Stefano Busani1, Giulia Serafini1, Elena Mantovani1, Claudia Venturelli2, Maddalena Giannella3, Pierluigi Viale3, Cristina Mussini4, Andrea Cossarizza5, Massimo Girardis1. 1. 1 Cattedra e Struttura di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy. 2. 2 Dipartimento Interaziendale Integrato di Medicina di Laboratorio e Anatomia Patologica, Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy. 3. 3 Clinica di Malattie Infettive, Dipartimento di scienze mediche e chirurgiche, Università di Bologna, Bologna, Italy. 4. 4 Dipartimento Attività Integrata di Medicine, Medicina d'Urgenza e Specialità Mediche, Malattie infettive, Università di Modena e Reggio Emilia, Modena, Italy. 5. 5 Dipartimento di Chirurgia, Medicina, Odontoiatria e Scienze Morfologiche, Università di Modena e Reggio Emilia, Modena, Italy.
Abstract
BACKGROUND: : Patients with septic shock by multidrug resistant (MDR) microorganism maybe considered a specific population of critical patients at very high risk of death in whom the effects of standard sepsis treatment has never been assessed. The objective of this retrospective analysis was to evaluate the risk factors for 30-day mortality and the impact of sepsis management in patients with septic shock caused by MDR bacteria. METHODS: : Patients with septic shock by MDR bacteria admitted to the mixed intensive care unit (ICU) of Modena University Hospital during a 6-year period were studied. The clinical and microbiological characteristics and sepsis treatments provided were analyzed and compared between survivors (S) and nonsurvivors (NS) at 30 days after septic shock appearance. RESULTS: : Ninety-four patients were studied. All therapeutic interventions applied to patients during their ICU stay did not show statistical significance between S and NS groups, except for administration of immunoglobulin M (IgM) preparation which were provided more frequently in S group ( P < .05). At the multivariate adjusted analysis, preexisting cancer (odds ratio [OR] = 2.965) and Acinetobacter baumannii infections (OR = 3.197) were independently correlated with an increased risk of 30-day mortality, whereas treatment with IgM preparation was protective (OR = 0.283). CONCLUSIONS: : This retrospective study showed that in patients with septic shock caused by MDR bacteria, history of cancer and infection sustained by A baumannii increase the risk of mortality and that standard sepsis treatments do not seem to provide any protective effect. Adjunctive therapy with IgM preparation seems to be beneficial, but further appropriate studies are needed to confirm the results observed.
BACKGROUND: : Patients with septic shock by multidrug resistant (MDR) microorganism maybe considered a specific population of critical patients at very high risk of death in whom the effects of standard sepsis treatment has never been assessed. The objective of this retrospective analysis was to evaluate the risk factors for 30-day mortality and the impact of sepsis management in patients with septic shock caused by MDR bacteria. METHODS: : Patients with septic shock by MDR bacteria admitted to the mixed intensive care unit (ICU) of Modena University Hospital during a 6-year period were studied. The clinical and microbiological characteristics and sepsis treatments provided were analyzed and compared between survivors (S) and nonsurvivors (NS) at 30 days after septic shock appearance. RESULTS: : Ninety-four patients were studied. All therapeutic interventions applied to patients during their ICU stay did not show statistical significance between S and NS groups, except for administration of immunoglobulin M (IgM) preparation which were provided more frequently in S group ( P < .05). At the multivariate adjusted analysis, preexisting cancer (odds ratio [OR] = 2.965) and Acinetobacter baumannii infections (OR = 3.197) were independently correlated with an increased risk of 30-day mortality, whereas treatment with IgM preparation was protective (OR = 0.283). CONCLUSIONS: : This retrospective study showed that in patients with septic shock caused by MDR bacteria, history of cancer and infection sustained by A baumannii increase the risk of mortality and that standard sepsis treatments do not seem to provide any protective effect. Adjunctive therapy with IgM preparation seems to be beneficial, but further appropriate studies are needed to confirm the results observed.
Authors: Stefano Busani; Sara De Biasi; Milena Nasi; Annamaria Paolini; Sophie Venturelli; Martina Tosi; Massimo Girardis; Andrea Cossarizza Journal: Front Immunol Date: 2020-05-05 Impact factor: 7.561
Authors: Mario Juhas; Emma Widlake; Jeanette Teo; Douglas L Huseby; Jonathan M Tyrrell; Yury S Polikanov; Onur Ercan; Anna Petersson; Sha Cao; Ali F Aboklaish; Anna Rominski; David Crich; Erik C Böttger; Timothy R Walsh; Diarmaid Hughes; Sven N Hobbie Journal: J Antimicrob Chemother Date: 2019-04-01 Impact factor: 5.790