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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Uncommon manifestations of neonatal group b Streptococcus infection: case report and literature review


Streptococcus agalactiae, also called Group B Streptococcus (GBS), is a common pathogen in the neonatal period that can cause early- and late-onset infections. The most common manifestations are bacteremia without an apparent focus of infection, pneumonia and meningitis. Additionally, GBS can rarely cause early- and late-onset infections with uncommon manifestations. If they go unrecognized, they may lead to inappropriate treatment and increased neonatal morbidity and mortality. In this article, a case report of an infant with early-onset GBS bullous impetigo is presented together with a short review of other uncommon manifestations of GBS infection.

Key words: Streptococcus agalactiae, infection, newborn

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Current management of sepsis and septic shock


Sepsis remains a leading cause of death in the intensive care unit. With no specific sepsis therapies available, management currently relies on infection control and hemodynamic stabilization. Rapid diagnosis enabling early initiation of appropriate therapy is essential to maximize survival rates. Effective antimicrobial therapy should be started as soon as possible after diagnosis, with empirical choices based on likely pathogens, local microbiological patterns, and any recent antimicrobial therapy. At the same time, fluids and vasopressor agents should be commenced to restore and maintain hemodynamic stability and adequate tissue perfusion. No effective immunomodulatory therapies are available, but some candidates are undergoing clinical trials. Better techniques for characterization of the degree of sepsis response in individual patients are needed to help target such agents more appropriately as some patients may benefit from immunosuppressive agents while others may require an immune stimulating intervention. The management of patients with septic shock is often complex and the development of sepsis teams should be encouraged so that the multiple components of treatment, e.g., insertion of intravascular lines, blood sampling for culture and biochemistry, positioning of required monitoring devices, fluid, antibiotic and vasoactive drug administration, etc, can be carried out simultaneously.

Key words: infection, fluid resuscitation, immunomodulation, organ dysfunction, sepsis team, vasopressors

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Outcome of liver transplant patients at the University Hospital Centre Zagreb


At the University Hospital Centre Zagreb, 37 patients underwent liver transplantation in the period from 2010 to 2014. Six patients had fatal complications in the early post-transplantation period and deceases in the surgical intensive care unit (ICU). All other patients (31) were transferred to the medical ICU and later to the medical ward. The most common indications for liver transplantation were alcoholic liver disease (9 patients) and hepatitis C (8 patients). Two-thirds of the patients were male (67.7%) with an average age of 51 years. Thirty patients were discharged alive from the hospital. Infections developed in nine patients, mostly pneumonia and peritonitis. Only one patient experienced infection caused by multi-drug resistant bacteria, namely peritonitis due to methicillin-resistant Staphylococcus aureus ( MRSA ). All infections were successfully treated with antibiotics and none of them caused graft rejection.

Key words: liver transplantation, infection, outcome assessment

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Invasive Candida infections in the nursery: state of the art


Neonatal sepsis caused by fungi (mainly Candida spp.) causes a huge burden of morbidity and mortality, poor late outcomes, as well as increased hospital costs.

Invasive Candida Infections (ICI) include bloodstream, urine, cerebrospinal, peritoneal infections, infections starting from burns and wounds, or from any other usually sterile site.

Premature neonates are particularly prone to this kind of disease, due to their decreased innate and adaptive immunities, translating into a specific, decreased resistance to candidiasis.

This specific, increased risk for ICI is greatest when gestational age and birth weight are lowest. As the burden of ICI has been increasing over the last years, research efforts have been focused towards identifying key risk factors, effective preventative strategies, and efficacious and well-tolerated antifungal drugs for the neonatal population.

This article summarizes the most remarkable issues in these areas, and features an overview of the current diagnostic, preventative and treatment strategies.

Key words: Candida, neonate, infection, preterm, micafungin, fluconazole

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