Retrospektive Erhebung der Polytraumadaten von 2007 - 2010 an der Berufsgenossenschaftlichen Unfallklinik Tübingen und am Universitätsklinikum Tübingen - Untersuchung prognostischer Faktoren im Hinblick auf Outcome -

480 Traumapatienten mit einem ISS >= 16 wurden ohne Altersbeschränkung in die Studie eingeschlossen. Der ISS-Mittelwert lag bei 30,2. Dieses Patientenkollektiv entsprach bei der Alters- und Geschlechtsverteilung sowie bei der Verteilung der Unfallarten den Angaben anderer Studien und des TR-DGU. Im Einklang mit der Literatur ließen sich im Schockraum als wichtige Prognosefaktoren im Hinblick auf Letalität Alter, ISS, GCS, Hb, Quick, PTT, BE, Laktat, pH und EK-Gabe bestätigen. Auch hinsichtlich der Entwicklung von Spätkomplikationen wie MOV und Sepsis zeigten sich in der hier vorliegenden Untersuchung diese Parameter mit Ausnahme des Alters und des BE als gute prognostische Faktoren. Außerdem ließen sich beim Vergleich der erhobenen Befunde mit den TR-DGU-Jahresberichten 2011 - 2013 für das Gesamtkollektiv des TR-DGU bzw. für die Patienten des TZT die bereits in den letzten Jahren in der Literatur beschriebenen Tendenzen in der Schwerverletzten-Versorgung weitgehend erkennen, wie zunehmendes Patientenalter, Abnahme des ISS-Mittelwertes, Zunahme des GCS-Mittelwertes am Unfallort, Rückgang der präklinischen Intubationsrate, Rückgang der präklinisch gegebenen Volumenmenge mit Verbesserung der Gerinnungssituation (Quick, PTT) und des Hb-Wertes bei Klinikaufnahme, Rückgang der Bluttransfusionen im Schockraum, Rückgang der Intensiv- und Beatmungszeit, Verbesserung des Outcomes nach GOS 2 - 5 sowie Rückgang der Letalität (GOS 1)

A prospective observational study of bacteraemia in adults admitted to an urban Mozambican hospital

Background. Bacteraemia is a common cause of fever among patients presenting to hospitals in sub-Saharan Africa. The worldwide rise of antibiotic resistance makes empirical therapy increasingly difficult, especially in resource-limited settings.Objectives. To describe the incidence of bacteraemia in febrile adults presenting to Maputo Central Hospital (MCH), an urban referral hospital in the capital of Mozambique, and characterise the causative organisms and antibiotic susceptibilities. We aimed to describe the antibiotic prescribing habits of local doctors, to identify areas for quality improvement. Methods. Inclusion criteria were: (i) ≥18 years of age; (ii) axillary temperature ≥38°C or ≤35°C; (iii) admission to MCH medical wards in the past 24 hours; and (iv) no receipt of antibiotics as an inpatient. Blood cultures were drawn from enrolled patients and incubated using the BacT/Alert automated system (bioMérieux, France). Antibiotic susceptibilities were tested using the Kirby-Bauer disc diffusion method. Results. Of the 841 patients enrolled, 63 (7.5%) had a bloodstream infection. The most common isolates were Staphylococcus aureus, Escherichia coli, and non-typhoidal Salmonella. Antibiotic resistance was common, with 20/59 (33.9%) of all bacterial isolates showing resistance to ceftriaxone, the broadest-spectrum antibiotic commonly available at MCH. Receipt of insufficiently broad empirical antibiotics was associated with poor in-hospital outcomes (odds ratio 8.05; 95% confidence interval 1.62 - 39.91; p=0.04). Conclusion. This study highlights several opportunities for quality improvement, including educating doctors to have a higher index of suspicion for bacteraemia, improving local antibiotic guidelines, improving communication between laboratory and doctors, and increasing the supply of some key antibiotics.

Multifocal tuberculosis-associated immune reconstitution inflammatory syndrome – a case report of a complicated scenario

Background Tuberculosis (TB)-associated Immune reconstitution inflammatory syndrome (TB-IRIS) is an aberrant inflammatory response in TB patients with advanced human immunodeficiency virus coinfection, after antiretroviral therapy commencement. Case presentation We present a rare case of a 51-year-old woman living with HIV who developed a series of TB-IRIS events occurring at multiple sites sequentially, highlighting the clinical complexity in diagnosis and management. Conclusion This case illustrates how complicated a clinical scenario of successive TB-IRIS episodes can be, in terms of clinical management

High seroprevalence of Leishmania infantum is linked to immune activation in people with HIV: a two-stage cross-sectional study in Bahia, Brazil

Visceral leishmaniasis is an opportunistic disease in HIV-1 infected individuals, unrecognized as a determining factor for AIDS diagnosis. The growing geographical overlap of HIV-1 and Leishmania infections is an emerging challenge worldwide, as co-infection increases morbidity and mortality for both infections. Here, we determined the prevalence of people living with HIV (PWH) with a previous or ongoing infection by Leishmania infantum and investigated the virological and immunological factors associated with co-infection. We adopted a two-stage cross-sectional cohort (CSC) design (CSC-I, n = 5,346 and CSC-II, n = 317) of treatment-naïve HIV-1-infected individuals in Bahia, Brazil. In CSC-I, samples collected between 1998 and 2013 were used for serological screening for leishmaniasis by an in-house Enzyme-Linked Immunosorbent Assay (ELISA) with SLA (Soluble Leishmania infantum Antigen), resulting in a prevalence of previous or ongoing infection of 16.27%. Next, 317 PWH were prospectively recruited from July 2014 to December 2015 with the collection of sociodemographic and clinical data. Serological validation by two different immunoassays confirmed a prevalence of 15.46 and 8.20% by anti-SLA, and anti-HSP70 serology, respectively, whereas 4.73% were double-positive (DP). Stratification of these 317 individuals in DP and double-negative (DN) revealed a significant reduction of CD4+ counts and CD4+/CD8+ ratios and a tendency of increased viral load in the DP group, as compared to DN. No statistical differences in HIV-1 subtype distribution were observed between the two groups. However, we found a significant increase of CXCL10 (p = 0.0076) and a tendency of increased CXCL9 (p = 0.061) in individuals with DP serology, demonstrating intensified immune activation in this group. These findings were corroborated at the transcriptome level in independent Leishmania- and HIV-1-infected cohorts (Swiss HIV Cohort and Piaui Northeast Brazil Cohort), indicating that CXCL10 transcripts are shared by the IFN-dominated immune activation gene signatures of both pathogens and positively correlated to viral load in untreated PWH. This study demonstrated a high prevalence of PWH with L. infantum seropositivity in Bahia, Brazil, linked to IFN-mediated immune activation and a significant decrease in CD4+ levels. Our results highlight the urgent need to increase awareness and define public health strategies for the management and prevention of HIV-1 and L. infantum co-infection