Mahieu R, et al. - An extended course of tetanus (up to 6 weeks) requiring ICU admission and protracted mechanical ventilation (MV) may have a significant impact on short- and long-term survival. In this study, a predominant occurrence of tetanus was reported in healthy elderly women, in a high-income country (France). Notably, a low 1-year mortality rate and good long-term functional status were reported despite prolonged MV and extended ICU length of stay.

Methods

• Tetanus screenings was performed in 22 ICUs in France, on patients admitted between January 2000 and December 2014.
• Using hospital databases and through the registers of the town hall of the patients, retrospective data were obtained.

Results

• This study comprised 70 patients in 15 different ICUs.
• According to the Ablett classification, 63 patients suffered from severe or very severe tetanus.
• The reported median age was 80 years [interquartile range 73–84], and women constituted 86% of patients.
• Findings demonstrated that 90% of patients (n = 63) needed MV for a median of 36 days [26–46], and 66% required administration of a neuromuscular-blocking agent for 23 days [14–29].
• Forty-three patients (61%) developed a nosocomial infection.
• Researchers found that ICU and 1-year mortality rates were 14% (n = 10) and 16% (n = 11), respectively.
• During the first week, 45% of deaths occurred.
• Researchers observed that advanced age, a higher SAPS II, any infection, and the use of vasopressors were significantly related to a lower number of days alive without ventilator support by day 90.
• They also identified age as the only factor that significantly differed between deceased and survivors at 1 year (83 [81–85] vs. 79 [73–84] years, respectively; p=0.03).
• In addition, data reported that 61% of survivors suffered no impairment to their functional status.