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Qiu J, Zimmet AN, Bell TD, Gadrey S, Brandberg J, Maldonado S, Zimmet AM, Ratcliffe S, Chernyavskiy P, Moorman JR, Clermont G, Henry TR, Nguyen NR, Moore CC. Pathophysiological Responses to Bloodstream Infection in Critically Ill Transplant Recipients Compared With Non-Transplant Recipients. Clin Infect Dis 2024; 78:1011-1021. [PMID: 37889515 DOI: 10.1093/cid/ciad662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Identification of bloodstream infection (BSI) in transplant recipients may be difficult due to immunosuppression. Accordingly, we aimed to compare responses to BSI in critically ill transplant and non-transplant recipients and to modify systemic inflammatory response syndrome (SIRS) criteria for transplant recipients. METHODS We analyzed univariate risks and developed multivariable models of BSI with 27 clinical variables from adult intensive care unit (ICU) patients at the University of Virginia (UVA) and at the University of Pittsburgh (Pitt). We used Bayesian inference to adjust SIRS criteria for transplant recipients. RESULTS We analyzed 38.7 million hourly measurements from 41 725 patients at UVA, including 1897 transplant recipients with 193 episodes of BSI and 53 608 patients at Pitt, including 1614 transplant recipients with 768 episodes of BSI. The univariate responses to BSI were comparable in transplant and non-transplant recipients. The area under the receiver operating characteristic curve (AUC) was 0.82 (95% confidence interval [CI], .80-.83) for the model using all UVA patient data and 0.80 (95% CI, .76-.83) when using only transplant recipient data. The UVA all-patient model had an AUC of 0.77 (95% CI, .76-.79) in non-transplant recipients and 0.75 (95% CI, .71-.79) in transplant recipients at Pitt. The relative importance of the 27 predictors was similar in transplant and non-transplant models. An upper temperature of 37.5°C in SIRS criteria improved reclassification performance in transplant recipients. CONCLUSIONS Critically ill transplant and non-transplant recipients had similar responses to BSI. An upper temperature of 37.5°C in SIRS criteria improved BSI screening in transplant recipients.
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Affiliation(s)
- Jiaxing Qiu
- Department of Medicine, Division of Cardiovascular Diseases, Center for Advanced Medical Analytics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Alex N Zimmet
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Taison D Bell
- Department of Medicine, Division of Pulmonary and Critical Care Medicine and Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Shrirang Gadrey
- Department of Medicine, Division of Hospital Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jackson Brandberg
- Department of Medicine, Division of Cardiovascular Diseases, Center for Advanced Medical Analytics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Samuel Maldonado
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Harvard University School of Medicine, Boston, Massachusetts, USA
| | - Amanda M Zimmet
- Department of Medicine, Division of Cardiovascular Diseases, Center for Advanced Medical Analytics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Sarah Ratcliffe
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Pavel Chernyavskiy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - J Randall Moorman
- Department of Medicine, Division of Cardiovascular Diseases, Center for Advanced Medical Analytics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Gilles Clermont
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Teague R Henry
- Department of Psychology and School of Data Science, University of Virginia, Charlottesville, Virginia, USA
| | - N Rich Nguyen
- Department of Computer Science, University of Virginia School of Engineering, Charlottesville, Virginia, USA
| | - Christopher C Moore
- Department of Medicine, Division of Infectious Diseases and International Health, Center for Advanced Medical Analytics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Menouni O, Brillouet-Banchereau AC, Galan G, Lélias A, Sautereau A, Gadrey S. [Extremely prolonged neuromuscular block after a single dose of rocuronium]. Ann Fr Anesth Reanim 2011; 30:841-843. [PMID: 21983058 DOI: 10.1016/j.annfar.2011.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 07/12/2011] [Indexed: 05/31/2023]
Abstract
Postoperative curarization in patients has been established. Nevertheless, extremely prolonged neuromuscular blockades are rare. We report the case of a prolonged neuromuscular blockade (lasting 10 hours) following a single dose of rocuronium, in an elderly patient with severe renal failure. We have studied the possible causes of prolonged curarization, and discussed the interest of the use of sugammadex in such cases.
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Affiliation(s)
- O Menouni
- Service d'anesthésie, hôpitaux de Bordeaux, CHU de Bordeaux, 12, rue Dubernat, 33404 Talence, France.
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