Postersession 4

  • A. Blesl, A. Horvath, C. Jüngst, F. Rainer, B. Leber, V. Stadlbauer
    P31 Impaired gut permeability and alterations of the gut microbiota in secondary sclerosing cholangitis of critically ill patients (SSC-CIP)
    Intensivmedizin
    Background and aims: SSC-CIP is a progressive, cholestatic liver disease with enigmatic pathophysiology. Ischemic injury of the biliary system, bile cast formation and recurrent biliary infections are discussed as major factors. Since it occurs only in a few patients surviving a critical illness, individual factors seem to be important in the pathogenesis. The aim of the study was to characterize gut microbiome composition and gut permeability in SSC-CIP patients in comparison to healthy controls. Methods: Serum and stool from 18 patients (mean age 59±13, 5 women, median 41 months after ICU admission, 39% cirrhosis) with SSC-CIP from two centers in Austria and Germany and from 21 healthy controls (mean age 58±7, 12 women) were collected. Patients were included when they developed sclerosing cholangitis diagnosed by endoscopic retrograde cholangiography or magnetic resonance cholangiography after a critical illness. Gut permeability was assessed by diamino-oxidase (DAO, serum), zonulin and calprotectin (stool) using ELISA. sCD14 and lipopolysaccharide binding protein (LBP) as markers for endotoxemia were measured by ELISA in serum. 16S rDNA was isolated from stool, sequenced using Illumina technique and analysed using QIIME. Results: SSC-CIP patients had a significantly reduced alpha-diversity (chao1 p<0.001). Significant differences in Beta Diversity could also be shown using Bray–Curtis dissimilarity and weighted Unifrac analysis. Patients with SSC-CIP showed significant oralisation of the microbiome as evidenced by an increase in Streptococcus, Rothia and Veillonella (p<0.05). Faecalibacterium prausnitzii was significantly reduced in SSC-CIP patients. SSC-CIP patients had significantly impaired gut permeability as evidenced by higher levels of DAO in serum and zonulin in stool. Bacterial translocation in SSC-CIP patients could be shown by the elevation of sCD14 and LBP. Summary and conclusions: Patients with SSC-CIP showed dysbiosis with reduced diversity, oralisation and loss of beneficial species. Biomarkers of gut permeability and endotoxemia were significantly elevated in SSC-CIP.Comprising, intestinal dysbiosis together with increased gut permeability seems to play a critical role as trigger and/or reinforcer of SSC-CIP.
  • M. Möller
    P32 Perkutane endoskopische Gastrostomie (PEG) unter dualer Thrombozytenaggregationshemmung- Wie hoch ist das Blutungsrisiko?
    Intensivmedizin
    Die leitliniengerechte Behandlung eines Herzinfarktes nach Reanimation sieht eine umgehende Katheterintervention mit Koronarstenting (PCI) vor. Anschließend muss eine strikte duale Plättchenhemmung (dPH) eingehalten werden. Zeigt sich im Verlauf eine schwere cerebrale Schädigung des Reanimierten, ist oft eine PEG- Anlage erforderlich. Allerdings sehen die bestehenden Leitlinien dafür eine 5-7 tägige dPH-Pause wegen erhöhter Blutungsgefahr vor; eine dPH- Pause ist aber mit einem deutlich erhöhten Stentthromboserisiko verbunden und kann deshalb nicht gefahrlos erfolgen. In der Praxis wird zunehmend über positive Erfahrungen eine PEG- Anlage unter laufender dPH berichtet. Wir stellen die eigenen Erfahrungen der PEG- Anlage unter laufender dPH vor. Methode: Retrospektive Analyse der PEG- Anlagen von 2008- 2014 bei Pat. mit persistierenden cerebralen Schäden nach Reanimation und PCI. Ergebnisse: Insgesamt wurden im Untersuchungszeitraum 92 PEG nach Reanimation durchgeführt. 51 PEG (55 %) erfolgten ohne Thrombozytenaggregationshemmer (TAH). 41 Pat. (45 %) standen unter TAH, davon 19 Pat (46 %) nur unter ASS, 22 Pat (54 %) standen unter dPH (19 Pat ASS/ Clopidogrel, je 1 Pat unter ASS/ Prasugrel bzw ASS/ Ticagrelor). 1 Pat unter ASS/ Plavix hatte eine geringe äußere Blutung aus dem Stichkanal. Endoskopisch zeigte sich eine unter Sicht spontan sistierende PEG Sickerblutung ohne Hb- Abfall. Bei 3 Patienten erfolgte bei nachfolgender akuter Anämisierung eine Kontrollgastroskopie; in keinem Fall war die PEG die Blutungsursache. Bei zwei Pat ohne TAH traten OP- bedürftige PEG- bedingte abdominelle Probleme (freie Luft, Peritonitis) auf. Kein Pat. starb an einer PEG- Komplikation. Schlussfolgerung: Die PEG- Anlage unter dualer Plättchenhemmung war in unserer Pat- Kohorte eine sichere Prozedur. Dies ist in Einklang mit neueren Angaben der Literatur; die im Wesentlichen auf Expertenmeinungen basierenden Leitlinien müssen überprüft werden.
  • L. Maas, S. Mair, R. Schmid, W. Huber
    P33 Machbarkeit der „individuell optimierten hämodynamischen Therapie“ bei nicht-selektionierten ICU-Patienten; eine systematische Datenbankanalyse
    Intensivmedizin
    Zielsetzung: Die Schlagvolumenvariabilität SVV scheint dem Globalen Enddiastolischen Volumen-Index GEDVI und v.a. dem ZVD in der Einschätzung des Flüssigkeitsbedarfs überlegen. Allerdings kann die SVV nur bei gleichzeitigem Vorliegen von Sinusrhythmus (SR) UND kontrollierter mechanischer Beatmung (KMB) eingesetzt werden. Daher versucht die „individuell optimierte hämodynamische Therapie“ (IOHT) bei Patienten, die passager SR und KMB aufweisen, die SVV auf einen Wert von 10% zu optimieren und zeitgleich den zugehörigen GEDVI zu dokumentieren. Dieser optimierte GEDVI (GDVI_opt) kann nachfolgend als individuelles Vorlastziel verwendet werden, wenn die Voraussetzungen der SVV nicht mehr erfüllt sind [1]. Der IOHT liegt die Hypothese zugrunde, dass es zwischen GEDVI und SVV einen starken intra-individuellen Zusammenhang gibt. Das Ziel unserer Studie war es, die inter- und intra-individuelle Assoziation von GEDVI und SVV bei Intensivpatienten zu untersuchen. Methode: Analyse einer prospektiv angelegten Datenbank mit 13,806 PiCCO-Messungen bei 762 Patienten. Inter- und intraindividuelle Korrelation von SVV und GEDVI bei Messungen mit SR und KMB. Analyse der Variabilität des GEDVI bei Patienten mit mehrfach gleichem SVV. Statistik: Spearman-Korrelation, Partialkorrelation, Variationskoeffizient; IBM SPSS 23. Ergebnisse: Die inter-individuelle Korrelation von SVV und GEDVI war niedrig (rs=-0,154; p<0,001). Entgegen der Prämisse der IOHT war auch die intra-individuelle Partialkorrelation niedrig (rpartial=-0,100; p=0,001). Die Korrelation von GEDVI und SVV, bei Messungen im Bereich der „Grauzone“ (SVV 9-13%), war nur geringfügig besser (inter-individuell: rs=-0,201; p=0,002; intra-individuell: rpartial=-0,180; p=0,007). In Einzelbeobachtungen mit wiederholt gleicher SVV zeigten sich bei Messungen innerhalb eines Patienten mit einer konstanten SVV von 10% stark variierende GEDVI-Werte (1. Patient mit 611, 781, 766, 729, 810 und 830 ml/m2; Mittelwert 755±79ml/m2; Variationskoeffizienten 10,4%.; 2. Patient mit 439, 630, 623 und 669 ml/m2; Mittelwert 590±103 ml/m2; Variationskoeffizienten 17%). Der Variationskoeffizient des GEDVI (bei konstanter SVV zwischen 9 und 13% (40 Datensätze)) war bei ≥4 Messungen signifikant höher als bei 2-3 Messungen (0,100±0,055 vs. 0.054±0,048; p=0,025). Schlussfolgerung: Die inter- sowie die intra-individuelle Assoziation zwischen GEDVI und SVV ist schwach. Der Variationskoeffzient des GEDVI bei gleicher SVV steigt mit der Anzahl der Messungen. Diese Beobachtungen stellen die Anwendung der IOHT bei nicht selektierten Patienten auf der internistischen ICU in Frage. Literatur: 1.) Goepfert MS et al.; Anestesiology 2013 Korrespondenzadresse: Wolfgang.Huber@tum.de
  • D. Dankl, F. Macholz, B. Bacher, H. Mairbäurl, MM. Berger
    P34 Remote ischemic preconditioning does not attenuate high-altitude-induced pulmonary hypertension and acute mountain sickness at 3450m
    Notfallmedizin
    Goal: Remote ischemic preconditioning (RIPC) has been shown to protect organs such as the lung and the brain remote from the preconditioned site against damage induced by subsequent hypoxia or ischemia. High-altitude pulmonary edema (HAPE) and acute mountain sickness (AMS) represent the pulmonary and the cerebral form of high-altitude diseases. In HAPE an exaggerated hypoxic pulmonary vasoconstriction is considered to play a pivotal role, while activation of the trigeminovascular system seems to induce AMS. We hypothesized that RIPC attenuates the rise in systolic pulmonary artery pressure (sPAP) and protects the brain from AMS after rapid, passive ascent to 3450 m. Method: Forty non-acclimatized volunteers were randomized into 2 groups. At low-altitude (750 m) the RIPC group underwent 4 cycles of lower limb ischemia, induced by inflation of 2 thigh cuffs to 200 mmHg for 5 min followed by 5 min of reperfusion. In the control group cuffs were inflated to only 20 mmHg. Thereafter, participants were transported by railway over 2 h to 3450 m. For determination of sPAP, peak-flow velocities of tricuspid valve regurgitation jets were measured at the highest coherent boundary of the spectral wave using continuous-wave Doppler, guided by color-flow Doppler with a 1.0-5.0 MHz sector array transducer. Right atrial to ventricular pressure gradient was calculated from a modified Bernoulli equation. Measurements were performed at low-altitude and after 5, 10, 24, 29 and 48h at high-altitude. AMS was evaluated by the Lake Louise score (LLS) and the AMS-C score. Data are given as means±SD. Results: At none of the different time points RIPC had an effect on sPAP (highest sPAP after 10 h at high-altitude; RIPC: 33±8 mmHg; controls: 37±7mmHg; P=0.19). There was also no difference in the incidence (RIPC: 35%, control: 35%) and severity of AMS (after 24 h at high-altitude (LLS for RIPC:4.6±4.1 and for control:3.0±1.8;AMS-C for RIPC:0.69±0.9 and for control:0.37±0.08;all P>0.20). Discussion and Conclusion: This study indicates that RIPC, performed immediately before passive ascent to 3450 m, does neither attenuate the degree of high-altitude pulmonary hypertension nor the incidence and severity of AMS. Thus, RIPC cannot be recommended for the prevention of high-altitude diseases. Dr. Daniel Dankl, Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital Salzburg, Müllner Hauptstr. 48, 5020 Salzburg, e-mail: d.dankl@salk.at
  • M. Sareban, T. Perz, F. Macholz, P. Schmidt, H. Mairbäurl, M. Berger, J. Niebauer
    P35 Increased Left Atrial Strain and Altered Left Ventricular Filling but no Diastolic Dysfunction Following Rapid Ascent to 4559m in Healthy Volunteers
    Notfallmedizin
    Introduction: High-altitude exposure and acute hypoxic pulmonary hypertension have been suggested to cause abnormal left ventricular (LV) diastolic function 1. This study aimed to evaluate physiologic variables and comprehensive echocardiographic indices of LV diastolic function following rapid ascent to high altitude in healthy volunteers. Methods: 50 subjects performed rapid (< 24 hrs) and active ascent to 4559m. All participants underwent 2D echocardiography during a baseline examination at low altitude (424m) as well as at three study time-points (7, 20 and 44h) after arrival at high altitude. In addition to heart rate (HR), mean arterial pressure (MAP) and systolic pulmonary artery pressure (sPAP), comprehensive 2D volumetric-, spectral Doppler-, tissue Doppler- as well as speckle tracking derived strain- indices for LV diastolic function were obtained. Results: HR (HRlow: 64.2 ± 11.2 vs. HRhigh: 79.1 ± 14.2 min-1, p < .001), MAP (MAPlow: 88.9 ± 5.9 vs. MAPhigh: 91.7 ± 7.0 mmHg, p = .002); and sPAP (sPAPlow: 24.4 ± 3.8 vs. sPAPhigh: 38.5 ± 8.2 mmHg, p < .001) increased significantly following ascent and remained elevated at high altitude. Left atrial (LA) reservoir Strain (ε) (εlow : 44.6 ± 9.4 vs. εhigh: 49.6 ± 12.6%, p < .05) increased significantly following ascent, remained elevated at high altitude and did not correlate with changes in physiologic variables. Spectral-Doppler derived index for LV filling (E/Alow: 1.7 ± 0.5 vs. E/Ahigh: 1.4 ± 0.5, p < .001) changed significantly due to a significant increase in late diastolic filling (Alow: 43.3 ± 9.0 vs. Ahigh: 53.1 ± 12.2 cm · sec-1). Changes in E/A correlated with changes in HR (r = .46, p < .001) but did not correlate with changes in sPAP or MAP. E/E’ as an estimate of LV filling pressure and LV diastolic function did not change. Conclusion: Rapid ascent to high altitude is associated with increased global LA strain without signs for LV diastolic dysfunction in healthy individuals. Comprehensive functional cardiac testing in subjects with preexisting LA or LV disease aspiring ascent to a hypoxic environment should be recommended in order to reduce high-altitude incidents. Rao M, Li J, Qin J, et al. Left ventricular function during acute high-altitude exposure in a large group of healthy young Chinese men. PLoS One. 2015;10(1):e0116936.
  • F. Seidel,L. Weidhase, S. Petros
    P36 Prävalenz vancomycinresistenter Enterokokken in der internistischen Intensivmedizin
    Intensivmedizin
    Zielsetzung: Multiresistente Erreger stellen insbesondere in der Intensivmedizin eine zunehmende Herausforderung dar. Nach bisherigen Untersuchungen ist die Rate an MRSA nahezu konstant, während gramnegative Bakterien und vancomycinresistente Enterokokken in den letzten Jahren deutlich zunehmen. Die Empfehlungen zum routinemäßigen Screening sind jedoch nicht einheitlich. Die häufig von chirurgischen Intensivstationen abgeleiteten Prävalenzen lassen sich nur unzureichend auf internistische Intensivstationen übertragen, auf denen wiederum viele infektionsgefährdete und immundefiziente Patienten behandelt werden. Ziel dieser Studie war es, die Prävalenz multiresistenter Erreger einschließlich vancomycinresistenter Enterokokken auf einer internistischen Intensivstation zu untersuchen. Methode: Während eines sechsmonatigen Zeitraums erfolgte bei allen Patienten unserer Intensivstation direkt bei Aufnahme ein standardisiertes Screening auf multiresistente Erreger. Neben den bisher routinemäßigen Abstrichen für MRSA (Nasenvorhof, Rachen) und 2MRGN/3MRGN (rektal) wurde auch VRE (rektal, Urin) in das Screening eingeschlossen. Ergebnisse: Insgesamt wurden 1120 Patienten eingeschlossen, wovon 67 Patienten aufgrund eines nicht vollständigen Screenings wieder ausgeschlossen wurden. Die verbleibenden 1053 Patienten (672 männlich, 381 weiblich) im Alter von 66,0 ± 15,9 Jahren wurden berücksichtigt. MRSA war bei 21 Patienten (2,0 %) zum Aufnahmezeitpunkt nachweisbar. Bei 14 (67 %) dieser Patienten war der MRSA-Nachweis bereits im Vorfeld bekannt. Ein Nachweis von 3MRGN im Stuhl gelang bei 70 Patienten (6,7 %), 38 (54 %) dieser Befunde waren bei Aufnahme bekannt. Bakterien mit 2MRGN-Resistenz waren bei 47 Patienten (4,5 %) nachweisbar, lediglich 3 (6,4 %) dieser Befunde waren bei Aufnahme bekannt. VRE 1 bzw. VRE 2 im Stuhl wurde bei 89 Patienten (8,5 %) nachgewiesen, bei 31 (35 %) dieser Patienten waren die Befunde bei Aufnahme bekannt. Der Nachweis von VRE 1 bzw. VRE 2 im Urin (16 Patienten, 1,5 %) ging in 13 Fällen mit einem positiven Nachweis im Rektalabstrich einher. Diskussion: Vancomycinresistente Enterokokken waren im routinemäßigen Screening auf multiresistente Erreger am häufigsten nachweisbar. Der Anteil der bereits prästationär mit VRE kolonisierten Patienten war jedoch im Vergleich zu den anderen multiresistenten Erregern gering. Die Relevanz der VRE-Kolonisierung und ihr Einfluss auf eine VRE-Infektion werden noch kontrovers diskutiert, eine Steigerung der Mortalität infolge einer Infektion durch multiresistente Erreger hingegen ist bekannt. Schlussfolgerung: Ein auch auf VRE erweitertes Routinescreening kann helfen, eine Kolonisation frühzeitig zu erkennen. Somit könnten eine assoziierte Infektion früher behandelt und das Übertragungsrisiko reduziert werden.
  • C. Putensen, B. Ellger, S. Sakka, M. Zoller, F.-A.Litty
    P37 The current clinical use of intravenous fosfomycin in ICU patients in two European countries – Insights from a non-interventional study with 209 patients
    Intensivmedizin
    Goal of the Study: Despite its use for more than 30 years the bactericidal broad spectrum antibiotic fosfomycin remains active against a wide range of Gram-positive and Gram-negative species. [1] Here, we present real-life efficacy and safety data on the current clinical use of intravenous fosfomycin in two countries with longstanding experience from the largest prospective non-interventional study conducted to date. Methods: Prospective, open, multi-center, non-interventional study (NCT01173575) in patients with severe bacterial infections from 19 intensive care units in Germany and Austria. Results and Discussion: From July 2010 to June 2016, 209 patients were included (ITT population: 77 females, 132 males, mean age: 59±16 years), and 182 had an evaluable endpoint (PP population). 153 patients (73.2%) received fosfomycin as second line therapy, 150 patients (71.8%) received a targeted fosfomycin therapy. One or at least two organ systems (± bacteremia) were affected in 161 (77%) and 37 (17.7%) patients, respectively. Main indications for fosfomycin with one organ involvement (± bacteremia) were infections of the CNS (21.5%), pneumonia incl. CAP, HAP and VAP (15.3%), BJI (11%), severe abdominal infections (11%) and bacteremia (10.5%). Most frequently identified pathogens were S. aureus (22.4%), S. epidermidis (14.3%), Enterococcus spp. (10.8%), E. coli (12%) and Klebsiella spp. (7.7%). At least one MDR pathogen was isolated from 51 patients (24.4%). Fosfomycin was administered with an average daily dose of 13.6±3.5 g over 12.4±8.6 days, almost exclusively (99%) combined with other antibiotics. The overall clinical success was favorable in 81.3% (148/182) of cases, and 84.8% (39/46) in patients with ≥ 1 MDR pathogen. Success rate ranged from 67% in endocarditis (6/9) to 89% (33/37) in CNS infections. Microbial eradication could be achieved in 63 of 90 patients with follow up data (70.0%, microbiological success was not investigated in all patients). Adverse drug reactions were mostly non serious (in total 16.7% (35/209); 34 non-serious, 3 serious). Conclusion: In Germany and Austria, intravenous fosfomycin is currently used mostly as second line combination treatment. A multi-drug resistant pathogen was isolated in only 24.4% of patients. The overall success rate of 81% despite predominant 2nd line treatment is very promising. Moreover, fosfomycin exhibits a favorable safety profile not limiting its clinical use even in critically ill patients. References: [1] Falagas ME, Vouloumanou EK, Samonis G, Vardakas KZ. Fosfomycin. Clin Microbiol Rev. 2016; 29:321–347. Acknowledgement: This study was funded by InfectoPharm Arzneimittel und Consilium GmbH and Sandoz GmbH Corresponding author: Dr. Felix-Alexander Litty InfectoPharm Arzneimittel und Consilium GmbH Von-Humboldt-Staße 1, 64646 Heppenheim felix-alexander.litty@infectopharm.com
  • C. Friedl, G. Hackl, G. Schlicher, K. Eller, P. Eller
    P38 Waterhouse-Friderichsen syndrome due to Neisseria meningitidis infection in a young adult with thrombotic microangiopathy and eculizumab treatment: a case report
    Intensivmedizin
    Background: The serologic response to meningococcal vaccination in patients with paroxysmal nocturnal hemoglobinuria and eculizumab treatment varies widely from 48% for serotype W to 87% for serotype C1. Case report: We report the case of a 22-year-old patient suffering from systemic lupus erythematosus (SLE) with thrombotic microangiopathy (TMA) who developed a Waterhouse-Friderichsen syndrome due to Neisseria meningitidis infection under chronic eculizumab treatment despite previous meningococcal vaccination. The patient had suffered from SLE since the age of 12 years. In April 2015 he developed TMA with acute renal failure refractory to corticosteroids, cyclophosphamide, and plasmapheresis. Therefore, eculizumab was started with a parallel antibiotic prophylaxis. In March 2016, the patient was vaccinated against Neisseria meningitidis serotype B and C. Three months after vaccination and 1 month after stopping ciprofloxacin, the patient was referred to the ICU with septic shock, acute renal failure, purpura fulminans and severe acute respiratory distress syndrome necessitating high-dose norepinephrine treatment with corticosteroids, continuous renal replacement therapy, invasive mechanical ventilation, and extracorporeal lung assistance. Blood cultures revealed meningococcal infection with Neisseria meningitidis serotype W135. The patient slowly recovered under antibiotic treatment with piperacillin and ceftriaxone, was dismissed from ICU after 18 days and discharged from our hospital after 48 days. Analysis of serological response to meningococcal vaccination revealed non-protective titers. He promptly received both meningococcal re-vaccination, and antibiotic prophylaxis with ciprofloxacin. Discussion: This case report emphasizes the occurrence of rare Neisseria serotypes in patients under chronic eculizumab treatment and thus strongly argues for the use polyvalent conjugate vaccine covering meningococcal strains A, C, W, Y, and B2. Moreover, we add further evidence that monitoring serological response to meningococcal vaccination in patients receiving eculizumab is essential before holding antibiotic prophylaxis. Conclusion: Given the extenuated serologic response in immunosuppressed patients, we favor prophylactic strategies against the risk of Neisseria spp. over immunization in patients with eculizumab. References: Alashkar F (2017) Serologic response to meningococcal vaccination in patients with paroxysmal nocturnal hemoglobinuria (PNH) chronically treated with the terminal complement inhibitor eculizumab. Ann Hematol Struijk GH (2013) Meningococcal sepsis complicating eculizumab treatment despite prior vaccination. Am J Transplant 13(3):819-20
  • G. Hackl, F. Eisner, G. Schilcher, T. Valentin, P. Eller
    P39 Influenza Virus Persistence correlates with Duration of Mechanical Ventilation in ARDS due to Influenza Pneumonia
    Intensivmedizin
    Goal of the study: Acute respiratory distress syndrome (ARDS) due to influenza pneumonia is the most common and severe complication of seasonal influenza infection and often necessitates intensive care treatment. Tehre is a dynamic relationship between clinical symptomatology and viral shedding in naturally acquired seasonal influenza virus infections [1]. We here investigated whether the influenza virus persistence correlated also with clinical outcomes in critically-ill patients suffering from ARDS due to influenza pneumonia. Methods: We conducted a retrospective single-centre study and comprehensively describe the clinical symptomatology, dynamics of viral shedding over the course of critical care treatment, and clinical outcome in a case series of 21 consecutive patients suffering from ARDS due to influenza pneumonia. Results and Discussion: On admission to the ICU, 90.5% of patients had lymphocytopenia, 42.9% had thrombocytopenia, 47.6% displayed elevated levels of creatinine, and 33.3% rhabdomyolysis. Obesity, chronic heart disease, and immunosuppression were the most common coexisting conditions. ARDS due to influenza pneumonia was associated with a high mortality rate of 33.3%, significant socioeconomic efforts of critical care management, and long hospitalization terms of 31.4±3.9 days. The time from admission to the last positive test result on real-time RT-PCR assay for influenza virus detection varied widely from 2 to 24 days (median 10 days, interquartile range 5-17 days). Interestingly, the persistence of influenza virus detection in bronchoalveolar lavages and nasal swabs directly correlated with the duration of mechanical ventilation and length of intensive care treatment. Conclusion: Influenza virus persistence and its strong correlation to clinical outcome in ARDS advocates for regular microbiological controls, and individualized isolation protocols. In the ICU, appropriate control strategies to avoid nosocomial spread of influenza infections are mandatory and must be adapted to potentially delayed influenza virus clearance in ARDS due to influenza pneumonia. References: Ip DK et al. The Dynamic Relationship Between Clinical Symptomatology and Viral Shedding in Naturally Acquired Seasonal and Pandemic Influenza Virus Infections. Clin Infect Dis. 2016 Feb 15;62(4):431-7
  • R. Welte1, I. Lorenz2, P. Eller³, M. Joannidis1, R. Bellmann1
    P40 Pharmacokinetics of anidulafungin in pleural effusion and ascites of critically ill patients
    Intensivmedizin
    Goal of the Study: Echinocandins such as anidulafungin are recommended for treatment of invasive candidiasis in critically ill patients [1]. As data on anidulafungin target-site kinetics is sparse, we determined anidulafungin pharmacokinetics in pleural effusion and ascites of critically ill patients. Methods: Samples of pleural effusionand ascites were drawn from pleural or ascites drains during the dosage interval. Anidulafungin was measured by HPLC and UV detection. The lower limit of quantification was 0.05 mg/L [2]. Results and Discussion: Seven critically ill patients were enrolled. Anidulafungin kinetics was determined in pleural effusion of two patients and in ascites of four patients. In one sample obtained from paracentesis, a single concentration was determined. In pleural effusion, peak levels were 2.02 and 1.02 mg/L. The median ascites peak level amounted to 0.75 mg/L. The respective plasma levels were 13.96, 8.83 and 5.18 mg/L. The penetration ratio, expressed by the ratio between the AUC in body fluid and the AUC in plasma, was 0.17 and 0.18 for pleural effusion. For ascites it was 0.07-0.37 (median 0.17). For fungi with an MIC of 0.008, AUC/MIC ratios amount to about 2,100 and 1,300 for pleural effusion and ascites, respectively. Conclusion: Concentrations in pleural effusion and in ascites were lower than the plasma levels, but may be adequate for highly susceptible pathogens. Anidulafungin pharmacodynamics in pleural effusion and in ascites should be assessed by further studies. References: 1. Pappas P et al. Clin Infect Dis 2016;62:e1-e50 2. Welte R et al. Intrinsic Activity, 2015; 3 (Suppl. 2):36 Acknowledgement: The study was supported by IIR grant WI194757 from Pfizer. Korrespondenzadresse: Ao. Prof. Dr. Romuald Bellmann Medizinische Universität Innsbruck A-6020 Innsbruck, Anichstraße 35 E-Mail: romuald.bellmann@i-med.ac.at