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  1. Article ; Online: Aspergillosis in the ICU - The new 21st century problem?

    Vandewoude, Koenraad H / Vogelaers, Dirk / Blot, Stijn I

    Medical mycology

    2018  Volume 44, Issue Supplement_1, Page(s) S71–S76

    Abstract: Invasive pulmonary aspergillosis (IPA) is a serious opportunistic infection mainly affecting seriously immunocompromised patients. The major risk factor is prolonged granulocytopenia. Most literature on the epidemiology and clinical impact of Aspergillus ...

    Abstract Invasive pulmonary aspergillosis (IPA) is a serious opportunistic infection mainly affecting seriously immunocompromised patients. The major risk factor is prolonged granulocytopenia. Most literature on the epidemiology and clinical impact of Aspergillus spp. infections concern patients with hematological malignancies, cancer, stem cell transplantation and solid organ transplant patients. However, evidence from recent literature indicates that Aspergillus spp. may cause invasive disease in other categories of patients without apparent immunodeficiency, including patients in intensive care units (ICUs). Clinical diagnosis of IPA in non-immunocompromised patients is difficult. Standardized diagnostic definitions, developed by the European Organization for the Research and Treatment of Cancer/Mycosis Study Group for research purposes in patients with cancer and in recipients of haematopoietic stem cell transplants, are not feasible for patient categories with an intermediate to low probability for acquiring IPA. In routine clinical practice, most Aspergillus isolates from non-sterile body sites do not represent disease. Invasive diagnostic procedures are often not feasible in patients with severe respiratory insufficiency and critical illness. The presence of systemic risk factors, or underlying predisposing lung disease or general debilitation, may enhance the clinical relevance of a positive culture. The finding of an Aspergillus spp. positive respiratory specimen in an ICU patient should not be discarded; pre-emptive antifungal treatment should be considered, while attempting to substantiate the diagnosis.
    Language English
    Publishing date 2018-07-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 1421796-x
    ISSN 1460-2709 ; 1369-3786
    ISSN (online) 1460-2709
    ISSN 1369-3786
    DOI 10.1080/13693780600919262
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  2. Article: Invasive aspergillosis in immunocompetent patients.

    Blot, Stijn I / Vandewoude, Koenraad H

    Southern medical journal

    2006  Volume 99, Issue 12, Page(s) 1398

    MeSH term(s) Aspergillosis/immunology ; Humans ; Immunocompetence ; Immunocompromised Host ; Opportunistic Infections/immunology
    Language English
    Publishing date 2006-12
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 185329-6
    ISSN 1541-8243 ; 0038-4348
    ISSN (online) 1541-8243
    ISSN 0038-4348
    DOI 10.1097/01.smj.0000251440.27396.a7
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  3. Article ; Online: Medical imaging and timely diagnosis of invasive pulmonary aspergillosis.

    Vandewoude, Koenraad H / Vogelaers, Dirk

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2007  Volume 44, Issue 3, Page(s) 380–381

    MeSH term(s) Aspergillosis/diagnostic imaging ; Aspergillosis/etiology ; Critical Illness ; Humans ; Immunocompromised Host ; Lung/diagnostic imaging ; Lung/pathology ; Lung Diseases, Fungal/diagnostic imaging ; Lung Diseases, Fungal/etiology ; Lung Diseases, Fungal/pathology ; Practice Guidelines as Topic ; Predictive Value of Tests ; Tomography, X-Ray Computed
    Language English
    Publishing date 2007-02-01
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1086/509931
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  4. Article: Invasive devices: no need? No use!

    Blot, Stijn I / Peleman, Renaat / Vandewoude, Koenraad H

    Intensive care medicine

    2007  Volume 33, Issue 2, Page(s) 209–211

    MeSH term(s) Cross Infection/etiology ; Equipment and Supplies/adverse effects ; Humans ; Intensive Care Units ; Netherlands
    Language English
    Publishing date 2007-02
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0342-4642 ; 0340-0964 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0342-4642 ; 0340-0964 ; 0935-1701
    DOI 10.1007/s00134-006-0465-2
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  5. Article: Obstacles to implementing evidence-based guidelines.

    Labeau, Sonia O / Vandijck, Dominique M / Vandewoude, Koenraad H / Blot, Stijn I

    Respiratory care

    2008  Volume 53, Issue 4, Page(s) 505–6; author reply 506

    MeSH term(s) Belgium ; Diffusion of Innovation ; Evidence-Based Medicine ; Guidelines as Topic ; Humans ; Intensive Care Units ; Pneumonia, Ventilator-Associated/prevention & control
    Language English
    Publishing date 2008-04
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 603252-7
    ISSN 0020-1324 ; 0098-9142
    ISSN 0020-1324 ; 0098-9142
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  6. Article ; Online: Education reduces ventilator-associated pneumonia rates.

    Labeau, Sonia O / Vandijck, Dominique M / Vandewoude, Koenraad H / Blot, Stijn I

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2008  Volume 46, Issue 3, Page(s) 479

    MeSH term(s) Health Education ; Health Personnel/education ; Humans ; Pneumonia, Ventilator-Associated/microbiology ; Pneumonia, Ventilator-Associated/prevention & control
    Language English
    Publishing date 2008-02-01
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1086/526344
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  7. Article: Candida peritonitis.

    Blot, Stijn I / Vandewoude, Koenraad H / De Waele, Jan J

    Current opinion in critical care

    2007  Volume 13, Issue 2, Page(s) 195–199

    Abstract: Purpose of review: The review highlights current insights in the epidemiology, diagnosis and therapy of Candida peritonitis, focusing on complicated secondary and tertiary peritonitis.: Recent findings: Candida peritonitis is still associated with ... ...

    Abstract Purpose of review: The review highlights current insights in the epidemiology, diagnosis and therapy of Candida peritonitis, focusing on complicated secondary and tertiary peritonitis.
    Recent findings: Candida peritonitis is still associated with poor prognosis. Antifungal prophylaxis is therefore recommended in patients with an overt risk profile for invasive candidiasis (immunodeficiency and prior antibiotic exposure). The clinical and microbiological diagnosis of Candida peritonitis remains problematic. It is still unclear which peritonitis patients may benefit from antifungal treatment. Antifungal therapy can be suggested in critically ill patients with nosocomial peritonitis where Candida is diagnosed based on perioperatively sampled peritoneal fluid. Patients with prior exposure to fluconazole are at risk for Candida nonalbicans spp. involvement with possible reduced susceptibility.
    Summary: The main challenge in Candida peritonitis remains the interpretation of Candida cultured from the peritoneal cavity. Future research should focus on more conclusive diagnosis and on factors potentially confounding outcome, such as site of the perforation and failure of surgical source control. While awaiting progress to discriminate Candida colonization from invasive infection, antifungal therapy is recommended in high-risk critically ill surgical patients. Rapid detection of Candida might be beneficial in this regard. Besides antifungal therapy, adequate source control is of key importance.
    MeSH term(s) Antifungal Agents/administration & dosage ; Antifungal Agents/therapeutic use ; Candida/isolation & purification ; Candidiasis/complications ; Candidiasis/drug therapy ; Chemoprevention ; Critical Care ; Humans ; Peritonitis/etiology ; Peritonitis/microbiology ; Time Factors
    Chemical Substances Antifungal Agents
    Language English
    Publishing date 2007-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0b013e328028fd92
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  8. Article: Evaluation of outcome in critically ill patients with nosocomial enterobacter bacteremia: results of a matched cohort study.

    Blot, Stijn I / Vandewoude, Koenraad H / Colardyn, Francis A

    Chest

    2003  Volume 123, Issue 4, Page(s) 1208–1213

    Abstract: Study objective: To evaluate the clinical impact of nosocomial Enterobacter bacteremia in critically ill patients.: Design: Retrospective (January 1992 to December 2000) matched cohort study.: Setting: Fifty-four-bed ICU (including medical, ... ...

    Abstract Study objective: To evaluate the clinical impact of nosocomial Enterobacter bacteremia in critically ill patients.
    Design: Retrospective (January 1992 to December 2000) matched cohort study.
    Setting: Fifty-four-bed ICU (including medical, surgical, cardiosurgical ICU, and burns unit) from a university hospital.
    Patients: Sixty-seven ICU patients with Enterobacter bacteremia (case patients) and 134 control patients.
    Intervention: Matching of control patients (1:2 ratio) was on the basis of the APACHE (acute physiology and chronic health evaluation) II system. As expected, mortality can be derived from this severity-of-disease classification system; this matching procedure results in an equal expected mortality rate for patients with Enterobacter bacteremia and control patients.
    Results: The overall rate of appropriate antibiotic therapy in patients with Enterobacter bacteremia was high (96%) and initiated soon after the onset of the bacteremia (0.5 +/- 0.9 days). Patients with Enterobacter bacteremia had more hemodynamic instability (p = 0.015), longer ICU stay (p < 0.001), and ventilator dependence (p < 0.001). No differences between case and control patients were found in age (52 years vs 53 years, p = 0.831), prevalence of acute renal failure (16% vs 16%, p = 0.892), and acute respiratory failure (93% vs 84%, respectively; p = 0.079). In-hospital mortality rates for case and control patients were not different (34% vs 39%, respectively; p = 0.536).
    Conclusion: After accurate adjustment for severity of underlying disease and acute illness, no difference was found between ICU patients with Enterobacter bacteremia and matched control patients. In the presence of fast and appropriate antibiotic therapy, Enterobacter bacteremia does not adversely affect the outcome in ICU patients.
    MeSH term(s) APACHE ; Aged ; Bacteremia/microbiology ; Bacteremia/mortality ; Critical Illness ; Cross Infection/drug therapy ; Cross Infection/microbiology ; Cross Infection/mortality ; Enterobacter ; Enterobacteriaceae Infections/drug therapy ; Enterobacteriaceae Infections/mortality ; Enterobacteriaceae Infections/nursing ; Hospital Mortality ; Humans ; Length of Stay ; Microbial Sensitivity Tests ; Middle Aged ; Retrospective Studies ; Survival Analysis
    Language English
    Publishing date 2003-04-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1378/chest.123.4.1208
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  9. Article: Estimates of attributable mortality of systemic candida infection in the ICU.

    Blot, Stijn I / Hoste, Eric A / Vandewoude, Koenraad H / Colardyn, Francis A

    Journal of critical care

    2003  Volume 18, Issue 2, Page(s) 130–1; author reply 131

    MeSH term(s) Antifungal Agents/administration & dosage ; Candidiasis/drug therapy ; Candidiasis/mortality ; Cohort Studies ; Hospital Mortality ; Intensive Care Units/statistics & numerical data
    Chemical Substances Antifungal Agents
    Language English
    Publishing date 2003-06
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 632818-0
    ISSN 1557-8615 ; 0883-9441
    ISSN (online) 1557-8615
    ISSN 0883-9441
    DOI 10.1053/jcrc.2003.50009
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  10. Article ; Online: Thrombocytopenia and outcome in critically ill patients with bloodstream infection.

    Vandijck, Dominique M / Blot, Stijn I / De Waele, Jan J / Hoste, Eric A / Vandewoude, Koenraad H / Decruyenaere, Johan M

    Heart & lung : the journal of critical care

    2010  Volume 39, Issue 1, Page(s) 21–26

    Abstract: Objective: Thrombocytopenia is common in intensive care units (ICUs), and is associated with a poor prognosis. An acute decrease in total platelet count is frequently observed in severe sepsis, followed by a relative increase indicating organ-failure ... ...

    Abstract Objective: Thrombocytopenia is common in intensive care units (ICUs), and is associated with a poor prognosis. An acute decrease in total platelet count is frequently observed in severe sepsis, followed by a relative increase indicating organ-failure recovery. However, few data are available describing this effect and its relationship with outcomes in specific subgroups of ICU patients.
    Methods: A retrospective, observational cohort study was conducted to investigate the incidence and prognosis of thrombocytopenia in a cohort of critically ill patients (n=155) with a microbiologically documented nosocomial bloodstream infection.
    Results: Thrombocytopenia occurred more frequently in nonsurvivors. The ICU mortality rates increased according to severity of thrombocytopenia. Thrombocytopenia was independently associated with worse outcomes in ICU patients with nosocomial bloodstream infection.
    Conclusion: Determining trends in platelet counts is of additional prognostic value, compared with single measurements.
    MeSH term(s) Adult ; Aged ; Critical Illness ; Erythrocyte Indices ; Female ; Humans ; Intensive Care Units/statistics & numerical data ; Male ; Middle Aged ; Platelet Count ; Prognosis ; Retrospective Studies ; Sepsis/complications ; Thrombocytopenia/etiology ; Thrombocytopenia/mortality
    Language English
    Publishing date 2010-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 193129-5
    ISSN 1527-3288 ; 0147-9563
    ISSN (online) 1527-3288
    ISSN 0147-9563
    DOI 10.1016/j.hrtlng.2009.07.005
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