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1. Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome

Author

Gerard Curley, Lorenzo Schiavoni, Giacomo Monti, Hernan Aguirre-Bermeo, Giacomo Bellani, Gustavo A. Plotnikow, Emre Erbabacan, Philippe Michel, Gyorgy Frendl, Niall Ferguson, Thomas Kander, Yasuaki Ogino, Felipe Martinez, Luca Brazzi, Ewan Goligher, SILVIO A. ÑAMENDYS-SILVA, Kai Zacharowski, Lars Hedlund, Rodrigo Biondi, Dana Tomescu, Alexey Gritsan, Matteo Pozzi, Andrea Cortegiani, Serena Knowles, Candelaria De Haro, Nuttapol Rittayamai, Shailesh Bihari, Olegs Sabelnikovs, Jonathan Chelly, Riccardo Colombo, Aroa Gomez Brey, Paolo Pelosi, Marco Bezzi, Hamidreza Jammati, Vivek Kakar, Daniel McAuley, Luciano Gattinoni, Nelson Barros, Sharif Zein, Paolo FORMENTI, VINCENZO POTA, Joana Berger-Estilita, Alistair Nichol, Michele Umbrello, Martin Dres, Carlo Volta, Jean-Daniel Chiche, Ingeborg Welters, Savino Spadaro, Tamas Szakmany, Anatole Harrois, Hasan M Al-Dorzi, Sebastien Jochmans, Maurizio Fusari, Christopher Tainter, Andrea Tinnirello, Sally Humphreys, Luis Alejandro Sánchez-Hurtado, Gilda Cinnella, Damien Roux, Evgeny Grigoryev, Ghaleb Almekhlafi, Dorothy Breen, Alessandro Protti, Necmettin Unal, Alejandro Bruhn, Ednan Bajwa, Rola Jaafar, Artigas Antonio, Ceri Battle, Christina Whitehead, Anil Hormis, Jon Laake, Serge Heines, Nora Di Tomasso, Guillermo M. Albaiceta, Raúl De Pablo Sánchez, Nicolas TERZI, Marcus Schultz, and Giovanna Occhipinti

Subjects
Mechanical ventilation, Pediatrics, medicine.medical_specialty, ARDS, Lung, business.industry, medicine.medical_treatment, 030208 emergency & critical care medicine, Acute respiratory distress, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, medicine.anatomical_structure, 030228 respiratory system, Severity of illness, Epidemiology, medicine, SOFA score, Prospective cohort study, business
Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: “worsening” if moderate or severe acute respiratory distress syndrome criteria were met, “persisting” if mild acute respiratory distress syndrome criteria were the most severe category, and “improving” if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. Results Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening. Conclusions Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.

Published
2019

2. Correction to: Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study

Author

Gerard Curley, Lorenzo Schiavoni, Giacomo Monti, Hernan Aguirre-Bermeo, Giacomo Bellani, John Laffey, Gustavo A. Plotnikow, Maria Manuela Pintado, Michael Lanspa, Emre Erbabacan, Gyorgy Frendl, Niall Ferguson, Thomas Kander, Yasuaki Ogino, Luca Brazzi, Ewan Goligher, SILVIO A. ÑAMENDYS-SILVA, Kai Zacharowski, Lars Hedlund, Dana Tomescu, Alexey Gritsan, Matteo Pozzi, Andrea Cortegiani, Candelaria De Haro, Nuttapol Rittayamai, Shailesh Bihari, Olegs Sabelnikovs, Jonathan Chelly, Riccardo Colombo, Fabiana Madotto, Sara Conti, NICOLAS NIN, Pierre-Eric DANIN, Marco Bezzi, Hamidreza Jammati, Vivek Kakar, Daniel McAuley, Frank M.P. Van Haren, Luciano Gattinoni, Kelvin Davies, Nelson Barros, Sharif Zein, Paolo FORMENTI, VINCENZO POTA, Andrea Coppadoro, Joana Berger-Estilita, Alistair Nichol, Michele Umbrello, Martin Dres, Carlo Volta, Ingeborg Welters, Savino Spadaro, Tamas Szakmany, Anatole Harrois, Hasan M Al-Dorzi, Sebastien Jochmans, Maurizio Fusari, Christopher Tainter, Tài PHAM, Andrea Tinnirello, Kenichi Nitta, Luis Alejandro Sánchez-Hurtado, Gilda Cinnella, Damien Roux, Evgeny Grigoryev, Luca MONTINI, Ghaleb Almekhlafi, Dorothy Breen, Alessandro Protti, Necmettin Unal, Alejandro Bruhn, Ednan Bajwa, Samuel Brown, Rola Jaafar, Artigas Antonio, Ceri Battle, Guillaume Carteaux, Christina Whitehead, Nicholas Mohr, Jon Laake, Serge Heines, Nora Di Tomasso, Guillermo M. Albaiceta, Raúl De Pablo Sánchez, Nicolas TERZI, Jan Máca, and Giovanna Occhipinti

Subjects
medicine.medical_specialty, Lung, medicine.anatomical_structure, business.industry, Anesthesiology, medicine, MEDLINE, Acute respiratory distress, Critical Care and Intensive Care Medicine, Intensive care medicine, business
Abstract

The members of the LUNG SAFE Investigators and the ESICM Trials Group were provided in such a way that they could not be indexed as collaborators on PubMed. The publisher apologizes for this error.

Published
2017

3. Impact of Early Acute Kidney Injury on Management and Outcome in Patients With Acute Respiratory Distress Syndrome: A Secondary Analysis of a Multicenter Observational Study

Author

Hernan Aguirre-Bermeo, Giacomo Bellani, Gustavo A. Plotnikow, Philippe Michel, Gyorgy Frendl, Niall Ferguson, Ewan Goligher, Lars Hedlund, Rodrigo Biondi, Alexey Gritsan, Serena Knowles, Candelaria De Haro, Olegs Sabelnikovs, Jonathan Chelly, Riccardo Colombo, Fabiana Madotto, Aroa Gomez Brey, Vivek Kakar, Bairbre McNicholas, Joana Berger-Estilita, Alistair Nichol, Jean-Daniel Chiche, Anatole Harrois, Christopher Tainter, Matthew Griffin, Evgeny Grigoryev, Dorothy Breen, Alessandro Protti, Necmettin Unal, Ednan Bajwa, Artigas Antonio, Ceri Battle, ANTONIO PELLICER, Christina Whitehead, Jon Laake, Raúl De Pablo Sánchez, Nicolas TERZI, Emanuele Rezoagli, AII - Inflammatory diseases, Intensive Care Medicine, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, McNicholas BA, Rezoagli E, Pham T, Madotto F, Guiard E, Fanelli V, Bellani G, Griffin MD, Ranieri M, Laffey JG, ESICM Trials Group and the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) Investigators., UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (SLuc) Service de soins intensifs, UCL - (MGD) Services des soins intensifs, McNicholas, Bairbre A, Rezoagli, Emanuele, Pham, Tài, Madotto, Fabiana, Guiard, Elsa, Fanelli, Vito, Bellani, Giacomo, Griffin, Matthew D, Ranieri, Marco, Laffey, John G, Pesenti A, Laffey JG, ESICM Trials Group and the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) Investigators, Giarratano A, Cortegiani A, Mcnicholas, B, Rezoagli, E, Pham, T, Madotto, F, Guiard, E, Fanelli, V, Bellani, G, Griffin, M, Ranieri, M, and Laffey, J

Subjects
Male, ARDS, medicine.medical_treatment, Comorbidity, Critical Care and Intensive Care Medicine, Severity of Illness Index, chemistry.chemical_compound, 0302 clinical medicine, acute kindey faliure, Risk Factors, Odds Ratio, 80 and over, Hospital Mortality, Prospective Studies, Aged, 80 and over, Respiratory Distress Syndrome, Respiration, Acute kidney injury, Middle Aged, acute kidney injury, acute respiratory distress syndrome, invasive mechanical ventilation, mortality, renal replacement therapy, Intensive Care Units, acute kidney injury, Creatinine, Artificial, Female, Glomerular Filtration Rate, Adult, invasive mechanical ventilation, renal replacement therapy, medicine.medical_specialty, Socio-culturale, Renal function, ard, 03 medical and health sciences, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, Severity of illness, medicine, Humans, acute kidney injury, acute respiratory distress syndrome, Renal replacement therapy, Aged, business.industry, 030208 emergency & critical care medicine, Carbon Dioxide, acute respiratory distress syndrome, medicine.disease, Respiration, Artificial, mortality, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], 030228 respiratory system, chemistry, Respiratory failure, business, Respiratory minute volume
Abstract

Contains fulltext : 208648.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To understand the impact of mild-moderate and severe acute kidney injury in patients with acute respiratory distress syndrome. DESIGN: Secondary analysis of the "Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure", an international prospective cohort study of patients with severe respiratory failure. SETTING: Four-hundred fifty-nine ICUs from 50 countries across five continents. SUBJECTS: Patients with a glomerular filtration rate greater than 60 mL/min/1.73 m prior to admission who fulfilled criteria of acute respiratory distress syndrome on day 1 and day 2 of acute hypoxemic respiratory failure. INTERVENTIONS: Patients were categorized based on worst serum creatinine or urine output into: 1) no acute kidney injury (serum creatinine < 132 micromol/L or urine output >/= 0.5 mL/kg/hr), 2) mild-moderate acute kidney injury (serum creatinine 132-354 micromol/L or minimum urine output between 0.3 and 0.5mL/kg/hr), or 3) severe acute kidney injury (serum creatinine > 354 micromol/L or renal replacement therapy or minimum urine output < 0.3 mL/kg/hr). MEASUREMENTS AND MAIN RESULTS: The primary outcome was hospital mortality, whereas secondary outcomes included prevalence of acute kidney injury and characterization of acute respiratory distress syndrome risk factors and illness severity patterns, in patients with acute kidney injury versus no acute kidney injury. One-thousand nine-hundred seventy-four patients met inclusion criteria: 1,209 (61%) with no acute kidney injury, 468 (24%) with mild-moderate acute kidney injury, and 297 (15%) with severe acute kidney injury. The impact of acute kidney injury on the ventilatory management of patients with acute respiratory distress syndrome was relatively limited, with no differences in arterial CO2 tension or in tidal or minute ventilation between the groups. Hospital mortality increased from 31% in acute respiratory distress syndrome patients with no acute kidney injury to 50% in mild-moderate acute kidney injury (p

Published
2019

4. Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study

Author

Volkan Hancı, Perihan Ergin Ozcan, Seyda Efsun Ozgunay, Halil Erkan Sayan, KUBILAY DEMIRAG, Mustafa Kemal Arslantaş, Hayrettin Daşkaya, Ender Gedik, NEDIM ÇEKMEN, Evren Şentürk, Süheyla Ünver, Günseli Orhun, Nihan Yapici, Necmettin Unal, Baykara, Nur, Akalin, Halis, Arslantas, Mustafa Kemal, Hanci, Volkan, Caglayan, Cigdem, Kahveci, Ferda, Demirag, Kubilay, Baydemir, Canan, Unal, Necmettin, Ege Üniversitesi, Baykara, N, Akalin, H, Arslantas, MK, Hanci, V, Caglayan, C, Kahveci, F, Demirag, K, Baydemir, C, Unal, N, Sakarya Üniversitesi/Tıp Fakültesi/Cerrahi Tıp Bilimleri Bölümü, and Palabıyık, Onur

Subjects
Male, Point prevalence, Turkey, Organ Dysfunction Scores, Prevalence, Critical Care and Intensive Care Medicine, DEFINITIONS, 0302 clinical medicine, Epidemiology, HOSPITAL MORTALITY, INFECTION, 030212 general & internal medicine, APACHE, OUTCOMES, Mortality rate, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, Shock, Septic, PATIENT MORTALITY, Systemic Inflammatory Response Syndrome, Intensive Care Units, Shock (circulatory), Female, medicine.symptom, ORGANISMS, Monte Carlo Method, Acinetobacter Infections, medicine.medical_specialty, Carbapenem resistance, Statistics, Nonparametric, Sepsis, 03 medical and health sciences, Intensive care, Internal medicine, medicine, Humans, Pseudomonas Infections, Aged, Septic shock, business.industry, Research, SEPTIC SHOCK, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, TRENDS, Klebsiella Infections, Systemic inflammatory response syndrome, Cross-Sectional Studies, Logistic Models, STATES, RISK-FACTORS, business
Abstract

WOS: 000430617700001, PubMed ID: 29656714, Background: The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey. Methods: A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded. Results: Of the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1: 4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients. Conclusions: A high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality.

Published
2017

5. Elective Tracheotomy Practices in Turkey

Author

Hakan Korkut Atalan, Nilgun Kavrut Ozturk, Nihan Yapici, Bulent Gucyetmez, Nahit Çakar, GULAY KIR, Nevzat Mehmet Mutlu, Necmettin Unal, and Acibadem University Dspace

Subjects
Male, Percutaneous, Pulmonology, Turkey, Cardiovascular Procedures, Physiology, medicine.medical_treatment, lcsh:Medicine, Constriction, Pathologic, Pathology and Laboratory Medicine, Vascular Medicine, 0302 clinical medicine, Tracheotomy, Surveys and Questionnaires, Epidemiology, Medicine and Health Sciences, Pulmonary Medicine, Respiratory System Procedures, lcsh:Science, Stenosis, Multidisciplinary, Hospitals, Intensive Care Units, Physiological Parameters, Elective Surgical Procedures, Female, Elective Surgical Procedure, Research Article, medicine.medical_specialty, Forceps, Surgical and Invasive Medical Procedures, Hemorrhage, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, Intensive care, Bronchoscopy, medicine, Humans, Obesity, Mechanical ventilation, business.industry, General surgery, Body Weight, lcsh:R, Biology and Life Sciences, 030208 emergency & critical care medicine, Respiration, Artificial, Surgery, Health Care, 030228 respiratory system, Health Care Facilities, lcsh:Q, business, Complication
Abstract

Objectives Elective tracheotomy (ET) procedures in intensive care units (ICU) might be different in accordance with countries and ICUs' features. The aim of the present study was to search the epidemiology of ET procedures in Turkey. Methods A questionnaire which consists of 43 questions was sent by e-mail to 238 ICUs which were officially recognized by The Turkish Ministry of Health. All answers were obtained between August 1, 2015 and August 31, 2015. Results Two hundred and three ICUs (85.3\%) participated in this study. 177 (87.2\%) and 169 (83.4\%) of ICU's were level III and mixed ICUs respectively. Anesthesiologists were the director of 189 (93.0\%) ICUs. Estimated total count of admitted, mechanically ventilated and tracheotomized patients in 2014 were 126282, 80569 (63.8\%) and 8989 (7.1\%) respectively. Most common indication for ET was prolonged mechanical ventilation (76.9\%). The first choice for ET procedure was percutaneous in 162 (79.8\%) ICUs. Griggs guide wire dilatational forceps (GWDF) technique was used as the first choice for elective percutaneous tracheotomy (EPT) by 143 (70.4\%) ICUs. Most common early EPT complication was bleeding (68.0\%) and late EPT complication was stenosis (35.0\%). While facilitation of weaning was most important advantage (26.1\%), bleeding and tracheal complications were most important disadvantages for EPT (29.1\%). Conclusions Most common indications for ET are prolonged MV and coma in Turkish ICUs. EPT is the preferred procedure for ET and GWDF is the most common technique. Bronchoscopy and USG are rarely used as a guide.

Published
2016

6. International standards for programmes of training in intensive care medicine in Europe

Author

Marco Maggiorini, Joel Starkopf, Julian Bion, Michael Darmon, Arzu Topeli, Theodoros Kyprianou, Manu Shankar-Hari, Ana Vujaklija Brajković, Dirk Schädler, Necmettin Unal, Charles Gomersall, Intensive care medicine, ICaR - Ischemia and repair, Intensive Care, and RS: SHE School of Health Professions Education

Subjects
Quality Control, medicine.medical_specialty, Standards, Consensus, Quality management, Delphi Technique, International Cooperation, media_common.quotation_subject, 610 Medicine & health, Critical Care and Intensive Care Medicine, Accreditation, Intensive care, medicine, Humans, Training, Quality (business), Intensive care medicine, Set (psychology), media_common, business.industry, Nominal group, CoBaTrICE, Quality assurance, Group Processes, Europe, Critical care, Education, Medical, Graduate, Respondent, Clinical Competence, Curriculum, business, Specialization
Abstract

PURPOSE To develop internationally harmonised standards for programmes of training in intensive care medicine (ICM). METHODS Standards were developed by using consensus techniques. A nine-member nominal group of European intensive care experts developed a preliminary set of standards. These were revised and refined through a modified Delphi process involving 28 European national coordinators representing national training organisations using a combination of moderated discussion meetings, email, and a Web-based tool for determining the level of agreement with each proposed standard, and whether the standard could be achieved in the respondent's country. RESULTS The nominal group developed an initial set of 52 possible standards which underwent four iterations to achieve maximal consensus. All national coordinators approved a final set of 29 standards in four domains: training centres, training programmes, selection of trainees, and trainers' profiles. Only three standards were considered immediately achievable by all countries, demonstrating a willingness to aspire to quality rather than merely setting a minimum level. Nine proposed standards which did not achieve full consensus were identified as potential candidates for future review. CONCLUSIONS This preliminary set of clearly defined and agreed standards provides a transparent framework for assuring the quality of training programmes, and a foundation for international harmonisation and quality improvement of training in ICM.

Published
2011

7. Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Author

Redouane Abouqal, Adrian Barnett, Eduardo Alexandrino Medeiros, Nicholas Graves, Achilleas Gikas, Kenan Hizel, VICTOR DANIEL ROSENTHAL, Yalim Dikmen, Oguz Dursun, Nurettin Erben, Hakan Leblebicioglu, Souha Kanj, Necmettin Unal, Nayide Barahona G., Ata Yalcin, and ABEL ARROYO SANCHEZ

Subjects
Pediatrics, medicine.medical_specialty, Epidemiology, Severity of Illness Index, Cohort Studies, Bacterial infections, Intensive care, Severity of illness, medicine, pneumonia, Humans, Developing Countries, hospital-acquired (noscomial) infections, business.industry, Confounding, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, hygiene and hospital infections, Length of Stay, Nosocomial infection control, medicine.disease, respiratory tract diseases, Intensive Care Units, Pneumonia, Infectious Diseases, Cohort, Emergency medicine, surveillance, business, Cohort study
Abstract

Dikmen, Yalim/0000-0002-3122-5099; Erben, Nurettin/0000-0003-0373-0132; Tsioutis, Constantinos/0000-0002-7865-8529; Barnett, Adrian/0000-0001-6339-0374; Abouqal, Redouane/0000-0002-6117-4341; Medeiros, Eduardo A/0000-0002-6205-259X; Leblebicioglu, Hakan/0000-0002-6033-8543; Gikas, Achilleas/0000-0002-8455-9631; Unal, Necmettin/0000-0002-9440-7893; Kanj, Souha/0000-0001-6413-3396; Graves, Nicholas/0000-0002-5559-3267; Barahona G., Nayide/0000-0003-3559-6900 WOS: 000296428300015 PubMed: 21320374 Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2.03 days (95% CI 1.52-2.54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity.

Published
2011

8. Time-dependent analysis of length of stay and mortality due to urinary tract infections in ten developing countries: INICC findings

Author

Redouane Abouqal, Adrian Barnett, Eduardo Alexandrino Medeiros, Nicholas Graves, Gökhan Aygün, Achilleas Gikas, VICTOR DANIEL ROSENTHAL, Yalim Dikmen, Hakan Leblebicioglu, Souha Kanj, Necmettin Unal, Nayide Barahona G., Ata Yalcin, and OMÜ

Subjects
Risk, Microbiology (medical), Pediatrics, medicine.medical_specialty, Critical Care, Urinary system, medicine.medical_treatment, Time dependent analysis, Urinary catheterization, Developing countries, law.invention, Middle East, Nosocomial infection, Africa, Northern, law, Intensive care, medicine, Humans, Intensive care unit, Hospital infection, Mortality, Developing Countries, Cross Infection, business.industry, International nosocomial infection control consortium, Confounding, Length of Stay, South America, INICC, Urinary tract infections, Random effects model, Europe, Catheter, Infectious Diseases, Catheter-Related Infections, North America, Urinary Tract Infections, Emergency medicine, Cohort, Length of stay, Urinary Catheterization, business
Abstract

Abouqal, Redouane/0000-0002-6117-4341; Leblebicioglu, Hakan/0000-0002-6033-8543; Dikmen, Yalim/0000-0002-3122-5099; Abouqal, Redouane/0000-0002-6117-4341; Barnett, Adrian/0000-0001-6339-0374; Yalcin, Ata Nevzat/0000-0002-7243-7354; Medeiros, Eduardo A/0000-0002-6205-259X; Unal, Necmettin/0000-0002-9440-7893; Kanj, Souha/0000-0001-6413-3396; Gikas, Achilleas/0000-0002-8455-9631; Graves, Nicholas/0000-0002-5559-3267; Barahona G., Nayide/0000-0003-3559-6900 WOS: 000286981200004 PubMed: 21168440 Objectives: To estimate the excess length of stay (LOS) and mortality in an intensive care unit (ICU) due to a Catheter associated urinary tract infections (CAUTI), using a statistical model that accounts for the timing of infection in 29 ICUs from 10 countries: Argentina, Brazil, Colombia, Greece, India, Lebanon, Mexico, Morocco, Peru, and Turkey. Methods: To estimate the extra LOS due to infection in a cohort of 69,248 admissions followed for 371,452 days in 29 ICUs, we used a multi-state model, including specific censoring to ensure that we estimate the independent effect of urinary tract infection, and not the combined effects of multiple infections. We estimated the extra length of stay and increased risk of death independently in each country, and then combined the results using a random effects meta-analysis. Results: A CAUTI prolonged length of ICU stay by an average of 1.59 days (95% CI: 0.58, 2.59 days), and increased the risk of death by 15% (95% CI: 3, 28%). Conclusions: A CAUTI leads to a small increased LOS in ICU. The increased risk of death due to CAUTI may be due to confounding with patient morbidity. (C) 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Published
2011

9. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

Author

Víctor Daniel Rosenthal, Dennis George Maki, Yatin Mehta, Hakan Leblebicioglu, Ziad Ahmed Memish, Haifaa Hassan Al-Mousa, Hanan Balkhy, Bijie Hu, Carlos Alvarez-Moreno, Eduardo Alexandrino Medeiros, Anucha Apisarnthanarak, Lul Raka, Luis E. Cuellar, Altaf Ahmed, Josephine Anne Navoa-Ng, Amani Ali El-Kholy, Souha Sami Kanj, Ider Bat-Erdene, Wieslawa Duszynska, Nguyen Van Truong, Leonardo N. Pazmino, Lucy Chai See-Lum, Rosalia Fernández-Hidalgo, Gabriela Di-Silvestre, Farid Zand, Sona Hlinkova, Vladislav Belskiy, Hussain Al-Rahma, Marco Tulio Luque-Torres, Nesil Bayraktar, Zan Mitrev, Vaidotas Gurskis, Dale Fisher, Ilham Bulos Abu-Khader, Kamal Berechid, Arnaldo Rodríguez-Sánchez, Florin George Horhat, Osiel Requejo-Pino, Nassya Hadjieva, Nejla Ben-Jaballah, Elías García-Mayorca, Luis Kushner-Dávalos, Srdjan Pasic, Luis E. Pedrozo-Ortiz, Eleni Apostolopoulou, Nepomuceno Mejía, May Osman Gamar-Elanbya, Kushlani Jayatilleke, Miriam de Lourdes-Dueñas, Guadalupe Aguirre-Avalos, Diego Marcelo Maurizi, Adriana Montanini, Maria Laura Spadaro, Lorenzo Santiago Marcos, Priscila Botta, Florencia Maria Jerez, Maria Constanza Chavez, Lucia Ramasco, Maria Isabel Colqui, Maria Silvia Olivieri, Ana Silvia Rearte, Gladys Edith Correa, Paola Deolinda Juarez, Paola Fabiana Gallardo, Miriam Patricia Brito, Gabriel Horacio Mendez, Julia Rosa Valdez, Lorena Paola Cardena, Jose Maria Harystoy, Gustavo Jorge Chaparro, Claudia Gabriela Rodriguez, Rodolfo Toomey, Maria Caridi, Monica Viegas, Marisa Liliana Bernan, Adriana Romani, Claudia Beatriz Dominguez, Luis Kushner Davalos, Rosana Richtmann, Camila Almeida Silva, Tatiane T. Rodrigues, Amaury Mielle Filho, Ernandi Dagoberto Seerig Palme, Aline Besen, Caroline Lazzarini, Caroline Batista Cardoso, Francisco Kennedy Azevedo, Ana Paula Fontes Pinheiro, Aparecida Camacho, Braulio Matias De Carvalho, Maria Jose Monteiro De Assis, Ana Paula Vasconcelos Carneiro, Maria Lilian Maciel Canuto, Keyla Harten Pinto Coelho, Tamiris Moreira, Agamenon Alves Oliveira, Marcela Maria Sousa Colares, Marcia Maria De Paula Bessa, Tereza De Jesus Pinheiro Gomes Bandeira, Renata Amaral De Moraes, Danilo Amâncio Campos, Tânia Mara Lima De Barros Araújo, Maria Tereza Freitas Tenório, Simone Amorim, Manuela Amaral, Julianne Da Luz Lima, Lindalva Pino Da Silva Neta, Caphiane Batista, Fabio Jorge De Lima Silva, Maria C. Ferreira De Souza, Katia Arruda Guimaraes, Julia Marcia Maluf Lopes, Karina M. Nogueira Napoles, Lorena Luiza Silva Neto Avelar, Lilian Aguiar Vieira, Luis Gustavo De Oliveira Cardo, Christianne F.V. Takeda, Glaydson A. Ponte, Fco Eduardo Aguiar Leitão, Ricardo De Souza Kuchenbecker, Rodrigo Pires Dos Santos, Erci Maria Onzi Siliprandi, Luiz Fernando Baqueiro Freitas, Ianick Souto Martins, Daiane Casi, Maria Angela Maretti Da Silva, Sergio Blecher, Margarete Villins, Reinaldo Salomao, Solange Regina Oliveira Castro, Daniela V. Da Silva Escudero, Mariana Andrade Oliveira Reis, Marcelo Mendonca, Valter Furlan, Antonio Claudio do Amaral Baruzzi, Tarquino Eristidesg Sanchez, Marina Moreira, Wania Vasconcelos de Freitas, Leonardo Passos de Souza, Velmira Angelova Velinova, Michael M. Petrov, Dimitar Georgiev Karadimov, Emil D. Kostadinov, Violeta Jivkova Dicheva, Chaohua Wang, Xiuqin Guo, Xihua Geng, Shufang Wang, Jinzhi Zhang, Ling Zhu, Shufang Zhuo, Chunli Guo, Tao Lili, Li Ruisheng, Liu Kun, Xuesong Yang, Li Yimin, Mao Pu, Li Changan, Yiang Shumei, Wu Kangxiong, Lin Meiyi, Guxiang Ye, Xu Ziqin, Suo Yao, Song Liqiang, Luis Marino Cañas Giraldo, Elsa Margarita Trujillo Ramirez, Paola Andrea Rios, Juan Carlos Torres Millan, Edwin Giovanny Chapeta Parada, Andres Eduardo Mindiola Rochel, Andres H. Corchuelo Martinez, Ana Marãa Perez Fernandez, Nayide Barahona Guzman, Alfredo Lagares Guzman, Marena Rodriguez Ferrer, Yazmin Leon Vega, Heidi Johanna Munoz, Germán Camacho Moreno, Sandra Liliana Romero Torres, Herlidia Taboada Hernandez, Ismael A. Valderrama MarquezClaudia Linares, Monica Espinosa Valencia, Lusayda Sanchez Corrales, Sandra Milena Bonilla, Jorge Ivan Marin Uribe, David Yepes Gomez, Javier Ospina Martinez, Luz Dary Burgos Florez, Johanna Osorio, Dagoberto Santofimio, Lorena Matta Cortes, Wilmer Villamil-Gomez, Gabriel Munoz Gutierrez, Adela Arguello Ruiz, Carlos Gonzalez Fuentes, Antonio Solano Chinchilla, Ivar Calvo Hernandez, Olber Chavarria Ugalde, Humberto Guanche Garcell, Clara Morales Perez, Selin Bardak, Sumru Ozkan, Nepomuceno Mejia, Adrian M. Puello Guerrero Glenny Mirabal, Margarita Delgado, Ramona Severino, Eliesel Lacerda, Gilda Tolari, María Marcela Bovera, Diego Barahona Pinto, Pedro Fernández González, Gasdali Santacruz, Nelly Alquinga, Celso Zaruma, Nelson Remache, Diego Morocho, Mario Arboleda, Mario Cadena Zapata, Maria Fernanda Garcia, Fabricio Picoita, Jorge Velez, Marcia Valle, Estuardo Salgado Yepez, Diego Morocho Tutillo, Ricardo Arteaga Mora, Andrea Peña Padilla, Mayra Chango, Karina Cabezas, Shirley Tenorio López, Ana Lucía Bonilla Escudero, Gladys Tatiana Sánchez, Hugo Alberto Gonzalez Flores, Islam Abdullorziz Ghazi, Mohamed Hassan, Ghada A. Ismail, Reham Hamed, Mona Mohiedden Abdel-Halim, May Abd El-Fattah, Doaa Abdel-Aziz, Zeinab Salah Seliem, Rasha Hamed Elsherif, Reham Ali Dewdar, Abeer Ahmed Mohmed, Lamiaa Abdel-Fatteh Ahmed, Lilian De Jesus Machuca, Concepcion Bran De Casares, Prokopis Kithreotis, Maria Daganou, Dimitrios Veldekis, Maria Kartsonaki, Achilleas Gikas, Marco Tulio Luque Torres, Denis Padgett, Doris Maribel Rivera, Namita Jaggi, Camilla Rodrigues, Bhagyesh Shah, Keyur Parikh, Jigar Patel, Riya Thakkar, Murali Chakravarthy, B.N. Gokul, R. Sukanya, Leema Pushparaj, Thejas Vini, Sukanya Rangaswamy, Saroj Kumar Patnaik, Vempati Venkateshwar, Biju John, Shamsher Dalal, Suneeta Sahu, Samir Sahu, Banambar Ray, Sudhiranjan Misra, Nisith Mohanty, Biraj Mohan Mishra, Prafulla Sahoo, Naresh Parmar, Sanghamitra Mishra, Basanta Kumar Pati, Santosh Singh, Bhabani Shankar Pati, Aparajita Panda, Swarna Banergee, Dipankar Padhihari, Soumya Samal, Karthikeya Varma, Velu Pandi Suresh Kumar, Ram Gopalakrishnan, Nagarajan Ramakrishnan, Babu Kuruvilla Abraham, Senthilkumar Rajagopal, Ramesh Venkatraman, Ashwin Kumar Mani, Dedeepiya Devaprasad, Lakshmi Ranganathan, Thara Francis, Kotturathu Mammen Cherain, Bala Ramachandran, Ravikumar Krupanandan, S. Muralidharan, Murali Karpagam, Baby Padmini, S. Saranya, Siva Kumar, Nirav Pandya, Rajesh Kakkar, Tenzin Zompa, Narinder Saini, Srinivas Samavedam, Ganshyam Jagathkar, Suhas Nirkhiwale, G.S. Gehlot, Shefali Bhattacharya, Sanjeev Sood, Suman Singh, Sanjeev Singh, Subhash Kumar Todi, Mahuya Bhattacharyya, Arpita Bhakta, Susmita Basu, Anuradha Agarwal, Manoj Agarwal, Mohit Kharbanda, Sankar Sengupta, Anirban Karmakar, Debkishore Gupta, Ajoy Krishna Sarkar, Rimita Dey, Chandramouli Bhattacharya, Mammen Chandy, V.R. Ramanan, Aseem Mahajan, Manas Roy, Sanjay Bhattacharya, Saswati Sinha, Indranil Roy, Umesh Gupta, Sujoy Mukherjee, Mrinmoy Bej, Purnima Mukherjee, Sumana Baidya, Afzal Azim, Asmita Sagar Sakle, Jehangir Soli Sorabjee, Mrunalini Subhash Potdar, Vaibhavi R. Subhedar, F.E. Udwadia, Hena Francis, Arpita Dwivedy, Sheena Binu, Suvin Shetty, Pravin Kumar Nair, Devendra K. Khanna, Felcy Chacko, Seelas Blessymole, Preeti Rajeev Mehta, Tanu Singhal, Sweta Shah, Vatsal Kothari, Reshma Naik, Mayur Harshadrai Patel, Deepesh Gokulchand Aggarwal, Burhanuddin Qutbuddin Jawadwala, Niketa Kaul Pawar, Shoeb Nizamuddin Kardekar, Abizer Nuruddin Manked, S.N. Myatra, J.V. Divatia, R. Kelkar, S.K. Biswas, V. Raut, S. Sampat, Alka Thool, Anil Karlekar, Sumi Nandwani, Sudhir Gupta, Sanjay Singhal, Madhu Gupta, Purva Mathur, Subodh Kumar, Kavita Sandhu, Arnab Dasgupta, Abhijeet Raha, Padmalatha Raman, Ashoo Wadhera, Binesh Badyal, Sarika Juneja, Bikas Mishra, Sunil Sharma, Megha Mehrotra, Jayant Shelgaonkar, Vikram Padbidri, Rohini Dhawale, Sheena Mary Sibin, Dileep Mane, Hanamant Kashinath Sale, Mohammad Mukhit Abdul Gaffar Kazi, Supriya Chabukswar, Anju Mathew, Dipti Gaikwad, Amol Harshe, Gita Nadimpalli, Sunil Bhamare, Soniya Thorat, Omnarayan Sarda, Pattabhiramarao Nadimpalli, Angelina Mendonca, Sujata Malik, Asmita Kamble, Nilakshi Kumari, Sohini Arora, Nita Munshi, Deepa Ganesh Divekar, Maithili Satish Kavathekar, Anuja Kedar Kulkarni, Madhupriya Vijay Suryawanshi, Madhavi Latha Bommala, Anil Bilolikar, Kashmira Limaye Joshi, Charulata Pamnani, Harvinder Wasan, Sonali Khamkar, Leena Steephen, Arjun Rajalakshmi, Anzar Thair, Aisha Mubarak, Swathy Sathish, Suresh Kumar, H. Sunil, Sujith Sujith, null Dinesh, Nagamani Sen, Nitin Shinde, Masoud Alebouyeh, Somayeh Jahani-Sherafat, Mohammad Reza Zali, Mohammad Reza Sarbazi, Nahid Mansouri, Elahe Tajeddin, Maryam Razaghi, Simasadat Seyedjavadi, Marjan Rashidan, Mansoor Masjedi, Behzad Maghsudi, Golnar Sabetian, Anahita Sanaei, Atefeh Yousefipour, Abdullah Mufareh Assiri, Elaine Mari Furukawa-Cinquini, Areej Dhafer Alshehri, Alysia Faye Giani, Nadia Lynette Demaisip, Elizabeth Laungayan Cortez, Analen Fabros Cabato, Jerlie Mae Gonzales Celiz, Ibrahim A.M. Al-Zaydani Asiri, Yassir Khidir Mohammed, Mohammed Abdullah Al Raey, Ali Omer Abdul Aziz, Saeed Ali Al Darani, Misbah Rehman Aziz, Roaa Hasan Basri, Duaa Khalil Al-Awadi, Syed Zahid Bukhari, Rosita Gasmin Aromin, Evangelina Balon Ubalde, Apsia Musa Molano, Hessa Abdullah Al Enizy, Celia Flores Baldonado, Fatima Mohammad Al Adwani, Arlu Marie Casuyon Pahilanga, Avigail M. Tan, Sonia Joseph, Deepa Sasidharan Nair, Nabeela Abdullah Al-Abdullah, Grace Sindayen, Annalyn Amor Malificio, Diaa Abdullah Mohammed, Hanan Mesfer Al Ghamdi, Ameurfina Curioso Silo, Marianina Brenda V. Valisto, Nektarios Foteinakis, Sameeh Salem Ghazal, Mercy V. Joseph, Ahmed Hakawi, Antigona Hasani, Ismet Jusufi, Gazmend Spahija, Nehat Baftiu, Agreta Gecaj-Gashi, Nasser Yehia Aly, Mohammad El-Dossoky Noweir, Suga Thomas Varghese, Ruby Jose Ramapurath, Amna Mostafa Mohamed, Sneha Mary George, Anu Kurian, Amani Fouad Sayed, Mona Foda Salama, Abeer Aly Omar, Flavie Maria Rebello, Dennis Malungcot Narciso, Nada Kara Zahreddine, Zeina Kanafani, Tala Kardas, Bassel Molaeb, Lamia Jurdi, Anwar Al Souheil, Mohamad Ftouni, Hasan Ayash, Tahsine Mahfouz, Tomas Kondratas, Dovile Grinkeviciute, Rimantas Kevalas, Greta Gailiene, Algirdas Dagys, Milena Petrovska, Katja Popovska, Zaneta Bogoevska-Miteva, Katerina Jankovska, Snezana Tufekcievska Guroska, Tanja Anguseva, Wan Nurbayah Wan Yusoff, Anis Shiham Zainal Abidin, Chin Seng Gan, Hasimah Zainol, Vineya Rai, Wong Kang Kwong, Mohd Shahnaz Hasan, Sasheela Sri La Sri Ponnampala, Jeyaganesh Veerakumaran, Ojan Assadian, Doan Mai Phuong, Nguyen Gia Binh, Kerinjeet Kaur, Joelene Lim, Lian-Huat Tan, Jegathesan Manikavasagam, Yuet-Meng Cheong, Hilario Coronado Magaña, Julio Cesar Mijangos Méndez, Federico Corona Jiménez, Sergio Esparza-Ahumada, Rayo Morfin-Otero, Eduardo Rodriguez-Noriega, Susana Gutierrez-Martinez, Hector Raul Perez-Gomez, Gerardo León-Garnica, Christian Mendoza-Mujica, Martha Cecilia Culebro Burguet, Jorge Horacio Portillo-Gallo, Fernando Aguilera Almazán, Gaspar Iglesias Miramontes, Maria del Rosario Vázquez Olivas, Lucio Alberto Aguilar Angel, Marisol Sanchez Vargas, Angel Orlando Flores Alvarado, Roberto Carlos Mares Morales, Luis Carlos Fernandez Alvarez, Hector Armando Rincon Leon, Karla Reyna Navarro Fuentes, Yuri Mariela Perez Hernandez, Gabriela Martinez Falcon, Angel Gonzalez Vargas, Marco A. Trujillo Juarez, Antonio Martinez Mulia, Paulina Alma Ulloa Camacho, Martha Y. Martinez-Marroquin, Marco Montell Garcia, Araceli Martinez Martinez, Elena Leon Sanchez, Guadalupe Gomez Flores, Marisela del Rocío González Martínez, Jesús Alfonso Galindo Olmeda, Georgina Olivarez, Enrique Barbachano Rodriguez, María Magdalena Gutierrez Castillo, María Guadalupe Villa González, Isaura Beatriz Sauceda Castañeda, Jaime Martínez Rodriguez, Otgon Baatar, Byambadorj Batkhuu, Kabiri Meryem, Barkat Amina, Rédouane Abouqal, Amine Ali Zeggwagh, Tarek Dendane, Khalid Abidi, Naoufel Madani, Syed Faisal Mahmood, Badaruddin A. Memon, Gul Hassan Bhutto, Nadeem Paul, Azra Parveen, Aun Raza, Amjad Mahboob, Summiya Nizamuddin, Faisal Sultan, Hammad Nazeer, Ashraf Ali Khan, Arifa Hafeez, Lydia Lara, Trudell Mapp, Balkys Alvarez, Magda Ivonne Rojas-Bonilla, Elizabeth Castano, Daisy A. De Moros, Roberto Espinoza Atarama, Maria Elena Calisto Pazos, Alfredo Paucar, Marlene Tasayco Ramos, Jenny Jurado, Dafne Moreno, Marãa E. Cruz Saldarriaga, Eliza Ramirez, Carlos Enrique La Hoz Vergara, Walter Enrique Prudencio Leon, Luis Isidro Castillo Bravo, Katya Fernanda Aibar Yaranga, Janet E. Pichilingue Chagray, Vanessa A. Marquez Mondalgo, Socorro Torres Zegarra, Nazario Silva Astete, Francisco Campos Guevara, Javier Soto Pastrana, Carlos F. Linares Calderon, Manuel Jesus Mayorga Espichan, Luis Martin Santivanez Monge, Maria V. Changano Rodriguez, Zoila Rosa Diaz Tavera, Fernando Martin Ramirez Wong, Selene Manga Chavez, Teodora Atencio-Espinoza, Victoria D. Villanueva, Maria Teresa Blanco-Abuy, Arnefelina S. Tamayo, Lailane D. Bergosa, Cristina Mari Jean P. Llames, Marilou F. Trajano, Suzette A. Bunsay, Jessica C. Amor, Regina Berba, Maria Carmen Sg Buenaflor, Ever Labro, Myrna T. Mendoza, Ofelia P. Javellana, Lilibeth G. Salvio, Rhoda Gay Rayco, Vanessa Bermudez, Andrzej Kubler, Marzena Zielinska, Magdalena Kosmider-Zurawska, Barbara Barteczko-Grajek, Ewa Szewczyk, Barbara Dragan, Malgorzata Anna Mikaszewska-Sokolewicz, Tomasz Lazowski, Elsie Cancel, Monica Sorina Licker, Liliana Alina Dragomirescu, Victor Dumitrascu, Dorel Sandesc, Ovidiu Bedreag, Marius Papurica, Delia Muntean, Igor Kotkov, Vladimir Kretov, Vladimir Shalapuda, Alexander Molkov, Sergey Puzanov, Ivan Utkin, Alexander Tchekulaev, Valentina Tulupova, Ljubica Nikolic, Goran Ristic, Jelena Eremija, Jelena Kojovic, Dragana Lekic, Sladjana Vasiljevic, Anna Lesnakova, Alzbeta Marcekova, Katarina Furova, May Osman Gamar Elanbya, Malik Abdo Ali, Shobhana Kumari Kadankunnel, Suwara Somabutr, Rungratchanee Pimathai, Suthinee Wanitanukool, Montri Luxsuwong, Namphon Supa, Pornpheth Prasan, Visanu Thamlikitkul, Silom Jamulitrat, Nonglak Suwalak, Parichart Phainuphong, Bouziri Asma, Borgi Aida, Bel Hadj Sarra, Khaldi Ammar, Gunay Tuncer Ertem, Cemal Bulut, Cigdem Ataman Hatipoglu, Fatma Sebnem Erdinc, Ali Pekcan Demiroz, Menekse Ozcelik, Basak Ceyda Meco, Mehmet Oral, Necmettin Unal, Cigdem Yildirim Guclu, Tanıl Kendirli, Erdal İnce, Ergin Çiftçi, Ayhan Yaman, Çağlar Ödek, Adem Karbuz, Bilge Aldemir Kocabaş, Nilgün Altın, Salih Cesur, Begum Atasay, Omer Erdeve, Hasan Akduman, Dilek Kahvecioglu, Ufuk Cakir, Duran Yildiz, Atila Kilic, Saadet Arsan, Dilek Arman, Serhat Unal, Yasemin Gelebek, Humeyra Zengin, Suha Sen, Hatice Cabadak, Ayse Erbay, Ata Nevzat Yalcin, Ozge Turhan, Melike Cengiz, Oguz Dursun, Perihan Gunasan, Sehnaz Kaya, Atilla Ramazanoglu, Cemal Ustun, Aliye Yasayacak, Hayrettin Akdeniz, Fatma Sirmatel, Ali Metin Otkun, Suzan Sacar, Alper Sener, Huseyn Turgut, Hulya Sungurtekin, Dogaç Ugurcan, Ceyda Necan, Cansu Yilmaz, Davut Ozdemir, Mehmet Faruk Geyik, Nevin Ince, Ayse Danis, Selvi Yener Erdogan, Nurettin Erben, Gaye Usluer, Ilhan Ozgunes, Cengiz Uzun, Oral Oncul, Levent Gorenek, Hakan Erdem, Orhan Baylan, Asu Ozgultekin, Asuman Inan, Sibel Bolukcu, Gunes Senol, Halil Ozdemir, Zeynel Gokmen, Sonay Incesoy Ozdemir, Ali Kaya, Gulden Ersoz, Necdet Kuyucu, Sevim Karacorlu, Zeynep Kaya, Ertugrul Guclu, Gulsume Kaya, Oguz Karabay, Saban Esen, Canan Aygun, Fatma Ulger, Ahmet Dilek, Hava Yilmaz, Mustafa Sunbul, Aynur Engin, Mehmet Bakir, Nazif Elaldi, Iftihar Koksal, Dincer Yildizdas, Ozden Ozgur Horoz, Ayşe Willke, Meliha Meriç Koç, Emel Azak, Naheed Elahi, Philip Annamma, Ashraf El Houfi, Maria Catalina Pirez Garcia, Hector Vidal, Fernando Perez, Gabriel D. Empaire, Yvis Ruiz, Dulce Hernandez, Dayana Aponte, Evelyn Salinas, Claudia Diaz, María Eugenia Guzmán Siritt, Zenaida Durán Gil De Añez, Luis Montes Bravo, Nelva Orozco, Eugenia Mejías, Nguyen Viet Hung, Nguyen Quoc Anh, Ngo Quy Chau, Truong Anh Thu, Le Thi Diem Tuyet, Dang Thi Van Trang, Vo Thi Hong Thoa, Nguyen Phuc Tien, Le Thi Anh Thu, Phan Thi Hang, Tran Thi My Hanh, Tran Thi Thuy Hang, Dinh Pham Phuong Anh, Ondokuz Mayıs Üniversitesi, KILIÇ, ATİLA, and MERİÇ KOÇ, MELİHA

Subjects
Imipenem, medicine.medical_specialty, Pediatrics, Low income countries, Asia, Epidemiology, Klebsiella pneumoniae, Health care-associated infection, Antibiotic resistance, Catheter-associated urinary tract infection, Ceftazidime, Network, Bloodstream infection, Developing countries, Nosocomial infection, Intensive care, medicine, Ventilator-associated pneumonia, Humans, Hospital infection, Prospective Studies, Urinary tract infection, Cross Infection, Infection Control, biology, business.industry, Health Policy, Public Health, Environmental and Occupational Health, medicine.disease, Nosocomial infection control, biology.organism_classification, Device-associated infection, United States, Europe, Pneumonia, Intensive Care Units, Infectious Diseases, Latin America, Amikacin, Emergency medicine, Africa, Limited resources countries, Central line-associated bloodstream infections, Centers for Disease Control and Prevention, U.S, business, medicine.drug
Abstract

Maghsoudi, Behzad/0000-0002-1279-8799; Kritsotakis, Evangelos/0000-0002-9526-3852; Yalcin, Ata Nevzat/0000-0002-7243-7354; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; ALDEMIR KOCABAS, Bilge/0000-0002-6396-5243; Masjedi, Mohammad Reza/0000-0002-6871-382X; Masjedi, Mansoor/0000-0001-6175-9289; Gan, Chin Seng/0000-0002-6758-4798; Oncul, Oral/0000-0002-1681-1866; Sabetian, Golnar/0000-0001-8764-2150; YAMAN, Ayhan/0000-0002-5651-1286; Ozdemir, Halil/0000-0002-7318-1688; Leon, Hector Armando Rincon/0000-0003-0715-200X; Delia, Muntean/0000-0001-9100-4530; Atasay, Fatma Begum/0000-0002-9114-5293; Zand, Farid/0000-0003-3489-3372; Kuchenbecker, Ricardo/0000-0002-4707-3683; Medeiros, Eduardo A/0000-0002-6205-259X; ROMERO LOPEZ-ALBERCA, CRISTINA/0000-0001-5856-8668; Salomao, Reinaldo/0000-0003-1149-4598; ozdemir, sonay incesoy/0000-0003-2863-901X; Meco, Basak Ceyda/0000-0003-2951-9634; Horoz, Ozden Ozgur/0000-0001-7590-650X; Horhat, Florin George/0000-0001-6133-0204; Kazi, Mohammad Mukhit/0000-0003-3824-5540; Ciftci, Ergin/0000-0002-4955-160X; Abouqal, Redouane/0000-0002-6117-4341; Leblebicioglu, Hakan/0000-0002-6033-8543; Garcell, Humberto Guanche/0000-0001-7279-0062; Kendirli, Tanil/0000-0001-9458-2803; de Souza, Maria Cecilia B V/0000-0003-0318-3087; Sanaei Dashti, Anahita/0000-0002-2827-3575; UNAL, SERHAT/0000-0003-1184-4711; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Barahona G., Nayide/0000-0003-3559-6900; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Karabay, Oguz/0000-0003-0502-432X; Kaya, Sehnaz/0000-0003-0002-1517; ERDEVE, OMER/0000-0002-3193-0812; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Gikas, Achilleas/0000-0002-8455-9631; Baylan, Orhan/0000-0002-6529-7824; Mitrev, Zan/0000-0001-7859-8821; yildizdas, dincer/0000-0003-0739-5108; Ngo, Quy Chau/0000-0002-6787-2757; Duszynska, Wieslawa/0000-0002-5880-4904; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; Gupta, Umesh/0000-0001-7717-1404; Navarro Fuentes, Karla Reyna/0000-0002-6894-8872; zali, Mohammadreza/0000-0002-9027-4560; Morocho Tutillo, Diego Rolando/0000-0002-4974-7856; El Kholy, Amani/0000-0002-0645-7664; Kanj, Souha/0000-0001-6413-3396; Assiri, Abdullah/0000-0002-5605-2876; Unal, Necmettin/0000-0002-9440-7893; Jayatilleke, Kushlani/0000-0002-3931-6630; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000341307100001 PubMed: 25179325 We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U. S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Published
2014

10. Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central line-associated bloodstream infection rates in the intensive care units of 15 developing countries

Author

Aruna Poojary, Redouane Abouqal, Sharmila Chatterjee, Reinaldo Salomao, Raman Krishna Kumar, Eduardo Alexandrino Medeiros, Sheila Myatra, Ahmet Dilek, Rafael Consunji MD MPH, VICTOR DANIEL ROSENTHAL, Nurettin Erben, Humberto Guanche Garcell, Zan Mitrev, Hakan Leblebicioglu, Souha Kanj, Necmettin Unal, Nayide Barahona G., Carlos Arturo Alvarez-Moreno, Ata Yalcin, Marena Luz Rodriguez Ferrer, and OMÜ

Subjects
Male, Pediatrics, antisepsis, Epidemiology, Bacteremia, intensive care unit, law.invention, Catheters, Indwelling, law, Risk Factors, Medicine, Infection control, Cross Infection, health care organization, Incidence (epidemiology), Chlorhexidine, article, clinical trial, catheter, Middle Aged, Intensive care unit, health survey, Intensive Care Units, Infectious Diseases, health program, Female, hospital infection, Guideline Adherence, Hand Disinfection, Microbiology (medical), Adult, medicine.medical_specialty, Developing country, bloodstream infection, Intensive care, Humans, controlled study, human, Developing Countries, Aged, treatment duration, business.industry, Public health, International Agencies, medicine.disease, Nosocomial infection control, major clinical study, International Nosocomial Infection Control Consortium, multicenter study, Catheter-Related Infections, Emergency medicine, incidence, Equipment Contamination, business, Disinfectants
Abstract

Yalcin, Ata Nevzat/0000-0002-7243-7354; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Abouqal, Redouane/0000-0002-6117-4341; Salomao, Reinaldo/0000-0003-1149-4598; Leblebicioglu, Hakan/0000-0002-6033-8543; Medeiros, Eduardo A/0000-0002-6205-259X; Barahona G., Nayide/0000-0003-3559-6900; Consunji, Rafael/0000-0002-9854-3585; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Chatterjee, Sharmila/0000-0001-5905-1089; Kanj, Souha/0000-0001-6413-3396; Chatterjee, Sharmila/0000-0002-3890-8386; Mitrev, Zan/0000-0001-7859-8821; Unal, Necmettin/0000-0002-9440-7893 WOS: 000283842300009 PubMed: 21029008 BACKGROUND. The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line-associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership. METHODS. Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line-days). Process surveillance results at baseline were compared with intervention period data. RESULTS. During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line-days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line-days; relative risk, 0.46 [95% confidence interval, 0.33-0.63]; P < .001). The number of deaths in patients with CLABSI decreased by 58%. During the intervention period, hand hygiene adherence improved from 50% to 60% (P < .001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45% to 85% (P < .001), that adopted chlorhexidine for antisepsis increased from 7% to 27% (P = .018), and that sought to remove unneeded catheters increased from 37% to 83% (P = .004); and the duration of central line placement decreased from 4.1 to 3.5 days (P < .001). CONCLUSIONS. Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54% and the number of CLABSI-associated deaths by 58% in INICC hospitals during the first 2 years.

Published
2010

11. Çiftlik Hayvanlarında Karayoluyla Nakil Koşullarının Mortalite ve Karkas Kalitesine Etkisi

Author

Ömer Faruk Güngör and Necmettin Ünal

Subjects
nakil, et kalitesi, dfd, ph, mortality, Agriculture, Agriculture (General), S1-972
Abstract

Son yıllarda gelişmiş ve gelişmekte olan ülkelerde kaliteli et üretimi ve et üretim kayıplarını azaltma ile ilgili yapılan bilimsel araştırma sayısında artış olduğu bilinmektedir. Yapılan araştırmalarda nakil koşullarının etin raf ömrünü ve etin görünümünü etkilediği bildirilmiştir. Kara yolu ile nakil koşullarının hayvan refahı kurallarına uygun olmadığı durumlarda mortality, karkas ezikleri meydana gelmekte ve etin normal pH’sı değişmektedir. Bu nedenle nakledilecek havanların özellikleri (ırk, tür, cinsiyet, yaş ve yetiştirme şekli) ve nâkilin etkenleri (bakıcılar, şoförler, yükleme, boşaltma, araç, alan, mevsim, açlık, susuzluk, sosyal grup, yolun mesafesi ve durumu) dikkate alınarak yapılacak iyi bir planlama üretim kayıplarını azaltacak ve et kalitesini artıracaktır. Bu derlemede, hayvanların karayoluyla nakillerinin planlanmasında dikkat edilmesi gereken kriterler hakkında araştırmacılara ve alanda çalışanlara kapsamlı bilgi sunmak amaçlanmıştır.

Published
2020
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12. Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study

Author

Nur Baykara, Halis Akalın, Mustafa Kemal Arslantaş, Volkan Hancı, Çiğdem Çağlayan, Ferda Kahveci, Kubilay Demirağ, Canan Baydemir, Necmettin Ünal, and Sepsis Study Group

Subjects
Intensive care, Sepsis, Carbapenem resistance, Point prevalence, Turkey, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey. Methods A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded. Results Of the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1:4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients. Conclusions A high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality. Trial registration ClinicalTrials.gov ID NCT03249246. Date: August 15, 2017. Retrospectively registered.

Published
2018
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13. Multivariate analysis of morphometry effect on race performance in Thoroughbred horses

Author

Yavuzkan Paksoy and Necmettin Ünal

Subjects
environmental factors, morphometric measurements, PCA, flat racing, Animal culture, SF1-1100
Abstract

ABSTRACT The objective of this study was to determine the effects of morphometric measurements on race performance (m/sec) of Thoroughbred horses. Data of morphometric measurements (withers height, rump height, chest girth, chest width, front chest width, chest depth, neck length, shoulder length, length of withers to rump, rump length, body length, head width, head length, and cannon circumference) were taken from 244 Thoroughbred horses chosen at random. A total of 2888 racing records were considered for race performance. The effects of environmental factors on morphometric measurements (stallion, gender, age, and mother age) and race performance (gender, age, mother age, year, hippodrome, race distance, racetrack, and race type) were analyzed using the least squares method. Principal component analysis (PCA) was performed for morphometric measurements, and then the factor loadings were rotated by Varimax method. Multiple linear regression analysis was applied for the significance of the obtained factors on race performance. Significant effects for stallion on all morphometric measurements, except head length and width, and for gender on withers height, cannon circumference, and head width were determined. Race performance was significantly influenced by stallion, gender, age, year, hippodrome, race distance, racetrack, and race type. After PCA, four factors with eigenvalues >1 were attained. The effects of factors on race performance were not significant, according to the results of multiple linear regression analysis. Therefore, the effects of the morphometric measurements examined on the race performance were not significant in Thoroughbred horses.

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