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3. Variation in the practice of tracheal intubation in Europe after traumatic brain injury: a prospective cohort study

Author

Gravesteijn, B.Y. (B. Y.), Sewalt, C.A. (C. A.), Ercole, A. (Ari), Lecky, F.E. (Fiona), Menon, D.K. (David ), Steyerberg, E.W. (Ewout), Maas, A.I.R. (Andrew), Lingsma, H.F. (Hester), Klimek, M. (Markus), Åkerlund, C. (C.), Adams, H. (H.), Amrein, K. (K.), Andelic, N. (Nada), Andreassen, L. (Lasse), Anke, A. (A.), Audibert, G. (Gérard), Azouvi, P. (P.), Azzolini, M. (M.), Bartels, R.H.M.A. (Ronald), Beer, R. (R.), Bellander, B.-M. (Bo-Michael), Benali, H. (H.), Berardino, M. (Maurizio), Beretta, L. (Luigi), Blaabjerg, M. (M.), Borgen, L. (L.), Brorsson, C. (C.), Buki, A. (A.), Cabeleira, M. (M.), Caccioppola, A. (A.), Calappi, E. (E.), Calvi, M. (M.), Cameron, P. (Peter), Carbayo, L. (L.), Carbonara, M. (M.), León, A. (A.), Chevallard, G. (G.), Chieregato, A. (Arturo), Citerio, G. (Giuseppe), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J. (J.), Correia, M. (M.), Cnossen, M.C. (Maryse), Czeiter, E. (Endre), Czosnyka, M. (Marek), Fizelier, C. (C.), De Keyser, V. (V.), Degos, V. (V.), Della Corte, F. (F.), den Boogert, H. (H.), Depreitere, B. (Bart), Dilvesi, D. (D.), Dixit, A. (A.), Donoghue, E. (E.), Dreier, J.P. (Jens), Dulière, G. (G.), Ercole Ari, A. (A.), Ezer, E. (E.), Fabricius, M. (Martin), Foks, K. (K.), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (A.), Galanaud, D. (Damien), Gantner, D. (D.), Ghuysen, A. (Alexandre), Giga, L. (L.), Golubovic, J. (J.), Gomez, P. (P.), Grossi, F. (F.), Gupta, D. (D.), Haitsma, I. (Iain), Helbok, R. (Raimund), Helseth, E. (Eirik), Hutchinson, P.J. (Peter J.), Jankowski, S. (S.), Karan, M. (M.), Kolias, A.G. (Angelos G.), Kondziella, D. (Daniel), Koskinen, L.-O. (Lars-Owe), Kovács, N. (N.), Lagares, A. (Alfonso), Laureys, S. (Steven), Lightfoot, R. (Roger), Lingsma, H. (H.), Maas, A. (A.), Manara, A. (Alex), Martino, C. (Costanza), Maréchal, H. (Hugues), Mattern, J. (J.), McFadyen, C. (C.), McMahon, C. (C.), Menovsky, T. (Tomas), Mulazzi, D. (D.), Muraleedharan, V. (V.), Murray, L. (L.), Nair, N. (N.), Negru, A. (A.), Nelson, D. (David), Newcombe, V.F. (Virginia F.), Noirhomme, Q. (Q.), Nyirádi, J. (J.), Ortolano, F. (F.), Payen, J.-F. (Jean-François), Perlbarg, V. (Vincent), Persona, P. (P.), Peul, W.C. (Wilco), Piippo-Karjalainen, A. (A.), Ples, H. (Horia), Pomposo, I. (I.), Posti, J. (J.), Puybasset, L. (Louis), Radoi, A. (A.), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rhodes, J.K.J. (Jonathan K.J.), Richter, S. (S.), Rocka, S. (Saulius), Roe, C. (C.), Roise, O. (O.), Rosenfeld, J. (J.), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Sahuquillo, J. (Juan), Sandro, O. (O.), Sakowitz, O. (Oliver), Porras, R. (R.), Schirmer-Mikalsen, K. (K.), Schou Rico, F. (F.), Smielewski, P. (P.), Sorinola, A. (A.), Stamatakis, E. (Emmanuel), Kowalk, A. (A.), Steyerberg, E. (E.), Stocchetti, N. (Nino), Sundström, N. (N.), Takala, R. (R.), Tamás, V. (V.), Tamosuitis, T. (T.), Tenovuo, O. (Olli), Thomas, M. (M.), Tibboel, D. (D.), Tolias, C.M. (Christos M.), Trapani, T. (T.), Tudora, C. (C.), Vajkoczy, P. (Peter), Vallance, S. (S.), Valeinis, E. (E.), Vámos, Z. (Z.), Van der Steen, G. (G.), van Dijck, J. (J.), van Essen, T. (T.), Vanhaudenhuyse, A. (A.), van Wijk, R. (R.), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Vik, A. (Anne), Vilcinis, R. (Rimantas), Volovici, V. (Victor), Voormolen, D. (D.), Vulekovic, P. (Peter), Williams, G. (Guy), Wolf, S. (Stefan), Younsi, A. (A.), Zeiler, F. (F.), Ziverte, A. (A.), Zoerle, T. (T.), Gravesteijn, B.Y. (B. Y.), Sewalt, C.A. (C. A.), Ercole, A. (Ari), Lecky, F.E. (Fiona), Menon, D.K. (David ), Steyerberg, E.W. (Ewout), Maas, A.I.R. (Andrew), Lingsma, H.F. (Hester), Klimek, M. (Markus), Åkerlund, C. (C.), Adams, H. (H.), Amrein, K. (K.), Andelic, N. (Nada), Andreassen, L. (Lasse), Anke, A. (A.), Audibert, G. (Gérard), Azouvi, P. (P.), Azzolini, M. (M.), Bartels, R.H.M.A. (Ronald), Beer, R. (R.), Bellander, B.-M. (Bo-Michael), Benali, H. (H.), Berardino, M. (Maurizio), Beretta, L. (Luigi), Blaabjerg, M. (M.), Borgen, L. (L.), Brorsson, C. (C.), Buki, A. (A.), Cabeleira, M. (M.), Caccioppola, A. (A.), Calappi, E. (E.), Calvi, M. (M.), Cameron, P. (Peter), Carbayo, L. (L.), Carbonara, M. (M.), León, A. (A.), Chevallard, G. (G.), Chieregato, A. (Arturo), Citerio, G. (Giuseppe), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J. (J.), Correia, M. (M.), Cnossen, M.C. (Maryse), Czeiter, E. (Endre), Czosnyka, M. (Marek), Fizelier, C. (C.), De Keyser, V. (V.), Degos, V. (V.), Della Corte, F. (F.), den Boogert, H. (H.), Depreitere, B. (Bart), Dilvesi, D. (D.), Dixit, A. (A.), Donoghue, E. (E.), Dreier, J.P. (Jens), Dulière, G. (G.), Ercole Ari, A. (A.), Ezer, E. (E.), Fabricius, M. (Martin), Foks, K. (K.), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (A.), Galanaud, D. (Damien), Gantner, D. (D.), Ghuysen, A. (Alexandre), Giga, L. (L.), Golubovic, J. (J.), Gomez, P. (P.), Grossi, F. (F.), Gupta, D. (D.), Haitsma, I. (Iain), Helbok, R. (Raimund), Helseth, E. (Eirik), Hutchinson, P.J. (Peter J.), Jankowski, S. (S.), Karan, M. (M.), Kolias, A.G. (Angelos G.), Kondziella, D. (Daniel), Koskinen, L.-O. (Lars-Owe), Kovács, N. (N.), Lagares, A. (Alfonso), Laureys, S. (Steven), Lightfoot, R. (Roger), Lingsma, H. (H.), Maas, A. (A.), Manara, A. (Alex), Martino, C. (Costanza), Maréchal, H. (Hugues), Mattern, J. (J.), McFadyen, C. (C.), McMahon, C. (C.), Menovsky, T. (Tomas), Mulazzi, D. (D.), Muraleedharan, V. (V.), Murray, L. (L.), Nair, N. (N.), Negru, A. (A.), Nelson, D. (David), Newcombe, V.F. (Virginia F.), Noirhomme, Q. (Q.), Nyirádi, J. (J.), Ortolano, F. (F.), Payen, J.-F. (Jean-François), Perlbarg, V. (Vincent), Persona, P. (P.), Peul, W.C. (Wilco), Piippo-Karjalainen, A. (A.), Ples, H. (Horia), Pomposo, I. (I.), Posti, J. (J.), Puybasset, L. (Louis), Radoi, A. (A.), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rhodes, J.K.J. (Jonathan K.J.), Richter, S. (S.), Rocka, S. (Saulius), Roe, C. (C.), Roise, O. (O.), Rosenfeld, J. (J.), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Sahuquillo, J. (Juan), Sandro, O. (O.), Sakowitz, O. (Oliver), Porras, R. (R.), Schirmer-Mikalsen, K. (K.), Schou Rico, F. (F.), Smielewski, P. (P.), Sorinola, A. (A.), Stamatakis, E. (Emmanuel), Kowalk, A. (A.), Steyerberg, E. (E.), Stocchetti, N. (Nino), Sundström, N. (N.), Takala, R. (R.), Tamás, V. (V.), Tamosuitis, T. (T.), Tenovuo, O. (Olli), Thomas, M. (M.), Tibboel, D. (D.), Tolias, C.M. (Christos M.), Trapani, T. (T.), Tudora, C. (C.), Vajkoczy, P. (Peter), Vallance, S. (S.), Valeinis, E. (E.), Vámos, Z. (Z.), Van der Steen, G. (G.), van Dijck, J. (J.), van Essen, T. (T.), Vanhaudenhuyse, A. (A.), van Wijk, R. (R.), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Vik, A. (Anne), Vilcinis, R. (Rimantas), Volovici, V. (Victor), Voormolen, D. (D.), Vulekovic, P. (Peter), Williams, G. (Guy), Wolf, S. (Stefan), Younsi, A. (A.), Zeiler, F. (F.), Ziverte, A. (A.), and Zoerle, T. (T.)

Abstract

Traumatic brain injury patients frequently undergo tracheal intubation. We aimed to assess current intubation practice in Europe and identify variation in practice. We analysed data from patients with traumatic brain injury included in the prospective cohort study collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI) in 45 centres in 16 European countries. We included patients who were transported to hospital by emergency medical services. We used mixed-effects multinomial regression to quantify the effects on pre-hospital or in-hospital tracheal intubation of the following: patient characteristics; injury characteristics; centre; and trauma system characteristics. A total of 3843 patients were included. Of these, 1322 (34%) had their tracheas intubated; 839 (22%) pre-hospital and 483 (13%) in-hospital. The fit of the model with only patient characteristics predicting intubation was good (Nagelkerke R2 64%). The probability of tracheal intubation increased with the following: younger age; lower pre-hospital or emergency department GCS; higher abbreviated injury scale scores (head and neck, thorax and chest, face or abdomen abbreviated injury score); and one or more unreactive pupils. The adjusted median odds ratio for intubation between two randomly chosen centres was 3.1 (95%CI 2.1–4.3) for pre-hospital intubation, and 2.7 (95%CI 1.9–3.5) for in-hospital intubation. Furthermore, the presence of an anaesthetist was independently associated with more pre-hospital intubation (OR 2.9, 95%CI 1.3–6.6), in contrast to the presence of ambulance personnel who are allowed to intubate (OR 0.5, 95%CI 0.3–0.8). In conclusion, patient and injury characteristics are key drivers of tracheal intubation. Between-centre differences were also substantial. Further studies are needed to improve the evidence base supporting

Published
2019
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4. Transmission of Methicillin‐Resistant Staphylococcus aureusInfection Through Solid Organ Transplantation: Confirmation Via Whole Genome Sequencing

Author

Wendt, J. M., Kaul, D., Limbago, B. M., Ramesh, M., Cohle, S., Denison, A. M., Driebe, E. M., Rasheed, J. K., Zaki, S. R., Blau, D. M., Paddock, C. D., McDougal, L. K., Engelthaler, D. M., Keim, P. S., Roe, C. C., Akselrod, H., Kuehnert, M. J., and Basavaraju, S. V.

Abstract

This manuscript describes two cases of donor‐derived methicillin‐resistant Staphylococcus aureus(MRSA) bacteremia, confirmed through comparison of S. aureuswhole genome sequence of DNA extracted from fixed donor tissue and recipients' isolates, that developed after transplantation of organs from a common donor who died from acute MRSA endocarditis. Also see case report by Altman et al on page 2640.

Published
2014
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6. Diversity, virulence, and antimicrobial resistance in isolates from the newly emerging klebsiella pneumoniaeST101 Lineage

Author

Adam J. Vazquez, Jason W. Sahl, Chandler C. Roe, Raffaele Zarrilli, Eliana Esposito, Roe, C. C., Vazquez, A. J., Esposito, E. P., Zarrilli, R., and Sahl, J. W.

Subjects
Microbiology (medical), Klebsiella pneumoniae, Streptogramin, lcsh:QR1-502, Virulence, Antimicrobial resistance, Yersiniabactin, Microbiology, lcsh:Microbiology, 03 medical and health sciences, chemistry.chemical_compound, Phylogenetic, Plasmid, Antibiotic resistance, Klebsiella, genomics, 030304 developmental biology, Original Research, Comparative genomics, Genetics, 0303 health sciences, biology, 030306 microbiology, biology.organism_classification, ST101, Multiple drug resistance, phylogenetics, chemistry, Genomic
Abstract

The global dissemination of Klebsiella pneumoniae and Klebsiella pneumoniae carbapenemase (KPC) has been largely attributed to a few high-risk sequence types (STs) (ST258, ST11, ST512) associated with human disease. ST101 is an emerging clone that has been identified in different parts of the world with the potential to become a global, persistent public health threat. Recent research suggests the ST101 lineage is associated with an 11% increase in mortality rate in comparison to non-ST101 infections. In this study, we generated a high-quality, near-finished genome assembly of a multidrug-resistant (MDR) isolate from Italy (isolate 4743) that is a single locus variant of ST101 (ST1685). We demonstrate that the 4743 genome contains virulence features such as an integrative conjugative element carrying the yersiniabactin siderophore (ICEKp3), the mannose-resistant Klebsiella-like (type III) fimbriae cluster (mrkABCDFHIJ), the ferric uptake system (kfuABC), the yersiniabactin receptor gene fyuA, a capsular K type K17, and an O antigen type of O1. K. pneumoniae 4743 carries the blaKPC-2 carbapenemase gene along with genes conferring resistance to aminoglycosides, beta-lactams, fluoroquinolones, fosfomycin, macrolides, lincosamides, and streptogramin B. A comparative genomics analysis of 44 ST101 genomes as well as newly sequenced isolate 4743 identified variable antimicrobial resistance (AMR) resistance profiles and incompatibility plasmid types, but similar virulence factor profiles. Using Bayesian methodologies, we estimate the common ancestor for the ST101 lineage emerged in 1990 (95% HPD: 1965 to 2007) and isolates within the lineage acquired bla KPC after the divergence from its parental clonal group and dissemination. The identification of virulence factors and antibiotic resistance genes acquired by this newly emerging clone provides insight into the reported increased mortality rates and highlights its potential success as a persistent nosocomial pathogen. With a combination of both colistin resistance, carbapenem resistance, and several known virulence factors, the ST101 genetic repertoire may be a "perfect storm" allowing for a newly emerging, high-risk, extensively antibiotic resistant clone. This high-risk clone appears adept at acquiring resistance and may perpetuate the dissemination of extensive antimicrobial resistance. Greater focus on the acquisition of virulence factors and antibiotic resistance genes is crucial for understanding the spread of antibiotic resistance.

Published
2019

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