Critical Care 2015

1. Crit Care. 2014 Dec 24;18(6):714. doi: 10.1186/s13054-014-0714-7.

Proton pump inhibitors increase the risk for hospital-acquired Clostridium
difficile infection in critically ill patients.

Barletta JF(1), Sclar DA(2).

Author information: 
(1)Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern
University, 19555 N 59th Avenue, Glendale, AZ, 85308, USA. jbarle@midwestern.edu.
(2)Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern
University, 19555 N 59th Avenue, Glendale, AZ, 85308, USA. dsclar@midwestern.edu.

INTRODUCTION: Proton pump inhibitors (PPI) have been linked to Clostridium
difficile infection (CDI) but there are few data specific to ICU patients. We
evaluated duration of PPI exposure as a potential risk factor for
hospital-acquired CDI in the ICU.
METHODS: This retrospective, case-control study was conducted using the
Multiparameter Intelligent Monitoring in Intensive Care II database, a large
publically available database of more than 35,000 ICU patients. Adult patients
with CDI were identified using the ICD-9 code for Clostridium difficile listed as
a secondary diagnosis. To be included, patients had to be present in an ICU for ≥
48 hours prior to Clostridium difficile acquisition. These patients were then
matched to patients without CDI using the ICD-9 primary diagnosis, age (+/-5
years) and SOFA score (+/-1). Successfully matched patients were reviewed for PPI
exposure and other potential confounding variables for CDI. PPI exposure was
characterized as short (<2 days) or long (≥ 2 days). Multivariate modeling was
performed to identify independent risk factors for CDI.
RESULTS: There were 408 patients evaluated and 81% received a PPI. The percentage
of patients who had a long exposure to PPIs was 83% in the CDI group compared to
73% with controls (P = 0.012). Upon inclusion of the following variables into a
multivariate analysis (long PPI exposure, histamine-2-receptor antagonist
administration, antibiotic administration, immunosuppression and study duration),
long PPI exposure (odds ratio (OR) (95% confidence interval (CI) = 2.03 (1.23 to
3.36), P = 0.006) and antibiotic use (OR (95% CI) = 2.52 (1.23 to 5.18), P =
0.012) were identified as independent predictors of CDI.
CONCLUSIONS: Proton pump inhibitors are independent risk factors for the
development of CDI in ICU patients. This risk is particularly exposed after two
or more days of therapy.

PMCID: PMC4293826
PMID: 25540023  [PubMed - indexed for MEDLINE]


2. Crit Care. 2014 Dec 23;18(6):711. doi: 10.1186/s13054-014-0711-x.

Arterial hyperoxia and mortality in critically ill patients: a systematic review
and meta-analysis.

Damiani E(1), Adrario E(2), Girardis M(3), Romano R(4), Pelaia P(5), Singer M(6),
Donati A(7).

Author information: 
(1)Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and
Public Health, Università Politecnica delle Marche, via Tronto 10, 60126,
Torrette di Ancona, Italy. eli.dam86@alice.it. (2)Anaesthesia and Intensive Care
Unit, Department of Biomedical Sciences and Public Health, Università Politecnica
delle Marche, via Tronto 10, 60126, Torrette di Ancona, Italy.
e.adrario@univpm.it. (3)Department of Anaesthesia and Intensive Care, University
Hospital of Modena, Via del Pozzo 71, 41124, Modena, Italy.
girardis.massimo@unimo.it. (4)Anaesthesia and Intensive Care Unit, Department of
Biomedical Sciences and Public Health, Università Politecnica delle Marche, via
Tronto 10, 60126, Torrette di Ancona, Italy. viboval@yahoo.it. (5)Anaesthesia and
Intensive Care Unit, Department of Biomedical Sciences and Public Health,
Università Politecnica delle Marche, via Tronto 10, 60126, Torrette di Ancona,
Italy. p.pelaia@univpm.it. (6)Bloomsbury Institute of Intensive Care Medicine,
University College London, Gower Street, London, WC1E 6BT, UK.
m.singer@ucl.ac.uk. (7)Anaesthesia and Intensive Care Unit, Department of
Biomedical Sciences and Public Health, Università Politecnica delle Marche, via
Tronto 10, 60126, Torrette di Ancona, Italy. a.donati@univpm.it.

INTRODUCTION: The safety of arterial hyperoxia is under increasing scrutiny. We
performed a systematic review of the literature to determine whether any
association exists between arterial hyperoxia and mortality in critically ill
patient subsets.
METHODS: Medline, Thomson Reuters Web of Science and Scopus databases were
searched from inception to June 2014. Observational or interventional studies
evaluating the relationship between hyperoxia (defined as a supranormal arterial
O2 tension) and mortality in adult intensive care unit (ICU) patients were
included. Studies primarily involving patients with exacerbations of chronic
pulmonary disease, acute lung injury and perioperative administration were
excluded. Adjusted odds ratio (OR) of patients exposed versus those not exposed
to hyperoxia were extracted, if available. Alternatively, unadjusted outcome data
were recorded. Data on patients, study characteristics and the criteria used for
defining hyperoxia exposure were also extracted. Random-effects models were used
for quantitative synthesis of the data, with a primary outcome of hospital
mortality.
RESULTS: In total 17 studies (16 observational, 1 prospective before-after) were
identified in different patient categories: mechanically ventilated ICU (number
of studies (k) = 4, number of participants (n) = 189,143), post-cardiac arrest (k
= 6, n = 19,144), stroke (k = 2, n = 5,537), and traumatic brain injury (k = 5, n
= 7,488). Different criteria were used to define hyperoxia in terms of PaO2 value
(first, highest, worst, mean), time of assessment and predetermined cutoffs. Data
from studies on ICU patients were not pooled because of extreme heterogeneity
(inconsistency (I(2)) 96.73%). Hyperoxia was associated with increased mortality
in post-cardiac arrest patients (OR = 1.42 (1.04 to 1.92) I(2) 67.73%) stroke (OR
= 1.23 (1.06 to 1.43) I(2) 0%) and traumatic brain injury (OR = 1.41 (1.03 to
1.94) I(2) 64.54%). However, these results are limited by significant
heterogeneity between studies.
CONCLUSIONS: Hyperoxia may be associated with increased mortality in patients
with stroke, traumatic brain injury and those resuscitated from cardiac arrest.
However, these results are limited by the high heterogeneity of the included
studies.

PMCID: PMC4298955
PMID: 25532567  [PubMed - indexed for MEDLINE

Diagnostic

None

Review

None

Clinical Prediction Rules

None

Member Login
Welcome, (First Name)!

Forgot? Show
Log In
Enter Member Area
My Profile Sign up to get full access. Log Out