High mortality of invasive pneumococcal disease compared with meningococcal disease in critically ill children.

OBJECTIVE: To ascertain outcome, patterns of disease, incidence of concurrent infection, superinfection and penicillin resistance in children requiring intensive care for Streptococcus pneumoniae infection and compare it to a similar disease pattern, namely Neisseria meningitidis b infection. DESIGN AND SETTING: Prospective cohort study in a regional paediatric intensive care unit (PICU). PATIENTS AND PARTICIPANTS: Children with invasive pneumococcal and meningococcal disease requiring intensive care. MEASUREMENTS AND RESULTS: The study included 22 children with invasive pneumococcal disease (IPD), median age 14 months (interquartile range 3-52), median Paediatric Index of Mortality (PIM) 0.051 (0.028-0.066), median length of PICU stay 8.5 days (4-13). Four patients died, three (13.5%) attributable to IPD. Incidence of concurrent infection 27%. There were no superinfections. All S. pneumoniae were sensitive to cefotaxime; one isolate (3.7%) was resistant to penicillin. There were 186 children with meningococcal disease (MD), with a higher PIM (median 0.068, 0.033-0.108), older age (29 months, 10.7-77.9) and shorter length of PICU stay (median 3 days, 2-6). Eight (4.3%) children died from MD. Incidence of concurrent and superinfection was 18% and 6%, respectively in children with MD. All N. meningitidis cases were sensitive to cefotaxime and penicillin. The standardized mortality ratio was considerably higher with IPD (2.0) than with MD (0.52). CONCLUSIONS: In invasive pneumococcal disease preventative measures including early recognition, immediate antibiotic therapy and vaccination need to be taken in the community, similar to the control of meningococcal disease. Invasive pneumococcal disease should command the same respect as meningococcal disease.

[Measurement of minimum disposable volume in the extraction of an analysis through an arterial catheter]. / Determinación del volumen mínimo desechable en laextracción de una analítica a través de un catéter arterial.

OBJECTIVE: Arterial catheters are used to extract blood samples. To maintain its permeability we use heparin solution, which may contaminate and alter the desired results. Our aim was to determine the volume of the minimum discards during blood extractions to avoid results that might be altered in the analysis of biochemistry. MATERIAL AND METHODS: A prospective study was carried out in 18 beds intensive care unit. Patients with arterial catheter (Seldicath) were included, maintaining 500 UI of heparin in saline of 500 ml, at a pressure of 300 mmHg through pressurizer (Tycos). The dead space (DS) in the radial arterial system is 0.8 ml and 1 ml in the femoral. We analyzed the reliability of different discards comparing the following: 3 ml + DS, 7.5 ml + DS, 12 ml + DS and 16.5 ml + DS. The statistical analysis was carried out through ANOVA and t Student. RESULTS: In biochemistry, significant differences were not found except for potasium (p< 0.001) with 3 ml+DS during control, although it is not clinically relevant [difference through = 0.1 mEq/l (DS 0.2)]. Significant differences in prothrombina (p = 0.004) were found in coagulation, comparing 3 ml+DS and 16.5 ml + DS and in cefaline, comparing 7.5 ml + DS (p< 0.0001) and 16.5 ml + DS. There were not significant differences in the studies of gases. CONCLUSIONS: Our study shows that to reach a reliable analytical results, it is not necessary to discard more than 3 ml+DS in biochemistry and in blood gases, and to determine cefalina time would necessary to discard a minimum of 7.5 ml+DS.

Factors related to hospital stay among patients with nosocomial infection acquired in the intensive care unit.

OBJECTIVES: To assess the influence of nosocomial infection on length of stay in the intensive care unit (ICU) and to determine the relative effect of other factors on extra length of hospitalization associated with nosocomial infection. DESIGN: Prospective cohort multicenter study in the context of the ENVIN-UCI project. SETTING: Medical or surgical ICUs of 49 different hospitals in Spain. METHODS: All consecutive patients (N = 6,593) admitted to ICUs of the participating hospitals who stayed for more than 24 hours during a 3-month period (from January 15 to April 15, 1996) were included. Length of ICU stay was compared between patients with and without nosocomial infections. RESULTS Uninfected patients (N = 5,868) had a median stay in the ICU of 3 days, whereas the median for infected patients (N = 725) was 17 days (P < .001). The median for infected patients with one episode of nosocomial infection was 13 days. The greatest length of stay (40 days) was among patients admitted to the ICU because of medical diseases, with an infection acquired before admission to the ICU, and with the largest number of nosocomial infection episodes. In extended stays, nosocomial infection was significantly associated with length of hospitalization (day 21; odds ratio, 22.38; 95% confidence interval 16.6 to 30.4), whereas an effect of variables related to severity of illness on admission (Acute Physiology and Chronic Health Evaluation II score, urgent surgery, and infection prior to ICU admission) was not found. CONCLUSIONS: The presence of nosocomial infection and the number of infection episodes were the variables with the strongest association with prolonged hospital stay among ICU patients.

Flow cytometric DNA analysis on fine needle aspiration biopsies of liver lesions.

Flow cytometric DNA analysis on fine needle aspiration biopsies of liver lesions The DNA cell content of 39 fine needle aspiration biopsies (FNAs) from five benign liver lesions, nine hepatocellular carcinomas (HCCs), and 25 metastatic tumours was analysed in a prospective fashion by flow cytometry (FCM). All benign lesions were diploid. Aneuploidy was found in five (55.6%) HCCs and in nine (36%) metastatic tumours. DNA index (DI) differences were not significant. The S-phase fraction (SPF) was higher in the malignant tumours, both combined (P < 0.02) and separated primary and metastatic (P < 0.05). We could not demonstrate an association between diploidy and percentage of benign hepatocytes in the smears of malignant tumours. The serum alpha-fetoprotein (AFP) level did not correlate with ploidy, DI, or SPF in the HCCs. In conclusion, ploidy and DI do not discriminate between benign and malignant liver lesions, but the SPF is higher in malignant tumours. DNA analysis does not help to distinguish primary from metastatic liver tumours. The presence of benign hepatocytes in samples from malignant tumours does not seem to influence the analysis of ploidy by FCM.