Pseudomonas is a clinically significant and opportunist pathogen, usually associated in causing high mortality nosocomial infections. The aim of this study was to determine the risk factors associated with septic shock in patients diagnosed with hematologic malignancies and Pseudomonas infections. A total of 80 Pseudomonas isolates (77 Pseudomonas aeruginosa) were collected from 66 patients aged 2-64 years: 52 with acute leukemia (79%), 7 with lymphoma (10.5%), and 7 with other hematologic disorders (10.5%), between 2001 and 2009. The median age of the patients was 30 years. Isolates were collected mostly from bloodstreams (45%) and skin lesions (31.5%). The median time for microbiologic documentation was 8 days (range 0-35 days) from onset of neutropenia. At least 11 patients (16.6%) had recurrent (≥2) infections. The clinical symptoms observed were skin lesions (34%), diarrhea (20%), isolated fever (18%), and respiratory symptoms (14%). The isolates tested were found resistant to piperacillin/tazobactam (43%), ceftazidime (31%), imipenem-cilastatin (26%), ciprofloxacin (25%), and amikacin (26%). Septic shock occurred in 16.2% of episodes (13/80). Crude mortality due to septic shock occurred in 19.6% of patients (13/66). The median time for response to antibiotic therapy in the remaining 80.4% of patients (53/66) was 2.5 days. Univariate analysis revealed that factors associated with septic shock were: fever for ≥3 days in patients on antibiotic therapy (P = 0.019), serum lactate >5 mmol (P = 0.05), hemoglobin level <50 g/l (P = 0.042), hypoproteinemia <50 g/l (P = 0.01), procalcitonin >10 ng/ml (P = 0.031), and hypophosphatemia (P = 0.001). Multivariate analysis revealed that hypophosphatemia (P = 0.018), hypoproteinemia (P = 0.028), and high serum lactate (P = 0.012) are significant factors, independently associated with increased risk of septic shock in patients with hematologic malignancies and Pseudomonas infections.
Digital ulcers (DU) are a well-known problem in patients with systemic sclerosis. It is an underestimated complication of the disease causing pain and morbidity. Essential thrombocytosis is another cause of DU. The association of theses two diseases increases the risk of ischemic complications and impairment of hand function which are frequently observed in patients with digital ulcers. This report deals with a 68-year-old patient with rare association of Essential thrombocytosis ,Systemic sclerosis and Raynaud's phenomenon that was refractory to medical treatment of Systemic sclerosis (illoprost,calcium channel blockers) and improved with hydrea R .
Plasmablastic myeloma is an atypical variant of multiple myeloma with a poor prognosis. We report a case of a 59-year-old-male, who was diagnosed to have plasmablastic myeloma. We emphasize the diagnostic difficulty of this type of myeloma and the therapeutic options.
e251asked which blood-borne pathogen they feared most, 45% identified HIV, 36% identified HCV, and 18% identified HBV. Conclusion:The experience of NSI's and underreporting seems to be frequent among MS. Therefore improved education and reporting strategies are needed to encourage the awareness of MS for an effective prevention of NSI's.
4552 Background Pseudomonas aeruginosa is a leading cause of nosocomial infections usually associated with high mortality. The aim of this study was to determine the predictive factors of severe sepsis or septic shock in patients with hematological malignancies and pseudomonas infections. Methods This study was conducted in a teaching hospital (Aziza Othmana University Hospital, Tunis, Tunisia) to evaluate the clinical profile of infections due to Pseudomonas species and to determine risk factors for severe sepsis or septic shock defined according to the criteria of the ACCP/SCCM. Pearson test was used for univariate analysis, and logistic regression for multivariate analysis. Results Between 2004 and 2009,a total of 73 pseudomonas isolates (70 P, aeruginosa) was collected in 60 patients : 47 with acute leukemia (78%), 7 with lymphoma (12%), and 6 with others hematological disorders (10%).The median age was 29 yrs (range, 2-64). Most common sites of the isolates were from bloodstream (45%), and skin lesions (31.5%). At least 11 patients (18%) had 2 or more infections due to Pseudomonas. The most common clinical signs observed were isolated fever (18%), respiratory symptoms (15%), diarrhea (21%), and skin lesions (29%).Susceptibility to major anti-pseudomonas antibiotics revealed that isolates tested were resistant to:piperacillin/tazobactam (40%), cefatazidim (28%), ciprofloxacin (20.5%), imipenem (22%), and amikacin (22%).Severe sepsis or septic shock occurred in 49% of episodes. Crude mortality was (18%, 11 of the 60 patients) all caused by septic shock. In univariate analysis factors associated with severe sepsis or septic shock were: Isolates from more than one site (p=0.04), Absolute neutrophil count < 0.1 × 109/l (p=0.003), concomitant infection with other microorganism (p=0.019), fever lasting for more than 3 days in patients with antibiotherapy (p=0.003), C-reactive protein > 100 mg/l (p <0.0001), serum lactate >2.2 mmol/l (p< 0.0001), serum bicarbonate < 19 mmol/l (p=0.002), hemoglobin level < 70g/l (p<0.0001), renal failure (p=0.006), hypophosphatemia <0.8mmol/l (p=0.003), total bilirubin > 50 μmol/l (p=0.03), and hypoproteinemia <64g/l (p<0.0001). By multivariate analysis, antibiotherapy for more than 3 days (p=0.025,OR=0.217, 95%CI:0.05-0.82), absolute neutrophil count <0.1× 109/l (p=0.046,OR=170;95% CI:1-267), C-reactive protein >100 (p=0.04,OR=15,95%CI: 1,1-219,8), hemoglobin level <70g/l (p=0.037,OR=17,95%CI: 1,1- 243), and hypophosphatemia (p=0.02,OR=148,95%CI:2.2-942) remained as independent predictors of severe sepsis or septic shock. Conclusions This study revealed that several factors such as level of neutrophil count, C-reactive protein, hemoglobin level, severe hypophosphatemia, and antibiotherapy > 72 h before microbiological documentation may play a significant and independent role for the development of severe sepsis/septic shock and increase mortality of Pseudomonas infections in patients with hematological malignancies. Disclosures: No relevant conflicts of interest to declare.
Background: Chemotherapy-induced neutropenia is a risk for serious infection.Septic shock still causes high mortality among cancer patients. We aimed at identifying predictive factors of mortality in neutropenic patients (ANC < 0.5 x 109/l) who developed septic shock.Methods: All cases of septic shock defined according to the ACCP/SCCM criteria observed in our department (Hematology, Aziza Othmana University Hospital) between 2005 and 2009 were included in this study. All clinical, biological and microbiological data were collected at the onset of septic shock and during outcome. Initial score on the Sequential Organ Failure Assessment (SOFA score) was performed for each patient. Statistical analysis was performed using Pearson test.Results: Thirty three septic shock were observed in patients with hematological malignancies:Acute leukemia (31),lymphoma (2).Median age was 27 years (range, 3-67).58% of septic shock were observed during chemotherapy induction phase .Median time for occurrence of septic shock was 15 days from onset of neutropenia (range, 2-32). Microbiological documentation was obtained in 23 cases (69.6%).The bacteria involved were:Klebsiella (9),Pseudomonas (7), Stenotrophomonas (4), E.coli (1), Octhrobacter anthropi (1) and Acinetobacter (1). 9 (39.1%) isolates were resistant to broad spectrum antibiotics. 20 patients (60.6%) developed ARDS during the evolution. Initial SOFA score was >11 (i.e. a risk of mortality of 95%) in only 6 patients (18.1%).Only 8 patients (24.2%) were admitted in ICU with a median time of 1.8 day (range, 1-3 days).Day 30 mortality was 85%.By univariate analysis predictors of mortality were: Disease status (p = 0.009), neutropenia lasting more than 15 days (p = 0.012),fever for more than 3 days in patient on antibiotherapy (p = 0.009), hemoglobin level <50 g/l (p = 0.038), isolate resistant to piperacillin/tazobactam (p = 0.025), presence of clinical symptoms from more than 1 site (p = 0.008), patients not on imipenem antibiotherapy at the onset of septic shock (p = 0.019), occurrence of ARDS during evolution of septic shock (p = 0.003) and non-admission in ICU (p = 0.043). No independent predictor found in multivariate analysis.Conclusion: This study revealed that several factors play a significant role in mortality during septic shock. Despite low proportion of patients with baseline high SOFA score, the mortality rate in our study was very high highlighting the need for appropriate management and early admission in ICU to improve outcome.
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