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47 ud af 47 tidsskrifter valgt, søgeord (sepsis, septic, sofa, qsofa) valgt, emner højest 30 dage gamle, sorteret efter nyeste først.
34 emner vises.
BMC Infectious Diseases, 18.04.2024
Tilføjet 18.04.2024
Abstract Background Metagenomic next-generation sequencing (mNGS) has been increasingly applied in sepsis. We aimed to evaluate the diagnostic and therapeutic utility of mNGS of paired plasma and peritoneal drainage (PD) fluid samples in comparison to culture-based microbiological tests (CMTs) among critically ill patients with suspected acute intra-abdominal infections (IAIs). Methods We conducted a prospective study from October 2021 to December 2022 enrolling septic patients with suspected IAIs (n = 111). Pairwise CMTs and mNGS of plasma and PD fluid were sent for pathogen detection. The mNGS group underwent therapeutic regimen adjustment based on mNGS results for better treatment. The microbial community structure, clinical features, antibiotic use and prognoses of the patients were analyzed. Results Higher positivity rates were observed with mNGS versus CMTs for both PD fluid (90.0% vs. 48.3%, p
Læs mere Tjek på PubMedInfection, 17.04.2024
Tilføjet 17.04.2024
Abstract Purpose Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. The purpose of the study was to measure the associations of specific exposures (deprivation, ethnicity, and clinical characteristics) with incident sepsis and case fatality. Methods Two research databases in England were used including anonymized patient-level records from primary care linked to hospital admission, death certificate, and small-area deprivation. Sepsis cases aged 65–100 years were matched to up to six controls. Predictors for sepsis (including 60 clinical conditions) were evaluated using logistic and random forest models; case fatality rates were analyzed using logistic models. Results 108,317 community-acquired sepsis cases were analyzed. Severe frailty was strongly associated with the risk of developing sepsis (crude odds ratio [OR] 14.93; 95% confidence interval [CI] 14.37–15.52). The quintile with most deprived patients showed an increased sepsis risk (crude OR 1.48; 95% CI 1.45–1.51) compared to least deprived quintile. Strong predictors for sepsis included antibiotic exposure in prior 2 months, being house bound, having cancer, learning disability, and diabetes mellitus. Severely frail patients had a case fatality rate of 42.0% compared to 24.0% in non-frail patients (adjusted OR 1.53; 95% CI 1.41–1.65). Sepsis cases with recent prior antibiotic exposure died less frequently compared to non-users (adjusted OR 0.7; 95% CI 0.72–0.76). Case fatality strongly decreased over calendar time. Conclusion Given the variety of predictors and their level of associations for developing sepsis, there is a need for prediction models for risk of developing sepsis that can help to target preventative antibiotic therapy.
Læs mere Tjek på PubMedEdward J. Schenck, Maria Plataki, Craig E. Wheelock
American Journal of Respiratory and Critical Care Medicine , 15.04.2024
Tilføjet 15.04.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 8, Page 903-904, April 15, 2024.
Læs mere Tjek på PubMedOsoul Chouchane, Alex R. Schuurman, Tom D. Y. Reijnders, Hessel Peters-Sengers, Joe M. Butler, Fabrice Uhel, Marcus J. Schultz, Marc J. Bonten, Olaf L. Cremer, Carolyn S. Calfee, Michael A. Matthay, Raymond J. Langley, Narges Alipanah-Lechner, Stephen F. Kingsmore, Angela Rogers, Michel van Weeghel, Frédéric M. Vaz, Tom van der Poll
American Journal of Respiratory and Critical Care Medicine , 15.04.2024
Tilføjet 15.04.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 8, Page 973-986, April 15, 2024.
Læs mere Tjek på PubMedInfection, 14.04.2024
Tilføjet 14.04.2024
Abstract Purpose Sepsis has a high incidence and a poor prognosis. Early recognition is important to facilitate timely initiation of adequate care. Sepsis screening tools, such as the (quick) Sequential Organ Failure Assessment ((q)SOFA) and National Early Warning Score (NEWS), could help recognize sepsis. These tools have been validated in a general immunocompetent population, while their performance in immunocompromised patients, who are particularly at risk of sepsis development, remains unknown. Methods This study is a post hoc analysis of a prospective observational study performed at the emergency department. Inclusion criteria were age ≥ 18 years with a suspected infection, while ≥ two qSOFA and/or SOFA criteria were used to classify patients as having suspected sepsis. The primary outcome was in-hospital mortality. Results 1516 patients, of which 40.5% used one or more immunosuppressives, were included. NEWS had a higher prognostic accuracy as compared to qSOFA for predicting poor outcome among immunocompromised sepsis patients. Of all tested immunosuppressives, high-dose glucocorticoid therapy was associated with a threefold increased risk of both in-hospital and 28-day mortality. Conclusion In contrast to NEWS, qSOFA underestimates the risk of adverse outcome in patients using high-dose glucocorticoids. As a clinical consequence, to adequately assess the severity of illness among immunocompromised patients, health care professionals should best use the NEWS.
Læs mere Tjek på PubMedBMC Infectious Diseases, 13.04.2024
Tilføjet 13.04.2024
Abstract Background Immunosuppression is a leading cause of septic death. Therefore, it is necessary to search for biomarkers that can evaluate the immune status of patients with sepsis. We assessed the diagnostic and prognostic value of low-density neutrophils (LDNs) and myeloid-derived suppressor cells (MDSCs) subsets in the peripheral blood mononuclear cells (PBMCs) of patients with sepsis. Methods LDNs and MDSC subsets were compared among 52 inpatients with sepsis, 33 inpatients with infection, and 32 healthy controls to investigate their potential as immune indicators of sepsis. The percentages of LDNs, monocytic MDSCs (M-MDSCs), and polymorphonuclear MDSCs (PMN-MDSCs) in PBMCs were analyzed. Sequential organ failure assessment (SOFA) scores, C-reactive protein (CRP), and procalcitonin (PCT) levels were measured concurrently. Results The percentages of LDNs and MDSC subsets were significantly increased in infection and sepsis as compared to control. MDSCs performed similarly to CRP and PCT in diagnosing infection or sepsis. LDNs and MDSC subsets positively correlated with PCT and CRP levels and showed an upward trend with the number of dysfunctional organs and SOFA score. Non-survivors had elevated M-MDSCs compared with that of patients who survived sepsis within 28 days after enrollment. Conclusions MDSCs show potential as a diagnostic biomarker comparable to CRP and PCT, in infection and sepsis, even in distinguishing sepsis from infection. M-MDSCs show potential as a prognostic biomarker of sepsis and may be useful to predict 28-day hospital mortality in patients with sepsis.
Læs mere Tjek på PubMedInfection, 13.04.2024
Tilføjet 13.04.2024
Abstract Purpose Sepsis has a high incidence and a poor prognosis. Early recognition is important to facilitate timely initiation of adequate care. Sepsis screening tools, such as the (quick) Sequential Organ Failure Assessment ((q)SOFA) and National Early Warning Score (NEWS), could help recognize sepsis. These tools have been validated in a general immunocompetent population, while their performance in immunocompromised patients, who are particularly at risk of sepsis development, remains unknown. Methods This study is a post hoc analysis of a prospective observational study performed at the emergency department. Inclusion criteria were age ≥ 18 years with a suspected infection, while ≥ two qSOFA and/or SOFA criteria were used to classify patients as having suspected sepsis. The primary outcome was in-hospital mortality. Results 1516 patients, of which 40.5% used one or more immunosuppressives, were included. NEWS had a higher prognostic accuracy as compared to qSOFA for predicting poor outcome among immunocompromised sepsis patients. Of all tested immunosuppressives, high-dose glucocorticoid therapy was associated with a threefold increased risk of both in-hospital and 28-day mortality. Conclusion In contrast to NEWS, qSOFA underestimates the risk of adverse outcome in patients using high-dose glucocorticoids. As a clinical consequence, to adequately assess the severity of illness among immunocompromised patients, health care professionals should best use the NEWS.
Læs mere Tjek på PubMedDan lv, Keji Zhang, Changqing Zhu, Xinhui Xu, Hao Gong, Li Liu
PLoS One Infectious Diseases, 12.04.2024
Tilføjet 12.04.2024
by Dan lv, Keji Zhang, Changqing Zhu, Xinhui Xu, Hao Gong, Li Liu This prospective observational study explored the predictive value of CD86 in the early diagnosis of sepsis in the emergency department. The primary endpoint was the factors associated with a diagnosis of sepsis. The secondary endpoint was the factors associated with mortality among patients with sepsis. It enrolled inpatients with infection or high clinical suspicion of infection in the emergency department of a tertiary Hospital between September 2019 and June 2021. The patients were divided into the sepsis and non-sepsis groups according to the Sepsis-3 standard. The non-sepsis group included 56 patients, and the sepsis group included 65 patients (19 of whom ultimately died). The multivariable analysis showed that CD86% (odds ratio [OR] = 1.22, 95% confidence interval [CI]: 1.04–1.44, P = 0.015), platelet count (OR = 0.99, 95%CI: 0.986–0.997, P = 0.001), interleukin-10 (OR = 1.01, 95%CI: 1.004–1.025, P = 0.009), and procalcitonin (OR = 1.17, 95%CI: 1.01–1.37, P = 0.043) were independent risk factors for sepsis, while human leukocyte antigen (HLA%) (OR = 0.96, 05%CI: 0.935–0.995, P = 0.022), respiratory rate (OR = 1.16, 95%CI: 1.03–1.30, P = 0.014), and platelet count (OR = 1.01, 95%CI: 1.002–1.016, P = 0.016) were independent risk factors for death in patients with sepsis. The model for sepsis (CD86%, platelets, interleukin-10, and procalcitonin) and the model for death (HLA%, respiratory rate, and platelets) had an area under the curve (AUC) of 0.870 and 0.843, respectively. CD86% in the first 24 h after admission for acute infection was independently associated with the occurrence of sepsis in the emergency department.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 9.04.2024
Tilføjet 9.04.2024
Abstract Aims We conducted a Mendelian randomization (MR) study to elucidate the anti-infective effects of ticagrelor.Methods and results Single-nucleotide polymorphisms (SNPs) associated with serum levels of ticagrelor or its major metabolite AR-C124910XX (ARC) in the PLATelet inhibition and patient Outcomes trial were selected as genetic proxies for ticagrelor exposure. Positive control analyses indicated that genetically surrogated serum ticagrelor levels (six SNPs) but not ARC levels (two SNPs) were significantly associated with lower risks of coronary heart disease. Therefore, the six SNPs were used as genetic instruments for ticagrelor exposure, and the genome-wide association study data for five infection outcomes were derived from the UK Biobank and FinnGen consortium. The two-sample MR analyses based on inverse variance-weighted methods indicated that genetic liability to ticagrelor exposure could reduce the risk of bacterial pneumonia (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.71–0.95, P = 8.75E-03) and sepsis (OR: 0.83, 95% CI: 0.73–0.94, P = 3.69E-03); however, no causal relationship between ticagrelor exposure and upper respiratory infection, pneumonia, and urinary tract infection was detected. Extensive sensitivity analyses corroborated these findings.Conclusion Our MR study provides further evidence for the preventive effects of ticagrelor on bacterial pneumonia and sepsis.
Læs mere Tjek på PubMedNatalia Maldonado, Inmaculada López-Hernández, Luis Eduardo López-Cortés, Pedro María Martínez Pérez-Crespo, Pilar Retamar-Gentil, Andrea García-Montaner, Sandra De la Rosa Riestra, Adrián Sousa-Domínguez, Josune Goikoetxea, Ángeles Pulido-Navazo, María Del Valle Ortíz, Clara Natera-Kindelán, Alfredo Jover-Sáenz, Alfonso del Arco-Jiménez, Carlos Armiñanzas-Castillo, Ana Isabel Aller-García, Jonathan Fernández-Suárez, Teresa Marrodán-Ciordia, Lucía Boix-Palop, Alejandro Smithson-Amat, José M Reguera-Iglesias, Fátima Galán-Sánchez, Alberto Bahamonde, Juan Manuel Sánchez Calvo, Isabel Gea-Lázaro, Inés Pérez-Camacho, Armando Reyes-Bertos, Berta Becerril-Carral, Álvaro Pascual, Jesús Rodríguez-Baño, the PROBAC REIPI/GEIRAS-SEIMC/SAMICEI
Clinical Microbiology and Infection, 8.04.2024
Tilføjet 8.04.2024
This study aimed to determine the association of E. coli microbiological factors with 30-day mortality in BSI patients presenting with a dysregulated response to infection (i.e., sepsis or septic shock).
Læs mere Tjek på PubMedCuenca, John A.; Nates, Joseph L.; Laserna, Andres; Heatter, Alba J.; Manjappachar, Nirmala; Martin, Peyton; Reyes, Maria P.; Hernandez, Mike; Hall, Jacob; Ramirez, Claudia M.; de Villalobos, Diego H.
Critical Care Explorations, 6.04.2024
Tilføjet 6.04.2024
A prospective cohort study was conducted to evaluate the 1-year survival of cancer patients with sepsis and vasopressor requirements. Eligible patients were admitted a Comprehensive Cancer Center’s ICU and were compared based on their admission lactate levels. Of the 132 included patients, 87 (66%) had high lactate (HL; > 2.0 mmol/L), and 45 (34%) had normal lactate (NL; ≤ 2.0 mmol/L). The 1-year survival rates of the two groups were similar (HL 16% vs. NL 18%; p = 0.0921). After adjustment for ICU baseline characteristics, HL was not significantly associated with a 1-year survival (Hazards ratio, 1.39; 95% CI, 0.94–2.05). Critically ill cancer patients with sepsis and vasopressor requirements, regardless of the lactate level, had 1-year survival of less than 20%. Large multicenter cancer registries would enable to confirm our findings and better understand the long-term trajectories of sepsis in this vulnerable population.
Læs mere Tjek på PubMedChaudhuri, Dipayan; Israelian, Lori; Putowski, Zbigniew; Prakash, Jay; Pitre, Tyler; Nei, Andrea M.; Spencer-Segal, Joanna L.; Gershengorn, Hayley B.; Annane, Djillali; Pastores, Stephen M.; Rochwerg, Bram
Critical Care Explorations, 6.04.2024
Tilføjet 6.04.2024
OBJECTIVES: We postulate that corticosteroid-related side effects in critically ill patients are similar across sepsis, acute respiratory distress syndrome (ARDS), and community-acquired pneumonia (CAP). By pooling data across all trials that have examined corticosteroids in these three acute conditions, we aim to examine the side effects of corticosteroid use in critical illness. DATA SOURCES: We performed a comprehensive search of MEDLINE, Embase, Centers for Disease Control and Prevention library of COVID research, CINAHL, and Cochrane center for trials. STUDY SELECTION: We included randomized controlled trials (RCTs) that compared corticosteroids to no corticosteroids or placebo in patients with sepsis, ARDS, and CAP. DATA EXTRACTION: We summarized data addressing the most described side effects of corticosteroid use in critical care: gastrointestinal bleeding, hyperglycemia, hypernatremia, superinfections/secondary infections, neuropsychiatric effects, and neuromuscular weakness. DATA SYNTHESIS: We included 47 RCTs (n = 13,893 patients). Corticosteroids probably have no effect on gastrointestinal bleeding (relative risk [RR], 1.08; 95% CI, 0.87–1.34; absolute risk increase [ARI], 0.3%; moderate certainty) or secondary infections (RR, 0.97; 95% CI, 0.89–1.05; absolute risk reduction, 0.5%; moderate certainty) and may have no effect on neuromuscular weakness (RR, 1.22; 95% CI, 1.03–1.45; ARI, 1.4%; low certainty) or neuropsychiatric events (RR, 1.19; 95% CI, 0.82–1.74; ARI, 0.5%; low certainty). Conversely, they increase the risk of hyperglycemia (RR, 1.21; 95% CI, 1.11–1.31; ARI, 5.4%; high certainty) and probably increase the risk of hypernatremia (RR, 1.59; 95% CI, 1.29–1.96; ARI, 2.3%; moderate certainty). CONCLUSIONS: In ARDS, sepsis, and CAP, corticosteroids are associated with hyperglycemia and probably with hypernatremia but likely have no effect on gastrointestinal bleeding or secondary infections. More data examining effects of corticosteroids, particularly on neuropsychiatric outcomes and neuromuscular weakness, would clarify the safety of this class of drugs in critical illness.
Læs mere Tjek på PubMedShannon R. West, Allison B. Suddaby, Gina R. Lewin, Carolyn B. Ibberson
Trends in Microbiology, 6.04.2024
Tilføjet 6.04.2024
Rothia spp. are Gram-positive, pleomorphic, non-motile, non-sporulating, facultative anaerobes. The Rothia genus currently consists of 11 valid species isolated from diverse sources ranging from mammalian hosts to natural and built environments. Rothia spp. are broadly recognized as commensal bacteria within the human oral cavity and respiratory tract, but some Rothia strains can also cause opportunistic infections such as endocarditis, pneumonia, and septicemia. Rothia spp. perform both respiration and mixed-acid fermentation and use simple and complex sugars as carbon sources.
Læs mere Tjek på PubMedDonaldson, Lachlan H.; Vlok, Ruan; Sakurai, Ken; Burrows, Morgan; McDonald, Gabrielle; Venkatesh, Karthik; Bagshaw, Sean M.; Bellomo, Rinaldo; Delaney, Anthony; Myburgh, John; Hammond, Naomi E.; Venkatesh, Balasubramanian
Critical Care Medicine, 5.04.2024
Tilføjet 5.04.2024
Objectives: To derive a pooled estimate of the incidence and outcomes of sepsis-associated acute kidney injury (SA-AKI) in ICU patients and to explore the impact of differing definitions of SA-AKI on these estimates. Data Sources: Medline, Medline Epub, EMBASE, and Cochrane CENTRAL between 1990 and 2023. Study Selection: Randomized clinical trials and prospective cohort studies of adults admitted to the ICU with either sepsis and/or SA-AKI. Data Extraction: Data were extracted in duplicate. Risk of bias was assessed using adapted standard tools. Data were pooled using a random-effects model. Heterogeneity was assessed by using a single covariate logistic regression model. The primary outcome was the proportion of participants in ICU with sepsis who developed AKI. Data Synthesis: A total of 189 studies met inclusion criteria. One hundred fifty-four reported an incidence of SA-AKI, including 150,978 participants. The pooled proportion of patients who developed SA-AKI across all definitions was 0.40 (95% CI, 0.37–0.42) and 0.52 (95% CI, 0.48–0.56) when only the Risk Injury Failure Loss End-Stage, Acute Kidney Injury Network, and Improving Global Outcomes definitions were used to define SA-AKI. There was significant variation in the incidence of SA-AKI depending on the definition of AKI used and whether AKI defined by urine output criteria was included; the incidence was lowest when receipt of renal replacement therapy was used to define AKI (0.26; 95% CI, 0.24–0.28), and highest when the Acute Kidney Injury Network score was used (0.57; 95% CI, 0.45–0.69; p < 0.01). Sixty-seven studies including 29,455 participants reported at least one SA-AKI outcome. At final follow-up, the proportion of patients with SA-AKI who had died was 0.48 (95% CI, 0.43–0.53), and the proportion of surviving patients who remained on dialysis was 0.10 (95% CI, 0.04–0.17). Conclusions: SA-AKI is common in ICU patients with sepsis and carries a high risk of death and persisting kidney impairment. The incidence and outcomes of SA-AKI vary significantly depending on the definition of AKI used.
Læs mere Tjek på PubMedSantosa, Ailiana; Oras, Jonatan; Li, Huiqi; Nwaru, Chioma; Kirui, Brian; Nyberg, Fredrik
Critical Care Medicine, 5.04.2024
Tilføjet 5.04.2024
Objectives: Some studies have examined survival trends among critically ill COVID-19 patients, but most were case reports, small cohorts, and had relatively short follow-up periods. We aimed to examine the survival trend among critically ill COVID-19 patients during the first two and a half years of the pandemic and investigate potential predictors across different variants of concern periods. Design: Prospective cohort study. Setting: Swedish ICUs, between March 6, 2020, and December 31, 2022. Patients: Adult COVID-19 ICU patients of 18 years old or older from the Swedish Intensive Care Register (SIR) that were linked to multiple other national registers. Measurement and Main Results: Survival probability and predictors of COVID-19 death were estimated using Kaplan-Meier and Cox regression analysis. Of 8975 patients, 2927 (32.6%) died. The survival rate among COVID-19 critically ill patients appears to have changed over time, with a worse survival in the Omicron period overall. The adjusted hazard ratios (aHRs) comparing older and younger ages were consistently strong but slightly attenuated in the Omicron period. After adjustment, the aHR of death was significantly higher for men, older age (40+ yr), low income, and with comorbid chronic heart disease, chronic lung disease, impaired immune disease, chronic renal disease, stroke, and cancer, and for those requiring invasive or noninvasive respiratory supports, who developed septic shock or had organ failures (p < 0.05). In contrast, foreign-born patients, those with booster vaccine, and those who had taken steroids had better survival (aHR = 0.87; 95% CI, 0.80–0.95; 0.74, 0.65–0.84, and 0.91, 0.84–0.98, respectively). Observed associations were similar across different variant periods. Conclusions: In this nationwide Swedish cohort covering over two and a half years of the pandemic, ICU survival rates changed over time. Older age was a strong predictor across all periods. Furthermore, most other mortality predictors remained consistent across different variant periods.
Læs mere Tjek på PubMedLee, Su Yeon; Park, Mi Hyeon; Oh, Dong Kyu; Lim, Chae-Man
Critical Care Medicine, 5.04.2024
Tilføjet 5.04.2024
Objectives: In 2018, the Centers for Disease Control and Prevention introduced the Adult Sepsis Event (ASE) definition, using electronic health records (EHRs) data for surveillance and sepsis quality improvement. However, data regarding ASE outside the United States remain limited. We therefore aimed to validate the diagnostic accuracy of the ASE and to assess the prevalence and mortality of sepsis using ASE. Design: Retrospective cohort study. Setting: A single center in South Korea, with 2732 beds including 221 ICU beds. Patients: During the validation phase, adult patients who were hospitalized or visiting the emergency department between November 5 and November 11, 2019, were included. In the subsequent phase of epidemiologic analysis, we included adult patients who were admitted from January to December 2020. Interventions: None. Measurements and Main Results: ASE had a sensitivity of 91.6%, a specificity of 98.3%, a positive predictive value (PPV) of 57.4%, and a negative predictive value of 99.8% when compared with the Sepsis-3 definition. Of 126,998 adult patient hospitalizations in 2020, 6,872 cases were diagnosed with sepsis based on the ASE (5.4% per year), and 893 patients were identified as having sepsis according to the International Classification of Diseases, 10th Edition (ICD-10) (0.7% per year). Hospital mortality rates were 16.6% (ASE) and 23.5% (ICD-10-coded sepsis). Monthly sepsis prevalence and hospital mortality exhibited less variation when diagnosed using ASE compared with ICD-10 coding (coefficient of variation [CV] for sepsis prevalence: 0.051 vs. 0.163, Miller test p < 0.001; CV for hospital mortality: 0.087 vs. 0.261, p = 0.001). Conclusions: ASE demonstrated high sensitivity and a moderate PPV compared with the Sepsis-3 criteria in a Korean population. The prevalence of sepsis, as defined by ASE, was 5.4% per year and was similar to U.S. estimates. The prevalence of sepsis by ASE was eight times higher and exhibited less monthly variability compared with that based on the ICD-10 code.
Læs mere Tjek på PubMedInfection, 4.04.2024
Tilføjet 4.04.2024
Abstract Purpose Candida auris, an emerging multidrug-resistant yeast, has been reported worldwide. In Italy, the first case was reported in 2019. We describe the first case of C. auris, imported from Greece, in Milan, using whole genome sequencing to characterise mutations associated with antifungal resistance. Case presentation On October 2022 an 80-year-old Italian man was hospitalised in Greece. In the absence of clinical improvement, the patient was transferred to our hospital, in Italy, where blood culture resulted positive for C. auris. Despite therapy, the patient died of septic shock. In a phylogenetic analysis the genome was assigned to Clade I with strains from Kenya, United Arab Emirates and India. D1/D2 region resulted identical to a Greek strain, as for many other strains from different World regions, highlighting the diffusion of this strain. Conclusion Importation of C. auris from abroad has been previously described. We report the first case of C. auris imported into Italy from Greece, according to phylogenetic analysis. This case reinforces the need for monitoring critically ill hospitalised patients also for fungi and addresses the need for the standardisation of susceptibility testing and strategies for diagnosis and therapy.
Læs mere Tjek på PubMedNatalia Maldonado, Inmaculada López-Hernández, Andrea García-Montaner, Luis Eduardo López-Cortés, Pedro María Martínez Pérez-Crespo, Pilar Retamar-Gentil, Adrián Sousa-Domínguez, Josune Goikoetxea, Ángeles Pulido-Navazo, Cristina Labayru-Echeverría, Clara Natera-Kindelán, Alfredo Jover-Sáenz, Alfonso del Arco-Jiménez, Carlos Armiñanzas-Castillo, Ana Isabel Aller, Jonathan Fernández-Suárez, Teresa Marrodán-Ciordia, Lucía Boix-Palop, Alejandro Smithson-Amat, José Mª Reguera-Iglesias, Fátima Galán-Sánchez, Alberto Bahamonde, Juan Manuel Sánchez Calvo, Isabel Gea-Lázaro, Inés Pérez-Camacho, Armando Reyes-Bertos, Berta Becerril-Carral, Jesús Rodríguez-Baño, Álvaro Pascual, Grupo PROBAC REIPI/GEIH-SEIMC/SAEI
The Lancet Microbe, 4.04.2024
Tilføjet 4.04.2024
In this exploratory study, the population structure of E coli causing sepsis or shock was similar to previous studies that included all bacteraemic isolates. Virulence genes, pathogenicity islands, and AMR genes were not randomly distributed among phylogroups or STs. These results provide a comprehensive characterisation of invasive E coli isolates causing severe response syndrome. Future studies are required to determine the contribution of these microbiological factors to severe clinical presentation and worse outcomes in patients with E coli bloodstream infection.
Læs mere Tjek på PubMedInfection, 2.04.2024
Tilføjet 2.04.2024
Abstract Purpose Candida auris, an emerging multidrug-resistant yeast, has been reported worldwide. In Italy, the first case was reported in 2019. We describe the first case of C. auris, imported from Greece, in Milan, using whole genome sequencing to characterise mutations associated with antifungal resistance. Case presentation On October 2022 an 80-year-old Italian man was hospitalised in Greece. In the absence of clinical improvement, the patient was transferred to our hospital, in Italy, where blood culture resulted positive for C. auris. Despite therapy, the patient died of septic shock. In a phylogenetic analysis the genome was assigned to Clade I with strains from Kenya, United Arab Emirates and India. D1/D2 region resulted identical to a Greek strain, as for many other strains from different World regions, highlighting the diffusion of this strain. Conclusion Importation of C. auris from abroad has been previously described. We report the first case of C. auris imported into Italy from Greece, according to phylogenetic analysis. This case reinforces the need for monitoring critically ill hospitalised patients also for fungi and addresses the need for the standardisation of susceptibility testing and strategies for diagnosis and therapy.
Læs mere Tjek på PubMedMichael Klompas, Greg S. Martin
American Journal of Respiratory and Critical Care Medicine , 1.04.2024
Tilføjet 1.04.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 7, Page 781-782, April 1, 2024.
Læs mere Tjek på PubMedRachel K. Hechtman, Patricia Kipnis, Jennifer Cano, Sarah Seelye, Vincent X. Liu, Hallie C. Prescott
American Journal of Respiratory and Critical Care Medicine , 1.04.2024
Tilføjet 1.04.2024
American Journal of Respiratory and Critical Care Medicine, Volume 209, Issue 7, Page 852-860, April 1, 2024.
Læs mere Tjek på PubMedGianni Bergamin, Joshua Hudson, Bart J Currie, Kate E Mounsey
International Journal of Infectious Diseases, 1.04.2024
Tilføjet 1.04.2024
Crusted scabies (CS, historically referred to as Norwegian scabies), caused by a proliferation of Sarcoptes scabiei mites, is a highly contagious and severe dermatological infection characterised by hyperkeratotic skin scaling that can progress from loose and flaky skin to thick adherent crusts. While hands and feet are most commonly affected, the most severe cases have near total body surface involvement [1]. Without adequate treatment, secondary infections can develop leading to bacterial sepsis with historically high fatality [2].
Læs mere Tjek på PubMedGetnet Amsalu, Christine Tedijanto Wen, Olga Perovic, Addisalem Gebru, Bezawit M. Hunegnaw, Fisseha Tadesse, Marshagne Smith, Addisalem Fikre, Delayehu Bekele, Lisanu Taddesse, Grace Chan
International Journal of Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Neonatal infections, particularly sepsis, meningitis, and pneumonia, are among the most common causes of mortality in the first 28 days of life, accounting for approximately 23% of 2.4 million neonatal deaths worldwide [1,2]. Treatment of infections is increasingly challenging in the context of antimicrobial resistance [3], with over 40% of neonatal sepsis cases estimated to have resistance or reduced susceptibility to both the first- (ampicillin/penicillin and gentamicin) and second-line (third-generation cephalosporins) treatments recommended by the World Health Organization (WHO) [4].
Læs mere Tjek på PubMedZhong, L., Zhong, Y., Chen, W., Liang, F., Liao, Y., Zhou, Y.
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
ObjectiveThe association between haemoglobin-to-red blood cell distribution width ratio (HRR) and all-cause mortality remains poorly understood. This study aimed to examine the influence of HRR at the time of admission mortality over 1 year and 30 days in patients with sepsis. DesignThis was a secondary analysis. SettingThis study was conducted in intensive care units (ICUs). ParticipantsAdult patients with sepsis were identified and included from an intensive care database based on eligibility criteria. Primary outcome and measureThe primary outcome was the rate of death within 1 year. The secondary outcome was the death rate within 30 days. ResultsA total of 4233 patients with sepsis who met the inclusion criteria were analysed, excluding those ineligible. These participants were divided into quartiles based on their HRR at admission. The overall mortality rates at 1 year and 30 days were 42.9% and 25.5%, respectively. A significant inverse association was observed between HRR quartiles and all-cause mortality (p
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background This real-world study assessed the epidemiology and clinical complications of Clostridioides difficile infections (CDIs) and recurrences (rCDIs) in hospital and community settings in Germany from 2015 − 2019. Methods An observational retrospective cohort study was conducted among adult patients diagnosed with CDI in hospital and community settings using statutory health insurance claims data from the BKK database. A cross-sectional approach was used to estimate the annual incidence rate of CDI and rCDI episodes per 100,000 insurants. Patients’ demographic and clinical characteristics were described at the time of first CDI episode. Kaplan-Meier method was used to estimate the time to rCDIs and time to complications (colonic perforation, colectomy, loop ileostomy, toxic megacolon, ulcerative colitis, peritonitis, and sepsis). A Cox model was used to assess the risk of developing complications, with the number of rCDIs as a time-dependent covariate. Results A total of 15,402 CDI episodes were recorded among 11,884 patients. The overall incidence of CDI episodes declined by 38% from 2015 to 2019. Most patients (77%) were aged ≥ 65 years. Around 19% of CDI patients experienced at least one rCDI. The median time between index CDI episode to a rCDI was 20 days. The most frequent complication within 12-months of follow-up after the index CDI episode was sepsis (7.57%), followed by colectomy (3.20%). The rate of complications increased with the number of rCDIs. The risk of any complication increased by 31% with each subsequent rCDI (adjusted hazard ratio [HR]: 1.31, 95% confidence interval: 1.17;1.46). Conclusions CDI remains a public health concern in Germany despite a decline in the incidence over recent years. A substantial proportion of CDI patients experience rCDIs, which increase the risk of severe clinical complications. The results highlight an increasing need of improved therapeutic management of CDI, particularly efforts to prevent rCDI.
Læs mere Tjek på PubMedBMC Infectious Diseases, 28.03.2024
Tilføjet 28.03.2024
Abstract Background This real-world study assessed the epidemiology and clinical complications of Clostridioides difficile infections (CDIs) and recurrences (rCDIs) in hospital and community settings in Germany from 2015 − 2019. Methods An observational retrospective cohort study was conducted among adult patients diagnosed with CDI in hospital and community settings using statutory health insurance claims data from the BKK database. A cross-sectional approach was used to estimate the annual incidence rate of CDI and rCDI episodes per 100,000 insurants. Patients’ demographic and clinical characteristics were described at the time of first CDI episode. Kaplan-Meier method was used to estimate the time to rCDIs and time to complications (colonic perforation, colectomy, loop ileostomy, toxic megacolon, ulcerative colitis, peritonitis, and sepsis). A Cox model was used to assess the risk of developing complications, with the number of rCDIs as a time-dependent covariate. Results A total of 15,402 CDI episodes were recorded among 11,884 patients. The overall incidence of CDI episodes declined by 38% from 2015 to 2019. Most patients (77%) were aged ≥ 65 years. Around 19% of CDI patients experienced at least one rCDI. The median time between index CDI episode to a rCDI was 20 days. The most frequent complication within 12-months of follow-up after the index CDI episode was sepsis (7.57%), followed by colectomy (3.20%). The rate of complications increased with the number of rCDIs. The risk of any complication increased by 31% with each subsequent rCDI (adjusted hazard ratio [HR]: 1.31, 95% confidence interval: 1.17;1.46). Conclusions CDI remains a public health concern in Germany despite a decline in the incidence over recent years. A substantial proportion of CDI patients experience rCDIs, which increase the risk of severe clinical complications. The results highlight an increasing need of improved therapeutic management of CDI, particularly efforts to prevent rCDI.
Læs mere Tjek på PubMedSara Cajander, Matthijs Kox, Brendon P Scicluna, Markus A Weigand, Raquel Almansa Mora, Stefanie B Flohé, Ignacio Martin-Loeches, Gunnar Lachmann, Massimo Girardis, Alberto Garcia-Salido, Frank M Brunkhorst, Michael Bauer, Antoni Torres, Andrea Cossarizza, Guillaume Monneret, Jean-Marc Cavaillon, Manu Shankar-Hari, Evangelos J Giamarellos-Bourboulis, Martin Sebastian Winkler, Tomasz Skirecki, Marcin Osuchowski, Ignacio Rubio, Jesus F Bermejo-Martin, Joerg C Schefold, Fabienne Venet
Lancet Respiratory Medicine, 27.03.2024
Tilføjet 27.03.2024
Sepsis is characterised by a dysregulated host immune response to infection. Despite recognition of its significance, immune status monitoring is not implemented in clinical practice due in part to the current absence of direct therapeutic implications. Technological advances in immunological profiling could enhance our understanding of immune dysregulation and facilitate integration into clinical practice. In this Review, we provide an overview of the current state of immune profiling in sepsis, including its use, current challenges, and opportunities for progress.
Læs mere Tjek på PubMedClinical Infectious Diseases, 26.03.2024
Tilføjet 26.03.2024
Abstract Background Streptococcal bacteremia is associated with high mortality. The study aims to identify predictors of mortality among patients with streptococcal bacteremia.Methods This retrospective study was conducted at the Lausanne University Hospital, Switzerland and included episodes of streptococcal bacteremia among adult patients from 2015 to 2023.Results During the study period, 861 episodes of streptococcal bacteremia were included. The majority of episodes were categorized in the Mitis group (348 episodes; 40%), followed by the Pyogenic group (215; 25%). Endocarditis was the most common source of bacteremia (164; 19%). The overall 14-day mortality rate was 8% (65 episodes). The results from the Cox multivariable regression model showed that a Charlson comorbidity index >4 (P 0.001; HR 2.87, CI 1.58-5.22), S. pyogenes (P 0.011; HR 2.54, CI 1.24-5.21), sepsis (P
Læs mere Tjek på PubMedBMC Infectious Diseases, 22.03.2024
Tilføjet 22.03.2024
Abstract Background Tuberculous sepsis is uncommon in individuals without human immunodeficiency virus (HIV) infection, and some patients may not exhibit clinical signs and symptoms of suspected sepsis upon admission, leading to delayed diagnosis and treatment. Case presentation This report present the case of a 60-year-old female patient who presented with erythema, edema, and pain in her right upper limb accompanied by fever and chills. Further evaluation revealed multiple intermuscular abscesses caused by suspected gram-positive bacteria. Despite receiving anti-infection treatment, the patient rapidly progressed to septic shock and respiratory failure. Metagenomic next-generation sequencing (mNGS) analysis of blood samples detected Mycobacterium tuberculosis complex groups (11 reads). Additionally, mNGS analysis of fluid obtained from puncture of the abscess in the right upper extremity also suggested Mycobacterium tuberculosis complex groups (221 981 reads). Consequently, the patient was diagnosed with tuberculous sepsis resulting from hematogenous dissemination of Mycobacterium tuberculosis. Following the administration of anti-tuberculosis treatment, a gradual recovery was observed during the subsequent follow-up period. Conclusion It is noteworthy that atypical hematogenous disseminated tuberculosis can be prone to misdiagnosis or oversight, potentially leading to septic shock. This case illustrates the importance of early diagnosis and treatment of tuberculosis sepsis. Advanced diagnostic techniques such as mNGS can aid clinicians in the early identification of pathogens for definitive diagnosis.
Læs mere Tjek på PubMedGuirgis, Faheem W.; Black, Lauren Page; Henson, Morgan; Bertrand, Andrew; DeVos, Elizabeth; Ferreira, Jason; Gao, Hanzhi; Wu, Samuel S.; Leeuwenburgh, Christiaan; Moldawer, Lyle; Moore, Frederick; Reddy, Srinivasa T.
Critical Care Medicine, 22.03.2024
Tilføjet 22.03.2024
Objectives: Low cholesterol levels in early sepsis patients are associated with mortality. We sought to test if IV lipid emulsion administration to sepsis patients with low cholesterol levels would prevent a decline or increase total cholesterol levels at 48 hours. Design: Phase II, adaptive, randomized pilot clinical trial powered for 48 patients. Setting: Emergency department or ICU of an academic medical center. Patients: Sepsis patients (first 24 hr) with Sequential Organ Failure Assessment greater than or equal to 4 or shock. Interventions: Patients meeting study criteria, including screening total cholesterol levels less than or equal to 100 mg/dL or high-density lipoprotein cholesterol (HDL-C) + low-density lipoprotein cholesterol (LDL-C) less than or equal to 70 mg/dL, were randomized to receive one of three doses of lipid emulsion administered twice in 48 hours or no drug (controls). The primary endpoint was a change in serum total cholesterol (48 hr – enrollment) between groups. Measurements and Main Results: Forty-nine patients were enrolled and randomized. Two patients randomized to lipid emulsion were withdrawn before drug administration. Data for 24 control patients and 23 lipid emulsion patients were analyzed. The mean change in total cholesterol from enrollment to 48 hours was not different between groups and was 5 mg/dL (sd 20) for lipid emulsion patients, and 2 mg/dL (sd 18) for control patients (p = 0.62). The mean changes in HDL-C and LDL-C were similar between groups. Mean change in triglycerides was elevated in lipid emulsion patients (61 mg/dL, sd 87) compared with controls (20 mg/dL, sd 70, p = 0.086). The 48-hour change in SOFA score was –2 (interquartile range [IQR] –4, –1) for control patients and –2 (IQR –3, 0) for lipid emulsion patients (p = 0.46). Conclusions: Administration of IV lipid emulsion to early sepsis patients with low cholesterol levels did not influence change in cholesterol levels from enrollment to 48 hours.
Læs mere Tjek på PubMedViriya Hantrakun, Ranjani Somayaji, Prapit Teparrukkul, Chaiyaporn Boonsri, Kristina Rudd, Nicholas P. J. Day, T. Eoin West, Direk Limmathurotsakul
PLoS One Infectious Diseases, 21.03.2024
Tilføjet 21.03.2024
by Viriya Hantrakun, Ranjani Somayaji, Prapit Teparrukkul, Chaiyaporn Boonsri, Kristina Rudd, Nicholas P. J. Day, T. Eoin West, Direk Limmathurotsakul
Læs mere Tjek på PubMedBMC Infectious Diseases, 20.03.2024
Tilføjet 20.03.2024
Abstract Background Vancomycin-associated acute kidney injury (VA-AKI) is the most clinically relevant side effect of vancomycin. The objective of this study was to investigate the association between VTC and VA-AKI as well as 30-day mortality in critically ill elderly adults. Method Elderly patients with trough serum vancomycin concentration records(VTC) in the Medical Information Mart-IV (MIMIC-IV) and eICU databases were retrospectively studied. Results A total of 3,146 critically ill elderly adults were finally enrolled. The incidence of VA-AKI in the elderly population was 76.5%. Logistic regression analysis revealed significant relationships between VA-AKI and various factors, including VTC, comorbidities, and laboratory indicators, and SOFA, and GCS score. For each mg/L increase, the OR for VA-AKI increased by 2.5%. The association between VTC and 30-day mortality was found to be statistically significant (odds ratio (OR): 1.021, 95% CI: 1.010–1.031), P 6, patients with baseline creatinine > 1.2 mg/dl and patients with or without exposed to other nephrotoxic medications. Conclusion This study found the significant association between VTC and the incidence of VA-AKI and 30-day mortality in critically ill elderly adults. The RCS curves indicated concentration ranges for AKI (19.67–35.72 mg/L) and 30-day mortality (19.17–42.86 mg/L), signifying increased risk.
Læs mere Tjek på PubMedBMC Infectious Diseases, 19.03.2024
Tilføjet 19.03.2024
Abstract Background Ralstonia pickettii is a low virulent, gram-negative bacillus that is rarely associated with human infections and may cause bacteremia. Microbacterium species are gram-positive coryneforms that are generally considered as a contaminant in Gram staining of blood cultures, especially when the time to positivity is longer than 48 h. Both these bacterial species are emerging opportunistic pathogens that may occasionally cause serious infections and even life-threatening health conditions. Case presentation Here, we report the case of a patient with bacteremia caused by both R. pickettii and Microbacterium. We advocate for providers to order rapid antibiotic susceptibility testing, since our patient’s suffered two kinds of rare pathogens with the opposite of drug sensitivity results to imipenem. Conclusions Our case present a patient suffered septic shock caused by R. pickettii and Microbacterium. Improving the antibiotic management based on the result of antimicrobial susceptibility tests is the key of successful treatment.
Læs mere Tjek på PubMedImmunity, 21.07.2023
Tilføjet 21.07.2023
Publication date: Available online 20 July 2023 Source: Immunity Author(s): Hang Thi Thuy Gander-Bui, Joëlle Schläfli, Johanna Baumgartner, Sabrina Walthert, Vera Genitsch, Geert van Geest, José A. Galván, Carmen Cardozo, Cristina Graham Martinez, Mona Grans, Sabine Muth, Rémy Bruggmann, Hans Christian Probst, Cem Gabay, Stefan Freigang
Læs mere Tjek på PubMed