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| Content Provider | Springer Nature : SpringerOpen |
|---|---|
| Author | Hurley, James C. |
| Abstract | Animal models implicate candida colonization facilitating invasive bacterial infections. The clinical relevance of this microbial interaction remains undefined and difficult to study directly. Observations from studies of anti-septic, antibiotic, anti-fungal, and non-decontamination-based interventions to prevent ICU acquired infection collectively serve as a natural experiment. Three candidate generalized structural equation models (GSEM), with Candida and Pseudomonas colonization as latent variables, were confronted with blood culture and respiratory tract isolate data derived from 464 groups from 279 studies including studies of combined antibiotic and antifungal exposures within selective digestive decontamination (SDD) interventions. Introducing an interaction term between Candida colonization and Pseudomonas colonization substantially improved GSEM model fit. Model derived coefficients for singular exposure to anti-septic agents (− 1.23; − 2.1 to − 0.32), amphotericin (− 1.78; − 2.79 to − 0.78) and topical antibiotic prophylaxis (TAP; + 1.02; + 0.11 to + 1.93) versus Candida colonization were similar in magnitude but contrary in direction. By contrast, the model-derived coefficients for singular exposure to TAP, as with anti-septic agents, versus Pseudomonas colonization were weaker or non-significant. Singular exposure to amphotericin would be predicted to more than halve candidemia and Pseudomonas bacteremia incidences versus literature benchmarks for absolute differences of approximately one percentage point or less. GSEM modelling of published data supports the postulated interaction between Candida and Pseudomonas colonization towards promoting bacteremia among ICU patients. This would be difficult to detect without GSEM modelling. The model indicates that anti-fungal agents have greater impact in preventing Pseudomonas bacteremia than TAP, which has no impact. |
| Related Links | https://icm-experimental.springeropen.com/counter/pdf/10.1186/s40635-022-00429-8 |
| Ending Page | 17 |
| Page Count | 17 |
| Starting Page | 1 |
| ISSN | 2197425X |
| DOI | 10.1186/s40635-022-00429-8 |
| Journal | Intensive Care Medicine Experimental |
| Issue Number | 1 |
| Volume Number | 10 |
| Language | English |
| Publisher | SpringerOpen |
| Publisher Date | 2022-01-21 |
| Access Restriction | Open |
| Subject Keyword | Topical antibiotics Candidemia Generalized structural equation modelling Anti-fungal Pseudomonas bacteremia |
| Content Type | Text |
| Resource Type | Article |
| Subject | Emergency Medicine Critical Care and Intensive Care Medicine Physiology (medical) |
| Aim | Intensive Care Medicine Experimental (ICMx) is an open access journal specifically dedicated to translational research, aimed at bringing discoveries, potential novel treatments and improved diagnostics closer to the bedside of a critically ill patient. As such, ICMx is uniquely positioned at the intersection of clinical and basic science with a primary focus on the physiology of critical care and emergency medicine. ICMx is intended for all those involved in research aimed at improving emergency care of the critically ill. ICMx aims at publishing research aspiring to: 1) advance understanding of critical illness pathophysiology, 2) support or enhance clinical trial design, 3) test experimental novel treatment interventions, 4) develop or refine experimental models that are relevant to critical care and acute physiologic derangements. ICMx welcomes original studies, reviews, hypothesis papers and state-of-the-art methodology papers. We also encourage correspondence pertinent to the works published in ICMx. Editorial comments will be solicited. ICMx is the official journal of the European Society of Intensive Care Medicine and is dedicated to translational research ICMx is one of few journals publishing research constructing the pipeline of novel discoveries that can advance critical care The board of ICMx represents physiologists, basic scientists dedicated to ICU medicine and ICU physicians, providing an ideal platform to bring discoveries to clinical applications in critical care |
| Journal Impact Factor | 3.1/2024 |
| 5-Year Journal Impact Factor | 3.3/2024 |
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