Please use this identifier to cite or link to this item: https://dora.health.qld.gov.au/qldresearchjspui/handle/1/5408
Title: Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality
Authors: Smith, Simon 
Liu, Yu-Hsuan
Carter, Angus
Kennedy, Brendan J
Dermedgoglou, Alexis 
Poulgrain, Suzanne S
Paavola, Matthew P
Minto, Tarryn L 
Luc, Michael
Hanson, Josh 
Issue Date: 2019
Source: Smith S, Liu YH, Carter A, Kennedy BJ, Dermedgoglou A, Poulgrain SS, Paavola MP, Minto TL, Luc M, Hanson J. Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. PLoS Negl Trop Dis. 2019 Dec 2;13(12):e0007929. doi: 10.1371/journal.pntd.0007929. PMID: 31790405; PMCID: PMC6907868.
Journal: PLoS neglected tropical diseases
Abstract: 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. 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. 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.
Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated authors: Simon Smith, Yu-Hsuan Liu, Angus Carter, Alexis Dermedgoglou, Suzanne S Poulgrain, Matthew P Paavola, Tarryn L Minto, Michael Luc, Josh Hanson
DOI: 10.1371/journal.pntd.0007929
Type: Article
Appears in Sites:Cairns & Hinterland HHS Publications

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