S Musa

Outcomes of critically ill patients with cirrhosis admitted to intensive care: an important perspective from the non-transplant setting.

Aliment Pharmacol Ther 2010; 32: 233–243

Clostridium difficile infection and inflammatory bowel disease

Abstract The importance of Clostridium difficile (C. difficile) infection amongst patients with inflammatory bowel disease (IBD) is increasingly being recognized. Recent studies have demonstrated a concerning trend towards increased rates of infection, morbidity, mortality and health costs, and guidelines now promote testing for C. difficile in IBD patients experiencing a relapse. This critical review focuses on the epidemiology, risk factors, pathogenesis, treatment options and outcomes associated with C. difficile infection in patients with IBD.

Clostridium difficile-Associated Disease Acquired in the Cardiothoracic Intensive Care Unit

OBJECTIVES To determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired while in the cardiothoracic intensive care unit (CTICU). DESIGN A 5-year retrospective study. SETTING The CTICU. PARTICIPANTS All CTICU patients with a positive C difficile stool toxin assay 48 hours after admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The results of all CTICU patients with a positive C difficile stool toxin assay were obtained from the Microbiology Department. Each patients medical notes and charts then were reviewed in turn. A total of 27 of 5,199 (0.5%) CTICU patients acquired CDAD. The median age was 74 years (IQR 68-77), and 17 (63%) patients were male. There were 21 (78%) surgical patients; 13 (62%) were elective admissions. The most frequent diagnosis on admission was valvular heart disease (10 [37%] patients). Sixteen (59%) patients underwent coronary artery bypass graft (CABG) surgery and/or valvular heart surgery. The median interval between CTICU admission and CDAD diagnosis was 10 days (IQR 5-18). Previously identified risk factors for ICU-acquired CDAD included age >65 years (23), antibiotic use (26), and medical device requirements (27). At the time of diagnosis, 14 (52%) patients had moderate CDAD. After treatment initiation, 8 (30%) patients developed worsening CDAD. The 30-day in-hospital mortality rate for CTICU-acquired CDAD was 26% (7 patients). CONCLUSIONS C difficile-associated disease rarely is acquired in the CTICU. Approximately one third of patients may experience disease progression, and just over a quarter may die within 30 days of diagnosis. The implementation of recommended severity definitions and treatment algorithms may reduce complication rates and merits prospective evaluation.

A study of muscle tissue oxygenation and peripheral microcirculatory dysfunction in cirrhosis using near infrared spectroscopy.

Background: The circulatory dysfunction associated with cirrhosis is well described. Reduced systemic vascular resistance and high cardiac output are the main features of the hyperdynamic state, but involvement of the peripheral microcirculation in this process is poorly understood. Near infrared spectroscopy (NIRS) has been used to assess muscle tissue oxygenation (StO2) in haemorrhagic and septic shock. Vascular occlusion testing (VOT) can produce dynamic changes in StO2 which represent tissue oxygen extraction, delivery, and hence, surrogate markers of microvascular function.