Treatment with IgM-enriched immunoglobulin in sepsis: a matched case-control analysis.

The therapeutic potential of IgM-enriched immunoglobulin preparations (IgGAM) in sepsis remains a field of debate. The use of polyclonal immunoglobulins as adjuvant therapy (Esen & Tugrul, 2009; Kaukonen et al., 2014; Molnár et al., 2013; Taccone et al., 2009) has been shown to improve clinical outcomes in terms of mortality. This study analyze the impact of IgM-enriched IgG (IgGM) as additional immunomodulation. Patients and methods: This is a retrospective registry of 1196 patients with severe sepsis and septic shock from nine Intensive Care Units in Colombia, from routine clinical practice; 220 patients treated with IgGAM were registered. Fully matched comparators for severity and type of infection selected among patients non-treated with IgGAM. Mortality after 28 days was 30.5% among IgGAM-treated patients and 40.5% among matched comparators. Results: Multivariate Cox regression analysis showed IgGAM treatment to be the only variable protective from death after 28 days (hazard ratio 0.62; 0.45-0.86; p: 0.004). Results reinforce the importance of IgGAM treatment for favorable outcome after septic shock and are in line with recent published meta-analyses. This study showed that treatment with IgGM in patients with sepsis was an independent modulator of the 28-day associated with a lower mortality.

Differential molecular approach and ESBL detection from Klebsiella pneumoniae and Escherichia coli isolated from the supraglottic region of patients undergoing mechanical ventilation in an intensive care unit / Aproximación molecular diferencial y detección de BLEES a partir de Klebsiella pneumoniae y Escherichia coli aisladas de la región supraglótica de pacientes sometidos a ventilación mecánica en una unidad de cuidados intensivos

Abstract Introduction: Given their ability for colonizing the supraglottic region, desiccation tolerance, resistance to β-lactam antibiotics, and adherence to both inert surfaces and epithelial cells, Klebsiella pneumoniae and Escherichia coli are potentially pathogenic microorganisms for patients undergoing mechanical ventilation in an intensive care unit (ICU). Objective: To perform a molecular characterization and detection of extended spectrum β-lactamases (ESBL) in K. pneumoniae and E. coli strains isolated from the supraglottic region of patients undergoing mechanical ventilation in an ICU. Materials and methods: A descriptive study was conducted in 18 isolates. Disk diffusion technique was used for detecting ESBL-producing bacteria. Molecular characterization was made by BOX-PCR technique, while ESBL production was confirmed by testing the isolates against cefotaxime and ceftazidime, alone and in combination with clavulanic acid. Results: a K. pneumoniae strain and another E. coli strain were confirmed as ESBL producers. A divergence greater than 50% was observed in most of the strains; besides non-infectious origin strains resistant to third generation cephalosporins were found. Conclusion: The polyclonality found in this study might indicate that most of the strains belong to each patient's microbiota.

Resumen Introducción. Dada su capacidad para colonizar la región supraglótica, tolerar desecación, resistir los antibióticos β-lactámicos y adherirse tanto a superficies como a células epiteliales, la Klebsiella pneumoniae y la Escherichia coli son microorganismos potencialmente patógenos para los pacientes de la unidad de cuidados intensivos (UCI) sometidos a ventilación mecánica. Objetivo. Realizar la caracterización molecular y la detección de β-lactamasas de espectro extendido (BLEES) a cepas de K. pneumoniae y E. coli aisladas de la región supraglótica de pacientes internados en UCI y sometidos a ventilación mecánica. Materiales y métodos. Estudio descriptivo realizado en 18 aislamientos. Se utilizó la técnica de difusión en disco para detectar bacterias productoras de BLEES. La caracterización molecular se realizó mediante la técnica de BOX-PCR y la producción de ESBL fue confirmada mediante la prueba con cefotaxima y ceftazidima, solas y combinadas con ácido clavulanico. Resultados. Una cepa de K. pneumoniae y otra de E. coli resultaron productoras de BLEES. La mayoría de cepas presentaron una divergencia superior al 50%, evidenciándose, además, cepas de origen no infeccioso resistentes a cefalosporinas de tercera generación. Conclusión. La policlonalidad encontrada podría indicar que la mayoría de las cepas pertenecen a la microbiota de cada paciente.