ABSTRACT
Three patients were recently transferred to two Intensive Care Units (ICUs) in the Netherlands from two different ICUs in Bucharest, Romania. The patients appeared to be colonised with several, partly identical, carbapenemase-producing bacteria (CPB) after a short hospitalisation in Romania. In this article, we show that it is important to be aware of the possibility that patients are colonised with CPB after a short hospitalisation abroad. This has consequences for infection prevention measurements, but probably also for the discontinuation of selective bowel decontamination in the ICU.
Subject(s)
Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Drug Resistance, Bacterial , Intensive Care Units , Adult , Bacteria , Cross Infection , Female , Hospitalization , Humans , Male , Netherlands/ethnology , Romania/epidemiology , Young AdultABSTRACT
OBJECTIVE: To determine the prevalence of oral feeding problems in neonatal intensive care unit (NICU) graduates at 1 to 2 years, and to identify clinical risk factors during NICU admission. STUDY DESIGN: Observational cohort study of 378 children, who received level III/IV NICU care for 4 days or more in 2011 to 2012, chromosomal abnormalities excluded. We detected feeding problems in four gestational age (GA) groups (<28, 28 to 31, 32 to 36 weeks, and term-borns) using the Dutch standardized Screeningslijst Eetgedrag Peuters, and collected clinical factors for logistic regression analyses. RESULTS: The prevalence of feeding problems was higher in NICU (20.4%) than in reference (15.0%) population (P=0.024), but similar for all GA groups (P=0.468). Prolonged tube feeding, that is, >30 days (odds ratio (OR) 2.50, confidence interval (CI) 1.13 to 5.56) and being born small for GA (OR 4.79, CI 1.64 to 14.03) were the most prevalent risk factors in children with GA ⩾32 and GA <32 weeks, respectively. CONCLUSION: Feeding problems are more prevalent in NICU graduates, with prolonged tube feeding as most important risk factor.
Subject(s)
Enteral Nutrition , Feeding and Eating Disorders/epidemiology , Infant, Small for Gestational Age , Child, Preschool , Cohort Studies , Female , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Length of Stay , Logistic Models , Male , Multivariate Analysis , Netherlands/epidemiology , Risk Factors , Severity of Illness IndexABSTRACT
For patients with community-acquired pneumonia (CAP), clinical response during the first days of treatment is predictive of clinical outcome. As risk assessments can improve the efficiency of pneumonia management, a prospective cohort study to assess clinical, biochemical and microbiological predictors of early clinical failure was conducted in patients with severe CAP (pneumonia severity index score of >90 or according to the American Thoracic Society definition). Failure was assessed at day 3 and was defined as death, a need for mechanical ventilation, respiratory rate >25/min, PaO2 <55 mm Hg, oxygen saturation <90%, haemodynamic instability, temperature >38 degrees C or confusion. Of 260 patients, 80 (31%) had early clinical failure, associated mainly with a respiratory rate >25/minute (n = 34), oxygen saturation <90% (n = 28) and confusion (n = 20). In multivariate logistic regression analysis, failure was associated independently with altered mental state (OR 3.19, 95% CI 1.75-5.80), arterial PaH <7.35 mm Hg (OR 4.29, 95% CI 1.53-12.05) and PaO2 <60 mm Hg (OR 1.75, 95% CI 0.97-3.15). A history of heart failure was associated inversely with clinical failure (OR 0.30, 95% CI 0.10-0.96). Patients who failed to respond had a higher 28-day mortality rate and a longer hospital stay. It was concluded that routine clinical and biochemical information can be used to predict early clinical failure in patients with severe CAP.
Subject(s)
Community-Acquired Infections/diagnosis , Pneumonia/diagnosis , Severity of Illness Index , Academic Medical Centers , Adolescent , Adult , Anti-Infective Agents/therapeutic use , Cohort Studies , Community-Acquired Infections/etiology , Community-Acquired Infections/physiopathology , Community-Acquired Infections/therapy , Female , Hospitals, Teaching , Humans , Male , Netherlands , Pneumonia/etiology , Pneumonia/physiopathology , Pneumonia/therapy , Prognosis , Regression Analysis , Risk Factors , Treatment FailureABSTRACT
Patients who have not received previous antiretroviral treatment (ART) have a high failure rate on the combination treatment of abacavir, lamivudine, and tenovir. We assessed the virological failure rate in eight patients with HIV-1 who switched to this combination after having complete virological suppression from their previous long-term ART (median 8.0 months, range 7.5-18.0). Five of the eight patients showed virological failure. Four of these five patients had either the K65R mutation, the M184V/I mutation, or both. This combination of drugs cannot therefore be recommended as alternative treatment in patients with HIV-1 who are fully virologically suppressed.
