scholarly journals Evaluation of Acute Renal Failure After Acinetobacter Baumannii-based Ventilator-associated Event: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Fatih Turan AYILGAN ◽  
Mehmet Salih SEVDI ◽  
Serdar DEMIRGAN ◽  
Funda GUMUS OZCAN ◽  
Kerem ERKALP ◽  
...  
Keyword(s):  
Septic Shock ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Acinetobacter Baumannii ◽  
Clinical Response ◽  
Total Duration ◽  
Response To Therapy ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Bacterial Eradication

Abstract Background: Ventilator-associated event (VAE) is the major complication caused mechanical ventilation (MV). We aimed to evaluate whether acute renal failure (ARF) has developed in patients who had been followed-up due to diagnosis of VAE with Acinetobacter baumannii (AcB), and whether renal replacement therapy (RRT) was used, and its relationship with mortality in patients who developed colistin during their treatment.Methods: Retrospective evaluation of the hospital electronic information system records of 2,622 patients were conducted in three years. Patients who had AcB-related VAE and underwent parental colistin treatment were evaluated according to age, gender, diagnosis for intensive care unit (ICU) administration, Acute Physiology and Chronic Health Evaluation (APACHE) II score, colistin dose and treatment duration, requirement for additional antibiotics, total time required for MV, total duration of ICU stay, presence of septic shock, requirement for percutaneous dilatation tracheostomy (PDT), ARF staging according to Kidney Disease Improving Global Outcomes criteria, requirement for RRT and mortality.Results: Total number of VAE cases was 85 (3.19%). AcB-related VAE was detected in 28 patients (32.9%). Bacterial eradication was achieved in 14 patients (50%), clinical response was received in 14 patients (50%), mean colistin dose was 298.2±85.5 mg/day, mean duration of colistin treatment was 14.3±8.6 days. ARF was detected as Stage-I in eight patients (28.6%), Stage-II in four (14.3%) and Stage-III in eight patients (28.6%). There was no difference between patients in need of RRT and those who did not, in terms of age, gender and body mass index. APACHE II score, bacterial eradication, presence of septic shock, clinical response to therapy, daily dose of colistin, duration of colistin treatment, MV duration, PDT requirement and time were similar in groups receiving RRT or not.Conclusion: Colistin treatment of AcB-related VAE caused ARF in 71.5% of the patients and led to serious conditions in 25% of patients requiring RRT.

Risk Factors to Predict Renal Failure and Death in the Medical Intensive Care Unit

1996 ◽  
Vol 11 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Laurie A. Ward ◽  
George N. Coritsidis ◽  
Christos P. Carvounis
Keyword(s):  
Intensive Care Unit ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Failure Group ◽  
Medical Intensive Care ◽  
Normal Albumin

The ability to predict outcomes based on admission criteria has important implications, both prognostically and for assessing interventions on comparable groups. Use of severity of disease scoring systems such as the APACHE II score for predicting mortality has become widespread. There is no comparable formula for acute renal failure. We prospectively evaluated 115 consecutive admissions to the medical intensive care unit to define risk for renal failure from admission data and to assess the impact of admission hypoalbuminemia levels on outcome. Diagnosis, age, serum creatinine and albumin levels, urinary electrolyte concentrations and osmolality, daily serum creatinine levels, and urine output were recorded. Admission APACHE II score was calculated. Admission hypoalbuminemia (57% of patients) was associated with both acute renal failure and death (odds ratios, 16.19 and 8.06, respectively). The Glasgow coma score distinguished between patients in whom acute renal failure developed and in those it did not. Low urine osmolality (<400 mOsm/kg) was the most significant factor in predicting mortality (odds ratio, 9.87). Mortality was lowest in the normal albumin group (2%), intermediate in the low albumin/no renal failure group (12%), and highest in the low albumin/acute renal failure group (53%). The APACHE II score was accurate in 3 of 14 deaths in the hypoalbuminemic population and in the one normal albumin patient who died. We conclude that at admission, hypoalbuminemia, urinary hypo-osmolality, and abnormal creatinine levels are predictive of acute renal failure and death, diagnosis, and mental status impact on the risk for acute renal failure. APACHE II lacks predictive value in hypoalbuminemic patients.

scholarly journals A multicenter comparison of dialysis membranes in the treatment of acute renal failure requiring dialysis.

1998 ◽  
Vol 9 (2) ◽  
pp. 257-266
Author(s):  
J Himmelfarb ◽  
N Tolkoff Rubin ◽  
P Chandran ◽  
R A Parker ◽  
R L Wingard ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Complement Activation ◽  
Severity Of Illness ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Dialysis Membrane ◽  
Significant Difference ◽  
Initiation Of Dialysis ◽  
Discharge From Hospital

The mortality of patients with acute renal failure (ARF) remains high, and in several large studies approaches 60%. This mortality is particularly high in patients with ARF who require dialysis and has not changed substantially over several years, despite the introduction of major advances in monitoring and treatment. Increasing prevalence of comorbidities has been suggested as the major factor in this persistently high mortality. This study investigates the potential role of the dialysis membrane on patient outcome in a prospective multicenter study of 153 patients with ARF requiring dialysis. The membrane assignment was made in alternating order and was limited to membranes with low complement activation (Biocompatible [BCM]) and cellulosic, high complement activation (Bioincompatible [BICM]). Both types of membranes were low-flux membranes. Patients were dialyzed with the assigned membrane until recovery, discharge from hospital, or death. The severity of illness of each patient was assessed using the APACHE II score at the time of initiation of dialysis. A logistic regression analysis was used to adjust for the APACHE II score. The results of the study showed a statistically significant difference in survival (57% in patients on BCM, 46% in patients on BICM; P = 0.03) and in recovery of renal function (64% in patients on BICM and 43% in patients on BICM; P = 0.001). These differences were particularly marked in the patients who were nonoliguric (>400 ml/d of urine output) at initiation of the study. In the subset of patients who were nonoliguric at the start of dialysis, a larger fraction (70%) became oliguric after initiating dialysis on a BICM membrane, in contrast to 44% who were initiated on a BCM membrane (P = 0.03). It is concluded that the biocompatibility of the dialysis membrane plays a role in the outcome of patients with ARF, particularly those who are nonoliguric at the time of initiation of dialysis.

scholarly journals Severe Legionnaires’ Disease Complicated by Rhabdomyolysis and Clinically Resistant to Moxifloxacin in a Splenectomised Patient: Too Much of a Coincidence?

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Theocharis Koufakis ◽  
Ioannis Gabranis ◽  
Marianneta Chatzopoulou ◽  
Anastasios Margaritis ◽  
Maria Tsiakalou
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Clinical Response ◽  
Clinical Course ◽  
Case Reports ◽  
Immunological Response ◽  
Poor Response ◽  
Response To Therapy ◽  
Resistance To Antibiotics ◽  
Legionnaires Disease

We here report a case of Legionnaires’ disease in a splenectomised patient, complicated by rhabdomyolysis and acute renal failure and characterized by a poor clinical response to moxifloxacin. Splenectomy is not included among the factors, typically associated with higher risk or mortality in patients with Legionellosis. However, our report is consistent with previous case reports describing severeLegionellainfections in asplenic subjects. The possibility that functional or anatomic asplenia may be a factor predisposing to severe clinical course or poor response to therapy in patients withLegionellainfection cannot be excluded, deserving further investigation in the future. More studies are required in order to clarify the underlying pathophysiological mechanisms that connect asplenia, immunological response toLegionella, and pathogen’s resistance to antibiotics.

scholarly journals Successful de-escalation antibiotic therapy using cephamycins for sepsis caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia: A sequential 25-case series

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 782-786
Author(s):  
Tsukasa Kuwana ◽  
Junko Yamaguchi ◽  
Kosaku Kinoshita ◽  
Satoshi Hori ◽  
Shingo Ihara ◽  
...  
Keyword(s):  
Septic Shock ◽  
Antibiotic Therapy ◽  
Vital Signs ◽  
Apache Ii ◽  
Empiric Antibiotic Therapy ◽  
Apache Ii Score ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Escalation Therapy ◽  
Extended Spectrum

AbstractCarbapenems are frequently used to treat infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E), but carbapenem-resistant Enterobacteriaceae bacteria are a clinical concern. Although cephamycins (cefmetazole; CMZ) have been shown to be effective against mild cases of ESBL-E infection, data on their use for severe ESBL-E infections with sepsis or septic shock remain scarce. Herein, we discuss a de-escalation therapy to CMZ that could be used after empiric antibiotic therapy in ICU patients with sepsis or septic shock caused by ESBL-E bacteremia. A sequence of 25 cases diagnosed with sepsis or septic shock caused by ESBL-E bacteria was evaluated. The attending infectious disease specialist physicians selected the antibiotics and decided the de-escalation timing. The median SOFA (Sequential Organ Failure Assessment) and APACHE II (Acute Physiology and Chronic Health Evaluation II) severity scores were 8 and 30; the rate of septic shock was 60%. Infections originated most frequently with urinary tract infection (UTI) (56%) and Escherichia coli (85%). Eleven patients were de-escalated to CMZ after vital signs were stable, and all survived. No patients died of UTI regardless of with or without de-escalation. The median timing of de-escalation antibiotic therapy after admission was 4 days (range, 3–6 days). At the time of de-escalation, the median SOFA score fell from 8 to 5, the median APACHE II score from 28 to 22, and the rate of septic shock from 55% to 0%. We conclude that for sepsis in UTI caused by ESBL-E bacteremia, de-escalation therapy from broad-spectrum antibiotics to CMZ is a potential treatment option when vital signs are stable.

The Relationship of the ACCP/SCCM Consensus Conference Classification of Sepsis to Mortality and Multiorgan Dysfunction among Medical ICU Patients

1996 ◽  
Vol 11 (6) ◽  
pp. 326-334 ◽  
Author(s):  
Marin H. Kollef ◽  
Paul R. Eisenberg
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Consensus Conference ◽  
Organ System ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Patients ◽  
Multiorgan Dysfunction

To determine the relation between the proposed ACCP/SCCM Consensus Conference classification of sepsis and hospital outcomes, we conducted a single-center, prospective observational study at Barnes Hospital, St. Louis, MO, an academic tertiary care hospital. A total of 324 consecutive patients admitted to the medical intensive care unit (ICU) were studied for prospective patient surveillance and data collection. The main outcome measures were the number of acquired organ system derangements and hospital mortality. Fifty-seven (17.6%) patients died during the study period. The proposed classifications of sepsis (e.g., systemic inflammatory response syndrome [SIRS], sepsis, severe sepsis, septic shock) correlated with hospital mortality ( r = 0.330; p < 0.001) and development of an Organ System Failure Index (OSFI) of 3 or greater ( r = 0.426; p < 0.001). Independent determinants of hospital mortality for this patient cohort ( p < 0.05) were development of an OSFI of 3 or greater (adjusted odds ratio [AOR], 13.9; 95% confidence interval [CI], 6.4–30.2; p < 0.001); presence of severe sepsis or septic shock (AOR, 2.6; 95% CI, 1.2–5.6; p = 0.002), and an APACHE II score ≥ of 18 or greater (AOR, 2.4; 95% CI, 1.0–5.8; p = 0.045). Intra-abdominal infection (AOR, 19.1; 95% CI, 1.6–230.1; p = 0.011), an APACHE II score ≥ of 18 or greater (AOR, 8.9; 95% CI, 4.2–18.6; p < 0.001), and presence of severe sepsis or septic shock (AOR, 2.9; 95% CI, 1.5–5.4; p = 0.001) were independently associated with development of an OSFI of 3 or greater. These data confirm that acquired multiorgan dysfunction is the most important predictor of mortality among medical ICU patients. In addition, they identify the proposed ACCP/SCCM Consensus Conference classification of sepsis as an additional independent determinant of both hospital mortality and multiorgan dysfunction.

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