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2026, Number 4

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Med Crit 2026; 40 (4)

Association between acquired muscle weakness in critically ill patients and multi-resistant infections: a complex interaction model; MIRANDA Trial

Correa BNR, López FJ, Ulloa YJ, Martínez RM

Language: Spanish
References: 20
Page: 286-293
PDF size: 787.17 Kb.


ABSTRACT

Introduction: ICU-acquired weakness (ICU-AW), assessed by the MRC sum score, is frequent and portends worse outcomes. Multidrug-resistant (MDR) infections add clinical complexity. Objective: to describe ICU-AW burden and early trajectories, and explore associations with outcomes in an MDR cohort. Material and methods: single-center retrospective cohort. Twenty-seven MDR patients (2024) were analyzed. Variables included MRC at admission, day 3, day 5; hospital mortality; ICU length-of-stay; APACHE II and SOFA. Severe ICU-AW: MRC < 36. For small n we used Clopper–Pearson CIs, exact/non-parametric tests, and effect sizes (Hedges g, point-biserial r). Results: median age 69 (IQR 60.5-71.0); male 48.1% (95%CI 28.7-68.1). Mortality 29.6% (8/27; 95%CI 13.8-50.2). ICU-AW was highly prevalent (MRC < 48: 96.3%; MRC<36: 63.0%, 95%CI 42.4-80.6). MRC declined by day 3 (−10) and day 5 (−12) from baseline. Mortality was higher in severe ICU-AW (OR 6.30, 95%CI 0.64-61.63; Fisher p = 0.190). SOFA and APACHE showed moderate effects (g = 0.76 and 0.44). Conclusion: in MDR ICU patients, ICU-AW is near-universal and worsens early. Larger, penalized analyses are warranted.


REFERENCES

  1. Rich MM, Raps EC, Bird SJ. Distinction between acute myopathysyndrome and critical illness polyneuropathy. Mayo Clin Proc.1995;70(2):198-200.

  2. Griffiths RD, Hall JB. Intensive care unit-acquired weakness. CritCare Med. 2010;38(3):779-787.

  3. Kress JP, Hall JB. ICU-acquired weakness and recovery fromcritical illness. N Engl J Med. 2014;370(17):1626-1635.

  4. Garnacho-Montero J, Amaya-Villar R, García-Garmendía JL, etal. Effect of critical illness polyneuropathy on the withdrawal frommechanical ventilation and the length of stay in septic patients.Crit Care Med. 2005;33(2):349-354.

  5. Singer M, Deutschman CS, Seymour CW, et al. The thirdinternational consensus definitions for sepsis and septic shock(Sepsis-3). JAMA. 2016;315(8):801-810.

  6. De Jonghe B, Cook D, Sharshar T, et al. Acquired neuromusculardisorders in critically ill patients: a systematic review. IntensiveCare Med. 1998;24(12):1242-1250.

  7. Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquiredweakness. Intensive Care Med. 2020;46(4):637-653.

  8. Yang T, Li Z, Jiang L, Wang Y, Xi X. Risk factors for intensivecare unit-acquired weakness: a systematic review and metaanalysis.Acta Neurol Scand. 2018;138(2):104-114.

  9. Paul M, Shani V, Muchtar E, Kariv G, Robenshtok E, LeiboviciL. Systematic review and meta-analysis of the efficacy ofappropriate empiric antibiotic therapy for sepsis. AntimicrobAgents Chemother. 2010;54(11):4851-4863.

  10. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrugresistant,extensively drug-resistant and pandrug-resistantbacteria: an international expert proposal for interim standarddefinitions for acquired resistance. Clin Microbiol Infect.2012;18(3):268-281.

  11. World Health Organization. WHO bacterial priority pathogens list2024: bacterial pathogens of public health importance to guideresearch, development and strategies to prevent and controlantimicrobial resistance. Geneva: WHO; 2024.

  12. Sibila O, Rodrigo-Troyano A, Shindo Y, Aliberti S, Restrepo MI.Multidrug-resistant pathogens in patients with pneumonia comingfrom the community. Curr Opin Pulm Med. 2016;22(3):219-226.

  13. Timsit JF, Bassetti M, Cremer O, et al. Rationalizing antimicrobialtherapy in the ICU: a narrative review. Intensive Care Med.2019;45(2):172-189.

  14. Versporten A, Zarb P, Caniaux I, et al. Antimicrobial consumptionand resistance in adult hospital inpatients in 53 countries: resultsof an internet-based global point prevalence survey. Lancet GlobHealth. 2018;6(6):e619-629.

  15. Kumar NR, Balraj TA, Kempegowda SN, Prashant A. Multidrugresistantsepsis: a critical healthcare challenge. Antibiotics(Basel). 2024;13(1):46.

  16. Fazzini B, Markl T, Costas C, et al. The rate and assessment ofmuscle wasting during critical illness: a systematic review andmeta-analysis. Crit Care. 2023;27(1):2.

  17. Petrucci M, Gemma S, Carbone L, et al. ICU-acquired weakness:from pathophysiology to management in critical care. EmergCare Med. 2025;2(1):4.

  18. Chen J, Huang M. Intensive care unit-acquired weakness: recentinsights. J Intensive Med. 2023;4(1):73-80.

  19. Witteveen E, Sommers J, Wieske L, et al. Diagnostic accuracyof quantitative neuromuscular ultrasound for the diagnosisof intensive care unit-acquired weakness: a cross-sectionalobservational study. Ann Intensive Care. 2017;7(1):40.

  20. Klawitter F, Walter U, Axer H, Patejdl R, Ehler J. Neuromuscularultrasound in intensive care unit-acquired weakness: currentstate and future directions. Medicina (Kaunas). 2023;59(5):844.




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