Ying-Hsuan Tai

Intestinal colonization with vancomycin-resistant Enterococcus (VRE) is a critical precursor to invasive infection. However, data on its determinants and prognostic implications in critically ill patients with sepsis remain limited. This study aimed to develop and internally validate a prediction model for intestinal VRE colonization and to assess its clinical consequences. We conducted a retrospective cohort study of adult patients with sepsis admitted to the intensive care unit (ICU) of a tertiary medical center in Taiwan in 2024. Multivariable logistic regression was used to identify independent predictors of intestinal VRE colonization, and two prediction models were developed and internally validated using a split-sample approach. Model performance was assessed by discrimination, calibration, and decision curve analysis. The incidences of VRE-related urinary tract infection and bacteremia within 30 days of ICU admission were compared between colonized and non-colonized patients. Among 250 eligible patients, 14.0% had intestinal VRE colonization. Three independent predictors were identified: the Charlson Comorbidity Index (adjusted odds ratio [aOR], 1.676; 95% confidence interval [CI], 1.268-2.214), prior exposure to cephalosporins (aOR, 2.80; 95% CI, 1.146-6.841), and enteral feeding (aOR, 5.21; 95% CI, 1.16-23.41). The final model showed good discrimination, with an AUC of 0.751 (95% CI, 0.572-0.930) in the validation cohort. Calibration analyses indicated good agreement between predicted and observed risks, and decision curve analysis showed positive net benefit across clinically relevant threshold probabilities. Patients with baseline VRE colonization had significantly higher risks of subsequent VRE-related urinary tract infection (22.9% vs. 1.4%, p < 0.001) and bacteremia (5.7% vs. 0.5%, p = 0.008). We developed and internally validated a prediction model with potential clinical utility for early risk stratification in critically ill patients with sepsis. Clinical trial number: not applicable.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with an exceedingly high mortality rate and limited therapeutic options. Early

We aimed to determine the incidence of subcutaneous emphysema following laparoscopic totally extraperitoneal (TEP) inguinal herniorrhaphy and to evaluate i

Background: Opioid-related oversedation is associated with respiratory depression and can lead to potentially catastrophic adverse events in hospitalized patients. This study aimed to investigate influential factors for postoperative sedation during morphine-based intravenous patient-controlled analgesia (IV-PCA). Methods: We enrolled patients who received morphine-based IV-PCA for postoperative pain at a medical hospital between January 2020 and November 2022. The primary outcome was unintentional sedation within 72 h after surgery. The Observer Assessment of Alertness/Sedation Scale (OAA/S) was used to assess the sedation depth at 12-hour intervals. Multivariable logistic regression models were used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (CI) for the outcome of interest. Results: A total of 1,461 patients were included for analyses. The multivariable analysis identified six independent factors for morphine-associated sedation, including age (aOR: 1.019, 95% CI: 1.008–1.030), current alcohol drinking (aOR: 2.14, 95% CI: 1.24–3.68), preoperative hemoglobin level (aOR: 0.41, 95% CI: 0.21–0.81, on base-2 logarithmic scale), intraoperative use of midazolam (aOR: 1.62, 95% CI: 1.07–2.45), basal morphine infusion (aOR: 2.08, 95% CI: 1.16–3.71), and duration of IV-PCA (aOR: 1.97, 95% CI: 1.09–3.57, on base-2 logarithmic scale). Basal morphine infusion was also associated with moderate-to-deep sedation (OAA/S score ≤ 3) (aOR: 2.75, 95% CI: 1.38–5.46). Furthermore, the combination of intraoperative midazolam use and basal morphine infusion was associated with an increased risk of sedation, suggesting a potential synergistic relationship. Conclusion: The identified risk factors for morphine-associated oversedation can facilitate early identification and prevention of complications in high-risk populations. Our findings suggest that perioperative use of sedative-hypnotics and continuous opioid infusions should be approached cautiously in at-risk patients.