Abstract. Scrub typhus, a zoonotic disease caused by the bacterium Orientia tsutsugamushi, has become endemic in many parts of India. We studied the clinical profile of this infection in 228 patients that reported to this tertiary care center from July 2013 to December 2014. The median age of patients was 35 years (interquartile range = 24.5-48.5 years), and 111 were males and 117 females. A high-grade fever occurred in 85%, breathlessness in 42%, jaundice in 32%, abdominal pain in 28%, renal failure in 11%, diarrhea in 10%, rashes in 9%, and seizures in 7%. Common laboratory abnormalities at presentation were a deranged hepatic function in 61%, anemia in 54%, leukopenia in 15%, and thrombocytopenia in 90% of our patients. Acute kidney injury (32%), acute respiratory distress syndrome (ARDS) (25%), and disseminated intravascular coagulation (DIC) (16%) were the commonest complications. A hepatorenal syndrome was seen in 38% and multiple organ dysfunction syndrome (MODS) in 20% patients. The overall case fatality rate was 13.6%. In univariate analysis, ARDS requiring mechanical ventilation, acute kidney injury requiring hemodialysis, hypotension requiring inotropic support, central nervous system dysfunction at presentation, and MODS were inversely associated with survival.

PURPOSE:Bloodstream infection can range from inapparent bacteremia until fulminant septic shock with high mortality. Microorganisms present in circulating blood whether continuously, intermittently, or transiently are a threat to every organ in the body. Culture of blood is a vital tool to diagnose such infections. Drug susceptibility patterns help in rationalizing therapy.OBJECTIVE:The objective of this study was to perform bacteriological analysis and assess drug sensitivity patterns of isolates from blood stream infections.DESIGN:Retrospective observational study was conducted from May 2015 to February 2017 at a tertiary care hospital, Port Blair, India. Blood samples were collected with aseptic guidelines and cultured for 7 days. Growths were identified using standard biochemical tests and subjected to sensitivity testing according to Modified Kirby–Bauer's disk diffusion method. Data for the source of blood collection and duration of incubation were noted and compared.RESULTS:A total of 270 (14.24%) pathogens were isolated from 1895 bacteremia suspect patient blood specimens. Contamination was observed at a rate of 1.63%. Gram-positive cocci (60.37%) were predominant organisms recovered followed by Gram-negative Bacilli (36.29%) and Yeasts (3.33%). Staphylococcus aureus, CoNS, and Acinetobacter spp. were the primary pathogens isolated. Aminoglycosides, carbapenems, and glycopeptides were the most effective drugs for treating bacteremia.CONCLUSIONS:Successful treatment of sepsis depends on early diagnosis and proper antimicrobial therapy. Local knowledge of bacteriological profile and antimicrobial sensitivity patterns helps rationalize empiric treatment strategies.

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Introduction Children with scrub typhus may present with one or more organ failures. Identifying the predictors of severe disease and need for pediatric intensive care unit (PICU) admission would help clinicians during outbreak seasons. Materials and methods This observational study included 160 children admitted to the emergency department (ED) with scrub typhus confirmed by polymerase chain reaction (PCR) between January 2013 and December 2015. Demographic, clinical, and laboratory data were collected and predictors for PICU admission were identified. Results There was a seasonal trend with peak presentation in post-monsoon months between August and October. Mean (SD) age at presentation was 6.8 (3.2) years. Fever was present in all with a median (IQR) duration of 9 (6–11) days. Respiratory distress (42%), altered sensorium (24%), hepatomegaly (93%), splenomegaly (57%), and lymphadenopathy (54%) were other features. Rash and eschar were noted in 24% each. Thrombocytopenia (83%), hypoalbuminemia (63%), and hyponatremia (62%) were common laboratory abnormalities. Meningoencephalitic presentation was noted in 29%; acute kidney injury (AKI) (16%), acute respiratory distress syndrome (ARDS) (11%), and myocarditis (3%) were other organ dysfunctions. Sixty-six (41%) children required PICU admission. Intensive care needs include invasive ventilation ( n = 27, 17%), vasoactive drugs therapy for hemodynamic support ( n = 43, 27%), osmotherapy to treat raised intracranial pressure ( n = 27, 17%), and renal replacement therapy ( n = 3, 2%). Mortality was 8.8%. On multivariable analysis, lymphadenopathy, respiratory distress, shock, elevated lactate, and meningoencephalitis predicted the requirement of PICU admission. Conclusion Scrub typhus presents with organ dysfunction during post-monsoon months. We identified predictors of intensive care in children with scrub typhus admitted to ED. Clinical significance Our results would help clinicians identify severe cases and prioritize resources. How to cite this article Nallasamy K, Gupta S, Bansal A, Biswal M, Jayashree M, Zaman K, et al. Clinical Profile and Predictors of Intensive Care Unit Admission in Pediatric Scrub Typhus: A Retrospective Observational Study from North India. Indian J Crit Care Med 2020;24(6):445–450.