Acinetobacter septicemia

Acinetobacter spp. Glucose non-fermenter, Gram negative rods and normal commensal of human sin, are increasingly frequent pathogens for nosocomial infections. The organism is noteworthy because of it's widespread resistance to most available antibiotics and serious outcome. Most reported incidences were hospital acquired infections like infected wounds, ventilator associated pneumonias or chatheter-related infections in critically-ill immuno-compromised patients. Community acquired acinetobacter infections are extremely rare; most reported instances being pneumonias in patients with underlying disease. We report a case of community acquired multi-resistant Acinetobacter septicemia in an apparently immuno-competent patient presenting as ARDS and ending fatally

Multiorgan failure in a cardiac surgical intensive care unit

To find out incidence and various risk factors associated with multiorgans failure [MOF] in patient after cardiac surgery. Design: A prospective study of 935 consecutive admissions to cardiac intensive care CSICU over a period of one year [April 1994 to March 1995]. Setting: Cardiac surgical intensive care unit AFIC / NIHD Rawalpindi. Subjects: Nine hundred thirty five patients admitted to CSICU after cardiac surgery. Main outcome measures: Risk factors, incidence, mortality in multiorgan failure. Mean age of patients was 29.6 years. Males were 66.8%. As regards preoperative risk factors, 24.3% had systemic disease, 19.5% had cardiac dysfunction, 7.5% and 3.4% had hepatic and renal dysfunction respectively, 7.3% underwent emergency surgery. Seventy% of patients underwent surgery on cardiopulmonary bypass [CPB]. Postoperatively 18.3% patients developed low cardiac output syndrome [LCOS]. Respiratory, acute renal and hepatic failure were seen in 7.5%, 4.6% and 2.9% respectively. 2.8% patients developed septicaemia and 2.2% developed MOF. Mean duration of ICU stay was 1.9 days. Conclusions: Cardiac surgical patients form a separate subset of MOF with different predisposing factors, pathophysiology and outcome. Pre-existing organ dysfunction clinical status, surgery on CPB, postoperative LCOS and septicaemia play significant role in causing MOF

role of activated clotting time in heparin administration for cardiopulmonary bypass

In the prebypass preparation of patients it is crucial that heparinization is adequate. Confusion reigns in the literature as to heparin regimen and appropriate levels of heparin effect as measured by the activated clotting time [Hemochron]. We studied 40 patients and measured activated clotting time [ACT] values after two different dosage regimen, i.e. 300 units/kg body weight of heparin [20 patients] or 15000 units/m2 of heparin [20 patients]. At the end, heparin was neutralized with 3 mg/kg body weight protamine sulphate in all 40 patients, regardless of the total heparin dose. Thirty two% of patients had ACT levels less than 400 seconds prebypass who received heparin in the dose of 300 units/kg body weight. From this study it is concluded that that the opitmal loading dose of heparin be 15000 units/m2 and ACT levels be monitored every half hour while on cardiopulmonary bypass