2012 February 11

Changes in antibiotic resistance level of nosocomial Pseudomonas aeruginosa isolates in the largest university hospital of Lithuania.

Feb 112012

Changes in antibiotic resistance level of nosocomial Pseudomonas aeruginosa isolates in the largest university hospital of Lithuania.

Medicina (Kaunas). 2011;47(5):278-83

Authors: Adukauskien? D, Vitkauskait? A, Skrodenien? E, Dambrauskien? A, Vitkauskien? A

Abstract
UNLABELLED: The aim was to estimate changes in the resistance rates of Pseudomonas aeruginosa (P. aeruginosa) strains isolated from patients treated in intensive care units of the largest university hospital.
MATERIALS AND METHODS: Isolates were identified with the Phoenix ID system (Becton Dickinson, USA). The minimum inhibitory concentration (MIC) of ceftazidime, ciprofloxacin, and amikacin were determined by the E-test and evaluated following the recommendations of the Clinical Laboratory Standards Institute.
RESULTS: In 2003, the proportion of P. aeruginosa strains resistant to piperacillin was greatest followed by strains resistant gentamicin and ciprofloxacin. In 2008, the resistance rates markedly changed being the highest to ciprofloxacin. An increase in the resistance rates to ciprofloxacin (+24%, P<0.001) and ceftazidime (+8.3%, P<0.05) was documented. In 2003, there were 66.7% of P. aeruginosa strains sensitive to all antibiotics tested, and this percentage decreased to 47.5% in 2008 (P<0.05). During the study, a significant increase in the median MICs for ciprofloxacin and amikacin was observed (P<0.001); however, no significant change was documented for ceftazidime.
CONCLUSIONS: P. aeruginosa remains an important nosocomial pathogen with relatively high overall resistance to antimicrobial agents, and the resistance level is increasing.

PMID: 21956136 [PubMed - indexed for MEDLINE]

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The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature.

J Am Med Inform Assoc Start a Discussion »

Feb 112012

The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature.

J Am Med Inform Assoc. 2012 Feb 9;

Authors: Hains IM, Georgiou A, Westbrook JI

Abstract
ObjectiveTo assess evidence of the impact of Picture Archiving and Communication Systems (PACS) on clinicians' work practices in the intensive care unit (ICU).MethodsWe searched Medline, Pre-Medline, CINAHL, Embase, and the SPIE Digital Library databases for English-language publications between 1980 and September 2010 using Medical Subject Headings terms and keywords.ResultsEleven studies from the USA and UK were included. All studies measured aspects of time associated with the introduction of PACS, namely the availability of images, the time a physician took to review an image, and changes in viewing patterns. Seven studies examined the impact on clinical decision-making, with the majority measuring the time to image-based clinical action. The effect of PACS on communication modes was reported in five studies.DiscussionPACS can impact on clinician work practices in three main areas. Most of the evidence suggests an improvement in the efficiency of work practices. Quick image availability can impact on work associated with clinical decision-making, although the results were inconsistent. PACS can change communication practices, particularly between the ICU and radiology; however, the evidence base is insufficient to draw firm conclusions in this area.ConclusionThe potential for PACS to impact positively on clinician work practices in the ICU and improve patient care is great. However, the evidence base is limited and does not reflect aspects of contemporary PACS technology. Performance measures developed in previous studies remain relevant, with much left to investigate to understand how PACS can support new and improved ways of delivering care in the intensive care setting.

PMID: 22323392 [PubMed - as supplied by publisher]

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Increased nonbeneficial care in patients spending their birthday in the ICU.

Intensive Care Med Start a Discussion »

Feb 112012

Increased nonbeneficial care in patients spending their birthday in the ICU.

Intensive Care Med. 2012 Feb 10;

Authors: Azoulay E, Garrouste M, Goldgran-Toledano D, Adrie C, Max A, Vesin A, Francais A, Zahar JR, Cohen Y, Allaouchiche B, Schlemmer B, Timsit JF

Abstract
OBJECTIVE: End-of-life decisions are based on objective and subjective criteria. Previous studies identified substantial subjective biases during end-of-life decision-making. We evaluated whether in-ICU patient's birthday influenced management decisions. DESIGN: We used a case-control design in which patients spending their birthday in the ICU (cases) were matched to controls on center, gender, age, severity, type of admission, and length of ICU stay before birthday. SETTING: 12 ICUs in French hospitals. PATIENTS: The cases and controls were patients with ICU admissions >48 h over a 10-year period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Compared with the 1,042 controls, the 223 cases were more often trauma patients and received a larger number and longer durations of life-sustaining interventions. This increased intensity of life support occurred after, but not before, the birthday. The cases had longer ICU stay lengths. ICU and hospital mortality were not different between the two groups. End-of-life decisions were made in 22% and 24% of cases and controls, respectively. However, these decisions were made later in the cases than in the controls (18 [5-33] versus 9 [3-19] days). CONCLUSIONS: Our finding that patients who spent their birthday in the ICU received a higher intensity of life-sustaining care and had longer ICU stays but did not have significantly different mortality rates compared with the controls suggests the use of nonbeneficial interventions. Staff members caring for patients whose birthdays fall during the ICU stay should be aware that this feature can bias end-of-life decisions, leading to an inappropriate level of care.

PMID: 22323081 [PubMed - as supplied by publisher]

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Coronary Computed Tomography Angiography After Stress Testing Results From a Multicenter, Statewide Registry, ACIC (Advanced Cardiovascular Imaging Consortium).

J Am Coll Cardiol Start a Discussion »

Feb 112012

Coronary Computed Tomography Angiography After Stress Testing Results From a Multicenter, Statewide Registry, ACIC (Advanced Cardiovascular Imaging Consortium).

J Am Coll Cardiol. 2012 Feb 14;59(7):688-95

Authors: Chinnaiyan KM, Raff GL, Goraya T, Ananthasubramaniam K, Gallagher MJ, Abidov A, Boura JA, Share D, Peyser PA

Abstract
OBJECTIVES: This study was conducted to evaluate the correlation between stress test results and coronary computed tomography angiography (CCTA) findings and comparative diagnostic performance of the 2 modalities in patients undergoing invasive coronary angiography (ICA).
BACKGROUND: Recent data suggest that only a third of patients undergoing ICA have obstructive coronary artery disease (CAD); accurate pre-ICA risk stratification is needed.
METHODS: At 47 centers participating in the ACIC (Advanced Cardiovascular Imaging Consortium) in Michigan, patients without known CAD who were undergoing CCTA within 3 months of a stress test were studied. Demographics, risk factors, symptoms, and stress test results were correlated with obstructive CAD (>50% stenosis) on CCTA and ICA.
RESULTS: Among 6,198 patients (age 56 ± 12 years, 48% men), >50% stenosis was seen in 1,158 (18.7%) on CCTA. Independent predictors included male sex (odds ratio [OR]: 2.37, 95% confidence interval [CI]: 1.83 to 3.06), current smoking (OR: 2.23, 95% CI: 1.57 to 3.17), older age (OR per 10-year increment: 2.14, 95% CI: 1.89 to 2.41), hypertension (OR: 1.8, 95% CI: 1.37 to 2.34), and typical angina (OR: 1.48, 95% CI: 1.03 to 2.12). Stress test results were not predictive. Among patients undergoing ICA (n = 621), there was a strong correlation of ICA with CCTA findings (OR: 9.09, 95% CI: 5.57 to 14.8, p < 0.001), but not stress results (OR: 0.79, 95% CI: 0.56 to 1.11, p = 0.17).
CONCLUSIONS: Stress test findings did not predict obstructive CAD on CCTA, observed in <20% of patients in this large study group. The strong association of CCTA with ICA suggests that it may serve as an effective "gatekeeper" to invasive testing in patients needing adjudication of stress test results. (Advanced Cardiovascular Imaging Consortium: A Collaborative Quality Improvement Project [ACIC]; NCT00640068).

PMID: 22322086 [PubMed - in process]

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Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial.

Lancet Infect Dis Start a Discussion »

Feb 112012

Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial.

Lancet Infect Dis. 2012 Feb 7;

Authors: Cornely OA, Crook DW, Esposito R, Poirier A, Somero MS, Weiss K, Sears P, Gorbach S,

Abstract
BACKGROUND: Infection with Clostridium difficile is the primary infective cause of antibiotic-associated diarrhoea. We aimed to compare efficacy and safety of fidaxomicin and vancomycin to treat patients with C difficile infection in Europe, Canada, and the USA. METHODS: In this multicentre, double-blind, randomised, non-inferiority trial, we enrolled patients from 45 sites in Europe and 41 sites in the USA and Canada between April 19, 2007, and Dec 11, 2009. Eligible patients were aged 16 years or older with acute, toxin-positive C difficile infection. Patients were randomly allocated (1:1) to receive oral fidaxomicin (200 mg every 12 h) or oral vancomycin (125 mg every 6 h) for 10 days. The primary endpoint was clinical cure, defined as resolution of diarrhoea and no further need for treatment. An interactive voice-response system and computer-generated randomisation schedule gave a randomisation number and medication kit number for each patient. Participants and investigators were masked to treatment allocation. Non-inferiority was prespecified with a margin of 10%. Modified intention-to-treat and per-protocol populations were analysed. This study is registered with ClinicalTrials.gov, number NCT00468728. FINDINGS: Of 535 patients enrolled, 270 were assigned fidaxomicin and 265 vancomycin. After 26 patients were excluded, 509 were included in the modified intention-to-treat (mITT) population. 198 (91·7%) of 216 patients in the per-protocol population given fidaxomicin achieved clinical cure, compared with 213 (90·6%) of 235 given vancomycin, meeting the criterion for non-inferiority (one-sided 97·5% CI -4·3%). Non-inferiority was also shown for clinical cure in the mITT population, with 221 (87·7%) of 252 patients given fidaxomicin and 223 (86·8%) of 257 given vancomycin cured (one-sided 97·5% CI -4·9%). In most subgroup analyses of the primary endpoint in the mITT population, outcomes in the two treatment groups did not differ significantly; although patients receiving concomitant antibiotics for other infections had a higher cure rate with fidaxomicin (46 [90·2%] of 51) than with vancomycin (33 [73·3%] of 45; p=0·031). Occurrence of treatment-emergent adverse events did not differ between groups. 20 (7·6%) of 264 patients given at least one dose of fidaxomicin and 17 (6·5%) of 260 given vancomycin died. INTERPRETATION: Fidaxomicin could be an alternative treatment for infection with C difficile, with similar efficacy and safety to vancomycin. FUNDING: Optimer Pharmaceuticals.

PMID: 22321770 [PubMed - as supplied by publisher]

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Qualitative study on perceptions of hand hygiene among hospital staff in a rural teaching hospital in India.

J Hosp Infect Start a Discussion »

Feb 112012

Qualitative study on perceptions of hand hygiene among hospital staff in a rural teaching hospital in India.

J Hosp Infect. 2012 Feb 7;

Authors: Joshi SC, Diwan V, Tamhankar AJ, Joshi R, Shah H, Sharma M, Pathak A, Macaden R, Stålsby Lundborg C

Abstract
BACKGROUND: Hand hygiene is a simple but underutilized measure to control healthcare-associated infections. AIM: To explore staff perceptions of hand hygiene using focus group discussions (FGDs) in a teaching hospital in India. METHODS: Qualitative study. The FGD guide included questions on transmission of infections, hand hygiene practices and problems with implementation, and ways to improve adherence to hand hygiene recommendations. The FGDs were recorded, transcribed verbatim, translated into English (when conducted in Hindi) and analysed using content analysis. FINDINGS: Two themes emerged: 'inter-relationship of knowledge, beliefs, motivation, practices and needs' and 'roles and responsibilities for sustainable and efficient implementation of context-relevant approaches and interventions'. Staff were generally aware of the importance of hand hygiene for the prevention of healthcare-associated infections, but perceived practical problems with implementation. CONCLUSIONS: The staff suggested various interventions and appeared to be prepared to follow hand hygiene guidelines if the hospital provided the necessary facilities.

PMID: 22321723 [PubMed - as supplied by publisher]

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