Martina Spaziante1, Simone Giuliano2, Giancarlo Ceccarelli1, Francesco Alessandri3, Cristian Borrazzo1, Alessandro Russo4, Mario Venditti5. 1. Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy. 2. Infectious Diseases, ASL AT, Asti, Italy. 3. Department of Anaesthesia and Intensive Care Medicine, "Sapienza" University of Rome, Rome, Italy. 4. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 5. Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy. Electronic address: mario.venditti@uniroma1.it.
Abstract
BACKGROUND: Data on septic thrombosis caused by Gram-negative bacilli (GN-ST) in intensive care unit (ICU) patients are currently limited. METHODS: The aim of this retrospective case-control study (matched 1:3) performed over a 15-month period on ICU patients with bacteraemia, associated (cases) or not (controls) with GN-ST, was to assess 30-day mortality and clinical/microbiological features of GN-ST. RESULTS: During the study period, 16 patients with GN-ST and 48 controls were analyzed. Polytrauma was the cause of ICU admission in 12 (75%) cases and 22 (46%) controls (p = 0.019). In no case of septic thrombosis was surgical debridement performed. The site of venous thrombosis was more frequently in the lower limbs, associated with bone fracture in nine out of 12 (75%) cases. The median duration of bacteraemia (22 days vs 1 day; p < 0.001) and time to clinical improvement (15 days vs 4 days; p < 0.001) were significantly longer in cases than in controls. On analysis of the receiver operating characteristics (ROC) curve, bacteraemia >72 h was significantly associated with GN-ST (area under the curve (AUC) 0.95, sensitivity 0.996 and specificity 0.810; p < 0.001). Finally, 30-day mortality was 20% in cases and 67% in controls (p < 0.001). CONCLUSIONS: Critically ill patients with GN-ST showed specific clinical features. Despite delayed bacteraemia clearance, targeted antibiotic therapy plus anticoagulation usually provided clinical improvement and a low 30-day mortality rate.
BACKGROUND: Data on septic thrombosis caused by Gram-negative bacilli (GN-ST) in intensive care unit (ICU) patients are currently limited. METHODS: The aim of this retrospective case-control study (matched 1:3) performed over a 15-month period on ICU patients with bacteraemia, associated (cases) or not (controls) with GN-ST, was to assess 30-day mortality and clinical/microbiological features of GN-ST. RESULTS: During the study period, 16 patients with GN-ST and 48 controls were analyzed. Polytrauma was the cause of ICU admission in 12 (75%) cases and 22 (46%) controls (p = 0.019). In no case of septic thrombosis was surgical debridement performed. The site of venous thrombosis was more frequently in the lower limbs, associated with bone fracture in nine out of 12 (75%) cases. The median duration of bacteraemia (22 days vs 1 day; p < 0.001) and time to clinical improvement (15 days vs 4 days; p < 0.001) were significantly longer in cases than in controls. On analysis of the receiver operating characteristics (ROC) curve, bacteraemia >72 h was significantly associated with GN-ST (area under the curve (AUC) 0.95, sensitivity 0.996 and specificity 0.810; p < 0.001). Finally, 30-day mortality was 20% in cases and 67% in controls (p < 0.001). CONCLUSIONS:Critically illpatients with GN-ST showed specific clinical features. Despite delayed bacteraemia clearance, targeted antibiotic therapy plus anticoagulation usually provided clinical improvement and a low 30-day mortality rate.
Authors: Jongtak Jung; Kyoung-Ho Song; Kang Il Jun; Chang Kyoung Kang; Nak-Hyun Kim; Pyoeng Gyun Choe; Wan Beom Park; Ji Hwan Bang; Eu Suk Kim; Sang-Won Park; Nam Joong Kim; Myoung-Don Oh; Hong Bin Kim Journal: BMC Infect Dis Date: 2020-09-17 Impact factor: 3.090
Authors: Alessandra Oliva; Ambrogio Curtolo; Lorenzo Volpicelli; Francesco Cogliati Dezza; Massimiliano De Angelis; Sara Cairoli; Donatella Dell'Utri; Bianca Maria Goffredo; Giammarco Raponi; Mario Venditti Journal: Antibiotics (Basel) Date: 2021-06-27