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Introduction: Klebsiella pneumoniae (KP) is a common Gram-negative bacterium causing a myriad of infections such as pneumonia, urinary tract infection and other nosocomial infections. Treatment options have been reduced due to the emergence of multi-drug resistant strains worldwide. On the other hand, inappropriate empirical antibiotics in septic shock are associated with poor outcome. In this study, we aim to evaluate the impact of appropriate empirical antibiotics on outcomes in KP bacteraemia in critical care setting. Methods: Adults admitted to intensive care unit of a regional hospital in Hong Kong with KP bacteraemia from January 2009 to June 2017 were retrospectively reviewed. Demographics, antibiotics, microbiology and outcomes were analyzed. Cox regression analysis was performed to determine independent predictors for 90-day mortality and logistic regression analysis was used to identify independent predictors for patients to have received inappropriate empirical antibiotics. Results: During the study period, a total of 205 patients with KP bacteraemia were identified, in which 148 received appropriate empirical antibiotics (72.2%) while 57 did not (27.8%). Inappropriate or no empirical antibiotics was associated with significantly higher 90-days mortality (HR 3.419; 95% CI 2.12-5.51; p 0.001). Other independent predictors include: concomitant congestive heart failure (HR 2.395; 95% CI 1.18- 4.83; p=0.015), medical patients (HR 2.390; 95% CI 1.40-4.07; p=0.001), higher total SOFA score (HR 1.097; 95% CI 1.05-1.14; p 0.001). Patients with chronic kidney disease (CKD) or end stage renal failure (ESRF) (OR 4.802, p=0.006), infection caused by ESBL or carbapenem resistance strain (OR 4.339, p=0.003), patients who were mechanically ventilated (OR 4.066, p=0.001) were more likely to have received inappropriate empirical antibiotics. Conclusion: Appropriate antibiotics improve mortality of patients with KP bacteraemia. Patients with preexisting CKD/ESRF, infection by ESBL or carbepenem resistance strain and mechanically ventilated patients are more likely to have received inappropriate antimicrobials treatment. [ABSTRACT FROM AUTHOR]

Introduction: Escherichia coli (EC) is one of the most common bloodstream infections and carries a significant mortality rate. International studies have shown that age, antibiotic resistance and choice of empirical antibiotics affect the prognosis of patients with EC bacteremia. However, there is scarce local data to evaluate on the prognostic factors for EC bacteremia in Hong Kong. Our study aimed to evaluate the clinical predictors and outcomes of EC bacteremia in critically ill patients admitted to Intensive Care Unit (ICU) in a regional hospital in Hong Kong. Methods: The study is a retrospective analysis of patients with EC bacteremia admitted to the Department of ICU of Pamela Youde Nethersole Eastern Hospital (PYNEH), from 1/1/2009 to 30/12/2017 (8 years). Patients' demographics, past medical histories, clinical parameters, microbiological data, drug prescriptions, and supportive treatments were analyzed. Results: Among 380 patients, 30-day non-survivors were older (p=0.016), more likely to present with respiratory sepsis (p 0.001) and require renal replacement therapy and mechanical ventilation during ICU stay (p 100 (HR=6.129; 95% CI=3.271-11.485; p=0.001), respiratory sepsis (HR=4.366; 95% CI=2.147- 8.878; p=1.3 (HR=3.007; 95% CI=1.685-5.365; p=70 (HR=2.999; 95% CI=1.597-5.632; p=0.001), liver cirrhosis (HR=2.632, CI=1.051-6.591, p=0.039), albumin 24g/L (HR=2.291; 95% CI=1.229-4.270; p=0.009) and interventional radiological (IR) procedures or operative interventions (HR=0.358; 95% CI=0.188-0.679; p=0.002) were independent risk factors for 30-day mortality. Conclusion: Disease severity, respiratory sepsis, use of steroid, age and liver cirrhosis are important predictors for 30-day mortality in critically ill patients with EC bacteremia, while IR procedures or operative interventions is associated with lower 30-day mortality. [ABSTRACT FROM AUTHOR]

Introduction: Aneurysmal subarachnoid hemorrhage (SAH) is a neurosurgical emergency that carries significant morbidities and mortality. Management includes bleeding control and supportive care to minimize secondary brain injuries. Fluid management in this group of patients remains a challenge. This study aims to determine whether early fluid balance can affect functional outcome. Methods: We retrospectively reviewed 140 patients with SAH admitted to intensive care unit (ICU) of Pamela Youde Nethersole Eastern Hospital between January 2011 to December 2016. Data on patients demographics and clinical characteristics were collected, including cumulative 4 days fluid balance, age, mean arterial pressure, maximum glucose, Acute Physiology and Chronic Health Evaluation (APACHE) IV score, Glasgow Coma Scale (GCS), modified Fisher scale, WFNS (World Federation of Neurosurgical Societies) grade, presence of vasospasm and surgical or endovascular management of the aneurysm. The primary outcome was Glasgow Outcome Scale (GOS) at 3 months with GOS 1 to 3 classified as poor outcome and GOS 4 to 5 as good outcome. Secondary outcomes were ventilator days, hospital and ICU length of stay (LOS). Results: One hundred and forty patients were included in the analysis. The median age was 55.5 years. Twenty (14.3%) patients had died. The cumulative 4 days fluid balance was associated with poor outcome in the univariate analysis (p=0.002). In the logistic regression analysis, it is not independently associated with poor outcome. Age, APACHE IV score, and modified Fisher scale 4 were independent predictors of poor outcome. The cumulative 4 days fluid balance was not associated with secondary outcomes: ICU LOS (Spearman's rho correlation coefficient, r=0.152, p=0.073), hospital LOS (r=0.126, p=0.137) and ventilator days (r=0.252, p=0.003). Conclusion: In this cohort of patients, age, APACHE IV, and modified Fisher scale 4 were independent predictors of poor functional outcome in patients with SAH. [ABSTRACT FROM AUTHOR]

Introduction: Aneurysmal subarachnoid hemorrhage (SAH) accounts for 80% of non-traumatic SAH and has higher morbidity and mortality. Hyperoxia and hypocapnia are associated with poor outcomes in critically ill patients with brain injuries or post-cardiac arrest status. Yet, the impact of hyperoxia and hypocapnia on neurological outcome in patients with aneurysmal SAH has not been well studied. In this study, we aim to evaluate their impact on neurological outcome in patients with aneurysmal SAH. Methods: Patients with aneurysmal SAH admitted to Intensive Care Unit of a regional hospital in Hong Kong from January 2011 to December 2016 were included. Patients' demographics and comorbidities, clinical and radiological grading, blood gas, Glasgow Outcome Scale (GOS) at 3 months were recorded. Logistic regression analysis was performed to assess independent predictors for poor neurological outcome, i.e. GOS 1-3 at 3 months after initial insult. Results: Among 244 patients with aneurysmal SAH, 50% (122 patients) had poor neurological outcome. They were older, had higher APACHE IV score, WFNS grading and Fisher grading scale, and lower GCS on day 1 and were more likely to have intracranial or intraventricular hemorrhage (ICH or IVH). Hyperoxia (PaO2>200 mmHg) and hypocapnia (PaCO2 50 (OR 5.172, 95% CI 2.348-11.393, p 55 (OR 4.113, 95% CI 1.871-9.039, p 2 (OR 3.555, 95% CI 1.472-8.586, p=0.005), and WFNS grade >3 (OR 2.986, 95% CI 1.282-6.955, p=0.011) independently predicted poor neurological outcome at 3 months. Conclusion: Hyperoxia but not hypocapnia was associated with poor neurological outcomes at 3 months in patients with aneurysmal SAH. [ABSTRACT FROM AUTHOR]