EXPERIENCE OF TARGETED ANTIBACTERIAL THERAPY IN A PATIENT WITH MULTIPLE ORGAN DYSFUNCTION SYNDROME

Objective : to analyze our own experience and literature data on the use of targeted antibacterial therapy in a patient with severe pneumonia and multiple organ dysfunction syndrome (MODS). Materials. The work presents a clinical case of successful treatment of a patient with community-acquired pneumonia, sepsis, and MODS, caused by multidrug resistant pathogens. Targeted antibiotic therapy was used during the treatment of the patient. Discussion . We have done a review of the literature and our own data on the antibiotic therapy for community-acquired pneumonia. The targeted antibacterial therapy in severe patients having a multidrug-resistant flora and MODS has the following features: it includes several drugs, is administered by courses, is often combined with antimycotic drugs, antibacterial drugs can be used via inhalation. The evaluation of clinical data, blood counts, as well as indicators of procalcitonin, C-reactive protein, and cholesterol provide substantial assistance during the monitoring of the therapy effectiveness. Conclusion. Among all the components of intensive care in a patient with community-acquired pneumonia, sepsis, and MODS, etiotropic therapy plays a leading role.

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The epidemiology of hospital death following pediatric severe community acquired pneumonia

Italian Journal of Pediatrics ◽

10.1186/s13052-021-00966-0 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Xiao-Xiao Ao

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Severe Pneumonia ◽

Multiple Organ ◽

Community Acquired Pneumonia ◽

Hospital Death ◽

Multiple Organ Dysfunction ◽

Respiratory Dysfunction ◽

Time To Death ◽

Severe Community Acquired Pneumonia

Abstract Background Community acquired pneumonia is the primary cause of pediatric hospitalizations and deaths in children under 5 years of age. But the epidemiology of death in pediatric severe community acquired pneumonia was not well characterized. Methods This retrospective observational study was performed at the academic Emergency department and intensive care unit and we investigated the timing, cause, mode and attribution of death in children with severe community acquired pneumonia. Results Of 962 subjects with severe community acquired pneumonia, there were 57 non-survivors (5.9% mortality). Median time to death was 7 [IQR 3,16] days from severe community acquired pneumonia recognition. Patients dying ≤7 days were younger, had greater illness severity and higher rate of congenital heart disease, who were more likely to die of a cardiovascular cause. Multiple organ dysfunction syndrome predominated in deaths > 7 days. Unsuccessful cardiopulmonary resuscitation was the most common mode of death at all timepoints. Our findings suggested that in pediatric severe community acquired pneumonia, early deaths were due primarily to cardiovascular dysfunction, while later deaths were more commonly due to multiple organ dysfunction syndrome. Conclusions Deaths from non-pulmonary factors accounted for a substantial portion of non-survivors. Respiratory dysfunction accounted for only a minority of deaths. Our study highlighted limitations associated with rescuing patients with severe pneumonia from death if extrapulmonary organ dysfunctions could not be simultaneously managed.

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The Epidemiology of Hospital Death Following Pediatric Severe Community Acquired Pneumonia

10.21203/rs.3.rs-118208/v1 ◽

2020 ◽

Author(s):

Xiao-Xiao Ao ◽

Li-Ping Tan ◽

Qiu-Feng Wan ◽

Yong-Qin Li

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Severe Pneumonia ◽

Multiple Organ ◽

Community Acquired Pneumonia ◽

Hospital Death ◽

Multiple Organ Dysfunction ◽

Respiratory Dysfunction ◽

Time To Death ◽

Severe Community Acquired Pneumonia

Abstract BackgroundCommunity acquired pneumonia is the primary cause of pediatric hospitalizations and deaths in children under 5 years of age. But the epidemiology of death in pediatric severe community acquired pneumonia was not well characterized. MethodsThis retrospective observational study was performed at the academic Emergency department and intensive care unit and we investigated the timing, cause, mode and attribution of death in children with severe community acquired pneumonia. ResultsOf 962 subjects with severe community acquired pneumonia, there were 57 non-survivors (5.9% mortality). Median time to death was 7 [IQR 3,16] days from severe community acquired pneumonia recognition. Patients dying ≤ 7 days were younger, had greater illness severity and higher rate of congenital heart disease, who were more likely to die of a cardiovascular cause. Multiple organ dysfunction syndrome predominated in deaths > 7 days. Unsuccessful cardiopulmonary resuscitation was the most common mode of death at all timepoints. Our findings suggested that in pediatric severe community acquired pneumonia, early deaths were due primarily to cardiovascular dysfunction, while later deaths were more commonly due to multiple organ dysfunction syndrome. ConclusionsDeaths from non-pulmonary factors accounted for a substantial portion of non-survivors. Respiratory dysfunction accounted for only a minority of deaths. Our study highlighted limitations associated with rescuing patients with severe pneumonia from death if extrapulmonary organ dysfunctions could not be simultaneously managed.

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A Continuum of Disease from Community-Acquired Pneumonia to Multiple Organ Dysfunction Syndrome

Journal of Respiratory Infections ◽

10.18297/jri/vol2/iss2/1/ ◽

2018 ◽

Vol 2 (2) ◽

pp. 4-6

Author(s):

Julio Ramirez ◽

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Multiple Organ ◽

Community Acquired Pneumonia ◽

Multiple Organ Dysfunction

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Multiple Organ Dysfunction Syndrome of Alcoholic Origin in an 18-Year-Old Patient

The International Annals of Medicine ◽

10.24087/iam.2018.2.12.712 ◽

2018 ◽

Vol 2 (12) ◽

Author(s):

Francesco Gazia ◽

Giacomo De Luca ◽

Imbalzano Gabriele ◽

Vincenzo Pellicanò

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Multiple Organ ◽

Multiple Organ Dysfunction

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IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury

Journal of Neurosurgery ◽

10.3171/2018.8.jns18676 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1931-1937 ◽

Cited By ~ 2

Author(s):

Sungho Lee ◽

Hyunsoo Hwang ◽

Jose-Miguel Yamal ◽

J. Clay Goodman ◽

Imoigele P. Aisiku ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Sofa Score ◽

Plasma Concentrations ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Poor Outcome ◽

Initial Plasma

OBJECTIVETraumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS.METHODSThe authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI.RESULTSTwo hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94–42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)–6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20–1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01–1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24–2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score ≥ 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18–19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06–1.40, p = 0.006).CONCLUSIONSAdmission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.

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