Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Guidelines 1 Sepsis flowchart (2021)
Bilag med flowchart til vurdering og behandling af sepsis og septisk shock, se også infmed.dk/guidelines#sepsis_guidelines_(2021).pdf 2 Sepsis guidelines (2021)
Disse rekommandationer retter sig mod voksne indlagt med mistænkt sepsis og septisk shock. Se flowchart på infmed.dk/bilag#sepsis_flowchart_(2021).pdf På vegne af Dansk Selskab for Infektionsmedicin: Lars Skov Dalgaard, Michael Dalager, Christian Philip Fischer, Rikke Krogh-Madsen, Gitte Kronborg, Jannik Helweg Larsen, Stig Lønberg Nielsen, Christian Søborg, Lars Toft. Nye artikler 1 Microglia mediate neurocognitive deficits by eliminating C1q-tagged synapses in sepsis-associated encephalopathy Ha-Yeun Chung, Jonathan Wickel, Nina Hahn, Nils Mein, Meike Schwarzbrunn, Philipp Koch, Mihai Ceanga, Holger Haselmann, Carolin Baade-Büttner, Nikolai von Stackelberg, Nina Hempel, Lars Schmidl, Marco Groth, Nico Andreas, Juliane Götze, Sina M. Coldewey, Michael Bauer, Christian Mawrin, Justina Dargvainiene, Frank Leypoldt, Stephan Steinke, Zhao-Qi Wang, Michael Hust, Christian Geis Science Advances, 27.05.2023 Tilføjet 27.05.2023 2 Protocol for a systematic review and meta-analysis assessing conservative versus liberal intravenous fluid administration in patients with sepsis or septic shock at risk of fluid overload Bharwani, A., Perez, M. L., Englesakis, M., Meyhoff, T. S., Perner, A., Sivapalan, P., Wilcox, M. E. BMJ Open, 24.05.2023 Tilføjet 24.05.2023 IntroductionIntravenous crystalloid fluid resuscitation forms a crucial part of the early intervention bundle for sepsis and septic shock, with the Surviving Sepsis Campaign guidelines recommending a 30 mL/kg fluid bolus within the first hour. Compliance with this suggested target varies in patients with comorbidities such as congestive heart failure, chronic kidney disease and cirrhosis due to concerns regarding iatrogenic fluid overload. However, it remains unclear whether resuscitation with higher fluid volumes puts them at greater risk of adverse outcomes. Thus, this systematic review will synthesise evidence from existing studies to assess the effects of a conservative as compared with a liberal approach to fluid resuscitation in patients at greater perceived risk of fluid overload due to comorbid conditions. Methods and analysisThis protocol was registered on PROSPERO and has been drafted following the checklist of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will search MEDLINE, MEDLINE Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations, Embase, Embase Classic, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection, CINAHL Complete and ClinicalTrials.gov. A preliminary search of these databases was performed from their inception to 30 August 2022. The risk of bias and random errors will be assessed using the revised Cochrane risk-of-bias tool for randomised clinical trials and the Newcastle-Ottawa Scale for case–control and cohort studies. If a sufficient number of comparable studies are identified, we will perform a meta-analysis applying random effects model. We will investigate heterogeneity using a combination of visual inspection of the funnel plot as well as the Egger’s test. Ethics and disseminationNo ethics approval is required for this study since no original data will be collected. The findings will be disseminated through peer-reviewed publication and conference presentation. PROSPERO registration numberCRD42022348181. Læs mere Tjek på PubMed3 Correction: Patient characteristics in sepsis-related deaths: prevalence of advanced frailty, comorbidity, and age in a Norwegian hospital trust Infection, 23.05.2023 Tilføjet 23.05.2023 4 Which Trial Do We Need? Optimal Antibiotic Duration for Patients with Sepsis Christina Yek, Alexander Lawandi, Scott R. Evans, Sameer S. Kadri Clinical Microbiology and Infection, 23.05.2023 Tilføjet 23.05.2023 Given the potential benefits of shortened antibiotic courses, prior studies comparing shorter versus longer antibiotic courses have typically adopted a non-inferiority design [3,11]. However, in a study of critically ill patients in whom suboptimal treatment could result in death, a non-inferiority trial would pose a serious ethical dilemma – how to select an “acceptable” increased risk of mortality to use as a non-inferiority margin? For these reasons, we have designed a trial that requires shorter antibiotic therapy demonstrate superior clinical outcomes over longer antibiotic therapy, allowing partial/full credit to be awarded based on patient and clinicians’ perceptions of outcome importance and severity. Should clinical outcomes be comparable among the study arms, the DOOR/RADAR framework acknowledges potential unmeasured benefits of shorter courses (e.g., reduced costs, unmeasured toxicity, and antibiotic pressures selecting for individual and global microbial resistance) and accordingly assigns superiority to shorter antibiotic courses. The duration of antibiotic therapy reflected in this adjustment would be the actual (rather than assigned) duration, allowing for a pragmatic analysis of the interventions as applied in practice while mitigating differences between intention-to-treat and per-protocol analyses resulting from poor protocol adherence. Læs mere Tjek på PubMed5 Order Set Usage is Associated With Lower Hospital Mortality in Patients With Sepsis Dale, Christopher R.; Schoepflin Sanders, Shelley; Chang, Shu Ching; Pandhair, Omar; Diggs, Naomi G.; Woodruff, Whitney; Selander, David N.; Mark, Nicholas M.; Nurse, Sarah; Sullivan, Mark; Mezaraups, Liga; O’Mahony, D. Shane Critical Care Explorations, 16.05.2023 Tilføjet 16.05.2023 IMPORTANCE: The Surviving Sepsis Campaign recommends standard operating procedures for patients with sepsis. Real-world evidence about sepsis order set implementation is limited. OBJECTIVES: To estimate the effect of sepsis order set usage on hospital mortality. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Fifty-four acute care hospitals in the United States from December 1, 2020 to November 30, 2022 involving 104,662 patients hospitalized for sepsis. MAIN OUTCOMES AND MEASURES: Hospital mortality. RESULTS: The sepsis order set was used in 58,091 (55.5%) patients with sepsis. Initial mean sequential organ failure assessment score was 0.3 lower in patients for whom the order set was used than in those for whom it was not used (2.9 sd [2.8] vs 3.2 [3.1], p < 0.01). In bivariate analysis, hospital mortality was 6.3% lower in patients for whom the sepsis order set was used (9.7% vs 16.0%, p < 0.01), median time from emergency department triage to antibiotics was 54 minutes less (125 interquartile range [IQR, 68–221] vs 179 [98–379], p < 0.01), and median total time hypotensive was 2.1 hours less (5.5 IQR [2.0–15.0] vs 7.6 [2.5–21.8], p < 0.01) and septic shock was 3.2% less common (22.0% vs 25.4%, p < 0.01). Order set use was associated with 1.1 fewer median days of hospitalization (4.9 [2.8–9.0] vs 6.0 [3.2–12.1], p < 0.01), and 6.6% more patients discharged to home (61.4% vs 54.8%, p < 0.01). In the multivariable model, sepsis order set use was independently associated with lower hospital mortality (odds ratio 0.70; 95% CI, 0.66–0.73). CONCLUSIONS AND RELEVANCE: In a cohort of patients hospitalized with sepsis, order set use was independently associated with lower hospital mortality. Order sets can impact large-scale quality improvement efforts. Læs mere Tjek på PubMed6 Evolving Management Practices for Early Sepsis-induced Hypoperfusion: A Narrative Review Elizabeth S. Munroe, Robert C. Hyzy, Matthew W. Semler, Manu Shankar-Hari, Paul J. Young, Fernando G. Zampieri, Hallie C. Prescott American Journal of Respiratory and Critical Care Medicine , 15.05.2023 Tilføjet 15.05.2023 American Journal of Respiratory and Critical Care Medicine, Volume 207, Issue 10, Page 1283-1299, May 15, 2023. Læs mere Tjek på PubMed7 Correction: Patient characteristics in sepsis-related deaths: prevalence of advanced frailty, comorbidity, and age in a Norwegian hospital trust Infection, 13.05.2023 Tilføjet 13.05.2023 8 The Association Between Time From Emergency Department Visit to ICU Admission and Mortality in Patients With Sepsis Shibata, Junichiro; Osawa, Itsuki; Fukuchi, Kiyoyasu; Goto, Tadahiro Critical Care Explorations, 10.05.2023 Tilføjet 10.05.2023 OBJECTIVES: The Surviving Sepsis Campaign Guidelines 2021 recommends that adult patients with sepsis requiring intensive care should be admitted to the ICU within 6 hours of their emergency department (ED) visits. However, there is limited evidence on whether 6 hours is the best target time for compliance with the sepsis bundle. We aimed to investigate the association between time from ED visits to ICU admission (i.e., ED length of stay [ED-LOS]) and mortality and identify the optimal ED-LOS for patients with sepsis. DESIGN: Retrospective cohort study. SETTING: The Medical Information Mart for Intensive Care Emergency Department and Medical Information Mart for Intensive Care IV databases. PATIENTS: Adult patients (≥ 18 yr old) who were transferred from the ED to the ICU and subsequently diagnosed with sepsis based on the Sepsis-3 criteria within 24 hours of ICU admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 1,849 patients with sepsis, we found a disproportionally higher mortality rate in patients immediately admitted to the ICU (e.g., < 2 hr). When using ED-LOS as a continuous variable, ED-LOS was not significantly associated with 28-day mortality (adjusted odds ratio [OR] per hour increase, 1.04; 95% CI, 0.96–1.13; p = 0.3) after an adjustment for potential confounders (e.g., demographics, triage vital signs, and laboratory results) in the multivariable analysis. However, when we categorized all patients into time quartiles (ED-LOS: < 3.3 hr, 3.3–4.5 hr, 4.6–6.1 hr, and > 6.1 hr), patients in the higher time quartiles (e.g., 3.3–4.5 hr) had higher 28-day mortality compared with those in the lowest time quartile (< 3.3 hr) (e.g., adjusted OR for patients in the second time quartile [3.3–4.5 hr] 1.59; 95% CI, 1.03–2.46; p = 0.04). CONCLUSIONS: Earlier admission to the ICU (e.g., within 3.3 hr of ED visits) was associated with lower 28-day mortality in patients with sepsis. Our findings suggest patients with sepsis who require intensive care may benefit from a more immediate ICU admission than 6 hours. Læs mere Tjek på PubMed9 Association Between Levels of Intensive Care and In-Hospital Mortality in Patients Hospitalized for Sepsis Stratified by Sequential Organ Failure Assessment Scores Ohbe, Hiroyuki; Sasabuchi, Yusuke; Doi, Kent; Matsui, Hiroki; Yasunaga, Hideo Critical Care Medicine, 9.05.2023 Tilføjet 9.05.2023 Objectives: To assess the association between levels of intensive care and in-hospital mortality in patients hospitalized for sepsis, stratified by Sequential Organ Failure Assessment (SOFA) score at admission. Design: A nationwide, propensity score-matched, retrospective cohort study. Setting: A Japanese national inpatient database with data on 70–75% of all ICU and high-dependency care unit (HDU) beds in Japan. Patients: Adult patients hospitalized for sepsis with SOFA scores greater than or equal to 2 on their day of admission between April 1, 2018, and March 31, 2021, were recruited. Propensity score matching was performed to compare in-hospital mortality, and patients were stratified into 10 groups according eto SOFA scores. Interventions: Two exposure and control groups according to treatment unit on day of admission: 1) ICU + HDU versus general ward and 2) ICU versus HDU. Measurements and Main Results: Of 97,070 patients, 19,770 (20.4%), 23,066 (23.8%), and 54,234 (55.9%) were treated in ICU, HDU, and general ward, respectively. After propensity score matching, the ICU + HDU group had significantly lower in-hospital mortality than the general ward group, among cohorts with SOFA scores greater than or equal to 6. There were no significant differences in in-hospital mortality among cohorts with SOFA scores 3–5. The ICU + HDU group had significantly higher in-hospital mortality than the general ward among cohorts with SOFA scores of 2. The ICU group had lower in-hospital mortality than the HDU group among cohorts with SOFA scores greater than or equal to 12. There were no significant differences in in-hospital mortality among cohorts with SOFA scores 5–11. The ICU group had significantly higher in-hospital mortality than the general ward group among cohorts with SOFA scores less than or equal to 4. Conclusions: Patients hospitalized for sepsis with SOFA scores greater than or equal to 6 in the ICU or HDU had lower in-hospital mortality than those in the general ward, as did those with SOFA scores greater than or equal to 12 in the ICU versus HDU. Læs mere Tjek på PubMed10 Bringing the Promise of Artificial Intelligence to Critical Care: What the Experience With Sepsis Analytics Can Teach Us Wardi, Gabriel; Owens, Robert; Josef, Christopher; Malhotra, Atul; Longhurst, Christopher; Nemati, Shamim Critical Care Medicine, 9.05.2023 Tilføjet 9.05.2023 11 Comparison of presepsin and Mid-regional pro-adrenomedullin in the diagnosis of sepsis or septic shock: a systematic review and meta-analysis BMC Infectious Diseases, 6.05.2023 Tilføjet 6.05.2023 Abstract Background The early diagnosis of sepsis is hampered by the lack of reliable laboratory measures. There is growing evidence that presepsin and Mid-regional pro-adrenomedullin (MR-proADM) are promising biomarkers in the diagnosis of sepsis. This study was conducted to evaluate and compare the diagnostic value of MR-proADM and presepsin in sepsis patients. Methods We searched Web of Science, PubMed, Embase, China national knowledge infrastructure, and Wanfang up to 22th July, 2022, for studies evaluating the diagnosis performance of presepsin and MR-proADM in adult sepsis patients. Risk of bias was assessed using quadas-2. Pooled sensitivity and specificity were calculated using bivariate meta-analysis. Meta-regression and subgroup analysis were used to find source of heterogeneity. Results A total of 40 studies were eventually selected for inclusion in this meta-analysis, including 33 for presepsin and seven for MR-proADM. Presepsin had a sensitivity of 0.86 (0.82–0.90), a specificity of 0.79 (0.71–0.85), and an AUC of 0.90 (0.87–0.92). The sensitivity of MR-proADM was 0.84 (0.78–0.88), specificity was 0.86 (0.79–0.91), and AUC was 0.91 (0.88–0.93). The profile of control group, population, and standard reference may be potential sources of heterogeneity. Conclusions This meta-analysis demonstrated that presepsin and MR-proADM exhibited high accuracy (AUC ≥ 0.90) in the diagnosis of sepsis in adults, with MR-proADM showing significantly higher accuracy than presepsin. Læs mere Tjek på PubMed12 Implementing Pediatric Surviving Sepsis Campaign Guidelines: Improving Compliance With Lactate Measurement in the PICU Mazloom, Anisha; Sears, Stacey M.; Carlton, Erin F.; Bates, Katherine E.; Flori, Heidi R. Critical Care Explorations, 27.04.2023 Tilføjet 27.04.2023 OBJECTIVES: The 2020 pediatric Surviving Sepsis Campaign (pSSC) recommends measuring lactate during the first hour of resuscitation for severe sepsis/shock. We aimed to improve compliance with this recommendation for patients who develop severe sepsis/shock while admitted to the PICU. DESIGN: Structured, quality improvement initiative. SETTING: Single-center, 26-bed, quaternary-care PICU. PATIENTS: All patients with PICU-onset severe sepsis/shock from December 2018 to December 2021. INTERVENTIONS: Creation of a multidisciplinary local sepsis improvement team, education program targeting frontline providers (nurse practitioners, resident physicians), and peer-to-peer nursing education program with feedback to key stakeholders. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was compliance with obtaining a lactate measurement within 60 minutes of the onset of severe sepsis/shock originating in our PICU using a local Improving Pediatric Sepsis Outcomes database and definitions. The process measure was time to first lactate measurement. Secondary outcomes included number of IV antibiotic days, number of vasoactive days, number of ICU days, and number of ventilator days. A total of 166 unique PICU-onset severe sepsis/shock events and 156 unique patients were included. One year after implementation of our first interventions with subsequent Plan-Do-Study-Act cycles, overall compliance increased from 38% to 47% (24% improvement) and time to first lactate decreased from 175 to 94 minutes (46% improvement). Using a statistical process control I chart, the preshift mean for time to first lactate measurement was noted to be 179 minutes and the postshift mean was noted to be 81 minutes demonstrating a 55% improvement. CONCLUSIONS: This multidisciplinary approach led to improvement in time to first lactate measurement, an important step toward attaining our target of lactate measurement within 60 minutes of septic shock identification. Improving compliance is necessary for understanding implications of the 2020 pSSC guidelines on sepsis morbidity and mortality. Læs mere Tjek på PubMed13 Emergence of mcr-8.2-harboring hypervirulent ST412 Klebsiella pneumoniae strain from pediatric sepsis: A comparative genomic survey Ruishan Liu, Hao Xu, Junhui Zhao, Xinjun Hu, Lingjiao Wu, Jie Qiao, Haoyu Ge, Xiaobing Guo, Jianjun Gou, Beiwen Zheng Virulence, 24.04.2023 Tilføjet 24.04.2023 14 The accuracy of infection diagnoses among patients meeting Sepsis-3 criteria in the emergency department Clinical Infectious Diseases, 24.04.2023 Tilføjet 24.04.2023 15 Hypothermia or hyperthermia, which is associated with patient outcomes in critically ill children with sepsis? --A retrospective study BMJ Open, 17.04.2023 Tilføjet 17.04.2023 ObjectivesIn the early stage of sepsis, identifying high-risk paediatric patients with a poor prognosis and providing timely and adequate treatment are critical. This study aimed to evaluate the effect of average body temperature within 24 hours of admission on the short-term prognosis of paediatric patients with sepsis. DesignA retrospective cohort study. SettingA single-centre, tertiary care hospital in China, containing patient data from 2010 to 2018. Participants1144 patients with sepsis were included. InterventionNone. Primary and secondary outcome measuresThe main outcome measure was in-hospital mortality, which was defined as death from any cause during hospitalisation. The secondary outcome was the length of hospital stay. ResultsThe LOWESS method showed a roughly ‘U’-shaped relationship between body temperature on the first day and in-hospital mortality. Multivariate logistic regression showed that severe hypothermia (OR 14.72, 95% CI 4.84 to 44.75), mild hypothermia (OR 3.71, 95% CI 1.26 to 10.90), mild hyperthermia (OR 3.41, 95% CI 1.17 to 9.90) and severe hyperthermia (OR 5.15, 95% CI 1.84 to 14.43) were independent risk factors for in-hospital mortality. Compared with other variables, the Wald 2 value of temperature on the first day minus the degree of freedom was the highest. ConclusionsWhether hypothermic or hyperthermic, the more abnormal the temperature on the first day is, the higher the risk of in-hospital death in children with sepsis. Læs mere Tjek på PubMed16 IV Vitamin C in Adults With Sepsis: A Bayesian Reanalysis of a Randomized Controlled Trial Angriman, Federico; Muttalib, Fiona; Lamontagne, François; Adhikari, Neill K. J.; LOVIT Investigators Critical Care Medicine, 15.04.2023 Tilføjet 15.04.2023 Objectives: The Lessening Organ Dysfunction with Vitamin C trial showed a harmful effect of vitamin C on 28-day death or persistent organ dysfunction. To maximize interpretation, we present a post hoc Bayesian reanalysis. Design: Bayesian reanalysis of a randomized placebo-controlled trial. Setting: Thirty-five ICUs. Patients: Adults with proven or suspected infection, vasopressor support, and no more than 24 hours of ICU admission. Interventions: Patients were allocated to receive either vitamin C (50 mg/kg of body weight) or placebo every 6 hours for up to 96 hours. Measurements and Main Results: The primary outcome was the composite of death or persistent organ dysfunction (i.e., vasopressor use, invasive mechanical ventilation, or new renal replacement therapy) at 28 days. We used Bayesian log-binomial models with random effects for hospital site and varying informative prior beliefs for the effect of vitamin C to estimate risk ratios (RRs) with 95% credible intervals (Crls) in the intention to treat population (vitamin C, 435 patients; placebo, 437 patients). Using weakly neutral priors, patients allocated to vitamin C had a higher risk of death or persistent organ dysfunction at 28 days (RR, 1.20; 95% Crl, 1.04–1.39; probability of harm, 99%). This effect was consistent when using optimistic (RR, 1.14; 95% Crl, 1.00–1.31; probability of harm, 98%) and empiric (RR, 1.09; 95% Crl, 0.97–1.22; probability of harm, 92%) priors. Patients allocated to vitamin C also had a higher risk of death at 28 days under weakly neutral (RR, 1.17; 95% Crl, 0.98–1.40; probability of harm, 96%), optimistic (RR, 1.10; 95% Crl, 0.94–1.30; probability of harm, 88%), and empiric (RR, 1.05; 95% Crl, 0.92–1.19; probability of harm, 76%) priors. Conclusions: The use of vitamin C in adult patients with proven or suspected infection and vasopressor support is associated with high probability of harm. Læs mere Tjek på PubMed17 The Gut Microbiome Modulates Body Temperature Both in Sepsis and Health Kale S. Bongers, Rishi Chanderraj, Robert J. Woods, Roderick A. McDonald, Mark D. Adame, Nicole R. Falkowski, Christopher A. Brown, Jennifer M. Baker, Katherine M. Winner, Daniel J. Fergle, Kevin J. Hinkle, Alexandra K. Standke, Kimberly C. Vendrov, Vincent B. Young, Kathleen A. Stringer, Michael W. Sjoding, Robert P. Dickson American Journal of Respiratory and Critical Care Medicine , 14.04.2023 Tilføjet 14.04.2023 American Journal of Respiratory and Critical Care Medicine, Volume 207, Issue 8, Page 1030-1041, April 15, 2023. Læs mere Tjek på PubMed18 Survival of community-acquired Bacillus cereus sepsis with venous sinus thrombosis in an immunocompetent adult man – a case report and literature review BMC Infectious Diseases, 12.04.2023 Tilføjet 12.04.2023 Abstract Background Bacillus cereus infections in immunocompetent patients are uncommon and mainly observed in fragile patients. It can cause lethal infections with multiple organ dysfunction syndrome (MODS). However, a patient presenting as venous sinus thrombosis and survival without sequela has not been reported. Case presentation A 20-year-old previously healthy male developed gastroenteritis after a meal, followed by fever, convulsions, and severe disturbance of consciousness. The patient had significant leukocytosis with a mildly elevated D-dimer, creatinine level, and respiratory failure. The CT(computed tomography) revealed fatal brain edema and subarachnoid hemorrhage. Previous blood culture in a local hospital revealed B. cereus, which was confirmed by mNGS(metagenomic next-generation sequencing) using blood and urine in our hospital. Accordingly, B. cereus sepsis with MODS were considered. Later, cerebral venous sinus thrombosis was proved. After anti-infection (linezolid 0.6 g, Q12h; and meropenem 1.0 g, Q8h), anti-coagulant (enoxaparin 6000U, Q12h), and other symptomatic treatments, the patient recovered completely without sequela at the 6-month follow-up. Conclusions This case suggests that in immunocompetent adults, there is still a risk of infection with B. cereus, causing severe MODS. Special attention should be paid to venous sinus thrombosis and subarachnoid hemorrhage in such cases, while, anti-coagulant is essential therapy. Læs mere Tjek på PubMed19 Association between the volume of fluid resuscitation and mortality modified by disease severity in patients with sepsis in ICU: a retrospective cohort study BMJ Open, 11.04.2023 Tilføjet 11.04.2023 ObjectiveThe important effect modifiers of high disease severity on the relationship between the different volumes of early fluid resuscitation and prognosis in septic patients are unknown. Thus, this study was designed to assess whether the efficacy of different volumes in the early fluid resuscitation treatment of sepsis is affected by disease severity. DesignRetrospective cohort study. SettingAdult intensive care unit (ICU) patients with sepsis from 2001 to 2012 in the MIMIC-III database. InterventionsThe intravenous fluid volume within 6 hours after the sepsis diagnosis serves as the primary exposure. The patients were divided into the standard (≥ 30 mL/kg) and restrict (<30 mL/kg) groups. Disease severity was defined by the sequential organ failure assessment (SOFA) score at ICU admission. Propensity score matching analysis was performed to ensure the robustness of our results. Primary and secondary outcome measuresThe primary endpoint of this study was 28-day mortality. Days without needing mechanical ventilation or vasopressor administration within 28-day of ICU admission serving as the secondary endpoint. ResultsIn total, 5154 consecutive individuals were identified in data analysis, 776 patients had a primary end-point event, 386 (49.68%) in the restrict group and 387 (49.81%) in the standard group. Compared with the restrict group, the standard group had higher 28-day mortality (adjusted HR, 1.32; 95% CI 1.03 to 1.70; p=0.03) in the subgroup with a sequential organ failure assessment (SOFA) score ≥10. By contrast, the risk of mortality reduction was modest in the subgroup with an SOFA score <10 (adjusted HR, 0.85; 95% CI 0.70 to 1.03; p=0.10). The effect of the interaction between the SOFA score and fluid resuscitation strategies on the 28-day mortality was significant (p=0.0035). ConclusionsHigh disease severity modifies the relationship between the volume of fluid resuscitation and mortality in patients with sepsis in the ICU; future studies investigating this interaction are warranted. Læs mere Tjek på PubMed20 Epidemiology, Resistance Profiles, and Outcomes of Bloodstream Infections in Community-Onset Sepsis in the United States Ohnuma, Tetsu; Chihara, Shingo; Costin, Blair; Treggiari, Miriam; Bartz, Raquel R.; Raghunathan, Karthik; Krishnamoorthy, Vijay Critical Care Medicine, 9.04.2023 Tilføjet 9.04.2023 Objectives: To describe frequency of positive blood cultures, patterns of pathogens’ characteristics and their resistance profile in patients with blood cultures drawn due to a presumed diagnosis of community-onset sepsis, and to examine the association between blood culture-positive pathogens and hospital mortality. Design: Retrospective cohort study. Setting: Two hundred one U.S. hospitals from 2016 to 2020 using the Premier Healthcare Database. Subjects: Adult patients presenting with community-onset sepsis who had blood cultures collected within 2 days of hospital admission. We defined sepsis using the U.S. Centers for Disease Control Adult Sepsis Event Surveillance criteria. Interventions: None. Measurements and Main Results: We identified 147,061 patients with community-onset sepsis. The number of blood culture-positive sepsis episodes was 21,167 (14%) and the number of nonblood culture-positive sepsis episodes was 20,326 (14%). Among patients with blood culture-positive sepsis, Gram-negative rods were isolated in 55% of patients, Gram-positive cocci were isolated in 47%. Of those, methicillin-resistant Staphylococcus aureus (MRSA) was 11%, ceftriaxone-resistant Enterobacterales/extended-spectrum β-lactamase was 7%, and carbapenem-resistant Enterobacterales was 1.3%. The crude in-hospital mortality was 17% for culture-negative sepsis, 13% for nonblood culture-positive sepsis, and 17% for blood culture-positive sepsis. In multilevel logistic regression models, compared with culture-negative sepsis, blood culture-positive sepsis (adjusted odds ratio [aOR], 0.89; 95% CI, 0.85–0.94) and nonblood culture-positive sepsis (aOR, 0.82; 95% CI, 0.78–0.87) were associated with lower odds of in-hospital mortality. Acinetobacter species, Pseudomonas aeruginosa, methicillin-sensitive Staphylococcus aureus, and MRSA were associated with higher in-hospital mortality, whereas Escherichia coli, Klebsiella species, Proteus species, and Streptococcus species were associated with lower in-hospital mortality. Conclusions: In patients hospitalized with community-onset sepsis, the prevalence of blood culture-positive sepsis was 14%. Among positive blood culture sepsis resistant organisms were infrequent. Compared with culture-negative sepsis, blood culture-positive sepsis and nonblood culture-positive sepsis were associated with lower in-hospital mortality. Læs mere Tjek på PubMed |
Referencer 1 Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med 2023; 388(6):499-510
Shapiro NI, Douglas IS, Brower RG, Brown SM, Exline MC, Ginde AA, Gong MN, Grissom CK, Hayden D, Hough CL, Huang W, Iwashyna TJ, Jones AE, Khan A, Lai P, Liu KD, Miller CD, Oldmixon K, Park PK, Rice TW, Ringwood N, Semler MW, Steingrub JS, Talmor D, Thompson BT, Yealy DM, Self WH
Intravenous fluids and vasopressor agents are commonly used in early resuscitation of patients with sepsis, but comparative data for prioritizing their delivery are limited. PMID: 366885072 Restriction of Intravenous Fluid in ICU Patients with Septic Shock. N Engl J Med 2022; 386(26):2459-2470
Meyhoff TS, Hjortrup PB, Wetterslev J, Sivapalan P, Laake JH, Cronhjort M, Jakob SM, Cecconi M, Nalos M, Ostermann M, Malbrain M, Pettilä V, Møller MH, Kjær MN, Lange T, Overgaard-Steensen C, Brand BA, Winther-Olesen M, White JO, Quist L, Westergaard B, Jonsson AB, Hjortsø CJS, Meier N, Jensen TS, Engstrøm J, Nebrich L, Andersen-Ranberg NC, Jensen JV, Joseph NA, Poulsen LM, Herløv LS, Sølling CG, Pedersen SK, Knudsen KK, Straarup TS, Vang ML, Bundgaard H, Rasmussen BS, Aagaard SR, Hildebrandt T, Russell L, Bestle MH, Schønemann-Lund M, Brøchner AC, Elvander CF, Hoffmann SKL, Rasmussen ML, Martin YK, Friberg FF, Seter H, Aslam TN, Ådnøy S, Seidel P, Strand K, Johnstad B, Joelsson-Alm E, Christensen J, Ahlstedt C, Pfortmueller CA, Siegemund M, Greco M, Raděj J, Kříž M, Gould DW, Rowan KM, Mouncey PR, Perner A
Intravenous fluids are recommended for the treatment of patients who are in septic shock, but higher fluid volumes have been associated with harm in patients who are in the intensive care unit (ICU). PMID: 357090193 Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47(11):1181-1247
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M
PMID: 34599691 4 Timing of norepinephrine initiation in patients with septic shock: a systematic review and meta-analysis. Crit Care 2020; 24(1):488
Li Y, Li H, Zhang D
The effect of the timing of norepinephrine initiation on clinical outcomes in patients with septic shock is uncertain. A systematic review and meta-analysis was performed to evaluate the impact of early and late start of norepinephrine support on clinical outcomes in patients with septic shock. PMID: 327627655 Procalcitonin to Reduce Long-Term Infection-associated Adverse Events in Sepsis. A Randomized Trial. Am J Respir Crit Care Med 2021; 203(2):202-210
Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, Panagaki A, Melachroinopoulos N, Drakou E, Marousis K, Chrysos G, Spyrou A, Alexiou N, Symbardi S, Alexiou Z, Lagou S, Kolonia V, Gkavogianni T, Kyprianou M, Anagnostopoulos I, Poulakou G, Lada M, Makina A, Roulia E, Koupetori M, Apostolopoulos V, Petrou D, Nitsotolis T, Antoniadou A, Giamarellos-Bourboulis EJ
Although early antimicrobial discontinuation guided by procalcitonin (PCT) has shown decreased antibiotic consumption in lower respiratory tract infections, the outcomes in long-term sepsis sequelae remain unclear. To investigate if PCT guidance may reduce the incidence of long-term infection-associated adverse events in sepsis. In this multicenter trial, 266 patients with sepsis (by Sepsis-3 definitions) with lower respiratory tract infections, acute pyelonephritis, or primary bloodstream infection were randomized (1:1) to receive either PCT-guided discontinuation of antimicrobials or standard of care. The discontinuation criterion was ≥80% reduction in PCT levels or any PCT ≤0.5 μg/L at Day 5 or later. The primary outcome was the rate of infection-associated adverse events at Day 180, a composite of the incidence of any new infection by or multidrug-resistant organisms, or any death attributed to baseline or multidrug-resistant organism infection. Secondary outcomes included 28-day mortality, length of antibiotic therapy, and cost of hospitalization. The rate of infection-associated adverse events was 7.2% (95% confidence interval [CI], 3.8-13.1%; 9/125) versus 15.3% (95% CI, 10.1-22.4%; 20/131) (hazard ratio, 0.45; 95% CI, 0.20-0.98; = 0.045); 28-day mortality 15.2% (95% CI, 10-22.5%; 19/125) versus 28.2% (95% CI, 21.2-36.5%; 37/131) (hazard ratio, 0.51; 95% CI, 0.29-0.89; = 0.02); and median length of antibiotic therapy 5 (range, 5-7) versus 10 (range, 7-15) days ( < 0.001) in the PCT and standard-of-care arms, respectively. The cost of hospitalization was also reduced in the PCT arm. In sepsis, PCT guidance was effective in reducing infection-associated adverse events, 28-day mortality, and cost of hospitalization.Clinical trial registered with www.clinicaltrials.gov (NCT03333304). PMID: 327579636 Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020; 395(10219):200-211
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, Colombara DV, Ikuta KS, Kissoon N, Finfer S, Fleischmann-Struzek C, Machado FR, Reinhart KK, Rowan K, Seymour CW, Watson RS, West TE, Marinho F, Hay SI, Lozano R, Lopez AD, Angus DC, Murray CJL, Naghavi M
Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. It is considered a major cause of health loss, but data for the global burden of sepsis are limited. As a syndrome caused by underlying infection, sepsis is not part of standard Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates. Accurate estimates are important to inform and monitor health policy interventions, allocation of resources, and clinical treatment initiatives. We estimated the global, regional, and national incidence of sepsis and mortality from this disorder using data from GBD 2017. PMID: 319544657 Procalcitonin-Guided Antibiotic Discontinuation and Mortality in Critically Ill Adults: A Systematic Review and Meta-analysis. Chest 2019; 155(6):1109-1118
Pepper DJ, Sun J, Rhee C, Welsh J, Powers JH, Danner RL, Kadri SS
Procalcitonin (PCT)-guided antibiotic discontinuation appears to decrease antibiotic use in critically ill patients, but its impact on survival remains less certain. PMID: 307723868 The Surviving Sepsis Campaign Bundle: 2018 Update. Crit Care Med 2018; 46(6):997-1000 9 Balanced Crystalloids versus Saline in Noncritically Ill Adults. N Engl J Med 2018; 378(9):819-828
Self WH, Semler MW, Wanderer JP, Wang L, Byrne DW, Collins SP, Slovis CM, Lindsell CJ, Ehrenfeld JM, Siew ED, Shaw AD, Bernard GR, Rice TW
Comparative clinical effects of balanced crystalloids and saline are uncertain, particularly in noncritically ill patients cared for outside an intensive care unit (ICU). PMID: 2948592610 Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med 2018; 378(9):829-839
Semler MW, Self WH, Wanderer JP, Ehrenfeld JM, Wang L, Byrne DW, Stollings JL, Kumar AB, Hughes CG, Hernandez A, Guillamondegui OD, May AK, Weavind L, Casey JD, Siew ED, Shaw AD, Bernard GR, Rice TW
Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes. PMID: 2948592511 A Comparison of the Quick-SOFA and Systemic Inflammatory Response Syndrome Criteria for the Diagnosis of Sepsis and Prediction of Mortality: A Systematic Review and Meta-Analysis. Chest 2018; 153(3):646-655
Serafim R, Gomes JA, Salluh J, Póvoa P
Several studies were published to validate the quick Sepsis-related Organ Failure Assessment (qSOFA), namely in comparison with the systemic inflammatory response syndrome (SIRS) criteria. We performed a systematic review and meta-analysis with the aim of comparing the qSOFA and SIRS in patients outside the ICU. PMID: 2928968712 Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study. Lancet Infect Dis 2017; 17(6):661-670
Donnelly JP, Safford MM, Shapiro NI, Baddley JW, Wang HE
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) present clinical criteria for the classification of patients with sepsis. We investigated incidence and long-term outcomes of patients diagnosed with these classifications, which are currently unknown. PMID: 2826806713 Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. JAMA 2017; 317(3):290-300
Raith EP, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R, Pilcher DV
The Sepsis-3 Criteria emphasized the value of a change of 2 or more points in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score, introduced quick SOFA (qSOFA), and removed the systemic inflammatory response syndrome (SIRS) criteria from the sepsis definition. PMID: 2811455314 Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Med 2016; 42(11):1695-1705
Hjortrup PB, Haase N, Bundgaard H, Thomsen SL, Winding R, Pettilä V, Aaen A, Lodahl D, Berthelsen RE, Christensen H, Madsen MB, Winkel P, Wetterslev J, Perner A
We assessed the effects of a protocol restricting resuscitation fluid vs. a standard care protocol after initial resuscitation in intensive care unit (ICU) patients with septic shock. PMID: 2768634915 Suspected sepsis: summary of NICE guidance. BMJ 2016; 354:i4030 16 The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315(8):801-10
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC
Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. PMID: 2690333817 Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315(8):775-87
Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, Angus DC, Rubenfeld GD, Singer M
Septic shock currently refers to a state of acute circulatory failure associated with infection. Emerging biological insights and reported variation in epidemiology challenge the validity of this definition. PMID: 2690333618 Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315(8):762-74
Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, Rubenfeld G, Kahn JM, Shankar-Hari M, Singer M, Deutschman CS, Escobar GJ, Angus DC
The Third International Consensus Definitions Task Force defined sepsis as "life-threatening organ dysfunction due to a dysregulated host response to infection." The performance of clinical criteria for this sepsis definition is unknown. PMID: 2690333519 Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 2015; 372(14):1301-11
Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM
Early, goal-directed therapy (EGDT) is recommended in international guidelines for the resuscitation of patients presenting with early septic shock. However, adoption has been limited, and uncertainty about its effectiveness remains. PMID: 2577653220 Goal-directed resuscitation for patients with early septic shock. N Engl J Med 2014; 371(16):1496-506
Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, Williams P
Early goal-directed therapy (EGDT) has been endorsed in the guidelines of the Surviving Sepsis Campaign as a key strategy to decrease mortality among patients presenting to the emergency department with septic shock. However, its effectiveness is uncertain. PMID: 2527231621 A randomized trial of protocol-based care for early septic shock. N Engl J Med 2014; 370(18):1683-93
Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC
In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock, mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal-directed therapy (EGDT), in which intravenous fluids, vasopressors, inotropes, and blood transfusions were adjusted to reach central hemodynamic targets, than among those receiving usual care. We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary. PMID: 2463577322 Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 2014; 370(15):1412-21
Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L
Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established. PMID: 2463577223 High versus low blood-pressure target in patients with septic shock. N Engl J Med 2014; 370(17):1583-93
Asfar P, Meziani F, Hamel JF, Grelon F, Megarbane B, Anguel N, Mira JP, Dequin PF, Gergaud S, Weiss N, Legay F, Le Tulzo Y, Conrad M, Robert R, Gonzalez F, Guitton C, Tamion F, Tonnelier JM, Guezennec P, Van Der Linden T, Vieillard-Baron A, Mariotte E, Pradel G, Lesieur O, Ricard JD, Hervé F, du Cheyron D, Guerin C, Mercat A, Teboul JL, Radermacher P
The Surviving Sepsis Campaign recommends targeting a mean arterial pressure of at least 65 mm Hg during initial resuscitation of patients with septic shock. However, whether this blood-pressure target is more or less effective than a higher target is unknown. PMID: 2463577024 Severe sepsis and septic shock. N Engl J Med 2013; 369(9):840-51 25 Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N Engl J Med 2012; 367(2):124-34
Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, Madsen KR, Møller MH, Elkjær JM, Poulsen LM, Bendtsen A, Winding R, Steensen M, Berezowicz P, Søe-Jensen P, Bestle M, Strand K, Wiis J, White JO, Thornberg KJ, Quist L, Nielsen J, Andersen LH, Holst LB, Thormar K, Kjældgaard AL, Fabritius ML, Mondrup F, Pott FC, Møller TP, Winkel P, Wetterslev J
Hydroxyethyl starch (HES) [corrected] is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis. PMID: 2273808526 Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Crit Care Med 2011; 39(9):2048-58
Jensen JU, Hein L, Lundgren B, Bestle MH, Mohr TT, Andersen MH, Thornberg KJ, Løken J, Steensen M, Fox Z, Tousi H, Søe-Jensen P, Lauritsen AØ, Strange D, Petersen PL, Reiter N, Hestad S, Thormar K, Fjeldborg P, Larsen KM, Drenck NE, Ostergaard C, Kjær J, Grarup J, Lundgren JD
For patients in intensive care units, sepsis is a common and potentially deadly complication and prompt initiation of appropriate antimicrobial therapy improves prognosis. The objective of this trial was to determine whether a strategy of antimicrobial spectrum escalation, guided by daily measurements of the biomarker procalcitonin, could reduce the time to appropriate therapy, thus improving survival. PMID: 2157232827 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31(4):1250-6
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G
In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious process that falls under the generalized term 'sepsis' and includes sepsis-associated organ dysfunction as well." The general definitions introduced as a result of that conference have been widely used in practice and have served as the foundation for inclusion criteria for numerous clinical trials of therapeutic interventions. Nevertheless, there has been an impetus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes. PMID: 1268250028 American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20(6):864-74 |
Dansk Selskab for Tropemedicin og International Sundhed (DSTMIS) generalforsamling 2023
København
Onsdag d. 31. maj
Ph.d. forsvar ved Michaela Tinggaard
Mærsk Tårnet, Panum Instituttet, København
Torsdag d. 1. juni
Ph.d. forsvar ved Carlota Fernández Antúnez
Auditorium 3 og 4, Hvidovre Hospital
Fredag d. 2. juni
European Meeting on HIV & Hepatitis 2023
Rom, Italien
Onsdag d. 7. juni
Houston, Texas, USA
Torsdag d. 15. juni
Tuberkulose - diagnostik og behandling (2023)
Tilføjet 30. maj 2023
Tuberkuloseinfektion hos immunsupprimerede (2023)
Tilføjet 26. februar 2023
Tilføjet 6. februar 2023
Tilføjet 6. februar 2023
COVID-19 retningslinje (2022v24)
Tilføjet 5. februar 2023
Retrovirology
Tilføjet 31. maj 2023
Lancet Respiratory Medicine
Tilføjet 31. maj 2023
PLoS One Infectious Diseases
Tilføjet 30. maj 2023
International Journal of Infectious Diseases
Tilføjet 30. maj 2023
Mycobacterial Genetic Technologies for Probing the Host-Pathogen Microenvironment
Infection and Immunity
Tilføjet 30. maj 2023
New Approaches to Chronic Hepatitis B.
Udvalgt og kommenteret af Professor Nina Weis
Tilføjet 19. januar 2023
Udvalgt og kommenteret af Professor Troels Lillebæk
Tilføjet 14. januar 2023
Bedaquiline-Pretomanid-Linezolid Regimens for Drug-Resistant Tuberculosis.
Udvalgt og kommenteret af Professor Troels Lillebæk
Tilføjet 14. januar 2023
Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19.
Udvalgt og kommenteret af Professor Jens Lundgren
Tilføjet 14. december 2022
The Huanan Seafood Wholesale Market in Wuhan was the early epicenter of the COVID-19 pandemic.
Udvalgt og kommenteret af Professor Jens Lundgren
Tilføjet 9. december 2022
COVID-19 retningslinje (2022v24)
Uploadet 5. februar 2023
Uploadet 13. maj 2021
Akut bakteriel meningitis (2018)
Uploadet 12. maj 2021
Borrelia klaringsrapport (2014)
Uploadet 12. maj 2021
Guidelines for diagnostik og behandling af spondylodiskitis (2018)
Uploadet 12. maj 2021
Nyhedsbrev
Skriv din email adresse og modtag nyheder om hjemmesiden.
© 2023 Dansk Selskab for Infektionsmedicin
CVR: 33634307
www.infmed.dk Version: 2.12.0 PHP version: 8.0.28 Design: Christian Philip Fischer Side indlæst på 2.273 s