In a large cohort of patients from 5 intensive care units (ICUs), patients who developed bloodstream infections while in the unit were 7 times more likely to die that those who did not develop such infections. In addition, researchers found that the mortality rate among the less severely ill ICU patients who developed a bloodstream infection was higher than that for more severely ill patients. The researchers found that among 2,783 ICU adult patients, 269 developed a unit-associated bloodstream infection over approximately a 20-month study period. According to the authors, bloodstream infections are a common healthcare associated infection among intensive care unit patients. They said that most bloodstream infections stem from intravascular catheters. Catheter-associated bloodstream infections represent approximately 15 percent of all ICU infections. In this study, 10 percent of the study population had documented ICU-associated bloodstream infections during their ICU stay. Of the 269 patients with documented bloodstream infections, 140 (56 percent) died in the hospital. Cirrhosis of the liver and admission to the hospital for more than 2 days before ICU admission were also found to significantly increase the death rate. This assemblage of patients represented the largest group ever studied to assess the association between mortality and ICU-associated bloodstream infection. The researchers said that their study supports implementing interventions to prevent bloodstream infection in less severely ill patients in the ICU, as well as in at-risk patients on general medical and surgical floors. The study appears in the second issue for March 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
THE ASSOCIATION BETWEEN OBESITY AND CHILDHOOD WHEEZING AND ASTHMA
Researchers showed that obesity, defined as body mass index (BMI) at the 95th percentile or higher for age and sex, was significantly associated with asthma and wheezing in a large group of 8- to 11-year-old children. The investigators studied the relationship between obesity, wheeze, and asthma in a community-based cohort of 788 children. Also, the biomedical scientists indicated their data pointed up that unrecognized sleep disordered breathing might explain a portion of the association between obesity and childhood wheezing. Of the 788 youthful participants, 188 either wheezed and/or had asthma. The majority, 600, had no active wheeze or asthma. A significant majority of the children with wheeze were: male, African American, born prematurely, had a primary caregiver with a high school education or less, had a maternal history of asthma, were atopic, and had greater airflow restriction during their lung function test. Also, according to the authors, compared with those who had neither wheeze nor asthma, children with active wheeze had a significantly higher BMI and a much greater prevalence of obesity. The researchers said that although it was unclear how obesity might mediate its effects on both the upper and lower airways, they felt it possible that children with upper and lower airway disease could be less physically active, and, therefore, predisposed to obesity. The research is published in the second issue for March 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
NEW NONINVASIVE TEST MEASURES COPD MORTALITY RISK
As compared with conventional lung function procedures, researchers have developed a new test to measure lung hyperinflation that offers a better single independent gauge for mortality risk in patients with chronic obstructive pulmonary disease (COPD). Investigators in Spain and the United States measured inspiratory capacity-to-total lung capacity in 689 COPD patients from 2 U.S. clinics and 2 Spanish clinics. The median follow-up period with the patients was 34 months. About 73 percent of the patients (503) were from the 2 U.S. clinics. (Patients with COPD have persistent obstruction of the airways associated with either emphysema or chronic bronchitis, which usually results from years of heavy cigarette smoking.) Of the 689 outpatients involved, 183 (27 percent) died during follow-up. They were older, had a lower body mass index, showed poorer lung function scores, walked a shorter distance during the 6-minute walking test, and had more breathlessness (dyspnea), according to the authors. As expressed by the new test, static lung hyperinflation or resting hyperinflation showed a cutoff point of 25 percent, with 286 patients (42 percent) demonstrating a less than 25 percent score and 403 patients (58 percent) scoring higher than 25 percent. However, among the patients who died, 71 percent had test scores under 25 percent. The investigators recommend that the new test be used in future assessments of patients with COPD. The study is published in the second issue for March 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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