title: Microbiological profile of septic complication in patients with cardiogenic shock following acute myocardial infarction (from the SHOCK study).
abstract: We sought to assess the microbiologic profile of patients with suspected sepsis who participated in the SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? (SHOCK) trial, a randomized controlled trial of early coronary revascularization in patients with cardiogenic shock complicating acute myocardial infarction. A protocol-mandated SEPSIS form was completed prospectively for 54 patients (18%) with fever or leukocytosis suggestive of sepsis. These patients were divided further into those with positive (n = 40) or negative (n = 14) culture results. The predominant pathogen isolated in patients with positive culture results was Staphylococcus aureus (32%), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Patients with both positive and negative culture results had longer median durations of mechanical ventilation (p <0.001 and p = 0.02), intra-aortic balloon pump (IABP) support (p = 0.074 and p = 0.021), and hospital stay (p <0.001 and p = 0.048) than controls. Sepsis was predicted by both duration of IABP support (p = 0.007) and use of multiple central catheters (p = 0.026). In conclusion, clinical sepsis is common after cardiogenic shock complicating acute myocardial infarction, particularly in patients who received prolonged IABP support or had multiple central catheters.
authors.affiliation: Division of Cardiology, Columbia University, College of Physicians and Surgeons, New York, New York, USA. sk2798@columbia.edu
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iwata
authors.forename: April
authors.initials: A
authors.lastname: Lowe
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D002404:Catheterization / Q000009:adverse effects; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006801:Humans; D007362:Intensive Care Units; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000009:adverse effects; D012770:Shock, Cardiogenic / Q000150:complications*; D013211:Staphylococcus aureus / Q000302:isolation & purification*