scholarly journals Pleural Listeriosis: A Rare Entity

2020 ◽  
Author(s):  
Maria Inês Silva ◽  
Isabel Ferreira ◽  
Teresa Brandão ◽  
Paulo Telles de Freitas
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Respiratory Infections ◽  
Blood Cultures ◽  
Cns Infection ◽  
Rare Entity ◽  
First Line ◽  
Uncommon Presentation ◽  
Worse Prognosis ◽  
Fluid Culture

Listeria monocytogenes is a gram positive bacillus responsible for listeriosis. This infection manifests mainly as bacteremia and / or central nervous system (CNS) infection. Involvement of other sites is rare. Pleural listeriosis is an uncommon presentation of L. monocytogenes infection and there is little data to guide the management of these patients. First-line antibiotics used empirically to treat bacterial respiratory infections are ineffective in treating these L. monocytogenes infections, which contributes to the progression of the infection and a worse prognosis. We present a case report of a patient admitted to an intensive care unit with septic shock secondary to systemic listeriosis with L. monocytogenes isolation in pleural fluid culture and blood cultures. The evolution of the hospitalization and the clinical outcome are reported.

scholarly journals Prognostic roles of time to positivity of blood cultures in patients with Escherichia coli bacteremia

2020 ◽  
Vol 148 ◽  
Author(s):  
Yufang Chen ◽  
Xun Huang ◽  
Anhua Wu ◽  
Xuan Lin ◽  
Pengcheng Zhou ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Blood Cultures ◽  
University Teaching ◽  
Clinical Value ◽  
Prognostic Assessment ◽  
Time To Positivity

Abstract The time to positivity (TTP) of blood cultures has been considered a predictor of clinical outcomes for bacteremia. This retrospective study aimed to determine the clinical value of TTP for the prognostic assessment of patients with Escherichia coli bacteremia. A total of 167 adult patients with E.coli bacteremia identified over a 22-month period in a 3500-bed university teaching hospital in China were studied. The standard cut-off TTP was 11 h in the patient cohort. The septic shock occurred in 27.9% of patients with early TTP (⩽11 h) and in 7.1% of those with a prolonged TTP (>11 h) (P = 0.003). The mortality rate was significantly higher for patients in the early than in the late group (17.7% vs. 4.0%, P < 0.001). Multivariate analysis showed that an early TTP (OR 4.50, 95% CI 1.70–11.93), intensive care unit admission (OR 8.39, 95% CI 2.01–35.14) and neutropenia (OR 4.20, 95% CI 1.55–11.40) were independently associated with septic shock. Likewise, the independent risk factors for mortality of patients were an early TTP (OR 3.80, 95% CI 1.04–12.90), intensive care unit admission (OR 6.45; 95% CI 1.14–36.53), a Pittsburgh bacteremia score ⩾2 (OR 4.34, 95% CI 1.22–15.47) and a Charlson Comorbidity Index ⩾3 (OR 11.29, 95% CI 2.81–45.39). Overall, a TTP for blood cultures within 11 h appears to be associated with worse outcomes for patients with E.coli bacteremia.

scholarly journals Treatment of COVID-19 by CD24FC; a mini-review to the current knowledge

2021 ◽  
Vol 6 (1) ◽  
pp. e04-e04
Author(s):  
Ghazal Ghasempour Dabaghi ◽  
Mehrdad Rabiee Rad ◽  
Lillian Saberian
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Immune Responses ◽  
Essential Role ◽  
Current Knowledge ◽  
Kidney Liver ◽  
Worse Prognosis ◽  
Immunomodulatory Function

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is already known for its respiratory infection, but it involved more organs such as the kidney, liver, and heart. Most of the patients with COVID-19 have mild symptoms, but 5% of cases are admitted to an intensive care unit (ICU) for severe symptoms, including multi-organ failure and septic shock. Excessive immune responses play an essential role in sepsis development and are associated with worse prognosis in COVID-19 patients. Consequently, reduction of these immune responses may be helpful for managing COVID-19 patients. In this mini-review, we discuss the prospective role of CD24FC, as a recombinant protein with immunomodulatory function, in the treatment of COVID-19 patients and its mechanism of action in the regulation of the immune system.

scholarly journals Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department.

2016 ◽  
Vol 29 (2) ◽  
pp. 88 ◽  
Author(s):  
Joao Miguel Carvas ◽  
Cátia Canelas ◽  
Gustavo Montanha ◽  
Carlos Silva ◽  
Francisco Esteves
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Venous Pressure ◽  
Blood Cultures ◽  
Surviving Sepsis Campaign ◽  
Central Venous ◽  
Resuscitation Bundle

<p><strong>Introduction:</strong> Severe sepsis and septic shock are common conditions with high levels of morbi-mortality surpassing those of coronary heart disease or stroke. The reality of hospital treated sepsis is largely unknown outside of the intensive care unit. We therefore aimed to evaluate the level of compliance with the Surviving Sepsis Campaign 6-hour bundle in a Portuguese emergency department and to relate it to the patient clinical outcomes. </p><p><strong>Material and Methods:</strong> We conducted a retrospective, observational cohort study with 178 severe sepsis/septic shock patients admitted to the intensive and intermediate care unit between January 1st 2012 and December 31st 2012.</p><p><strong>Results:</strong> In the study, period septic shock was diagnosed in 100 patients (56.2%) and severe sepsis in 78 patients (43.8%). Compliance with the sepsis bundle was: (1) 62.9% for lactate measurement; (2) 62.9% for blood cultures before antibiotics; (3) 41.6% for antibiotics in the first 3 hours; (4) 76.4% for fluid administration; (5) 25% for vasopressor administration; (6) 37% for central venous pressure measurement and (7) 39% for central venous oxygen saturation measurement. Full compliance was observed in 22% of the patients. The individual bundle measure - Blood cultures before antibiotics - was significantly associated with a decreased risk of both intensive care unit mortality and 28-day mortality. There was also a trend for an inverse correlation between increased compliance with the full bundle and the intensive care unit and 28-days hospital mortality.</p><p><strong>Discussion:</strong> There was a low compliance with the Surviving Sepsis Campaign 6-hour bundle, a result that replicates the findings in similar international studies. The explanation is complex but it may include the lack of institutional quality monitoring in the emergency department.<br /><strong></strong></p><p><strong>Conclusions:</strong> The compliance with a sepsis resuscitation bundle starting in the emergency department was positively associated with the outcomes of the septic patients. Nonetheless the bundle was unreliably performed.</p><p> </p>

scholarly journals Persistently higher serum sCD40L levels are associated with outcome in septic patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yingjian Liang ◽  
Chengrui Zhu ◽  
Yini Sun ◽  
Zhiliang Li ◽  
Liang Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Odds Ratio ◽  
Cd40 Ligand ◽  
Surgical Patients ◽  
Soluble Cd40 Ligand ◽  
Icu Admission ◽  
Time Changes ◽  
And Control ◽  
Type Of Surgery

Abstract Background Soluble CD40 ligand (sCD40L) exhibits proinflammatory and procoagulant effects. Recent data indicated that sCD40L plays a significant role in septic patients. The aim of the present study was to determine sCD40L changes in surgical patients without sepsis (SWS) and surgical sepsis patients (SS) during the first 3 days after intensive care unit (ICU) admission and to observe the association between sCD40L and mortality. Methods Time changes in sCD40L levels were assessed for 3 days after ICU admission in 49 patients with SS and compared with those in 19 SWS patients. Serum sCD40L concentration was detected by ELISA. Survival at 28 days served as the endpoint. Results SS had significantly higher sCD40L levels than SWS and control patients. We observed an association between sCD40L levels ≥1028.75 pg/mL at day 2 and 28-day mortality (odds ratio = 7.888; 95% confidence interval = 1.758 to 35.395; P = 0.007). We could not discover any significant differences in sex, presence of septic shock, site of infection, length of stay in the ICU, PaO2/FiO2 ratio, incidence of AKI, ARDS, or type of surgery between nonsurvivors and survivors. Conclusions Septic patients show persistently higher circulating sCD40L levels in the first 3 days after ICU admission, and serum sCD40L levels are associated with the mortality of patients with sepsis. Thus, serum sCD40L may be used as a reliable biomarker and therapeutic target in sepsis.

scholarly journals Use of multiple anticholinergic medications can predispose patients to severe non-exertional hyperthermia

2021 ◽  
Vol 14 (3) ◽  
pp. e239873
Author(s):  
Ahila Manivannan ◽  
Dana Kabbani ◽  
Diane Levine
Keyword(s):  
Intensive Care Unit ◽  
Altered Mental Status ◽  
Blood Cultures ◽  
Oral Temperature ◽  
Anticholinergic Effects ◽  
Quick Recovery ◽  
Presenting Symptoms ◽  
Anticholinergic Medications ◽  
Cooling Mechanism ◽  
Staphylococcus Hominis

We present a case of a 64-year-old woman who developed severe non-exertional hyperthermia (NEHT) due to excessive anticholinergic effects from her psychiatric medications. The patient was found unresponsive in a non-air-conditioned room where the outside temperature was over 33°C. She presented with altered mental status, hypotension and an oral temperature of 42°C. Drug–drug interactions from her home medications for depression, bipolar disorder and seizures (amitriptyline, cyclobenzaprine, benztropine, topiramate, clonazepam, trazodone) were suspected. Blood cultures grew Staphylococcus hominis. The patient quickly returned to baseline with supportive care in the intensive care unit. She was treated for the Staph hominis bacteraemia with a 7-day course of vancomycin. Due to her quick recovery and lack of neurological findings, severe NEHT with associated bacteraemia was determined to have caused her presenting symptoms. This patient’s multiple anticholinergic medications increased her susceptibility to develop NEHT by inhibited sweating, this patient’s natural cooling mechanism.

Staphylococcus epidermidis Bacteremia in Neonates: Further Observations and the Occurrence of Focal Infection

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 832-837 ◽  
Author(s):  
Gary J. Noel ◽  
Paul J. Edelson
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Staphylococcus Epidermidis ◽  
Neonatal Intensive Care ◽  
Blood Cultures ◽  
Focal Infection ◽  
Clinically Significant ◽  
Vascular Catheters

The frequency and clinical significance of Staphylococcus epidermidis isolates from blood cultures of neonates collected during a 17-month period in The New York Hospital neonatal intensive care unit (NICU) were reviewed. Twenty-three episodes of clinically significant S epidermidis bacteremia were detected using the criteria of isolation from 3/3 blood culture bottles from a single culture, or isolation from two or more blood cultures taken at different times, or simultaneous isolation from blood and fluid, pus or vascular catheter. Of these 23 episodes of S epidermidis bacteremia, ten were associated with colonized vascular catheters, and four episodes occurred in infants with necrotizing enterocolitis. Focal S epidermidis infection occurred in ten episodes, and persistent bacteremia occurred frequently in this setting. S epidermidis was the most frequent cause of bacteremia in the Neonatal Intensive Care Unit during the period reviewed. Of the isolates determined to be clinically significant, 74% were resistant to methicillin and cephalothin and 91% were resistant to gentamicin. All isolates were sensitive to vancomycin. In addition to removing vascular catheters suspected of being colonized and searching for potential sites of focal infection, an antibiotic regimen that includes vancomycin should be initiated once significant S epidermidis bacteremia has been recognized in the neonate.

Predicting value of prehospital body temperature for ICU admission of septic shock patients

2019 ◽  
Vol 18 (1) ◽  
pp. 56-58
Author(s):  
Romain Jouffroy ◽  
◽  
Anastasia Saade ◽  
Stephane Durand ◽  
Pascal Philippe ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Body Temperature ◽  
Propensity Score Analysis ◽  
Call Centre ◽  
Icu Patients ◽  
Icu Admission ◽  
Score Analysis ◽  
The Mean ◽  
Proper Orientation

To specify whether an association exists between pre-hospital body temperature collected by the emergency medical services (EMS) call centre, and intensive care unit (ICU) admission of patients with septic shock. An observational study based on data collected by the EMS of Paris. All septic shocks were included. Among, the 140 calls concerning septic shock, 22 patients (16%) were admitted to ICU. The mean core temperature was 37.4±1.6°C for ICU and 38.6±1.1°C (p<4.10^-5) for non-ICU patients. Using propensity score analysis, the relative risk for ICU admission of patients with pre-hospital fever or hypothermia was 0.31 and 2 respectively. The study highlights the potential usefulness of early temperature measurement in septic shock patients to allow early proper orientation.

scholarly journals Pleuroparenchymal Fibroelastosis: A New Entity within the Spectrum of Rare Idiopathic Interstitial Pneumonias

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Karina Portillo ◽  
Ignasi Guasch ◽  
Caroline Becker ◽  
Felipe Andreo ◽  
Maria Teresa Fernández-Figueras ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Elastic Fiber ◽  
Optimal Management ◽  
Rare Entity ◽  
European Respiratory Society ◽  
Pleuroparenchymal Fibroelastosis ◽  
Idiopathic Interstitial Pneumonias ◽  
Recurrent Respiratory Infections ◽  
Progressive Dyspnea ◽  
Invasive Techniques

Pleuroparenchymal fibroelastosis (PPFE) is a rare entity that has been recently included in the official American Thoracic Society/European Respiratory Society (ATS/ERS) statement in 2013 as a group of rare idiopathic interstitial pneumonias (IIPs). PPFE is characterized by pleural and subpleural parenchymal thickening due to elastic fiber proliferation, mainly in the upper lobes. The etiology of the disease is unclear, although some cases have been associated as a complication after bone marrow transplantation, lung transplantation (LT), chemotherapy, and recurrent respiratory infections. The patients usually report progressive dyspnea and dry cough and are predisposed to develop spontaneous or iatrogenic pneumothoraces after surgical lung biopsy (SLB) for its diagnosis. That is why better awareness with the clinical and radiologic features can help optimal management by the multidisciplinary team. Novel invasive techniques such as cryobiopsy may become useful tools in these patients as it could spare SLB. We present the first reported cases in Spain.

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