13 research outputs found
Management of ventilator associated pneumonia with a new antibiotic adjuvant entity (ceftriaxone + sulbactam + disodium edetate) - A novel approach to spare carbapenems
No full textMucormycosis of Mandible with Unfavorable Outcome
No full textMucormycosis is a fulminant fungal infection that occurs most often in diabetic and immunocompromised individuals. Our patient, with uncontrolled diabetes mellitus and multiple systemic disorders, developed postextraction mucormycosis of mandible, an extremely rare complication. An initial clinical and radiographic diagnosis of mandibular osteomyelitis was made and the lesion was treated medically and surgically with curettage and saucerisation. The specimen was sent for histopathological evaluation, which showed necrotic area containing broad aseptate fungal hyphae with right angle branching consistent with mucormycosis. The patient succumbed to multipleorgan failure secondary to septicemia. The disease is usually fatal with a poor survival rate; there is still paucity of literature on the definitive management of this disease involving the mandible. This paper emphasizes the need for correction of underlying immunodeficiency and early diagnosis with aggressive multimodality treatment approach to offer the best chance of survival
Ceftazidime–avibactam for the Treatment of Intra-abdominal Sepsis and Urosepsis: A Retrospective Hospital-based Study in India
No full textBackground:
In India, microbial susceptibility to antibiotics has been gradually decreasing, thus making treatment of multidrug-resistant bacterial infections challenging. We aimed to assess the effectiveness of ceftazidime–avibactam in patients with intra-abdominal sepsis or urosepsis.
Methods:
This hospital-based, single-center retrospective study was conducted between April 2020 and March 2022 using data from inpatient records. Outcomes included inpatient mortality, clinical success/failure, and microbiological cure/failure measured on day 14/end of treatment, length of hospitalization and intensive care unit (ICU) admission, treatment and infection characteristics, recurrence within 30 days, and healthcare resource utilization. Descriptive statistics were used for data analysis.
Results:
Data from 46 patients (mean age = 65.2 ± 14.5 years, 73.9% male) were included. Ceftazidime–avibactam treatment was initiated within 5 days of hospitalization in 51.2% of patients. The median (range) duration of treatment was 8 (1, 20) days, and the average daily dose was 4.6 g. Inpatient and 30-day all-cause mortality rates were 41.5% and 17.1%, respectively. We observed clinical success, defined a priori, by day 14 in 58.5% of patients and microbiological cure in 61.3%. Most patients (97.0%) did not have recurrent infections. The median (range) length of hospitalization and ICU admission was 15.5 (3, 63) days and 11 (2, 63) days, respectively. Most patients (85.7%) utilized various healthcare resources during hospitalization.
Conclusion:
Among patients with available data, most showed clinical success (58.5%) and microbiological cure (61.3%) within 14 days of treatment initiation with ceftazidime–avibactam, with nearly no recurrence of infection, indicating treatment effectiveness in patients with intra-abdominal sepsis or urosepsis in an Indian hospital setting
Case Report Mucormycosis of Mandible with Unfavorable Outcome
No full textMucormycosis is a fulminant fungal infection that occurs most often in diabetic and immunocompromised individuals. Our patient, with uncontrolled diabetes mellitus and multiple systemic disorders, developed postextraction mucormycosis of mandible, an extremely rare complication. An initial clinical and radiographic diagnosis of mandibular osteomyelitis was made and the lesion was treated medically and surgically with curettage and saucerisation. The specimen was sent for histopathological evaluation, which showed necrotic area containing broad aseptate fungal hyphae with right angle branching consistent with mucormycosis. The patient succumbed to multipleorgan failure secondary to septicemia. The disease is usually fatal with a poor survival rate; there is still paucity of literature on the definitive management of this disease involving the mandible. This paper emphasizes the need for correction of underlying immunodeficiency and early diagnosis with aggressive multimodality treatment approach to offer the best chance of survival
Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements
No full textBackground: Despite various therapies to treat sepsis, it is one of the leading causes of mortality in the intensive care unit patients globally. Knowledge about the pathophysiology of sepsis has sparked interest in extracorporeal therapies (ECT) which are intended to balance the dysregulation of the immune system by removing excessive levels of inflammatory mediators.
Aim: To review recent data on the use of ECT in sepsis and to assess their effects on various inflammatory and clinical outcomes.
Methods: In this review, an extensive English literature search was conducted from the last two decades to identify the use of ECT in sepsis. A total of 68 articles from peer-reviewed and indexed journals were selected excluding publications with only abstracts.
Results: Results showed that ECT techniques such as high-volume hemofiltration, coupled plasma adsorption/filtration, resin or polymer adsorbers, and CytoSorb® are emerging as adjunct therapies to improve hemodynamic stability in sepsis. CytoSorb® has the most published data in regard to the use in the field of septic shock with reports on improved survival rates and lowered sequential organ failure assessment scores, lactate levels, total leucocyte count, platelet count, interleukin- IL-6, IL-10, and TNF levels.
Conclusion: Clinical acceptance of ECT in sepsis and septic shock is currently still limited due to a lack of large random clinical trials. In addition to patient-tailored therapies, future research developments with therapies targeting the cellular level of the immune response are expected
Consensus statement on the management of invasive candidiasis in Indian scenario
No full textInvasive fungal infections in critically ill patients are associated with increased morbidity and mortality. Candida species are among the most common causes of nosocomial bloodstream infections and of invasive infections in intensive care units (ICUs). The high mortality mandates early identification of invasive candidiasis which is vital to initiate appropriate and timely treatment and improve outcomes. Delaying the initiation of treatment could result in an increase in mortality which can be avoided by usage of more rapid diagnostic techniques. There are multiple diagnostic tests including culture and non-culture tests like 1,3-β-D-glucan and newer techniques like MALDI-TOF which are available to diagnose candidemia but each with their drawbacks. Additionally, there are various guidelines like IDSA and ESCMID on treatment which aim to minimize death, late complications from deep-seated candidiasis and rise of drug- resistant Candida strains. Through this consensus statement prepared by a panel of experts, all of whom are senior intensivists, infectious disease specialists and microbiologists, we aim to address the major aspects of management of invasive candidiasis in the Indian population as per the authors opinions, backed by published evidence and supported by the latest clinical guidelines
Antimicrobial lessons from a large observational cohort on intra-abdominal infections in intensive care units
No full textSevere intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed
Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis
No full textPurpose: To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control.
Methods: Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI).
Results: The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value ≤ 4-55.4% for a value > 12, p < 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (< 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]).
Conclusion: 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome
