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Sozio E, Pieralli F, Azzini AM, Tintori G, Demma F, Furneri G, Sbrana F, Bertolino G, Fortunato S, Meini S, Bragantini D, Morettini A, Nozzoli C, Menichetti F, Concia E, Tascini C. A prediction rule for early recognition of patients with candidemia in Internal Medicine: results from an Italian, multicentric, case-control study. Infection 2018; 46:625-633. [PMID: 29949088 DOI: 10.1007/s15010-018-1162-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/05/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Increasing prevalence of candidemia in Internal Medicine wards (IMWs) has been reported in recent years, but risk factors for candida bloodstream infection in patients admitted to IMW may differ from those known in other settings. The aim of this study was to identify risk factors and define a prediction rule for the early recognition of the risk of candidemia in IMW inpatients. METHODS This was a multicentric, retrospective, observational case-control study on non-neutropenic patients with candidemia admitted to IMWs of four large Italian Hospitals. Each eligible patient with candidemia (case) was matched to a control with bacteremia. Stepwise logistic regression analyses were performed. RESULTS Overall, 300 patients (150 cases and 150 controls) were enrolled. The following factors were associated with an increased risk of candidemia and weighted to build a score: total parenteral nutrition (OR 2.45, p = 0.008; 1 point); central venous catheter (OR 2.19, p = 0.031; 1 point); peripherally inserted central catheter (OR 5.63, p < 0.0001; 3 points), antibiotic treatment prior (OR 2.06; p = 0.059; 1 point) and during hospitalization (OR2.38, p = 0.033; 1 point); neurological disability (OR 2.25, p = 0.01; 1 point); and previous hospitalization within 3 months (OR 1.56, p = 0.163; 1 point). At ROC curve analysis, a final score ≥ 4 showed 84% sensitivity, 76% specificity, and 80% accuracy in predicting the risk of candidemia. CONCLUSIONS The proposed scoring system showed to be a simple and highly performing tool in distinguishing bloodstream infections due to Candida and bacteria in patients admitted to IMW. The proposed rule might help to reduce delay in empirical treatment and improve appropriateness in antifungal prescription in septic patients.
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Affiliation(s)
- Emanuela Sozio
- Emergency Department, North-West District, Tuscany HealthCare, Spedali Riuniti Livorno, Viale Alfieri 36, 57100, Leghorn, Italy.
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Giancarlo Tintori
- Emergency Medicine Unit, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Federica Demma
- Health Economics and Outcome Research Department-EBMA Consulting, Milan, Italy
| | - Gianluca Furneri
- Health Economics and Outcome Research Department-EBMA Consulting, Milan, Italy
| | | | | | - Simona Fortunato
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Simone Meini
- Department of Internal Medicine, S.M. Annunziata Hospital, Florence, Italy
| | - Damiano Bragantini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Alessandro Morettini
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Ercole Concia
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
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Sahu MK, Das A, Hote MP, Rajashekar P, Sreenivas V, Airan B. Predictors of intra-aortic balloon pump insertion in different spectrum of patients undergoing elective coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0577-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nakahira J, Sawai T, Minami T. Elective Use of Intra-Aortic Balloon Pump During Aortic Valve Replacement in Elderly Patients to Reduce Postoperative Cardiac Complications. Artif Organs 2013; 38:503-7. [DOI: 10.1111/aor.12207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Junko Nakahira
- Department of Anesthesiology; Osaka Medical College; Osaka Japan
| | - Toshiyuki Sawai
- Department of Anesthesiology; Osaka Medical College; Osaka Japan
| | - Toshiaki Minami
- Department of Anesthesiology; Osaka Medical College; Osaka Japan
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Theologou T, Bashir M, Rengarajan A, Khan O, Spyt T, Richens D, Field M. Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev 2011; 2011:CD004472. [PMID: 21249662 PMCID: PMC8094869 DOI: 10.1002/14651858.cd004472.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The intra aortic balloon pump (IABP) is a mechanical assist device which improves cardiac function. The device has a well-established place in algorithms for managing low cardiac output following cardiac surgery. There is increasing evidence that certain cardiac surgery patients benefit from a period of preoperative augmentation with the intra aortic balloon pump. OBJECTIVES To determine the effect of the preoperative intra aortic balloon pump on mortality and morbidity in a number of different patients groups undergoing coronary artery bypass grafting. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 3, 2009), MEDLINE (2000 to August 2009), EMBASE (1998 to August 2009), BIOSIS previews (1969 to August 2009) and ISI Proceedings (1990 to August 2009) were searched. References and ongoing registers of studies were checked. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) of any size or length were included. DATA COLLECTION AND ANALYSIS Papers were assessed for inclusion by two authors independently and differences were settled by consensus with a third author. Date are presented in the form of odds ratios (OR) and 95% confidence intervals (CI). MAIN RESULTS Six trials were included (five on-pump and one off-pump). This update adds the results of one further trial. Data from a total of 255 patients were included in the meta-analysis of mortality outcomes; all on-pump. Generally, the patients were considered as "high risk" and 132 were treated preoperatively with IABP and 123 served as controls. There were four hospital deaths in the intervention arm and 23 in the non-intervention arm (OR 0.18, 95% CI 0.08 to 0.41; P<0.0001). In a subgroup analysis, low cardiac index (<2.0 L/min/m(2)) was noted in 21 out of 105 patients in the treatment arm and 59 patients out of 88 in the non-treatment arm (OR 0.14, 95% CI: 0.08 to 0.25; P<0.00001). An off-pump versus on-pump analysis was not possible due to the limited number of off-pump studies. However a single well-conducted RCT suggested favourable effect of the preoperative IABP in off-pump patients. AUTHORS' CONCLUSIONS Evidence suggests that preoperative IABP may have a beneficial effect on mortality and morbidity in specific high risk patient groups undergoing coronary artery bypass grafting, however there are many problems with the quality, validity and generalisability of the trials. However, the available evidence is not robust enough to extend the use of IABP to truly elective, high risk patients. Defining more precisely which patient groups may benefit would be the challenge for the future.
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Affiliation(s)
- Thomas Theologou
- Department of Cardiothoracic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham, UK, NG5 1PB
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Chang SN, Hwang JJ, Chen YS, Lin JW, Chiang FT. Clinical experience with intra-aortic balloon counterpulsation over 10 years: A retrospective cohort study of 459 patients. Resuscitation 2008; 77:316-24. [DOI: 10.1016/j.resuscitation.2008.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 12/12/2007] [Accepted: 01/06/2008] [Indexed: 10/22/2022]
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