Author Of 4 Presentations
A CASE OF MACROPHAGE ACTIVASION SYNDROME WITH FAVORABLE OUTCOME
Abstract
Background
Sepsis is a syndrome caused by a dysregulated host response to infection. Our knowledge of the pathophysiology of sepsis suggests that some patients present with hyper inflammation leading to different clinical phenotypes like Macrophage Activation Syndrome (MAS). The hallmark finding in the diagnosis of MAS is fever and high levels of ferritin.
Objectives
To present a case of secondary MAS due to sepsis and favorable outcome.
Methods
We would like to report a septic episode, involving MAS, in a 9 months old female infant with sort bowel syndrome. At the age of 4 months she developed sepsis and multiorgan dysfunction syndrome (MODS). She was hemodynamically unstable, with acute renal injury, hepatobillary dysfunction and DIC. Although her organs were supported we failed to stabilize her homeostasis, especially her hematologic parameters (pancytopenia). Her ferritin was 3200 ng/mL and she fulfilled the criteria for MAS.
Results
She has treated with methylprendisolone (2 mg/Kg) and IVIG (1g/Kg) with rapid resolution of her septic episode and normalization of her laboratory findings (pancytopenia, hepatobillary dysfunction, DIC). At the age of 8 months she had a second infection. She has feverish but hemodynamically stable without MODS. Her ferritin was 2800 ng/ml and we added in her treatment methylprensidolone and IVIG with quick resolution of her symptoms.
Conclusion
Although MAS secondary to sepsis has a high mortality rate we suggest that intermediate phenotypes exist in this process. Patient with high ferritin and sepsis may benefit from immune therapy at an earlier clinical stage.
PROSPECTIVE SURVEILLANCE OF DEVICE-ASSOCIATED INFECTIONS IN PEDIATRIC INTENSIVE CARE UNITS IN GREECE: A MULTICENTRE STUDY
Abstract
Background
Surveillance of health care-associated infections (HAIs) plays a key role in infection control and management.
Objectives
To identify the incidence of 3 device-associated HAIs (DA-HAIs) in pediatric intensive care units (PICUs) in Greece: catheter-related bloodstream infection (CRI), intubation-associated pneumonia (IAP) and catheter-associated urinary tract infection (CAUTI).
Methods
Prospective surveillance study (July-December 2017) was conducted in four PICUs in Greece using European Centre for Disease Prevention and Control(ECDC) HAI-net ICU protocol, version 2.2. Included patients were admitted for >48 hours to PICU. Medical records were assessed daily. Patient–days, device-days, demographics, severity illness score, susceptibility of isolated pathogens, and outcome were recorded.
Results
153 children were included with median age 4 years (IQR, 1-9), 88 (57.5%) male, median PRISM III 5 (IQR, 3-8), and median length of stay (LOS) 7 days (IQR, 4-15). Crude mortality was 7.8%. Device utilization rates of central line, intubation devices and urinary catheters were 0.79, 0.65, and 0.70, respectively. CRI, IAP and CAUTI rates were 2.32, 10.5 and 4.6 per 1,000device-days. 14(35%) microbiologically confirmed blood stream infections (BSI) out of 40 HAIs were of unknown origin. Patients with DA-HAIs had greater severity score (p<0.001) and increased LOS (28.5 vs 6 days, p<0.001). Enterobacteriae spp(16/40) were the most commonly found pathogens. Carbapenem resistance was 43.8% for Klebsiella pneumoniae, 33.3% for Pseudomonas aeruginosa and 80% for Acinetobacter baumanii.
Conclusion
Active surveillance of DA-HAIs has never been performed in a multicentre PICU setting in Greece. DA-HAIs incidence and isolate resistance rates stress the need for infection control bundles and antimicrobial stewardship interventions.
Video on Demand
CLINICAL AND MICROBIOLOGICAL STUDY OF BACTERAEMIA IN PICU PATIENTS (2013-2017)
Abstract
Background
Bacteraemias are responsible for increased morbidity, mortality, prolonged length of stay in PICU patients.
Objectives
Study of microbiological and epidemiological characteristics of bacteraemia occurring in PICU patients.
Methods
All septicaemias with positive blood cultures (BACTEK 9240) were included. Microbiological and epidemiological data were retrieved retrospectively, based on LIS of Microbiology Department and PICU medical files.
Results
From 2013 to 2017, 1181 patients were admitted. 93 bacteraemia incidents were documented in 67 patients (57% boys, age: 18 days-16 years old). Two strains were isolated in 9 incidents whereas, 16 patients had multiple episodes of bacteraemia (in 10 patients: 2 episodes, in 4 patients: 3 episodes, in 2 patients: 4 episodes). Total length of stay was 1-192 days (median: 33 days), hospitalization days in PICU prior to bacteraemia were 3-120 days (median: 13 days), duration of septicemia was 1-9 days (median: 1 day). In total, 102 strains were isolated: 53 Gram(-) bacteria (Enterobacterspp: 16, Klebsiellaspp: 10, P.aeruginosa: 9, A.baumanii: 5, S.maltophiliα: 5, E.coli: 4, N.meningitidis: 1, E.meningosepticum: 1, S.marcescens: 1, Campylobacter jejuni: 1) and 49 Gram(+) bacteria (staphylococci coagulase negative: 31, S.aureus: 9, Enterococcusspp: 5, Candida albicans: 2, Bacillusspp: 2). Only three strains were carbapenemases producers (A.baumanii, P.aeruginosa, K.pneumoniae) and 2 strains (E.cloacae) were ESBL(+)/cephalosporinases overproducers. In total, 75 incidents of bacteraemia were categorized as nosocomial infections (13.7/1000 hospitalization days).
Conclusion
Multiresistant strains were rarely isolated in our unit. No epidemic was detected, however constant vigilance is required to assure firm compliance to infection control measures.
CEREBROVASCULAR INCIDENTS IN A PICU: 21 YEARS IN RETROSPECT
Abstract
Background
Cerebrovascular incidents are rare in paediatric patients and are usually due to vascular malformation or underlying disease.
Objectives
Retrospective study of epidemiology, etiology, frequent clinical manifestations, predisposing factors and outcome of cerebrovascular incidents in paediatric patients in Greece.
Methods
Patients with non-traumatic cerebrovascular incidents, hospitalized in our PICU from 1/1/1998 to 31/12/2018, were included in the study.
Results
During the last 21 years, 26 patients with cerebrovascular incidents were hospitalized (median age: 5 3/12years). Nine patients (36%) were younger than one year of age. The most frequent clinical symptoms were headache (70%), drowsiness (65%), acute neurological signs (53%), convulsions (31%). 42% of the patients were intubated at the emergency department due to low GCS. 88% of them suffered from cerebral hemorrhage whereas, only 12% were diagnosed with cerebrovascular occlusion. 30% of patients were diagnosed with arteriovenous malformation and underwent embolism and 42% had surgical intervention (hematoma drainage, hydrocephalus drainage or craniectomy). In 3 of 26 patients predisposing factors were identified (hemophilia, Noonan syndrome, aneurysm). Median length of stay was 5 days (2-51 days). Outcome: 23% of patients died in PICU, 42% had no neurological symptoms at discharge, 20% suffered from mild neurological symptoms whereas, 15% of patients depicted severe neurological disability.
Conclusion
The most frequent symptom of cerebrovascular incidents in paediatric patients is severe headache. Approximately 50% of these incidents are due to arteriovenous malformations that may be treated with embolism or, an underlying disease. General prognosis of cerebrovascular incidents in children is better than that of adults.