RESUMO
BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a significant healthcare-associated infection carrying substantial mortality. We aimed to assess the clinical impact of active screening cultures for CRAB. METHODS: A systematic review and meta-analysis, aiming to answer two questions: 1. Does screening vs no screening improve clinical outcomes? 2. Does positive screening ("CRAB carrier") predict CRAB infections? We searched MEDLINE, Cochrane library, Web of Science, and conferences, until January 2024, comparative studies reporting clinical outcomes (mortality, invasive CRAB infections). RESULTS: Of 5,407 screened publications, 9 studies (10,865 individuals) were included for study question #2. Invasive CRAB infection rate was significantly higher among CRAB carriers (odds ratio [OR] 11.14, 95% confidence interval [CI] 4.95-25.05, with substantial heterogeneity stemming from size rather than direction of the effect). Negative predictive value (NPV) of non-carriage for invasive infection was 97%. CRAB bloodstream infections rate was significantly higher among carriers (OR 16.23, 95% CI 2.9-110.08). No significant difference was demonstrated between the two groups CRAB ventilator-associated pneumonia, length of stay, and mortality. Only one study reported outcomes for the screening vs no screening (study question #1). CONCLUSIONS: Data to support active CRAB screening are scarce regarding its clinical benefit for patients. Positively screened patients are at significantly higher risk for invasive CRAB infections, with high NPV for non-carriage. This did not translate to reduced mortality.
RESUMO
BACKGROUND: Literature to date has suggested advantages of sedation with the combination of ketamine and propofol over ketamine alone or propofol alone. However, there is a paucity of data regarding sedation with the combination of ketamine and propofol in pediatric emergency medicine. METHODS: A retrospective case series analysis of children who underwent sedation with the combination of ketamine and propofol in a pediatric emergency department was conducted. Study covariates were extracted from the emergency department medical records. RESULTS: Four hundred twenty-nine patients, 297 males and 132 females, with a median age of 6.8 years (interquartile range, 3.9-10.9 years), underwent sedation by pediatric emergency physicians. Serious adverse events during sedation (SAEDS) were recorded in 52 procedures (12.1%), which included 39 hypoxic events (9.1%), 12 apneic events (2.8%), and 1 laryngospasm (0.2%). All SAEDS were managed successfully, and no child underwent intubation because of an adverse reaction or required hospitalization. Multivariate logistic regression analysis did not reveal any association between age, weight, fasting time, analgesic medication provided before sedation, length of procedure, capnography use, dosages of medications, and the presence of SAEDS. CONCLUSIONS: This is the largest reported series of sedation with the combination of ketamine and propofol in pediatric emergency medicine. Findings suggest that sedation with the combination of ketamine and propofol can be safely performed by a skilled emergency physician.
