The incidence of nosocomial infections in patients with isolated severe traumatic brain injury

Mujdragić

et al. 2021

Cureus

IntroductionNecrotizing fasciitis is a severe inflammatory disease of the body's soft tissue characterized by spreading rapidly and high mortality. Rapid surgical intervention along with other supportive measures of treatment have a great impact on the outcome of treatment. Material and methodsThis study was conducted by a retrospective medical record review of all patients with a microbiologically and clinically confirmed diagnosis of necrotizing fasciitis who were admitted to the general surgery department at the General Hospital Novi Pazar, Serbia, during the period between 2017 and 2020. Demographic, clinical, laboratory, and microbiology data were analyzed. ResultsA total of 13 cases were identified, which represents 0.21% of the total number of patients treated at the surgical department during the period January 2017 to November 2020. The mean age of patients was 55 years, with a male/female ratio of 1:1.6. All of them had at least one comorbidity and more than half had three or more. Diabetes, cardiovascular diseases, and obesity were the most common comorbidities. The most common causes of infection were Klebsiella spp, Pseudomonas aeruginosa, S. pyogenes, and S. aureus. All patients received multiple surgical interventions (mean 2.3). ConclusionTreating necrotizing fasciitis requires a multidisciplinary approach. Early diagnosis and rapid clinical response allow for better disease outcomes. Getting to know more about necrotizing fasciitis will help doctors make better decisions when treating it.

Section: Discussionmentioning

confidence: 99%

Necrotizing Soft Tissue Infection: A Single-Center Retrospective Study of Treatment and Outcomes

Mujdragić

et al. 2021

Cureus

“…Infections are common in hospitalized patients after a TBI, with up to 50% incidence reported after severe injuries [ 23 , 84 ]. Infections are most often attributed to exposure to intensive care units, prolonged use of ventilators and catheters, and invasive surgical procedures that may be required in this population [ 3 , 74 , 77 ].…”

Section: Introductionmentioning

confidence: 99%

“…Considering the high incidence of pediatric TBI, and the high proportion of TBI patients that sustain an infection post-injury [ 23 , 84 ], it is imperative that this secondary immune challenge is incorporated into preclinical modeling to determine how it may influence outcomes. The current study therefore employed an experimental model of TBI in pediatric mice, followed by peripheral administration of lipopolysaccharide (LPS) at 4 days post-TBI.…”

Section: Introductionmentioning

confidence: 99%

A systemic immune challenge to model hospital-acquired infections independently regulates immune responses after pediatric traumatic brain injury

Sharma

Zamani

Dill

et al. 2021

J Neuroinflammation

Background Traumatic brain injury (TBI) is a major cause of disability in young children, yet the factors contributing to poor outcomes in this population are not well understood. TBI patients are highly susceptible to nosocomial infections, which are mostly acquired within the first week of hospitalization, and such infections may modify TBI pathobiology and recovery. In this study, we hypothesized that a peripheral immune challenge such as lipopolysaccharide (LPS)—mimicking a hospital-acquired infection—would worsen outcomes after experimental pediatric TBI, by perpetuating the inflammatory immune response. Methods Three-week-old male mice received either a moderate controlled cortical impact or sham surgery, followed by a single LPS dose (1 mg/kg i.p.) or vehicle (0.9% saline) at 4 days post-surgery, then analysis at 5 or 8 days post-injury (i.e., 1 or 4 days post-LPS). Results LPS-treated mice exhibited a time-dependent reduction in general activity and social investigation, and increased anxiety, alongside substantial body weight loss, indicating transient sickness behaviors. Spleen-to-body weight ratios were also increased in LPS-treated mice, indicative of persistent activation of adaptive immunity at 4 days post-LPS. TBI + LPS mice showed an impaired trajectory of weight gain post-LPS, reflecting a synergistic effect of TBI and the LPS-induced immune challenge. Flow cytometry analysis demonstrated innate immune cell activation in blood, brain, and spleen post-LPS; however, this was not potentiated by TBI. Cytokine protein levels in serum, and gene expression levels in the brain, were altered in response to LPS but not TBI across the time course. Immunofluorescence analysis of brain sections revealed increased glia reactivity due to injury, but no additive effect of LPS was observed. Conclusions Together, we found that a transient, infection-like systemic challenge had widespread effects on the brain and immune system, but these were not synergistic with prior TBI in pediatric mice. These findings provide novel insight into the potential influence of a secondary immune challenge to the injured pediatric brain, with future studies needed to elucidate the chronic effects of this two-hit insult.

“…Trauma is the main risk factor for HAI 33,34,35 , half of our cohort was admitted to the ICU due to traffic and work accidents (50.00%, 127/254). In total, the mortality rate and length of stay in the unit for both groups (resistant and susceptible isolates) were statistically significant, higher (mortality) and longer (LOS) for patients with BSIs due to multi-resistant organisms.…”

Section: Discussionmentioning

confidence: 99%

Multi-drug resistance and other predictors for mortality in severe sepsis and sepsis chock due to Gram-negative and Gram-positive pathogens in a tertiary care hospital in Brazil: a retrospective matched case vs case vs control study design

Sabino¹,

Campos²,

Machado³

et al. 2021

Arch. Health

Introduction: Infections, mainly bloodstream infections (BSI), acquired in the intensive care unit (ICU) are associated with significant rates of morbidity and mortality, especially when caused by pathogens. The objectives the study were to determine risk factors and mortality rates in 30 days for patients with BSI caused by microorganisms resistant versus microorganisms susceptible to antimicrobials. Methods: A case-vs-control study was carried out, in which patients were identified with BSI acquired in the ICU. Control patients were paired, considering: age, acute mean severity classification (ASIS), and chronic disease scores, Charlson's Comorbidity Index (CHARLSON) both ≥ 3. Results: Retrospective cohort study of 531 patients, 254 with bloodstream infection (BSI), and 277 uninfected controls during hospital stay. Of those infected, 181 presented multidrug-resistant isolates (MDR) and 73, isolates susceptible to antibiotics. The univariate analysis showed statistically significant frequencies for BSIs, when compared with controls, of isolates resistant to multiple drugs and susceptible. There was also significance in the mortality rate among patients with resistant and susceptible pathogens (40.3% vs 34.2%, P<0.05). Multivariate analysis showed that only trauma and previous use of antibiotics were independent risk factors for BSIs in critically ill patients with infection, both by MDR and antibiotic-sensitive isolates. Conclusion: Mortality and bacteremia were higher in BSIs due to antibiotic-resistant isolates in a cohort of intensive care patients. The lack of financial and human resources results in multiple barriers in developing countries like Brazil and the prevention of these infections becomes a major challenge.