Tae W. Chong

Cost of Gram-negative resistance*

Objective: It is unclear that infections with Gram‐negative rods resistant to at least one major class of antibiotics (rGNR) have a greater effect on patient morbidity than infections caused by sensitive strains (sGNR). We wished to test the hypothesis that rGNR infections are associated with higher resource utilization. Design: Retrospective observational cohort study of prospectively collected data. Setting: University hospital surgical intensive care unit and ward. Patients: Surgical patients with at least one GNR infection. Measurements: We compared admissions treated for rGNR infection with those with sGNR infections. Primary outcomes were total hospital costs and hospital length of stay. Other outcomes included antibiotic treatment cost, in‐hospital death, and intensive care unit length of stay. After univariate analysis comparing outcomes after rGNR infection with those after sGNR infection, multivariate linear regression models for hospital cost and length of stay were created to account for potential confounders. Main Results: Cost data were available for 604 surgical admissions treated for at least one GNR infection (Centers for Disease Control and Prevention criteria), 137 (23%) of which were rGNR infections. Admissions with rGNR infections were associated with a higher severity of illness at the time of infection (Acute Physiology and Chronic Health Evaluation II score, 17.6 ± 0.6 vs. 13.9 ± 0.3), had higher median hospital costs (

Does the addition of glutamine to enteral feeds affect patient mortality

80,500 vs.

Effect of an intensive care unit rotating empiric antibiotic schedule on the development of hospital-acquired infections on the non-intensive care unit ward.

29,604, p < .0001) and median antibiotic costs (

E2 Quasispecies Specificity of Hepatitis C Virus Association With Allografts Immediately After Liver Transplantation

2,607 vs.

Thoracic aortic endografting is the treatment of choice for elderly patients with thoracic aortic disease

758, p < .0001), and had longer median hospital length of stay (29 vs. 13 days, p < .0001) and median intensive care unit length of stay (13 days vs. 1 day, p < .0001). Infection with rGNR within the first 7 days of admission was independently predictive of increased hospital cost (incremental increase in median hospital cost estimated at

Does body mass index affect infection-related outcomes in the intensive care unit?

11,075; 95% confidence interval,

Reduction in Rates of Methicillin-Resistant Staphylococcus aureus Infection after Introduction of Quarterly Linezolid–Vancomycin Cycling in a Surgical Intensive Care Unit

3,282–

Does prior transfusion worsen outcomes from infection in surgical patients

20,099). Conclusions: Early infection with rGNR is associated with a high economic burden, which is in part related to increased antibiotic utilization compared with infection with sensitive organisms. Efforts to control overuse of antibiotics should be pursued.

HCV Infection of the Transplanted Liver: Changing CD81 and HVR1 Variants Immediately After Liver Transplantation

Objective:Studies have failed to consistently demonstrate improved survival in intensive care unit (ICU) patients receiving immune-modulating nutrient-enhanced enteral feeds when compared with standard enteral feeds. The objective was to study in a prospective fashion the effects of adding glutamine to standard or immune-modulated (supplemented with omega-3 fatty acids, β-carotene, and amino acids such as glutamine and arginine) tube feeds. Design:Prospective, unblinded study using sequential allocation. Setting:A university surgical trauma ICU. Patients:All surgical and trauma patients admitted to the surgical trauma ICU at a university hospital over a 3-yr period who were to receive enteral feeds (n = 185). Interventions:Sequential assignment to three isocaloric, isonitrogenous diets was performed as follows: standard 1-kcal/mL feeds with added protein (group 1), standard feeds with the addition of 20–40 g/day (0.6 g/kg/day) glutamine (group 2), or an immune-modulated formula with similar addition of glutamine (group 3). The goal for all patients was 25–30 kcal/kg/day and 2 g/kg/day protein. Measurements and Main Results:Patients were followed until discharge from the hospital. The primary end point was in-hospital mortality, and multiple secondary end points were recorded. In-hospital mortality for group 1 was 6.3% (four of 64) vs. 16.9% (ten of 59, p = .09) for group 2 and 16.1% (ten of 62, p = .09) for group 3. After controlling for age and severity of illness, the difference in mortality between patients receiving standard tube feeds and all patients receiving glutamine was not significant (p ≤ .11). There were no statistically significant differences between the groups for secondary end points. Conclusions:The addition of glutamine to standard enteral feeds or to an immunomodulatory formula did not improve outcomes. These findings suggest that enteral glutamine should not be routinely administered to patients with surgical critical illness.

Evolution of face transplant: An argument for a national donor registry

ObjectiveWe have previously shown that a rotating empirical antibiotic schedule could reduce infectious mortality in an intensive care unit (ICU). We hypothesized that this intervention would decrease infectious complications in the non-ICU ward to which these patients were transferred. DesignProspective cohort study. SettingAn ICU and the ward to which the ICU patients were transferred at a university medical center. PatientsAll patients treated on the general, transplant, or trauma surgery services who developed hospital-acquired infection while on the non-ICU wards. InterventionsA 2-yr study consisting of 1-yr non–protocol-driven antibiotic use and 1-yr quarterly rotating empirical antibiotic assignment for patients treated in the ICU from which a portion of the patients were transferred. Measurements and Main ResultsThere were 2,088 admissions to the non-ICU wards during the nonrotation year and 2,183 during the ICU rotation year. Of these patients, 407 hospital-acquired infections were treated during the nonrotation year and 213 were treated during the ICU rotation (19.7 vs. 9.8 infections/100 admissions, p < .0001). During the ICU rotation year a decrease in the rate of resistant Gram-positive and resistant Gram-negative infections on the non-ICU wards occurred (2.5 vs. 1.6 infections/100 admissions, p = .04; 1.0 vs. 0.4 infections/100 admissions, p = .03). Subgroup analysis revealed that the decrease in resistant infections on the wards was due to a reduction in resistant Gram-positive and resistant Gram-negative infections among non-ICU ward patients admitted initially from areas other than the ICU implementing the antibiotic rotation (e.g., home, other ward, or a different ICU) (1.8 vs. 0.5 infections/100 admissions, p = .0001; 0.7 vs. 0.2 infections/100 admissions, p = .02), not due to differences for those transferred to the ward from the rotation ICU (10.4 vs. 9.7 infections/100 admissions, p = 1.0; 4.3 vs. 1.9 infections/100 admissions, p = .3). No differences in infection-related mortality were detected. ConclusionsAn effective rotating empirical antibiotic schedule in an ICU is associated with a reduction in infectious morbidity (hospital-acquired and resistant hospital-acquired infection rates) on the non-ICU wards to which patients are transferred.