Real-time investigation of a Burkholderia cenocepacia bacteremia outbreak in a Vietnamese Intensive Care Unit
Ontology highlight
ABSTRACT:
PROVIDER: PRJEB77781 | ENA |
REPOSITORIES: ENA
Dataset's files
| Action | DRS | |||
|---|---|---|---|---|
| ERR13381300_1.fastq.gz | Fastqsanger.gz | |||
| ERR13381300_2.fastq.gz | Fastqsanger.gz | |||
| ERR13381301_1.fastq.gz | Fastqsanger.gz | |||
| ERR13381301_2.fastq.gz | Fastqsanger.gz | |||
| ERR13381302_1.fastq.gz | Fastqsanger.gz |
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Project description:Critically ill intensive care unit (ICU) patients commonly develop severe muscle wasting and impaired muscle function, leading to delayed recovery, with subsequent increased morbidity and financial costs, and decrease quality of life of survivors. Acute Quadriplegic Myopathy (AQM) is one of the most common neuromuscular disorders associated with ICU-acquired muscle weakness. Although there are no available treatments for the ICU-acquired muscle weakness, it has been demonstrated that early mobilization can improve its prognosis and functional outcomes. This study aims at improving our understanding of the effects of passive mechanical loading on skeletal muscle structure and function by using a unique experimental rat ICU model allowing analyses of the temporal sequence of changes in mechanically ventilated and pharmacologically paralyzed animals at durations varying from 6 h to 14 days. Results show that passive mechanical loading alleviated the muscle wasting and the loss of force-generation associated with the ICU intervention, resulting in a doubling of the functional capacity of the loaded vs. unloaded muscles after a 2-week ICU intervention. We demonstrated that the improved maintenance of muscle structure and function is likely a consequence of a reduced oxidative stress, and a reduced loss of the molecular motor protein myosin. A complex temporal gene expression pattern, delineated by microarray analysis, was observed with loading-induced changes in transcript levels of sarcomeric proteins, muscle developmental processes, stress response, ECM/cell adhesion proteins and metabolism. Thus, the results from this study show that passive mechanical loading alleviates the severe negative consequences on muscle structure and function associated with mechanical silencing in ICU patients, strongly supporting early and intense physical therapy in immobilized ICU patients.
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Project description:Critically ill intensive care unit (ICU) patients commonly develop severe muscle wasting and impaired muscle function, leading to delayed recovery, with subsequent increased morbidity and financial costs, and decrease quality of life of survivors. Acute Quadriplegic Myopathy (AQM) is one of the most common neuromuscular disorders associated with ICU-acquired muscle weakness. Although there are no available treatments for the ICU-acquired muscle weakness, it has been demonstrated that early mobilization can improve its prognosis and functional outcomes. This study aims at improving our understanding of the effects of passive mechanical loading on skeletal muscle structure and function by using a unique experimental rat ICU model allowing analyses of the temporal sequence of changes in mechanically ventilated and pharmacologically paralyzed animals at durations varying from 6 h to 14 days. Results show that passive mechanical loading alleviated the muscle wasting and the loss of force-generation associated with the ICU intervention, resulting in a doubling of the functional capacity of the loaded vs. unloaded muscles after a 2-week ICU intervention. We demonstrated that the improved maintenance of muscle structure and function is likely a consequence of a reduced oxidative stress, and a reduced loss of the molecular motor protein myosin. A complex temporal gene expression pattern, delineated by microarray analysis, was observed with loading-induced changes in transcript levels of sarcomeric proteins, muscle developmental processes, stress response, ECM/cell adhesion proteins and metabolism. Thus, the results from this study show that passive mechanical loading alleviates the severe negative consequences on muscle structure and function associated with mechanical silencing in ICU patients, strongly supporting early and intense physical therapy in immobilized ICU patients. This study aims to unravel the effects of passive mechanical loading on skeletal muscle structure and function in an experimental rat ICU model at duration varying between 6h and 14 days. A total of 23 experimental female Sprague-Dawley rats were included in this study. The experimental rats were anaesthetized, treated with the neuromuscular blocking agent (NMBA) M-NM-1-cobrotoxin, mechanically ventilated and monitored for durations varying from 6h to 4 days (n=13), from 5 to 8 days (n=4), and from 9 to 14 days (n=6). The left leg of the animal was activated for 6 hours at the shortest duration and 12 hours per day at durations 12 hours and longer throughout the experiment, using a mechanical lever arm that produced a continuous passive maximal ankle joint flexions-extensions at a speed of 13.3 cycles per minute. Muscle biopsies were obtained from gastrocnemius muscle (proximal part) immediately after euthanasia, were quickly frozen in liquid propane cooled by liquid nitrogen, and stored at -80M-BM-0C. RNA was extracted.
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Project description:BackgroundTo investigate an outbreak of Burkholderia cenocepacia bacteremia. Observational study and chart review in a multidisciplinary adult Intensive Care Unit (ICU) at a tertiary care hospital.MethodsPatients' demographic variables, comorbid conditions, ICU admission diagnosis, disease severity and outcome were analyzed. In case-patients, time and possible sources of bacteremia, molecular assays, antimicrobial susceptibility and response to therapy were also recorded.ResultsDuring a 9-month period, 30 episodes of B. cenocepacia bacteremia were diagnosed in 21 patients. Median time for a positive blood culture was 9 days after admission. None of the case-patients had respiratory colonization prior to onset of bacteremia. Pathogen was susceptible to meropenem, piperacillin/tazobactam, ciprofloxacin and trimethoprim /sulphamethoxazole. Surveillance involved environmental and patient/personnel cultures. All samples were negative for B. cenocepacia. However, extensive assessment revealed lapses in infection control procedures. PFGE molecular typing showed that all isolates were indistinguishable. Prior surgery and septic shock on ICU admission were significantly more frequent among case-patients. These patients needed significantly prolonged mechanical ventilation, central venous catheterization and ICU hospitalization. All patients responded to antimicrobial therapy and the attributed mortality was zero. Complete elimination of the outbreak was achieved only after strict enforcement of infection control policies and ICU disinfection.ConclusionThe outbreak influenced ICU morbidity but it did not affect mortality. Although extensive environmental investigations failed to identify the source of infection, B.cenocepacia disappeared after implementation of control measures. Effective outbreak elimination cannot be limited to offending reservoir removal but needs to extend to efficient infection control practices.
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