INTRODUCTION Alcohol withdrawal syndrome is an important problem for management of alcoholism. It is known that alcohol alters the function of neurotransmitters such as serotonin, but our review found no studies associating serotonin concentration changes with patient clinical status during detoxification. The authors hypothesized that total platelet serotonin concentration should significantly increase during alcohol detoxification.

OBJECTIVE Assess possible association between total (endogenous and captured) platelet serotonin concentration and clinical status of patients with alcohol withdrawal syndrome, at beginning and end of detoxification with clomethiazole.

METHODS Thirty-one alcohol-dependent patients, diagnosed with alcohol withdrawal syndrome according to DSM-IV and classified in three clinical groups (18–20, 21–22 and 23–26 points) per the Clinical Institute Withdrawal Assessment for Alcohol Scale, were included in a prospective case series from May 2009 through May 2011 at the Hermanos Ameijeiras Clinical-Surgical Teaching Hospital in Cuba. Patients were predominantly male (87%), ranging in age from 22 to 57 years; 40% were white, 40% mestizo and 20% black. All had been hospitalized for detoxification in the hospital’s psychiatry service. Blood samples taken were mixed with 1% EDTA and centrifuged for isolating platelets. Serotonin concentrations (endogenous and captured) were measured within 2 hours of blood collection and mean values at treatment days 1 and 12 compared by t test (p <0.05).

RESULTS Total serotonin concentration mean values (µg of serotonin per mg of total platelet protein) were statistically different between days 1 and 12 of treatment (1.329±0.916 µg/mg vs. 2.573±1.224 µg/mg; p <0.001). There was a direct association between total serotonin concentration and patient clinical classification both initially and at day 12. At day 1, the 29 patients in the group with 18–20 points had mean serotonin of 1.358±0.0.94 µg/mg; one patient with 21 points had serotonin of 1.25 µg/mg; and one patient with 24 points had serotonin of 0.740 µg/mg. At day 12, 26 patients had 0–1 points, with mean serotonin 2.688±1.244 µg/mg; and 5 patients had 2–8 points, with mean serotonin 1.244±0.596 µg/mg. No patient had >8 points at day 12.

CONCLUSIONS Serotonin is a potential biomarker for initial clinical classification and outcome monitoring and could be useful to psychiatrists working with patients in this area of medical practice and research. Further studies including more patients and variables are necessary to support these preliminary results.

KEYWORDS Alcoholism, alcohol withdrawal syndrome, serotonin, biomarkers, Cuba

INTRODUCTION Nosocomial pneumonia associated with use of mechanical ventilators is one of the greatest challenges confronted by intensivists worldwide. The literature associates several bacteria with this type of infection; most common in intensive care units are Acinetobacter baumannii, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and some of the Enterobacteriaceae family.

OBJECTIVES To identify the causal agents of nosocomial ventilator-associated pneumonia in patients receiving mechanical ventilation in the intensive care units of Havana’s Hermanos Ameijeiras Clinical-Surgical Teaching Hospital in 2011, and to characterize their antibiotic resistance.

METHODS A cross-sectional descriptive study was conducted using hospital administrative data of quantitative cultures from positive tracheal aspirates for January through December, 2011. Records were analyzed from 77 intensive care unit patients who developed nosocomial ventilator-associated pneumonia. Variables examined were age and sex, and pathogens identified from culture of tracheal aspirate and related antibiotic susceptibility.

RESULTS Species most frequently isolated were: Acinetobacter baumannii in 53 patients (68.8%), Pseudomonas aeruginosa in 34 patients (44.2%), other species of Pseudomonas in 15 patients (19.5%), and Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli in 12 patients each (15.6%). Some patients presented more than one pathogen in concurrent or successive infections. Antimicrobial susceptibility testing found high percentages of resistance to antibiotics in all these pathogens. Least resistance was found to colistin.

CONCLUSIONS The prevalence of antibiotic resistance in bacteria causing nosocomial ventilator-associated pneumonia is of concern. Colistin is the drug of choice among the antibiotics reviewed, but sensitivity to other antibiotics should be assessed to search for more appropriate broad-spectrum antibiotics for treating nosocomial ventilator-associated pneumonia. Our results also suggest the need to strengthen infection control efforts, particularly in intensive care units, and to reassess compliance with quality control procedures. Multidisciplinary research involving microbiologists, epidemiologists, internists and intensivists is needed to fully understand the etiological and resistance patterns observed.

KEYWORDS Acinetobacter baumannii, nosocomial infections, mechanical ventilation, ventilator-associated pneumonia, bacterial resistance, microbial sensitivity tests, bacterial sensitivity tests, Cuba