Acute and Critical Care

Original Article

Infection
The prognostic impact of rheumatoid arthritis in sepsis: a population-based analysis: Lavi Oud, John Garza; Acute Crit Care. 2022;37(4):533-542. Published online October 6, 2022; DOI: https://doi.org/10.4266/acc.2022.00787

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Background
Rheumatoid arthritis (RA) is associated with increased risk of sepsis and higher infection-related mortality compared to the general population. However, the evidence on the prognostic impact of RA in sepsis has been inconclusive. We aimed to estimate the population-level association of RA with short-term mortality in sepsis. Methods: We used statewide data to identify hospitalizations aged ≥18 years in Texas with sepsis, with and without RA during 2014–2017. Hierarchical logistic models with propensity adjustment (primary model), propensity score matching, and multivariable logistic regression without propensity adjustment were used to estimate the association of RA with short-term mortality among sepsis hospitalizations. Results: Among 283,025 sepsis hospitalizations, 7,689 (2.7%) had RA. Compared to sepsis hospitalizations without RA, those with RA were older (aged ≥65 years, 63.9% vs. 56.4%) and had higher burden of comorbidities (mean Deyo comorbidity index, 3.2 vs. 2.7). Short-term mortality of sepsis hospitalizations with and without RA was 26.8% vs. 31.4%. Following adjustment for confounders, short-term mortality was lower among RA patients (adjusted odds ratio [aOR], 0.910; 95% confidence interval [CI], 0.856–0.967), with similar findings on alternative models. On sensitivity analyses, short-term mortality was lower in RA patients among sepsis hospitalizations aged ≥65 years and those with septic shock, but not among those admitted to intensive care unit (ICU; aOR, 0.990; 95% CI, 0.909–1.079). Conclusions: RA was associated, unexpectedly, with lower short-term mortality in septic patients. However, this “protective” association was driven by those patients without ICU admission. Further studies are warranted to confirm these findings and to examine the underlying mechanisms.

Citations

Citations to this article as recorded by

Genetic associations between autoimmune diseases and the risks of severe sepsis and 28-day mortality: a two-sample Mendelian randomization study
Xin Tie, Yanjie Zhao, Jing Su, Xing Liu, Tongjuan Zou, Wanhong Yin
Frontiers in Medicine.2024;[Epub] CrossRef
Evolving Paradigms in Sepsis Management: A Narrative Review
Min-Ji Kim, Eun-Joo Choi, Eun-Jung Choi
Cells.2024; 13(14): 1172. CrossRef

Case Reports

A Case of Bilateral Knee Septic Arthritis Caused by Pneumococcal Bacteremia: Yo Han Park, Jong Chan Lee, Junhyeon Cho, Jinyong Park, Myeungcheol Shin; Korean J Crit Care Med. 2013;28(3):230-233.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.230

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Abstract PDF

Pneumococcus can cause pneumonia, sinusitis, infective endocarditis, meningitis and primary bacteremia. However, few reports in the literature show bilateral septic arthritis with pneumococcal bacteremia. We report on a case of a 78-year old woman who presented with fever, pain and swelling in both knees. Both knee fluid aspirates were purulent with thick viscosity, and the gram stain revealed gram positive cocci in chains. The patient underwent emergent washing and arthroscopic debridement, followed with empirical antibiotics treatment. Two out of two blood cultures were positive for penicillin-susceptible Streptococcus pneumonia. Synovial fluid cultures were also positive for S. pneumoniae. The patient was treated with intravenous ceftriaxone for 4 weeks. Bilateral knee septic arthritis with pneumococcal bacteremia is rarely reported. Here we report on the case with a review of the literature.

Citations

Citations to this article as recorded by

Analysis of Characteristics and Prognosis of Healthcare-Associated Secondary Bloodstream Infection
Ju Yeon Song, Ihn Sook Jeong, Sookyung Hyun
Korean Journal of Healthcare-Associated Infection Control and Prevention.2017; 22(2): 43. CrossRef

Dantrolene and Post-operative Hyperthermia: A Case Report: Ja Kyung Koo, Cheol Hong Kim, Ah Leum Lim, Se Ah Kwon, Ji Young Park, Soon Jae Lee, In Gyu Hyun, Je Hyun Yoo; Korean J Crit Care Med. 2009;24(2):92-98.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.92

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Abstract PDF: Malignant hyperthermia is a rare, fatal pharmacogenetic disorder that occurs during general anesthesia following exposure to a depolarizing muscle relaxant, such as succinylcholine, or volatile anesthetics. Clinical findings in malignant hyperthermia include muscle rigidity, sinus tachycardia, increased CO2 production, skin cyanosis with mottling, and marked hyperthermia. For treatment, cooling techniques must be accompanied by discontinuation of the provocative medication. Furthermore, dantrolene administration is the mainstay of treatment for malignant hyperthermia, and should be initiated as soon as the diagnosis is suspected. We recently experienced a case with post-operative fever of 41.0degrees C refractory to conventional anti-pyretic measures and finally resolved with dantrolene administration, in a patient with methicillin-sensitive Staphylococcus aureus monoarthritis of the knee and rapid progression of diffuse septic pneumonia requiring mechanical ventilation.

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