Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

A study of the effect of theophylline on the anti-inflammatory potency of dexamethasone using alpha-aminoisobutyric acid uptake in rat skin fibroblasts: A possible mechanism through the glucocorticoid receptor

The action of theophylline on the uptake of a-aminoisobutyric acid (AIB; an indicator of anti-inflammatory potency) stimulated by the glucocorticoid, dexamethasone, in cultured rat fibroblast monolayers was evaluated. Theophylline alone (0.1 mM) did not show significant activity (3314 +/- 27 cpm) compared with the baseline level (3186 +/- 130 cpm), but in the presence of 10 nM dexamethasone the stimulation of AIB uptake was increased to 5263 +/- 100 cpm, approximately to the same extent as with 100 nM dexamethasone alone (5397 +/- 28 cpm); Activation of glucocorticoid-receptor complexes in rat fibroblast cytosol was studied by assessing the extent of their binding to DNA-cellulose. Activated and non-activated forms of glucocorticoid-receptor complexes were analysed by DEAE-Sephadex chromatography. Theophylline (1 mM) was found to have a direct effect (0 degrees C), similar to that of heat (25 degrees C) on DNA-celulose binding, that is approximately 64.5% and 68.7%, respectively, thus indicating that theophylline promotes activation of glucocorticoid receptors at low temperature. The effect of theophylline on the stimulation of AIB uptake by dexamethasone when considered in the light of its activation of GR receptors in the fibroblast cytosol indicates that this effect may be mediated by GR activation. (O) 1998 Academic Press

Anaphylaxis induced by lentils

Background: The legume food family is large and includes peanut and soybean, two of the most frequent causes of food allergy. Literature on type I hypersensitivity to lentils, also a legume, is scarce. Objective: To describe a child with repeated anaphylactic reactions related to lentils. Methods: Skin prick tests with both commercial and cooked extracts and serum- specific IgE measured by CAP-RIA were used to identify specific IgE antibodies to various legumes. Results: An 8-year-old girl suffered four episodes of anaphylaxis related to lentils from ages 3 to 7 years. The first three involved ingestion of cooked lentils and each time smaller amounts induced symptoms. The fourth episode occurred with inhalation exposure to cooking lentil soup. Subsequently, she presented with contact urticaria from raw chickpeas and an anaphylactic reaction after ingestion of cooked chickpeas. Prick tests showed strongly positive reactions to lentil and chickpea and weaker positive reactions to peanut, pea, soybean, and white bean. CAP-RIA was class 6 to lentil; class 5 to peanut, pea, and soybean: class 4 to white bean, and class 0 to green bean. Conclusion: Severe type I hypersensitivity to lentils occurred in this patient and was associated with clinically relevant hypersensitivity to chickpeas. Prick tests and CAP-RIA demonstrated multiple positive reactions to other legumes

Contact reactions to fragrances

Background: The most common reaction to fragrances is contact dermatitis, a delayed hypersensitivity reaction; however, other reactions include immediate contact reactions (contact urticaria) and photo-allergic reactions. Fragrance mix (FM) and balsam of Peru (BP) are used to screen for fragrance allergy. Objective: To study the different types of allergic skin reactions to fragrance compounds. Methods: Delayed hypersensitivity reactions to FM and BP were studied in 4,975 patients with suspected contact dermatitis by routine patch testing interpreted at 48 and 96 hours. In 664 of the patients, patch tests were read at 30 minutes to evaluate for immediate (wheal-and-flare) contact reactions and again at 48 and 96 hours. Photopatch tests to FM were performed in 111 patients with suspected photo-allergic dermatitis. Results: Delayed contact reactions to FM occurred in 6.6% of females and 5.4% of males and to BP in 3.9% of females and 4.1% of males. Analysis of data over time (12 study years) showed an increased trend for reactions to fragrances, particularly in males. Sensitivity to other contact allergens (polysensitivity) was found in 62% of patients and polysensitivity presented more often with generalized contact dermatitis. The most sensitizing components of the fragrance mix that were tested in 38 patients were cinnamic alcohol, oak moss, and cinnamic aldehyde. There were 112 immediate patch test reactions to FM and 113 to BP in 664 patients. Immediate contact reactions were followed by delayed contact reactions in 13.4% of patients for FM and 8.8% for BP, representing a significant increase in the frequency of delayed contact reactions. Patients with immediate contact reactions to fragrances did not have a higher incidence of atopy (25.9%). No cases of positive photopatch test reactions to FM were seen. Conclusion: Fragrances commonly cause both delayed and immediate patch test reactions and patients with immediate contact reactions have an increase in delayed contact reactions to the same allergen