Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality.
Background Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit (ICU) support. Multiple strategies-including protective ventilation and early renal replacement therapy (RRT)-have been recommended to improve outcomes. However, management guidelines vary widely...
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ftdoajarticles:oai:doaj.org/article:4d9ef73989be4f128495b2ecfb29bdf6 2023-05-15T15:13:12+02:00 Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. Simon Smith Yu-Hsuan Liu Angus Carter Brendan J Kennedy Alexis Dermedgoglou Suzanne S Poulgrain Matthew P Paavola Tarryn L Minto Michael Luc Josh Hanson 2019-12-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0007929 https://doaj.org/article/4d9ef73989be4f128495b2ecfb29bdf6 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0007929 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007929 https://doaj.org/article/4d9ef73989be4f128495b2ecfb29bdf6 PLoS Neglected Tropical Diseases, Vol 13, Iss 12, p e0007929 (2019) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2019 ftdoajarticles https://doi.org/10.1371/journal.pntd.0007929 2022-12-31T09:15:14Z Background Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit (ICU) support. Multiple strategies-including protective ventilation and early renal replacement therapy (RRT)-have been recommended to improve outcomes. However, management guidelines vary widely around the world and there is no consensus on the optimal approach. Methodology/principal findings All cases of leptospirosis admitted to the ICU of Cairns Hospital in tropical Australia between 1998 and 2018 were retrospectively reviewed. The patients' demographics, presentation, management and clinical course were examined. The 55 patients' median (interquartile range (IQR)) age was 47 (32-62) years and their median (IQR) APACHE III score was 67 (48-105). All 55 received appropriate antibiotic therapy, 45 (82%) within the first 6 hours. Acute kidney injury was present in 48/55 (87%), 18/55 (33%) required RRT, although this was usually not administered until traditional criteria for initiation were met. Moderate to severe acute respiratory distress syndrome developed in 37/55 (67%), 32/55 (58%) had pulmonary haemorrhage, and mechanical ventilation was required in 27/55 (49%). Vasopressor support was necessary in 34/55 (62%). Corticosteroids were prescribed in 20/55 (36%). The median (IQR) fluid balance in the initial three days of ICU care was +1493 (175-3567) ml. Only 2/55 (4%) died, both were elderly men with multiple comorbidities. Conclusion In patients with severe leptospirosis in tropical Australia, prompt ICU support that includes early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for RRT initiation and corticosteroid therapy is associated with a very low case-fatality rate. Prospective studies are required to establish the relative contributions of each of these interventions to optimal patient outcomes. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 13 12 e0007929 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Simon Smith Yu-Hsuan Liu Angus Carter Brendan J Kennedy Alexis Dermedgoglou Suzanne S Poulgrain Matthew P Paavola Tarryn L Minto Michael Luc Josh Hanson Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit (ICU) support. Multiple strategies-including protective ventilation and early renal replacement therapy (RRT)-have been recommended to improve outcomes. However, management guidelines vary widely around the world and there is no consensus on the optimal approach. Methodology/principal findings All cases of leptospirosis admitted to the ICU of Cairns Hospital in tropical Australia between 1998 and 2018 were retrospectively reviewed. The patients' demographics, presentation, management and clinical course were examined. The 55 patients' median (interquartile range (IQR)) age was 47 (32-62) years and their median (IQR) APACHE III score was 67 (48-105). All 55 received appropriate antibiotic therapy, 45 (82%) within the first 6 hours. Acute kidney injury was present in 48/55 (87%), 18/55 (33%) required RRT, although this was usually not administered until traditional criteria for initiation were met. Moderate to severe acute respiratory distress syndrome developed in 37/55 (67%), 32/55 (58%) had pulmonary haemorrhage, and mechanical ventilation was required in 27/55 (49%). Vasopressor support was necessary in 34/55 (62%). Corticosteroids were prescribed in 20/55 (36%). The median (IQR) fluid balance in the initial three days of ICU care was +1493 (175-3567) ml. Only 2/55 (4%) died, both were elderly men with multiple comorbidities. Conclusion In patients with severe leptospirosis in tropical Australia, prompt ICU support that includes early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for RRT initiation and corticosteroid therapy is associated with a very low case-fatality rate. Prospective studies are required to establish the relative contributions of each of these interventions to optimal patient outcomes. |
format |
Article in Journal/Newspaper |
author |
Simon Smith Yu-Hsuan Liu Angus Carter Brendan J Kennedy Alexis Dermedgoglou Suzanne S Poulgrain Matthew P Paavola Tarryn L Minto Michael Luc Josh Hanson |
author_facet |
Simon Smith Yu-Hsuan Liu Angus Carter Brendan J Kennedy Alexis Dermedgoglou Suzanne S Poulgrain Matthew P Paavola Tarryn L Minto Michael Luc Josh Hanson |
author_sort |
Simon Smith |
title |
Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. |
title_short |
Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. |
title_full |
Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. |
title_fullStr |
Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. |
title_full_unstemmed |
Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. |
title_sort |
severe leptospirosis in tropical australia: optimising intensive care unit management to reduce mortality. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2019 |
url |
https://doi.org/10.1371/journal.pntd.0007929 https://doaj.org/article/4d9ef73989be4f128495b2ecfb29bdf6 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 13, Iss 12, p e0007929 (2019) |
op_relation |
https://doi.org/10.1371/journal.pntd.0007929 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007929 https://doaj.org/article/4d9ef73989be4f128495b2ecfb29bdf6 |
op_doi |
https://doi.org/10.1371/journal.pntd.0007929 |
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PLOS Neglected Tropical Diseases |
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13 |
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12 |
container_start_page |
e0007929 |
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1766343794619318272 |