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Lower respiratory tract infections in the intubated patient constitute a serious health problem due to their associated morbidity and mortality. Microaspiration of the buccopharyngeal secretions is the main physiopathological mechanism underlying the development of pneumonia and tracheobronchitis in intubated patients. All care bundles designed to prevent these infections include the use of antiseptics to reduce buccopharyngeal colonization. Chlorhexidine is the antiseptic most frequently assessed in clinical trials and meta-analyses that conclude that oral hygiene with chlorhexidine reduces the incidence of ventilator-associated pneumonia - maximum effectiveness being achieved when the product is administered at a concentration of 2%. However, 2meta-analyses have warned of a possible increase in mortality when chlorhexidine is used as an oral antiseptic. We therefore recommend its use but with extreme caution during application in order to avoid aspiration of the antiseptic. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson., (Copyright © 2018. Publicado por Elsevier España, S.L.U.)

Objective: Carbapenemase-producing Enterobacterias is a global health hazard due to their ease of transmission, difficulty of treatment, and their personal and economic impact. We analyze the factors associated with an increased risk of infection by Klebsiella pneumoniae carbapenemase-producing bacteria (KPC) and factors related to poor prognosis., Methods: We designed a case-control study. KPC isolates were taken during an outbreak in a hospital in Madrid. A logistic regression was performed with the main variables., Results: Sixteen cases of clinically documented infections were isolated. Overall mortality rates in the cases group was 25%. The most frequent location was blood (37.5%) followed by urine (25%). All but one were OXA-48. Regarding factors related to an increased risk of developing infection, only previous exposure to antibiotics presented statistical significance difference OR 13 (2.40-70.46). With respect to the overall mortality, the presence of pneumonia OR 25 (1.93-323.55) or the use of invasive mechanical ventilation was associated with greater risk 15 OR 33 (1.92-122.8) For attributable mortality only invasive ventilation had a significant association OR 18 (1.48-218.95)., Conclusions: Exposure to previous antibiotics is an independent risk factor for developing KPC infection, adjusted for all other clinical and demographic variables. Risk factors such as the presence of pneumonia or the use of invasive mechanical ventilation were associated with a worse prognosis in terms of overall and attributable mortality., (©The Author 2018. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Unlabelled: We conducted a clinical trial to determine the impact of coating surfaces with copper in reducing hospital-acquired infections, mortality associated with nosocomial infections and antimicrobial costs in the UCI. The study took place at Carlos Van Buren Hospital, Valparaíso, Chile. No differences in the frequency of nosocomial infections were found. Not in rates of ventilator-associated pneumonia (p = 0.9), nor in catheter- associated urinary tract infection (p = 0.9) or in central venous catheter associated bacteremia (p = 0.3). There were no differences in infection-free survival (p = 0.9). There were less costs of antimicrobials in patients in which copper was used. The fact that the sample size was not completed could explain that no significant differences in infections were found., Conclusion: The use of copper as a surface in the ICU showed no statistically significant differences in rates of nosocomial infections during the study period, however, these results could be related to the sample size.

Objectives: In this prospective clinical trial we aimed to answer if spontaneous exhaled breath condensate (EBC) in the trap of the expiratory arm of the ventilator could replace EBC collected by coolant chamber standardized with Argon as an inert gas. Second, if EBC pH could predict ventilator associated pneumonia (VAP) and mortality., Patients: We included 34 critically ill patients (males = 26), aged = 54.85 ± 19.86 (mean ± SD) yrs, that required mechanical ventilation due to non-pulmonary direct cause (APACHE II score = 23.58 ± 14.7; PaO(2)/FiO(2) = 240.00 ± 98.29)., Setting: ICU with 9 beds from a regional teaching hospital., Intervention and Results: The patients were followed up until development of VAP, successful weaning or death. There were significant differences between mean EBC pH from the 4 procedures with the exception of spontaneous EBC de-aerated with Argon (n = 79; 6.74 ± 0.28) and coolant chamber deaerated with Argon (n = 79; 6.70 ± 0.36; p = NS by Tukey's Multiple Comparison Test). However, none of the procedures were extrapolated between each other according to Bland & Altman method. The mean EBC pH from the trap without Argon was 6.50 ± 0.28. From the total of 34 patients, 22 survived and were discharged and 12 patients died in the ICU., Conclusion: Spontaneous EBC pH could not be extrapolated to EBC pH from coolant chamber and it did not change in subjects who dead, neither subject with VAP in comparison with baseline data. The lack of other biomarker in EBC and the lack of a control group determinate the need for further studies in this setting., (Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.)

Objective: We analyze the most suitable time to perform tracheostomy in neurocritically ill patients. We compare morbimortality and use of resources between those patients in which tracheostomy was done early (9 days), in a selected group of patients., Material and Methods: We made an observational prospective study involving a group of patients diagnosed as traumatic brain injury (TBI) or stroke, whose tracheostomy was performed during their stay at the Intensive Care Unit. We compared two groups: a) early tracheostomy (during first 9 days of ICU stay); b) late tracheostomy (made on 10th day or later). As variables, we studied: demographic data, severity of illness at admission, admittance department, diagnosis, length of intubation, length of mechanical ventilation (LMV), sedation and antibiotic treatment needs, ventilator-associated pneumonia (VAP) events, ICU length of stay and mortality. We calculated relative risk of suffering from pneumonia and made a multivariate logistic regression to establish which factors were associated with an increased risk of developing pneumonia. Statistical signification p

Objective: to identify lethality and mortality rates and, mortality risk factors in ventilator associated pneumonia (VAP) on 114 patients treated between 2000 and 2007., Method: Twenty five risk factors were analyzed, emphasizing age, gender, APACHE score, associated diseases, hypotension at intake, coma, hospitalization time, length of time of ventilation, emergency intubation, reintubation, previous antibiotics, and resistant microrganisms., Results: Lethality was 25.4 %, and mortality was 2.4 %. Association between lethality, and APACHE score was found (p: 0.04). Critical APACHE value was 22. Also, in early pneumonia, association between lethality and nasogastric tube (p: 0.01, I.C. 95 % 1.39 - 6.35) was found. No association with late pneumonia was found among mortality and clinical practices. Death's RR (relative risk) increase in following values with: previous neurological disease 2.7 (p: 0.15, IC 95 % 1.15 - 6.5), neurological comaRR 2 (p: 0.2, IC 95 % 0.54 - 7.53). Nevertheless, at multivariate analysis no mortality risk factors were identified. Fair association with time in ICU (p: 0.051 IC 95 % 0.99 - 1.17) and, male sex (p: 0.051, IC 95 % 0.99 - 6.72) was found., Conclusions: We observed multiple factors associated to mortality in VAP: use of nasogastric catheter, longer stay in ICU and male sex.

Unlabelled: Ventilator-associated pneumonia (VAP) is a complication with an increased risk of morbidity and mortality. Inadequate antibiotic treatment is a risk factor of mortality which can be improved. For this reason it is important to know the local etiology of VAP. During a one year-period we investigated the etiology of VAP in a teaching hospital. Forty eight VAP were included, of which 19 were women. The median age was 59.5 (range 17-91 years), twelve VAP were early onset. Methicillin resistant Staphylococcus aureus (MRSA) was the main microorganism isolated, regardless of timing of diagnosis of VAP, followed by polimicrobial etiology, Acinetobacter sp and P. aeruginosa. Etiology was not associated with comorbidity; however previous antibiotic use was related with MRSA and polymicrobial etiology. Mortality was 35% and was mainly associated with P. aeruginosa isolation., Conclusion: MRSA was the main cause of VAP regardless of the timing of its occurrence.