Anti-Bacterial Agents, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, MESH : Middle Aged, MESH : Clinical Protocols, MESH: Intensive Care, MESH: Hospital Mortality, MESH : France, MESH: Physician's Practice Patterns, Aged, MESH: Humans, business.industry, MESH : Pneumonia, Research, MESH : Humans, 030208 emergency & critical care medicine, MESH: Adult, Odds ratio, Pneumonia, MESH : Bacteremia, medicine.disease, MESH: Male, MESH: Prospective Studies, MESH: France, Emergency medicine, Intraabdominal Infections, MESH: Intensive Care Units, business, MESH: Female
Abstract

CIAR (Club d'infectiologie en Anesthésie-Réanimation) Study Group: Pr B Allaouchiche (HCL, CHU Lyon), Pr C Arich (CHU Nimes), Pr C Auboyer (CHU St-Etienne), Dr JP Caramella (CHG Nevers), Dr JF Cochard (CHU Bordeaux), Dr A Combes (CHG Meaux), Dr P Courant (CHG Avignon), Dr J Durand-Gasselin (CHG Toulon), Pr J Duranteau (APHP, CHU Bicetre), Dr H Floch (CHU Nantes), Dr F Fraisse (CHG St Denis), Pr M Freysz (CHU Dijon), Dr B Garrigues (CHG Aix-en-Provence), Dr B Georges (CHU Toulouse), Pr F Gouin (APHM, CHU Marseille), Pr L Jacob (APHP, CHU St Louis), Pr P Juvin (APHP, CHU Beaujon), Dr J Keinlen (CHU Montpellier), Dr AM Korinek (APHP, CHU Pitie Salpetriere), Dr C Lamer (Institut Mutualiste Montsouris, Paris), Pr JY Lefrant (CHU Nimes), Dr O Lesieur (CHG La Rochelle), Dr Yazine Mahjoub (CHU Amiens), Pr Y Malledant (CHU Rennes), Pr C Martin (APHM, CHU Marseille), Pr O Mimoz (CHU Poitiers), Pr C Paugam-Burtz (APHP, CHU Beaujon, Clichy), Dr PF Perrigault (CHU Montpellier), Pr T Pottecher (CHU Strasbourg), Pr JL Pourriat (APHP, CHU Hotel Dieu), Dr JF Poussel (CHG Metz), Dr A Rabbat (APHP, CHU Hotel Dieu), Dr J Reignier (CHG La Roche sur Yon), Dr P Sichel (CHG Cherbourg), Dr JP Sollet (CHG Argenteuil), Dr D Thevenin (CHG Lens), Dr G Viquesnel (CHU Caen).; International audience; INTRODUCTION: Few studies have addressed the decision-making process of antibiotic therapy (AT) in intensive care unit (ICU) patients. METHODS: In a prospective observational study, all consecutive patients admitted over a one-month period (2004) to 41 French surgical (n = 22) or medical/medico-surgical ICUs (n = 19) in 29 teaching university and 12 non-teaching hospitals were screened daily for AT until ICU discharge. We assessed the modalities of initiating AT, reasons for changes and factors associated with in ICU mortality including a specific analysis of a new AT administered on suspicion of a new infection. RESULTS: A total of 1,043 patients (61% of the cohort) received antibiotics during their ICU stay. Thirty percent (509) of them received new AT mostly for suspected diagnosis of pneumonia (47%), bacteremia (24%), or intra-abdominal (21%) infections. New AT was prescribed on day shifts (45%) and out-of-hours (55%), mainly by a single senior physician (78%) or by a team decision (17%). This new AT was mainly started at the time of suspicion of infection (71%) and on the results of Gram-stained direct examination (21%). Susceptibility testing was performed in 261 (51%) patients with a new AT. This new AT was judged inappropriate in 58 of these 261 (22%) patients. In ICUs with written protocols for empiric AT (n = 25), new AT prescribed before the availability of culture results (P = 0.003) and out-of-hours (P = 0.04) was more frequently observed than in ICUs without protocols but the appropriateness of AT was not different. In multivariate analysis, the predictive factors of mortality for patients with new AT were absence of protocols for empiric AT (adjusted odds ratio (OR) = 1.64, 95% confidence interval (95%CI): 1.01 to 2.69), age ≥60 (OR = 1.97, 95% CI: 1.19 to 3.26), SAPS II score >38 (OR = 2.78, 95% CI: 1.60 to 4.84), rapidly fatal underlying diseases (OR = 2.91, 95% CI: 1.52 to 5.56), SOFA score ≥6 (OR = 4.48, 95% CI: 2.46 to 8.18). CONCLUSIONS: More than 60% of patients received AT during their ICU stay. Half of them received new AT, frequently initiated out-of-hours. In ICUs with written protocols, empiric AT was initiated more rapidly at the time of suspicion of infection and out-of-hours. These results encourage the establishment of local recommendations for empiric AT.

Published
2011

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