Masterclass 7 - Specials in Intensive Care

The Gram-negative bacterial pathogen Klebsiella pneumoniae has consistently evolved over the past two decades, generating genetic variants that exhibit mixed phenotypes of hyper-resistance and hypervirulence including carbapenem-resistant K. pneumoniae (CRKP), hypervirulent K. pneumoniae (HvKP) and carbapenem-resistant hypervirulent K. pneumoniae (CR-HvKP). These bacterial strains were found to persist as ‘normal flora’ in patients and remain viable for a prolonged period in clinical settings, resulting in further dissemination and infections among hospital patients. Treatment with the last resort antibiotics such as ceftazidime/avibactin and colistin readily leads to the development of resistance, resulting in extremely limited choices of agents for treatment of infections caused by these superbugs. Comprehensive surveillance data in China showed that K. pneumoniae has become the most common clinically isolated bacterial pathogens since 2014. It is also listed as the most common bacterial pathogen that causes blood stream infections and the bacterial species that causes the highest mortality rate. It is commonly accepted that K. pneumoniae poses a major threat to hospital patients, with the situation being out of control in certain countries in Asia. A thorough understanding of the evolution trend, transmission dynamics and pathogenic mechanisms of this notorious pathogen is essential for development of effective intervention strategies to promptly prevent it from being further disseminated to a scale of global public health calamity. In this talk, I will share with you the updates research conducted in our lab on the understanding of evolution and current trend of K. pneumoniae in clinical setting.

ICU beds are expensive and critical resources in modern healthcare. Its under provision would jeopardise the quality of healthcare, while its over provision overburden the limited resources. However, there is no hard and fast rule on what is the optimal number of ICU beds for a given population. Hong Kong has around 3.5 ICU beds per 100,000 population, which is on the low side when compared with other developed countries. As such, the occupancy rate of ICU beds is always high in Hong Kong. A native view of the occupancy rate is to see whether an ICU is "busy" or not. However, it is an oversimplified view and may not be accurate. Is there any other insight we could gain from the ICU utilisation data? In the presentation, the current ICU bed utilisation data of Hong Kong will be reviewed. Then, a few examples on how other uses of the utilisation data will be discussed: determining the number of required isolation room in an ICU expansion project; demonstrating the impact of new service commissioning on the availability of ICU service to other users. Lastly, a method of resampling of the ICU utilisation data would be introduced. With this method, one could estimate the strain of ICU beds with minimal assumptions. When resampling is applied to data from local ICUs, the results showed that triage pressure existed to a varying degree.

The relationship between intensive care medicine and healthcare quality and safety will be explored in this session. From the exploration, the speaker will identify opportunities and threats to share with the audience.