1471: KLEBSIELLA PNEUMONIAE SEPTIC SHOCK IN A NONHUMAN PRIMATE INTENSIVE CARE MODEL

SummaryRats which were infected with the gramnegative pathogen Klebsiella pneumoniae develop disseminated intravascular coagulation (DIC), multi-organ failure (MOF) and finally die in a septic shock. We investigated the therapeutic effect of antibiotic (tobramycin) treatment combined with the infusion of the highly specific thrombin inhibitor rec. hirudin. Although administration of 2 mg/kg tobramycin alone leads to a decrease of the bacterial burden, DIC could not be prevented. Infusion of rec. hirudin (0.25 mg/kg x h) for 4 h (start of treatment 1 h post infection), in addition to a bolus administration of tobramycin, led to an amelioration of DIC parameters as fibrinogen, thrombin-antithrombin complex (TAT) and platelets. Serum transaminase levels (GOT, GPT) as a marker of MOF were significantly improved by rec. hirudin, the T50 value increased from 17 h in the tobramycin group to 42 h in the tobramycin + rec. hirudin giuup, muilality rates were 90% or 60%, respectively. Combination of heparin (10011/kg x h) and tobramycin was not effective on survival.

Download Full-text

Validation of the pediatric refractory septic shock definition: post hoc analysis of a controlled trial

Annals of Intensive Care ◽

10.1186/s13613-021-00822-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Luc Morin ◽

Karthik Narayanan Ramaswamy ◽

Muralidharan Jayashree ◽

Arun Bansal ◽

Karthi Nallasamy ◽

...

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Receiver Operating Curve ◽

Double Blind ◽

Post Hoc Analysis ◽

Prognostic Accuracy ◽

Refractory Septic Shock ◽

Post Hoc

Abstract Background The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) developed and validated a definition of pediatric refractory septic shock (RSS), based on two septic shock scores (SSS). Both bedside SSS (bSSS) and computed SSS (cSSS) were found to be strongly associated with mortality. We aimed at assessing the accuracy of the RSS definition on a prospective cohort from India. Methods Post hoc analysis of a cohort issued from a double-blind randomized trial that compared first-line vasoactive drugs in children with septic shock. Sequential bSSS and cSSS from 60 children (single-center study, 53% mortality) were analyzed. The prognostic value of the ESPNIC RSS definition was tested for 28-day all-cause mortality. Results In this septic shock cohort, RSS was diagnosed in 35 patients (58.3%) during the first 24 h. Death occurred in 30 RSS patients (85.7% mortality) and in 2 non-RSS patients (8% mortality), OR = 60.9 [95% CI: 10.5–676.2], p < 0.001 with a median delay from sepsis onset of 3 days [1.0–6.7]. Among patients diagnosed with RSS, the mortality was not significantly different according to vasopressors randomization. Diagnosis of RSS with bSSS and cSSS had a high discrimination for death with an area under the receiver operating curve of 0.916 [95% CI: 0.843–0.990] and 0.925 [95% CI: 0.845–1.000], respectively. High prognostic accuracy of the bSSS was found in the first hours following intensive care admission. The best interval of prognostication occurs after the 12th hour following treatment initiation (AUC 0.973 [95% CI: 0.925–1.000]). Conclusions The ESPNIC refractory septic shock definition accurately identifies, within the first 6 h of septic shock management, children with lethal outcome.

Download Full-text

Healthcare trajectories before and after critical illness: population-based insight on diverse patients clusters

Annals of Intensive Care ◽

10.1186/s13613-019-0599-3 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Youenn Jouan ◽

Leslie Grammatico-Guillon ◽

Noémie Teixera ◽

Claire Hassen-Khodja ◽

Christophe Gaborit ◽

...

Keyword(s):

Septic Shock ◽

Mechanical Ventilation ◽

Intensive Care ◽

Critical Illness ◽

Length Of Stay ◽

Population Based ◽

Hospital Length Of Stay ◽

Healthcare Use ◽

Icu Admission ◽

Icu Discharge

Abstract Background The post intensive care syndrome (PICS) gathers various disabilities, associated with a substantial healthcare use. However, patients’ comorbidities and active medical conditions prior to intensive care unit (ICU) admission may partly drive healthcare use after ICU discharge. To better understand retative contribution of critical illness and PICS—compared to pre-existing comorbidities—as potential determinant of post-critical illness healthcare use, we conducted a population-based evaluation of patients’ healthcare use trajectories. Results Using discharge databases in a 2.5-million-people region in France, we retrieved, over 3 years, all adult patients admitted in ICU for septic shock or acute respiratory distress syndrome (ARDS), intubated at least 5 days and discharged alive from hospital: 882 patients were included. Median duration of mechanical ventilation was 11 days (interquartile ranges [IQR] 8;20), mean SAPS2 was 49, and median hospital length of stay was 42 days (IQR 29;64). Healthcare use (days spent in healthcare facilities) was analyzed 2 years before and 2 years after ICU admission. Prior to ICU admission, we observed, at the scale of the whole study population, a progressive increase in healthcare use. Healthcare trajectories were then explored at individual level, and patients were assembled according to their individual pre-ICU healthcare use trajectory by clusterization with the K-Means method. Interestingly, this revealed diverse trajectories, identifying patients with elevated and increasing healthcare use (n = 126), and two main groups with low (n = 476) or no (n = 251) pre-ICU healthcare use. In ICU, however, SAPS2, duration of mechanical ventilation and length of stay were not different across the groups. Analysis of post-ICU healthcare trajectories for each group revealed that patients with low or no pre-ICU healthcare (which represented 83% of the population) switched to a persistent and elevated healthcare use during the 2 years post-ICU. Conclusion For 83% of ARDS/septic shock survivors, critical illness appears to have a pivotal role in healthcare trajectories, with a switch from a low and stable healthcare use prior to ICU to a sustained higher healthcare recourse 2 years after ICU discharge. This underpins the hypothesis of long-term critical illness and PICS-related quantifiable consequences in healthcare use, measurable at a population level.

Download Full-text

Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Antibiotics ◽

10.3390/antibiotics10010076 ◽

2021 ◽

Vol 10 (1) ◽

pp. 76

Author(s):

Matthaios Papadimitriou-Olivgeris ◽

Christina Bartzavali ◽

Alexandra Georgakopoulou ◽

Fevronia Kolonitsiou ◽

Chrisavgi Papamichail ◽

...

Keyword(s):

Septic Shock ◽

Klebsiella Pneumoniae ◽

Critically Ill ◽

Critically Ill Patients ◽

Primary Outcome ◽

Bloodstream Infections ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Carbapenemase Gene ◽

Comorbidity Index

Background: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. Methods: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. blaKPC, blaVIM, blaNDM, and blaOXA genes were detected by PCR. Results: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. blaKPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. Conclusions: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.

Download Full-text

Epidemiologic characteristics of Klebsiella pneumoniae isolates in ventilator-associated pneumonia in intensive care units

African Journal of Clinical and Experimental Microbiology ◽

10.4314/ajcem.v18i1.2 ◽

2016 ◽

Vol 18 (1) ◽

pp. 11

Author(s):

A.A. El Sharkawy ◽

M.A. Mansour ◽

H.M. Helmy ◽

D.M. Abd El Azeem

Keyword(s):

Intensive Care ◽

Klebsiella Pneumoniae ◽

Intensive Care Units ◽

Ventilator Associated Pneumonia ◽

Epidemiologic Characteristics

Download Full-text

Necrotizing Soft Tissue Infections in Intensive Care

Journal of Intensive Care Medicine ◽

10.1177/08850666211010127 ◽

2021 ◽

pp. 088506662110101

Author(s):

Alexandru Ogica ◽

Christoph Burdelski ◽

Holger Rohde ◽

Stefan Kluge ◽

Geraldine de Heer

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Soft Tissue ◽

Sofa Score ◽

Laboratory Data ◽

Serum Lactate ◽

Soft Tissue Infections ◽

Necrotizing Soft Tissue Infections ◽

The Mean ◽

Organ Dysfunctions

Background: Necrotizing soft tissue infections (NSTIs) are typically characterized by extensive soft tissue destruction with systemic signs of toxicity, ranging from sepsis to septic shock. Our aim was to analyze the clinical characteristics, microbiological results, laboratory data, therapies, and outcome of patients with NSTIs admitted to an intensive care unit (ICU). Methods: A monocentric observational study of patients admitted to the ICU of a university hospital between January 2009 and December 2017. The demographic characteristics, comorbidities, clinical features, microbiology and laboratory results, organ dysfunctions, therapies, and outcome were retrospectively analyzed. Results: There were 59 patients and 70% males. The mean age (± SD) was 55 ± 18; type II (monomicrobial) NSTI was present in 36 patients (61%); the most common isolated pathogen was Streptococcus pyogenes in 28 patients (48%). Septic shock was diagnosed in 41 patients (70%). The most common organ dysfunctions were circulatory and renal in 42 (71%) and 38 patients (64%). The mean value (± SD) of serum lactate at admission to the ICU was 4.22 ± 5.42 mmol/l, the median SOFA score and SAPS II were 7 (IQR 4 - 10) and 46 (IQR 30.5 - 53). ICU mortality rate was 25%. Both SOFA score and serum lactate demonstrated a good prognostic value regarding ICU outcome (OR 1.29, 95%CI 1.07-1.57, P < 0.007 and OR 1.53, 95%CI 1.19-1.98, P < 0.001). A cut-off value for serum lactate of 6.55 mmol/L positively predicted mortality with 67% sensitivity and 97% specificity. Conclusion: NSTIs carry a high risk of septic shock and multiple organ dysfunction syndrome and thus are still associated with high mortality. In our study, the value of serum lactate at admission to the ICU correlated well with mortality. This easy-to-measure parameter could play a role in the decision-making process regarding prognosis and continuation of care.

Download Full-text

Safety in Incubators: A Hazard Now Corrected

PEDIATRICS ◽

10.1542/peds.48.1.165 ◽

1971 ◽

Vol 48 (1) ◽

pp. 165-165

Author(s):

Margery Franklin ◽

Ruth M. Heyn ◽

Dietric W. Roloff

Keyword(s):

Intensive Care ◽

Newborn Infants ◽

Recent Experience ◽

Potential Hazard ◽

Care Model ◽

Change Position

A recent experience made us aware of a potential hazard from equipment used in the care of newborn infants. A newborn boy who weighed 1,585 gm after 36 weeks' gestation and thus was small for date, was cared for in an Air-Shields C-86 Isolette, Intensive Care Model. He became very active and was able to change position inside the incubator. On several occasions he was seen with his head or feet pressed against the sides of the incubator.

Download Full-text

Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

10.21203/rs.3.rs-658252/v1 ◽

2021 ◽

Author(s):

Yuzhen Qiu ◽

Wen Xu ◽

Yunqi Dai ◽

Ruoming Tan ◽

Jialin Liu ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Klebsiella Pneumoniae ◽

Critically Ill Patients ◽

Bloodstream Infections ◽

Polymyxin B ◽

Mortality Rates ◽

Carbapenem Resistant ◽

All Cause Mortality ◽

Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

Download Full-text

Neutrophil-to-lymphocyte count ratio in predicting prognosis of septic shock patients

QJM ◽

10.1093/qjmed/hcab086.080 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hoda Omar Mahmoud ◽

Niven Gerges Fahmy ◽

Mona Ahmed Mohamed Abdelmotaleb Ammar ◽

Mostafa Mansour Mohamed Elsaid ELryany

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Lymphocyte Count ◽

Late Mortality ◽

Late Death ◽

Tertiary Referral Center ◽

Risk Of Death ◽

Count Ratio ◽

Significant Difference ◽

Common Causes

Abstract Background Septic shock is one of the most common causes of admission to the intensive care unit in the world and one of the most common causes of death among intensive care patients. Since the definition of sepsis and septic shock and many studies have been designed to understand everything about sepsis regarding mechanism, pathophysiology, complications, diagnosis, management and all other aspects. Objective To find the association between neutrophil to lymphocyte count ratio and the mortality from septic shock patients. The work aims also to determine if this ratio can be used as a prognostic marker of septic shock patients and to compare this ratio with other sepsis markers as C-reactive protein (CRP) and procalcitonin. Patients and Methods This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 125 patients between January 2018 to January 2019. The ethics committee of our institution approved the study protocol, and written informed consent was obtained from each patient’s family. Results In our study, the neutrophils count was significantly increased in survived patients compared with early and late mortality patients in day 1 while lymphocytes count was lower in survived patient than early and late mortality patients and the NLCR in our study was higher in survived patients than early and late mortality patients. In day 4, our results revealed significant increase in neutrophils count in patients of late mortality compared with its count in survived patients, while lymphocytes didn't show any significant difference compared with its count in survived patients with significant increase in NLCR in patients of late mortality compared with those of survived patients in day 4. Both CRP and procalcitonin are increased in patients of early and late mortality groups compared with its value in survived patients in day 1 and 4. Conclusion This study demonstrates a real relationship between the NLCR and the risk of death in septic shock patients. Septic shock patients at risk of early death presented a low NLCR at admission, although late death was associated with an increased NLCR during the first 5 days. Early and late death should be distinguished because they may involve different underlying mechanisms, and the NLCR might be considered as a discriminant indicator of early or late death. In addition, our findings provide more insight into biology. The circulating neutrophil and lymphocyte trends observed in this study offer an interesting mechanistic viewpoint. We observed that circulating lymphocytes and the NLCR behave in opposite ways in early- and late death patients, supporting the hypothesis that divergent mechanisms could be involved in these two groups.

Download Full-text