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The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy.

Background and objectives Increasing experimental evidence suggests that acute respiratory distress syndrome (ARDS) may promote AKI. The primary objective of this study was to assess ARDS as a risk factor for AKI in critically ill patients.Design, setting, participants, & measurements This was an observational study on a prospective database fed by 18 intensive care units (ICUs). Patients with ICU stays .24 hours were enrolled over a 14-year period. ARDS was defined using the Berlin criteria and AKI was defined using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria. Patients with AKI before ARDS onset were excluded.Results This study enrolled 8029 patients, including 1879 patients with ARDS. AKI occurred in 31.3% of patients and was more common in patients with ARDS (44.3% versus 27.4% in patients without ARDS; P,0.001). After adjustment for confounders, both mechanical ventilation without ARDS (odds ratio [OR], 4.34; 95% confidence interval [95% CI], 3.71 to 5.10) and ARDS (OR, 11.01; 95% CI, 6.83 to 17.73) were independently associated with AKI. Hospital mortality was 14.2% (n=1140) and was higher in patients with ARDS (27.9% versus 10.0% in patients without ARDS; P,0.001) and in patients with AKI (27.6% versus 8.1% in those without AKI; P,0.001). AKI was associated with higher mortality in patients with ARDS (42.3% versus 20.2%; P,0.001).Conclusions ARDS was independently associated with AKI. This study suggests that ARDS should be considered as a risk factor for AKI in critically ill patients.

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After participating in this activity, the participant should be better able to:1. Illustrate factors associated with arterial catheter-related colonization.2. Explain risk factors associated with central venous catheter-associated colonization.3. Use this information in a clinical setting.Unless otherwise noted below, each faculty or staff's spouse/life partner (if any) has nothing to disclose.Dr. Timsit has disclosed that he received grants/research fees from Jousea-Cilog, Pfizer, and MSD; was a consultant/advisor for 3M, Core Fusion, and Sanofi-Pasteur; and was on the speaker's bureau for Astelles. He is currently receiving grants/reserach fees from Ethicon; is a consultant/advisor for 3M and Core Fusion; and is on the speaker's bureau for Astelles. The remaining authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.All faculty and staff in a position to control the content of this CME activity have disclosed that they have no financial relationship with, or financial interests in, any commercial companies pertaining to this educational activity.Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit. Background: Scheduled replacement of central venous catheters and, by extension, arterial catheters, is not recommended because the daily risk of catheter-related infection is considered constant over time after the first catheter days. Arterial catheters are considered at lower risk for catheter-related infection than central venous catheters in the absence of conclusive evidence. Objectives: To compare the daily risk and risk factors for colonization and catheter-related infection between arterial catheters and central venous catheters.Methods: We used data from a trial of seven intensive care units evaluating different dressing change intervals and a chlorhexidine-impregnated sponge. We determined the daily hazard rate and identified risk factors for colonization using a marginal Cox model for clustered data.Results: We included 3532 catheters and 27,541 catheter-days. Colonization rates did not differ between arterial catheters and central venous catheters (7.9% [11.4/1000 catheter-days] and 9.6% [11.1/1000 catheterdays], respectively). Arterial catheter and central venous catheter catheterrelated infection rates were 0.68% (1.0/1000 catheter-days) and 0.94% (1.09/ 1000 catheter-days), respectively. The daily hazard rate for colonization increased steadily over time for arterial catheters (p ‫؍‬ .008) but remained