The Three Truths of Grader Boob's Birthday Eve

1.  It is late, in that I haven't gone to yesterday's bed yet; 


2.  I'm desperate, in that loosey-goosey, self-referential, golden-red patina sort of way common only to the truly ultra-diuresed; and...


3.  The research citation, below, from title to conclusions, is hilarity, itself (although dependent on:


1.  bug-eyed insomnia; and...


2.  the attenuated aridity of my kidneys):

End-of-Life Treatment and Bacterial Antibiotic Resistance:
A Potential Association

Phillip D. Levin, MB, BChir, Andrew E. Simor, MD, Allon E. Moses, MD and Charles L. Sprung, MD, FCCP

Chest 2010 Sep 138:588

Correspondence to:
Phillip Levin, MB, BChir, Department of Anesthesiology and Critical Care Medicine, POB 12000, Jerusalem 91120, Israel; e-mail: phillipl@hadassah.org.il

Abstract
Background: Great variability exists in the occurrence of antibiotic-resistant bacteria in ICUs around the world. The contribution of specific ICU care variables to these geographic variations is unknown.

Methods: ICU patients from two ICUs (in Jerusalem and Toronto) who were admitted for > 48 h and who grew a resistant bacteria in any culture during ICU admission were compared with those without resistant organisms across a range of demographic and ICU care interventions. Significant variables were investigated with logistic regression to identify factors predictive of infection/colonization with a resistant organism.

Results: Resistant organisms were acquired by 82/423 (19%) patients. Patients acquiring a resistant organism had a higher incidence of diabetes mellitus (21/82, 26% vs 52/341, 15%; P = .026), were more frequently admitted from another ICU (17/82, 21% vs 33/341, 10%; P = .005), received more antibiotics in the ICU (19 ± 17 vs 14 ± 14 days; P = .005), and had more ventilator (10 ± 10 vs 7 ± 8; P = .031) and central line days (10 ± 8 vs 7 ± 8; P < .001). These patients had a lower incidence of limitation-of-therapy orders (9/82, 11% vs 78/341, 23%; P = .015). Only the absence of a limitation-of-therapy order (odds ratio, 2.62; 95% CI, 1.21-5.68; P = .014) was independently associated with the acquisition of resistant organisms. Further, among ICU fatalities, 5/45 (11%) patients acquired a resistant organism prior to withdrawal vs 17/44 (39%) nonwithdrawal fatalities (P = .003). Nonwithdrawal fatalities received significantly more third-line antibiotics (7 ± 14 vs 2 ± 4; P = .031) despite similar ICU lengths of stay (15 ± 21 days for nonwithdrawal fatalities vs 10 ± 11 for withdraw fatalities; P = .210)


Conclusions: End-of-life treatment is independently associated with acquisition of resistant bacteria. Patients dying without withdraw orders receive more antibiotics and develop more resistant organisms. These patients may represent a reservoir of resistant bacteria in the ICU.


In honor of Grader Boob's very literateness, in lieu of a gift card, in memory of all the poèmes trouvés (volés! volés!) in the cafés and bars of the East Bay Scene, a bit of poesy:

These patients may

represent a reservoir.

Of resistant

bacteria!  Of

resistant,

bacteria!

Bacteria

in

the

ICU, in the

ICU.

I dunno, Brother-Unit, it just struck me as funny.  You could have taken those same precious research dollars and used them in a way much more advantageous to The Species.  But, in that case, my pome wouldn'ae a-been borned. 

We'll be giving you the Birthday Buzz in the morning, before you head out to do your duty among The Uneducated, The Great Unwashed, The Hoi Polloi. 

Never forget, they pay your salary.  (I'm passing away from mirth.)

In any event, from the instant of your arrival in the back of that London cab, to the moment of your far off departure, a reservoir of resistant bacteria, you've been, among a good many things, a stringent proof of God's existence.  (With extra points for showing your work.)