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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: sepsis (Page 1 of 4)

Cardiac surgery and sepsis in postoperative period – our experience

Abstract

The occurrence of sepsis after cardiac surgery is a rare event; however, its occurrence showed catastrophic clinical outcomes. The high morbidity and mortality revealed the need to improve treatment, aiming at patients’ better clinical outcome.

Patients that develop sepsis, regardless of the infectious focus and the subjacent disease, present high morbidity and mortality, which vary from 17% to 65%. The main predictors of infections in the postoperative period are: body mass index ≥40kg/m², haemodialysis in the preoperative period, pre-op cardiogenic shock, age ≥80 years, pre-op treatment with immunosuppressive agents, diabetes mellitus, ECC time ≥200 minutes, mechanical circulatory support, three or more revascularized vessels.

From January 2015 to December 2015, we studied 675 adult patients who underwent cardiac surgery. Prophylactic antibiotic therapy was prescribed and given according to our protocol, from the induction of anaesthesia to the first postoperative day.

Sepsis in the postoperative period was defined as evidence on infection associated with two or more criteria of systemic inflammatory response syndrome: body temperature >38°C or <36°C, leukocytes >12,000 cells/mm³, positive blood cultures, respiratory rate >20/min, heart rate >100/min.

Key words: sepsis, postoperative period, cardiac surgery

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Immature granulocyte count on the new Sysmex XN-9000: performance and diagnosis of sepsis in the intensive care unit

Abstract

Introduction. The amount of immature leukocytes reflects marrow response to bacterial infection, and this may be quantified as the band or immature granulocyte (IG) count. The aim of this study was to analyze the IG count performance of the Sysmex XN-9000 hematology analyzer in intensive care unit (ICU) patients.

Methods. 480 peripheral blood samples from adult patients admitted to the ICU (301 control, 119 sepsis and 60 septic shock) were analyzed with Sysmex XN-9000. Serum C reactive protein (CRP) was measured on Siemens ADVIA 2400. IG count in peripheral blood was determined either by XN-9000 or optical microscopy (OM). Agreement between the two methods was assessed with Pearson’s correlation, Passing-Bablok regression and Bland Altman bias. Diagnostic accuracy was estimated through ROC curves analysis. Sysmex XN-9000 imprecision and within-run precision were also evaluated.

Results. Pearson’s correlation (r) relative to IG count, as absolute and percentage values, was 0.89 (p <0.0001) and 0.74 (p <0.0001), respectively, with a Bias of 0.22 and 1.69 respectively. The Area Under the curve (AUC) for the IG count for diagnosing sepsis was greater on XN-9000 than OM and equal to the serum CRP. The diagnostic accuracy of IG counts improves when taking into account the conventional criteria for diagnosing sepsis.

Conclusion. IG count appears suitable and reliable when performed using XN-9000. Even if a modest overestimation was found, the diagnostic accuracy showed by IG analysis on XN-9000 may represent a valid alternative to OM count for diagnosing sepsis in ICU patients.

Key words: immature granulocyte, Sysmex XN, sepsis, automated cell count

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Neonatal early onset sepsis due to Moraxella osloensis: Case-report and revision of the literature

Abstract

We report the first case of early-onset systemic neonatal infection associated with Moraxella osloensis bacteriemia in a full term baby. The genus Moraxella is constituted by a group of pleomorphic bacteria obligate aerobes, Gram-negative, oxidase positive and indole negative infrequently isolated from clinical specimens. The organism is rarely reported in the literature as the causative agent of infection in humans, mostly in immunocompromised patients. Only 12 cases of M. osloensis-related infections during childhood have been reported in the literature so far. This unique report of M. osloensis infection, during the neonatal period, concerns the isolation of the bacteria in purulent secretions from the eyes of a 3-week-old baby with opthalmia. In our patient, the precocity of the onset of symptoms allows us to hypothesize a vertical transmission of the bacteria.

Key words: Moraxella, newborn, sepsis

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An unusual infection in a patient with peripherally inserted central catheter

Abstract

A peripherally inserted central catheter (PICC) is widely used in transfusion therapy and for monitoring many kinds of diseases, especially in critically ill patients. Compared with other catheters, it has a lower risk of catheter-related bloodstream infections. Aeromonas Hydrophila (AH) is a kind of opportunistic pathogen, vibrionaceae aeromonas, and gram-negative brevibacterium, widely distributed in nature, in all kinds of body fluid. It usually causes gastrointestinal infections, and rarely causes Aeromonas septicemia. To date, there has been no report of a PICC-related AH infection. We report the case of a 40-year-old female with breast cancer, who suffered post-op. severe sepsis and double lower limb cellulitis with multiple organ failure. All of this was due to AH invading the blood through the PICC.

Key words: Aeromonas Hydrophila, peripherally inserted central catheter, sepsis, multiple organ failure

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Liver abscess caused by Actinomyces odontolyticus, Abiotrophia species, Haemophilus parainfluenzae, Streptococcus anginosus i Streptococcus intermedius – case report

Abstract

We present a case of a 78-year-old female patient who was admitted to the medical intensive care unit because of high fever, weakness and abdominal pain. Bacteriological studies showed sepsis and allowed the isolation of Actinomyces odontolyticus and Abiotrophia species as causative agents. Further investigation led to a diagnosis of liver abscess from which there was also isolated Haemophilus parainfluenzae, Streptococcus intermedius and Streptococcus anginosus, as well as the above mentioned bacteria. All named microorganisms represent a part of normal oropharyngeal flora and may cause abscesses or sepsis under certain circumstances. As far as we know, liver abscess due to Abiotrophia species was never reported.

Key words: Actinomyces odontolyticus, Abiotrophia species, Haemophilus parainfluenzae, Streptococcus intermedius, Streptococcus anginosus, sepsis, liver abscess

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