Prevention and treatment of infections in intensive care patients: Challenges and potential improvements

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    Abstract

    Infections pose a major threat to intensive care (ICU) patients, with considerable mortality and long-term sequelae in survivors.

    In this thesis, three major subjects regarding infections in ICU patients are discussed. The aim of included studies is the improvement of prevention and treatment of such infections.

    The first part describes the incidence of highly resistant microorganisms (HRMOs), comparing characteristics and outcome of ICU-patients with versus those without HRMO. In this cohort, a small but relevant proportion of patients was HRMO-positive, with most HRMOs imported to as opposed to acquired in the ICU. Most HRMOs were Gram-negatives. The clinical outcome was worse in those with HRMO compared to those without HRMO.

    The second part describes the pharmacokinetics of beta-lactam antibiotics. First, plasma concentrations of continuously dosed piperacillin in ICU-patients were evaluated, followed by evaluation of plasma concentrations of cefotaxime in a randomised trial. In this trial, one group was treated by intermittent, the other group by continuous dosing of cefotaxime. In both trials, continuous dosing did not guarantee the attainment of target concentrations, but in the cefotaxime-trial continuous dosing led to adequate plasma concentrations more often compared to intermittent dosing.

    The third part describes the dynamics of fecal microbiota in ICU-patients admitted for planned cardiosurgery. Bacterial diversity decreased during admission compared to baseline. Also, the relative abundance of anaerobes, considered part of a ‘healthy’ gut microbiota decreased, whereas the relative abundance of some pathobionts increased. In most patients the change in microbiota during hospital stay reverted to the original composition post-discharge.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • Smet ,de, Anne-Marie, Supervisor
    • Zijlstra, Jan, Supervisor
    • Harmsen, Hermie J.M. , Co-supervisor
    • Bult, Wouter, Co-supervisor
    • van Dijl, Jan Maarten, Assessment committee
    • van der Voort, Peter, Assessment committee
    • De Waele, Jan, Assessment committee, External person
    Award date12-Oct-2020
    Place of Publication[Groningen]
    Publisher
    Print ISBNs978-94-6402-194-3
    Electronic ISBNs978-94-6402-198-1
    DOIs
    Publication statusPublished - 2020

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