[Antimicrobial stewardship program in an Intensive Care Unit: A retrospective observational analysis of the results 15 months after its implementation]. / Programa de optimización del uso de antimicrobianos en un Servicio de Medicina Intensiva: análisis retrospectivo observacional de los resultados 15 meses después de su implementación.

OBJECTIVE: We aim to evaluate the adherence rate to an Antimicrobial Stewardship Program (ASP) in an Intensive Care Unit (ICU), and to assess its effect on the use of antibiotics, quality indicators and clinical outcomes. METHODS: Retrospective description of the interventions proposed by the ASP. We compared antimicrobial use, quality and safety indicators in an ASP versus a non-ASP period. The study was performed in a polyvalent ICU of a medium-size University Hospital (600 beds). We studied patients admitted to the ICU for any cause during the ASP period, provided that a microbiological sample aiming to diagnose a potential infection has been drawn, or antibiotics have been started. We elaborated and registered of non-mandatory recommendations to improve antimicrobial prescription (audit and feedback structure) and its registry during the ASP period (15 months, October 2018-December 2019). We compared indicators in a period with ASP (April-June 2019) and without ASP (April-June 2018). RESULTS: We issued 241 recommendations on 117 patients, 67% of them classified as de-escalation type. The rate of adherence to the recommendations was high (96.3%). In the ASP period, the mean number of antibiotics per patient (3.3±4.1 vs 2.4±1.7, p=0.04) and the days of treatment (155 DOT/100 PD vs 94 DOT/100 PD, p <0.01) were reduced. The implementation of the ASP did not compromise patient safety or produce changes in clinical outcomes. CONCLUSIONS: The implementation of an ASP is widely accepted in the ICU, reducing the consumption of antimicrobials, without compromising patient safety.

Determinants of mortality in cancer patients with unscheduled admission to the Intensive Care Unit: A prospective multicenter study / Factores determinantes de la mortalidad en pacientes con cáncer ingresados de forma no programada en la Unidad de Cuidados Intensivos: estudio multicéntrico prospectivo

Objectives To analyze clinical fatures associated to mortality in oncological patients with unplanned admission to the Intensive Care Unit (ICU), and to determine whether such risk factors differ between patients with solid tumors and those with hematological malignancies. Design An observational study was carried out. Setting A total of 123 Intensive Care Units across Spain. Patient All cancer patients with unscheduled admission due to acute illness related to the background oncological disease. Interventions None. Main variables Demographic parameters, severity scores and clinical condition were assessed, and mortality was analyzed. Multivariate binary logistic regression analysis was performed. Results A total of 482 patients were included: solid cancer (n=311) and hematological malignancy (n=171). Multivariate regression analysis showed the factors independently associated to ICU mortality to be the APACHE II score (OR 1.102; 95% CI 1.064–1.143), medical admission (OR 3.587; 95% CI 1.327–9.701), lung cancer (OR 2.98; 95% CI 1.48–5.99) and mechanical ventilation after the first 24h of ICU stay (OR 2.27; 95% CI 1.09–4.73), whereas no need for mechanical ventilation was identified as a protective factor (OR 0.15; 95% CI 0.09–0.28). In solid cancer patients, the APACHE II score, medical admission, antibiotics in the previous 48h and lung cancer were identified as independent mortality indicators, while no need for mechanical ventilation was identified as a protective factor. In the multivariate analysis, the APACHE II score and mechanical ventilation after 24h of ICU stay were independently associated to mortality in hematological cancer patients, while no need for mechanical ventilation was identified as a protective factor. Neutropenia was not identified as an independent mortality predictor in either the total cohort or in the two subgroups (AU)

Objetivos Determinar las características clínicas asociadas con la mortalidad en pacientes oncológicos ingresados de forma no programada en la UCI. También evaluamos si estos factores de riesgos difieren en los pacientes con neoplasias hematológicas o tumores sólidos. Diseño Estudio observacional. Ámbito Ciento veintitrés Unidades de Cuidados Intensivos en España. Pacientes Todos los pacientes con cáncer ingresados de forma no programada debido a una enfermedad aguda asociada con la enfermedad oncológica. Intervenciones Ninguna. Variables principales Las variables analizadas fueron los datos demográficos, escalas pronósticas de gravedad y el estado clínico del paciente. Se analizó la mortalidad y los factores relacionados con ésta. Se aplicó un análisis de regresión logística binaria multivariante. Resultados Se incluyó a un total de 482 pacientes: con tumores sólidos (n=331) y con neoplasias hematológicas (n=171). En el análisis de regresión multivariante, los factores asociados de manera independiente con la mortalidad en la UCI fueron la puntuación APACHE II (OR 1,102; IC del 95% 1,064-1,143), el ingreso médico (OR 3,587; IC del 95% 1,327-9,701), el cáncer de pulmón (OR 2,98, IC del 95% 1,48-5,99) y la ventilación mecánica tras las primeras 24h de ingreso en la UCI (OR 2,27; IC del 95% 1,09-4,73), mientras que la no necesidad de ventilación mecánica fue un factor protector (OR 0,15; IC del 95% 0,09-0,28). En el caso de los tumores sólidos, la puntuación APACHE II, el ingreso médico, la administración de antibióticos en las 48 h previas y el cáncer de pulmón fueron variables independientes relacionadas con la mortalidad, y la no necesidad de ventilación mecánica se identificó como un factor protector. En el análisis multivariante, la puntuación APACHE II y la ventilación mecánica al cabo de 24h desde el ingreso en la UCI se asociaron de manera independiente con mortalidad en pacientes con neoplasias hematológicas (AU)

Determinants of mortality in cancer patients with unscheduled admission to the Intensive Care Unit: A prospective multicenter study.

OBJECTIVES: To analyze clinical features associated to mortality in oncological patients with unplanned admission to the Intensive Care Unit (ICU), and to determine whether such risk factors differ between patients with solid tumors and those with hematological malignancies. DESIGN: An observational study was carried out. SETTING: A total of 123 Intensive Care Units across Spain. PATIENTS: All cancer patients with unscheduled admission due to acute illness related to the background oncological disease. INTERVENTIONS: None. MAIN VARIABLES: Demographic parameters, severity scores and clinical condition were assessed, and mortality was analyzed. Multivariate binary logistic regression analysis was performed. RESULTS: A total of 482 patients were included: solid cancer (n=311) and hematological malignancy (n=171). Multivariate regression analysis showed the factors independently associated to ICU mortality to be the APACHE II score (OR 1.102; 95% CI 1.064-1.143), medical admission (OR 3.587; 95% CI 1.327-9.701), lung cancer (OR 2.98; 95% CI 1.48-5.99) and mechanical ventilation after the first 24h of ICU stay (OR 2.27; 95% CI 1.09-4.73), whereas no need for mechanical ventilation was identified as a protective factor (OR 0.15; 95% CI 0.09-0.28). In solid cancer patients, the APACHE II score, medical admission, antibiotics in the previous 48h and lung cancer were identified as independent mortality indicators, while no need for mechanical ventilation was identified as a protective factor. In the multivariate analysis, the APACHE II score and mechanical ventilation after 24h of ICU stay were independently associated to mortality in hematological cancer patients, while no need for mechanical ventilation was identified as a protective factor. Neutropenia was not identified as an independent mortality predictor in either the total cohort or in the two subgroups. CONCLUSIONS: The risk factors associated to mortality did not differ significantly between patients with solid cancers and those with hematological malignancies. Delayed intubation in patients requiring mechanical ventilation might be associated to ICU mortality.