Acute and Critical Care

Original Articles

Pediatrics
Early detection of bloodstream infection in critically ill children using artificial intelligence: Hye-Ji Han, Kyunghoon Kim, June Dong Park; Acute Crit Care. 2024;39(4):611-620. Published online November 22, 2024; DOI: https://doi.org/10.4266/acc.2024.00752

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Abstract PDF: Background
Despite the high mortality associated with bloodstream infection (BSI), early detection of this condition is challenging in critical settings. The objective of this study was to create a machine learning tool for rapid recognition of BSI in critically ill children.
Methods
Data were extracted from a derivative cohort comprising patients who underwent at least one blood culture during hospitalization in the pediatric intensive care unit (PICU) of a tertiary hospital from January 2020 to June 2023 for model development. Data from another tertiary hospital were utilized for external validation. Variables selected for model development were age, white blood cell count with segmented neutrophil count, C-reactive protein, bilirubin, liver enzymes, glucose, body temperature, heart rate, and respiratory rate. Algorithms compared were extra trees, random forest, light gradient boosting, extreme gradient boosting, and CatBoost.
Results
We gathered 1,806 measurements and recorded 290 hospitalizations from 263 patients in the derivative cohort. Median age on admission was 43 months, with an interquartile range of 10–118.75 months, and a male predominance was observed (n=160, 55.2%). Candida albicans was the most prevalent pathogen, and median duration to confirm BSI was 3 days (range, 3–4). Patients with BSI experienced significantly higher in-hospital mortality and prolonged stays in the PICU than patients without BSI. Random forest classifier achieved the highest area under the receiver operating characteristic curve of 0.874 (0.762 for the validation set).
Conclusions
We developed a machine learning model that predicts BSI with acceptable performance. Further research is necessary to validate its effectiveness.

Infection
Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India: Naveen Paliwal, Pooja Bihani, Rishabh Jaju, Sadik Mohammed, Prabhu Prakash, Vidya Tharu; Acute Crit Care. 2024;39(4):535-544. Published online November 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00101

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Abstract PDF: Background
Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in intensive care units (ICUs). Ventilator bundle (VB) implementation has been shown to decrease the incidence of VAP. This study presents a 1-year quality improvement (QI) project conducted in the ICU of a tertiary care hospital with the goal of increasing VB compliance to greater than 90% and evaluating its impact on VAP incidence and ICU length of stay.
Methods
A series of Plan-Do-Study-Act (PDSA) cycles, including educational boot camps, checklist implementation, and simulation-based training, was implemented. Emphasis on standardization and documentation for each VB component further improved compliance. Data were compared using a chi-square test, unpaired t-test, or Mann-Whitney U-Test, as appropriate. A P-value <0.05 was considered statistically significant.
Results
The initial observed compliance was 40.7%, with a significant difference between knowledge and implementation. The compliance increased to 90% after the second PDSA cycle. In the third PDSA cycle, uniformity and standardization of all components of VAP were ensured. After increasing the VB compliance at greater than 90%, there was a significant decline in the incidence of VAP, from 62.4/1,000 ventilatory days to 25.7/1,000 ventilatory days, with a 2.34 times risk reduction in the VAP rate (P= 0.004)
Conclusions
The study highlights the effectiveness of a structured QI approach in enhancing VB compliance and reducing VAP incidence. There is a need for continued education, protocol standardization, and continuous monitoring to ensure the sustainability of this implementation.

Review Article

Infection
Microbial infections in burn patients: Souvik Roy, Preeti Mukherjee, Sutrisha Kundu, Debashrita Majumder, Vivek Raychaudhuri, Lopamudra Choudhury; Acute Crit Care. 2024;39(2):214-225. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01571

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Abstract PDF

Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.

Citations

Citations to this article as recorded by

Enhancing clinical outcomes in burn and surgical intensive care unit patients
Mahta Moghaddam Ahmadi, Moein Moghaddam Ahmadi
Burns.2024; 50(8): 2137. CrossRef
Postacute Overview of Burn Injuries
Tuba Sengul, Holly Kirkland-Kyhn, Asiye Gul
Nursing Clinics of North America.2024;[Epub] CrossRef
Development of a Stringent Ex Vivo-Burned Porcine Skin Wound Model to Screen Topical Antimicrobial Agents
Ping Chen, Eliza A. Sebastian, S. L. Rajasekhar Karna, Kai P. Leung
Antibiotics.2024; 13(12): 1159. CrossRef
The SOS Response Activation and the Risk of Antibiotic Resistance Enhancement in Proteus spp. Strains Exposed to Subinhibitory Concentrations of Ciprofloxacin
Agnieszka Zabłotni, Marek Schmidt, Małgorzata Siwińska
International Journal of Molecular Sciences.2024; 26(1): 119. CrossRef

Original Articles

Infection
Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes: Ahlem Trifi, Selim Sellaouti, Asma Mehdi, Lynda Messaoud, Eya Seghir, Badis Tlili, Sami Abdellatif; Acute Crit Care. 2023;38(4):425-434. Published online November 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00773

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Abstract PDF Supplementary Material

Background
Coronavirus disease 2019 (COVID-19) pandemic disrupted adherences to healthcare-associated infection (HAI) prevention protocols. Herein, we studied the characteristics of all HAIs occurring in critically ill COVID-19 patients.
Methods
A retrospective, single-center cohort of critical COVID-19 patients during 2021. Microbiological samples were collected if HAI was suspected. We analyzed all factors that could potentially induce HAI, using septic shock and mortality as endpoints.
Results
Sixty-four among 161 included patients (39.7%) presented a total of 117 HAIs with an incidence density of 69.2 per 1,000 hospitalization days. Compared to the prior COVID-19 period (2013–2019), the identification of HAI increased in 2021. HAIs were classified into ventilator-associated pneumonia (VAP; n=38), bloodstream infection (n=32), urinary tract infection (n=24), catheter-related infection (n=12), and fungal infection (n=11). All HAIs occurred significantly earlier in the post–COVID-19 period (VAP: 6 vs. 10 days, P=0.045, in 2017 and 2021). Acinetobacter baumannii (39.5%) and Klebsiella pneumoniae (27%) were the most commonly isolated pathogens that exhibited a multidrug-resistant (MDR) profile, observed in 89% and 64.5%, respectively. The HAI factors were laboratory abnormalities (odds ratio [OR], 6.4; 95% confidence interval [CI], 2.3–26.0), cumulative steroid dose (OR, 1.9; 95% CI, 1.3–4.0), and invasive procedures (OR, 20.7; 95% CI, 5.3–64.0). HAI was an independent factor of mortality (OR, 8.5; P=0.004).
Conclusions
During the COVID-19 era, the incidence of HAIs increased and MDR isolates remained frequent. A severe biological inflammatory syndrome, invasive devices, and elevated cumulative steroid dosages were related to HAIs. HAI was a significant death factor.

Citations

Citations to this article as recorded by

Depression during the COVID pandemic in La Manouba Governorate, Tunisia: A community survey
Mauro G Carta, Viviane Kovess, Amina Aissa, Amine Larnaout, Yosra Zgueb, Lubna A Alnasser, Maria Francesca Moro, Federica Sancassiani, Elisa Cantone, Salsabil Rjaibi, Nada Zoghlami, Mejdi Zid, Hajer Aounallah-Skhiri, Uta Ouali
International Journal of Social Psychiatry.2024; 70(6): 1128. CrossRef
Multidrug-Resistant Klebsiella pneumoniae Strains in a Hospital: Phylogenetic Analysis to Investigate Local Epidemiology
Maria Vittoria Ristori, Fabio Scarpa, Daria Sanna, Marco Casu, Nicola Petrosillo, Umile Giuseppe Longo, De Florio Lucia, Silvia Spoto, Rosa Maria Chiantia, Alessandro Caserta, Raffaella Rosy Vescio, Flavio Davini, Lucrezia Bani, Elisabetta Riva, Massimo C
Microorganisms.2024; 12(12): 2541. CrossRef

Infection
Evaluating the use of the respiratory-rate oxygenation index as a predictor of high-flow nasal cannula oxygen failure in COVID-19: Scott Weerasuriya, Savvas Vlachos, Ahmed Bobo, Namitha Birur Jayaprabhu, Lauren Matthews, Adam R Blackstock, Victoria Metaxa; Acute Crit Care. 2023;38(1):31-40. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01081

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Abstract PDF Supplementary Material: Background
It can be challenging for clinicians to predict which patients with respiratory failure secondary to coronavirus disease 2019 (COVID-19) will fail on high-flow nasal cannula (HFNC) oxygen and require escalation of therapy. This study set out to evaluate the association between the respiratory rate-oxygenation index (ROX) and HFNC failure in such patients and to assess whether ROX trajectory correlates with treatment failure.
Methods
This was a single-centre, retrospective, observational study of patients with COVID-19 requiring HFNC, conducted over a 3-month period. ROX was calculated as “pulse-oximetry oxygen saturation (SpO2) over the fractional inspired oxygen concentration (FiO2)/respiratory rate” for each patient at 2, 4, and 12 hours from starting HFNC. HFNC failure was defined as escalation to continuous positive airway pressure ventilation or invasive mechanical ventilation (IMV). Time-to-event analyses were performed to account for the longitudinal data set and time-dependent variables.
Results
We included 146 patients. Ninety-three (63.7%) experienced HFNC failure, with 53 (36.3%) requiring IMV. Higher ROX values were associated with a lower subhazard of HFNC failure on time-to-HFNC failure analysis (subhazard ratio, 0.29; 95% confidence interval [CI], 0.18–0.46; P<0.001). This remained true after controlling for informative censoring. Median ROX values changed differentially over time, increasing in the HFNC success group (0.06 per hour; 95% CI, 0.05–0.08; P<0.001) but not in the HFNC failure group (0.004 per hour; 95% CI, –0.05 to 0.08; P=0.890).
Conclusions
A higher ROX is associated with a lower risk of HFNC failure. Monitoring ROX trajectory over time may help identify patients at risk of treatment failure. This has potential clinical applications; however, future prospective studies are required.

Infection
Study of the gut microbiome as a novel target for prevention of hospital-associated infections in intensive care unit patients: Suzan Ahmed Elfiky, Shwikar Mahmoud Ahmed, Ahmed Mostafa Elmenshawy, Gehad Mahmoud Sultan, Sara Lotfy Asser; Acute Crit Care. 2023;38(1):76-85. Published online February 23, 2023; DOI: https://doi.org/10.4266/acc.2022.01116

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Abstract PDF

Background
Hospital-acquired infections (HAIs) are increasing due to the spread of multi-drugresistant organisms. Gut dysbiosis in an intensive care unit (ICU) patients at admission showed an altered abundance of some bacterial genera associated with the occurrence of HAIs and mortality. In the present study, we investigated the pattern of the gut microbiome in ICU patients at admission to correlate it with the development of HAIs during ICU stay.
Methods
Twenty patients admitted to an ICU with a cross-matched control group of 30 healthy subjects of matched age and sex. Quantitative SYBR green real-time polymerase chain reaction was done for the identification and quantitation of selected bacteria.
Results
Out of those twenty patients, 35% developed ventilator-associated pneumonia during their ICU stay. Gut microbiome analysis showed a significant decrease in Firmicutes and Firmicutes to Bacteroidetes ratio in ICU patients in comparison to the control and in patients who developed HAIs in comparison to the control group and patients who did not develop HAIs. There was a statistically significant increase in Bacteroides in comparison to the control group. There was a statistically significant decrease in Bifidobacterium and Faecalibacterium prausnitzii and an increase in Lactobacilli in comparison to the control group with a negative correlation between Acute Physiology and Chronic Health Evaluation (APACHE) II score and Firmicutes to Bacteroidetes and Prevotella to Bacteroides ratios.
Conclusions
Gut dysbiosis of patients at the time of admission highlights the importance of identification of the microbiome of patients admitted to the ICU as a target for preventing of HAIs

Citations

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Safety, feasibility, and impact on the gut microbiome of kefir administration in critically ill adults
Vinod K. Gupta, Sanu Rajendraprasad, Mahmut Ozkan, Dhanya Ramachandran, Sumera Ahmad, Johan S. Bakken, Krzysztof Laudanski, Ognjen Gajic, Brent Bauer, Simon Zec, David W. Freeman, Sahil Khanna, Aditya Shah, Joseph H. Skalski, Jaeyun Sung, Lioudmila V. Kar
BMC Medicine.2024;[Epub] CrossRef
Bringing gut microbiota into the spotlight of clinical research and medical practice
Efstathia Davoutis, Zoi Gkiafi, Panagis M Lykoudis
World Journal of Clinical Cases.2024; 12(14): 2293. CrossRef
Antimicrobial Peptides and Their Assemblies
Ana Maria Carmona-Ribeiro
Future Pharmacology.2023; 3(4): 763. CrossRef

Infection
Risk factors associated with development of coinfection in critically Ill patients with COVID-19: Erica M. Orsini, Gretchen L. Sacha, Xiaozhen Han, Xiaofeng Wang, Abhijit Duggal, Prabalini Rajendram; Acute Crit Care. 2022;37(3):312-321. Published online August 29, 2022; DOI: https://doi.org/10.4266/acc.2022.00136

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Abstract PDF

Background
At outset of the coronavirus disease 2019 (COVID-19) pandemic, the significance of bacterial and fungal coinfections in individuals with COVID-19 was unknown. Initial reports indicated that the prevalence of coinfection in the general population was low, but there was uncertainty regarding the risk of coinfection in critically ill patients.
Methods
Nine hundred critically ill adult patients with COVID-19 infection were enrolled in this observational case-control study. Patients with a coinfection (case) and patients without a coinfection (control) were compared using univariate and multivariable analyses. A subgroup analysis was performed on patients with coinfection, dividing them into early (infection within 7 days) and late (infection after 7 days) infection groups.
Results
Two hundred and thirty-three patients (25.9%) had a bacterial or fungal coinfection. Vasopressor use (P<0.001) and severity of illness (higher Acute Physiology and Chronic Health Evaluation III score, P=0.009) were risk factors for the development of a coinfection. Patients with coinfection had higher mortality and length of stay. Vasopressor and corticosteroid use and central line and foley catheter placement were risk factors for late infection (>7 days). There were high rates of drug-resistant infections.
Conclusions
Critically ill patients with COVID-19 are at risk for both community-acquired and hospital-acquired infections throughout their hospitalization for COVID-19. It is important to consider the development of a coinfection in clinically worsening critically ill patients with COVID-19 and consider the likelihood of drug-resistance when choosing an empiric regimen.

Citations

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Prevalence and risk factors associated with multidrug-resistant bacteria in COVID-19 patients
Abdu Aldarhami, Ahmed A. Punjabi, Abdulrahman S. Bazaid, Naif K. Binsaleh, Omar W. Althomali, Subuhi Sherwani, Omar Hafiz, Ali A. Almishaal
Medicine.2024; 103(10): e37389. CrossRef
Prevalence of secondary infections and association with mortality rates of hospitalized COVID-19 patients
Khalifa Binkhamis, Alanoud S. Alhaider, Ayah K. Sayed, Yara K. Almufleh, Ghadah A. Alarify, Norah Y. Alawlah
Annals of Saudi Medicine.2023; 43(4): 243. CrossRef
Blood Stream Infections in COVID-19 Patients From a Tertiary Care Center in Lebanon: Causative Pathogens and Rates of Multi-Drug Resistant Organisms
Sarah B. Nahhal, Johnny Zakhour, Abdel Hadi Shmoury, Tedy Sawma, Sara F. Haddad, Tamara Abdallah, Nada Kara Zahreddine, Joseph Tannous, Nisrine Haddad, Nesrine Rizk, Souha S. Kanj
Mayo Clinic Proceedings: Innovations, Quality & Outcomes.2023; 7(6): 556. CrossRef

Review Article

Neurology
Transient splenial lesions of the corpus callosum and infectious diseases: Kyu Sun Yum, Dong-Ick Shin; Acute Crit Care. 2022;37(3):269-275. Published online August 17, 2022; DOI: https://doi.org/10.4266/acc.2022.00864

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Abstract PDF

Transient splenial lesion of the corpus callosum can be observed in various diseases such as cancer, drug use, metabolic disorders, and cerebrovascular disorders, as well as in patients with infectious diseases. During the coronavirus disease 2019 (COVID-19) pandemic, there were increasing reports of these lesions being detected on brain imaging tests performed in patients with neurological symptoms. On brain magnetic resonance imaging, findings suggestive of cytotoxic edema are observed in the splenium; these are known to disappear with improvement of clinical symptoms. Cytokinopathy caused by infection increases the permeability of the blood–brain barrier and activates the glial cells of the brain to induce cytotoxic edema. Most patients have a good prognosis. The causes, mechanism, diagnosis, treatment and prognosis of transient splenial lesions of the corpus callosum will be summarized in this review.

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Legionella‐induced dysarthria and rhabdomyolysis with acute renal failure achieving recovery
Husam El Sharu, Soban Ahmad, Hunter Coore
Clinical Case Reports.2024;[Epub] CrossRef
Rickettsial infection causing non-aneurysmal subarachnoid hemorrhage with transient corpus callosum lesion
Zahraa Noureddine El Moussaoui, Zahraa Saker, Hasan Rahhal, Ali Nasserdine, Mahmoud Younes
Journal of Medicine, Surgery, and Public Health.2024; 2: 100093. CrossRef
Cytotoxic lesions of the corpus callosum due to FOLFIRINOX chemotherapy
Mafalda Soares, Sara Rosa, Sofia Bettencourt, Rita Ferreira, Mariana Sardinha, Margarida Dias, Bruno Cunha
Brain Disorders.2024; 15: 100157. CrossRef
Contrasting association pattern of plasma low-density lipoprotein with white matter integrity in APOE4 carriers versus non-carriers
Zhenyao Ye, Yezhi Pan, Rozalina G. McCoy, Chuan Bi, Chen Mo, Li Feng, Jiaao Yu, Tong Lu, Song Liu, J. Carson Smith, Minxi Duan, Si Gao, Yizhou Ma, Chixiang Chen, Braxton D. Mitchell, Paul M. Thompson, L. Elliot Hong, Peter Kochunov, Tianzhou Ma, Shuo Chen
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Original Articles

Trauma
Determination of risk factors associated with surgical site infection in patients undergoing preperitoneal pelvic packing for unstable pelvic fracture: Kang Min Kim, Myoung Jun Kim, Jae Sik Chung, Ji Wool Ko, Young Un Choi, Hongjin Shim, Ji Young Jang, Keum Seok Bae, Kwangmin Kim; Acute Crit Care. 2022;37(2):247-255. Published online April 22, 2022; DOI: https://doi.org/10.4266/acc.2021.01396

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Abstract PDF

Background
Several recent studies have shown that preperitoneal pelvic packing (PPP) effectively produces hemostasis in patients with unstable pelvic fractures. However, few studies have examined the rate of surgical site infections (SSIs) in patients undergoing PPP following an unstable pelvic fracture. The purpose of the present study was to evaluate factors associated with SSI in such patients.
Methods
We retrospectively reviewed the medical charts of 188 patients who developed hemorrhagic shock due to pelvic fracture between April 2012 and May 2021. Forty-four patients were enrolled in this study.
Results
SSI occurred in 15 of 44 patients (34.1%). The SSIs occurred more frequently in cases of repacking during the second-look surgery (0 vs. 4 [26.7%], P=0.010) and combined bladder-urethra injury (1 [3.4%] vs. 4 [26.7%], P=0.039). The incidence of SSIs was not significantly different between patients undergoing depacking within or after 48 hours (12 [41.4%] vs. 5 [33.3%], P=0.603). The mean time to diagnosis of SSI was 8.1±3.9 days from PPP. The most isolated organism was Staphylococcus epidermidis.
Conclusions
Repacking and combined bladder-urethra injury are potential risk factors for SSI in patients with unstable pelvic fracture. Close observation is recommended for up to 8 days in patients with these risk factors. Further, 48 hours after PPP, removing the packed gauze on cessation of bleeding and not performing repacking can help prevent SSI. Additional analyses are necessary with a larger number of patients with the potential risk factors identified in this study.

Citations

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Angioembolization Has Similar Efficacy and Lower Total Charges than Preperitoneal Pelvic Packing in Patients with Pelvic Ring or Acetabulum Fractures
Aaron Singh, Travis Kotzur, Ezekial Koslosky, Rishi Gonuguntla, Lorenzo Canseco, David Momtaz, Ali Seifi, Case Martin
Journal of Orthopaedic Trauma.2024;[Epub] CrossRef
Factors Associated With Pelvic Infection After Pre-Peritoneal Pelvic Packing for Hemodynamically Unstable Pelvic Fractures
Jennifer E. Baker, Husayn A. Ladhani, Caitlyn McCall, Chelsea R. Horwood, Nicole L. Werner, Barry Platnick, Clay Cothren Burlew
Surgical Infections.2024; 25(5): 399. CrossRef
Comparison of Conventional versus Modified Preperitoneal Pelvic Packing in Patients with Bleeding Pelvic Fractures: A Single-Center Retrospective Pilot Study
Sebeom Jeon, Byungchul Yu, Gil Jae Lee, Min A Lee, Jungnam Lee, Kang Kook Choi
Journal of Clinical Medicine.2024; 13(14): 4062. CrossRef
Current Management of Hemodynamically Unstable Patients with Pelvic Fracture
Kevin Harrell, Chelsea Horwood, Clay Cothren Burlew
Current Surgery Reports.2023; 11(4): 92. CrossRef
Open Fixation After Preperitoneal Pelvic Packing Is Associated With a High Surgical Site Infection Rate
Ye Joon Kim, Bryan L. Scott, Fredric M. Pieracci, Ernest E. Moore, Cyril Mauffrey, Joshua A. Parry
Journal of Orthopaedic Trauma.2023; 37(11): 547. CrossRef
Extraperitoneal pelvic packing in trauma – a review
Sajad Ahmad Salati
Polish Journal of Surgery.2022; 95(3): 46. CrossRef

Infection
Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review: Sofia R. Valdoleiros, Cristina Torrão, Laura S. Freitas, Diana Mano, Celina Gonçalves, Carla Teixeira; Acute Crit Care. 2022;37(1):61-70. Published online January 26, 2022; DOI: https://doi.org/10.4266/acc.2021.01151

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Abstract PDF Supplementary Material

Background
Nosocomial meningitis is a medical emergency that requires early diagnosis, prompt initiation of therapy, and frequent admission to the intensive care unit (ICU).
Methods
A retrospective study was conducted in adult patients diagnosed with nosocomial meningitis who required admission to the ICU between April 2010 and March 2020. Meningitis/ventriculitis and intracranial infection were defined according to Centers for Disease Control and Prevention guidelines.
Results
An incidence of 0.75% of nosocomial meningitis was observed among 70 patients. The mean patient age was 59 years and 34% were ≥65 years. Twenty-two percent of patients were in an immunocompromised state. A clear predisposing factor for nosocomial meningitis (traumatic brain injury, basal skull fracture, brain hemorrhage, central nervous system [CNS] invasive procedure or device) was present in 93% of patients. Fever was the most frequent clinical feature. A microbiological agent was identified in 30% of cases, of which 27% were bacteria, with a predominance of Gram-negative over Gram-positive. Complications developed in 47% of cases, 24% of patients were discharged with a Glasgow coma scale <14, and 37% died. There were no clear clinical predictors of complications. Advanced age (≥65 years old) and the presence of complications were associated with higher hospital mortality.
Conclusions
Nosocomial meningitis in critical care has a low incidence rate but high mortality and morbidity. In critical care patients with CNS-related risk factors, a high level of suspicion for meningitis is warranted, but diagnosis can be hindered by several confounding factors.

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Procalcitonin As Diagnostic Tool for CNS Infections—Overall, Not Good Enough (Yet?)*
Michael A. Pizzi, Katharina M. Busl
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A retrospective analysis of 20,178 adult neurological infection admissions to United Kingdom critical care units from 2001 to 2020
Joseph Donovan, Abena Glover, John Gregson, Andrew W. Hitchings, Emma C. Wall, Robert S. Heyderman
BMC Infectious Diseases.2024;[Epub] CrossRef
Clinical Characteristics, Treatment, and Outcomes of Veterans with Cerebrospinal Fluid Culture Positive for Gram-Negative Rod Bacteria: A Retrospective Analysis over 18 Years in 125 Veterans Health Administration Hospitals
Shinya Hasegawa, Eiyu Matsumoto, Jennifer R. Carlson, Hiroyuki Suzuki
Current Microbiology.2024;[Epub] CrossRef
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Anbarasi Madoure, Dharanya Gopalakrishnan Srinivasan, Tejaswi Mishra, Lokesh Kumar Penubarthi
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Sakke Niemelä, Laura Lempinen, Eliisa Löyttyniemi, Jarmo Oksi, Jussi Jero
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Fieber in der Intensivmedizin
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Case Report

Infection
The first case of abdominal mycotic aneurysm caused by K1 hypervirulent Klebsiella pneumoniae in a healthy adult: Misun Kim, Jeong Rae Yoo, Hyunjoo Oh, Young Ree Kim, Keun Hwa Lee, Sang Taek Heo; Acute Crit Care. 2021;36(4):390-394. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00010

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Abstract PDF

Incidence of hypervirulent Klebsiella pneumoniae (hvKp) infection has been steadily increasing in the Asia-Pacific rim. The characteristic of hvKp infection is its ability to cause multiple site infections and unpredictable metastatic spread in the community. We describe the first case of mycotic aneurysm caused by hvKp serotype K1 in a previously healthy man and review the literature. Of a total of 13 cases, including our case, three cases were related to hvKp. Among patients with hvKp, the level of mycotic aneurysm in most patients was the infrarenal aorta, and they underwent an aortic graft or coil embolization. All strains were susceptible to most antimicrobial agents, except ampicillin. Early detection of hvKp can help to prevent the metastatic spread of pathogens and be useful for optimal patient care and epidemiologic research.

Citations

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Designing a conjugate vaccine targeting Klebsiella pneumoniae ST258 and ST11
Min Li, Mingkai Yu, Yigang Yuan, Danyang Li, Daijiao Ye, Min Zhao, Zihan Lin, Liuzhi Shi
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Review Article

Infection
Identification and infection control of carbapenem-resistant Enterobacterales in intensive care units: Jongyoun Yi, Kye-Hyung Kim; Acute Crit Care. 2021;36(3):175-184. Published online August 12, 2021; DOI: https://doi.org/10.4266/acc.2021.00409

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Abstract PDF

Infections with multidrug-resistant organisms among patients in intensive care units (ICUs) are associated with high mortality. Among multidrug-resistant organisms, carbapenem-resistant Enterobacterales (CRE) harbor important pathogens for healthcare-associated infections, including pneumonia, bacteremia, and urinary tract infections. Risk factors for CRE colonization include underlying comorbid conditions, prior antibiotics exposure, prior use of healthcare facilities, device use, and longer ICU stay. The mortality rate due to invasive CRE infection is 22%–49%, and CRE colonization is associated with an approximately 10-fold increased risk of CRE infection. Infection control measures include hand hygiene, contact precautions, minimizing the use of devices, and environmental control. Additionally, implementing active surveillance of CRE carriage should be considered in ICU settings.

Citations

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Comparison of mortality rates in patients with carbapenem-resistant Enterobacterales bacteremia according to carbapenemase production: a multicenter propensity-score matched study
Moon Seong Baek, Jong Ho Kim, Joung Ha Park, Tae Wan Kim, Hae In Jung, Young Suk Kwon
Scientific Reports.2024;[Epub] CrossRef
Investigation of Intestinal Colonization and Infection of Carbapenem Resistant Enterobacteriaceae in Intensive Care Unit Patients and Analysis of Influencing Factors
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Advances in Clinical Medicine.2024; 14(05): 315. CrossRef
Risk factors of colonization and diversity of clinically significant carbapenemases in gut microbiota of ICU patients: a single-center prospective observational study
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Russian Journal of Anesthesiology and Reanimatology.2024; (5): 41. CrossRef
Occurrence of blaNDM-1, blaNDM-5, blaNDM-7, and blaKPC-2 genes in clinical isolates of enterobacterales with high genetic variability, from colonization and infection in patients with or without COVID-19, from a hospital in Brazil
Lamartine Rodrigues Martins, Maria Izabely Silva Pimentel, Érica Maria de Oliveira, Moacir Batista Jucá, Elizabeth Maria Bispo Beltrão, Ana Catarina de Souza Lopes
Journal of Applied Microbiology.2024;[Epub] CrossRef
Emergence and expansion of carbapenem resistant enterobacterales in the Western Cape Province, South Africa
Kedišaletše Moloto, Mae Newton-Foot, Andrew Whitelaw, Angela Dramowski, Tsegaye Alemeyhu
PLOS ONE.2024; 19(8): e0309315. CrossRef
Identification and Preliminary Hierarchisation of Selected Risk Factors for Carbapenemase-Producing Enterobacteriaceae (CPE) Colonisation: A Prospective Study
Małgorzata Timler, Wojciech Timler, Ariadna Bednarz, Łukasz Zakonnik, Remigiusz Kozłowski, Dariusz Timler, Michał Marczak
International Journal of Environmental Research and Public Health.2023; 20(3): 1960. CrossRef
Epidemiology and prevention of hospital-acquired carbapenem-resistant Enterobacterales infection in hospitalized patients, Northeast Ethiopia
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IJID Regions.2023; 7: 77. CrossRef
Gut microbiota alterations in critically Ill patients with carbapenem-resistant Enterobacteriaceae colonization: A clinical analysis
Moon Seong Baek, Seungil Kim, Won-Young Kim, Mi-Na Kweon, Jin Won Huh
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Aztreonam: clinical and pharmacological characteristics at the present stage
D.A. Popov, N.A. Zubareva, A.A. Parshakov
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Original Articles

Infection
Clinical features and outcomes of critically ill patients with Elizabethkingia meningoseptica: an emerging pathogen: Abdullah Umair, Nosheen Nasir; Acute Crit Care. 2021;36(3):256-261. Published online July 26, 2021; DOI: https://doi.org/10.4266/acc.2020.01158

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Abstract PDF

Background
Elizabethkingia meningoseptica, formerly known as Chryseobacterium meningosepticum, is a non-motile, non-fastidious, catalase and oxidase-positive, aerobic, glucosenon- fermentative, Gram-negative bacillus that was first defined by Elizabeth O. King in 1959. It has emerged as an opportunistic pathogen that has infected patients in extreme age groups and immunocompromised individuals, especially in intensive care settings. There has been an increased interest in this pathogen due to its increasing occurrence around the world, ubiquitous nature, and inherent capacity for antimicrobial resistance.
Methods
We describe an observational study at a tertiary care center in Karachi, Pakistan, based on patients admitted between January 2013 and December 2018, with E. meningoseptica infections. All patients were confirmed to have a positive clinical culture specimen for E. meningoseptica along with symptoms and signs consistent with infection. Data were collected on a structured proforma from the Hospital Information Management Systems.
Results
Sixteen patients with E. meningoseptica that met the criteria for infection were identified, 13 of whom required admission. Eight patients had bacteremia in addition to confirmed E. meningoseptica infection. Two of the isolates were multi-drug resistant and only sensitive to minocycline. Nine out of 13 patients that were admitted required intubation and mechanical ventilation. The median length of hospital stay was 13 days, and five out of the 13 patients died during the hospital stay.
Conclusions
This is the largest case series to date reporting E. meningoseptica infections and highlights the importance of this organism as an emerging nosocomial pathogen.

Citations

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Elizabethkingia meningoseptica Outbreak in NICU: An Observational Study on a Debilitating Neuroinfection in Neonates
Manish Swami, Praneetha Mude, Shrutiprajna Kar, Sushree Sarathi, Ashoka Mohapatra, Usha Devi, Pankaj K. Mohanty, Tapas K. Som, Behera Bijayini, Tanushree Sahoo
Pediatric Infectious Disease Journal.2024; 43(1): 63. CrossRef
Clinical Characteristics and Risk Factors for Infection and Death in Critically Ill Patients with Pulmonary Infection with Elizabethkingia Spp.
Mengwen Feng, Min Huang, Yuanyuan Fan, Genyan Liu, Suming Zhou, Jing Zhou
Infection and Drug Resistance.2024; Volume 17: 2673. CrossRef
Clinical and microbiological features of positive blood culture episodes caused by non-fermenting gram-negative bacilli other than Pseudomonas and Acinetobacter species (2020–2023)
Roberto Casale, Matteo Boattini, Sara Comini, Paulo Bastos, Silvia Corcione, Francesco Giuseppe De Rosa, Gabriele Bianco, Cristina Costa
Infection.2024;[Epub] CrossRef
Mortality Risk and Antibiotic Therapy for Patients with Infections Caused by Elizabethkingia Species—A Meta-Analysis
Chienhsiu Huang, Sufang Kuo, Lichen Lin
Medicina.2024; 60(9): 1529. CrossRef
Elizabethkingia meningoseptica in Dubai, United Arab Emirates: A 7-year multicenter study
Hawra Ali Hussain Alsayed, Narjes Saheb Sharif-Askari, Fatemeh Saheb Sharif-Askari, Rabih Halwani
American Journal of Infection Control.2024;[Epub] CrossRef
“Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates
Prajnha U.P., Anisha Maria Fernandes, Suchitra Shenoy M., Sinchana Bhat
F1000Research.2024; 13: 1367. CrossRef
Multi-Drug-Resistant Elizabethkingia meningoseptica: A Rare Cause of Late-Onset Sepsis in a Preterm Neonate
Abdul Wasey Hashmi, Muhammad Ahmad, Muhammad Muneeb Israr, Ibtesam e Fajar, Farid Adnan
Cureus.2023;[Epub] CrossRef
Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains
Despoina Koulenti, Kalwaje Eswhara Vandana, Jordi Rello
Current Opinion in Infectious Diseases.2023; 36(6): 545. CrossRef
Epidemiological, clinical, and laboratory features of patients infected with Elizabethkingia meningoseptica at a tertiary hospital in Hefei City, China
Yajuan Li, Tingting Liu, Cuixiao Shi, Bo Wang, Tingting Li, Ying Huang, Yuanhong Xu, Ling Tang
Frontiers in Public Health.2022;[Epub] CrossRef

Surgery
Association between postoperative fluid balance and mortality and morbidity in critically ill patients with complicated intra-abdominal infections: a retrospective study: Joohyun Sim, Jae Young Kwak, Yun Tae Jung; Acute Crit Care. 2020;35(3):189-196. Published online August 19, 2020; DOI: https://doi.org/10.4266/acc.2020.00031

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Abstract PDF Supplementary Material

Background
Postoperative fluid overload may increase the risk of developing pulmonary complications and other adverse outcomes. We evaluated the impact of excessive fluid administration on postoperative outcomes in critically ill patients.
Methods
We reviewed the medical records of 320 patients admitted to intensive care unit (ICU) after emergency abdominal surgery for complicated intra-abdominal infection (cIAI) between January 2013 and December 2018. The fluid balance data of the patients were reviewed for a maximum of 7 days. The patients were grouped based on average daily fluid balance with a cutoff value of 20 ml/kg/day. Propensity score matching was performed to reduce the underlying differences between the groups.
Results
Patients with an average daily fluid balance of ≥20 ml/kg/day were associated with higher rates of 30-day mortality (11.8% vs. 2.4%; P=0.036) than those with lower fluid balance (<20 ml/kg/day). Kaplan-Meier survival curves for 30-day mortality in these groups also showed a better survival rate in the lower fluid balance group with a statistical significance (P=0.020). The percentage of patients who developed pulmonary consolidation during ICU stay (47.1% vs. 24.7%; P=0.004) was higher in the fluid-overloaded group. Percentages of newly developed pleural effusion (61.2% vs. 57.7%; P=0.755), reintubation (18.8% vs. 10.6%; P=0.194), and infectious complications (55.3% vs. 49.4%; P=0.539) showed no significant differences between the two groups.
Conclusions
Postoperative fluid overload in patients who underwent emergency surgery for cIAI was associated with higher 30-day mortality and more frequent occurrence of pulmonary consolidation. Postoperative fluid balance should be adjusted carefully to avoid adverse clinical outcomes.

Citations

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The Association Between Fluid Management and Intraoperative Blood Pressure and Patients’ Outcome After Complex Spine Surgeries
Ye Rin Koh, Yufei Li, Joan Koh, Elyad Ekrami, Xiaodan Liu, Maged Y. Argalious, Mariel R. Manlapaz, Christopher A. Troianos, Michael P. Steinmetz, Ehab Farag
Anesthesia & Analgesia.2024;[Epub] CrossRef
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James Tankel, David Chayen, Sharon Einav
Surgery in Practice and Science.2023; 12: 100146. CrossRef
Risk of fluid accumulation after cardiac surgery
Atte Koskinen, Jenni Aittokallio, Jarmo Gunn, Joonas Lehto, Arto Relander, Emma Viikinkoski, Tuija Vasankari, Juho Jalkanen, Maija Hollmén, Tuomas O. Kiviniemi
JTCVS Open.2023; 16: 602. CrossRef
Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
Sine Wichmann, Marija Barbateskovic, Ning Liang, Theis Skovsgaard Itenov, Rasmus Ehrenfried Berthelsen, Jane Lindschou, Anders Perner, Christian Gluud, Morten Heiberg Bestle
Annals of Intensive Care.2022;[Epub] CrossRef
Goal directed fluid removal with furosemide versus placebo in intensive care patients with fluid overload: A trial protocol for a randomised, blinded trial (GODIF trial)
Sine Wichmann, Theis S. Itenov, Rasmus E. Berthelsen, Theis Lange, Anders Perner, Christian Gluud, Pia Lawson‐Smith, Lars Nebrich, Jørgen Wiis, Anne C. Brøchner, Thomas Hildebrandt, Meike T. Behzadi, Kristian Strand, Finn H. Andersen, Thomas Strøm, Mikko
Acta Anaesthesiologica Scandinavica.2022; 66(9): 1138. CrossRef
Lung Ultrasound-Guided Fluid Management versus Standard Care in Surgical ICU Patients: A Randomised Controlled Trial
Daniel-Mihai Rusu, Ioana Grigoraș, Mihaela Blaj, Ianis Siriopol, Adi-Ionut Ciumanghel, Gigel Sandu, Mihai Onofriescu, Olguta Lungu, Adrian Constantin Covic
Diagnostics.2021; 11(8): 1444. CrossRef

Infection
A Retrospective Study Investigating Risks of Acute Respiratory Distress Syndrome and Mortality Following Human Metapneumovirus Infection in Hospitalized Adults: Hyunjung Hwang, Yujin Kim, Jeong-Woong Park, Sung Hwan Jeong, Sun Young Kyung; Korean J Crit Care Med. 2017;32(2):182-189. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00038

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Abstract PDF Supplementary Material

Background
Human metapneumovirus (hMPV) is a relatively recently identified respiratory virus that induces respiratory symptoms similar to those of respiratory syncytial virus infection in children. The characteristics of hMPV-infected adults are unclear because few cases have been reported.
Methods
We conducted a retrospective review of hospitalized adult patients with a positive multiplex real-time polymerase chain reaction assay result from 2012 to 2016 at a single tertiary referral hospital in South Korea. We analyzed clinical characteristics of the enrolled patients and divided patients into an acute respiratory distress syndrome (ARDS) group and a non-ARDS group.
Results
In total, 110 adults were reviewed in this study. Their mean age was 61.4 years, and the majority (n = 105, 95.5%) had comorbidities or were immunocompromised. Most of the patients had pneumonia on chest X-ray (n = 88, 93.6%), 22 (20.0%) had ARDS, and 12 (10.9%) expired during hospitalization. The mortality rate for patients with ARDS was higher than that of the other patients (36.4% vs. 5.7%, P = 0.001). The risk factor for hMPV-associated ARDS was heart failure (odds ratio, 5.24; P = 0.044) and laboratory values were increased blood urea nitrogen and increased C-reactive protein. The acquisition site of infection was divided into community vs. nosocomial; 43 patients (39.1%) had a nosocomial infection. The risk factors for nosocomial infection were an immunocompromised state, malignancy and immunosuppressive treatment.
Conclusions
These data suggest that hMPV is one of the important respiratory pathogens important respiratory pathogen that causes pneumonia/ARDS in elderly, immunocompromised individuals and that it may be transmitted via the nosocomial route.

Citations

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A Case of Metapneumovirus Pneumonia-Related Acute Respiratory Distress Syndrome in a Young Adult Patient
Tae Wan Kim, Won-Young Kim
The Korean Journal of Medicine.2024; 99(2): 111. CrossRef
Human Metapneumovirus Pneumonia Precipitating Acute Respiratory Distress Syndrome in an Adult Patient
Dena H Tran, Muhammad Sameed, Ellen T Marciniak, Avelino C Verceles
Cureus.2021;[Epub] CrossRef
Outcomes of severe human metapneumovirus-associated community-acquired pneumonia in adults
Sang-Ho Choi, Sang-Bum Hong, Jin Won Huh, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Sung-Han Kim, Heungsup Sung, Hyun Jung Koo, Kyung-Hyun Do, Sang-Oh Lee, Chae-Man Lim, Yang Soo Kim, Jun Hee Woo, Younsuck Koh
Journal of Clinical Virology.2019; 117: 1. CrossRef

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