IIème Journée de Formation en antibiothérapie
Antibiothérapie et Résistance
Le JEUDI 6 Décembre 2012
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La date limite de dépot du dossier est le 30 novembre 2012.
Outcome of ICU patients with Clostridium difficile infection
Critical Care 2012, 16:R215 doi:10.1186/cc11852
Published: 5 November 2012Introduction: As data from Clostridium difficile infection (CDI) in intensive care unit (ICU) are still scarce, our objectives were to assess the morbidity and mortality of ICU-acquired CDI.
Methods: We compared patients with ICU-acquired CDI (watery or unformed stools occurring > 72 hours after ICU admission with a stool sample positive for C. difficile toxin A or B) with two groups of controls hospitalized at the same time in the same unit. The first control group comprised patients with ICU-acquired diarrhea occurring > 72 hours after ICU admission with a stool sample negative for C. difficile and for toxin A or B. The second group comprised patients without any diarrhea.
Results: Among 5260 patients, 512 patients developed one episode of diarrhea. Among them, 69 (13.5%) had a CDI; 10 (14.5%) of them were community-acquired, contrasting with 12 (17.4%) that were hospital-acquired and 47 (68%) that were ICU-acquired. A pseudomembranous colitis was associated in 24/47 (51%) ICU patients. The median delay between diagnosis and metronidazole administration was one day (25thQ ; 75thQ [0 ; 2] days). The case-fatality rate for patients with ICU-acquired CDI was 10/47 (21.5%), as compared to 112/443 (25.3%) for patients with negative tests. Neither the crude mortality (Cause specific hazard ratio; CSHR = 0.70, 95% confidence interval; CI 0.36 - 1.35, p=0.3) nor the adjusted mortality to confounding variables (CSHR=0.81, 95% CI 0.4-1.64, p=0.6) were significantly different between CDI patients and diarrheic patients without CDI. Compared to the general ICU population, neither the crude mortality (SHR=0.64, 95% CI 0.34-1.21, p=0.17), nor the mortality adjusted to confounding variables (Cause specific hazard ratio (CSHR) =0.71, 95% confidence interval (CI) 0.38 - 1.35, p=0.3), were significantly different between the two groups. The estimated increase in the duration of stay due to CDI was 8.0 days +/- 9.3 days, (p=0.4) in comparison to the diarrheic population, and 6.3 days +/- 4.3 (p=0.14) in comparison to the general ICU population.
Conclusions: If treated early, ICU-acquired CDI is not independently associated with an increased mortality and impacts marginally the ICU length of stay.
Full text available here: http://ccforum.com/content/16/6/R215/abstract
Multiple-center evaluation of mortality associated with acute kidney injury in critically ill patients: a competing risks analysis
Christophe Clec'h , Frederic Gonzalez, Alexandre Lautrette, Moliere Nguile-Makao, Maite Garrouste-Orgeas, Samir Jamali, Dany Goldgran-Toledano, Adrien Descorps-Declere, Frank Chemouni, Rebecca Hamidfar-Roy, Elie Azoulay and Jean-Francois Timsit
Critical Care 2011, 15:R128doi:10.1186/cc10241
Introduction: To assess the association between acute kidney injury (AKI) and mortality in critically ill patients using an original competing risks approach.Methods : Unselected patients admitted between 1997 and 2009 to 13 French medical or surgical intensive care units were included in this observational, cohort study. AKI was defined according to the RIFLE criteria. The following data were recorded: baseline characteristics, daily serum creatinine, daily Sequential Organ Failure Assessment (SOFA) score, vital status at hospital discharge, and lengths of stays. Patients were classified according to the maximum RIFLE class reached during the ICU stay. The association of AKI with hospital mortality considering "discharge alive" as a competing event was assessed through the Fine and Gray model.
Results : Of the 8639 study patients, 32.9% had AKI, of whom 19.1% received renal replacement therapy. Patients with AKI had higher crude mortality rates and longer lengths of stays than patients without AKI. In the Fine and Gray model, independent risk factors for hospital mortality were: RIFLE classes Risk (sub-hazard ratio -SHR-: 1.58; 95% confidence interval -CI-: 1.32-1.88; p < 0.0001), Injury (SHR: 3.99; 95% CI: 3.43-4.65; p < 0.0001) and Failure (SHR: 4.12; 95% CI: 3.55-4.79; p < 0.0001), non-renal SOFA score (SHR: 1.19 per point; 95% CI: 1.18-1.21; p < 0.0001), class 3 of Mc Cabe (SHR: 2.71; 95% CI: 2.34-3.15; p < 0.0001), and respiratory failure (SHR: 3.08; 95% CI: 1.36-7.01; p < 0.01).
Conclusions : By using a competing risks approach, this study confirms that AKI affecting critically ill patients is associated with increased hospital mortality.
Réalpes a organisé une réunion intitulée: Insuffisance Rénale Aiguë le Jeudi 16 juin 2011
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