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Gram-negative bacteremia is an independent predisposing factor for critical illness polyneuromyopathy


Critical illness polyneuromyopathy (CIPM) is a major clinical problem in the ICU resulting in prolonged ICU stay and increased morbidity and mortality.


To investigate risk factors of CIPM involved, in a general multidisciplinary ICU.

Patients and participants

Four hundred and seventy-four (323 males/151 females, age 55 ± 19) consecutively admitted patients in a 28-bed university multidisciplinary ICU were prospectively evaluated. All patients were assigned admission APACHE II (15 ± 7) and SOFA (6 ± 3) scores and were subsequently evaluated for newly developed neuromuscular weakness. We examined muscle strength according to the Medical Research Council scale, deep tendon reflexes, sensory function and muscle wasting. Laboratory values and medical therapy were recorded daily. Other potential causes of new-onset generalized weakness after ICU admission were excluded before the diagnosis of CIPM was established. Out of the 474 patients, 185 remained in the ICU for ≥10 days.


Forty-four (23.8%) out of those 185 patients developed generalized weakness that met the criteria for CIPM. Patients with CIPM had a higher admission APACHE II score (18.9 ± 6.6 vs 15.6 ± 6.4, P = 0.004) and SOFA score (8.4 ± 2.9 vs 7.1 ± 2.9, P = 0.013). Multivariate logistic regression analysis showed that risk factors independently associated with the development of CIPM were severity of illness at the time of admission to the ICU, administration of aminoglycoside antibiotics and high blood glucose levels. Analysis according to severity of illness stratification revealed the emergence of Gram-negative bacteremia as the most important independent predisposing factor for CIPM development in less severely ill patients.


CIPM has a high incidence in the ICU setting. Our study revealed the important association that Gram-negative bacteremia, aminoglycosides, hyperglycemia and severity of illness have with CIPM development.

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Kritikos, K., Angelopoulos, E., Siafaka, A. et al. Gram-negative bacteremia is an independent predisposing factor for critical illness polyneuromyopathy. Crit Care 11 (Suppl 2), P343 (2007).

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