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47 ud af 47 tidsskrifter valgt, søgeord (sepsis) valgt, emner højest 180 dage gamle, sorteret efter nyeste først.
177 emner vises.
Kyu Jin Lee, Yong Kyun Kim, Kyeongman Jeon, Ryoung-Eun Ko, Gee Young Suh, Dong Kyu Oh, Sung Yoon Lim, Yeon Joo Lee, Su Yeon Lee, Mi-Hyeon Park, Chae-Man Lim, Sunghoon Park, on behalf of the Korean Sepsis Alliance (KSA) investigators
PLoS One Infectious Diseases, 13.03.2024
Tilføjet 13.03.2024
by Kyu Jin Lee, Yong Kyun Kim, Kyeongman Jeon, Ryoung-Eun Ko, Gee Young Suh, Dong Kyu Oh, Sung Yoon Lim, Yeon Joo Lee, Su Yeon Lee, Mi-Hyeon Park, Chae-Man Lim, Sunghoon Park, on behalf of the Korean Sepsis Alliance (KSA) investigators Background The understanding of shock indices in patients with septic shock is limited, and their values may vary depending on cardiac function. Methods This prospective cohort study was conducted across 20 university-affiliated hospitals (21 intensive care units [ICUs]). Adult patients (≥19 years) with septic shock admitted to the ICUs during a 29-month period were included. The shock index (SI), diastolic shock index (DSI), modified shock index (MSI), and age shock index (Age-SI) were calculated at sepsis recognition (time zero) and ICU admission. Left ventricular (LV) function was categorized as either normal LV ejection fraction (LVEF ≥ 50%) or decreased LVEF (
Læs mere Tjek på PubMedLisanne M. van Leeuwen, Elandri Fourie, Gerrie van den Brink, Vincent Bekker, Marlies A. van Houten
Clinical Microbiology and Infection, 10.03.2024
Tilføjet 10.03.2024
An accurate diagnosis of early onset sepsis (EOS) is challenging due to subtle symptoms and the lack of a good diagnostic tool, resulting in considerable antibiotic overtreatment. A biomarker, discriminating between infected and non-infected newborns early in the disease, could improve EOS prediction. Numerous biomarkers have been tested, but have never been compared directly.
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.03.2024
Tilføjet 8.03.2024
Abstract Background Invasive meningococcal disease (IMD), including sepsis and meningitis, can develop when Neisseria meningitidis bacteria breach the barrier and gain access to the circulation. While IMD is a rare outcome of bacterial exposure, colonization of the oropharynx is present in approximately 10% of the human population. This asymptomatic carriage can be long or short term, and it is unknown which determining factors regulate bacterial colonization. Despite descriptions of many bacterial virulence factors and recent advances in detailed genetic identification and characterization of bacteria, the factors mediating invasion and disease vs. asymptomatic carriage following bacterial colonization remain unknown. The pharyngeal epithelia play a role in the innate immune defense against pathogens, and the aim of this study was to investigate the proinflammatory response of pharyngeal epithelial cells following meningococcal exposure to describe the potential inflammatory mediation performed during the initial host‒pathogen interaction. Clinically relevant isolates of serogroups B, C, W and Y, derived from patients with meningococcal disease as well as asymptomatic carriers, were included in the study. Results The most potent cellular response with proinflammatory secretion of TNF, IL-6, CXCL8, CCL2, IL-1β and IL-18 was found in response to invasive serogroup B isolates. This potent response pattern was also mirrored by increased bacterial adhesion to cells as well as induced cell death. It was, however, only with serogroup B isolates where the most potent cellular response was toward the IMD isolates. In contrast, the most potent cellular response using serogroup Y isolates was directed toward the carriage isolates rather than the IMD isolates. In addition, by comparing isolates from outbreaks in Sweden (epidemiologically linked and highly genetically similar), we found the most potent proinflammatory response in cells exposed to carriage isolates rather than the IMD isolates. Conclusion Although certain expected correlations between host‒pathogen interactions and cellular proinflammatory responses were found using IMD serogroup B isolates, our data indicate that carriage isolates invoke stronger proinflammatory activation of the epithelial lining than IMD isolates.
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.03.2024
Tilføjet 8.03.2024
Abstract Background There is limited information about the outcomes of polymicrobial bloodstream infections in patients with sepsis. We aimed to investigate outcomes of polymicrobial bloodstream infections compared to monomicrobial bloodstream infections. Methods This study used data from the Korean Sepsis Alliance Registry, a nationwide database of prospective observational sepsis cohort. Adult sepsis patients with bloodstream infections from September 2019 to December 2021 at 20 tertiary or university-affiliated hospitals in South Korea were analyzed. Results Among the 3,823 patients with bloodstream infections, 429 of them (11.2%) had polymicrobial bloodstream infections. The crude hospital mortality of patients with sepsis with polymicrobial bloodstream infection and monomicrobial bloodstream infection was 35.7% and 30.1%, respectively (p = 0.021). However, polymicrobial bloodstream infections were not associated with hospital mortality in the proportional hazard analysis (HR 1.15 [0.97–1.36], p = 0.11). The inappropriate use of antibiotics was associated with increased mortality (HR 1.37 [1.19–1.57], p
Læs mere Tjek på PubMedInfection, 7.03.2024
Tilføjet 7.03.2024
Abstract Purpose Blood cultures (BCs) are key for pathogen detection in septic patients. We investigated the extent to which sampling was performed and what factors were associated with the absence of general or inadequate BC sampling. Methods We conducted a retrospective cohort study of hospitalized patients with sepsis admitted to one of three EDs in 2018. Primary outcome was the extent of general BC collection of at least 1 set. Secondary outcome was the extent of adequate BC sampling, defined as ≥ 2 sets before antibiotic therapy (AT). Multivariable logistic regression analysis was performed to identify factors associated with deficits in both outcomes. Results 1143 patients were analyzed. BCs were collected from 946 patients. Single BCs were taken from 520 patients, ≥ 2 sets from 426 patients. Overall, ≥ 2 BCs were taken from 349 patients before AT. BC sampling before AT occurred significantly more frequently when ≥ 2 BC sets were taken rather than a single one (81.9%, versus 68.4%, p
Læs mere Tjek på PubMedBMC Infectious Diseases, 7.03.2024
Tilføjet 7.03.2024
Abstract Background Invasive meningococcal disease (IMD), including sepsis and meningitis, can develop when Neisseria meningitidis bacteria breach the barrier and gain access to the circulation. While IMD is a rare outcome of bacterial exposure, colonization of the oropharynx is present in approximately 10% of the human population. This asymptomatic carriage can be long or short term, and it is unknown which determining factors regulate bacterial colonization. Despite descriptions of many bacterial virulence factors and recent advances in detailed genetic identification and characterization of bacteria, the factors mediating invasion and disease vs. asymptomatic carriage following bacterial colonization remain unknown. The pharyngeal epithelia play a role in the innate immune defense against pathogens, and the aim of this study was to investigate the proinflammatory response of pharyngeal epithelial cells following meningococcal exposure to describe the potential inflammatory mediation performed during the initial host‒pathogen interaction. Clinically relevant isolates of serogroups B, C, W and Y, derived from patients with meningococcal disease as well as asymptomatic carriers, were included in the study. Results The most potent cellular response with proinflammatory secretion of TNF, IL-6, CXCL8, CCL2, IL-1β and IL-18 was found in response to invasive serogroup B isolates. This potent response pattern was also mirrored by increased bacterial adhesion to cells as well as induced cell death. It was, however, only with serogroup B isolates where the most potent cellular response was toward the IMD isolates. In contrast, the most potent cellular response using serogroup Y isolates was directed toward the carriage isolates rather than the IMD isolates. In addition, by comparing isolates from outbreaks in Sweden (epidemiologically linked and highly genetically similar), we found the most potent proinflammatory response in cells exposed to carriage isolates rather than the IMD isolates. Conclusion Although certain expected correlations between host‒pathogen interactions and cellular proinflammatory responses were found using IMD serogroup B isolates, our data indicate that carriage isolates invoke stronger proinflammatory activation of the epithelial lining than IMD isolates.
Læs mere Tjek på PubMedTakehiko OamiShabnam AbtahiTakashi ShimazuiChing-Wen ChenYan Y. SweatZhe LiangEileen M. BurdAlton B. FarrisJoe T. RolandSachiko TsukitaMandy L. FordJerrold R. TurnerCraig M. CoopersmithaDepartment of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA 30322bDepartment of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba 260-8670, JapancLaboratory of Mucosal Pathobiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115dDepartment of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322eEpithelial Biology Center, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37240fAdvanced Comprehensive Research Organization, Teikyo University, Tokyo 173-0003, JapangDepartment of Surgery and Emory Transplant Center, Emory University School of Medicine, Atlanta, GA 30322
Proceedings of the National Academy of Sciences, 6.03.2024
Tilføjet 6.03.2024
Proceedings of the National Academy of Sciences, Volume 121, Issue 10, March 2024.
Læs mere Tjek på PubMedInfection, 6.03.2024
Tilføjet 6.03.2024
Abstract Purpose Blood cultures (BCs) are key for pathogen detection in septic patients. We investigated the extent to which sampling was performed and what factors were associated with the absence of general or inadequate BC sampling. Methods We conducted a retrospective cohort study of hospitalized patients with sepsis admitted to one of three EDs in 2018. Primary outcome was the extent of general BC collection of at least 1 set. Secondary outcome was the extent of adequate BC sampling, defined as ≥ 2 sets before antibiotic therapy (AT). Multivariable logistic regression analysis was performed to identify factors associated with deficits in both outcomes. Results 1143 patients were analyzed. BCs were collected from 946 patients. Single BCs were taken from 520 patients, ≥ 2 sets from 426 patients. Overall, ≥ 2 BCs were taken from 349 patients before AT. BC sampling before AT occurred significantly more frequently when ≥ 2 BC sets were taken rather than a single one (81.9%, versus 68.4%, p
Læs mere Tjek på PubMedBMC Infectious Diseases, 5.03.2024
Tilføjet 5.03.2024
Abstract Background There is limited information about the outcomes of polymicrobial bloodstream infections in patients with sepsis. We aimed to investigate outcomes of polymicrobial bloodstream infections compared to monomicrobial bloodstream infections. Methods This study used data from the Korean Sepsis Alliance Registry, a nationwide database of prospective observational sepsis cohort. Adult sepsis patients with bloodstream infections from September 2019 to December 2021 at 20 tertiary or university-affiliated hospitals in South Korea were analyzed. Results Among the 3,823 patients with bloodstream infections, 429 of them (11.2%) had polymicrobial bloodstream infections. The crude hospital mortality of patients with sepsis with polymicrobial bloodstream infection and monomicrobial bloodstream infection was 35.7% and 30.1%, respectively (p = 0.021). However, polymicrobial bloodstream infections were not associated with hospital mortality in the proportional hazard analysis (HR 1.15 [0.97–1.36], p = 0.11). The inappropriate use of antibiotics was associated with increased mortality (HR 1.37 [1.19–1.57], p
Læs mere Tjek på PubMedBMC Infectious Diseases, 5.03.2024
Tilføjet 5.03.2024
Abstract Background The performance of the sepsis-induced coagulopathy (SIC) and sequential organ failure assessment (SOFA) scores in predicting the prognoses of patients with sepsis has been validated. This study aimed to investigate the time course of SIC and SOFA scores and their association with outcomes in patients with sepsis. Methods This prospective study enrolled 209 patients with sepsis admitted to the emergency department. The SIC and SOFA scores of the patients were assessed on days 1, 2, and 4. Patients were categorized into survivor or non-survivor groups based on their 28-day survival. We conducted a generalized estimating equation analysis to evaluate the time course of SIC and SOFA scores and the corresponding differences between the two groups. The predictive value of SIC and SOFA scores at different time points for sepsis prognosis was evaluated. Results In the non-survivor group, SIC and SOFA scores gradually increased during the first 4 days (P < 0.05). In the survivor group, the SIC and SOFA scores on day 2 were significantly higher than those on day 1 (P < 0.05); however, they decreased on day 4, dropping below the levels observed on day 1 (P < 0.05). The non-survivors showed higher SIC scores on days 2 (P < 0.05) and 4 (P < 0.001) than the survivors, whereas no significant differences were found between the two groups on day 1 (P > 0.05). The performance of SIC scores on day 4 for predicting mortality was more accurate than that on day 2, with areas under the curve of 0.749 (95% confidence interval [CI]: 0.674–0.823), and 0.601 (95% CI: 0.524–0.679), respectively. The SIC scores demonstrated comparable predictive accuracy for 28-day mortality to the SOFA scores on days 2 and 4. Cox proportional hazards models indicated that SIC on day 4 (hazard ratio [HR] = 3.736; 95% CI: 2.025–6.891) was an independent risk factor for 28-day mortality. Conclusions The time course of SIC and SOFA scores differed between surviving and non-surviving patients with sepsis, and persistent high SIC and SOFA scores can predict 28-day mortality.
Læs mere Tjek på PubMedClinical & Experimental Immunology, 2.03.2024
Tilføjet 2.03.2024
Abstract Sepsis is characterised by a dysfunctional host response to infection culminating in life-threatening organ failure that requires complex patient management and rapid intervention. Timely diagnosis of the underlying cause of sepsis is crucial, and identifying those at risk of complications and death is imperative for triaging treatment and resource allocation. Here, we explored the potential of explainable machine learning models to predict mortality and causative pathogen in sepsis patients. By using a modelling pipeline employing multiple feature selection algorithms, we demonstrate the feasibility to identify integrative patterns from clinical parameters, plasma biomarkers and extensive phenotyping of blood immune cells. Whilst no single variable had sufficient predictive power, models that combined five and more features showed a macro area under the curve (AUC) of 0.85 to predict 90 day mortality after sepsis diagnosis, and a macro AUC of 0.86 to discriminate between Gram-positive and Gram-negative bacterial infections. Parameters associated with the cellular immune response contributed the most to models predictive of 90 day mortality, most notably, the proportion of T cells among PBMCs, together with expression of CXCR3 by CD4+ T cells and CD25 by mucosal-associated invariant T (MAIT) cells. Frequencies of Vδ2+ γδ T cells had the most profound impact on the prediction of Gram-negative infections, alongside other T cell-related variables and total neutrophil count. Overall, our findings highlight the added value of measuring the proportion and activation patterns of conventional and unconventional T cells in the blood of sepsis patients in combination with other immunological, biochemical and clinical parameters.
Læs mere Tjek på PubMedAmerson, Stephen J.; Hoffman, McKenna; Abouzahr, Fadi; Ahmad, Mohammad; Sterling, Rachel K.; Gidwani, Hitesh; Sousse, Linda E.; Dellavolpe, Jeffrey D.
Critical Care Explorations, 2.03.2024
Tilføjet 2.03.2024
BACKGROUND: Streptococcal toxic shock syndrome (STSS) is a fulminant complication of predominantly invasive group A streptococcal infections. STSS is often characterized by influenza-like symptoms, including fever, chills, and myalgia that can quickly progress to sepsis with hypotension, tachycardia, tachypnea, and multiple organ failure (kidney, liver, lung, or blood). Mortality can exceed 50% depending on the severity of symptoms. CASE SUMMARY: Here, we describe a novel, multi-extracorporeal intervention strategy in a case of severe septic shock secondary to STSS. A 28-year-old woman 5 days after cesarean section developed STSS with respiratory distress, hypotension, and multiple organ failure. Despite conventional therapy with intubation, antibiotics, vasopressors, and fluid resuscitation, her condition worsened. She was placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) with subsequent initiation of pathogen hemoperfusion using the Seraph 100 blood filter, followed by immunomodulation with the selective cytopheretic device (SCD). No device-related adverse events were observed. The patient’s condition gradually stabilized with discontinuation of vasopressors after 4 days, ECMO decannulation after 6 days, evidence of renal recovery after 7 days, and extubation from mechanical ventilation after 14 days. She was transferred to conventional hemodialysis after 13 days and discontinued all kidney replacement therapy 11 days later. CONCLUSIONS: This is the first reported use of VA-ECMO, Seraph 100 hemoperfusion, and cell-directed immunomodulation with SCD. This multimodal approach to extracorporeal support represents a promising therapeutic strategy for the most refractory critical care cases. Further studies are needed to assess the safety and efficacy of this sequential approach.
Læs mere Tjek på PubMedNovazzi Federica, Colombini Lorenzo, Perniciaro Simona, Genoni Angelo, Agosti Massimo, Santoro Francesco, Mancini Nicasio
Clinical Microbiology and Infection, 1.03.2024
Tilføjet 1.03.2024
Streptococcus pyogenes (Group A Streptococcus – GAS) is responsible for millions of infections and more than 500,000 deaths worldwide annually [1]. Generally, the primary site of GAS is the oropharynx with pharyngotonsillitis and scarlet fever as its most common “suppurative” manifestations, possibly complicated by “non-suppurative” autoimmune sequelae. However, an increase in invasive GAS (iGAS) infections with detectable bacteremia was reported throughout Europe since late 2022 [2]. Even if less frequently than Streptococcus agalactiae (Group B streptococcus - GBS) and Escherichia coli, GAS can occasionally colonize the female genital tract and cause serious complications including puerperal sepsis and early-onset neonatal sepsis (EOS) [3].
Læs mere Tjek på PubMedFlorian B. Mayr, Derek C. Angus
American Journal of Respiratory and Critical Care Medicine , 1.03.2024
Tilføjet 1.03.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 5, Page 468-469, March 1, 2024.
Læs mere Tjek på PubMedMichael A. Matthay, Eric P. Schmidt, Julie A. Bastarache, Carolyn S. Calfee, Charles W. Frevert, Thomas R. Martin
American Journal of Respiratory and Critical Care Medicine , 1.03.2024
Tilføjet 1.03.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 5, Page 488-490, March 1, 2024.
Læs mere Tjek på PubMedHallie C. Prescott, David A. Harrison, Kathryn M. Rowan, Manu Shankar-Hari, Hannah Wunsch
American Journal of Respiratory and Critical Care Medicine , 1.03.2024
Tilføjet 1.03.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 5, Page 507-516, March 1, 2024.
Læs mere Tjek på PubMedSégolène Gendreau, Thomas Frapard, Guillaume Carteaux, Arthur Kwizera, Neill K. J. Adhikari, Mervyn Mer, Glenn Hernandez, Armand Mekontso Dessap
American Journal of Respiratory and Critical Care Medicine , 1.03.2024
Tilføjet 1.03.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 5, Page 517-528, March 1, 2024.
Læs mere Tjek på PubMedJournal of the American Medical Association, 1.03.2024
Tilføjet 1.03.2024
Sepsis has been recognized as an important cause of morbidity and mortality for more than 2800 years. Derived from the Greek word sepo (σηπω, translated as “I rot,”), sepsis appears in writings of Homer, Hippocrates, Aristotle, and Galen. Conceptually, sepsis denotes a “line in the sand” within the broad spectrum of host-microbe interactions. It indicates that not only is the microbe unwanted (in contrast to the many microbes that live on and within us and contribute to health and digestion), but the host’s attempts to eradicate the microbe are resulting in collateral damage.
Læs mere Tjek på PubMedJournal of the American Medical Association, 1.03.2024
Tilføjet 1.03.2024
Everyone must acknowledge the difficulty of distinguishing diseases…whoever denies this may as well deny that there is such a thing as medical art.William Cullen
Læs mere Tjek på PubMedJournal of the American Medical Association, 1.03.2024
Tilføjet 1.03.2024
This article revises criteria to identify sepsis in children after an exhaustive process that involved surveying clinicians, reviewing health record databases, conducting a systematic review and meta-analysis, and undergoing a Delphi consensus process.
Læs mere Tjek på PubMedJournal of the American Medical Association, 1.03.2024
Tilføjet 1.03.2024
This cohort study derives and validates novel criteria for diagnosis of pediatric sepsis and septic shock across high-resource and low-resource international settings.
Læs mere Tjek på PubMedTaylor, Stephanie P.; Kowalkowski, Marc A.; Skewes, Sable; Chou, Shih-Hsiung
Critical Care Medicine, 28.02.2024
Tilføjet 28.02.2024
Objective: To evaluate real-world implications of updated Surviving Sepsis Campaign (SSC) recommendations for antibiotic timing. Design: Retrospective cohort study. Setting: Twelve hospitals in the Southeastern United States between 2017 and 2021. Patients: One hundred sixty-six thousand five hundred fifty-nine adult hospitalized patients treated in the emergency department for suspected serious infection. Interventions: None. Measurements and Main Results: We determined the number and characteristics of patients affected by updated SSC recommendations for initiation of antibiotics that incorporate a risk- and probability-stratified approach. Using an infection prediction model with a cutoff of 0.5 to classify possible vs. probable infection, we found that 30% of the suspected infection cohort would be classified as shock absent, possible infection and thus eligible for the new 3-hour antibiotic recommendation. In real-world practice, this group had a conservative time to antibiotics (median, 5.5 hr; interquartile range [IQR], 3.2–9.8 hr) and low mortality (2%). Patients categorized as shock absent, probable infection had a median time to antibiotics of 3.2 hours (IQR, 2.1–5.1 hr) and mortality of 3%. Patients categorized as shock present, the probable infection had a median time to antibiotics 2.7 hours (IQR, 1.7–4.6 hr) and mortality of 17%, and patients categorized as shock present, the possible infection had a median time to antibiotics 6.9 hours (IQR, 3.5–16.3 hr) and mortality of 12%. Conclusions: These data support recently updated SSC recommendations to align antibiotic timing targets with risk and probability stratifications. Our results provide empirical support that clinicians and hospitals should not be held to 1-hour targets for patients without shock and with only possible sepsis.
Læs mere Tjek på PubMedRaphaël Lecomte, Colin Deschanvres, Alexis Bourreau, Louise Ruffier d'Epenoux, Paul Le Turnier, Benjamin Gaborit, Marie Chauveau, Magali Michel, Thierry Le Tourneau, Pascale Bémer, Stéphane Corvec, David Boutoille
International Journal of Infectious Diseases, 28.02.2024
Tilføjet 28.02.2024
In most cases, treatment of infective endocarditis (IE) is empirical until the causative pathogens are identified, with two major important points. First, empirical antimicrobial therapy (EAT) is the cornerstone of sepsis therapy and any delay in time to appropriate antimicrobial therapy increases sepsis mortality, particularly in cases of septic shock [1]. Second, since Staphylococcus aureus is the leading cause of IE and is associated with higher mortality [2,3], it is crucial that EAT for infective endocarditis includes drugs that have optimal anti-staphylococcal activity [4,5].
Læs mere Tjek på PubMedYue, J., Zhao, H., Li, J., Wu, J., Zheng, R.
BMJ Open, 28.02.2024
Tilføjet 28.02.2024
ObjectivesTo evaluate the knowledge, attitudes and practices towards diagnosing and managing paediatric sepsis among paediatric physicians and nurses. DesignA cross-sectional, questionnaire-based study. Setting21 hospitals in Hubei Province between February 2023 and March 2023. ParticipantsPaediatric physicians and nurses. InterventionsNone. Primary and secondary outcome measuresThe questionnaire contained 35 items across four dimensions (demographic information, knowledge, attitude and practice). ResultsThe study included 295 participants (173 women). The average knowledge, attitude and practice scores were 10.93±2.61 points (possible range, 0–20 points), 32.22±2.65 points (possible range, 7–35 points) and 36.54±5.24 points (possible range, 9–45 points), respectively. Knowledge had a direct influence on both attitude (β=0.240, 95% CI 0.136 to 0.365, p=0.009) and practice (β=0.278, 95% CI 0.084 to 0.513, p=0.010), which also indirectly influenced practice through attitude (β=0.162, 95% CI 0.078 to 0.290, p=0.007). Attitude directly influenced practice (β=0.677, 95% CI 0.384 to 0.902, p=0.025). A higher attitude score was associated with good practice (OR=1.392; 95% CI 1.231 to 1.576; p
Læs mere Tjek på PubMedTilahun, B. D., Yilak, G., Amena, N., Abate, B. B., Fantahun, A., Deribe, L.
BMJ Open, 28.02.2024
Tilføjet 28.02.2024
ObjectiveTo assess the uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care units of selected governmental hospitals in Addis Ababa, Ethiopia, 2022. DesignA cross-sectional study conducted from 3 March 2022 to 30 March 2022. SettingThe research was conducted at a government hospital in Addis Ababa, Ethiopia. ParticipantsOut of 305 eligible participants, 303 were parents of preterm infants’ participants with complete data. Primary outcome measureLevels of parental uncertainty, assessed by using the Mishel scale of uncertainty. Simple and multivariable linear regression analyses were conducted to assess associations between variables. ResultsThe mean uncertainty expressed by parents was 101.3 (SD=21.12). There were significant associations found with various factors. The sex of the respondent fathers (β=–4.65, 95% CI –9.32 to –0.025), length of neonatal intensive care unit (NICU) stay >10 days (β=14.64, 95% CI 8.71 to 20.56), gestational week between 34 and 37 weeks (β=–7.47, 95% CI –11.42 to –3.52), parents with college degrees and above (β=–14.15, 95% CI –22.94 to –5.34), parents with neonates who were preterm and had neonatal sepsis (β=10.42, 95% CI –17.57 to –3.27), parents without a history of neonatal NICU admission (β=–6.16, 95% CI –11.69 to –0.63) and parents who were housewives (β=6.51, 95% CI 1.83 to 12.19) all showed significant associations. ConclusionFactors like educational status, gestational week, neonatal admission history and NICU stay length contribute to parental uncertainty. Promoting empathy and clear communication is crucial. Hospitals should develop compassionate protocols for information delivery, including regular updates and effective addressing of concerns. Fostering a supportive environment helps parents express emotions and seek support.
Læs mere Tjek på PubMedInfection, 26.02.2024
Tilføjet 26.02.2024
Abstract Purpose Sepsis suspicion by Emergency Medical Services (EMS) is associated with improved patient outcomes. This study assessed sepsis incidence and recognition by EMS and analyzed which of the screening tools recommended by the Surviving Sepsis Campaign best facilitates sepsis prediction. Methods Retrospective cohort study of claims data from health insurances (n = 221,429 EMS cases), and paramedics’ and emergency physicians’ EMS documentation (n = 110,419); analyzed outcomes were: sepsis incidence and case fatality compared to stroke and myocardial infarction, the extent of documentation for screening-relevant variables and sepsis suspicion, tools’ intersections for screening positive in identical EMS cases and their predictive ability for an inpatient sepsis diagnosis. Results Incidence of sepsis (1.6%) was similar to myocardial infarction (2.6%) and stroke (2.7%); however, 30-day case fatality rate was almost threefold higher (31.7% vs. 13.4%; 11.8%). Complete vital sign documentation was achieved in 8.2% of all cases. Paramedics never, emergency physicians rarely (0.1%) documented a sepsis suspicion, respectively septic shock. NEWS2 had the highest sensitivity (73.1%; Specificity:81.6%) compared to qSOFA (23.1%; Sp:96.6%), SIRS (28.2%; Sp:94.3%) and MEWS (48.7%; Sp:88.1%). Depending on the tool, 3.7% to 19.4% of all cases screened positive; only 0.8% in all tools simultaneously. Conclusion Incidence and mortality underline the need for better sepsis awareness, documentation of vital signs and use of screening tools. Guidelines may omit MEWS and SIRS as recommendations for prehospital providers since they were inferior in all accuracy measures. Though no tool performed ideally, NEWS2 qualifies as the best tool to predict the highest proportion of septic patients and to rule out cases that are likely non-septic.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 25.02.2024
Tilføjet 25.02.2024
Abstract Klebsiella pneumoniae is the leading cause of neonatal sepsis and is increasingly difficult to treat due to antibiotic resistance. Vaccination represents a tractable approach to combat this resistant bacterium; however, there is currently not a licensed vaccine. Surface polysaccharides, including O-antigens of lipopolysaccharide, have long been attractive candidates for vaccine inclusion. Herein we describe the generation of a bioconjugate vaccine targeting seven predominant O-antigen subtypes in K. pneumoniae. Each bioconjugate was immunogenic in isolation, with limited cross-reactivity among subtypes. Vaccine-induced antibodies demonstrated varying degrees of binding to a wide variety of K. pneumoniae strains. Further, sera from vaccinated mice induced complement-mediated killing of many of these strains. Finally, increased capsule interfered with O-antigen antibodies’ ability to bind and mediate killing of some K. pneumoniae strains. Taken together, these data indicate that this novel heptavalent O-antigen bioconjugate vaccine formulation exhibits limited efficacy against some, but not all, K. pneumoniae isolates.
Læs mere Tjek på PubMedBMC Infectious Diseases, 24.02.2024
Tilføjet 24.02.2024
Abstract Introduction The Neutrophil-Lymphocyte Ratio (NLR) in blood has demonstrated its capability to predict bacteremia in emergency departments, and its association with mortality has been established in patients with sepsis in intensive care units. However, its potential concerning mortality and readmission in patients with Gram-negative bacteremia (GNB) is unexplored. Methods This retrospective cohort study included patients with GNB between 2018 and 2022 from six hospitals in the Capital Region of Denmark. Patients who were immunosuppressed or had missing NLR values on the day of blood culture were excluded. Logistic regression models were used to analyze the association between NLR levels and 90-day all-cause mortality, while the logit link interpretation of the cumulative incidence function was used to assess the association between NLR levels and 60-day readmission. Associations were quantified as odds ratios (OR) with corresponding 95% confidence intervals (CI). Results The study included 1763 patients with a median age was 76.8 years and 51.3% were female. The median NLR was 17.3 and 15.8% of patients had a quick sequential organ failure assessment score of two or three. Urinary tract infection (UTI) was the most frequent focus and Escherichia coli the most frequent pathogen. Statistically significant differences in median NLR were found by age group and pathogen, and for patients with or without hypertension, liver disease, chronic obstructive pulmonary disease, dementia, and alcohol abuse. 378 patients (21.4%) died before 90 days. 526 (29.8%) patients were readmitted to the hospital within 60 days. For each doubling of the NLR, the OR for all-cause 90-day mortality was 1.15 (95% CI, 1.04–1.27) and 1.12 (95% CI, 1.02–1.24) for 60-day readmission. Analysis of subgroups did not show statistically significant differences between groups in relation to the association between NLR and mortality. The discriminatory ability of NLR for mortality was limited and comparable to blood neutrophil or lymphocyte count, producing receiver operating characteristic curves with an area under the curve of 0.59 (95% CI, 0.56–0.63), 0.60 (95% CI, 0.56–0.65) and 0.53 (95% CI, 0.49–0.56), respectively. Conclusion Blood neutrophil-lymphocyte ratio was associated with 90-day all-cause mortality and 60-day readmission in patients with GNB. However, the ratio has limited ability in predicting mortality or readmission.
Læs mere Tjek på PubMedWebb, Lece V; Evans, Jakob; Smith, Veronica; Pettibone, Elisabeth; Tofil, Jarod; Hicks, Jessica Floyd; Green, Sherry; Nassel, Ariann; Loberger, Jeremy M
Critical Care Explorations, 23.02.2024
Tilføjet 23.02.2024
IMPORTANCE: Sepsis is a leading cause of morbidity and mortality in the United States and disparate outcomes exist between racial/ethnic groups despite improvements in sepsis management. These observed differences are often related to social determinants of health (SDoH). Little is known about the role of SDoH on outcomes in pediatric sepsis. OBJECTIVE: This study examined the differences in care delivery and outcomes in children with severe sepsis based on race/ethnicity and neighborhood context (as measured by the social vulnerability index). DESIGN, SETTING, AND PARTICIPANTS: This retrospective, cross-sectional study was completed in a quaternary care children’s hospital. Patients 18 years old or younger who were admitted between May 1, 2018, and February 28, 2022, met the improving pediatric sepsis outcomes (IPSO) collaborative definition for severe sepsis. Composite measures of social vulnerability, care delivery, and clinical outcomes were stratified by race/ethnicity. MAIN OUTCOMES AND MEASURES: The primary outcome of interest was admission to the PICU. Secondary outcomes were sepsis recognition and early goal-directed therapy (EGDT). RESULTS: A total of 967 children met the criteria for IPSO-defined severe sepsis, of whom 53.4% were White/non-Hispanic. Nearly half of the cohort (48.7%) required PICU admission. There was no difference in illness severity at PICU admission by race (1.01 vs. 1.1, p = 0.18). Non-White race/Hispanic ethnicity was independently associated with PICU admission (odds ratio [OR] 1.35 [1.01–1.8], p = 0.04). Although social vulnerability was not independently associated with PICU admission (OR 0.95 [0.59–1.53], p = 0.83), non-White children were significantly more likely to reside in vulnerable neighborhoods (0.66 vs. 0.38, p < 0.001). Non-White race was associated with lower sepsis recognition (87.8% vs. 93.6%, p = 0.002) and less EGDT compliance (35.7% vs. 42.8%, p = 0.024). CONCLUSIONS AND RELEVANCE: Non-White race/ethnicity was independently associated with PICU admission. Differences in care delivery were also identified. Prospective studies are needed to further investigate these findings.
Læs mere Tjek på PubMedNina S. Groeneveld, Sabine E. Olie, Douwe H. Visser, Linde Snoek, Diederik van de Beek, Matthijs C. Brouwer, Merijn W. Bijlsma, NOGBS study group
International Journal of Infectious Diseases, 21.02.2024
Tilføjet 21.02.2024
Neonatal and infant meningitis and sepsis are associated with substantial mortality and long-term morbidity.[1] Early detection of meningitis in suspected sepsis patients is important because of the difference in empiric antibiotic regimen, dosage and duration of antibiotic treatment. Also, it influences the need for monitoring of complications during hospitalization, as well as the risk of long-term neurodevelopmental impairment.[2] The interpretation of CSF parameters in neonates can be difficult due to considerable overlap of CSF characteristics between sepsis and meningitis.
Læs mere Tjek på PubMedJessie J. Goldsmith, Christy Vu, Ziheng Zhu, Jennifer MacLachlan, Tilda N. Thomson, Patricia Therese Campbell, Katherine B. Gibney
International Journal of Infectious Diseases, 21.02.2024
Tilføjet 21.02.2024
Invasive group A streptococcal disease (iGAS) is a rare and life-threatening infection. It occurs when group A Streptococcus bacteria (GAS, Streptococcus pyogenes) invade otherwise sterile sites of the body, such as the blood and cerebrospinal fluid.[1] Globally, it is estimated that 15–25% of iGAS cases are fatal.[1] Severe manifestations such as sepsis, streptococcal toxic shock syndrome (STSS) and necrotising fasciitis have higher case fatality rates, even in well-resourced settings.[1, 2] iGAS is managed with antibiotics, and often requires surgery and supportive care for organ dysfunction.[2] However, patients frequently experience rapid clinical progression and urgent medical attention is critical.[2] It is imperative that the factors that increase the risk of iGAS are well understood to support early diagnosis and rapid institution of life-saving medical care.
Læs mere Tjek på PubMedInfection, 20.02.2024
Tilføjet 20.02.2024
Abstract Purpose Sepsis suspicion by Emergency Medical Services (EMS) is associated with improved patient outcomes. This study assessed sepsis incidence and recognition by EMS and analyzed which of the screening tools recommended by the Surviving Sepsis Campaign best facilitates sepsis prediction. Methods Retrospective cohort study of claims data from health insurances (n = 221,429 EMS cases), and paramedics’ and emergency physicians’ EMS documentation (n = 110,419); analyzed outcomes were: sepsis incidence and case fatality compared to stroke and myocardial infarction, the extent of documentation for screening-relevant variables and sepsis suspicion, tools’ intersections for screening positive in identical EMS cases and their predictive ability for an inpatient sepsis diagnosis. Results Incidence of sepsis (1.6%) was similar to myocardial infarction (2.6%) and stroke (2.7%); however, 30-day case fatality rate was almost threefold higher (31.7% vs. 13.4%; 11.8%). Complete vital sign documentation was achieved in 8.2% of all cases. Paramedics never, emergency physicians rarely (0.1%) documented a sepsis suspicion, respectively septic shock. NEWS2 had the highest sensitivity (73.1%; Specificity:81.6%) compared to qSOFA (23.1%; Sp:96.6%), SIRS (28.2%; Sp:94.3%) and MEWS (48.7%; Sp:88.1%). Depending on the tool, 3.7% to 19.4% of all cases screened positive; only 0.8% in all tools simultaneously. Conclusion Incidence and mortality underline the need for better sepsis awareness, documentation of vital signs and use of screening tools. Guidelines may omit MEWS and SIRS as recommendations for prehospital providers since they were inferior in all accuracy measures. Though no tool performed ideally, NEWS2 qualifies as the best tool to predict the highest proportion of septic patients and to rule out cases that are likely non-septic.
Læs mere Tjek på PubMedSuntornsut, P., Asadinia, K. S., Limato, R., Tamara, A., Rotty, L. W. A., Bramanti, R., Nusantara, D. U., Nelwan, E. J., Khusuwan, S., Suphamongkholchaikul, W., Chamnan, P., Piyaphanee, W., Vu, H. T. L., Nguyen, Y. H., Nguyen, K. H., Pham, T. N., Le, Q. M., Vu, V. H., Chau, D. M., Vo, D. E. T. H., Harriss, E. K., van Doorn, H. R., Hamers, R. L., Lorencatto, F., Atkins, L., Limmathurotsakul, D.
BMJ Open, 20.02.2024
Tilføjet 20.02.2024
ObjectiveBlood culture (BC) sampling is recommended for all suspected sepsis patients prior to antibiotic administration. We examine barriers and enablers to BC sampling in three Southeast Asian countries. DesignA Theoretical Domains Framework (TDF)-based survey, comprising a case scenario of a patient presenting with community-acquired sepsis and all 14 TDF domains of barriers/enablers to BC sampling. SettingHospitals in Indonesia, Thailand and Viet Nam, December 2021 to 30 April 2022. Participants1070 medical doctors and 238 final-year medical students were participated in this study. Half of the respondents were women (n=680, 52%) and most worked in governmental hospitals (n=980, 75.4%). Outcome measuresBarriers and enablers to BC sampling. ResultsThe proportion of respondents who answered that they would definitely take BC in the case scenario was highest at 89.8% (273/304) in Thailand, followed by 50.5% (252/499) in Viet Nam and 31.3% (157/501) in Indonesia (p
Læs mere Tjek på PubMedRoss, James T.; Robles, Anamaria J.; Mazer, Monty B.; Studer, Amy C.; Remy, Kenneth E.; Callcut, Rachael A.
Critical Care Explorations, 19.02.2024
Tilføjet 19.02.2024
OBJECTIVES: Cell-free hemoglobin (CFH) is a potent mediator of endothelial dysfunction, organ injury, coagulopathy, and immunomodulation in hemolysis. These mechanisms have been demonstrated in patients with sepsis, hemoglobinopathies, and those receiving transfusions. However, less is known about the role of CFH in the pathophysiology of trauma, despite the release of equivalent levels of free hemoglobin. DATA SOURCES: Ovid MEDLINE, Embase, Web of Science Core Collection, and BIOSIS Previews were searched up to January 21, 2023, using key terms related to free hemoglobin and trauma. DATA EXTRACTION: Two independent reviewers selected studies focused on hemolysis in trauma patients, hemoglobin breakdown products, hemoglobin-mediated injury in trauma, transfusion, sepsis, or therapeutics. DATA SYNTHESIS: Data from the selected studies and their references were synthesized into a narrative review. CONCLUSIONS: Free hemoglobin likely plays a role in endothelial dysfunction, organ injury, coagulopathy, and immune dysfunction in polytrauma. This is a compelling area of investigation as multiple existing therapeutics effectively block these pathways.
Læs mere Tjek på PubMedBMC Infectious Diseases, 17.02.2024
Tilføjet 17.02.2024
Abstract Background The early identification of sepsis presenting a high risk of deterioration is a daily challenge to optimise patient pathway. This is all the most crucial in the prehospital setting to optimize triage and admission into the appropriate unit: emergency department (ED) or intensive care unit (ICU). We report the association between the prehospital National Early Warning Score 2 (NEWS-2) and in-hospital, 30 and 90-day mortality of SS patients cared for in the pre-hospital setting by a mobile ICU (MICU). Methods Septic shock (SS) patients cared for by a MICU between 2016, April 6th and 2021 December 31st were included in this retrospective cohort study. The NEWS-2 is based on 6 physiological variables (blood pressure, heart rate, respiratory rate, temperature, oxygen saturation prior oxygen supplementation, and level of consciousness) and ranges from 0 to 20. The Inverse Probability Treatment Weighting (IPTW) propensity method was applied to assess the association with in-hospital, 30 and 90-day mortality. A NEWS-2 ≥ 7 threshold was chosen for increased clinical deterioration risk definition and usefulness in clinical practice based on previous reports. Results Data from 530 SS patients requiring MICU intervention in the pre-hospital setting were analysed. The mean age was 69 ± 15 years and presumed origin of sepsis was pulmonary (43%), digestive (25%) or urinary (17%) infection. In-hospital mortality rate was 33%, 30 and 90-day mortality were respectively 31% and 35%. A prehospital NEWS-2 ≥ 7 is associated with an increase in-hospital, 30 and 90-day mortality with respective RRa = 2.34 [1.39–3.95], 2.08 [1.33–3.25] and 2.22 [1.38–3.59]. Calibration statistic values for in-hospital mortality, 30-day and 90-day mortality were 0.54; 0.55 and 0.53 respectively. Conclusion A prehospital NEWS-2 ≥ 7 is associated with an increase in in-hospital, 30 and 90-day mortality of septic shock patients cared for by a MICU in the prehospital setting. Prospective studies are needed to confirm the usefulness of NEWS-2 to improve the prehospital triage and orientation to the adequate facility of sepsis.
Læs mere Tjek på PubMedBMC Infectious Diseases, 17.02.2024
Tilføjet 17.02.2024
Abstract Background Autoimmune diseases (ADs) may be complicated by sepsis when intensive care unit (ICU) admission. But repeated sepsis among AD patients has not been studied yet. The aim of this study is to investigate the impact of repeated in-ICU sepsis on the 1-year overall-cause mortality, septic shock and in-ICU death of AD patients. Methods Data of AD patients with sepsis retrieved from Medical Information Mart for Intensive Care IV (MIMIC-IV) database were divided into the single group and the repeated group according to the frequency of in-ICU sepsis. Propensity score matching was used to balance inter-group bias. Cox proportional hazard regression and sensitivity analysis were utilized to assess the variables on mortality. Results The incidence of repeated in-ICU sepsis in baseline was 19.8%. The repeated in-ICU sepsis was a risk factor for 1-year overall-cause mortality among AD patients (adjusted hazard ratio [HR] = 1.50, 95% CI: 1.16–1.93, P = 0.002), with robust adjusted HRs by the adjustment for confounders in the sensitivity analysis (all P
Læs mere Tjek på PubMedBMC Infectious Diseases, 16.02.2024
Tilføjet 16.02.2024
Abstract Background The early identification of sepsis presenting a high risk of deterioration is a daily challenge to optimise patient pathway. This is all the most crucial in the prehospital setting to optimize triage and admission into the appropriate unit: emergency department (ED) or intensive care unit (ICU). We report the association between the prehospital National Early Warning Score 2 (NEWS-2) and in-hospital, 30 and 90-day mortality of SS patients cared for in the pre-hospital setting by a mobile ICU (MICU). Methods Septic shock (SS) patients cared for by a MICU between 2016, April 6th and 2021 December 31st were included in this retrospective cohort study. The NEWS-2 is based on 6 physiological variables (blood pressure, heart rate, respiratory rate, temperature, oxygen saturation prior oxygen supplementation, and level of consciousness) and ranges from 0 to 20. The Inverse Probability Treatment Weighting (IPTW) propensity method was applied to assess the association with in-hospital, 30 and 90-day mortality. A NEWS-2 ≥ 7 threshold was chosen for increased clinical deterioration risk definition and usefulness in clinical practice based on previous reports. Results Data from 530 SS patients requiring MICU intervention in the pre-hospital setting were analysed. The mean age was 69 ± 15 years and presumed origin of sepsis was pulmonary (43%), digestive (25%) or urinary (17%) infection. In-hospital mortality rate was 33%, 30 and 90-day mortality were respectively 31% and 35%. A prehospital NEWS-2 ≥ 7 is associated with an increase in-hospital, 30 and 90-day mortality with respective RRa = 2.34 [1.39–3.95], 2.08 [1.33–3.25] and 2.22 [1.38–3.59]. Calibration statistic values for in-hospital mortality, 30-day and 90-day mortality were 0.54; 0.55 and 0.53 respectively. Conclusion A prehospital NEWS-2 ≥ 7 is associated with an increase in in-hospital, 30 and 90-day mortality of septic shock patients cared for by a MICU in the prehospital setting. Prospective studies are needed to confirm the usefulness of NEWS-2 to improve the prehospital triage and orientation to the adequate facility of sepsis.
Læs mere Tjek på PubMedArai, Riku; Murata, Nobuhiro; Fukamachi, Daisuke; Okumura, Yasuo; Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD) Investigators
Critical Care Medicine, 15.02.2024
Tilføjet 15.02.2024
Objectives: This study aimed to investigate the current use and impact of pulmonary artery catheters (PACs) in patients with cardiogenic shock (CS) who underwent Impella support. Design: This was a prospective multicenter observational study between January 2020 and December 2021 that registered all patients with drug-refractory acute heart failure and in whom the placement of an Impella 2.5, CP, or 5.0 pump was attempted or successful in Japan. Setting: Cardiac ICUs in Japan. Patients: Between January 2020 and December 2021, a total of 3112 patients treated with an Impella were prospectively enrolled in the Japan registry for percutaneous ventricular assist device (J-PVAD). Among them, 2063 patients with CS were divided into two groups according to the PAC use. Interventions: None. Measurements and Main Results: The primary endpoint was the 30-day mortality, and the secondary endpoints were hemolysis, acute kidney injury, sepsis, major bleeding unrelated to the Impella, and ventricular arrhythmias within 30 days. PACs were used in 1358 patients (65.8%) who underwent an Impella implantation. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) was significantly higher in the patients with PACs than in those without. Factors associated with PAC use were the prevalence of hypertension, out-of-hospital cardiac arrest, New York Heart Association classification IV, the lesser prevalence of a heart rate less than 50, and the use of any catecholamine. The primary and secondary endpoints did not significantly differ according to the PAC use. Focusing on the patients with VA-ECMO use, the 30-day mortality and hemolysis were univariately lower in the patients with PACs. Conclusions: The J-PVAD findings indicated that PAC use did not have a significant impact on the short-term outcomes in CS patients undergoing Impella support. Further prospective studies are required to explore the clinical implications of PAC-guided intensive treatment strategies in these patients.
Læs mere Tjek på PubMedBolanaki, Myrto; Winning, Johannes; Slagman, Anna; Lehmann, Thomas; Kiehntopf, Michael; Stacke, Angelika; Neumann, Caroline; Reinhart, Konrad; Möckel, Martin; Bauer, Michael
Critical Care Medicine, 15.02.2024
Tilføjet 15.02.2024
Objectives: Consensus regarding biomarkers for detection of infection-related organ dysfunction in the emergency department is lacking. We aimed to identify and validate biomarkers that could improve risk prediction for overt or incipient organ dysfunction when added to quick Sepsis-related Organ Failure Assessment (qSOFA) as a screening tool. Design: In a large prospective multicenter cohort of adult patients presenting to the emergency department with a qSOFA score greater than or equal to 1, admission plasma levels of C-reactive protein, procalcitonin, adrenomedullin (either bioavailable adrenomedullin or midregional fragment of proadrenomedullin), proenkephalin, and dipeptidyl peptidase 3 were assessed. Least absolute shrinkage and selection operator regression was applied to assess the impact of these biomarkers alone or in combination to detect the primary endpoint of prediction of sepsis within 96 hours of admission. Setting: Three tertiary emergency departments at German University Hospitals (Jena University Hospital and two sites of the Charité University Hospital, Berlin). Patients: One thousand four hundred seventy-seven adult patients presenting with suspected organ dysfunction based on qSOFA score greater than or equal to 1. Interventions: None. Measurements and Main Results: The cohort was of moderate severity with 81% presenting with qSOFA = 1; 29.2% of these patients developed sepsis. Procalcitonin outperformed all other biomarkers regarding the primary endpoint (area under the curve for receiver operating characteristic [AUC-ROC], 0.86 [0.79–0.93]). Adding other biomarkers failed to further improve the AUC-ROC for the primary endpoint; however, they improved the model regarding several secondary endpoints, such as mortality, need for vasopressors, or dialysis. Addition of procalcitonin with a cutoff level of 0.25 ng/mL improved net (re)classification by 35.2% compared with qSOFA alone, with positive and negative predictive values of 60.7% and 88.7%, respectively. Conclusions: Biomarkers of infection and organ dysfunction, most notably procalcitonin, substantially improve early prediction of sepsis with added value to qSOFA alone as a simple screening tool on emergency department admission.
Læs mere Tjek på PubMedSchade Skov, C., Ostervang, C., Brabrand, M., Lassen, A. T., Nielsen, D. S.
BMJ Open, 14.02.2024
Tilføjet 14.02.2024
ObjectiveSepsis is a condition associated with high mortality and morbidity, and survivors often experience physical and psychological decline. Previous research has primarily focused on sepsis survivors discharged from the intensive care unit (ICU). We aimed to explore and understand the consequences of sepsis experienced by sepsis survivors in general. DesignA qualitative study inspired by a phenomenological hermeneutical approach was conducted. Data were analysed using systematic text condensation. SettingPatients with sepsis were identified on admission to the emergency department and invited to an interview 3 months after discharge. ParticipantsSixteen sepsis survivors were purposively sampled and interviewed. Among these survivors, one patient was admitted to the ICU. ResultsThree main themes were derived from the analysis: new roles in life, cognitive impairment and anxiety. Although many survivors described a physical decline, they experienced psychological and cognitive impairments after sepsis as the most influential factors in daily life. The survivors frequently experienced fatigue, withdrawals from social activities and anxiety. ConclusionSepsis survivors’ experiences appeared to overlap regardless of ICU admission or treatment at the general ward. Identifying patients with sepsis-related decline is important to understand and support overall patient processes and necessary in meeting specific needs of these patients after hospital discharge.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.02.2024
Tilføjet 14.02.2024
Abstract Background Autoimmune diseases (ADs) may be complicated by sepsis when intensive care unit (ICU) admission. But repeated sepsis among AD patients has not been studied yet. The aim of this study is to investigate the impact of repeated in-ICU sepsis on the 1-year overall-cause mortality, septic shock and in-ICU death of AD patients. Methods Data of AD patients with sepsis retrieved from Medical Information Mart for Intensive Care IV (MIMIC-IV) database were divided into the single group and the repeated group according to the frequency of in-ICU sepsis. Propensity score matching was used to balance inter-group bias. Cox proportional hazard regression and sensitivity analysis were utilized to assess the variables on mortality. Results The incidence of repeated in-ICU sepsis in baseline was 19.8%. The repeated in-ICU sepsis was a risk factor for 1-year overall-cause mortality among AD patients (adjusted hazard ratio [HR] = 1.50, 95% CI: 1.16–1.93, P = 0.002), with robust adjusted HRs by the adjustment for confounders in the sensitivity analysis (all P
Læs mere Tjek på PubMedBMC Infectious Diseases, 13.02.2024
Tilføjet 13.02.2024
Abstract Background Metagenomic next-generation sequencing (mNGS) could improve the diagnosed efficiency of pathogens in bloodstream infections or sepsis. Little is known about the clinical impact of mNGS test when used for the early diagnosis of suspected infections. Herein, our main objective was to assess the clinical efficacy of utilizing blood samples to perform mNGS for early diagnosis of suspected infections, as well as to evaluate its potential in guiding antimicrobial therapy decisions. Methods In this study, 212 adult hospitalized patients who underwent blood mNGS test in the early stage of suspected infections were enrolled. Diagnostic efficacy of mNGS test and blood culture was compared, and the clinical impact of mNGS on clinical care was analyzed. Results In our study, the total detection rate of blood mNGS was significantly higher than that of culture method (74.4% vs. 12.1%, P
Læs mere Tjek på PubMedBMC Infectious Diseases, 13.02.2024
Tilføjet 13.02.2024
Abstract Background Chronic comorbid conditions are common in patients with sepsis and may affect the outcomes. This study aimed to evaluate the prevalence and outcomes of common comorbidities in patients with sepsis. Methods We conducted a nationwide retrospective cohort study. Using data from the National Health Insurance Service of Korea. Adult patients (age ≥ 18 years) who were hospitalized in tertiary or general hospitals with a diagnosis of sepsis between 2011 and 2016 were analyzed. After screening of all International Classification of Diseases 10th revision codes for comorbidities, we identified hypertension, diabetes mellitus (DM), liver cirrhosis (LC), chronic kidney disease (CKD), and malignancy as prevalent comorbidities. Results Overall, 373,539 patients diagnosed with sepsis were hospitalized in Korea between 2011 and 2016. Among them, 46.7% had hypertension, 23.6% had DM, 7.4% had LC, 13.7% had CKD, and 30.7% had malignancy. In-hospital mortality rates for patients with hypertension, DM, LC, CKD, and malignancy were 25.5%, 25.2%, 34.5%, 28.0%, and 33.3%, respectively, showing a decreasing trend over time (P
Læs mere Tjek på PubMedSharma-Oates, Archana; Sullivan, Jack; Pestana, Daniel; dos Santos, Claudia C.; Binnie, Alexandra; Lord, Janet M.
Critical Care Explorations, 11.02.2024
Tilføjet 11.02.2024
OBJECTIVES: DNA methylation can be used to determine an individual’s biological age, as opposed to chronological age, an indicator of underlying health status. This study aimed to assess epigenetic age in critically ill patients with and without sepsis to determine if higher epigenetic age is associated with admission diagnosis or mortality. DESIGN: Secondary analysis of whole blood DNA methylation data generated from a nested case–control study of critically ill septic and nonseptic patients. SETTING: Four tertiary care hospitals in Canada. INTERVENTIONS: None. PATIENTS: Critically ill patients with and without sepsis. MEASUREMENTS AND MAIN RESULTS: Epigenetic age was derived from DNA methylation data using the Hannum and PhenoAge algorithms and deviation from the patient’s chronological age in years was determined. Of the 66 patients with sepsis, 34 were male (51.5%), the mean age was 65.03 years and 25 patients (37.8%) died before discharge. Of the 68 nonseptic patients, 47 were male (69.1%), the mean age was 64.92 years and 25 (36.7%) died before discharge. Epigenetic age calculated using the PhenoAge algorithm showed a significant age acceleration of 4.97 years in septic patients (p = 0.045), but no significant acceleration in nonseptic patients. Epigenetic age calculated using the Hannum algorithm showed no significant acceleration in the septic or nonseptic patients. Similarly, in the combined septic and nonseptic cohorts, nonsurvivors showed an epigenetic age acceleration of 7.62 years (p = 0.004) using the PhenoAge algorithm while survivors showed no significant age acceleration. Survivor status was not associated with age acceleration using the Hannum algorithm. CONCLUSIONS: In critically ill patients, epigenetic age acceleration, as calculated by the PhenoAge algorithm, was associated with sepsis diagnosis and mortality.
Læs mere Tjek på PubMedTridon, Chloé; Bachelet, Delphine; El Baied, Majda; Eloy, Philippine; Ortuno, Sofia; Para, Marylou; Wicky, Paul-Henri; Vellieux, Geoffroy; de Montmollin, Etienne; Bouadma, Lila; Manceau, Hana; Timsit, Jean-François; Peoc’h, Katell; Sonneville, Romain
Critical Care Explorations, 11.02.2024
Tilføjet 11.02.2024
OBJECTIVES: Neurologic outcomes of patients under venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be worsened by secondary insults of systemic origin. We aimed to assess whether sepsis, commonly observed during ECMO support, is associated with brain injury and outcomes. DESIGN: Single-center cohort study of the “exposed-non-exposed” type on consecutive adult patients treated by VA-ECMO. SETTING: Medical ICU of a university hospital, France, 2013–2020. PATIENTS: Patients with sepsis at the time of VA-ECMO cannulation (“sepsis” group) were compared with patients without sepsis (“no sepsis” group). The primary outcome measure was poor functional outcome at 90 days, defined by a score greater than or equal to 4 on the modified Rankin scale (mRS), indicating severe disability or death. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 196 patients were included (“sepsis,” n = 128; “no sepsis,” n = 68), of whom 87 (44.4%) had presented cardiac arrest before VA-ECMO cannulation. A poor functional outcome (mRS ≥ 4) was observed in 99 of 128 patients (77.3%) of the “sepsis” group and 46 of 68 patients (67.6%) of the “no sepsis” group (adjusted logistic regression odds ratio (OR) 1.21, 95% CI, 0.58–2.47; inverse probability of treatment weighting (IPTW) OR 1.24; 95% CI, 0.79–1.95). Subsequent analyses performed according to pre-ECMO cardiac arrest status suggested that sepsis was independently associated with poorer functional outcomes in the subgroup of patients who had experienced pre-ECMO cardiac arrest (adjusted logistic regression OR 3.44; 95% CI, 1.06–11.40; IPTW OR 3.52; 95% CI, 1.68–7.73), whereas no such association was observed in patients without pre-ECMO cardiac arrest (adjusted logistic regression OR 0.69; 95% CI, 0.27–1.69; IPTW OR 0.76; 95% CI, 0.42–1.35). Compared with the “no sepsis” group, “sepsis” patients presented a significant increase in S100 calcium-binding protein beta concentrations at day 1 (0.94 μg/L vs. 0.52 μg/L, p = 0.03), and more frequent EEG alterations (i.e., severe slowing, discontinuous background, and a lower prevalence of sleep patterns), suggesting brain injury. CONCLUSION: We observed a detrimental role of sepsis on neurologic outcomes in the subgroup of patients who had experienced pre-ECMO cardiac arrest, but not in other patients.
Læs mere Tjek på PubMedO’Neal, Hollis R. Jr; Sheybani, Roya; Janz, David R.; Scoggins, Robert; Jagneaux, Tonya; Walker, James E.; Henning, Daniel J.; Rosenman, Elizabeth; Mahler, Simon A.; Regunath, Hariharan; Sampson, Christopher S.; Files, D. Clark; Fremont, Richard D.; Noto, Michael J.; Schneider, Erica E.; Shealey, Wesley R.; Berlinger, Matthew S.; Carver, Thomas C.; Walker, Morgan K.; Ledeboer, Nathan A.; Shah, Ajay M.; Tse, Henry T.K.; DiCarlo, Dino; Rice, Todd W.; Thomas, Christopher B.
Critical Care Explorations, 11.02.2024
Tilføjet 11.02.2024
OBJECTIVES: To assess the in vitro IntelliSep test, a microfluidic assay that quantifies the state of immune activation by evaluating the biophysical properties of leukocytes, as a rapid diagnostic for sepsis. DESIGN: Prospective cohort study. SETTING: Five emergency departments (EDs) in Louisiana, Missouri, North Carolina, and Washington. PATIENTS: Adult patients presenting to the ED with signs (two of four Systemic Inflammatory Response Syndrome criteria, where one must be temperature or WBC count) or suspicion (provider-ordered culture) of infection. INTERVENTIONS: All patients underwent testing with the IntelliSep using ethylene diamine tetraacetic acid-anticoagulated whole blood followed by retrospective adjudication for sepsis by sepsis-3 criteria by a blinded panel of physicians. MEASUREMENTS AND MAIN RESULTS: Of 599 patients enrolled, 572 patients were included in the final analysis. The result of the IntelliSep test is reported as the IntelliSep Index (ISI), ranging from 0.1 to 10.0, divided into three interpretation bands for the risk of sepsis: band 1 (low) to band 3 (high). The median turnaround time for ISI results was 7.2 minutes. The ISI resulted band 1 in 252 (44.1%), band 2 in 160 (28.0%), and band 3 in 160 (28.0%). Sepsis occurred in 26.6% (152 of 572 patients). Sepsis prevalence was 11.1% (95% CI, 7.5–15.7%) in band 1, 28.1% (95% CI, 21.3–35.8%) in band 2, and 49.4% (95% CI, 41.4–57.4%) in band 3. The Positive Percent Agreement of band 1 was 81.6% and the Negative Percent Agreement of band 3 was 80.7%, with an area under the receiver operating characteristic curve of 0.74. Compared with band 1, band 3 correlated with adverse clinical outcomes, including mortality, and resource utilization. CONCLUSIONS: Increasing ISI interpretation band is associated with increasing probability of sepsis in patients presenting to the ED with suspected infection.
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.02.2024
Tilføjet 8.02.2024
Abstract Background Sepsis not only causes inflammation, but also damages the heart and increases the risk of death. The glycolytic pathway plays a crucial role in the pathogenesis of sepsis-induced cardiac injury. This study aims to investigate the value of bisphosphoglycerate mutase (BPGM), an intermediate in the glycolytic pathway, in evaluating cardiac injury in septic patients and predicting poor prognosis in sepsis. Methods This prospective study included 85 patients with sepsis. Serum BPGM was measured at the time of enrollment, and the patients were divided into a BPGM-positive group (n = 35) and a BPGM-negative group (n = 50) according to their serum BPGM levels. Baseline clinical and echocardiographic parameters, and clinical outcomes were analyzed and compared between the two groups. Kaplan–Meier analysis was used to compare the 28-day survival rate between BPGM-negative and BPGM-positive patients. Multivariate logistic regression analysis was conducted to explore the independent risk factors for 28-day mortality in septic patients. The predictive value of serum BPGM for sepsis-induced myocardial injury and poor prognosis in sepsis was evaluated using receiver operating characteristic (ROC)curve analysis. Result The serum level of BPGM was significantly higher in patients who died within 28 days compared to survivors (p
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.02.2024
Tilføjet 8.02.2024
Abstract Background Maternal sepsis is the third leading cause of maternal death in the world. Women in resource-limited countries shoulder most of the burdens related to sepsis. Despite the growing risk associated with maternal sepsis, there are limited studies that have tried to assess the impact of maternal sepsis in resource-limited countries. The current study determined the outcomes of maternal sepsis and factors associated with having poor maternal outcomes. Methods A facility-based retrospective cross-sectional study design was employed to assess the clinical presentation, maternal outcomes, and factors associated with maternal sepsis. The study was conducted in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Sociodemographic characteristics, clinical characteristics and outcomes of women with maternal sepsis were analyzed using a descriptive statistic. The association between dependent and independent variables was determined using multivariate logistic regression. Results Among 27,350 live births, 298 mothers developed sepsis, giving a rate of 109 maternal sepsis for every 10,000 live births. There were 22 maternal deaths, giving rise to a case fatality rate of 7.4% and a maternal mortality ratio of 75 per 100,000 live births. Admission to the intensive care unit and use of mechanical ventilator were observed in 23.5% and 14.1% of the study participants, respectively. A fourth (24.2%) of the mothers were complicated with septic shock. Overall, 24.2% of women with maternal sepsis had severe maternal outcomes (SMO). Prolonged hospital stay, having parity of two and above, having the lung as the focus of infection, switchof antibiotics, and developing septic shock were significantly associated with SMO. Conclusions This study revealed that maternal sepsis continues to cause significant morbidity and mortality in resource-limited settings; with a significant number of women experiencing death, intensive care unit admission, and intubation attributable to sepsis. The unavailability of recommended diagnostic modalities and management options has led to the grave outcomes observed in this study. To ward off the effects of infection during pregnancy, labor and postpartum period and to prevent progression to sepsis and septic shock in low-income countries, we recommend that concerted and meticulous efforts should be applied to build the diagnostic capacity of health facilities, to have effective infection prevention and control practice, and to avail recommended diagnostic and management options.
Læs mere Tjek på PubMedJennifer R Verani, Dianna M Blau, Emily S Gurley, Victor Akelo, Nega Assefa, Vicky Baillie, Quique Bassat, Mussie Berhane, James Bunn, Anelsio C A Cossa, Shams El Arifeen, Revathi Gunturu, Martin Hale, Aggrey Igunza, Adama M Keita, Sartie Kenneh, Karen L Kotloff, Dickens Kowuor, Rita Mabunda, Zachary J Madewell, Shabir Madhi, Lola Madrid, Sana Mahtab, Judice Miguel, Florence V Murila, Ikechukwu U Ogbuanu, Julius Ojulong, Dickens Onyango, Joe O Oundo, J Anthony G Scott, Samba Sow, Milagritos Tapia, Cheick B Traore, Sithembiso Velaphi, Cynthia G Whitney, Inacio Mandomando, Robert F Breiman
The Lancet Microbe, 8.02.2024
Tilføjet 8.02.2024
K pneumoniae substantially contributed to deaths in the first 2 years of life across multiple high-mortality settings, and resistance to antibiotics used for sepsis treatment was common. Improved strategies are needed to rapidly identify and appropriately treat children who might be infected with this pathogen. These data suggest a potential impact of developing and using effective K pneumoniae vaccines in reducing neonatal, infant, and child deaths globally.
Læs mere Tjek på PubMedJoshua Osowicki, Fergus Hamilton, Todd C. Lee, Michael Marks, Erin K. McCreary, Emily G. McDonald, Jonathan H. Ryder, Steven YC. Tong
Clinical Microbiology and Infection, 7.02.2024
Tilføjet 7.02.2024
The spectre of severe invasive infections caused by Streptococcus pyogenes and Staphylococcus aureus haunt clinicians and patients alike. They are the quintessential causes of devastating high profile ‘front page sepsis’ cases affecting children and adults, often without recognised risk factors, and typically associated with toxic shock syndromes (TSS) and necrotizing soft tissue infections (NSTI), as seen in the global surge of invasive S. pyogenes disease from late 2022.(1) These fulminant clinical syndromes demand rapid empiric antibiotic treatment and urgent surgical intervention for source control.
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