A leukocyte score to improve clinical outcome predictions in bacteremic pneumococcal pneumonia in adults.

BACKGROUND: Bacteremic pneumococcal pneumonia (BPP) is associated with high and early mortality. A simple procedure to predict mortality is crucial. METHODS: All adult patients with BPP admitted from 2005 through 2013 to the University Hospital of Dijon, France, were enrolled to study 30-day mortality and associated factors, particularly leukocyte counts. A simple leukocyte score was created by adding 1 point each for neutropenia (<1500 cells/mm(3)), lymphopenia (<400), and monocytopenia (<200). RESULTS: One hundred and ninety-two adult patients (mean age, 69 years; standard deviation [SD], 19 years) who had developed and were hospitalized for BPP (58% community-acquired) were included. The 30-day crude mortality rate was 21%. The mean Pneumonia Severity Index score was high at 127.3 (SD = 41.3). Among the 182 patients who had a white blood cell count, 34 (19%) had a high leukocyte score (≥2). Multivariate analysis revealed that mortality was significantly associated with a high leukocyte score (odds ratio, 6.28; 95% confidence interval, 2.35-16.78), a high respiratory rate, a low serum bicarbonate level, and an altered mental status (all P < .05). The leukocyte score was not significantly dependent on the previous state of immunosuppression, alcoholism, or viral coinfection, but it did correlate with an acute respiratory distress syndrome and a low serum bicarbonate level. CONCLUSIONS: This new leukocyte score, in combination with the well known predictive factors, seems of interest in predicting the risk of death in BPP. A high score correlated with organ dysfunction and probably reflects the level of immunoparalysis. Its predictive value has to be confirmed in other cohorts.

Impact of pooling powdered infant formula samples on bacterial evolution and Cronobacter detection.

Enterobacter sakazakii has been identified as the causative agent of serious neonatal infections, associated with high mortality rates. In most cases, powdered infant formula (PIF) has been identified as the source of infection. Recently, strains commonly referred to as E. sakazakii were proposed for classification in a new genus, Cronobacter. The standardised method for detection of Cronobacter in PIF (ISO/TS 22964; IDF/RM 210) involves pre-enrichment in buffered peptone water (BPW), followed by selective enrichment and plating onto ESIA chromogenic agar. For greater convenience and to reduce analysis cost, the common practice in the food industry is to pool samples at a constant dilution rate, in order to perform a single pre-enrichment and subsequent analysis. The consequences on the sensitivity of Cronobacter detection are not evident. We evaluated the impact of pooling on the growth of Cronobacter and PIF background microflora in samples undergoing pre-enrichment culturing in BPW. Growth of the pathogen was monitored by direct plating onto selective agar or by using a recently developed sensitive enumeration method, based on membrane filtration followed by transfer of the filter onto the selective agar. The evolution of the total bacterial population of the PIF was monitored from a qualitative and quantitative point, using molecular or classical microbiological methods. Results showed that pooling had a negative impact on the maximum population of Cronobacter attained, whereas no clear effect was observed on the onset of growth. This observation suggests strong bacterial interactions with the PIF background microflora, confirmed by a generally higher background microflora growth potential in PIF samples from various origins. These important findings suggest that, in some cases, the practice of pooling samples may affect the performance of the detection method.

Amiodarone-related acute respiratory distress syndrome following sudden withdrawal of steroids.

Acute lung toxicity is a rare but classical complication of amiodarone therapy. We report the case of a patient who developed an optic neuropathy after 15 years of amiodarone administration, and who was treated for 2 weeks with steroids. Following withdrawal of steroids, the patient rapidly developed an acute respiratory distress syndrome. Postmortem lung histologic examination was consistent with amiodarone-induced pneumonitis. Since this complication is thought to be of immunological origin, we speculate that the sudden withdrawal of steroids was implicated in the development of the acute lung injury.