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Article: Bloodstream Infection in the Intensive Care Unit: Evolving Epidemiology and Microbiology.

Munro, Carly / Zilberberg, Marya D / Shorr, Andrew F

2024 Volume 13, Issue 2

Abstract: Bloodstream infections (BSIs) arising in the intensive care unit (ICUs) present a significant challenge and we completed a narrative review of the emerging literature on this issue. Multiple reports document that these infections are associated with ... ...

Abstract	Bloodstream infections (BSIs) arising in the intensive care unit (ICUs) present a significant challenge and we completed a narrative review of the emerging literature on this issue. Multiple reports document that these infections are associated with substantial morbidity and mortality. Also, they can be caused by a variety of pathogens. Generally classified as either community or hospital in onset, or as either primary or secondary in origin, the microbiology of ICU BSIs varies across the globe. Gram-positive pathogens predominate in certain regions such as the United States while Gram-negative organisms occur more frequently in Europe, Asia, and Latin America. The incidence of ICU BSIs climbed during the recent pandemic. BSIs complicating the care of persons suffering from Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection significantly heighten the risk for death compared to patients who develop ICU BSIs but who are not infected with SARS-CoV-2. Furthermore, rates of antimicrobial resistance are generally increasing in ICU BSIs. This fact complicates attempts to ensure that the patient receives initially appropriate antimicrobial therapy and is of particular concern in Methicillin-resistant
Language	English
Publishing date	2024-01-26
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2681345-2
ISSN	2079-6382
ISSN	2079-6382
DOI	10.3390/antibiotics13020123
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Statistics on steroids: How recognizing competing risks gets us closer to the truth about COVID-19-associated VAP.

Shorr, Andrew F / Zilberberg, Marya D

Critical care (London, England)

2022 Volume 26, Issue 1, Page(s) 397

MeSH term(s)	Humans ; COVID-19 ; Pneumonia, Ventilator-Associated ; Risk Factors ; Steroids
Chemical Substances	Steroids
Language	English
Publishing date	2022-12-21
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-022-04264-x
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Zs.A 5517: Show issues

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Article ; Online: Sepsis and Septic Shock: Evolving Evidence, Evolving Paradigms.

Shorr, Andrew F / Zilberberg, Marya D

Seminars in respiratory and critical care medicine

2022 Volume 43, Issue 1, Page(s) 39–45

Abstract: Sepsis and septic shock represent important infection-related medical emergencies that result in significant morbidity and mortality. The prevalence and microbiology of these processes are evolving. Nonetheless, timely and appropriate antibiotic therapy ... ...

Abstract	Sepsis and septic shock represent important infection-related medical emergencies that result in significant morbidity and mortality. The prevalence and microbiology of these processes are evolving. Nonetheless, timely and appropriate antibiotic therapy continues to represent the most important determinant of survival. Recent trials have clarified that crystalloids are preferred for initial resuscitation, and balanced crystalloids appear superior to 0.9% saline. Controversy remains regarding not only the rate and rapidity of fluid resuscitation but also about the timing and use of vasopressors to maintain blood pressure. While some newer alternative vasopressors may have a role in sepsis, more evidence supporting their use is required. Conflicting data exist regarding the impact of corticosteroids on mortality in septic shock. However, these reports indicate that adjunctive hydrocortisone can lead to more rapid shock reversal.
MeSH term(s)	Crystalloid Solutions ; Fluid Therapy ; Humans ; Resuscitation ; Sepsis/drug therapy ; Shock, Septic/drug therapy ; Vasoconstrictor Agents/therapeutic use
Chemical Substances	Crystalloid Solutions ; Vasoconstrictor Agents
Language	English
Publishing date	2022-02-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1183617-9
ISSN	1098-9048 ; 1069-3424
ISSN (online)	1098-9048
ISSN	1069-3424
DOI	10.1055/s-0041-1740975
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Zs.A 1555: Show issues

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Article ; Online: Heeding the Prophetic Call: New Insights Into Nosocomial Pneumonia.

Shorr, Andrew F / Zilberberg, Marya D

Chest

2020 Volume 158, Issue 6, Page(s) 2245–2246

MeSH term(s)	Cross Infection/epidemiology ; Healthcare-Associated Pneumonia ; Humans ; Intensive Care Units ; Pneumonia/diagnosis ; Prospective Studies
Language	English
Publishing date	2020-11-05
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2020.06.057
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Ui III Zs.45: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 349: Show issues

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Article ; Online: Descriptive Epidemiology and Outcomes of Nonventilated Hospital-Acquired, Ventilated Hospital-Acquired, and Ventilator-Associated Bacterial Pneumonia in the United States, 2012-2019.

Zilberberg, Marya D / Nathanson, Brian H / Puzniak, Laura A / Shorr, Andrew F

Critical care medicine

2023 Volume 50, Issue 3, Page(s) 460–468

Abstract: Objectives: Multiple randomized controlled trials exploring the outcomes of patients with ventilator-associated bacterial pneumonia and hospital-acquired bacterial pneumonia have noted that hospital-acquired bacterial pneumonia patients who require ... ...

Abstract	Objectives: Multiple randomized controlled trials exploring the outcomes of patients with ventilator-associated bacterial pneumonia and hospital-acquired bacterial pneumonia have noted that hospital-acquired bacterial pneumonia patients who require subsequent ventilated hospital-acquired bacterial pneumonia suffered higher mortality than either those who did not (nonventilated hospital-acquired bacterial pneumonia) or had ventilator-associated bacterial pneumonia. We examined the epidemiology and outcomes of all three conditions in a large U.S. database. Design: Retrospective cohort. Setting: Two hundred fifty-three acute-care hospitals, United States, contributing data (including microbiology) to Premier database, 2012-2019. Patients: Patients with hospital-acquired bacterial pneumonia or ventilator-associated bacterial pneumonia identified based on a slightly modified previously published International Classification of Diseases, 9th Edition/International Classification of Diseases, 10th Edition-Clinical Modification algorithm. Interventions: None. Measurements and main results: Among 17,819 patients who met enrollment criteria, 26.5% had nonventilated hospital-acquired bacterial pneumonia, 25.6% vHAPB, and 47.9% ventilator-associated bacterial pneumonia. Ventilator-associated bacterial pneumonia predominated in the Northeastern United States and in large urban teaching hospitals. Patients with nonventilated hospital-acquired bacterial pneumonia were oldest (mean 66.7 ± 15.1 yr) and most likely White (76.9%), whereas those with ventilator-associated bacterial pneumonia were youngest (59.7 ± 16.6 yr) and least likely White (70.3%). Ventilated hospital-acquired bacterial pneumonia was associated with the highest comorbidity burden (mean Charlson score 4.1 ± 2.8) and ventilator-associated bacterial pneumonia with the lowest (3.2 ± 2.5). Similarly, hospital mortality was highest among patients with ventilated hospital-acquired bacterial pneumonia (29.2%) and lowest in nonventilated hospital-acquired bacterial pneumonia (11.7%), with ventilator-associated bacterial pneumonia in-between (21.3%). Among survivors, 24.5% of nonventilated hospital-acquired bacterial pneumonia required a rehospitalization within 30 days of discharge, compared with 22.5% among ventilated hospital-acquired bacterial pneumonia and 18.8% ventilator-associated bacterial pneumonia. Unadjusted hospital length of stay after infection onset was longest among ventilator-associated bacterial pneumonia and shortest among nonventilated hospital-acquired bacterial pneumonia patients. Median total hospital costs mirrored length of stay: ventilator-associated bacterial pneumonia $77,657, ventilated hospital-acquired bacterial pneumonia $62,464, and nonventilated hospital-acquired bacterial pneumonia $39,911. Conclusions: Both hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia remain associated with significant mortality and cost in the United States. Our analyses confirm that of all three conditions, ventilated hospital-acquired bacterial pneumonia carries the highest risk of death. In contrast, ventilator-associated bacterial pneumonia remains most costly. Nonventilated hospital-acquired bacterial pneumonia survivors were most likely to require a readmission within 30 days of discharge.
MeSH term(s)	Adult ; Cost of Illness ; Cross Infection/economics ; Cross Infection/epidemiology ; Female ; Healthcare-Associated Pneumonia/economics ; Healthcare-Associated Pneumonia/epidemiology ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Pneumonia, Bacterial/economics ; Pneumonia, Bacterial/epidemiology ; Pneumonia, Ventilator-Associated/economics ; Pneumonia, Ventilator-Associated/epidemiology ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; United States ; Young Adult
Language	English
Publishing date	2023-01-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005298
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Zs.A 1261: Show issues

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ab Jg. 2022: Lesesaal (EG)

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Article: Sepsis and Septic Shock: Evolving Evidence, Evolving Paradigms

Shorr, Andrew F. / Zilberberg, Marya D.

Seminars in Respiratory and Critical Care Medicine

(Life-Threatening Infections: Pulmonary and Systemic Infections)

2022 Volume 43, Issue 01, Page(s) 39–45

Series title	Life-Threatening Infections: Pulmonary and Systemic Infections
Abstract	Sepsis and septic shock represent important infection-related medical emergencies that result in significant morbidity and mortality. The prevalence and microbiology of these processes are evolving. Nonetheless, timely and appropriate antibiotic therapy continues to represent the most important determinant of survival. Recent trials have clarified that crystalloids are preferred for initial resuscitation, and balanced crystalloids appear superior to 0.9% saline. Controversy remains regarding not only the rate and rapidity of fluid resuscitation but also about the timing and use of vasopressors to maintain blood pressure. While some newer alternative vasopressors may have a role in sepsis, more evidence supporting their use is required. Conflicting data exist regarding the impact of corticosteroids on mortality in septic shock. However, these reports indicate that adjunctive hydrocortisone can lead to more rapid shock reversal.
Keywords	antibiotics ; corticosteroids ; fluids ; sepsis ; resuscitation ; vasopressors
Language	English
Publishing date	2022-02-01
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	1183617-9
ISSN	1098-9048 ; 1069-3424
ISSN (online)	1098-9048
ISSN	1069-3424
DOI	10.1055/s-0041-1740975
Database	Thieme publisher's database

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Zs.A 1555: Show issues

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Article ; Online: Novelty and nuance in the intensive care unit: new options to combat multidrug resistant pneumonia.

Shorr, Andrew F / Zilberberg, Marya D

Current opinion in infectious diseases

2020 Volume 34, Issue 2, Page(s) 151–155

Abstract: Purpose of review: To describe the increasing burden of multidrug resistant (MDR) Gram-negative pathogens in severe pneumonia and to examine the clinical trials supporting a role for novel agents for the treatment of this infection.: Recent findings: ...

Abstract	Purpose of review: To describe the increasing burden of multidrug resistant (MDR) Gram-negative pathogens in severe pneumonia and to examine the clinical trials supporting a role for novel agents for the treatment of this infection. Recent findings: MDR Gram-negative bacteria cause an increasing proportion of severe pneumonias. Although the epidemiology of resistance varies across the globe, all regions have seen an evolution in resistance, especially among Enterobacterales spp, Pseudomonas aeruginosa, and Acinetobacter bumannii. Fortunately, several clinical trials have established the role for multiple new antibiotics in pneumonia. Although these drugs all have different ranges of in vitro activity and potency, each helps to address the problem of MDR. These studies have varied based on the proportion of subjects undergoing mechanical ventilation and the comparator agents employed. Although all these trials have demonstrated noninferiority to the comparator, the mortality rates across the analyses ranged from <% to >20%. None of the recent investigations included immunocompromised subjects. Summary: Multiple new agents exist for treating MDR Gram-negative pneumonia. These agents are not interchangeable. Thus, one must approach their adoption with a nuanced eye.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Drug Resistance, Multiple, Bacterial ; Gram-Negative Bacteria/drug effects ; Gram-Negative Bacteria/physiology ; Gram-Negative Bacterial Infections/drug therapy ; Gram-Negative Bacterial Infections/microbiology ; Humans ; Intensive Care Units/statistics & numerical data ; Pneumonia, Bacterial/drug therapy ; Pneumonia, Bacterial/microbiology
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-12-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645085-4
ISSN	1473-6527 ; 1535-3877 ; 0951-7375 ; 1355-834X
ISSN (online)	1473-6527 ; 1535-3877
ISSN	0951-7375 ; 1355-834X
DOI	10.1097/QCO.0000000000000712
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 2462: Show issues

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Article ; Online: Inappropriate Empiric Therapy Impacts Complications and Hospital Resource Utilization Differentially Among Different Types of Bacterial Nosocomial Pneumonia: A Cohort Study, United States, 2014-2019.

Zilberberg, Marya D / Nathanson, Brian H / Puzniak, Laura A / Zilberberg, Noah W D / Shorr, Andrew F

Critical care explorations

2022 Volume 4, Issue 4, Page(s) e0667

Abstract: Nosocomial pneumonia (NP) remains a costly complication of hospitalization fraught with subsequent complications and augmented resource utilization. Consisting of ventilated hospital-acquired bacterial pneumonia (vHABP), nonventilated hospital-acquired ... ...

Abstract	Nosocomial pneumonia (NP) remains a costly complication of hospitalization fraught with subsequent complications and augmented resource utilization. Consisting of ventilated hospital-acquired bacterial pneumonia (vHABP), nonventilated hospital-acquired bacterial pneumonia (nvHABP), and ventilator-associated bacterial pneumonia (VABP), each may respond differently to inappropriate empiric treatment (IET). We explored whether IET affects the three pneumonia types differently. Design: A multicenter, retrospective cohort study within the Premier Research database. Setting: Acute care hospitals in the United States. Patients: Patients with three types of NP were identified based on a previously published Interventions: None. Measurements and main results: We compared the impact of IET on hospital costs, length of stay (LOS), and development of Conclusions: Although IET is relatively uncommon, it affects resource utilization and the risk of complications differently across NP types. The impact of IET is greatest on both LOS and costs in nvHABP and is greater on VABP than vHABP in terms of EF and RT.
Language	English
Publishing date	2022-04-07
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000667
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Article: Descriptive Epidemiology and Outcomes of Hospitalizations With Complicated Urinary Tract Infections in the United States, 2018.

Zilberberg, Marya D / Nathanson, Brian H / Sulham, Kate / Shorr, Andrew F

Open forum infectious diseases

2022 Volume 9, Issue 1, Page(s) ofab591

Abstract: Background: Hospitalizations with complicated urinary tract infection (cUTI) in the United States have increased. Though most often studied as a subset of cUTI, catheter-associated UTI (CAUTI) afflicts a different population of patients and carries ... ...

Abstract	Background: Hospitalizations with complicated urinary tract infection (cUTI) in the United States have increased. Though most often studied as a subset of cUTI, catheter-associated UTI (CAUTI) afflicts a different population of patients and carries outcomes distinct from non-CA cUTI (nCAcUTI). We examined the epidemiology and outcomes of hospitalizations in these groups. Methods: We conducted a cross-sectional multicenter study within the 2018 National Inpatient Sample (NIS) database, a 20% stratified sample of discharges from US community hospitals, to explore characteristics and outcomes of patients discharged with a UTI diagnosis. We divided cUTI into mutually exclusive categories of nCAcUTI and CAUTI. We applied survey methods to develop national estimates. Results: Among 2 Conclusions: There are >626
Language	English
Publishing date	2022-01-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofab591
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Article: Examining the Burden of Potentially Avoidable Heart Failure Hospitalizations.

Zilberberg, Marya D / Nathanson, Brian H / Sulham, Kate / Mohr, John F / Goodwin, Matthew / Shorr, Andrew F

ClinicoEconomics and outcomes research : CEOR

2023 Volume 15, Page(s) 721–731

Abstract: Background: Two-thirds of the 1 million annual US CHF hospitalizations are for diuresis only; some may be avoidable. We describe a population of low-severity short-stay (

Abstract	Background: Two-thirds of the 1 million annual US CHF hospitalizations are for diuresis only; some may be avoidable. We describe a population of low-severity short-stay (</= 4 days) patients admitted for CHF.<br />Methods: We conducted a retrospective cohort study within the Premier Healthcare Database, 2016-2021. CHF was defined via an administrative code algorithm. High severity (CHF-H) was marked by cardiogenic shock, the need for respiratory or circulatory support, and/or a Charlson comorbidity index >2. We compared baseline characteristics, processes of care, and outcomes in low-severity (CHF-L) to CHF-H. Results: Among 301,672 short-stay CHF patients, 135,304 (44.8%) were CHF-L. Compared to CHF-H, CHF-L was younger (70.5 ± 14.1 vs 72.1 ± 13.6 years, p < 0.001), more commonly female (48.6% vs 45.8%, p < 0.001), and more likely to receive IV ACE-I/ARB agents (0.5% vs 0.4%, p = 0.003). Most other IV medications were more common in CHF-H, and anticoagulation was the most prevalent non-diuretic IV therapy in both groups (23.8% vs 33.3%, p < 0.001). Hospital mortality (0.2% vs 1.5%, p < 0.001) and CHF-related 30-day readmissions (8.1% vs 10.5%, p < 0.001) were lower in CHF-L than CHF-H. Conclusion: Among short-stay CHF patients, nearly ½ meet criteria for CHF-L, and are mainly admitted for fluid management. Avoiding these admissions could result in substantial savings.
Language	English
Publishing date	2023-09-29
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2520698-9
ISSN	1178-6981
ISSN	1178-6981
DOI	10.2147/CEOR.S423868
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