Fatal Pseudomonas aeruginosa pneumonia in a previously healthy woman was most likely associated with a contaminated hot tub

Community-acquired pneumonia due to Pseudomonas aeruginosa in previously healthy individuals is a rare disease that is associated with high fatality. On 14 February 2010 a previously healthy 49-year-old woman presented to an emergency room with signs and symptoms of pneumonia, 2 days after returning from a spa holiday in a wellness hotel. Blood cultures and respiratory specimens grew P. aeruginosa. Despite adequate antimicrobial therapy, the patient died of septic multiorgan failure on day nine of hospitalization. On February 26, nine water samples were taken from the hotel facilities used by the patient: In the hot tub sample 37,000 colony-forming units of P. aeruginosa/100 ml were detected. Two of five individual colonies from the primary plate used for this hot tub water sample were found to be genetically closely related to the patients’ isolates. Results from PFGE, AFLP and MLST analysis allowed the two lung isolates gained at autopsy and the whirlpool bathtub isolates to be allocated into one cluster. The patient most likely acquired P. aeruginosa from the contaminated water in the hotel’s hot tub. The detection of P. aeruginosa in high numbers in a hot tub indicates massive biofilm formation in the bath circulation and severe deficiencies in hygienic maintenance. The increasing popularity of hot tubs in hotels and private homes demands increased awareness about potential health risks associated with deficient hygienic maintenance

Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO a retrospective single-center experience

Objective In this retrospective case series, survival rates in different indications for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and differential diagnoses of COVID-19 associated refractory circulatory failure are investigated. Methods Retrospective analysis of 28 consecutive COVID-19 patients requiring VA-ECMO. All VA-ECMO’s were cannulated peripherally, using a femoro-femoral cannulation. Results At VA-ECMO initiation, median age was 57 years (IQR: 51–62), SOFA score 16 (IQR: 13–17) and norepinephrine dosing 0.53μg/kg/min (IQR: 0.35–0.87). Virus-variants were: 61% wild-type, 14% Alpha, 18% Delta and 7% Omicron. Indications for VA-ECMO support were pulmonary embolism (PE) (n = 5, survival 80%), right heart failure due to secondary pulmonary hypertension (n = 5, survival 20%), cardiac arrest (n = 4, survival 25%), acute heart failure (AHF) (n = 10, survival 40%) and refractory vasoplegia (n = 4, survival 0%). Among the patients with AHF, 4 patients suffered from COVID-19 associated heart failure (CovHF) (survival 100%) and 6 patients from sepsis associated heart failure (SHF) (survival 0%). Main Complications were acute kidney injury (AKI) 93%, renal replacement therapy was needed in 79%, intracranial hemorrhage occurred in 18%. Overall survival to hospital discharge was 39%. Conclusion Survival on VA-ECMO in COVID-19 depends on VA-ECMO indication, which should be considered in further studies and clinical decision making. A subgroup of patients suffers from acute heart failure due to inflammation, which has to be differentiated into septic or COVID-19 associated. Novel biomarkers are required to ensure reliable differentiation between these entities; a candidate might be soluble interleukin 2 receptor

Reaktion auf Nanoapatit-haltige Implantate mit pharmakologisch aktivem Polymer

We investigated a new group of nanocrystalline hydroxyapatite (HA) with an organic component. The HA had the same crystal dimensions as in human bone, which is known to facilitate the cellular degradation. The organic component allowed the binding of pharmacologic active substances and the controlled release after implantation as well as a control of the degradation rate of the HA. HA was coprecipitated and photopolymerized containing the Makropolymer Indomethacin/Tyrosin/HEMA (Indo-OA), and as controls containing Poly-HEMA (HEMA-OA) alone or Poly-L-Lysin (PLL-OA). These were investigated in a standardized rabbit-model with a critical-size-defect in spongy bone. The host-and material response were examinated after 7, 28 and 84 days (d) using histology, histomorphometry, electronmicroscopy and in-situ-hybridisation techniques. Nanocrystalline HA was similarly bonded and subjected to remodelling like normal bone. The biological behavior of HA was strongly influenced by the added organic polymer. Indo-OA showed the weakest inflammatory reaction, the smallest amount of fibrous tissue, the fastest incorporation in bone and the highest amount of bone-contact and number of osteoclast-like-cells at the interface after 7 and 28d. On a molecular basis it showed an acceleration and increase of bone-formation as compared to the empty-hole-controlled and the other materials. After 84d it showed less bone-contact as HEMA-OA, mostly because 2 of 6 implants prepared for lightmicroscopic evaluation showed nearly no bone-contact. One of those showed signs of chronic infection. The weak mechanic properties of the nanocristalline HA could be improved by adding the organic component. The MEMA-OA implants appeared to be the most stable ones. HEMA-OA (as the anchor-substance for indomethacin in the HA) had no negative influence on bone metabolism. PLL-OA is unfavourable because it showed the strongest inflammatory reaction, surface erosion and implant-fragmentation as well as the lowest bone-contact at the interface. (orig.)SIGLEAvailable from: http://diss.fu-berlin.de/2003/321/index.html / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman