Tag Archives: Infection

Dysbiosis Across Multiple Body Sites in Critically Ill Adult Surgical Patients

Current evidence suggests that symbiosis of commensal microflora play a significant role in health and illness. The effect that commensal microflora play in critical care is less well known. Yeh et al set out to assess the dynamics of colonization of critically ill surgical and trauma patients. The authors examined 32 critically ill surgical and trauma patients in a major tertiary care intensive care unit (ICU) and collected information on bacterial colonization at gastrointestinal, tracheal, urinary, oral, and skin sites.

Over the course of the study (and in comparison to healthy controls) colonization in the ICU group showed a decrease in diversity of microflora across multiple sites and a change in colonization from non-pathogenic to pathogenic bacteria.

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Rapid Diagnosis of Infection in the Critically Ill

The rapid diagnosis of infection and early initiation of appropriate antimicrobials is essential to optimizing an intensive care unit patient’s chances of survival. However, current culture-based pathogen identification is slow and unreliable. In contrast, polymerase chain reaction followed by electrospray ionization-mass spectrometry (PCR/ESI-MS) does not depend on the growth of organisms in culture and may offer a distinct advantage over currently available methods. The Rapid Diagnosis of Infections in the Critically Ill (RADICAL) study is a multicenter observational study conducted by Vincent et al, with the aim of comparing results obtained using PCR/ESI-MS technology and standard culture.

The authors found that PCR/ESI-MS provides rapid pathogen identification in critically ill patients.

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The Efficacy of Subglottic Secretion Suctioning

Pneumonia is a common ventilator-associated event (VAE), yet consensus on its definition (it had been traditionally referred to as ventilator-associated pneumonia [VAP]) is lacking. Despite this, many strategies have been shown to decrease its incidence. Damas et al conducted a single-center, randomized controlled trial in Belgium assessing the effect of subglottic secretion suctioning on VAP incidence.

They found that subglottic secretion suctioning resulted in a significant reduction of VAP prevalence. Though we now have consistent evidence showing the benefit of subglottic suctioning, cost analyses touting its worth and guidelines recommending its use, why has the critical care community not adopted this practice more widely?

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