Infectious Disease & Sepsis

Staphylococcal Scalded Skin Syndrome (SSSS) is a serious skin disorder caused by infection with certain strains of Staphylococcus bacteria. These bacteria release exotoxins, specifically exfoliative toxins, which target the protein desmoglein-1 that helps cells in the outer layer of the skin (the epidermis) stick together. When these toxins disrupt the protein, they cause the skin cells to separate, leading to widespread blistering and the appearance of scalded skin.

The symptoms of SSSS typically begin with fever, irritability, and redness of the skin. The skin then becomes tender and forms fluid-filled blisters, which can easily rupture, leaving areas that look like burns or scalds. It's important to note that the mucous membranes, such as those in the mouth and eyes, are typically not involved in SSSS, which can help differentiate it from other similar-looking conditions.

The results of this study do not support the use of landiolol (a beta blocker) for managing patients with tachycardia treated with norepinephrine for established septic shock.

Landiolol and Organ Failure in Patients With Septic Shock: The STRESS-L Randomized Clinical Trial | Resuscitation | JAMA | JAMA Network

Inhaled Amikacin for the Prevention of VAP

In a multicenter, double-blind, randomized controlled trial involving critically ill adults undergoing mechanical ventilation for over 72 hours, patients were administered either inhaled amikacin (20 mg/kg ideal body weight daily) or a placebo for three days. The study aimed to determine the efficacy of preventive inhaled antibiotics in reducing ventilator-associated pneumonia.

Out of the 847 patients analyzed, 15% in the amikacin group and 22% in the placebo group developed ventilator-associated pneumonia within 28 days. The amikacin group showed a significant reduction in the incidence of pneumonia with a difference in restricted mean survival time of 1.5 days (P=0.004). Furthermore, the amikacin group had fewer infection-related ventilator complications compared to the placebo group. The research concludes that a 3-day course of inhaled amikacin can decrease the occurrence of ventilator-associated pneumonia in patients ventilated for at least three days.

Vitamin C for Patients With COVID-19

The LOVIT-COVID trial and the vitamin C section of the REMAP-CAP trial were synchronized to enhance the efficiency of the research. They included 1568 critically ill patients (1037 on vitamin C and 531 in the control group) and 1022 non-critically ill patients (456 on vitamin C and 566 in the control group). Patients were given 50 mg/kg of vitamin C through an IV every 6 hours for a maximum of 96 hours. While both trials were planned together, LOVIT-COVID used a placebo, whereas REMAP-CAP compared vitamin C to standard care. The study was halted once set criteria for potential harm and lack of effectiveness were reached. Among the critically ill patients, those on vitamin C had a median of 7 days without organ support, compared to 10 days in the control group, with an 8.6% probability of effectiveness, 91.4% of potential harm, and 99.9%…