Acute and Critical Care

Original Articles

Pulmonary
Sequential Organ Failure Assessment score as a predictor of mortality in ventilated patients with multidrug-resistant bacteremia: Yeseul Oh, Jiyeon Roh, Jaemin Lee, Hyun Sung Chung, Kwangha Lee, Min Ki Lee; Acute Crit Care. 2020;35(3):169-178. Published online August 31, 2020; DOI: https://doi.org/10.4266/acc.2020.00143

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Background
The occurrence of multidrug-resistant (MDR) bacteremia in ventilated patients may be associated with a high mortality rate. We evaluated whether Sequential Organ Failure Assessment (SOFA) score on the day of bacteremia could predict 90-day mortality in these patients.
Methods
Data were obtained retrospectively from 202 patients (male, 60.4%; median age, 64 years) hospitalized at a single university-affiliated tertiary care hospital. All adult patients who had were ventilated and had one of the following six MDR bacteremias between March 2011 and February 2018 were enrolled: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant Gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), or vancomycin-resistant Enterococcus faecium.
Results
The overall 90-day mortality rate after the day of bacteremia was 59.9%. The areas under the receiver operating characteristic curves for the SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 0.732 (95% confidence interval [CI], 0.666 to 0.792; P<0.001) and 0.662 (95% CI, 0.593 to 0.727; P<0.001), respectively, with no difference between the two (P=0.059). Also, the cutoff value of the SOFA score was 9 (based on Youden’s index). Multivariate Cox regression analysis showed that this cut-off value was significantly associated with higher mortality rate (hazard ratio, 2.886; 95% CI, 1.946 to 4.221; P<0.001).
Conclusions
SOFA score measured on the day of bacteremia may be a useful prognostic indicator of 90-day mortality in ventilated patients with MDR bacteremia.

Citations

Citations to this article as recorded by

Serial evaluation of the serum lactate level with the SOFA score to predict mortality in patients with sepsis
Heemoon Park, Jinwoo Lee, Dong Kyu Oh, Mi Hyeon Park, Chae-Man Lim, Sang-Min Lee, Hong Yeul Lee
Scientific Reports.2023;[Epub] CrossRef
The value of admission Troponin I to predict outcomes in suspected infections in elderly patients admitted in Internal Medicine: results from the SOFA-T collaboration, a multi-center study
N. Tarquinio, G. Viticchi, V. Zaccone, M. Martino, A. Fioranelli, P. Morciano, G. Moroncini, C. Di Pentima, A. Martini, C. Nitti, A. Salvi, M. Burattini, L. Falsetti
Internal and Emergency Medicine.2021; 16(4): 981. CrossRef

Infection
Current Status and Survival Impact of Infectious Disease Consultation for Multidrug-Resistant Bacteremia in Ventilated Patients: A Single-Center Experience in Korea: Insu Kim, Won-Young Kim, Eun Suk Jeoung, Kwangha Lee; Acute Crit Care. 2018;33(2):73-82. Published online April 26, 2018; DOI: https://doi.org/10.4266/acc.2017.00591

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Background
We evaluated the current status and survival impact of infectious disease consultation (IDC) in ventilated patients with multidrug-resistant (MDR) bacteremia.
Methods
One hundred sixty-one consecutive patients from a single tertiary care hospital were enrolled over a 5-year period. Patients with at least one of the following six MDR bacteremias were included: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), and vancomycin-resistant Enterococcus faecium.
Results
Median patient age was 66 years (range, 18 to 95), and 57.8% of subjects were male. The 28-day mortality after the day of blood culture was 52.2%. An IDC was requested for 96 patients based on a positive blood culture (59.6%). Patients without IDC had significantly higher rate of hemato-oncologic diseases as a comorbidity (36.9% vs. 11.5%, P < 0.001). Patients without an IDC had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (median, 20; range, 8 to 38 vs. median, 16; range, 5 to 34, P < 0.001) and Sequential Organ Failure Assessment (SOFA) score (median, 9; range, 2 to 17 vs. median, 7; range, 2 to 20; P = 0.020) on the day of blood culture and a higher 28-day mortality rate (72.3% vs. 38.5%, P < 0.001). In patients with SOFA ≥9 (cut-off level based on Youden’s index) on the day of blood culture and gram-negative bacteremia, IDC was also significantly associated with lower 28-day mortality (hazard ratio [HR], 0.298; 95% confidence interval [CI], 0.167 to 0.532 and HR, 0.180; 95% CI, 0.097 to 0.333; all P < 0.001] based on multivariate Cox regression analysis.
Conclusions
An IDC for MDR bacteremia was requested less often for ventilated patients with greater disease severity and higher 28- day mortality after blood was drawn. In patients with SOFA ≥9 on the day of blood culture and gram-negative bacteremia, IDC was associated with improved 28-day survival after blood draw for culture.

Citations

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Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study
Davide Fiore Bavaro, Nicolò De Gennaro, Alessandra Belati, Lucia Diella, Roberta Papagni, Luisa Frallonardo, Michele Camporeale, Giacomo Guido, Carmen Pellegrino, Maricla Marrone, Alessandro Dell’Erba, Loreto Gesualdo, Nicola Brienza, Salvatore Grasso, Gi
Antibiotics.2023; 12(4): 712. CrossRef
The role of infectious disease consultations in the management of patients with fever in a long-term care facility
Soo-youn Moon, Kyoung Ree Lim, Jun Seong Son, Ali Amanati
PLOS ONE.2023; 18(9): e0291421. CrossRef
Impact of infectious diseases consultation among patients with infections caused by gram-negative rod bacteria: a systematic literature review and meta-analysis
Shinya Hasegawa, Satoshi Kakiuchi, Joseph Tholany, Takaaki Kobayashi, Alexandre R. Marra, Marin L. Schweizer, Riley J. Samuelson, Hiroyuki Suzuki
Infectious Diseases.2022; 54(8): 618. CrossRef
Infectious Disease Consults of Pseudomonas aeruginosa Bloodstream Infection and Impact on Health Outcomes
Swetha Ramanathan, Fritzie S Albarillo, Margaret A Fitzpatrick, Katie J Suda, Linda Poggensee, Amanda Vivo, Martin E Evans, Makoto Jones, Nasia Safdar, Chris Pfeiffer, Bridget Smith, Geneva Wilson, Charlesnika T Evans
Open Forum Infectious Diseases.2022;[Epub] CrossRef
Timeliness of Infectious Diseases Referral and Inappropriate Antibiotic Usage Post-Referral in an Asian Tertiary Hospital
Liang En Wee, Aidan Lyanzhiang Tan, Limin Wijaya, Maciej Piotr Chlebicki, Julian Thumboo, Ban Hock Tan
Tropical Medicine and Infectious Disease.2019; 4(4): 137. CrossRef

Infection
Clinical Application of the Quick Sepsis-Related Organ Failure Assessment Score at Intensive Care Unit Admission in Patients with Bacteremia: A Single-Center Experience of Korea: Hae Jung Na, Eun Suk Jeong, Insu Kim, Won-Young Kim, Kwangha Lee; Korean J Crit Care Med. 2017;32(3):247-255. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00241

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Background
We evaluated the clinical usefulness of the quick Sepsis-Related Organ Failure Assessment (qSOFA) score (based on the 2016 definition of sepsis) at intensive care unit admission in Korean patients with bacteremia. Methods: We retrospectively analyzed clinical data from 236 patients between March 2011 and February 2016. In addition to the qSOFA, the Modified Early Warning score (MEWS) and systemic inflammatory response syndrome (SIRS) criteria were calculated. Results: The patients’ median age was 69 years, and 61.0% were male. Of the patients, 127 (53.8%) had a qSOFA score ≥2 points. They had significantly higher rates of septic shock, thrombocytopenia, and hyperlactatemia, and increased requirements for ventilator care, neuromuscular blocking agents, vasopressors, and hemodialysis within 72 hours after intensive care unit admission. They also had a significantly higher 28-day mortality rate. When analyzed using common thresholds (MEWS ≥5 and ≥2 SIRS criteria), patients with a MEWS ≥5 had the same results as those with a qSOFA score ≥2 (P < 0.05). However, patients with ≥2 SIRS criteria showed no significant differences. Conclusions: Our results show that a qSOFA score ≥2 at admission is a useful screening tool for predicting disease severity and medical resource usage within 72 hours after admission, and for predicting 28-day mortality rates in patients with bacteremia. In addition, qSOFA scores may be more useful than SIRS criteria in terms of prognostic utility.

Citations

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A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review
Magnolia Cardona, Claudia C. Dobler, Eyza Koreshe, Daren K. Heyland, Rebecca H. Nguyen, Joan P.Y. Sim, Justin Clark, Alex Psirides
Journal of Critical Care.2021; 66: 33. CrossRef
Consensus recommendation: Indications and methods for microbiological wound diagnostics
Axel Kramer, Ojan Assadian, Jürgen Bohnert, Georg Daeschlein, Joachim Dissemond, Veronika Gerber, Peter Hinz, Adam Junka, Simon Kim, Roald Papke, Christian Willy
Wound Medicine.2018; 23: 53. CrossRef

Case Reports

Infection
Septic Shock due to Unusual Pathogens, Comamonas testosteroni and Acinetobacter guillouiae in an Immune Competent Patient: Hyun Jung Kim, Yunkyoung Lee, Kyunghwan Oh, Sang-Ho Choi, Heungsup Sung, Jin Won Huh; Korean J Crit Care Med. 2015;30(3):180-183. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.180

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Abstract PDF

Comamonas testosteroni and Acinetobacter guillouiae are gram-negative bacilli of low virulence that are widely distributed in nature and normal flora. Despite their common occurrence in environments, they rarely cause infectious disease. We experienced a case of septic shock by C. testosterone and A. guillouiae, and isolated them by 16S ribosomal RNA sequencing method from the blood cultures of a previous healthy female during postoperative supportive care. This is the first case of septic shock required ventilator care and continuous renal replacement therapy due to these organisms in Korea.

Citations

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An investigation of clinical characteristics and antimicrobial agent susceptibility patterns in clinical Comamonas testosteroni isolates: An increasingly prevalent nosocomial pathogen
Bahadır Orkun Ozbay, Adalet Aypak, Aliye Bastug, Ömer Aydos, İpek Mumcuoglu, Sevim Gayenur Büyükberber, Ayşe Müge Karcıoğlu, Hurrem Bodur
Infectious Diseases Now.2023; 53(2): 104622. CrossRef
Bullfrogs (Lithobates catesbeianus) as a Potential Source of Foodborne Disease
Andrea P. Zepeda-Velazquez, Fabián-Ricardo Gómez-De-Anda, Luis F. Aguilar-Mendoza, Nayeli Shantal Castrejón-Jiménez, Juan Carlos Hernández-González, Jorge A. Varela-Guerrero, Jorge-Luis de-la-Rosa-Arana, Vicente Vega-Sánchez, Nydia E. Reyes-Rodríguez
Journal of Food Protection.2023; 86(4): 100067. CrossRef
The Emergence of the Genus Comamonas as Important Opportunistic Pathogens
Michael P. Ryan, Ludmila Sevjahova, Rachel Gorman, Sandra White
Pathogens.2022; 11(9): 1032. CrossRef
A rare case of peritoneal dialysis‐associated peritonitis caused by Comamonas testosteroni
Roman Kuźniewicz, Mirosław Śnit, Dariusz Szczyra
Seminars in Dialysis.2022; 35(6): 556. CrossRef
The complex pattern of codon usage evolution in the family Comamonadaceae
Eugenio Jara, María A. Morel, Guillermo Lamolle, Susana Castro-Sowinski, Diego Simón, Andrés Iriarte, Héctor Musto
Ecological Genetics and Genomics.2018; 6: 1. CrossRef
First microbiota assessments of children's paddling pool waters evaluated using 16S rRNA gene-based metagenome analysis
Toko Sawabe, Wataru Suda, Kenshiro Ohshima, Masahira Hattori, Tomoo Sawabe
Journal of Infection and Public Health.2016; 9(3): 362. CrossRef

Endocarditis Caused by Community-Acquired Klebsiella pneumoniae Infection - A Case Report -: Ji Ae Hwang, Charles Her, Yang Wook Kim; Korean J Crit Care Med. 2013;28(1):41-45.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.41

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Abstract PDF

In community-acquired Klebsiella pneumoniae infection, pyogenic liver abscess is common as a primary site of infection, particularly in Asia, that can progress to bacteremia. Diabetes mellitus is a usual predisposing factor. Pneumonia as primary site of infection by community-acquired Klebsiella pneumoniae infection is not common but carries a poor outcome. Early administration of appropriate antibiotics is extremely important to avoid the development of bacteremia and septicemia. An infective endocarditis caused by community-acquired Klebsiella pneumoniae infection is very rare; particularly, such a case of endocarditis in which pneumonia was the primary site of infection has never been reported previously. In this report we described a case of community-acquired Klebsiella pneumoniae infection that started with pneumonia and progressed to bacteremia, leading to endocarditis, liver abscess, and other systemic septic complications. Delayed administration of appropriate antibiotics may have played a role in this case.

Citations

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Infective endocarditis caused by Klebsiella pneumoniae in a patient with non ST elevation myocardial infarction
M.Yu. Zhilinskiy, N.V. Mukhina, I.S. Komarova, S.A. Rachina, N.A. Cherkasova, A.B. Borisov, L.V. Fedina, S.M. Nasrulloeva
Clinical Microbiology and Antimicrobial Chemotherapy.2023; 25(1): 100. CrossRef
Infective endocarditis by Klebsiella species: a systematic review
Petros Ioannou, Eugenia Miliara, Stella Baliou, Diamantis P. Kofteridis
Journal of Chemotherapy.2021; 33(6): 365. CrossRef

Randomized Controlled Trial

Central Venous Catheter-related Infection in Major Burn Patients: Comparison of Subclavian Vein and Femoral Vein: Young Ho Jang, Yong Hoon Son, Sang Kyu Kim, Joon Mo Park, Mi Young Lee, Jin Mo Kim; Korean J Crit Care Med. 2011;26(4):245-249.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.245

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BACKGROUND
A central venous catheter (CVC) is usually inserted in patients with severe burns and the selection of the CVC is often difficult due to widespread burned skin. We investigated the incidences of colonization and catheter-related blood stream infection (CRBSI) according to the insertion site of the CVC in major burn patients METHODS: In 63 adult massive burn patients in the intensive care unit, 93 CVCs (47 polyurethane standard CVCs and 46 Oligon anti-mocrobial CVCs) were randomly inserted via the subclavian vein (SCV group, n = 66) or femoral vein (FEV group, n = 27). All catheter tips removed were routinely cultured. Bacterial findings from the burn wound and peripheral blood were also monitored in all patients RESULTS: There was no significant difference in the average insertion length of the CVC (14.3 +/- 6.8 days in SCV and 13.6 +/- 3.8 days in FEV) between the two groups. There were no significant differences in CVC colonization (48.5% in SCV and 63.0% in FEV) and CRBSI (7.6% in SCV and 11.1% in FEV) between the two groups. Logistic analysis found that the use of polyurethane standard CVC is significantly associated with increased risk of CVC colonization (odds ratio = 2.68) CONCLUSIONS: The placement of the CVC via the femoral vein does not increase the incidence of CVC colonization in massive burn patients. The use of Oligon anti-microbial CVC may be helpful to reduce CVC colonization in major burn patients.

Citations

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An Ounce of Prevention Saves Tons of Lives: Infection in Burns
Nishant Merchant, Karen Smith, Marc G. Jeschke
Surgical Infections.2015; 16(4): 380. CrossRef

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