[Severe community-acquired pneumonia admitted at the intensive care unit: main clinical and bacteriological features and prognostic factors: a Tunisian experience]

INTRODUCTION

Severe community-acquired pneumonia (SCAP) remains a major cause of death. The aim of this study was to describe the main clinical and bacteriological features and to determine predictive factors for death in patients with SCAP who were admitted in intensive care unit (ICU) in a Tunisian setting.

METHOD

It is a retrospective study conducted between March 2005 and December 2010 at the intensive care unit of the University Hospital of Mahdia (Tunisia). All patients hospitalized at the ICU with a SCAP diagnosis according to the American Thoracic Society criteria were included.

RESULTS

Two hundred and nine patients (mean age: 64±16 years, and mean SAPS II: 42±17) were included. Overall, 24% had a bacteriological diagnosis. Streptococcus pneumoniae was the most frequently detected. Use of mechanical ventilation was required in 57% of patients and 45% experimented septic shock upon admission. The mortality rate at ICU was 29% (n=60). In multivariate analysis, a septic shock at admission and the use of mechanical ventilation were both associated with death.

CONCLUSION

SCAP were associated with high mortality in the ICU.

[Spontaneous pneumothorax and Recklinghausen's disease: a case report]

The Von Recklinghausen disease is a genetic hereditary neurofibromatosis. It causes neurofibroma, axillary and inguinal lentigines, and café-au-lait spots in the skin. It may affect the lung in 5 to 20% of cases, causing neurofibroma, infiltrative and cystic lesions, emphysematous or bubble injury leading to a chronic respiratory failure. The risk of pneumothorax in theses cases seems higher. Few reviews reported the pulmonary manifestations in the Recklinghausen disease and specially the pneumothorax as a complication while the direct relation between this neurofibromatosis and the lung disease is not clearly established yet. We report a case report of spontaneous pneumothorax with slow evolution complicating the course of a patient with Recklinghausen disease.

Bedside capillary blood glucose measurements in critically ill patients: influence of catecholamine therapy

OBJECTIVE

To evaluate the effects of catecholamine therapy on the accuracy of capillary glucose measurements in hyperglycemic patients.

PARTICIPANTS

43 hyperglycemic patients older than 18 years admitted to the intensive care unit of a tertiary medical center were included from December 2005 to March 2006.

MEASUREMENTS

This prospective study compares fingerstick and earlobe measurements simultaneously to sampled laboratory venous glucose in patients treated without (group 1) or with (group 2) catecholamine. Three venous samples for serum glucose analysis at three fixed hours and simultaneously two capillary glucose determinations were performed during the two first successive days after inclusion. A difference between the methods of glucose measurements greater than 2.3 mmol/l was considered significant.

RESULTS

The mean difference between the two methods was -0.05 mmol/l in group 1 and +0.29 mmol/l in group 2, while the limits of agreement were +4.03 and -4.13 mmol/l and +5.63 and -5.05 mmol/l in groups 1 and 2, respectively. A difference between paired measurements greater than 2.3 mmol/l was observed in 29% in group 1 and in 40% in group 2 (p=0.038). The alternative site did not improve the accuracy.

CONCLUSIONS

In critically ill patients treated with catecholamine capillary fingerstick blood glucose measurement seems inaccurate. Earlobe sampling does not improve accuracy.

[Duration of antibiotic therapy for ventilator-associated pneumonia: comparison of 7 and 10 days. A pilot study]

OBJECTIVE

To compare the efficiency of a 7-day antibiotics regimen with a 10-day regimen for ventilator-associated pneumonia (VAP).

STUDY DESIGN

Prospective randomized study.

PATIENTS AND METHODS

Adults patients ventilated for more than 48 hours in the intensive care unit (ICU) with a clinical diagnosis of VAP documented by positive quantitative cultures of tracheal aspiration were included in this study. All included patients were randomized in two groups. Ten-day group: 10 days antibiotic therapy, and 7-day group: 7 days antibiotic therapy. Primary judgment criteria were 14- and 28-day mortality, the number of days without antibiotics. Secondary judgments criteria were rate of recurrent pulmonary infection, the evolution of the clinical pulmonary infection scores (CPIS), the length of ICU stay and the length of mechanical ventilation.

RESULTS

Thirty patients were included in this study (16 in the 10-day group and 14 in the 7-day group). The demographic and clinical characteristics of the groups assigned to receive antibiotic therapy for 7 or 10 days were generally similar. The 14-day and 28-day mortality rate following VAP onset were 31.2 and 37.5% in the 10-day group and 7.1 and 35.7% in the 7-day group. The difference was not significant. The number of day without antibiotics and without mechanical ventilation turned out: 1.75 and 2.06 days versus 4.14 and 3.43 days in the 10-day group and 7-day group respectively, the recurrent rate of pulmonary infection (12.5% versus 14.3%, p=0.6), the length of stay in the ICU (27.7 days versus 26.0 days, p=0.8) and the evolution of the CPIS were no different in the two groups.

CONCLUSION

In patients with microbiologically confirmed VAP who received appropriate empirical antibiotic therapy, a 7-day antibiotic regimen was as efficient clinically and microbiologically as a 10-day antibiotic regimen with a reduction of antibiotic use.