Publications by authors named "Nseir S"
Invasive fungal infections during extracorporeal membrane oxygenation.
Intensive Care Med
December 2024
Objectives: A post hoc analysis used pooled STRIVE/ReSTORE trial data to determine outcomes with rezafungin versus caspofungin by Candida species and antifungal susceptibility.
Methods: The efficacy and safety of once weekly rezafungin 400/200 mg versus once daily caspofungin 70/50 mg was demonstrated in the randomized, double-blind phase 2 STRIVE (NCT02734862) and phase 3 ReSTORE (NCT03667690) trials involving adults with candidaemia and/or invasive candidiasis. In this analysis, data were pooled for patients with a documented Candida infection within 96 hours of randomization who also received ≥1 dose of study drug.
Alpha-1 antitrypsin (A1AT) is the major circulating serine protease inhibitor. Hypersialylated glycoforms (HSG) are produced to boost A1AT anti-inflammatory and anti-protease properties. Their occurrence and prognostic impact outside severe COVID-19 or community-acquired pneumonia are unknown.
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- - The study investigates how intestinal colonization with multidrug-resistant Enterobacterales (MDRE-IC) affects the risk of bloodstream infections (nE-BSI) in hospitalized patients, finding that MDRE-IC significantly increases this risk.
- - Conducted at a large hospital in 2019, the research involved over 7000 patients, with 11.9% found to have MDRE-IC; those colonized had a higher incidence of nE-BSI compared to non-colonized patients.
- - The results highlight the importance of improving infection control and antibiotic use strategies in hospitals to reduce the risk of bloodstream infections related to MDRE colonization.
Background: Rezafungin is an echinocandin approved in the US and EU to treat candidaemia and/or invasive candidiasis. This post-hoc, pooled analysis of the Phase 2 STRIVE and Phase 3 ReSTORE trials assessed rezafungin versus caspofungin in patients with candidaemia and/or invasive candidiasis (IC) in the intensive care unit (ICU) at randomisation.
Methods: STRIVE and ReSTORE were randomised double-blind trials in adults with systemic signs and mycological confirmation of candidaemia and/or IC in blood or a normally sterile site ≤ 96 h before randomisation.
Article Synopsis
- - The study analyzed 79 patients with severe tuberculosis-related ARDS who received ECMO treatment at 20 centers worldwide, focusing on their 90-day survival rates and related complications.
- - Results showed that 51% of patients survived for 90 days, with significant complications including major bleeding and infections; miliary TB patients had a notably higher survival rate than those with cavitary TB.
- - Factors like older age, drug-resistant TB, and higher pre-ECMO SOFA scores were identified as key predictors of mortality, suggesting that ECMO could be a valuable intervention for patients with TB-induced ARDS.
Article Synopsis
- The study aimed to investigate whether there is a relationship between microaspiration of secretions and ventilator-associated events (VAE) in intubated patients.
- Data was collected from 261 patients, with only 31 developing VAE; statistical analysis found no significant links between microaspiration and VAE incidence.
- The findings suggest that measuring microaspiration in critically ill intubated patients may not be a reliable method for predicting VAE outcomes.
Severe acute respiratory infections, such as community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia, constitute frequent and lethal pulmonary infections in the intensive care unit (ICU). Despite optimal management with early appropriate empiric antimicrobial therapy and adequate supportive care, mortality remains high, in part attributable to the aging, growing number of comorbidities, and rising rates of multidrug resistance pathogens. Biomarkers have the potential to offer additional information that may further improve the management and outcome of pulmonary infections.
View Article and Find Full Text PDFBackground: Critical-illness survivors may experience post-traumatic stress disorder (PTSD) and quality-of-life impairments. Resilience may protect against psychological trauma but has not been adequately studied after critical illness. We assessed resilience and its associations with PTSD and quality of life, and also identified factors associated with greater resilience.
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- - Drug poisoning often results in patients needing intensive care, where complications like aspiration can occur, leading to serious health risks like bacterial pneumonia or pneumonitis.
- - This study evaluated how well the IDSA and BTS criteria differentiate between bacterial aspiration pneumonia (BAP) and aspiration pneumonitis (AP) in comatose patients on ventilation due to drug poisoning, using data from 95 patients at Lille University Hospital.
- - The findings showed that both criteria had low sensitivity and specificity for identifying bacterial complications, with IDSA having 62% sensitivity and 33% specificity, and BTS having 50% sensitivity and 38% specificity.
Background: Immunosuppression at intensive care unit (ICU) admission has been associated with a higher incidence of ICU-acquired infections, some of them related to opportunistic pathogens. However, the association of immunosuppression with the incidence, microbiology and outcomes of ICU-acquired bacterial bloodstream infections (BSI) has not been thoroughly investigated.
Methods: Retrospective single-centered cohort study in France.
Severe community-acquired pneumonia (sCAP) remains one of the leading causes of admission to the intensive care unit, thus consuming a large share of resources and is associated with high mortality rates worldwide. The evidence generated by clinical studies in the last decade was translated into recommendations according to the first published guidelines focusing on severe community-acquired pneumonia. Despite the advances proposed by the present guidelines, several challenges preclude the prompt implementation of these diagnostic and therapeutic measures.
View Article and Find Full Text PDFPurpose: The effect of renal replacement therapy (RRT) in comatose patients with acute kidney injury (AKI) remains unclear. We compared two RRT initiation strategies on the probability of awakening in comatose patients with severe AKI.
Methods: We conducted a post hoc analysis of a trial comparing two delayed RRT initiation strategies in patients with severe AKI.
Immunocompromised patients account for an increasing proportion of the typical intensive care unit (ICU) case-mix. Because of the increased availability of new drugs for cancer and auto-immune diseases, and improvement in the care of the most severely immunocompromised ICU patients (including those with hematologic malignancies), critically ill immunocompromised patients form a highly heterogeneous patient population. Furthermore, a large number of ICU patients with no apparent immunosuppression also harbor underlying conditions altering their immune response, or develop ICU-acquired immune deficiencies as a result of sepsis, trauma or major surgery.
View Article and Find Full Text PDFNational and international guidelines were recently published regarding the treatment of Enterobacteriaceae resistant to third-generation cephalosporins infections. We aimed to assess the implementation of the French guidelines in critically ill patients suffering from extended-spectrum β-lactamase-producing Enterobacteriaceae bloodstream infection (ESBL-E BSI). We conducted a retrospective observational cohort study in the ICU of three French hospitals.
View Article and Find Full Text PDFTo evaluate parental reports of postoperative pain, improvement and satisfaction following frenectomy with scalpel versus carbon dioxide (CO) laser treatment. Forty-nine patients aged 2-6 years with a short labial or lingual frenulum who required frenectomy were randomly assigned to undergo CO laser or scalpel treatment. They were divided into a labial and a lingual frenulum group based on the severity of attachment.
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- Endomyocardial biopsy (EMB) is important for diagnosing fulminant myocarditis in adults, but its timing and effects on patient outcomes are still being studied.
- In a study involving 419 patients across 36 centers, those who had an early EMB (within 2 days of ICU admission) showed significantly better survival rates (63%) without needing heart transplants or LVAD compared to those with delayed EMB (40%).
- The research suggests that early EMB is associated with lower mortality rates and better overall outcomes, supporting its prompt use in ICU patients suspected of having fulminant myocarditis.
Purpose: Lower respiratory tract infections (LRTI) are the most frequent infectious complication in patients admitted to the intensive care unit (ICU). We aim to report the clinical characteristics of ICU-admitted patients due to nosocomial LRTI and to describe their microbiology and clinical outcomes.
Methods: A prospective observational study was conducted in 13 countries over two continents from 9th May 2016 until 16th August 2019.
Article Synopsis
- Many ICU-acquired infections are caused by multidrug-resistant bacteria (MDR), leading to higher mortality rates and longer stays in the ICU, especially for COVID-19 patients.
- Although there is some research on the link between COVID-19 and MDR infections, few studies have effectively compared these cases with non-COVID-19 patients.
- The higher incidence of MDR infections in COVID-19 patients may be due to factors like longer ICU stays, immunomodulatory treatments, and increased strain on healthcare resources during the pandemic.