Resistance to Carbapenem Antibiotics Doubled in Intensive Care Units

MedicalResearch.com Interview with:

Eilish McCann, PhD</strong> Director, Outcomes Research (Center for Observational and Real-World Evidence) Merck

Dr. Eilish McCann

Eilish McCann, PhD
Director, Outcomes Research (Center for Observational and Real-World Evidence)
Merck

MedicalResearch.com: What is the background for this study?

Response: One of the most pressing challenges facing medicine today is the emergence of bacterial resistance to antibiotics. One area of high concern is the increasing prevalence of resistance to powerful antibiotics like carbapenems, as patients with infections due to carbapenem-resistant bacteria have very few alternate effective treatment options.

In this study we used real-world data from a Becton, Dickinson and Company electronic research data set to analyze over 140,000 bacterial isolates from patients at 342 hospitals across the United States, so that we could investigate where the burden of carbapenem resistance is most acute. Importantly analysis of real-world data in this way allows us to gain insights from a large number of hospitals, giving a broad and nationally representative picture of the resistance burden.

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Risk Factors for Unplanned Transfer to the ICU after ED Admission

MedicalResearch.com Interview with:
Marleen Boerma MD
Department of Emergency Medicine
Elisabeth-Tweesteden Hospital
Tilburg, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24 hours after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED.

This study shows that there were significantly more hypercapnia patients in the ICU admission group (n=17) compared to the non-ICU group (n=5)(p=0.028). There were significantly greater rates of tachypnea in septic patients (p=0.022) and low oxygen saturation for patients with pneumonia (p=0.045). The level of documentation of respiratory rate was poor.

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Expensive Intensive Care Units Often Overutilized

MedicalResearch.com Interview with:

Dr. Dong W. Chang, MD MS</strong> Division of Respiratory and Critical Care Physiology and Medicine Los Angeles Biomed Research Institute at Harbor-University of California Los Angeles, Medical Center Torrance California

Dr. Dong Chang

Dr. Dong W. Chang, MD MS
Division of Respiratory and Critical Care Physiology and Medicine
Los Angeles Biomed Research Institute at Harbor-University of California
Los Angeles, Medical Center
Torrance California

MedicalResearch.com: What is the background for this study?

Response: The study was based on our overall impression that ICU care is often delivered to patients who are unlikely to derive long-term benefit (based on their co-morbidities/severity of illness, etc.). However, what surprised us was the magnitude of this problem. Our study found more than half the patients in ICU at a major metropolitan acute-care hospital could have been cared for in less expensive and invasive settings.

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ICU Care May Lead To More Tests and Costs Without Necessarily Better Outcomes

MedicalResearch.com Interview with:
Dong W. Chang, MD, MS

Dong W. Chang, MD, is a lead researcher at LA BioMed, one of the nation’s leading independent nonprofit research institutes. His research interests include improving the delivery of care to patients with a focus on identifying new healthcare models for reducing hospital re-admission. He also is the director of Medical-Respiratory ICU at Harbor-UCLA Medical Center in Torrance

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: With the use of intensive care units (ICUs) on the rise in many hospitals, researchers at LA BioMed and UCLA examined ICU usage. They found patients who were admitted to these units underwent more costly and invasive procedures but didn’t have better mortality rates than hospitalized patients with the same medical conditions who weren’t admitted to the ICU.

The study, published in JAMA Internal Medicine, examined records from 156,842 hospitalizations at 94 acute care hospitals for four medical conditions where ICU care is frequently provided but may not be medically necessary:diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal hemorrhage and congestive heart failure. The study found the hospitals that utilize ICUs more frequently were more likely to perform invasive procedures and incur higher costs. But the study found these hospitals had no improvement in mortality among patients in the ICU when compared with other hospitalized patients with these four conditions.

Smaller hospitals and teaching hospitals used ICUs at higher rates for patients with the four conditions studied that did larger hospitals. The difference in the average costs ranged from $647 more for upper gastrointestinal hemorrhage care in the ICU to $3,412 more to care for a patient with congestive heart failure in the ICU when compared with hospital care for the same conditions outside the ICU.

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Standardized Approach Markedly Reduces Cardiac Monitor Alarms

Christopher E. Dandoy, MD, MSc Divisions of Bone Marrow Transplantation and Immunodeficiency, and James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical CenterMedicalResearch.com Interview with:
Christopher E. Dandoy
, MD, MSc
Divisions of Bone Marrow Transplantation and Immunodeficiency, and
James M. Anderson Center for Health Systems Excellence
Cincinnati Children’s Hospital Medical Center

MedicalResearch.com Editor’s Note: Dr. Dandoy discusses a novel program to reduce the frequency of cardiac alarms in the setting of a large inpatient intensive care unit.

Medical Research: What is the background for this study? Why did you decide to do this study?

Dr. Dandoy: During our three month investigation period we had roughly a million alarms go off in our intensive care unit. Our unit nurses reported spending 30-40 minutes per day responding to the various alarms.

We first looked to see if there were established guidelines in the literature for cardiac monitors and found there were none. The alarms were a source of frustration and anxiety not just for the unit staff but also for patients and family members.

Medical Research: What are the elements of your alarm reduction program?

Dr. Dandoy: The first element was simply to have a plan or a process for initial ordering of monitor parameters based on age-appropriate standards. In our case, we established a standard order set in Epic, our electronic records program.

Epic Cardiac Monitor Order Set Epic Cardiac Monitor Order Set

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Do Arterial Catheters Improve ICU Patient Care?

Hayley Gershengorn MD Assistant Professor, Department of Medicine (Critical Care) Assistant Professor, The Saul R. Korey Department of Neurology Albert Einstein College of Medicine Bronx, NY 10461MedicalResearch.com Interview with:
Hayley Gershengorn MD
Assistant Professor, Department of Medicine (Critical Care)
Assistant Professor, The Saul R. Korey Department of Neurology
Albert Einstein College of Medicine
Bronx, NY 10461

Medical Research:  What are the main findings of the study?

Dr. Gershengorn: Using a large national database, we found there to be no association between the use of arterial catheters and mortality in mechanically ventilated medical intensive care unit patients. Similarly, we found no beneficial association between arterial catheters and mortality in any of the eight other critically ill subgroups evaluated.
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Calorific controversy for intensive care patients

Patients who are fed more calories while in intensive care have lower mortality rates than those who receive less of their daily-prescribed calories, according to a recent study of data from the largest critical care nutrition database in the world.

“Our finding is significant as there have been a number of previous studies in the area of critical care nutrition that have produced conflicting clinical recommendations and policy implications,” says study lead Daren Heyland, a professor of Medicine at Queen’s, director of the Clinical Evaluation Research Unit at Kingston General Hospital, and scientific director of the proposed Technology Evaluation in the Elderly Network. “Since caloric delivery is essential for improving the chances of these critically ill patients, it’s vital that we know what the optimal level is.”

Dr. Heyland’s team examined the records of 7872 mechanically ventilated, artificially fed patients in 352 ICUs in 33 countries. They found that patients receiving at least two-thirds of their prescribed calorie intake had reduced mortality rates when compared with patients receiving less than one-third of their prescribed calorie intake. The researchers identified that the optimal caloric intake was about 80 to 85 per cent of total prescribed calorie intake.

World-wide, patients in ICUs typically receive 50 to 60 per cent of their prescribed calories so efforts to improve caloric delivery are important to improve the chances of critically ill patients surviving their illness.

In a further study, Dr Heyland and his research team examined the use of supplemental intravenous nutrition, in addition to the traditional use of feeding tubes. They concluded that efforts to improve the delivery of nutrition delivered via a feeding tube into the stomach are more important than the use of supplemental intravenous nutrition.

These respective findings were both recently published in Critical Care Medicine, a leading US-based ICU journal.