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1. Antibiotic use and impact on outcome from bacteraemic critical illness: the BActeraemia Study in Intensive Care (BASIC)

Author

Corona, A, Bertolini, G, Lipman, J, Wilson, Ap, Singer, M, Rodriguez, A, Cueto, G, Canales, Hs, Acosta Gnass, S, Marinoni, M, Becherucci, A, Baccaro, F, Peake, S, Reece, G, Blythe, D, Mcfayden, B, French, C, Hawker, F, Dobb, G, Seppelt, I, Finfer, S, Skowronski, G, Banerjee, A, Richards, B, Neumark, G, Hiesmayr, M, Rutraert, P, Franck, S, Spapen, H, Ludovic, L, Bruzzi de Carvalho, F, Souza, P, Gasparovic, V, Barsic, B, Chytra, I, Novak, I, Pestel, G, Kaiser, S, Giokas, G, Matamis, D, Yap Hiu Yi, F, Kapadia, F, Iqbal, M, Batoli, T, Costanzo, E, Pistocchini, A, Acquarolo, A, Greco, S, Di Masi, P, Quattrocchi, P, Navarra, M, Rotella, S, Giugiaro, P, Todesco, L, Borromeo, R, Ostando, M, Benassai, C, Pezzi, G, Marchi, M, Luise, C, Di Filippo, A, Mangani, V, Pelagatti, C, Pasetti, G, Salvi, G, Salcuni, R, Marongiu, A, Tavola, M, Rossi, G, Biffali, F, Brunori, E, Piccioni, G, Guadagnucci, A, David, Antonio, Pulici, M, Ughi, F, Sicignano, A, Leggieri, C, Fiore, G, Banfi, G, Lanza, S, Postiglione, M, Bosso, R, Piga, G, Croce, G, Sapuppo, Mf, Giarratano, A, Barbagallo, M, Favetta, P, Gorietti, A, Breschi, C, Andrei, O, Bertolini, R, Bonfà, A, Rossi, S, Asti, A, Rendina, F, Bilotta, F, Azzeri, F, Piacevoli, Q, Hellmann, F, Vaira, C, Avarello, N, Clementi, S, Della Valle, A, Segala, V, Berardino, M, Vaj, M, Sega, P, Bcchi, A, Pizzaballa, Ml, Cohen, J, Sprung, C, Hashimoto, S, Baskiene, R, Mcdonald, J, Sollid, S, Paiva, Ja, Moreno, R, Gloria, C, Yaghi, A, Voga, G, Joo Lee, Y, Zaragoza, R, Valles, J, Gonzalez Diaz, G, Alvarez Lerma, F, Sirvent, Jm, Herve, Z, Romand, Ja, Niblett, D, Laurenson, J, Peters, T, von der Osten, I, and Tomic, V.

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Pediatrics, Asia, Critical Care, medicine.drug_class, Critical Illness, Antibiotics, Bacteremia, Microbial Sensitivity Tests, Outcome (game theory), Pharmacotherapy, Intensive care, Epidemiology, medicine, Humans, Pharmacology (medical), Prospective Studies, Antibiotic use, Intensive care medicine, bloodstream infections, critically ill patients, prevalence, antibiotic strategy, Aged, Aged, 80 and over, Pharmacology, Australasia, business.industry, Septic shock, Mortality rate, Odds ratio, Middle Aged, South America, medicine.disease, Drug Utilization, Confidence interval, Anti-Bacterial Agents, Europe, Treatment Outcome, Infectious Diseases, Critical illness, Female, business, Fungemia
Abstract

The lack of prospective, randomized, controlled trial data to guide optimal antibiotic use in bacteraemic critically ill patients has led to a wide variety of strategies and major issues with drug resistance. We therefore prospectively investigated the epidemiology of bacteraemia and fungaemia in intensive care units (ICUs); and the impact of timing, type and appropriateness of antibiotic intervention.We conducted a multinational, multicentre, prospective observational study in 132 ICUs from 26 countries with no interventions.1702 patients [European (69.6%), Australasian (12.2%), South American (8.3%) and Asian (9.9%)] developed 1942 bacteraemic episodes over the study period. Mortality rates were similar for those receiving empirical (40.5%), semi-targeted (37.6%) or fully targeted (33.3%) antibiotic therapy (P=0.40), and in those initially receiving broad- (39.3%) or restricted-spectrum (39.1%) therapy (P=0.94). First-line therapy was effective in terms of the antibiogram (where available) in 70.4% of cases. This in vitro susceptibility ranged from 76.3% for broad-spectrum antibiotics to 46.3% for restricted-spectrum antibiotics (P0.0001). However, no antibiotic policy-associated variable, including in vitro susceptibility (odds ratio 0.89, 95% confidence interval 0.61-1.30), was a statistically significant predictor of mortality.We could not show an impact of antibiotics on mortality in critically ill patients, despite in vitro activity and early commencement. Randomized, multicentre trials are urgently needed to establish the appropriate duration, timing and combinations of antibiotics that will both optimally treat infection and minimize development of resistance and other complications.

Published
2010

3. Emphysematous pyelonephritis

Author

John Victor Peter, Biradar, V., and Peake, S. L.

Subjects
Adult, Emphysema, Pyelonephritis, Humans, Diabetic Nephropathies, Female, General Medicine, Kidney, Tomography, X-Ray Computed, Nephrectomy
Published
2005

4. Monoclonal antibodies--immunotherapy for the critically ill

Author

Peake S

Subjects
medicine.drug_class, medicine.medical_treatment, Critical Illness, Critical Care and Intensive Care Medicine, Monoclonal antibody, Sepsis, 03 medical and health sciences, Mice, 0302 clinical medicine, Intensive care, medicine, Animals, Humans, 030212 general & internal medicine, Septic shock, business.industry, Antibodies, Monoclonal, 030208 emergency & critical care medicine, Immunotherapy, medicine.disease, Antibodies, Bacterial, Transplantation, Clinical trial, Anesthesiology and Pain Medicine, Shock (circulatory), Immunology, Cytokines, medicine.symptom, business, Cell Adhesion Molecules
Abstract

Monoclonal antibodies (mAb) have revolutionised many areas of medicine, particularly research and diagnostics. Murine, human and humanised mAb have all been developed. The most important clinical applications to date have been in the fields of transplantation and oncology. Experimental and limited clinical trials suggest mAb are emerging as a new therapeutic strategy in the critically ill. Antibodies against a variety of bacteria or their products are potentially useful in gram-positive and gram-negative shock. Anti-cytokine and anti-neutrophil adhesion molecule mAb may be effective not only in septic shock but also in other conditions associated with acute inflammation and cytokine release, e.g., acid aspiration, ischaemia/reperfusion injury (myocardial infarction, haemorrhagic shock, aortic aneurysm repair). Antibodies inhibiting neutrophil adhesion may also be efficacious in asthma, pulmonary fibrosis, meningitis and cerebral malaria. The use of these and other mAb in intensive care is an exciting prospect and future clinical studies will determine the extent of their role in the management of the critically ill.

Published
1993

5. Resuscitation fluid use in critically ill adults: an international cross sectional study in 391 intensive care units

Author

Finfer, S, Liu, B, Taylor, C, Bellomo, R, Billot, L, Cook, D, Du, B, Mcarthur, C, Myburgh, J, Jacobs, S, Gazzard, R, Edington, J, Ghelani, D, Blythe, D, Richards, B, Mccalman, C, Parr, M, Walker, C, Seppelt, I, Cole, L, Stevens, D, Cade, J, Webb, S, Woolfe, C, van Heerden PV, Cooper, J, Mitchell, I, Peake, S, French, C, Playford, H, Bannerjee, A, Berwanger, O, da Silva, N, Mario Teles, J, Guimarães, H, Rocha, M, Piras, C, Mcintyre, L, Bagshaw, Sm, Stelfox, T, Green, R, Hall, R, Son, W, Meade, M, Kumar, A, Wittman, R, Martin, C, Leblanc, M, Lim, S, Keenan, S, Magder, S, Chittock, D, Wang, W, Dong, J, Chen, X, Li, A, Zhuang, H, Liu, W, Liu, Y, He, Q, Wang, J, Zhou, N, Bai, Y, Wang, L, Lu, F, Chen, W, Wang, S, Zhou, J, Zhang, Z, Xu, Y, Li, T, Sun, X, Wang, B, Zhao, C, Song, Q, Pan, L, Ma, P, Li, Q, Li, G, Chen, D, Liu, L, Gao, K, Han, S, Wan, X, Zhang, Y, Chao, Y, Xi, X, Jiang, L, Han, C, Qin, T, Jiang, W, Li, Y, Liu, X, Hu, Z, Ding, Y, Li, W, Wang, X, Weng, L, Wang, D, Li, S, An, Y, Zhang, W, Luo, H, Luo, Y, Zhu, X, Li, H, Li, C, Qu, H, Mao, E, Min, D, Wang, C, Zhang, J, Ren, H, Liu, H, Wang, M, Zhao, M, Fei, D, Qian, C, Liu, R, Shi, B, Guo, H, Guan, X, Wu, J, Zhou, L, Yu, K, Wang, H, Wang, Y, Li, D, Huang, Q, Su, M, Dong, C, Zhang, X, Wu, B, Qin, Y, Zhang, N, Kang, Y, Deng, Y, Ai, Y, Guo, Y, Cui, Q, Jia, J, Chen, H, Yan, J, Xu, Q, Sun, R, Hong, J, Fang, Q, Zheng, X, Qiu, H, Liu, S, Zhou, Q, Li, J, Schonemann, N, Bendtsen, A, Thornberg, K, Boensen, H, Tousi, H, Bestle, M, Pawlowicz, M, Høen Beck, D, Carl, P, Ronholm, E, Welling, K, Strelitz, J, Kancir, C, Hostrup, A, Perner, A, Jensen, R, Westergard Nielsen, J, Bennett, S, Ball, A, Becker, H, Desikan, S, Watson, N, Watson, D, Smith, I, Wright, M, Millo, J, Morris, J, Williams, A, Peebles Brown, A, Grainger, K, Marsh, R, Christmas, D, Harling, D, Boulanger, C, Davenport, A, Goldsmith, A, Cook, B, Drage, S, Goodall, J, Higgins, D, Price, J, Margarson, M, Sherry, T, Mcauley, F, Syndercombe, A, Jones, G, Reid, J, Andrivet, P, Jamali, S, Rigaud, J, Gaffine, A, Kerkeni, Mejean, C, Drault, J, Beuret, P, Bourffandeau, B, Gasselin, J, de Jonghe, B, Mercat, A, Quenot, J, Broux, C, Timsit, J, Mokhtar, H, Jacobs, F, Pease, S, Mourvillier, B, Lasocki, S, Clabault, K, Rahmani, H, Cariou, A, Guerin, C, Combes, A, Duguet, A, Thuong, M, Janvier, G, Schortgen, F, Icahai, C, Megarbane, B, Payen, D, Leon, R, Gruson, D, Guidet, B, Tardu, D, Roch, A, Ridel, C, Fartoukh, M, Mentec, H, Guitton, C, Blot, F, Oppert, M, Spies, C, Gründling, M, Friesecke, S, Meier, A, Martin, J, Jaschinski, U, Gärtner, R, Weyland, W, Wappler, F, Bromber, H, Welte, T, Hadem, J, Fiedler, F, Peckelsen, C, Fritz, H, Rensing, H, Ragaller, M, Reinhart, K, Brunkhorst, Fm, Riessen, R, Gerlach, H, Hoffmann, U, Chow, Fl, Cheng, C, Joynt, G, Buckley, T, Auyeung, Kw, Young, K, Ching, Ck, Sigurdsson, S, Sigvaldason, K, Hreinsson, K, Kapadia, F, Donnelly, M, Bailie, R, Breen, D, Bates, J, Marsh, B, Motherway, C, Mcauley, D, Trinder, J, Manzoni, A, Mottura, G, Bonaccorso, G, Luzzani, A, De Blasio, E, Bonanno, R, Cardarelli, N, De Cristofaro, M, Mazzola, E, Monfregola, M, Isetta, M, Franchi, F, Trisolino, F, Marchetti, G, Piga, G, Todesco, L, Perno, S, Bianchin, A, Blasetti, A, Rossi, S, Salcuni, R, Greco, M, Beck, E, Antonini, B, Malacarne, P, Prandi, E, Negro, G, Cubeddu, G, Pasquinucci, G, Ferrari, E, Rotelli, S, Savioli, M, Mediani, T, Tognoli, E, Ribola, A, Laperchia, L, Meinardi, S, Cancellieri, F, Mancosu, S, Segala, V, Gamberini, E, Garofalo, G, Dentini, N, Carnevale, L, Bilotta, F, Brunod, F, Casagrande, L, Riva, I, Osti, D, Sitta, V, Alleva, S, Becattini, G, Munaron, S, Cavallo, R, Marzullo, A, Ferrari, F, Calicchio, G, Sucre, M, Quattrocchi, L, Breschi, C, Gratarola, A, Sciacca, P, Postiglione, M, Barattini, M, Rossi, M, Falcelli, C, Coaloa, M, Cattin, S, Palmese, S, David, Antonio, Calabrese, P, Dote, K, Ohashi, I, Morimatsu, H, Goto, Y, Hagioka, S, Mcguiness, S, Gibson, A, Henderson, S, Freebairn, R, Williams, T, Liang, J, Van Haren, F, Dinsdale, D, Serra, I, Arabi, Y, Qushmaq, I, Abouchala, N, Kherallah, M, Mandourah, Y, Cuthbertson, B, Willis, P, Cole, S, Macdougall, M, Andrews, P, Alcorn, D, Carins, C, Digby, B, Tan, Ck, Lee, P, Chan, Y, Petersen, P, Albert, J, Guldbrand, P, Juhlin Dannfeldt, M, Nielsen, N, Hjelmqvist, H, Nordlund, P, Berkius, J, Oldner, A, Konrad, D, Zatterman, R, Metcalf, K, Friberg, H, Chew, M, Lindgren, K, Aneman, A, Gatz, R, Blomqvist, H, Wizelius, I, Andersson, M, Rodling Wahlstrom, M, Stiernstrom, H, Lindgren, P, Elvstad, T, Hyddmark, U, Merz, T, Laube, M, Haberthuer, C, Jaeggi, M, Maggiorini, M, Stover, J, Ahmed, R, Kellum, J, Murugan, R, Salmon, A, Vlahakis, N, Cohn, S, and Chung, K.

Subjects
Adult, Male, endocrine system, medicine.medical_specialty, Resuscitation, Internationality, Cross-sectional study, Critical Illness, Critical Care and Intensive Care Medicine, complex mixtures, Resuscitation fluid, Intensive care, medicine, Humans, Colloids, Medical prescription, Intensive care medicine, Generalized estimating equation, Aged, critically ill adults, business.industry, Research, digestive, oral, and skin physiology, Odds ratio, Middle Aged, Confidence interval, body regions, Intensive Care Units, Cross-Sectional Studies, intensive care units, Emergency medicine, Commentary, Fluid Therapy, Female, business, Perfusion
Abstract

Introduction Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients. Methods We conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products). Results During the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score). Conclusions Administration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were.

Published
2010

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