| 1. |
- Fronczek, Jakub, et al.
(författare)
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Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU : a prospective cohort study
- 2021
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Ingår i: Critical Care. - : BioMed Central (BMC). - 1364-8535 .- 1466-609X. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context.METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score.RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01).CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2).
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| 2. |
- Agvald-Öhman, Christina
(författare)
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Colonization, infection and dissemination in intensive care patients
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Nosocomial infections are a substantial problem in hospitals all over the world and the incidence is among the highest in the intensive care unit, affecting mortality and morbidity for the individual patient and cost for the society. In order to prevent these infections it is important to gain knowledge about colonization and infection pathways as well as about bacterial dissemination between patients. The overall aim of the present study was to investigate bacterial and fungal colonization pattern, dissemination pattern within and between patients and the incidence of some ICU-acquired infections in intensive care patients, treated in a multidisciplinary Swedish university hospital ICU. Colonization and dissemination patterns of microorganisms were studied by microbiological analyses and antimicrobial susceptibility was monitored over time. Subtyping was performed by using phenotyping as well as genotyping methods, such as the Phene-Plate system and PFGE (pulse-field gel-electrophoresis). Fungal colonization index and other risk factors for acquiring invasive candida infection, were studied in patients with a length of stay of at least seven days. In addition, the status of the immunosystem was monitored with HLA-DR expression once a week in these patients. The main results and conclusions of this thesis can be summarized as: * Intubated intensive care patients are often heavily colonized in the lower airways with potentially pathogenic microorganisms, aerobic and anaerobic bacteria as well as yeasts. * Different colonization routes were demonstrated for different species; primary colonization of the oropharynx or concomitantly in the lower airways, was shown for Staphylococcus, Enterococcus, Enterobacteriaceae and Candida spp., while Pseudomonas and other non-fermenting gram-negative rods and several anaerobic species often showed primary colonization of the trachea. * The dissemination rate of CoNS between ICU patients was high, 70% of patients treated for more than three days were involved in at least one transmission event. * Prolonged ICU stay was correlated to an increased rate of cross-transmission between patients as well as a significantly higher risk of being colonized with multi-resistant strains. * The diversity of colonizing CoNS was significantly decreased in ICU patients with a length of stay of at least five days. * The endogenous spreading of resistant clones within patient’s skin and mucosal areas increased with time. * The incidence of invasive candida infections was high in the ICU patient population studied, despite a frequent use of antifungal agents. This was probably due to that the majority of the patients were burdened by several risk factors. * High colonization index (≥ 0.8) and recent extensive abdominal surgery was identified as significant risk factors for acquiring invasive candida infection in ICU patients with a length of stay of at least seven days. In conclusion, the results of the present study emphasize the importance of compliance to barrier treatment, implementation and continuously follow-up of infection control programmes. Furthermore, the results underline the importance of a prudent use of antimicrobial agents for therapy and prophylaxis, based on daily reconsideration of the treatment according to microbiological and laboratory results and the patient’s condition, especially in this vulnerable patient population.
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| 3. |
- Agvald-Öhman, Christina, et al.
(författare)
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»Skjut på« och »dra« metod för att minska vårdrelaterade infektioner på IVA : Pilotprojekt med aktiv uppföljning
- 2010
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Ingår i: Läkartidningen. - : Lakartidningen. - 0023-7205 .- 1652-7518. ; 107:1-2
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Tidskriftsartikel (refereegranskat)abstract
- Vårdrelaterade infektioner är ett särskilt stort problem inom intensivvården där patienterna är kritiskt sjuka och har många riskfaktorer. För att minska frekvensen vårdrelaterade infektioner måste ett strukturerat arbete bedrivas från flera olika utgångspunkter. Vi måste bli bättre på att diagnostisera, dokumentera och förebygga dessa infektioner. Kombinerad intervention av typen »push« och »pull« visade på lovande resultat med införande av bättre diagnostiska metoder och en upplevelse av ökad motivation hos personalen efter besöket.
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