REFRACTORY GRAM-NEGATIVE SEPTIC SHOCK COMPLICATED BY EXTENDED PURPURA FULMINANS AND MULTIPLE ORGAN FAILURE IN A 23-YEAR-OLD PUERPERA -A CASE REPORT-

Background: Pregnancy-related infections are the third most common cause of maternal death worldwide. The aim of this report is to present a case of pregnancy-related infection, which progressed into refractory septic shock accompanied by purpura fulminans and multiple organ failure. Case: A 23-year-old woman in the postpartum period developed fulminant, refractory septic shock complicated by purpura fulminans and multiple organ failure syndrome (acute respiratory distress syndrome, acute kidney injury, and encephalopathy). Management included antibacterial therapy, fluid and transfusion therapy, nutritional support, protective mechanical ventilation, hydrocortisone, a large dose of ascorbic acid, and thiamine. There were no neurological consequences and all organ functions returned to normal, although the predicted hospital mortality based on the Sequential Organ Failure Assessment (SOFA) score was more than 90%. Conclusions: Septic shock is a significant, yet not completely understood life-threatening condition, which can be associated with purpura fulminans, multiple organ dysfunction, disseminated intravascular coagulation, and massive tissue necrosis

OUTCOME PREDICTORS OF STROKE MORTALITY IN THE NEUROCRITICAL CARE UNIT

Background: Risk factors for medium to long-term mortality after stroke are well-established but predictors of in-hospital stroke mortality are less clearly characterized. Kazakhstan has the highest age-standardized mortality rate from ischemic stroke in the world. Methods: We performed a retrospective analysis of patients with stroke who were admitted over a 3.5-years period to the neurocritical care unit of a tertiary care hospital in Nur-Sultan, Kazakhstan. Results: In total, 148 critically ill patients were included in the analysis (84 ischemic stroke, 64 hemorrhagic stroke). The mean age was 63 years, 45% were male and the mean Glasgow Coma Score (±SD) at baseline was 10.3 (±3.4). The in-hospital mortality rate was similar in patients with ischemic (36%) and hemorrhagic (39%) stroke (HR 0.88, 95%CI 0.48–1.60). Median survival was 38 days (range: 1–89 days) in patients with ischemic stroke and 39 days (range: 1–63 days) in patients with hemorrhagic stroke. Univariable analysis found that patients who had a lower Glasgow Coma Scale, were in coma and who had cerebral edema were more likely to die in-hospital (P = 0.04, 0.02, <0.01, respectively). Conclusions: Our analysis showed that mortality risk in critically ill patients with hemorrhagic stroke was closer to mortality risk in patients with ischemic stroke than has been reported in other analyses. Hypertension, chronic heart failure, ischemic heart disease and atrial fibrillation were the most frequent comorbidities in patients who developed severe (life-threatening) stroke. Coma and cerebral edema on admission appear to be associated with poor outcome. This is the first publication of in-hospital stroke mortality from a Central Asian population and could form the basis for future research including development of risk scores and identifying modifiable risk factors

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes