In critically ill medical patients, a strategy of monthly rotation of anti-Pseudomonas beta-lactams and ciprofloxacin may perform better than a strategy of mixing in the acquisition of P. aeruginosa resistant to selected beta-lactams.

Homozygosity for 4G of the PAI-1 gene confers an increase in the risk of mortality in adult patients with septic shock due to a greater organ failure.

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Clinicians should be aware of the characteristic clinical and histopathologic presentation of this variant of dermatomyositis to establish an early diagnosis. Further evidence is needed to clarify the risk of cardiac involvement in this subset of patients.

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We have read with interest the article by Abidi and colleagues [1] in which the authors point out that eosinopenia could be useful to differentiate between noninfection and infection in patients recently admitted to an intensive care unit (ICU). The association of eosinopenia with infections is not new and has been described previously [2].To test this hypothesis, we reviewed 191 patients (age >18 years, with a minimum ICU stay of 24 hours) admitted to the medical ICU of our hospital. We exuded HIV-infected patients and those with hematological malignancies. Total leukocyte and eosinophil count (EC) were measured at ICU admission. The results are shown in Table 1. Although the EC was lower and the proportion of patients with eosinopenia (<40 cells/ml) was higher in the noninfectious systemic inflammatory response syndrome (SIRS) group compared with the infectious SIRS group, these differences were not statistically significant. Therefore, the EC was not useful to Letter

Gene polymorphisms, giving rise to low serum levels of mannose-binding lectin (MBL) or MBL-associated protease 2 (MASP2), have been associated with an increased risk of infections. The objective of this study was to assess the outcome of intensive care unit (ICU) patients with systemic inflammatory response syndrome (SIRS) regarding the existence of functionally relevant MBL2 and MASP2 gene polymorphisms. The study included 243 ICU patients with SIRS admitted to our hospital, as well as 104 healthy control subjects. MBL2 and MASP2 single nucleotide polymorphisms were genotyped using a sequence-based typing technique. No differences were observed regarding the frequencies of low-MBL genotypes (O/O and XA/O) and MASP2 polymorphisms between patients with SIRS and healthy controls. Interestingly, ICU patients with a noninfectious SIRS had a lower frequency for low-MBL genotypes and a higher frequency for high-MBL genotypes (A/A and A/XA) than either ICU patients with an infectious SIRS or healthy controls. The existence of low-or / high-MBL genotypes or a MASP2 polymorphism had no impact on the mortality rates of the included patients. The presence of high-MBL-producing genotypes in patients with a noninfectious insult is a risk factor for SIRS and ICU admission.

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