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Infectious diseases as a trigger in thrombotic microangiopathies in intensive care unit (ICU) patients?
Paul Coppo1, Christophe Adrie, Elie Azoulay
1Department of Critical Care Medicine, Hôpital Saint-Louis and University of Paris VII, 1 Rue Claude Vellefaux, 75010, Paris, France.
Objective:
Thrombotic microangiopathy (TMA) has been associated with a large number of underlying diseases. We conducted a descriptive, retrospective study including all TMA adult patients admitted to our ICU, with a particular interest in infectious episodes as a trigger of TMA.
Patients:
All adult patients (30) with a diagnosis of TMA admitted to the medical ICU at Saint-Louis Hospital (Paris, France) between 1992 and 1998 were retrospectively included.
Methods:
All patients with clinical and microbiological evidence of bacterial infection were treated with intravenous antibiotics. The specific treatment of TMA consisted in solvent/detergent-treated plasma administration by plasma exchange or high volume plasma infusion (30 ml/kg per day) in fractionated doses.
Results:
Among the 30 adult patients studied, TMA in 16 (53%) was associated with microbiologically documented infection. An acute infection was found in 8/9 patients with an HIV-related TMA, in 2/6 patients with a systemic lupus erythematosus (SLE)-related TMA and in 3/6 patients with TMA associated with other disorders. In three patients, an acute infectious disease was the only cause associated with the TMA. Four other patients had clinical manifestations suggesting an infection process but without bacteriological documentation. Escherichia coli was isolated in 7/16 cases and verotoxin was found in the stools of two other patients. All patients were treated with plasma administration and those with evidence of infection were systematically and intensively treated with antibiotics. Eventually 8 patients died (27%), 20 (67%) reached complete remission and 2 partial remission.
Conclusion:
Bacterial infections are commonly observed amongst TMA patients hospitalized in ICUs and may act as a trigger of this disease. Screening for infection is a requirement in patients with TMA, either idiopathic or associated with other conditions.
Insights
Bacterial infections frequently trigger thrombotic microangiopathy (TMA) in ICU patients. Prompt infection screening is crucial for managing TMA, whether idiopathic or secondary to other conditions.
Area of Science:
- Critical Care Medicine
- Hematology
- Infectious Diseases
Background:
- Thrombotic microangiopathy (TMA) is a serious condition linked to various underlying diseases.
- Infectious episodes are increasingly recognized as potential triggers for TMA.
- Understanding the interplay between infection and TMA is vital for patient outcomes.
Purpose of the Study:
- To investigate the association between infectious episodes and thrombotic microangiopathy (TMA) in adult ICU patients.
- To identify the role of bacterial infections as a trigger for TMA.
- To evaluate treatment outcomes in TMA patients with and without documented infections.
Main Methods:
- A retrospective study of 30 adult patients diagnosed with TMA in a medical ICU.
- Inclusion criteria focused on patients admitted between 1992 and 1998.
- Data collection included clinical, microbiological, and treatment information.
Main Results:
- Over half (53%) of TMA cases were associated with microbiologically documented infections.
- Bacterial infections were particularly noted in HIV-related TMA and other systemic disorders.
- Escherichia coli was a common pathogen identified; overall mortality was 27% with 67% achieving complete remission.
Conclusions:
- Bacterial infections are a common occurrence in ICU patients with TMA and can precipitate the condition.
- Systematic screening for infections is essential in all TMA patients, regardless of etiology.
- Intensive antibiotic therapy alongside plasma administration improved patient outcomes.