Scandinavian journal of infectious diseases
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A 37-y-old male was admitted to the ICU because of meningitis and respiratory failure with epileptic seizures. Spinal fluid grew Streptococcus salivarius. ⋯ The clinical situation deteriorated over the following d and the patient died from multi-organ failure. Careful hygiene measures are needed to prevent such a severe complication.
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Scand. J. Infect. Dis. · Jan 2007
Case ReportsEndovascular repair of mycotic aneurysms of the aorta: an alternative to conventional bypass surgery in patients with acute sepsis.
Treatment of mycotic aneurysms of the aorta includes excision of infected tissue followed by anatomic or extra-anatomic bypass. However, operative mortality remains high particularly in elderly patients with comorbidities. ⋯ In 1 of these patients, stent grafting was attained during the acute, bacteraemic phase of infection. After 12 and 20 months, respectively, of diagnosis, both patients are doing well.
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Scand. J. Infect. Dis. · Jan 2007
Case ReportsCandida albicans tricuspid and pulmonic valve endocarditis: challenge of relapsing risk and role of combined medical treatment and surgery.
Candida albicans endocarditis involves infrequently the tricuspid valve and involvement of the pulmonic valve is rare. We report our experience with an immunosuppressed liver-transplanted female who developed both tricuspid and pulmonic valve endocarditis, review the literature and discuss the importance of effective antimycotic therapy combined with surgical replacement of the affected valve.
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Ventilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection among patients requiring mechanical ventilation. A prospective surveillance programme of all patients has been implemented at the ICU, Karolinska University Hospital, Sweden since 2001. ⋯ Risk factors for VAP were aspiration (hazard ratio 3.79; 95% CI 1.48-9.68), recent surgery (HR 3.58; 95% CI 1.15-11.10) and trauma (HR 3.00; 95% CI 1.03-8.71). 11 patients of 33 (33%) with VAP died within 28 d compared to 46 of 288 (16%) without ICU-acquired pneumonia (odds ratio 2.73; 95% CI 0.97-7.63). We conclude that: 1) incidence of VAP was 15% and the most important risk factor was aspiration; 2) APACHE II score > or = 20 is a stronger predictor for poor outcome than VAP; 3) a minority of patients with APACHE II score > or = 20 develop VAP; and 4) continuous surveillance programmes are feasible and provide valuable data for improvement of quality of care.
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Scand. J. Infect. Dis. · Jan 2007
Multicenter StudyPrescription of antibiotic agents in Swedish intensive care units is empiric and precise.
Since the prescription of antibiotics in the hospital setting is often empiric, particularly in the critically ill, and therefore fraught with potential error, we analysed the use of antibiotic agents in Swedish intensive care units (ICUs). We examined indications for antibiotic treatment, agents and dosage prescribed among 393 patients admitted to 23 ICUs at 7 tertiary care centres, 11 secondary hospitals and 5 primary hospitals over a 2-week period in November 2000. Antibiotic consumption was higher among ICU patients in tertiary care centres with a median of 84% (range 58-87%) of patients on antibiotics compared to patients in secondary hospitals (67%, range 35-93%) and in primary hospitals (38%, range 24-80%). ⋯ This study showed that a high proportion of ICU patients receive antimicrobial agents and, as expected, empirical-based therapy is more common than culture-based therapy. Antibiotics given were usually active in vitro against the pathogen found in blood cultures. We ascribe this to a relatively modest antibiotic resistance problem in Swedish hospitals.