Damien Contou1, Géraldine d'Ythurbide2, Jonathan Messika1, Christophe Ridel2, Antoine Parrot1, Michel Djibré1, Alexandre Hertig2, Eric Rondeau2, Muriel Fartoukh3. 1. Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, 4, rue de la Chine, 75020 Paris, France. 2. Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, France. 3. Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, 4, rue de la Chine, 75020 Paris, France. Electronic address: muriel.fartoukh@tnn.aphp.fr.
Abstract
OBJECTIVES: To describe the spectrum of infection and multidrug-resistant bacterial colonization, and to identify early predictors of infection in patients with chronic kidney disease (CKD) admitted to the critical care unit (CCU). METHODS: A 7-month observational prospective single-centre study in a French university hospital. RESULTS: 791 patients were admitted to the CCU, 135 of whom (17%) had severe CKD. Among these, 41 (30%) were infected on admission. Infection was microbiologically documented in 32 patients (78%), of which 7 (22%) were related to Pseudomonas aeruginosa. There was no infection related to extended-spectrum β-lactamase-producing enterobacteriaceae despite a 12% carriage rate on admission. A temperature ≥37.6 °C and a leukocyte count >12.000/mm³ were specific but poorly sensitive of infection (91% and 80%, and 45% and 39%, respectively). Using the threshold of 0.85 ng/ml, procalcitonin was a strong independent predictor of infection on admission (OR 12.8, 95% CI 4.4-37.3). Age (≥60 years) and the cause of CKD were two other predictors. CONCLUSIONS: Infection accounts for one-third of CCU admissions in CKD patients, with a high prevalence of P. aeruginosa. The usual diagnostic criteria are inaccurate for diagnosing infection in this population. A procalcitonin ≥0.85 ng/ml might be helpful for early identifying CKD patients with infection.
OBJECTIVES: To describe the spectrum of infection and multidrug-resistant bacterial colonization, and to identify early predictors of infection in patients with chronic kidney disease (CKD) admitted to the critical care unit (CCU). METHODS: A 7-month observational prospective single-centre study in a French university hospital. RESULTS: 791 patients were admitted to the CCU, 135 of whom (17%) had severe CKD. Among these, 41 (30%) were infected on admission. Infection was microbiologically documented in 32 patients (78%), of which 7 (22%) were related to Pseudomonas aeruginosa. There was no infection related to extended-spectrum β-lactamase-producing enterobacteriaceae despite a 12% carriage rate on admission. A temperature ≥37.6 °C and a leukocyte count >12.000/mm³ were specific but poorly sensitive of infection (91% and 80%, and 45% and 39%, respectively). Using the threshold of 0.85 ng/ml, procalcitonin was a strong independent predictor of infection on admission (OR 12.8, 95% CI 4.4-37.3). Age (≥60 years) and the cause of CKD were two other predictors. CONCLUSIONS:Infection accounts for one-third of CCU admissions in CKDpatients, with a high prevalence of P. aeruginosa. The usual diagnostic criteria are inaccurate for diagnosing infection in this population. A procalcitonin ≥0.85 ng/ml might be helpful for early identifying CKDpatients with infection.