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

Chediak-Higashi syndrome in the intensive care unit

Chediak-Higashi Syndrome is a rare autosomal recessive disease characterized by recurrent infections, giant cytoplasmic granules and oculocutaneous albinism. We describe the clinical and laboratory findings of a patient with Chediak-Higashi syndrome who was diagnosed and treated in the intensive care unit because of bleeding tendency after surgery

Crush syndrome patients after the Marmara earthquake

Background: To assess the treatment and outcome of patients with crush injury sustained in the Marmara earthquake. Methods: Seven hundred eighty three patients were transferred to a university hospital and 25 of them were admitted to the intensive care unit. The medical records of 18 crush injury patients were retrospectively reviewed. Results: The major associated injuries were in the lower extremities, upper extremities, and chest. Seven patients underwent fasciotomy and six patients had amputations. Twelve patients required mechanical ventilation. Adult respiratory distress syndrome developed in four patients. Oliguria occurred in eight patients. Hyperkalaemia was seen in six patients and four of them underwent emergency haemodialysis. One patient died because of hyperkalaemia on arrival to the intensive care unit. Renal failure was treated with haemodialysis or haemoperfusion in 13 patients. Five patients died because of multiple organ failure and two patients because of sepsis. Conclusion: Crush syndrome is a life treatening event. The authors believe that early transportation and immediate intensive care therapy would have improved the survival rate

Effect of surfactant types on the biocompatibility of electrospun HAp/PHBV composite nanofibers

WOS: 000345644300008PubMed ID: 25091188Bone tissue engineering literature conveys investigations regarding biodegradable polymers where bioactive inorganic materials are added either before or after electrospinning process. The goal is to mimic the composition of bone and enhance the biocompatibility of the materials. Yet, most polymeric materials are hydrophobic in nature; therefore, their surfaces are not favorable for human cellular adhesion. In this sense, modifications of the hydrophobic surface of electrospun polymer fibers with hydrophilic and bioactive nanoparticles are beneficial. In this work, dispersion of hydroxyapatite (HAp), which is similar to the mineral component of natural bone, within biodegradable and biocompatible polymer poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) with the aid of a surfactant has been investigated. Non-ionic TWEEN20 and 12-hydroxysteric acid (HSA), cationic dodecyl trimethyl ammonium bromide (DTAB) and anionic sodium deoxycholate and sodium dodecyl sulfate (SDS) surfactants were used for comparison in order to prepare stable and homogenous nanocomposite suspensions of HAp/PHBV for the electrospinning process. Continuous and uniform composite nanofibers were generated successfully within a diameter range of 400-1,000 nm by the mediation of all surfactant types. Results showed that incorporation of HAp and any of the surfactant types strongly activates the precipitation rate of the apatite-like particles and decreases percent crystallinity of the HAp/PHBV mats. Mineralization was greatly enhanced on the fibers produced by using DTAB, HSA, and especially SDS on where also osteoblastic metabolic activity was similarly increased. The produced HAp/PHBV nanofibrous composite scaffolds would be a promising candidate as an osteoconductive bioceramic/polymer composite material for tissue engineering applications.TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK)A. Suslu acknowledges the support from TUBITAK, in the framework of the National Scholarship Programme for PhD Students