[The adult respiratory stress syndrome and septic shock associated with tuberculosis]. / Síndrome de distrés respiratorio del adulto y shock séptico asociados a tuberculosis.

The increase in the incidence of tuberculosis infection in the last few years has caused a recurrence of atypical clinical forms, as well as the development of associations and uncommon complications during the clinical course, which include the adult respiratory distress syndrome (ARDS) and septic shock. Three patients with ARDS are here reported; two patients had findings of septic shock and negative serology to human immunodeficiency virus and the only etiological agent documented was M. tuberculosis. The three patients required hemodynamic support and two of them mechanical ventilation. None of the patients survived the episode. Tuberculosis, particularly the disseminated forms, should be considered as possible etiology in high risk patients with septic shock, ARDS or both.

Septicaemia in a medical intensive care unit. Clinical, biochemical and microbiological data of 109 cases.

Blood cultures were obtained from 39% of all 574 admissions to our Medical Intensive Care Unit. (ICU); in 109 (19%) a pathogenic organism was demonstrated. 45% of the septicaemias were detected within the first 48 h of ICU stay have been considered as "non ICU-acquired". Septicaemic patients were significantly older, had longer ICU stays and a higher mortality rate (62%) than non septicaemic patients (28%) (p less than 0.05). Gram negative organisms (69%) predominated over gram positive (29%) and Serratia marcescens and coagulase positive Staphylococcus were the most frequently isolated. Shock appeared in 32% and had an extremely high mortality (91%) and was associated with the presence of "multiple species septicaemia". Prior to the septicaemia the survivors differed from the fatalities only in the level of serum albumin; this was significantly lower in patients with gram negative in comparison with gram positive septicaemias and in patients who developed shock. Arterial, pulmonary artery and urinary catheters, and endotracheal devices were used frequently in these patients and were statistically associated with the presence of septicaemia. The airway was the most frequent possible source for the septicaemia.

Amikacin treatment of Serratia septicemia in critically ill patients.

Serratia marcescens septicemia represents a serious problem in high risk critical care patients. Treatment is difficult because Serratia is usually resistant to most antibiotics. Amikacin is at present the most effective antibiotic in vitro against gentamycin-resistant Serratia, although significant loss of activity may occur in vivo in the group of compromised patients, whose ultimate prognosis may depend eventually upon other associated conditions. In this Medical ICU, 15 patients with Serratia septicemia who were treated with in vitro effective antibiotics (14 were given amikacin) had a mortality of 60%, while 5 patients who received ineffective in vitro antibiotics had a mortality of 100%. In this ICU, 80% of the Serratia isolates were resistant to gentamycin, while only 2.8% were resistant to amikacin. Because amikacin-resistant strains of Serratia have already emerged, appropriate use of this antibiotic is essential in order not to promote the selection of amikacin-resistant strains.

Association of a low serum albumin with infection and increased mortality in critically ill patients.

214 patients among 282 consecutive admissions had at least one measurement of serum albumin (SA) during their stay on the ICU and were classified according to their lowest value of SA. Mean SA was 2.88 /+- 0.74 g/100 mg. Survivors had a mean SA (3.18 /+- 0.60) higher than non-survivors (2.35 /+- 0.68 g/100 ml) (p < 0.05). 64% of patients were admitted with an abnormally low SA (less than 3.5 g/100 ml) and in 56% of these the initial value was higher than the last. Mortality increased in the groups with lower SA and the level of SA was associated with infection (x2 = 73.9) and mortality (x2 = 69.7) (p < 0.05). The percentage of infected patients who died increased in groups with lower SA.