2010 January 09

Patients hospitalized with 2009 pandemic influenza A (H1N1) – New York City, May 2009.

MMWR Morb Mortal Wkly Rep Start a Discussion »

Jan 092010

Patients hospitalized with 2009 pandemic influenza A (H1N1) - New York City, May 2009.

MMWR Morb Mortal Wkly Rep. 2010 Jan 8;58(51):1436-40

Authors:

The first cases of 2009 pandemic influenza A (H1N1) in New York City occurred in April 2009, raising many questions about how best to contain the epidemic. To rapidly assess the severity of influenza illness and identify persons at highest risk for severe infection, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) reviewed the medical charts of the first 99 patients with laboratory confirmed H1N1 admitted to any NYC hospital. The purpose of the review was to characterize the demographics of the first hospitalized patients, identify associated underlying medical conditions, describe the course and severity of disease, and examine the use of antiviral medications. This report summarizes the findings of this analysis. Approximately 60% of admitted patients were aged <;18 years. The most commonly documented underlying condition was asthma, observed among 50% of patients aged <18 years and 46% of adult patients. Multiple underlying conditions were observed in 17% of patients (12% of children, 24% of adults). Patients treated with oseltamivir within 2 days of symptom onset had shorter median hospitalizations than those who did not (2 days versus 3 days [p = 0.03]). The findings of this assessment were used to inform immediate outbreak response measures in New York City. During such outbreaks, public education campaigns should encourage patients at high risk of severe illness to seek treatment promptly after symptom onset and should emphasize the importance of early antiviral therapy for patients with underlying risk conditions.

PMID: 20057350 [PubMed - in process]

Link to Article at PubMed

Ventilation with lower tidal volumes as compared to conventional tidal volumes for patients without acute lung injury – a preventive randomized controlled trial.

Crit Care Start a Discussion »

Jan 092010

Ventilation with lower tidal volumes as compared to conventional tidal volumes for patients without acute lung injury - a preventive randomized controlled trial.

Crit Care. 2010 Jan 7;14(1):R1

Authors: Determann RM, Royakkers A, Wolthuis EK, Vlaar AP, Choi G, Paulus F, Hofstra JJ, de Graaff MJ, Korevaar JC, Schultz MJ

ABSTRACT: INTRODUCTION: Recent cohort studies have identified use of large tidal volumes as a major risk factor for development of lung injury in mechanically ventilated patients without acute lung injury (ALI). We compared the effect of conventional versus lower tidal volumes on pulmonary inflammation and development of lung injury in critically ill patients without ALI at onset of mechanical ventilation. METHODS: Randomized controlled non-blinded preventive trial comparing mechanical ventilation with tidal volumes of 10 ml versus 6 ml per kilogram of predicted body weight in critically ill patients without ALI at the onset of mechanical ventilation. The primary endpoint was cytokine levels in bronchoalveolar lavage fluid and plasma during mechanical ventilation. The secondary endpoint was development of lung injury, as determined by consensus criteria for ALI, duration of mechanical ventilation, and mortality. RESULTS: One hundred fifty patients (74 conventional vs. 76 lower tidal volume) were enrolled and analyzed. No differences were observed in lavage fluid cytokine levels at baseline between randomization groups. Plasma interleukin-6 (IL-6) levels decreased significantly stronger in the lower tidal volume group (from 51 [20 - 182] ng/ml to 11 [5 - 20] ng/ml vs. 50 [21 - 122] ng/ml to 21 [20 - 77] ng/ml; P = 0.01). The trial was stopped prematurely for safety reasons because development of lung injury was higher in the conventional tidal volume group as compared to the lower tidal volume group (13.5% vs. 2.6%, P = 0.01). Univariate analysis showed statistical relations between baseline lung injury score, randomization group, level of positive end-expiratory pressure (PEEP), number of transfused blood products, presence of a risk factor for ALI and baseline IL-6 lavage fluid levels and development of lung injury. Multivariate analysis revealed randomization group and level of PEEP as independent predictors of the development of lung injury. CONCLUSIONS: Mechanical ventilation with conventional tidal volumes is associated with sustained cytokine production as measured in plasma. Our data suggest mechanical ventilation with conventional tidal volumes contributes to development of lung injury in patients without ALI at onset of mechanical ventilation. Trial registration: ISRCTN82533884.

PMID: 20055989 [PubMed - as supplied by publisher]

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Influenza Vaccination among Healthcare Workers: Ten-Year Experience of a Large Healthcare Organization.

Infect Control Hosp Epidemiol Start a Discussion »

Jan 092010

Influenza Vaccination among Healthcare Workers: Ten-Year Experience of a Large Healthcare Organization.

Infect Control Hosp Epidemiol. 2010 Jan 7;

Authors: Ajenjo MC, Woeltje KF, Babcock HM, Gemeinhart N, Jones M, Fraser VJ

Objective. To describe the results of different measures implemented to improve adherence to the healthcare worker (HCW) influenza immunization program at BJC HealthCare during the period from 1997 through 2007. Design. Descriptive retrospective study. Setting. BJC HealthCare, a 13-hospital nonprofit healthcare organization in the Midwest. Methods. We reviewed and analyzed HCW influenza vaccination data from all BJC HealthCare Occupational Health Services and hospitals during the period from 1997 through 2007. Occupational health staff, infection prevention personnel, and key influenza vaccination campaign leaders were also interviewed regarding implementation measures during the study years. Results. At the end of 2007, BJC HealthCare had approximately 26,000 employees. With the use of multiple progressive interventions, influenza vaccination rates among BJC employees increased from 45% in 1997 to 72% in 2007 ([Formula: see text]). The influenza vaccination rate in 2007 was significantly higher than in 2006: 72%, compared with 54% ([Formula: see text]). Five hospitals had influenza vaccination rates that exceeded the target goal of 80% in 2007. The most successful interventions were adding influenza vaccination rates to the quality scorecard incentive program and the use of declination statements, both of which were implemented in 2007. The most important barriers to success identified by interview respondents were HCWs' misconceptions about influenza vaccination and a perceived lack of leadership support. Conclusions. Influenza vaccination rates among HCWs significantly improved with multiple interventions over the years. However, the BJC HealthCare influenza vaccination target of 80% was not attained at all hospitals with these measures. More aggressive interventions, such as implementing mandatory influenza vaccination policies, are needed to achieve higher vaccination rates.

PMID: 20055666 [PubMed - as supplied by publisher]

Link to Article at PubMed

Optimizing Empirical Antimicrobial Therapy for Infection due to Gram-Negative Pathogens in the Intensive Care Unit: Utility of a Combination Antibiogram.

Infect Control Hosp Epidemiol Start a Discussion »

Jan 092010

Optimizing Empirical Antimicrobial Therapy for Infection due to Gram-Negative Pathogens in the Intensive Care Unit: Utility of a Combination Antibiogram.

Infect Control Hosp Epidemiol. 2010 Jan 7;

Authors: Christoff J, Tolentino J, Mawdsley E, Matushek S, Pitrak D, Weber SG

Objective. To determine whether the use of dual antimicrobial therapy based on the results of a combination antibiotic susceptibility report (antibiogram) increases the likelihood of selecting adequate empirical coverage in critically ill patients with infection due to potentially resistant gram-negative pathogens. Design. Retrospective data analysis. Setting. Urban academic medical center. Methods. An analysis of culture results and susceptibility data from intensive care unit patients determined by the clinical microbiology laboratory was performed. The proportion of 5 common gram-negative pathogens susceptible to monotherapy with 1 of 3 antipseudomonal antibiotics (piperacillin-tazobactam, ceftazidime, or imipenem) was compared with the proportion susceptible to each of these 3 "backbone" agents plus 1 of 4 additional antimicrobial agents used in combination. Results. More than 5,000 clinical isolates were examined. When all isolates recovered during the entire study period were included, the addition of any of the second antibiotics studied to each of the 3 backbone agents significantly increased the likelihood of covering the causative pathogen ([Formula: see text] for each). The benefit of combination therapy was variable when results for each of the 5 organisms were examined individually. When temporal trends in susceptibility were examined, the decrease in the proportion of organisms susceptible to monotherapy was statistically significant for both imipenem and ceftazidime ([Formula: see text]). Conclusions. Reporting antibiotic susceptibility data in the form of a combination antibiogram may be useful to clinicians who are considering empirical antimicrobial therapy in the intensive care unit.

PMID: 20055664 [PubMed - as supplied by publisher]

Link to Article at PubMed