Admission of tetanus patients to the ICU: a retrospective multicentre study

Abstract

Background An extended course of tetanus (up to 6 weeks) requiring ICU admission and protracted mechanical ventilation (MV) may have a significant impact on short- and long-term survival. The subject is noteworthy and deserves to be discussed.MethodsTwenty-two ICUs in France performed tetanus screenings on patients admitted between January 2000 and December 2014. Retrospective data were collected from hospital databases and through the registers of the town hall of the patients.ResultsSeventy patients were included in 15 different ICUs. Sixty-three patients suffered from severe or very severe tetanus according to the Ablett classification. The median age was 80 years [interquartile range 73–84], and 86% of patients were women. Ninety per cent of patients (n = 63) required MV for a median of 36 days [26–46], and 66% required administration of a neuromuscular-blocking agent for 23 days [14–29]. A nosocomial infection occurred in 43 patients (61%). ICU and 1-year mortality rates were 14% (n = 10) and 16% (n = 11), respectively. Forty-five per cent of deaths occurred during the first week. Advanced age, a higher SAPS II, any infection, and the use of vasopressors were significantly associated with a lower number of days alive without ventilator support by day 90. Age was the only factor that significantly differed between deceased and survivors at 1 year (83 [81–85] vs. 79 [73–84] years, respectively; p = 0.03). Sixty-one per cent of survivors suffered no impairment to their functional status.ConclusionIn a high-income country, tetanus mainly occurs in healthy elderly women. Despite prolonged MV and extended ICU length of stay, we observed a low 1-year mortality rate and good long-term functional status.

Multicenter Study of Tetanus Patients in Fujian Province of China: A Retrospective Review of 95 Cases

“…The hospitalization time of the patients with complications in our study tended to increase, and other studies have found that patients with concurrent infection had a lower survival at 90 days without mechanical ventilation [19]. Approximately 40% of patients with artificial airways were intubated; 60% received tracheotomy; in addition, approximately one-third of patients receiving tracheotomy did not receive mechanical ventilation.…”

“…Although the total length of stay in the ICU in patients with tracheotomy was longer than that of patients with endotracheal intubation, there was no difference between the mechanical ventilation duration and total length of hospitalization. Current studies suggest that tracheotomy is superior to endotracheal intubation because it can reduce the incidence of tracheal stenosis caused by a lengthy period of endotracheal intubation [19].…”

<p>Clinical features and outcomes of tetanus: a retrospective study</p>

“…Tetanus is an acute infectious disease caused by the bacterium, Clostridium tetani ( C. tetani ), as defined by the WHO,1 which generates a neurologic toxin2 Because of the high mortality rate, tetanus is still a significant issue worldwide, especially in developing counties 3,4. In developed countries, tetanus has a low incidence; specifically, there were 43 cases per year between 1998 and 2000 5.…”

Diagnosis of Severe Tetanus Assisted by Next-Generation Sequencing Analysis of Etiology: A Case Report

“…Looking into the journals and scienti c literature, we can nd very few publications related to diagnoses or long-term prognosis 4,5 .Hence, this case report becomes important to impart knowledge to treating doctors in Intensive Care Units to learn features of tetanus for early recognition and need for prompt diagnosis and treatment.…”