Latest news with #patients
Medscape
an hour ago
- Health
- Medscape
ICU Skin Decolonisation May Raise Resistant Infections
Universal skin decolonisation of patients admitted to intensive care units (ICU) may not improve infection control. New research led by the University of Aberdeen indicated that it might increase meticillin-resistant Staphylococcus epidermidis (MRSE) bloodstream infections in vulnerable patients. Hospital-associated infections cause significant morbidity and mortality, with critically ill patients in ICUs at particularly high risk. Surveillance figures from English ICUs show an ICU-associated bloodstream infection rate of 3.5 per 1000 bed-days for stays of two nights or more in the year to March 2024. Over 25% of patients with these infections die within 30 days. Reasons for the increased infection rate in ICUs include high antibiotic use leading to significant skin flora colonisation by resistant bacteria. Invasive procedures including indwelling catheters and the insertion of intravascular devices are independently associated with meticillin-resistant Staphylococcus aureus (MRSA) colonisation and infection. Need for a New Infection Control Approach Decolonisation protocols were introduced in the 1990s to curb rising nosocomial MRSA infections due to MRSA. Nationwide infection control programmes since the mid-2000s led to sharp declines in MRSA rates in NHS hospitals over the next decade. One UK-wide study in ICU patients between 2007 and 2016 showed a 78% decrease in bloodstream infections overall and a 97% reduction in MRSA bloodstream infections. However, data from the National Institute for Health and Care Research show this decline plateaued after 2012. Rates have subsequently been largely static, suggesting the need for a new approach. Routine ICU decolonisation typically involves chlorhexidine skin disinfection combined with nasal mupirocin. The Aberdeen team noted conflicting evidence on chlorhexidine's effectiveness. They also raised concerns that biocide skin and mucous membrane decolonisation might lead to reduced susceptibility to chlorhexidine and selection for multidrug-resistant pathogens. Study Compares Universal and Targeted Decolonisation The researchers compared universal versus targeted skin and nasal decolonisation in ICU patients at two Scottish hospitals in adjacent health boards with different protocols. The study included patients aged 16 years and over admitted between 1 July 2009 and 28 Feb 2022. One hospital switched from universal decolonisation of all admissions to targeting only MRSA carriers from 1 February 2019. The other hospital used targeted decolonisation throughout. The researchers analysed rates of S. epidermidis bloodstream infections and tested MRSE and chlorhexidine susceptibility. Results Show Benefits in Reducing Resistant Infections The results, published in The Lancet Microbe , showed that S epidermidis was identified in 334 (45%) of 735 bloodstream infections in the hospital that de-escalated decolonisation. Of these, 197 occurred before de-escalation. Overall, bloodstream infection rates did not increase after de-escalation. However, MRSE infections declined significantly after the switch – from 10.4 to 4.3 cases per 1000 occupied bed days. The probability of MRSE among infections fell from 89.2% to 56.7%. By contrast, the control hospital reported 167 (60%) S. epidermidis bloodstream infections among 278 total, with no significant changes in infection rates or MRSE incidence. Genetic analyses revealed de-escalation was linked to fewer bloodstream infections caused by multidrug-resistant S. epidermidis strains. There was reduced carriage of mobile genetic elements and genes related to multidrug resistance and biofilm production. Balancing Benefits and Risks "In ICU settings with low MRSA incidence, the benefits of universal decolonisation should be balanced against the risks of selecting MRSE sequence types adapted for invasive and device-associated infection," the researchers concluded. Professor Karolin Hijazi, chair in oral and maxillofacial medicine at the University of Aberdeen and study lead, commented in a press release: "This research essentially demonstrates that the excess use of disinfectants in universal decolonisation offered no advantage in terms of control of serious blood infections in a low MRSA ICU setting, but instead caused the unintended rise of MRSE bloodstream infections." Implications for Infection Control Policy The authors recommended that hospitals consider the "unintended harms of universal decolonisation", especially given the global rise of antimicrobial resistance. Hijazi added that such practices increase resistance risks and costs without added benefit in low-MRSA settings. The findings should inform standardised national guidelines for effective and safe patient decolonisation, in line with the government's 5-year action plan for antimicrobial resistance, the researchers said. They described the emergence and spread of antimicrobial resistance as a 'silent pandemic' and stressed that reducing unnecessary decolonisation could help contain resistance and reduce costs.
Medscape
4 hours ago
- Health
- Medscape
Preemptive TIPS Promising for Fundal Variceal Bleeding
TOPLINE: In patients with cirrhosis and acute fundal variceal bleeding, the use of preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) with a covered stent within 72 hours of initial bleeding resulted in superior outcomes, with a higher probability of patients being free of death or rebleeding at 1 year than those using standard treatment. METHODOLOGY: Researchers conducted a randomised trial across 17 tertiary centres in France to compare two strategies for preventing rebleeding of non-type 1 gastro-oesophageal varices. They included 101 patients with cirrhosis and acute fundal variceal bleeding (mean age, 58.2 years; 80% men) from January 3, 2019, to February 25, 2023, who achieved initial haemostasis with endoscopic glue injection for at least 12 hours. Patients were randomly assigned to either receive p-TIPS within 72 hours of the initial endoscopic glue injection (n = 47) or continue with on-demand glue obliteration combined with non-selective beta blockers (n = 54). The primary composite endpoint was all-cause mortality or clinically significant rebleeding, defined as recurrent melena or haematemesis requiring hospitalisation or blood transfusion or causing a 3 g/dL drop in haemoglobin, within 1 year from the initial haemostasis. Analyses were conducted in the modified intention-to-treat population. TAKEAWAY: The 1-year probability of being free from death or rebleeding was higher in the p-TIPS group than in the glue obliteration and non-selective beta-blocker group (77% vs 37%; hazard ratio, 0.25; P < .0001). The overall survival did not differ significantly between the two groups; however, 37% of patients in the glue obliteration and non-selective beta-blocker group required TIPS after a median of 25 days. The cumulative incidence of hepatic encephalopathy at 1 year was 35% in the p-TIPS group and 32% in the glue obliteration and non-selective beta-blocker group. Complications related to glue injection occurred in 22 procedures, including 13 bleeding episodes, eight glue migrations (three in the p-TIPS group and five in the glue obliteration group), and one case of cardiac decompensation in the p-TIPS group. The number of patients who experienced any adverse or serious adverse event did not differ significantly between the groups, and no deaths were considered related to the treatment. IN PRACTICE: "The results of the present study strongly support the use of p-TIPS in the management of acute gastric variceal bleeding and add an additional argument in favour of TIPS, which improves prognosis by effectively treating the haemodynamic disorders associated with cirrhosis," the authors of the study wrote. "In patients with cirrhosis and bleeding from fundal varices, p-TIPS with a covered stent is associated with markedly decreased death or rebleeding and should therefore be considered as a first-line therapy," they added. SOURCE: This study was led by Jean-Paul Cervoni, MD, Service d'Hépatologie et de Soins Intensifs, CHU Besançon, Besançon, France. It was published online on June 12, 2025, in The Lancet Gastroenterology & Hepatology. LIMITATIONS: A small sample size precluded definitive subgroup analyses (eg, variceal type). An overrepresentation of alcohol-related cirrhosis may have limited the applicability of the findings to other aetiologies. Eight patients in the p-TIPS group were treated beyond the 72-hour window. DISCLOSURES: This study was funded by the French Ministry of Health. Two authors reported receiving payment for lectures and one author reported receiving consulting fees from Gore. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
BreakingNews.ie
5 hours ago
- Health
- BreakingNews.ie
Trolley watch: 342 people waiting for trollies across Irish hospitals
There are total of 342 admitted patients on trolleys in hospitals on Friday. The Irish Nurses and Midwives Organisation (INMO) says University Hospital Limerick accounts for the largest number of those with 67, followed by University Hospital Galway with 51 and Sligo University Hospital with 29. Advertisement Of the total number of people waiting for beds, 243 are in emergency departments while 99 are in wards.
Medscape
6 hours ago
- Health
- Medscape
RIPC Shows No Benefit in Noncardiac Surgery
TOPLINE: The application of remote ischemic preconditioning (RIPC), a noninvasive technique used to induce brief episodes of limb ischemia and reperfusion, did not reduce the rates of postoperative myocardial injury and other complications compared with sham RIPC among patients undergoing high- or intermediate-risk noncardiac surgery. METHODOLOGY: Researchers conducted a large, multinational randomized controlled trial (PRINCE) to assess whether RIPC reduces myocardial injury and other complications in high-risk adults undergoing noncardiac surgery. They included 1213 patients (mean age, 70 years; 60% men) undergoing intermediate- or high-risk noncardiac surgical procedures under general anesthesia across 25 hospitals in eight countries. The participants were randomly assigned to receive either RIPC or sham RIPC. The RIPC intervention consisted of three 5-minute cycles of ischemia induced by inflating a blood pressure cuff to 200 mm Hg, with each cycle followed by 5 minutes of reperfusion while the cuff was deflated. The primary outcome was the rate of postoperative myocardial injury, defined by serum cardiac troponin levels exceeding the 99th percentile of the reference limit. TAKEAWAY: The occurrence of myocardial injury did not differ significantly between patients in the RIPC group and those in the sham RIPC group (relative risk, 1.02; P = .84). The number of patients presenting with postoperative troponin values five times above the 99th percentile was not significantly different between the RIPC and sham-RIPC groups. Additionally, prespecified adverse events did not differ significantly between the groups, except for 30-day hospital readmission rates (6% vs 3.5%), and episodes of limb petechiae (1.7% vs 0.2%), which were significantly more frequent in the RIPC group than in the sham RIPC group. IN PRACTICE: 'In contrast to previous findings, the PRINCE trial provides robust evidence of the absence of beneficial effects of RIPC on biochemical and clinical outcomes in high- and intermediate-risk noncardiac surgery patients,' the authors wrote. SOURCE: The study was led by Massimiliano Greco, MD, of Humanitas University in Pieve Emanuele, Italy. It was published online on June 13, 2025, in Circulation. LIMITATIONS: The study did not protocolize anesthesia induction. Preoperative troponin levels were not measured. Additionally, as most participants were from high-income European countries, the findings may have limited generalizability to low- and middle-income settings. DISCLOSURES: This study was funded by the Italian Ministry of Health. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Washington Post
6 hours ago
- Entertainment
- Washington Post
At D.C. children's hospital, opera singers offer light, hope and healing
Kwezikazi Mfithi stepped into a hallway at Children's National Hospital to wait as her 2-month-old daughter got an X-ray for her heart troubles. Then, she heard music — opera. Mfithi, 26, had planned to walk to the hospital's garden for a break and send text messages to catch up with friends and family. But the singers' voices moved her to go to the hospital's atrium. With a soft, gray blanket wrapped around her shoulders, she sat for an hour, mesmerized, as she and about two dozen other families, patients and hospital workers listened to the performance.
