{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:19:38Z","timestamp":1785521978999,"version":"3.56.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":61,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Technology Research and Development Funding of Suzhou city","award":["SYW2025057"],"award-info":[{"award-number":["SYW2025057"]}]},{"name":"Technology Research and Development Funding of Suzhou city","award":["SYW2025153"],"award-info":[{"award-number":["SYW2025153"]}]},{"name":"Multicenter Clinical Research Project on Major Diseases of Suzhou city","award":["DZXYJ202513"],"award-info":[{"award-number":["DZXYJ202513"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tetanus is a life-threatening but vaccine-preventable disease. Despite existing preventive measures, severe tetanus continues to impose a significant burden in low- and middle-income countries. However, contemporary data on the clinical characteristics, treatment strategies, complications, and prognosis of patients with severe tetanus remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational cohort study of adult patients with severe tetanus (Ablett grade III or IV) admitted to the intensive care unit (ICU) of a tertiary infectious disease hospital from January 2014 to December 2024. Patient demographics, clinical manifestations, laboratory findings, treatment strategies, complications, and outcomes were extracted from electronic medical records and summarized using descriptive statistical methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 36 patients were included, the majority were older men from rural areas, and relatively few had received post-exposure prophylaxis. In the early stage of the disease, dysphagia and generalized muscle hypertonia were more frequent than classic symptoms such as trismus and opisthotonos. Most patients required tracheostomy, deep sedation, neuromuscular blockade, and invasive mechanical ventilation. Infectious complications were common, particularly pulmonary infections (80.6%). More than half of the patients (55.6%) had culture results indicating antimicrobial resistance. The median ICU length of stay was 27.5 days, and the in-hospital mortality rate was 16.7%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although severe tetanus is potentially fatal, outcomes can be improved with advanced intensive care management. Early intervention, comprehensive supportive therapy, strict infection control, and strengthened tetanus vaccination and post-exposure prophylaxis strategies are crucial.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-13697-6","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T12:44:35Z","timestamp":1779972275000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics, management, and outcomes of severe tetanus in the intensive care unit"],"prefix":"10.1186","volume":"26","author":[{"given":"Bin-bin","family":"Gu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng-feng","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teng","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing-hua","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"issue":"10181","key":"13697_CR1","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1016\/S0140-6736(18)33131-3","volume":"393","author":"LM Yen","year":"2019","unstructured":"Yen LM, Thwaites CL, Tetanus. Lancet. 2019;393(10181):1657\u201368. https:\/\/doi.org\/10.1016\/S0140-6736(18)33131-3.","journal-title":"Lancet"},{"key":"13697_CR2","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.2147\/IDR.S204650","volume":"12","author":"Z Fan","year":"2019","unstructured":"Fan Z, Zhao Y, Wang S, Zhang F, Zhuang C. Clinical features and outcomes of tetanus: a retrospective study. Infect Drug Resist. 2019;12:1289\u201393. https:\/\/doi.org\/10.2147\/IDR.S204650.","journal-title":"Infect Drug Resist"},{"key":"13697_CR3","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.ijid.2023.04.402","volume":"132","author":"J Li","year":"2023","unstructured":"Li J, Liu Z, Yu C, et al. Global epidemiology and burden of tetanus from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Int J Infect Dis. 2023;132:118\u201326. https:\/\/doi.org\/10.1016\/j.ijid.2023.04.402.","journal-title":"Int J Infect Dis"},{"issue":"1","key":"13697_CR4","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s41182-021-00336-w","volume":"49","author":"R Davies-Foote","year":"2021","unstructured":"Davies-Foote R, Trung TN, Duoc NVT, et al. Risk factors associated with mechanical ventilation, autonomic nervous dysfunction and physical outcome in Vietnamese adults with tetanus. Trop Med Health. 2021;49(1):50. https:\/\/doi.org\/10.1186\/s41182-021-00336-w.","journal-title":"Trop Med Health"},{"key":"13697_CR5","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.2147\/IJGM.S512024","volume":"18","author":"J Xu","year":"2025","unstructured":"Xu J, Wang Y, Huang G, et al. Factors Influencing the Length of Emergency Intensive Care Unit Stay in Adult Tetanus Patients. Int J Gen Med. 2025;18:1855\u201364. https:\/\/doi.org\/10.2147\/IJGM.S512024.","journal-title":"Int J Gen Med"},{"key":"13697_CR6","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s40560-017-0266-4","volume":"5","author":"VD Phu","year":"2017","unstructured":"Phu VD, Nadjm B, Duy NHA, et al. Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology. J Intensive Care. 2017;5:69. https:\/\/doi.org\/10.1186\/s40560-017-0266-4.","journal-title":"J Intensive Care"},{"issue":"Suppl 2","key":"13697_CR7","doi-asserted-by":"publisher","first-page":"S155","DOI":"10.5005\/jp-journals-10071-23829","volume":"25","author":"DR Karnad","year":"2021","unstructured":"Karnad DR, Gupta V. Intensive Care Management of Severe Tetanus. Indian J Crit Care Med. 2021;25(Suppl 2):S155\u201360. https:\/\/doi.org\/10.5005\/jp-journals-10071-23829.","journal-title":"Indian J Crit Care Med"},{"key":"13697_CR8","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/j.jcrc.2017.12.025","volume":"44","author":"M Nakajima","year":"2018","unstructured":"Nakajima M, Aso S, Matsui H, Fushimi K, Yasunaga H. Clinical features and outcomes of tetanus: Analysis using a National Inpatient Database in Japan. J Crit Care. 2018;44:388\u201391. https:\/\/doi.org\/10.1016\/j.jcrc.2017.12.025.","journal-title":"J Crit Care"},{"key":"13697_CR9","doi-asserted-by":"publisher","first-page":"2007","DOI":"10.2147\/IDR.S404747","volume":"16","author":"Y Gou","year":"2023","unstructured":"Gou Y, Li SM, Zhang JF, Hei XP, Lv BH, Feng K. 6084 Cases of Adult Tetanus from China: A Literature Analysis. Infect Drug Resist. 2023;16:2007\u201318. https:\/\/doi.org\/10.2147\/IDR.S404747.","journal-title":"Infect Drug Resist"},{"issue":"2","key":"13697_CR10","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1093\/cid\/ciaa017","volume":"72","author":"AM Slifka","year":"2021","unstructured":"Slifka AM, Park B, Gao L, Slifka MK. Incidence of Tetanus and Diphtheria in Relation to Adult Vaccination Schedules. Clin Infect Dis. 2021;72(2):285\u201392. https:\/\/doi.org\/10.1093\/cid\/ciaa017.","journal-title":"Clin Infect Dis"},{"issue":"7","key":"13697_CR11","doi-asserted-by":"publisher","first-page":"e101782","DOI":"10.1136\/bmjopen-2025-101782","volume":"15","author":"Z Chen","year":"2025","unstructured":"Chen Z, Lin Z, Zhang W, et al. Mortality and risk factors in hospitalised adult patients with tetanus: a systematic review and meta-analysis. BMJ Open. 2025;15(7):e101782. https:\/\/doi.org\/10.1136\/bmjopen-2025-101782.","journal-title":"BMJ Open"},{"issue":"11","key":"13697_CR12","doi-asserted-by":"publisher","first-page":"e645","DOI":"10.1016\/S1473-3099(25)00292-0","volume":"25","author":"R Sudarshan","year":"2025","unstructured":"Sudarshan R, Sayo AR, Renner DR, et al. Tetanus: recognition and management. Lancet Infect Dis. 2025;25(11):e645\u201357. https:\/\/doi.org\/10.1016\/S1473-3099(25)00292-0.","journal-title":"Lancet Infect Dis"},{"key":"13697_CR13","doi-asserted-by":"publisher","first-page":"1301724","DOI":"10.3389\/fpubh.2024.1301724","volume":"12","author":"Y An","year":"2024","unstructured":"An Y, Guo Y, Li L, et al. Management and outcome of adult generalized tetanus in a Chinese tertiary hospital. Front Public Health. 2024;12:1301724. https:\/\/doi.org\/10.3389\/fpubh.2024.1301724.","journal-title":"Front Public Health"},{"key":"13697_CR14","doi-asserted-by":"publisher","first-page":"107","DOI":"10.12688\/wellcomeopenres.16731.2","volume":"6","author":"NV Hao","year":"2021","unstructured":"Hao NV, Yen LM, Davies-Foote R, et al. The management of tetanus in adults in an intensive care unit in Southern Vietnam. Wellcome Open Res. 2021;6:107. https:\/\/doi.org\/10.12688\/wellcomeopenres.16731.2.","journal-title":"Wellcome Open Res"},{"issue":"1","key":"13697_CR15","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1186\/s13613-017-0333-y","volume":"7","author":"R Mahieu","year":"2017","unstructured":"Mahieu R, Reydel T, Maamar A, et al. Admission of tetanus patients to the ICU: a retrospective multicentre study. Ann Intensive Care. 2017;7(1):112. https:\/\/doi.org\/10.1186\/s13613-017-0333-y.","journal-title":"Ann Intensive Care"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-026-13697-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-13697-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-13697-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:09:56Z","timestamp":1785517796000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-026-13697-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["13697"],"URL":"https:\/\/doi.org\/10.1186\/s12879-026-13697-6","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]},"assertion":[{"value":"12 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This retrospective study involving human data was approved by the Ethics Committee of The Fifth People\u2019s Hospital of Suzhou (Approval No. HX-2025-001-02). All procedures involving human participants were performed in accordance with relevant guidelines and regulations and with the Declaration of Helsinki. The requirement for informed consent to participate was waived because of the retrospective design of the study and the use of de-identified clinical data.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1403"}}