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Latest Results for Malaria Journal, 2.04.2019
Tilføjet 03.04.2019 23:08
Care-seeking behaviour and treatment practices for malaria in children under 5 years in Mozambique: a secondary analysis of 2011 DHS and 2015 IMASIDA datasets
In Mozambique, the prevalence of malaria in children under 5 years of age is among the highest in the world, but limited data exist on determinants of care-seeking behaviour for malaria. This study aimed at determining the trends and factors associated with care-seeking behaviour for fever among children under 5 years of age and to assess the treatment practices for malaria.
Secondary data analysis of two cross-sectional studies. Descriptive statistics were used to summarize socio-economic and demographic characteristics of participants, using data from the 2011 Demographic and Health Survey and 2015 Indicators of Immunization, Malaria and HIV/AIDS Survey. Complex sampling logistic regression model was used to identify factors associated with care-seeking behaviour, with estimated adjusted odds ratio and respective 95% confidence intervals, only for 2015 IMASIDA data.
A total of 10,452 and 5168 children under 5 years of age were enrolled in the 2011 DHS and 2015 IMASIDA, respectively. Care-seeking for fever in public and private sectors remained stable during this period (62.6%; 835/1432 in 2011 and 63.7%; 974/1529 in 2015). The main place where care was sought in both surveys was public hospitals (86.2%; 773/897 in 2011 and 86.7%; 844/974 in 2015). Prescription of anti-malarial drugs increased from 42.9% (385/897) in 2011 to 53.8% (524/974) in 2015. Artemether–lumefantrine was the most used anti-malarial drug for febrile children in both surveys and its use increased from 59.0% (219/373) in 2011 to 89.3% (457/512) in 2015. Data from 2015 elucidated that care-seeking was more common in children whose mothers had a secondary level of education (AOR = 2.27 [95% CI 1.15–4.49]) and among those in poorer quintile (AOR = 1.46 [95% CI 0.83–1.90]). Mothers with higher education level (AOR = 0.16 [95% CI 0.34–0.78]) were less likely to seek out care. People from Manica (AOR = 2.49 [1.03–6.01]), Sofala ([AOR = 2.91 [1.03–8.24]), Inhambane (AOR = 3.95 [1.25–12.45]), Gaza (AOR = 3.25 [1.22–8.65]) and Maputo Province (AOR = 2.65 [1.10–6.41]) were more likely to seek care than people from Maputo City.
Data from this study showed that care-seeking in Mozambique remained suboptimal. Interventions to raise the awareness for early care-seeking during episodes of fever should be urgently reinforced and intensified.
Critical Care Medicine - Online First, 25.07.2019
Tilføjet 27.07.2019 09:55
Clinical Examination for the Prediction of Mortality in the Critically Ill: The Simple Intensive Care Studies-I
Caregivers use clinical examination to timely recognize deterioration of a patient, yet data on the prognostic value of clinical examination are inconsistent. In the Simple Intensive Care Studies-I, we evaluated the association of clinical examination findings with 90-day mortality in critically ill patients.
Prospective single-center cohort study.
ICU of a single tertiary care level hospital between March 27, 2015, and July 22, 2017.
All consecutive adults acutely admitted to the ICU and expected to stay for at least 24 hours.
A protocolized clinical examination of 19 clinical signs conducted within 24 hours of admission.
Independent predictors of 90-day mortality were identified using multivariable logistic regression analyses. Model performance was compared with established prognostic risk scores using area under the receiver operating characteristic curves (AUC). Robustness of our findings was tested by internal bootstrap validation and adjustment of the threshold for statistical significance.
A total of 1,075 patients were included, of whom 298 patients (28%) had died at 90-day follow-up. Multivariable analyses adjusted for age and norepinephrine infusion rate demonstrated that the combination of higher respiratory rate, higher systolic blood pressure, lower central temperature, altered consciousness, and decreased urine output was independently associated with 90-day mortality (AUC = 0.74; 95% CI, 0.71–0.78). Clinical examination had a similar discriminative value as compared with the Simplified Acute Physiology Score-II (SAPS-II) (AUC = 0.76; 95% CI, 0.73–0.79; p = 0.29) and Acute Physiology and Chronic Health Evaluation-IV (APACHE-IV) (AUC = 0.77; 95% CI, 0.74–0.80; p = 0.16) and was significantly better than the Sequential Organ Failure Assessment (SOFA) (AUC = 0.67; 95% CI, 0.64–0.71; p < 0.001).
Clinical examination has reasonable discriminative value for assessing 90-day mortality in acutely admitted ICU patients. In our study population, a single, protocolized clinical examination had similar prognostic abilities compared with the SAPS-II and APACHE-IV and outperformed the SOFA score.
New affiliation for Dr. Eck: Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Drs. Hiemstra, van der Horst, and Keus drafted the manuscript and conducted the analyses. Drs. van der Horst and Keus created the idea of the study. Drs. Eck and Koster developed the protocol and implemented the study. Mr. Wiersema and Dr. Kaufmann contributed substantially to the data collection. Drs. Wetterslev and Snieder contributed to the statistical analyses and design of the detailed statistical analyses plan. Professors Scheeren, Perner, and Pettilä critically reviewed the article. All authors critically reviewed the article and agreed with the final version and findings.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Prof dr. Scheeren received research funding and honoraria from Edwards Lifesciences and Masimo Inc. (Irvine, CA) for consulting and lecturing and from Pulsion Medical Systems SE for lecturing in the past. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Ethics approval: Medisch Ethische Toetsingscommissie, University Medical Center Groningen; METc M15.168207.
ORCID IDs: Dr. Hiemstra: 0000-0001-6547-2138; Dr. Eck: 0000-0001-7440-2465; Mr. Wiersema: 0000-0003-2413-2852; Dr. Kaufmann: 0000-0003-0589-8879; Dr. Koster: 0000-0002-8927-3077; Dr. Scheeren: 0000-0002-9184-4190; Dr. Snieder; 0000-0003-1949-2298; Dr. Perner: 0000-0002-4668-0123; Dr. Wetterslev: 0000-0001-7778-1771; Dr. Keus: 0000-0003-1516-1475; Dr. van der Horst: 0000-0003-3891-8522.
For information regarding this article, E-mail: firstname.lastname@example.org
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Latest Results for BMC Infectious Diseases, 16.10.2019
Tilføjet 16.10.2019 17:00
Clinical outcomes of patients treated with intravenous zanamivir for severe influenza A(H1N1)pdm09 infection: a case report series
Intravenous (IV) zanamivir could be a suitable alternative for the treatment of severe influenza A(H1N1)pdm09 infection in patients who are unable to take oral or inhaled medication, for example, those on mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, data on the clinical outcomes of such patients is limited.
We report the clinical outcomes of four patients who were admitted at the intensive care unit during the 2017–2018 influenza season with severe sepsis (SOFA score > 11) and acute respiratory distress syndrome requiring ECMO and mechanical ventilation. Two patients were immune-compromised. The A(H1N1)pdm09 genome was confirmed by polymerase chain reaction (PCR) on nasopharyngeal specimen swabs prior to administration of IV zanamivir at a dose of 600 mg twice daily. Weekly qualitative PCR analysis was done to monitor viral clearance, with zanamivir treatment being discontinued upon receipt of negative results. In addition, the patients were managed for concomitant multidrug-resistant bacterial infections, with infection resolution confirmed with blood cultures.
The median time for zanamivir treatment was 10 days (IQR 10–17). The clinical outcome was favourable with all four patients surviving and improving clinically. All four patients achieved viral clearance of A(H1N1)pdm09 genome, and resolution of multidrug-resistant bacterial infections.
IV zanamivir could be a good therapeutic option in patients with severe influenza A(H1N1)pdm09 infection who are unable to take oral or aerosolised antiviral medication. We recommend prospective randomized control trials to support this hypothesis.
Clinical Infectious Diseases Advance Access, 12.06.2019
Tilføjet 12.06.2019 18:03
Dengue infection complicated by hemophagocytic lymphohistiocytosis: Experiences from 180 severe dengue patients
AbstractBackgroundGlobally approximately 500,000 people with severe dengue (SD) require hospitalization yearly; about 12,500 (2.5%) die. Secondary hemophagocytic lymphohistiocytosis (sHLH) is a potentially fatal hyperinflammatory condition for which HLH-directed therapy (as etoposide and dexamethasone) can be life-saving. Prompted by the high mortality in SD and the increasing awareness that patients with SD may develop sHLH, our objectives were to i) determine the frequency of dengue-HLH in SD, ii) describe clinical features of dengue-HLH, iii) assess mortality rate in SD and dengue-HLH, and iv). identify mortality-associated risk factors in SD.MethodsA 5-year retrospective single-center study on all adult patients with SD admitted to a tertiary ICU in Malaysia.ResultsThirty-nine/180 (22%) patients with SD died. Twenty-one/180 (12%) had HLH defined as HLH-probability ≥70% according to HScore; nine (43%) died. Similarly, 12/31 (39%) fulfilling ≥4 and 7/9 (78%) fulfilling ≥5 HLH-2004 diagnostic criteria died. Peak values of AST, ALT, LDH, and creatinine correlated to fatality (OR=2.9, 3.4, 5.8, and 31.9; all p
International Journal of Infectious Diseases, 24.04.2019
Tilføjet 25.04.2019 08:53
Efficacy and accuracy of qSOFA and SOFA scores as prognostic tools for community-acquired and healthcare-associated pneumonia
Tilføjet 23.08.2019 07:34
Eligibility and subsequent burden of cardiovascular disease of four strategies for blood pressure-lowering treatment: a retrospective cohort study
A cardiovascular risk-based strategy (QRISK2 ≥10%) could prevent over a third more cardiovascular disease events than the 2011 NICE guideline and a fifth more than the 2019 NICE guideline, with similar efficiency regarding number treated per event avoided.
Clinical Microbiology and Infection,
Tilføjet 23.10.2019 02:34
Measuring patient centred long term outcome following a bloodstream infection: a pilot study
To evaluate the sequential organ failure assessment (SOFA), modified SOFA scoring and a novel performance score based on the Karnofsky score for measuring outcome following a bloodstream infection.
Latest Results for BMC Infectious Diseases, 5.11.2019
Tilføjet 05.11.2019 17:52
Multicentric experience with interferon gamma therapy in sepsis induced immunosuppression. A case series
The sepsis-induced immunodepression contributes to impaired clinical outcomes of various stress conditions. This syndrome is well documented and characterized by attenuated function of innate and adaptive immune cells. Several pharmacological interventions aimed to restore the immune response are emerging of which interferon-gamma (IFNγ) is one. It is of paramount relevance to obtain clinical information on optimal timing of the IFNγ-treatment, −tolerance, −effectiveness and outcome before performing a RCT. We describe the effects of IFNγ in a cohort of 18 adult and 2 pediatric sepsis patients.
In this open-label prospective multi-center case-series, IFNγ treatment was initiated in patients selected on clinical and immunological criteria early ( 7 days) following the onset of sepsis. The data collected in 18 adults and 2 liver transplanted pediatric patients were: clinical scores, monocyte expression of HLA-DR (flow cytometry), lymphocyte immune-phenotyping (flow cytometry), IL-6 and IL-10 plasma levels (ELISA), bacterial cultures, disease severity, and mortality.
In 15 out of 18 patients IFNγ treatment was associated with an increase of median HLA-DR expression from 2666 [IQ 1547; 4991] to 12,451 [IQ 4166; 19,707], while the absolute number of lymphocyte subpopulations were not affected, except for the decrease number of NK cells 94.5 [23; 136] to 32.5 [13; 90.8] (0.0625)]. Plasma levels of IL-6 464 [201–770] to 108 (89–140) ng/mL (p = 0.04) and IL-10 from IL-10 from 29 [12–59] to 9 [1–15] pg/mL decreased significantly. Three patients who received IFNγ early after ICU admission (
Latest Results for BMC Infectious Diseases, 25.07.2019
Tilføjet 25.07.2019 23:57
Prevalence and factors associated with one-year mortality of infectious diseases among elderly emergency department patients in a middle-income country
This study aimed to determine the prevalence of infectious diseases and risk factors for one-year mortality in elderly emergency department (ED) patients.
A retrospective cohort study of patients aged 65 and over who visited the ED of one urban teaching hospital in Bangkok, Thailand and who were diagnosed with infectious diseases between 1 January 2016 and 30 June 2016.
There were 463 elderly patients who visited ED with infectious diseases, accounting for 14.5% (463/3,196) of all elderly patients’ visits. The most common diseases diagnosed by emergency physicians (EPs) were pneumonia [151 (32.6%) patients] followed by pyelonephritis [107 (23.1%) patients] and intestinal infection [53 (11.4%) patients]. Moreover, 286 (61.8%) patients were admitted during the study period. The in-hospital mortality rate was 22.7%. 181 (39.1%) patients died within 1 year. Our multivariate analysis showed that age 85 years and older [odds ratio (OR) = 1.89; 95% confidence interval (CI): 1.36–2.63], Charlson Co-morbidity Index score ≥ 5 (OR = 3.51; 95% CI2.14–5.77), lactate ≥4 mmol/l (OR = 2.66;95% CI 1.32–5.38), quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2 (OR = 5.46; 95% CI 2.94–10.12), and platelet count
Clinical Infectious Diseases Advance Access, 18.05.2019
Tilføjet 21.05.2019 04:10
Prognostic accuracy of sTREM-1-based algorithms in febrile adults presenting to Tanzanian outpatient clinics
AbstractBackgroundThe inability to identify individuals with acute fever at risk of death is a barrier to effective triage and management of severe infections, especially in low-resource settings. Since endothelial and immune activation contribute to the pathogenesis of various distinct life-threatening infections, we hypothesized that measuring mediators of these pathways at clinical presentation would identify febrile adults at risk of death.MethodsPlasma concentrations of markers of endothelial (Angpt-2, sFlt-1, sVCAM-1, sICAM-1) and immune (sTREM-1, IL-6, IL-8, CHI3L1, sTNFR1, PCT, CRP) activation pathways were determined in consecutive adults with acute fever (>38°C) at presentation to outpatient clinics in Dar es Salaam, Tanzania. We evaluated the accuracy of these mediators in predicting all-cause mortality, and examined whether markers could improve the prognostic accuracy of clinical scoring systems, including the quick Sequential Organ Failure Assessment (qSOFA) and Glasgow Coma Scale (GCS).ResultsOf 507 febrile adults, 32 died (6.3%) within 28 days of presentation. sTREM-1 was the best prognostic marker for 28-day mortality (area under the receiver operating characteristic [AUROC] 0.87, 95% CI 0.81-0.92) and was significantly better than CRP (P
International Journal of Infectious Diseases,
Tilføjet 04.11.2019 09:26
Reply to: Why would procalcitonin perform better in patients with a SOFA-score less than 8?
We appreciated the comments by Dr van Oers and colleagues concerning the effect of PCT-guided cessation of antibiotics in patients with the SOFA score less than 8. Our meta-analysis revealed that PCT-guided cessation of antibiotic therapy decreased the short-term mortality in patients with an average SOFA score < 8, suspected sepsis or lower algorithm adherence (< 70%), but not in those with a score > 8, confirmed sepsis or higher adherence(Peng et al., 2019). Compared to the standard care group, PCT-guided antibiotic therapy failed to decrease the mortality or shorten the ICU length of stay, as previous trials reported(Bouadma et al., 2010; Jensen et al., 2011; Bloos et al., 2016).
Latest Results for BMC Infectious Diseases, 11.02.2019
Tilføjet 11.02.2019 16:45
Systemic inflammatory response syndrome in Sepsis-3: a retrospective study
In the new Sepsis-3 definition, sepsis is defined as “life-threatening organ dysfunction due to a dysregulated host response to infection.” We tested the predictive validity of the systematic inflammatory response syndrome (SIRS) criteria in patients in the Sepsis-3 cohort.
Among 1243 electronic health records from 1 January to 31 December 2015 at Sichuan University West China Hospital, we identified patients with sepsis and septic shock according to the Sepsis-3 definition and divided them into 2 subsets: SIRS-positive and SIRS-negative. We compared their characteristics and outcomes as well as the predictive validity of the SIRS criteria for in-hospital mortality.
Of the 1243 patients, 631 were enrolled. Among these, 538 (85.3%) patients had SIRS-positive sepsis or septic shock, 168 (31.2%) of whom died, and 93 (14.7%) had SIRS-negative sepsis or septic shock, 20 (21.5%) of whom died (p = 0.06). Over a 1-year period, these groups had similar characteristics and changes in mortality. Among patients of the Sepsis-3 cohort admitted to the intensive care unit, the predictive validity for in-hospital mortality was lower for the SIRS criteria (area under the receiver operating characteristic curve [AUROC], 0.53; 95% confidence interval [95% CI], 0.49–0.57) than for the sequential (sepsis-related) organ failure assessment (SOFA) criteria (AUROC, 0.70; 95% CI, 0.66–0.74; p ≤ 0.01 for both). The SIRS score had poor predictive validity for the risk of in-hospital mortality.
In this cohort study of the new Sepsis-3 definition, we found that the SIRS criteria are weaker than the SOFA criteria with respect to their predictive efficacy for in-hospital death.
JAMA Current Issue, 25.06.2019
Tilføjet 26.06.2019 02:34
The Proliferation of Articles on Clinical Scoring Systems
This Viewpoint charts the rise in publications describing risk prediction tools, such as the FRAX, CHADS2, and SOFA scores, and discusses the implications of using algorithms for clinical decisions in the absence of evidence about the effects of the tools on patient care and outcomes.
Tilføjet 07.12.2019 05:46
The public health control of scabies: priorities for research and action
We read the Article by David Engelman and colleagues1 with interest. Their overview of the key operational research questions to develop a global control programme for scabies provides a clear research agenda for the years to come.1 Mass drug administration (MDA) using ivermectin reduced the prevalence of both scabies and impetigo tremendously in Fiji with a sustained effect even 24 months after the intervention.2 Future studies should prioritise the inclusion of non-island populations.
PLOS ONE: sortOrder=DATE_NEWEST_FIRST&filterJournals=PLoSONE&q=subject%3A%22infectious+diseases%22, 7.05.2019
Tilføjet 07.05.2019 21:19
Use of prehospital qSOFA in predicting in-hospital mortality in patients with suspected infection: A retrospective cohort study
by Satoshi Koyama, Yutaka Yamaguchi, Koichiro Gibo, Izumi Nakayama, Shinichiro Ueda
Background The quick sequential organ failure assessment (qSOFA) score has recently been introduced to the emergency department (ED) and wards, and it predicted a higher number of deaths among patients with sepsis compared with baseline risk. However, studies about the application of the qSOFA score are limited in prehospital settings. Thus, this study aimed to assess the performance of prehospital qSOFA score in predicting the risk of mortality among patients with infection. Methods This single center, retrospective cohort study was conducted in a Japanese tertiary care teaching hospital between April 2016 and March 2017. We enrolled all consecutive adult patients transported to the hospital by ambulance and admitted to the ED due to a suspected infection. We calculated the prehospital qSOFA score using the first vital sign obtained at the scene by emergency medical service (EMS) providers. The primary outcome was in-hospital mortality. The Cox proportional hazards model was used to assess the association between prehospital qSOFA positivity and in-hospital mortality. Results Among the 925 patients admitted to the ED due to a suspected infection, 51.1% (473/925) were prehospital qSOFA-positive and 48.9% (452/925) were prehospital qSOFA-negative. The in-hospital mortality rates were 14.0% (66/473) in prehospital qSOFA-positive patients and 6.0% (27/452) in prehospital qSOFA-negative patients. The Cox proportional hazard regression model revealed a strong association between prehospital qSOFA score and in-hospital mortality (adjusted hazard ratio: 2.41, 95% confidence interval: 1.51–3.98; p
Latest Results for BMC Infectious Diseases, 13.02.2019
Tilføjet 13.02.2019 20:42
Utility of qSOFA score in identifying patients at risk for poor outcome in Staphylococcus aureus bacteremia
The prognostic capability of the quick Sequential Organ Failure Assessment (qSOFA) bedside scoring tool is uncertain in non-ICU patients with sepsis due to bacteremia given the low number of patients previously evaluated.
We performed a retrospective cohort study of adult hospitalized patients with Staphylococcus aureus bacteremia (SAB). Medical charts were reviewed to determine qSOFA score, systemic inflammatory response syndrome (SIRS) criteria, and Pitt bacteremia score (PBS) at initial presentation; their predictive values were compared for ICU admission within 48 h, ICU stay duration > 72 h, and 30-day mortality.
Four hundred twenty-two patients were included; 22% had qSOFA score ≥2. Overall, mean age was 56y and 75% were male. More patients with qSOFA ≥2 had altered mentation (23% vs 5%, p
International Journal of Infectious Diseases,
Tilføjet 04.11.2019 09:26
Why would procalcitonin perform better in patients with a SOFA-score less than 8?