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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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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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Procalcitonin – potential, limitations and availability

Abstract

Bacterial infections and sepsis are major problems in critically ill patients. Timely diagnosis and therapy reduce morbidity and mortality. Many studies have included the investigation of various biomarkers whose elevated concentrations can indicate sepsis; among them, PCT proved to be most useful.

PCT is synthesized in the thyroid gland as a prohormone of calcitonin. In healthy individuals the PCT concentration is <0.1 ng/mL.

The advantage of the PCT is a high negative predictive value for the exclusion of sepsis, with the cut-off value of 0.5 ng/ml. A concentration between 2 and 10 ng/ml indicates strong sepsis, whereas a value ≥10 ng/ml is associated with septic shock. In addition to the diagnosis of sepsis, the measurement of PCT concentration is useful for the introduction and monitoring of antibiotic therapy, which is performed according to an algorithm based on the cut-off value for PCT.

Immunoassays are used to measure PCT concentrations in serum or plasma. It is possible to determine the concentration in whole blood by using point-of-care testing.

In pathological conditions that are not associated with sepsis, PCT is useful as a prognostic indicator of disease complications. Some studies suggest that PCT is a potential early indicator of acute coronary syndrome.

Key words: procalcitonin, bacterial infection, sepsis, intensive care unit

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Extravascular lung water index as an indicator of lung injury in septic patients

Abstract

Introduction. Transpulmonary thermodilution using PiCCO (Pulse-induced Contour Cardiac Output) is a standard minimally invasive method used for haemodynamic monitoring. Objectives. The goal of this paper is to examine the correlation and dynamics of the ExtraVascular Lung Water Index (EVLWI) as an indicator of acute lung injury in septic patients who underwent major abdominal surgery. Two groups of patients were selected: the ones with ALI (Acute Lung Injury): ALI patient group, and the ones without ALI: non-ALI patient group. A correlation between EVLWI and other haemodynamic and respiratory data in both groups were analyzed.

Materials and methods. The study included 48 patients. Throughout the seven-day period EVLWI, GEDVI (Global End-Diastolic Volume Index), ITBVI (IntraThoracic Blood Volume Index), CI (Cardiac Index), SVRI (Systemic Vascular Resistance Index) were measured in both groups using PiCCO monitoring over 8-hour intervals as well as heart rate, mean arterial pressure, serum albumin concentration, PaCO2 (arterial partial pressure of carbon dioxide), PaO2 (arterial partial pressure of oxygen), PaO2/FiO2 (arterial partial pressure of oxygen/fraction of inspired oxygen) ratio, lung compliance, lung resistance and ScvO2 (central venous oxygen saturation). All patients were analgosedated, intubated, mechanically ventilated, in sinus cardiac rhythm. Circulatory unstable patients had vasoactive support and Sequential Organ Failure Assessment (SOFA) scores calculated. Ventilator settings and dosage of vasoactive drugs were kept constant during the study.

Results. EVLWI was significantly higher in ALI patients group compared to non-ALI patients group. In patients with ALI group 11/22 patients died (50%), in the non-ALI patients group 6/26 patients died (23%). EVLWI was significantly higher in patients that died compared to ones who survived.

Conclusion. EVLWI is a good indicator of early acute lung injury in surgical patients with sepsis.

Key words: extravascular lung water index, acute lung injury, PiCCO monitoring, sepsis

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