We present a case report concerning fatal bacteremia caused by Pantoeaagglomerans in a critically ill patient.
Pantoea is a genus of Enterobacteriacae Gram-negative bacteria family that includes at least 20 species; mostly isolated in the ecological niches.Continue reading
Bloodstream infections (BSIs) are a frequent and life threatening condition in hospital settings. The case fatality rate associated with BSI reaches 35-50% when associated with admission to intensive care unit (ICU). The extensive use of intravascular catheters, however, is recognized as the most important factor contributing to the occurrence of BSI. Catheter-related BSIs (CR-BSIs) are the most common types of BSI in ICU. Bacteraemias that occur in the ICU are classified as Community Onset BSI and Hospital Acquired (HA) BSI. They are also distinguished in primary and secondary. Community-onset BSIs are those that occur in outpatients or are first identified 48 h after admission to hospital/ICU, and they may be sub classified further as health care associated (HCA), when they occur in patients with significant prior health care exposure, or community associated, in other cases. Hospital Acquired (HA) and / or ICU-acquired BSIs are defined as those occurring more than 48 hours after the patient's admission into the hospital or ICU or within 48 hours of leaving the hospital or the ICU. Community acquired BSIs usually due to susceptible bacteria should be clearly differentiated from HCA and HA BSIs frequently due to resistant hospital strains. A bedridden status, presence of indwelling devices, recent hospitalization or contact with health care facilities and recent antibiotic therapy may represent the most important risk factors for the development of emerging multi drug resistant (MDR) GN infections. The basic components of the treatment of a bacteraemia in the ICU are determining the type of bacteraemia in order to target potential pathogens, the initiation of empirical antimicrobial therapy based on the guidelines, and the source control if it is a secondary bacteremia. These goals become difficult to achieve in case of BSI due to multi-drug resistant pathogens with high MICs to antimicrobials. The main mechanisms which have put in danger the marvelous antibiotic weapon are the production of ESBL (several different subtypes), the production of carbapenemases and metallo-betalactamases, with consequent spread of multi or pan-resistant organism and the emerging growing resistance in colistin. The targeted treatment should be applied immediately after receiving the susceptibility test from the cultures. Targeted treatment essentially consists in redefining antibiotic treatment, in de-escalation in order to decrease the antibiotic selection pressure, and in determining the duration of treatment. Source control is recognized as an important part of the therapy of BSIs and has been recently shown to be independently related with outcome. Depending on the source of the infection (pneumonia, CRBSIs, urinary tract infections, intra-abdominal infections), the therapeutic strategy should be based on international guidelines in combination with local microbiology and local antibiotic resistance data.Continue reading
Clinical evaluation of pupils is considered as an essential part of neurological examination. The pupillary response to light is controlled by the autonomic nervous system. Numerous factors affect pupils dynamics, like e.g. luminance, visual field area, pain, drug administration, age, the functional integrity of anatomical structures involved, e.t.c. Moreover, pupillometry card method and examination of pupil reaction with the use of a penlight is subjective to a lot of bias. Portable infrared pupillometry allows a more objective and detail evaluation of pupil’s dynamics. That’s why it has already found applications in various clinical areas, like e.g. neurology, psychology, ophthalmology, endocrinology, anesthesia, pain management, intensive care, emergency medicine. This review focuses on physiology of pupil’s dynamics and on applications of infrared pupillometry in perioperative setting.Continue reading
The goal of of the present study is to investigate short-term and long-term functional outcome of a 8-bed, multidisciplinary pediatric intensive care unit (PICU) of a general hospital 300 PICU patients were enrolled prospectively in this observational cohort study. Functional outcome was evaluated through Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) scales at admission (baseline), at PICU and hospital discharge, at 3 and 6 months, and at 1 and 2 years. Delta DPCPC and DPOPC alterations at discharge were related to major diagnostic categories and 2-year survival.Baseline PCPC and POPC scores were normal in 67% and 58.7% of study population, mild disability were recorded in 17.3% and 14.7%, moderate disability at 8% and 14%, severe disability at 4.3% and 9.3% and coma at 3.3% and 3.3%, respectively.Continue reading
Delirium, a serious and common manifestation of brain dysfunction in critically ill patients gained great attention over the last decade. Important risk factors such as use of benzodiazepines, coma, preexisting cognitive impairment, alcoholism and high severity of illness at ICU admission were i-dentified. Screening tools like the CAM-ICU and the ICDSC were extensively validated in many different ICU patient populations and are recommended for routine monitoring in everyday practice. Sedation with novel sedatives such as dexmedetomidine, implementation of non pharma-ceutical, preventive interventions and early mobilization of patients may reduce the incidence of this syndrome. The role of haloperidol and atypical antipsychotics in the prevention and treatment of ICU delirium is still under investigation.Continue reading
The purpose of this study was to investigate the performance of the Pediatric Risk of Mortality (PRISM III–24) in a Greek pediatric intensive care unit (PICU). We prospectively followed 300 PICU patients in an observational cohort study. PRISM III-24 performance was assessed in the whole population and in 4 preselected groups (infants, patients with length of PICU stay > 4 days, patients with co-morbidities, ventilated patients) with standard discrimination and calibration me-thods.Continue reading