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1.  WSES guidelines for management of Clostridium difficile infection in surgical patients 
Sartelli, Massimo | Malangoni, Mark A. | Abu-Zidan, Fikri M. | Griffiths, Ewen A. | Di Bella, Stefano | McFarland, Lynne V. | Eltringham, Ian | Shelat, Vishal G. | Velmahos, George C. | Kelly, Ciarán P. | Khanna, Sahil | Abdelsattar, Zaid M. | Alrahmani, Layan | Ansaloni, Luca | Augustin, Goran | Bala, Miklosh | Barbut, Frédéric | Ben-Ishay, Offir | Bhangu, Aneel | Biffl, Walter L. | Brecher, Stephen M. | Camacho-Ortiz, Adrián | Caínzos, Miguel A. | Canterbury, Laura A. | Catena, Fausto | Chan, Shirley | Cherry-Bukowiec, Jill R. | Clanton, Jesse | Coccolini, Federico | Cocuz, Maria Elena | Coimbra, Raul | Cook, Charles H. | Cui, Yunfeng | Czepiel, Jacek | Das, Koray | Demetrashvili, Zaza | Di Carlo, Isidoro | Di Saverio, Salomone | Dumitru, Irina Magdalena | Eckert, Catherine | Eckmann, Christian | Eiland, Edward H. | Enani, Mushira Abdulaziz | Faro, Mario | Ferrada, Paula | Forrester, Joseph Derek | Fraga, Gustavo P. | Frossard, Jean Louis | Galeiras, Rita | Ghnnam, Wagih | Gomes, Carlos Augusto | Gorrepati, Venkata | Ahmed, Mohamed Hassan | Herzog, Torsten | Humphrey, Felicia | Kim, Jae Il | Isik, Arda | Ivatury, Rao | Lee, Yeong Yeh | Juang, Paul | Furuya-Kanamori, Luis | Karamarkovic, Aleksandar | Kim, Peter K | Kluger, Yoram | Ko, Wen Chien | LaBarbera, Francis D. | Lee, Jae Gil | Leppaniemi, Ari | Lohsiriwat, Varut | Marwah, Sanjay | Mazuski, John E. | Metan, Gokhan | Moore, Ernest E. | Moore, Frederick Alan | Nord, Carl Erik | Ordoñez, Carlos A. | Júnior, Gerson Alves Pereira | Petrosillo, Nicola | Portela, Francisco | Puri, Basant K. | Ray, Arnab | Raza, Mansoor | Rems, Miran | Sakakushev, Boris E. | Sganga, Gabriele | Spigaglia, Patrizia | Stewart, David B. | Tattevin, Pierre | Timsit, Jean Francois | To, Kathleen B. | Tranà, Cristian | Uhl, Waldemar | Urbánek, Libor | van Goor, Harry | Vassallo, Angela | Zahar, Jean Ralph | Caproli, Emanuele | Viale, Pierluigi
In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.
PMCID: PMC4545872  PMID: 26300956
2.  Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators' survey 
Critical Care  2013;17(6):R289.
Although fever and hypothermia are common abnormal physical signs observed in patients admitted to intensive care units (ICU), little data exist on their optimal management. The objective of this study was to describe contemporary practices and determinants of management of temperature abnormalities among patients admitted to ICUs.
Site leaders of the multi-national EUROBACT study were surveyed regarding diagnosis and management of temperature abnormalities among patients admitted to their ICUs.
Of the 162 ICUs originally included in EUROBACT, responses were received from 139 (86%) centers in 23 countries in Europe (117), South America (8), Asia (5), North America (4), Australia (3) and Africa (2). A total of 117 (84%) respondents reported use of a specific temperature threshold in their ICU to define fever. A total of 14 different discrete levels were reported with a median of 38.2°C (inter-quartile range, IQR, 38.0°C to 38.5°C). The use of thermometers was protocolized in 91 (65%) ICUs and a wide range of methods were reportedly used, with axillary, tympanic and urinary bladder sites as the most common as primary modalities. Only 31 (22%) of respondents indicated that there was a formal written protocol for temperature control among febrile patients in their ICUs. In most or all cases practice was to control temperature, to use acetaminophen, and to perform a full septic workup in febrile patients and that this was usually directed by physician order. While reported practice was to treat nearly all patients with neurological impairment and most patients with acute coronary syndromes and infections, severe sepsis and septic shock, this was not the case for most patients with liver failure and fever.
A wide range of definitions and management practices were reported regarding temperature abnormalities in the critically ill. Documenting temperature abnormality management practices, including variability in clinical care, is important to inform planning of future studies designed to optimize infection and temperature management strategies in the critically ill.
PMCID: PMC4057370  PMID: 24326145
Fever; hypothermia; intensive care unit; sepsis; septic shock; bacteremia
3.  Mortality associated with timing of admission to and discharge from ICU: a retrospective cohort study 
Although the association between mortality and admission to intensive care units (ICU) in the "after hours" (weekends and nights) has been the topic of extensive investigation, the timing of discharge from ICU and outcome has been less well investigated. The objective of this study was to assess effect of timing of admission to and discharge from ICUs and subsequent risk for death.
Adults (≥18 years) admitted to French ICUs participating in Outcomerea between January 2006 and November 2010 were included.
Among the 7,380 patients included, 61% (4,481) were male, the median age was 62 (IQR, 49-75) years, and the median SAPS II score was 40 (IQR, 28-56). Admissions to ICU occurred during weekends (Saturday and Sunday) in 1,708 (23%) cases, during the night (18:00-07:59) in 3,855 (52%), and on nights and/or weekends in 4,659 (63%) cases. Among 5,992 survivors to ICU discharge, 903 (15%) were discharged on weekends, 659 (11%) at night, and 1,434 (24%) on nights and/or weekends. After controlling for a number of co-variates using logistic regression analysis, admission during the after hours was not associated with an increased risk for death. However, patients discharged from ICU on nights were at higher adjusted risk (odds ratio, 1.54; 95% confidence interval, 1.12-2.11) for death.
In this study, ICU discharge at night but not admission was associated with a significant increased risk for death. Further studies are needed to examine whether minimizing night time discharges from ICU may improve outcome.
PMCID: PMC3269385  PMID: 22115194
4.  Quality of life in patients aged 80 or over after ICU discharge 
Critical Care  2010;14(1):R2.
Our objective was to describe self-sufficiency and quality of life one year after intensive care unit (ICU) discharge of patients aged 80 years or over.
We performed a prospective observational study in a medical-surgical ICU in a tertiary non-university hospital. We included patients aged 80 or over at ICU admission in 2005 or 2006 and we recorded age, admission diagnosis, intensity of care, and severity of acute and chronic illnesses, as well as ICU, hospital, and one-year mortality rates. Self-sufficiency (Katz Index of Activities of Daily Living) was assessed at ICU admission and one year after ICU discharge. Quality of life (WHO-QOL OLD and WHO-QOL BREF) was assessed one year after ICU discharge.
Of the 115 consecutive patients aged 80 or over (18.2% of admitted patients), 106 were included. Mean age was 84 ± 3 years (range, 80 to 92). Mortality was 40/106 (37%) at ICU discharge, 48/106 (45.2%) at hospital discharge, and 73/106 (68.9%) one year after ICU discharge. In the 23 patients evaluated after one year, self-sufficiency was unchanged compared to the pre-admission status. Quality of life evaluations after one year showed that physical health, sensory abilities, self-sufficiency, and social participation had slightly worse ratings than the other domains, whereas social relationships, environment, and fear of death and dying had the best ratings. Compared to an age- and sex-matched sample of the general population, our cohort had better ratings for psychological health, social relationships, and environment, less fear of death and dying, better expectations about past, present, and future activities and better intimacy (friendship and love).
Among patients aged 80 or over who were selected at ICU admission, 80% were self-sufficient for activities of daily living one year after ICU discharge, 31% were alive, with no change in self-sufficiency and with similar quality of life to that of the general population matched on age and sex. However, these results must be interpreted cautiously due to the small sample of survivors.
PMCID: PMC2875504  PMID: 20064197
5.  Model for predicting short-term mortality of severe sepsis 
Critical Care  2009;13(3):R72.
To establish a prognostic model for predicting 14-day mortality in ICU patients with severe sepsis overall and according to place of infection acquisition and to sepsis episode number.
In this prospective multicentre observational study on a multicentre database (OUTCOMEREA) including data from 12 ICUs, 2268 patients with 2737 episodes of severe sepsis were randomly divided into a training cohort (n = 1458) and a validation cohort (n = 810). Up to four consecutive severe sepsis episodes per patient occurring within the first 28 ICU days were included. We developed a prognostic model for predicting death within 14 days after each episode, based on patient data available at sepsis onset.
Independent predictors of death were logistic organ dysfunction (odds ratio (OR), 1.22 per point, P < 10-4), septic shock (OR, 1.40; P = 0.01), rank of severe sepsis episode (1 reference, 2: OR, 1.26; P = 0.10 ≥ 3: OR, 2.64; P < 10-3), multiple sources of infection (OR; 1.45, P = 0.03), simplified acute physiology score II (OR, 1.02 per point; P < 10-4), McCabe score ([greater than or equal to]2) (OR, 1.96; P < 10-4), and number of chronic co-morbidities (1: OR, 1.75; P < 10-3, ≥ 2: OR, 2.24, P < 10-3). Validity of the model was good in whole cohorts (AUC-ROC, 0.76; 95%CI, 0.74 to 0.79; and HL Chi-square: 15.3 (P = 0.06) for all episodes pooled).
In ICU patients, a prognostic model based on a few easily obtained variables is effective in predicting death within 14 days after the first to fourth episode of severe sepsis complicating community-, hospital-, or ICU-acquired infection.
PMCID: PMC2717433  PMID: 19454002

Results 1-5 (5)