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Contains fulltext : 138898.pdf (Publisher’s version ) (Closed access) BACKGROUND: Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. AIMS: We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients. METHODS: We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. RESULTS: The EPIC II database includes 13,796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, P < 0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, P < 0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, P < 0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (P < 0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P < 0.05). CONCLUSIONS: Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.

The pregnant woman has fi ve times greater the risk of developing pulmonary thromboembolism with respect to non-pregnant, mainly due to the cardiovascular and coagulation changes characteristic of pregnancy, and the risk increases with the presence of other fac- tors such as age, previous pulmonary embolism, systemic lupus erythematosus and multiparity, among others. The diagnostic process begins with clinical suspicion. Determination of D-dimer is useful because its negative predictive value. The helical computed tomography has a high sensitivity and specifi city in the diagnosis of pulmonary thromboembolism, while pulmonary angiography remains the defi nitive diagnostic study. Treatment consists of anticoagulation as soon as the diagnosis is established, both unfractionated heparin and low molecular weight heparins are the drugs of choice over vitamin K antagonists, primarily because the fi rst ones do not cross the placental barrier, and have fewer side effects due to their short half-life.

Background: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II.Methods: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days.Results: Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality.Conclusions: The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections. © 2014 De Waele et al. licensee BioMed Central Ltd., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. Design: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. Setting: EPIC II included 1265 intensive care units in 76 countries. Patients: Patients in participating intensive care units on study day. Interventions: None. MEASUREMENT AND MAIN RESULTS:: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. Conclusion: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use. Copyright 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Acinetobacter baumannii has emerged as an important nosocomial pathogen. It is difficult to control and treat. The most seriously ill patients and those previously infected are more likely than others to be infected or colonized by A. baumannii. The epidemiology of A. baumannii infection is complex, with the coexistence of epidemic and endemic infections. The A. baumannii are the species isolated in 90% of the nosocomial infections and in 92% of the nosocomial bacteremias. The intensive care units presented the greater number of nosocomial bacteremias by A. baumannii. The most common sources of A. baumannii are respiratory tract, surgical wound, catheter, urinary tract and others. The most frequently clinical manifestation is sepsis and a fulminating course is observed when the patient presents septic shock. Progressive resistance of A. baumannii to antimicrobial limits the therapeutic options. The patients with A. baumannii multidrug-resistant present an excessive rate of attributed mortality, length of stay and costs.

Determine the severity and the course of Acinetobacter baumannii blood infections (AbBI).We carried out a prospective review of all Acinetobacter baumannii (A. baumannii) isolated from the Intensive Care Unit (ICU) of a medical facility.During the study period, 46 patients were identified with AbBI. The rate of AbBI was 14 per 1,000 admissions. A. baumannii was ICU acquired in 85% of cases studied. The median time frame between ICU admission and acquisition of AbBI was 9 +/- 7 days. 31 patients displayed blood infection (BI) by A. baumannii alone and 15 with polymicrobial BI. The clinical manifestation of the 31 patients with AbBI included the following symptoms: 42% presented with septic shock, 42% had severe sepsis and 16% had sepsis. Two or more episodes of AbBI were observed among 13% of patients. Of A. baumannii isolates, 17% were resistant to imipenem. Patient mortality with AbBI alone was 45% and 40% for polymicrobial BI. Patient mortality for septic shock was 60%, 70% died during the first 72 hrs after AbBI.AbBI displayed an endemic pattern during the study period. Severe sepsis and septic shock were the most common clinical presentations of AbBI. AbBI are associated with a significant increase in the death rate of patient in the ICU studied.