S. Maitra, A. Som, S. Bhattacharjee

To identify sensitivity, specificity and predictive accuracy of quick sequential organ failure assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria to predict in-hospital mortality in hospitalized patients with suspected infection.

José Moreira, Ariane Paixão, Juliana Oliveira, Waldir Jaló, Ofélio Manuel, Rafaela Rodrigues, Alexandra Oliveira, Leonardo Tinoco, João Lima, Beatriz Grinsztejn, Valdiléa G. Veloso, André M. Japiassú, Cristiane C. Lamas

To compare the discriminatory capacity of the quick Sequential Organ Failure Assessment (qSOFA) versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting 30-day mortality and intensive care unit (ICU) admission in patients with suspicion of infection at an HIV reference center.

Rudd KE, Seymour CW, Aluisio AR, et al.

This pooled cohort analysis assesses the association of quick Sequential (Sepsis-Related Organ Failure Assessment (qSOFA) score with excess hospital death among patients with suspected infection in low- to middle-income countries and compares the mortality association using qSOFA vs systemic inflammatory response syndrome (SIRS) criteria.

Abstract Purposes Streptococcus pneumoniae is a leading pathogen of severe community, hospital or nursing facility infections. We sought to describe characteristics of invasive pneumococcal infection (IPI) and pneumonia (due to the high mortality of intensive care-associated pneumonia) and to report outcomes according to various types of comorbidity. Methods Multicenter observational cohort study on the prospective Outcomerea database, including adult patients, with a hospital stay 

Freire, M. P., Pierrotti, L. C., Zerati, A. E., Benites, L., Motta-Leal Filho, J. M. d., Ibrahim, K. Y., Araujo, P. H., Abdala, E.

Objectives: The management of long-term central venous catheters (LTCVCs) infections by multi-drug resistant (MDR) bacteria in cancer patient is a challenger. The objectives of this study were to analyse outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavourable outcomes and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections.Methods: We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day-mortality, and treatment failure. We analysed risk factors by Cox forward-stepwise regression.Results: We identified 296 LTCVC-associated infections, 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Staphylococcus aureus.46 (21.7%) infections were due to multi-drug resistant (MDR) Gram-negative.ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high Sequential Organ Failure Assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day-mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, haematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors.Conclusions: Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.

Zhenjun Yu, Ni Zhou, Ali Li, Jie Chen, Huazhong Chen, Zebao He, Fei Yan, Haihong Zhao, Jiansheng Zhu

Shields, R. K., Nguyen, M. H., Chen, L., Press, E. G., Kreiswirth, B. N., Clancy, C. J.

Ceftazidime-avibactam was used to treat 77 patients with carbapenem-resistant Enterobacteriaceae (CRE) infections at our center. Thirty- and 90-day survival rates were 81% and 69%, respectively; rates were higher than predicted by SAPS II and SOFA scores at the onset of infection. Clinical success was achieved in 55% of patients, but varied by site of infection. Success rates were lowest for pneumonia (36%) and higher for bacteremia (75%) and urinary tract infections (88%). By multivariate analysis, pneumonia (P=0.045) and receipt of renal replacement therapy (RRT; P=0.046) were associated with clinical failure. Microbiologic failures occurred in 32% of patients, and occurred more commonly among patients infected with KPC-3-producing than KPC-2-producing CRE (P=0.002). Pneumonia was an independent predictor of microbiologic failures (P=0.007). Ceftazidime-avibactam resistance emerged in 10% of patients, including 14% infected with Klebsiella pneumoniae and 32% with microbiologic failures. RRT was an independent predictor for the development of resistance (P=0.009). Resistance was identified exclusively among K. pneumoniae harboring variant KPC-3 enzymes. Upon phylogenetic analysis of whole genome sequences, resistant isolates from 87.5% (7/8) of patients clustered within a previously defined sequence type (ST)258, clade II sub-lineage; resistant isolates from one patient clustered independently from other ST258, clade II isolates. In conclusion, our report offers new insights into the utility and limitations of ceftazidime-avibactam across CRE infection types. Immediate priorities are to identify ceftazidime-avibactam dosing and therapeutic regimens that improve upon the poor outcomes among patients with pneumonia, and in those receiving RRT.

Abstract Purpose Endogenous fungal endophthalmitis (EFE) is a severe consequence of candidemia. The prevalence of, and risk factors for, EFE is not well studied. Methods We retrospectively collected cases of patients with candidemia who had undergone ophthalmological examination between April 2011 and March 2016 in five regional hospitals. We conducted bivariate and multivariate analyses using patients’ age, gender, causative Candida species, diabetes status, corticosteroid use, cancer status, neutropenia, intensive care unit admission, presence of central venous catheter (CVC), presence of shock, prior antibiotic use, 30-day mortality, and highest Sequential Organ Failure Assessment (SOFA) score. Data on sustained positive blood culture, β-d glucan, CVC removal, empirical antifungal drug used, and time to appropriate antifungal therapy were also collected if available. Results Of 174 patients with candidemia, 35 (20.1%) were diagnosed with EFE, including 31 (17.8%) with chorioretinitis and 4 (2.3%) with vitritis. Bivariate analysis (EFE group vs. non-EFE group) found that Candida albicans candidemia (77.1 vs. 34.5%, P 

Adhikari NJ, Rubenfeld GD.

In the past 2 years, sepsis has received considerable attention from the global community. In 2017, the World Health Assembly passed a resolution urging all 194 UN Member States to implement actions to reduce the burden of sepsis, and for the World Health Organization to report on the public health implications of sepsis and its global consequences. It has become clear that early resuscitation targeted to hemodynamic goals is more expensive and no more effective than routine care in high-income countries. In Zambia, a protocolized resuscitation strategy actually increased mortality. These data and other studies continue to suggest that some evidence on sepsis therapy does not generalize on a global scale.

Christian Brun-Buisson

Meta-analyses of accuracy of the qSOFA to predict hospital mortality of patients with suspected infection show suboptimal performance of this abridged score. However, a score composed of only 3 clinical variables, such as the qSOFA or CRB can hardly be very accurate, but can serve as a warning integrated into clinical decision making, to help triaging patients in the ED. qSOFA does not help identifying infection. More complete, generic severity scores are nevertheless of major interest for stratification or analyses of epidemiolgical studies and clinical trials in septic patients.

F. Wu, Y. Ye, X. Zhou

We read with interest the meta-analysis by Maitra et al. who found that quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) seemed to be a poorly sensitive predictive marker for in-hospital mortality in hospitalized patients with suspected infection [1]. Though the review sounds comprehensive and scientific, we have some different views to address.