Clinical characteristics and outcome of critically ill patients with bacteremia caused by extended-spectrum β-lactamase-producing and non-producing Escherichia coli

The number of patients infected with extended-spectrum beta-lactamase (ESBL)-producing organisms has increased dramatically worldwide, and high mortality rates are seen in severely ill patients. This study retrospectively compared the clinical characteristics and outcomes of critically ill patients in an intensive care unit (ICU) at the Tsuyama Chuo Hospital (Okayama, Japan) who were hospitalized for bacteremia caused by ESBL-producing Escherichia coli (ESBL-EC) or non-ESBL-producing E. coli (non-ESBL-EC) between January 2006 and December 2016 (11 years). We analyzed the patients' age, sex, underlying disease(s), sequential organ failure assessment scores, primary focus of bacteremia, empiric antibiotics, rate of appropriateness of empiric antibiotics, and treatment duration, with 28-day mortality being the primary outcome. The study included 24 patients with ESBL-EC bacteremia and 77 with non-ESBL-EC bacteremia. The rate of appropriate initial antibiotic treatment was significantly lower (54.2% vs. 96.1%, respectively; P < 0.01) and the mortality due to bacteremia significantly higher (37.5% vs. 15.6%, respectively; P = 0.04) in the ESBL-EC than in the non-ESBL-EC bacteremia group. A subgroup analysis focusing on patients who were administered appropriate empiric antibiotics showed that the 28-day mortality rate did not differ significantly between the two groups (P = 0.23). To our knowledge, this is the first study to compare the outcomes of patients with ESBL-EC and non-ESBL-EC bacteremia in a Japanese ICU setting. Initial empiric antibiotic therapy covering ESBL-producing pathogens should be considered for critically ill patients in the ICU.     

血小板和淋巴细胞比值与脓毒症患者预后的关系

目的探讨血小板和淋巴细胞比值(PLR)与脓毒症患者预后的关系.方法回顾性分析2017年1月至2018年1年入上海长征医院ICU脓毒症患者的临床资料,根据PLR水平将患者分为低PLR组(PLR≤135)、中PLR组(135SOFA)、血乳酸(Lac)及降钙素原(PCT)水平,比较各组患者28 d病死率、急性肾损伤(AKI)发生率、行持续肾脏替代治疗(CRRT)率、住ICU时间和住ICU费用,比较三组患者1年累计生存率,分析血PLR、Lac及SOFA评分对脓毒症患者病死率的预测价值.结果低、中、高PLR三组患者的SOFA评分(分)分别为6.1±1.6、5.7±2.0和8.7±2.6,血Lac(mmol/L)分别为1.9±0.7、2.2±0.8和3.3±1.4,高PLR组患者SOFA评分和血Lac高于低PLR组和中PLR组,差异有统计学意义(P分别为0.032和0.019).三组患者的28 d病死率分别为11.9%、18.0%和30.7%,高PLR组明显高于其他两组,差异有统计学意义(P=0.027).三组患者的1年累计生存率分别为34(81.0%)、47(77.0%)、45(60.0%),差异有统计学意义(Log Rank卡方值6.936,P=0.031),PLR、血Lac及SOFA评分预测患者1年病死率的ROC曲线下面积(AUC)分别为0.690、0.701和0.746.结论PLR可在一定程度上预测脓毒症患者的预后.     

Sequential Organ Failure Assessment (SOFA) scores differ between genders in a sepsis cohort: Cause or effect?

Abstract

Background. Controversy exists regarding the influence of gender on sepsis events and outcome. Epidemiological data from other countries may not always apply to local circumstances. The aim of this study was to identify gender differences in patient characteristics, treatment, and outcome related to the occurrence of sepsis at admission to the ICU.

Methods. A prospective observational cohort study on patients admitted to the ICU over a 3-year period fulfilling sepsis criteria during the first 24 hours. Demographic data, APACHE II score, SOFA score, TISS 76, aetiology, length of stay (LOS), mortality rate, and aspects of treatment were collected and then analysed with respect to gender differences.

Results. There were no gender-related differences in mortality or length of stay. Early organ dysfunction assessed as SOFA score at admission was a stronger risk factor for hospital mortality for women than for men. This discrepancy was mainly associated with the coagulation sub-score. CRP levels differed between genders in relation to hospital mortality. Infection from the abdominopelvic region was more common among women, whereas infection from skin or skin structures were more common in men.

Conclusion. In this cohort, gender was not associated with increased mortality during a 2-year follow-up period. SOFA score at ICU admission was a stronger risk factor for hospital mortality for women than for men. The discrepancy was mainly related to the coagulation SOFA sub-score. Together with differences in CRP levels this may suggest differences in inflammatory response patterns between genders.     

PCT、CRP与APACHEⅡ及SOFA评分两个评分系统相关性比较及对脓毒症患者预后的评估价值研究

目的：研究PCT和CRP两种检测指标与APACHE Ⅱ及SOFA评分两个评分系统的关系,比较PCT和CRP在脓毒症患者预后评估中的价值。方法：回顾性分析2011年1月至2012年12月入住我院ICU患者的临床资料,收集入院24h内行PCT、CRP检测、APACHE Ⅱ评分和SOFA评分脓毒症患者的资料,分析不同预后患者PCT、CRP与APACHE Ⅱ及SOFA评分关系以及不同水平APACHEⅡ及SOFA评分时与PCT、CRP的关系。结果：PCT与APACHEⅡ、SOFA评分系统较CRP具有显著相关性（P〈0.001）,不同水平APACHEⅡ、SOFA评分时PCT水平差异较CRP具有显著性（p〈0．05）,PCT评价预后的ROC曲线下面积较CRP评价预后的ROC线下面积具有明显差异（P〈0．05）。结论：PCT较CRP与两个临床评分系统具有更明显的相关性,同时PCT较CRP能更好地反映脓毒症患者的病情严重程度以及预后情况。     

Characteristics and prognosis of Herpesviridae-related pneumonia in critically ill burn patients

BackgroundThe aim of this study was to describe the prevalence, characteristics and outcome of critically burn patients with pulmonary HSV reactivation.MethodsRetrospective, single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients with bronchoalveolar lavage performed for pneumoniae suspicion and screened for HSV from January 2013 and April 2017. We used logistic regression to identify factors associated with HSV reactivation and outcomes.Results94 patients were included, mean age was 51 (39?64) years; median total body surface area burned was 36 (25–54)% and ICU mortality 38%. Fifty-five patients (59%) had pulmonary HSV reactivation and 30 (55%) were treated with acyclovir. Patients with HSV reactivation were more severely ill with higher SOFA score at admission compared to patient without HSV reactivation (6 [3–8] vs. 2 [1–4], p < 0.0001 respectively). In multivariate analysis, sex, SOFA score at admission and smoke inhalation were significantly associated with HSV reactivation. Only septic shock was associated with 90-day mortality when HSV reactivation was not.ConclusionsPulmonary HSV reactivation is frequent among severely ill burn patients. Initial severity and smoke inhalation are risk factors. Antiviral treatment was not associated with outcome.