[Show abstract][Hide abstract] ABSTRACT: Patients who suffer from a ventilator-associated pneumonia (VAP) are ventilated longer, stay longer in the ICU and in hospital and therefore lead to higher costs. Despite the therapeutic potential of the VAP nowadays there is about 10% additional mortality observed. Although the clinical VAP diagnosis is limited (sensitivity/specificity) rapid diagnosis promotes treatment (calculated antibiotic therapy) and improves the survival rate. And in the course the review of the VAP diagnosis of unnecessary antibiotics reduces the resistance development in that area and also the selection pressure.
[Show abstract][Hide abstract] ABSTRACT: Impact of gender on severe infections is in highly controversial discussion with natural survival advantage of females described in animal studies but contradictory to those described human data. This study aims to describe the impact of gender on outcome in mixed intensive care units (ICUs) with a special focus on sepsis.
We performed a prospective, observational, clinical trial at Charité University Hospital in Berlin, Germany. Over a period of 180 days, patients were screened, undergoing care in three mainly surgical ICUs. In total, 709 adults were included in the analysis, comprising the main population ([female] n = 309, [male] n = 400) including 327 as the sepsis subgroup ([female] n = 130, [male] n = 197).
Basic characteristics differed between genders in terms of age, lifestyle factors, comorbidities, and SOFA-score (Sequential Organ Failure Assessment). Quality and quantity of antibiotic therapy in means of antibiotic-free days, daily antibiotic use, daily costs of antibiotics, time to antibiotics, and guideline adherence did not differ between genders. ICU mortality was comparable in the main population ([female] 10.7% versus [male] 9.0%; P = 0.523), but differed significantly in sepsis patients with [female] 23.1% versus [male] 13.7% (P = 0.037). This was confirmed in multivariate regression analysis with OR = 1.966 (95% CI, 1.045 to 3.701; P = 0.036) for females compared with males.
No differences in patients' outcome were noted related to gender aspects in mainly surgical ICUs. However, for patients with sepsis, an increase of mortality is related to the female sex.
[Show abstract][Hide abstract] ABSTRACT: Computer-assisted decision support systems (CDSS) are designed to improve infection management. The aim of this prospective, clinical pre- and post-intervention study was to investigate the influence of CDSS on infection management of severe sepsis and septic shock in intensive care units (ICUs). Data were collected for a total of 180 days during two study periods in 2006 and 2007. Of the 186 patients with severe sepsis or septic shock, 62 were stratified into a low adherence to infection management standards group (LAG) and 124 were stratified into a high adherence group (HAG). ICU mortality was significantly increased in LAG versus HAG patients (Kaplan-Meier analysis). Following CDSS implementation, adherence to standards increased significantly by 35%, paralleled with improved diagnostics, more antibiotic-free days and a shortened time until antibiotics were administered. In conclusion, adherence to infection standards is beneficial for patients with severe sepsis or septic shock and CDSS is a useful tool to aid adherence.
The Journal of international medical research 10/2010; 38(5):1605-16. DOI:10.1177/147323001003800505 · 1.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: National and international evidence based recommendations for anti-infective therapies in the intensive care unit are difficult to implement into daily clinical work. However, adequate and early applications of anti-infective therapies are important outcome factors for the clinical course of severe infections. With support of the German Society of Anaesthesiology and Intensive Care Medicine and the Association of German Anaesthesiologists (DGAI/BDA) a web based anti-infective program was developed to address these issues. The program includes interdisciplinary consented evidence based algorithms to help with immediate diagnostics and initial anti-infective therapies. Currently, with the title "ABx local" a subproject is launched to broaden program functions. It unifies current evidence based recommendations and local internal standards or comments on one platform to achieve priority of therapy options e.g. based on resistance patterns.
[Show abstract][Hide abstract] ABSTRACT: Rising numbers of nosocomial infections, increasing antibiotic resistance and limited development of new anti-infective agents demand rational use of antibiotics; the success of intensive care treatment is significantly connected with the success of treatment of infection. In recent years there has been a paradigm change concerning anti-infective therapy strategies. Escalation strategies have now been replaced by initial broad spectrum therapy followed by de-escalation. The concept of "never change a winning team" after confirmation of the responsible pathogen or upon clinical improvement of the patient is, however, no longer acceptable. Shorter duration of antibiotic therapy in ventilator-associated pneumonia is not associated with poorer outcome (although eradication can not be achieved) and therefore shorter durations of therapy are now recommended. Early and appropriate antibiotic therapy - avoiding needless antibiotic prescription, and reducing selection pressure and consequently increased bacterial resistance - is associated with improvement in the therapy of nosocomial infections. However, this knowledge is not implemented in daily practice. Therefore, boards of scientific societies and institutions like the EU and WHO are advocating so-called "stewardship programs" for antibiotic therapy. This review highlights a range of new strategies concerning antibiotic treatment and describes a web-based computer program for appropriate antibiotic therapy on intensive care units.
Intensiv- und Notfallbehandlung 01/2009; 34(1):26-35.
[Show abstract][Hide abstract] ABSTRACT: Circulating endothelial progenitor cells (EPCs) actively supply cells that may participate in tumor angiogenesis. The differing effects of low-dose metronomic trofosfamide as opposed to conventional dose-dense chemotherapy on plasma levels of vascular endothelial growth factor (VEGF) and the numbers of circulating EPC are reported. Patients and Methods: Blood samples were obtained from cancer patients, 18 receiving oral metronomic chemotherapy of trofosfamide with or without celecoxib, and 24 receiving conventional dose-dense chemotherapy, eight of them in adjuvant intention. Mononuclear cells were analyzed by flow cytometry for CD34, CD45 and vascular endothelial growth factor-receptor 2 (VEGF-R2) coexpression, defining EPCs, and for plasma levels of VEGF by ELISA at day 0, 10 and 21 of therapy. Results: After conventional dose-dense chemotherapy, the numbers of circulating EPCs and the VEGF plasma concentrations increased sharply, doubling pretherapeutic levels at day 21. In contrast, under low-dose metronomic chemotherapy, the numbers of circulating EPCs decreased significantly and VEGF plasma concentrations remained unchanged. Conclusion: These observations provide evidence that conventional dose-dense chemotherapy leads to rebound EPC mobilization even when given with adjuvant intention, while low-dose metronomic scheduling of cytotoxic substances such as trofosfamide may sharply reduce EPC release into the circulation.
In vivo (Athens, Greece) 11/2008; 22(6):831-6. · 0.97 Impact Factor