Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria. Results: Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days. Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients. Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common. Copyright:
Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria. Results:Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days. Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients. Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common. Copyright:
Authors: Nguyen Van Hao; Huynh Thi Loan; Lam Minh Yen; Evelyne Kestelyn; Duc Du Hong; Duong Bich Thuy; Nguyen Thanh Nguyen; Ha Thi Hai Duong; Tran Thi Diem Thuy; Phung Tran Huy Nhat; Phan Nguyen Quoc Khanh; Nguyen Thi Phuong Dung; Nguyen Hoan Phu; Nguyen Thanh Phong; Pham Thi Lieu; Pham Thi Tuyen; Bui Thi Bich Hanh; Ho Dang Trung Nghia; Pham Kieu Nguyet Oanh; Phan Vinh Tho; Tran Tan Thanh; Hugo C Turner; H Rogier van Doorn; Le Van Tan; Duncan Wyncoll; Nicholas Pj Day; Ronald B Geskus; Guy E Thwaites; Nguyen Van Vinh Chau; C Louise Thwaites Journal: Lancet Glob Health Date: 2022-06 Impact factor: 38.927
Authors: Andrew Kazibwe; Noah Emokol Okiror; Felix Bongomin; Amelia Margaret Namiiro; Joseph Baruch Baluku; Robert Kalyesubula; Magid Kagimu; Irene Andia-Biraro Journal: Open Forum Infect Dis Date: 2022-07-25 Impact factor: 4.423