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- Fransson, G, et al.
(author)
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Linking local microbiology databases with the Swedish Intensive Care Registry to examine impact of bacterial resistance on the critically ill.
- 2007
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In: Acta anaesthesiologica Scandinavica. Volume 51, Issue Supplement s118. - Malden, MA, United States : Wiley-Blackwell. ; , s. 33-33 (Poster 25)
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Conference paper (other academic/artistic)abstract
- Background and aims: Bacterial resistance to antibiotics hasemerged as an important factor influencing patient mortalityand morbidity. The overall purpose of this project is to exam-ine the impact of bacterial resistance on resource use andoutcome in the critically ill. The aims of the current report isto demonstrate that linkage of local microbiology databasesand the Swedish Intensive Care Registry (SIR) was possibleand to provide a preliminary analysis of data from a sub-group of ICU patients (chronic obstructive pulmonary dis-ease, COPD).Methods: Admissions due to an acute exacerbation of COPDwere matched with bacteriology samples obtained 14 daysbefore ICU admission, during ICU stay and 14 days after dis-charge from ICU by linking six local microbiology databaseswith patient data in SIR. Linkage was by the patient’s uniquepersonal number and ICU admission and discharge days.Results: We found 195 patients with median APACHE II prob-ability 0.22 (iqr 0.12–0.37), median length of stay (LOS) 46 (iqr 21–125) hours and 79% 30 day survival. Cultures from 2 weeks before (n=128), during ICU-stay (n=750) and from14 days after ICU discharge (n=228) were identified. During ICU stay airways (n=261), blood or intravascular devices (n=246) and other sites (n=243) were cultured. The totalnumber of airway cultures per patient increased linearly withlength of stay (P<0.01,r2= 0.61). Gram-negative bacteria were most common in positive airway cultures (41%) followedby Candida spp (22%), while positive blood cultures were pre-dominantly Gram-positive (71%). 30-day-mortality was 10/53 with positive and 10/29 with negative airway cultures(P=0.23).Conclusion: Linkage of local microbiology databases and theSwedish Intensive Care Registry is possible and can generate information that may be used to examine relationships between bacterial resistance and outcomes in the critically illpatient.
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- Gunnarsson, Mats, et al.
(author)
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Effects of inhalation of corticosteroids immediately after experimental chlorine gas lung injury
- 2000
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In: Journal of Trauma - Injury, Infection and Critical Care. - 1079-6061. ; 48:1, s. 101-107
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Journal article (peer-reviewed)abstract
- Background: To assess the effects of treatment with nebulized corticosteroids immediately after chlorine gas injury. Methods: Eighteen anesthetized and mechanically ventilated pigs were exposed to chlorine gas (140 ppm for 10 minutes) and observed for 6 hours. Nine pigs were treated with nebulized beclomethasone-dipropionate 20 ╡g/kg (BDP group), and nine pigs were given no treatment (control group). Results: All animals developed severe pulmonary dysfunction. The initial decrease in PaO2 was similar in both groups, but BDP-treated animals improved whereas control animals deteriorated (p < 0.005, analysis of variance). Pulmonary vascular resistance increased in both groups but less in the BDP group (p < 0.01). Lung-thorax compliance was better preserved in the BDP group (p < 0.01), and oxygen delivery was significantly better in the BDP group (p < 0.01). One animal died in the BDP group, as did three animals in the control group. Conclusion: Immediate treatment with nebulized BDP improved pulmonary and cardiovascular function after experimental chlorine gas injury.
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- Hanberger, Håkan, 1954-, et al.
(author)
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Low antibiotic resistance rates in Staphylococcus aureus, Escherichia coli and Klebsiella spp but not in Enterobacter spp and Pseudomonas aeruginosa : A prospective observational study in 14 Swedish ICUs over a 5-year period
- 2007
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 51:7, s. 937-941
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Journal article (peer-reviewed)abstract
- Background: Intensive care units (ICUs) are hot zones for emergence and spread of antibiotic resistance because of frequent invasive procedures, antibiotic usage and transmission of bacteria. We report prospective data on antibiotic use and bacterial resistance from 14 academic and non-academic ICUs, participating in the ICU-STRAMA programme 1999-2003. Methods: The quantity of antibiotics delivered to each ICU was calculated as defined daily doses per 1000 occupied bed days (DDD1000). Specimens for culture were taken on clinical indications and only initial isolates were considered. Species-related breakpoints according to the Swedish Reference Group for Antibiotics were used. Antibiotic resistance was defined as the sum of intermediate and resistant strains. Results: Mean antibiotic use increased from 1245 DDD1000 in 1999 to 1510 DDD1000 in 2003 (P = 0.11 for trend). Of Staphylococcus aureus, 0-1.8% were methicillin resistant (MRSA). A presumptive extended spectrum beta-lactamase (ESBL) phenotype was found in <2.4% of Escherichia coli, based on cefotaxime susceptibility, except a peak in 2002 (4.6%). Cefotaxime resistance was found in 2.6-4.9% of Klebsiella spp. Rates of resistance among Enterobacter spp. to cefotaxime (20-33%) and among Pseudomonas aeruginosa to imipenem (22-33%) and ciprofloxacin (5-21%) showed no time trend. Conclusion: MRSA and cefotaxime-resistant E. coli and Klebsiella spp strains were few despite high total antibiotic consumption. This may be the result of a slow introduction of resistant strains into the ICUs, and good infection control. The cause of imipenem and ciprofloxacin resistance in P. aeruginosa could reflect the increased consumption of these agents plus spread of resistant clones. © 2007 The Authors.
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- Hällgren, Anita, 1963-, et al.
(author)
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Rectal colonization and frequency of enterococcal cross-transmission among prolonged-stay patients in two Swedish intensive care units
- 2005
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In: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 37:8, s. 561-571
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Journal article (peer-reviewed)abstract
- The aims of this study were to gain insight into the dynamics of the rectal flora during prolonged ICU stay, with a particular focus on colonization and cross-transmission with resistant pathogens, and to evaluate methods for the rapid isolation of relevant bacteria from rectal swabs. Patients admitted to a general intensive care unit (GICU) or a cardiothoracic ICU (TICU) at the University Hospital of Linköping, Sweden, between 1 November 2001 and January 2002 with a length of stay > 5 d were included (n = 20). Chromogenic UTI agar medium was used for discrimination of different species, and appropriate antibiotics were added to detect resistance. Direct plating was compared to enrichment broth for a subset of specimens. The study showed an early alteration in rectal flora, with a dramatic decrease in Gram-negative rods in favour of Gram-positive bacteria. An ampicillin- and high-level gentamicin resistant clone of Enterococcus faecium was found in 6 of 10 patients in the GICU and 2 of 11 patients in the TICU. Enrichment broth did not enhance the detection of Gram-negative bacteria compared to direct plating on Chromogenic UTI medium, but enrichment broths were needed for optimal detection of resistant Gram-positive bacteria.
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- Berkius, Johan, et al.
(author)
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Characteristics and long-term outcome of acute exacerbations in chronic obstructive pulmonary disease : An analysis of cases in the Swedish Intensive Care Registry during 2002-2006
- 2008
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 52:6, s. 759-765
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Journal article (peer-reviewed)abstract
- Background: Chronic obstructive pulmonary disease (COPD) represents a major and growing health problem. The purpose of this work was to examine characteristics, resource use and long-term survival in patients with an acute exacerbation of COPD that were admitted to Swedish intensive care units (ICU). Methods: Patient characteristics at admission, length of stay (LOS), resource use and outcome were collected for admissions due to COPD during 2002-2006 in the database of the Swedish Intensive Care Registry. Vital status was secured for 99.6% of the patients. Kaplan-Meier survival estimates were computed for index admissions only. Results: We identified 1009 patients with 1199 admissions due to COPD (1.3% of all intensive care admissions). The mean (SD) age was 70.2 (9.1) years and the proportion of women were 61.5%. Mean (SD) Acute Physiology and Chronic Health Evaluation II probability of hospital death was 0.31 (0.19). Median LOS was 28 (interquartile range 52) h. The number of readmissions was 190 during the 5-year study. Older patients had fewer readmissions (OR 0.96, 95% CI: 0.95-0.98/year increase in age). ICU mortality was 7.3% (87 of 1199 admissions) and 30-day mortality was 26.0% (262 of 1009 index admissions). Median survival was 14.5 months and 31% of patients survived 3 years after the index admission. Conclusions: Short (30 days) and long-term survival is poor in acute COPD. Readmissions are frequent reflecting the severity of this chronic illness. Patients are less likely to be readmitted with increasing age which may be due to withholding of further intensive care. © 2008 The Authors.
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