Microbiological profile of septic complication in patients with cardiogenic shock following acute myocardial infarction (from the SHOCK study).
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.
Kohsaka
Shun
S
Division of Cardiology, Columbia University, College of Physicians and Surgeons, New York, New York, USA. sk2798@columbia.edu
Menon
Venu
V
Iwata
Kentaro
K
Lowe
April
A
Sleeper
Lynn A
LA
Hochman
Judith S
JS
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*