Guidelines 1 Aspleni (2024v1.2)
Rekommandationer for profylakse og vaccination ved aspleni. Denne vejledning dækker anbefalinger omhandlende vaccinationer, antibiotika profylakse og patientinformation om generelle forholdsregler for at beskytte personer med aspleni mod infektioner. Version 1.2, 22.10.2024. Ændringer siden version 1.1: Vaccination mod Haemophilus influenzae ændret til 1 dosis (fejlagtigt angivet 3 doser). Menveo beskytter efter 1 dosis (fejlagtigt angivet som nødvendigt med 2. dosis efter 2-3 mdr). Link til bilag om vaccinationer tilføjet i Quickguiden. 2 Sepsis flowchart (2021)
Bilag med flowchart til vurdering og behandling af sepsis og septisk shock, se også infmed.dk/guidelines#sepsis_guidelines_(2021).pdf 3 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 Blood microbiota in HIV-infected and HIV-uninfected patients with suspected sepsis detected by metagenomic next-generation sequencing
BMC Infectious Diseases, 29.10.2024 Tilføjet 29.10.2024 Abstract Background Information on the comparison of blood microbiota between human immunodeficiency virus (HIV)-infected and HIV-uninfected patients with suspected sepsis by metagenomic next-generation sequencing (mNGS) is limited. Methods Retrospectively analysis was conducted in HIV-infected and HIV-uninfected patients with suspected sepsis at Changsha First Hospital (China) from March 2019 to August 2022. Patients who underwent blood mNGS testing were enrolled. The blood microbiota detected by mNGS were analyzed. Results A total of 233 patients with suspected sepsis who performed blood mNGS were recruited in this study, including 79 HIV-infected and 154 HIV-uninfected patients. Compared with HIV-uninfected patients, the proportions of mycobacterium (p = 0.001), fungus (p Læs mere Tjek på PubMed2 Procalcitonin-Guided Management and Duration of Antibiotic Therapy in Critically Ill Cancer Patients With Sepsis (Pro-Can Study): A Randomized Controlled Trial
Nazer, Lama H.; Awad, Wedad; Thawabieh, Hadeel; Abusara, Aseel; Abdelrahman, Deema; Addassi, Awad; Abuatta, Osama; Sughayer, Maher; Shehabi, Yahya Critical Care Explorations, 25.10.2024 Tilføjet 25.10.2024 OBJECTIVES: To evaluate the effect of procalcitonin-guided management on the duration of antibiotic therapy in critically ill cancer patients with sepsis. DESIGN: Randomized, controlled, single-blinded trial. SETTING: A comprehensive multidisciplinary cancer hospital in Jordan. PATIENTS: Adults with cancer treated in the ICU who were started on antibiotics for suspected infection, met the SEPSIS-3 criteria, and were expected to stay in the ICU greater than or equal to 48 hours. INTERVENTIONS: Patients were randomized to the procalcitonin-guided or standard care (SC) arms. All patients had procalcitonin measured daily, up to 5 days or until ICU discharge or death. For the procalcitonin arm, a procalcitonin-guided algorithm was provided to guide antibiotic management, but clinicians were allowed to override the algorithm, if clinically indicated. In the SC arm, ICU clinicians were blinded to the procalcitonin levels. MEASUREMENTS AND MAIN RESULTS: Primary outcome was time to antibiotic cessation. We also evaluated the number of antibiotic-free days at 28 days, hospital discharge, or death, whichever came first, and antibiotic defined daily doses (DDDs). We enrolled 77 patients in the procalcitonin arm and 76 in the SC arm. Mean age was 58 ± 14 (sd) years, 67% were males, 74% had solid tumors, and 13% were neutropenic. Median (interquartile range [IQR]) Sequential Organ Failure Assessment scores were 7 (6–10) and 7 (5–9) and procalcitonin concentrations (ng/mL) at baseline were 3.4 (0.8–16) and 3.4 (0.5–26), in the procalcitonin and SC arms, respectively. There was no difference in the median (IQR) time to antibiotic cessation in the procalcitonin and SC arms, 8 (4–11) and 8 (5–13), respectively (p = 0.463). Median (IQR) number of antibiotic-free days were 20 (17–24) and 20 (16–23), (p = 0.484) and total DDDs were 1541.4 and 2050.4 in the procalcitonin and SC arms, respectively. CONCLUSIONS: In critically ill cancer patients with sepsis, procalcitonin-guided management did not reduce the duration of antibiotic treatment. Læs mere Tjek på PubMed3 Synergy of bacteriophage depolymerase with host immunity rescues sepsis mice infected with hypervirulent Klebsiella pneumoniae of capsule type K2
Deyi Zhao Miran Tang Zhexiao Ma Panjie Hu Qingxia Fu Zhuocheng Yao Cui Zhou Tieli Zhou Jianming Cao a School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Chinab Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Chinac Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang, China Virulence, 21.10.2024 Tilføjet 21.10.2024 4 Adjudication of Codes for Identifying Sepsis in Hospital Administrative Data by Expert Consensus
Garland, Allan; Li, Na; Sligl, Wendy; Lane, Alana; Thavorn, Kednapa; Wilcox, M. Elizabeth; Rochwerg, Bram; Keenan, Sean; Marrie, Thomas J.; Kumar, Anand; Curley, Emily; Ziegler, Jennifer; Dodek, Peter; Loubani, Osama; Gervais, Alain; Murthy, Srinivas; Neto, Gina; Prescott, Hallie C.; for the Sepsis Canada Network Critical Care Medicine, 21.10.2024 Tilføjet 21.10.2024 Objectives: Refine the administrative data definition of sepsis in hospitalized patients, including less severe cases. Design and Setting: For each of 1928 infection and 108 organ dysfunction codes used in Canadian hospital abstracts, experts reached consensus on the likelihood that it could relate to sepsis. We developed a new algorithm, called AlgorithmL, that requires at least one infection and one organ dysfunction code adjudicated as likely or very likely to be related to sepsis. AlgorithmL was compared with four previously described algorithms, regarding included codes, population-based incidence, and hospital mortality rates—separately for ICU and non-ICU cohorts in a large Canadian city. We also compared sepsis identification from these code-based algorithms with the Centers for Disease Control’s Adult Sepsis Event (ASE) definition. Subjects: Among Calgary’s adult population of 1.033 million there were 61,632 eligible hospitalizations. Interventions: None. Measurements and Main Results: AlgorithmL includes 720 infection codes and 50 organ dysfunction codes. Comparison algorithms varied from 42–941 infection codes to 2–36 organ codes. There was substantial nonoverlap of codes in AlgorithmL vs. the comparators. Annual sepsis incidence rates (per 100,000 population) based on AlgorithmL were 91 in the ICU and 291 in the non-ICU cohort. Incidences based on comparators ranged from 28–77 for ICU to 11–266 for non-ICU cohorts. Hospital sepsis mortality rates based on AlgorithmL were 24% in ICU and 17% in non-ICU cohorts; based on comparators, they ranged 27–38% in the ICU cohort and 18–47% for the non-ICU cohort. Of AlgorithmL-identified cases, 41% met the ASE criteria, compared with 42–82% for the comparator algorithms. Conclusions: Compared with other code-based algorithms, AlgorithmL includes more infection and organ dysfunction codes. AlgorithmL incidence rates are higher; hospital mortality rates are lower. AlgorithmL may more fully encompass the full range of sepsis severity. Læs mere Tjek på PubMed5 Aging-induced dysbiosis worsens sepsis severity but is attenuated by probiotics in D-galactose-administered mice with cecal ligation and puncture model
Chalisa Pinitchun, Wimonrat Panpetch, Thansita Bhunyakarnjanarat, Kanyarat Udompornpitak, Huy Thanh Do, Peerapat Visitchanakun, Dhammika Leshan Wannigama, Suwasin Udomkarnjananun, Monruedee Sukprasansap, Tewin Tencomnao, Pattarin Tangtanatakul, Asada Leelahavanichkul PLoS One Infectious Diseases, 19.10.2024 Tilføjet 19.10.2024 by Chalisa Pinitchun, Wimonrat Panpetch, Thansita Bhunyakarnjanarat, Kanyarat Udompornpitak, Huy Thanh Do, Peerapat Visitchanakun, Dhammika Leshan Wannigama, Suwasin Udomkarnjananun, Monruedee Sukprasansap, Tewin Tencomnao, Pattarin Tangtanatakul, Asada Leelahavanichkul Introduction Despite the well-established effects of aging on brain function and gut dysbiosis (an imbalance in gut microbiota), the influence of aging on sepsis-associated encephalopathy (SAE) and the role of probiotics in this context remain less understood. Methods C57BL/6J mice (8-week-old) were subcutaneously administered with 8 weeks of D-galactose (D-gal) or phosphate buffer solution (PBS) for aging and non-aging models, respectively, with or without 8 weeks of oral Lacticaseibacillus rhamnosus GG (LGG). Additionally, the impact of the condition media from LGG (LCM) was tested in macrophages (RAW 264.7 cells), microglia (BV-2 cells), and hippocampal cells (HT-22 cells). Result Fecal microbiome analysis demonstrated D-gal-induced dysbiosis (reduced Firmicutes and Desulfobacterota with increased Bacteroidota and Verrucomicrobiota), which LGG partially neutralized the dysbiosis. D-gal also worsens cecal ligation and puncture (CLP) sepsis severity when compared with PBS-CLP mice, as indicated by serum creatinine (Scr) and alanine transaminase (ALT), but not mortality, neurological characteristics (SHIRPA score), and serum cytokines (TNF-α and IL-6). Additionally, D-gal-induced aging was supported by fibrosis in the liver, kidney, and lung; however, CLP sepsis did not worsen fibrosis. Interestingly, LGG attenuated all parameters (mortality, Scr, ALT, SHIRPA, and cytokines) in non-aging sepsis (PBS-CLP) while improving all these parameters, except for mortality and serum IL-6, in aging sepsis (D-gal CLP). For the in vitro test using lipopolysaccharide (LPS) stimulation, LCM attenuated inflammation in some parameters on RAW264.7 cells but not BV-2 and HT-22 cells, implying a direct anti-inflammatory effect of LGG on macrophages, but not in cells from the brain. Conclusion D-gal induced fecal dysbiosis and worsened sepsis severity as determined by Scr and ALT, and LGG could alleviate most of the selected parameters of sepsis, including SAE. However, the impact of LGG on SAE was not a direct delivery of beneficial molecules from the gut to the brain but partly due to the attenuation of systemic inflammation through the modulation of macrophages. Læs mere Tjek på PubMed6 Association between liver fibrosis and the in-hospital mortality in patients with sepsis-induced coagulopathy
BMC Infectious Diseases, 11.10.2024 Tilføjet 11.10.2024 Abstract Background The impact of liver fibrosis on the clinical outcomes of patients with sepsis-induced coagulopathy (SIC) is not well understood. This study aimed to evaluate the association between liver fibrosis scores and in-hospital mortality in SIC patients. Methods In this retrospective observational cohort study, data were collected from patients diagnosed with sepsis and admitted to the ICU at the First Affiliated Hospital of Wenzhou Medical University between January 2017 and December 2023. Liver fibrosis was evaluated using three scores: Fibrosis-4 (Fib-4), Aspartate Aminotransferase–to–Platelet Ratio Index (APRI), and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS). Patients were divided into tertiles according to their liver fibrosis scores, and the primary outcome was in-hospital mortality. Multivariable logistic regression and restricted cubic spline regression analyses were used to assess associations, complemented by sensitivity analyses through subgroup evaluations. Results The cohort included 948 patients diagnosed with SIC with an in-hospital mortality of 26.16%. Multivariate logistic regression analysis revealed a significant association between higher liver fibrosis scores and increased in-hospital mortality. Specifically, patients in the highest tertile of Fib-4, APRI, and NFS scores had significantly higher odds of mortality (FIB-4: OR 3.62, 95% CI 1.03–12.69; APRI: OR 2.16, 95% CI 0.88–5.30; NFS: OR 6.80, 95% CI 2.11–21.93) compared to those in the lowest tertile. The restricted cubic spline regression model showed a linear increase in the risk of in-hospital mortality with increasing liver fibrosis score. Sensitivity analysis confirmed the consistency and stability of the results across the different subgroups. Conclusion Our study suggests that elevated liver fibrosis scores, particularly Fib-4 and NFS, are associated with higher in-hospital mortality in SIC patients. Further research, especially larger prospective studies, are needed to validate these findings. Læs mere Tjek på PubMed7 Effect of low vs. high vancomycin trough level on the clinical outcomes of adult patients with sepsis or gram-positive bacterial infections: a systematic review and meta-analysis
BMC Infectious Diseases, 8.10.2024 Tilføjet 8.10.2024 Abstract Background & objective The Infectious Disease Society of America guidelines recommend vancomycin trough levels of 15–20 mg/L for severe methicillin-resistant Staphylococcus aureus. However, recent consensus guidelines of four infectious disease organizations no longer recommend vancomycin dosing using minimum serum trough concentrations. Therefore, this study aimed to evaluate the impact of low ( Læs mere Tjek på PubMed8 The triglyceride-glucose index dynamic trajectory reveals the association between the clinical subphenotype of insulin resistance and mortality in patients with sepsis
BMC Infectious Diseases, 3.10.2024 Tilføjet 3.10.2024 Abstract Background The relationship between the dynamic changes in insulin resistance (IR) and the prognosis of septic patients remains unclear. This study aims to investigate the correlation between the clinical subphenotype of IR represented by the triglyceride-glucose (TyG) index trajectory and the mortality rate among patients with sepsis. Methods In this retrospective cohort study, we utilized data from septic patients within the Medical Information Mart for Intensive Care (MIMIC)-IV database version 2.0 to construct trajectories of the TyG index over 72 h. Subsequently, we computed the similarity among various TyG index trajectories with the dynamic time warping (DTW) algorithm and utilized the hierarchical clustering (HC) algorithm to demarcate distinct cluster and identified subphenotypes according to the trajectory trend. Subsequently, we assessed the mortality risk between different subphenotypes using analyses such as survival analysis and validated the robustness of the results through propensity score matching (PSM) and various models. Results A total of 2350 patients were included in the study. Two trajectory trends: TyG index decreasing (n = 926) and TyG index increasing (n = 1424) were identified, which indicated corresponding to the clinical subphenotype of increased and alleviative IR respectively. The 28-day and in-hospital mortality for the increased IR group was 28.51% and 25.49% respectively. In comparison, patients in the alleviative IR group with a 28-day mortality of 23.54% and an in-hospital mortality of 21.60%. These subphenotypes exhibited distinct prognosis, time dependent Cox model showed the increased IR group with a higher 28-day mortality [hazard ratio (HR): 1.07, 95% confidence interval (CI): 1.02–1.12, P = 0.01] and in-hospital mortality [HR: 1.05, 95% CI: 1.00–1.11, P = 0.045] compared to the alleviative IR group. Sensitivity analyses with various models further validated the robustness of our findings. Conclusion Dynamic increase in the TyG index trajectory is associated with elevated mortality risk among patients with sepsis, which suggests that dynamic increased IR exacerbates the risk of poor outcomes in patients. Læs mere Tjek på PubMed9 The triglyceride-glucose index dynamic trajectory reveals the association between the clinical subphenotype of insulin resistance and mortality in patients with sepsis
BMC Infectious Diseases, 2.10.2024 Tilføjet 2.10.2024 Abstract Background The relationship between the dynamic changes in insulin resistance (IR) and the prognosis of septic patients remains unclear. This study aims to investigate the correlation between the clinical subphenotype of IR represented by the triglyceride-glucose (TyG) index trajectory and the mortality rate among patients with sepsis. Methods In this retrospective cohort study, we utilized data from septic patients within the Medical Information Mart for Intensive Care (MIMIC)-IV database version 2.0 to construct trajectories of the TyG index over 72 h. Subsequently, we computed the similarity among various TyG index trajectories with the dynamic time warping (DTW) algorithm and utilized the hierarchical clustering (HC) algorithm to demarcate distinct cluster and identified subphenotypes according to the trajectory trend. Subsequently, we assessed the mortality risk between different subphenotypes using analyses such as survival analysis and validated the robustness of the results through propensity score matching (PSM) and various models. Results A total of 2350 patients were included in the study. Two trajectory trends: TyG index decreasing (n = 926) and TyG index increasing (n = 1424) were identified, which indicated corresponding to the clinical subphenotype of increased and alleviative IR respectively. The 28-day and in-hospital mortality for the increased IR group was 28.51% and 25.49% respectively. In comparison, patients in the alleviative IR group with a 28-day mortality of 23.54% and an in-hospital mortality of 21.60%. These subphenotypes exhibited distinct prognosis, time dependent Cox model showed the increased IR group with a higher 28-day mortality [hazard ratio (HR): 1.07, 95% confidence interval (CI): 1.02–1.12, P = 0.01] and in-hospital mortality [HR: 1.05, 95% CI: 1.00–1.11, P = 0.045] compared to the alleviative IR group. Sensitivity analyses with various models further validated the robustness of our findings. Conclusion Dynamic increase in the TyG index trajectory is associated with elevated mortality risk among patients with sepsis, which suggests that dynamic increased IR exacerbates the risk of poor outcomes in patients. Læs mere Tjek på PubMed10 Mendelian randomization analysis reveals causal association of anthropometric measures on sepsis risk and mortality
Chu-Yun Liu, Yu-Shen Yang, Meng-Qin Pei, He-fan He PLoS One Infectious Diseases, 1.10.2024 Tilføjet 1.10.2024 by Chu-Yun Liu, Yu-Shen Yang, Meng-Qin Pei, He-fan He The objective of this study was to explore the potential causalities of fat mass, nonfat mass and height (henceforth, ‘anthropometric measures’) with sepsis risk and mortality. We conducted the Mendelian randomization (MR) investigation using genome-wide association study (GWAS) summary statistics of anthropometric measures, sepsis, and sepsis mortality. The GWAS summary data from the UK Biobank was used. Firstly, MR analysis was performed to estimate the causal effect of anthropometric measures on the risk of sepsis. The inverse-variance weighted (IVW) method was utilized as the primary analytical approach, together with weighted median-based method. Cochrane’s Q test and MR-Egger intercept test were performed to assess heterogeneity and pleiotropy, respectively. Finally, we performed a series of sensitivity analyses to enhance the precision and veracity of our findings. The IVW method showed that genetically predicted weight-related measures were suggestively linked to an increased risk of sepsis. However, height displayed no causal association with sepsis risk and mortality. Furthermore, weight-related measures also displayed significant MR association with the sepsis mortality, except body nonfat mass and right leg nonfat mass. However, MVMR analysis indicated the observed effects for weight-related measures in the univariable MR analyses are more likely a bias caused by the interrelationship between anthropometric measures. According to the MR-Egger intercept assessment, our MR examination was not influenced by horizontal pleiotropy (all p>0.05). Moreover, the reliability of the estimated causal association was confirmed by the sensitivity analyses. In conclusion, these findings provided vital new knowledge on the role of anthropometric-related measures in the sepsis etiology. Læs mere Tjek på PubMed11 HNL Dimer in plasma is a unique and useful biomarker for the monitoring of antibiotic treatment in sepsis
Per Venge, Christer Peterson, Shengyuan Xu, Anders Larsson, Joakim Johansson, Jonas Tydén PLoS One Infectious Diseases, 27.09.2024 Tilføjet 27.09.2024 by Per Venge, Christer Peterson, Shengyuan Xu, Anders Larsson, Joakim Johansson, Jonas Tydén Introduction Sepsis is a growing problem worldwide and associated with high mortality and morbidity. The early and accurate diagnosis and effective supportive therapy are critical for combating mortality. The aim of the study was to compare the kinetics of four biomarkers in plasma in patients admitted to ICU including sepsis and during antibiotics treatment. Methods The biomarkers evaluated were HBP (Heparin-binding protein), HNL Dimer (Human Neutrophil Lipocalin), HNL Total and PCT (Procalcitonin). Plasma was obtained at admission to ICU and during follow-up at days 2 and 3. Antibiotic treatment was started or reviewed on admission to ICU. The results were compared to SOFA and KDIGO-scores and to survival. 277 patients admitted to ICU were included of which 30% had sepsis. The other groups were categorized as miscellaneous, other medical and trauma. Results The plasma concentrations of all four biomarkers were highly elevated with the highest concentrations in sepsis patients. During the follow-up period HNL Dimer decreased already day 2 and further so day 3 (p Læs mere Tjek på PubMed12 Divergent autoantibody and cytokine levels in COVID‐19 sepsis patients influence survival
Daniel Kühn, Natalie Heinen, Kathrin Sutter, Simon T. Herrmann, Maximilian K. Nocke, Daniel Todt, Peter D. Burbelo, Eike Steinmann, Dominik Ziehe, Björn Koos, Michael Adamzik, Christian Putensen, Alexander Zarbock, Ute Gravemann, Christine Jork, Stephanie Pfaender, SepsisDataNet.NRW and CovidDataNet.NRW research group Journal of Medical Virology, 26.09.2024 Tilføjet 26.09.2024 13 Frequency of and Risk Factors for Increased Healthcare Utilization After Pediatric Sepsis Hospitalization
Carlton, Erin F.; Rahman, Moshiur; Maddux, Aline B.; Weiss, Scott L.; Prescott, Hallie C. Critical Care Medicine, 20.09.2024 Tilføjet 20.09.2024 Objectives: To determine the frequency of and risk factors for increased post-sepsis healthcare utilization compared with pre-sepsis healthcare utilization. Design: Retrospective observational cohort study. Setting: Years 2016–2019 MarketScan Commercial and Medicaid Database. Patients: Children (0–18 yr) with sepsis treated in a U.S. hospital. Interventions: None. Measurements and Main Results: We measured the frequency of and risk factors for increased healthcare utilization in the 90 days post- vs. pre-sepsis hospitalization. We defined increased healthcare utilization as an increase of at least 3 days in the 90 days post-hospitalization compared with the 90 days pre-hospitalization based on outpatient, emergency department, and inpatient hospitalization. We identified 2801 patients hospitalized for sepsis, of whom 865 (30.9%) had increased healthcare utilization post-sepsis, with a median (interquartile range [IQR]) of 3 days (1–6 d) total in the 90 days pre-sepsis and 10 days (IQR, 6–21 d) total in the 90 days post-sepsis (p < 0.001). In multivariable models, the odds of increased healthcare use were higher for children with longer lengths of hospitalization (> 30 d adjusted odds ratio [aOR], 4.35; 95% CI, 2.99-6.32) and children with preexisting complex chronic conditions, specifically renal (aOR, 1.47; 95% CI, 1.02–2.12), hematologic/immunologic (aOR, 1.34; 95% CI, 1.03–1.74), metabolic (aOR, 1.39; 95% CI, 1.08–1.79), and malignancy (aOR, 1.89; 95% CI, 1.38–2.59). Conclusions: In this nationally representative cohort of children who survived sepsis hospitalization in the United States, nearly one in three had increased healthcare utilization in the 90 days after discharge. Children with hospitalizations longer than 30 days and complex chronic conditions were more likely to experience increased healthcare utilization. Læs mere Tjek på PubMed14 Assessment of Racial, Ethnic, and Sex-Based Disparities in Time-to-Antibiotics and Sepsis Outcomes in a Large Multihospital Cohort
Pak, Theodore R.; Sánchez, Sarimer M.; McKenna, Caroline S.; Rhee, Chanu; Klompas, Michael Critical Care Medicine, 20.09.2024 Tilføjet 20.09.2024 Objectives: To characterize associations between race/ethnicity/sex, time-to-antibiotics, and mortality in patients with suspected sepsis or septic shock. Design: Retrospective cohort study, with race/ethnicity/sex as the exposure, and time-to-antibiotics (relative to emergency department arrival) and in-hospital mortality as the outcome. Setting: Five Massachusetts hospitals. Patients: Forty-nine thousand six hundred nine adults admitted 2015–2022 with suspected sepsis or septic shock (blood cultures drawn and IV antibiotics administered within 24 hr of arrival, plus evidence of organ dysfunction for sepsis, and hypotension or lactate ≥ 4.0 mmol/L for septic shock). Interventions: None. Measurements and Main Results: Among included patients, 22,598 (46%) were women, 36,626 (75%) were White, and 4,483 (9.2%) were Black. Women had longer median time-to-antibiotics than men when presenting with either suspected sepsis (203 vs. 190 min) or septic shock (160 vs. 142 min). Differences in time-to-antibiotics for women vs. men persisted after adjusting for age, race, comorbidities, source of infection, and severity of illness (adjusted odds ratio [aOR] for 3–6 vs. < 3 hr; 1.16 [95% CI, 1.07–1.25] for sepsis and aOR, 1.09 [95% CI, 1.01–1.18] for septic shock). Median time-to-antibiotics was also longer for Black vs. White patients for both sepsis (215 vs. 194 min; aOR for 3–6 vs. < 3 hr; 1.24 [95% CI, 1.06–1.45]) and septic shock (median 159 vs. 148 min; aOR, 1.32 [95% CI, 1.12–1.55]). There was no association between race/ethnicity/sex and in-hospital mortality for sepsis without shock; however, women with septic shock had higher mortality (aOR, 1.16; 95% CI, 1.04–1.29) vs. men. Higher mortality for women with septic shock persisted when also adjusting for time-to-antibiotics (aOR, 1.16; 95% CI, 1.03–1.32). Conclusions: In a large cohort of patients with sepsis, time-to-antibiotics was longer for both women and Black patients even after detailed risk-adjustment. Women with septic shock had higher adjusted in-hospital mortality than men, but this association was not moderated by time-to-antibiotics. Læs mere Tjek på PubMed15 Characteristics and Outcomes of Children and Young Adults With Sepsis Requiring Continuous Renal Replacement Therapy: A Comparative Analysis From the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)
Stanski, Natalja L.; Gist, Katja M.; Hasson, Denise; Stenson, Erin K.; Seo, JangDong; Ollberding, Nicholas J.; Muff-Luett, Melissa; Cortina, Gerard; Alobaidi, Rashid; See, Emily; Kaddourah, Ahmad; Fuhrman, Dana Y.; on behalf of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) Investigators Critical Care Medicine, 20.09.2024 Tilføjet 20.09.2024 Objectives: Pediatric sepsis-associated acute kidney injury (AKI) often requires continuous renal replacement therapy (CRRT), but limited data exist regarding patient characteristics and outcomes. We aimed to describe these features, including the impact of possible dialytrauma (i.e., vasoactive requirement, negative fluid balance) on outcomes, and contrast them to nonseptic patients in an international cohort of children and young adults receiving CRRT. Design: A secondary analysis of Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK), an international, multicenter, retrospective study. Setting: Neonatal, cardiac and PICUs at 34 centers in nine countries from January 1, 2015, to December 31, 2021. Patients: Patients 0–25 years old requiring CRRT for AKI and/or fluid overload. Interventions: None. Measurements and Main Results: Among 1016 patients, 446 (44%) had sepsis at CRRT initiation and 650 (64%) experienced Major Adverse Kidney Events at 90 days (MAKE-90) (defined as a composite of death, renal replacement therapy [RRT] dependence, or > 25% decline in estimated glomerular filtration rate from baseline at 90 d from CRRT initiation). Septic patients were less likely to liberate from CRRT by 28 days (30% vs. 38%; p < 0.001) and had higher rates of MAKE-90 (70% vs. 61%; p = 0.002) and higher mortality (47% vs. 31%; p < 0.001) than nonseptic patients; however, septic survivors were less likely to be RRT dependent at 90 days (10% vs. 18%; p = 0.011). On multivariable regression, pre-CRRT vasoactive requirement, time to negative fluid balance, and median daily fluid balance over the first week of CRRT were not associated with MAKE-90; however, increasing duration of vasoactive requirement was independently associated with increased odds of MAKE-90 (adjusted OR [aOR], 1.16; 95% CI, 1.05–1.28) and mortality (aOR, 1.20; 95% CI, 1.1–1.32) for each additional day of support. Conclusions: Septic children requiring CRRT have different clinical characteristics and outcomes compared with those without sepsis, including higher rates of mortality and MAKE-90. Increasing duration of vasoactive support during the first week of CRRT, a surrogate of potential dialytrauma, appears to be associated with these outcomes. Læs mere Tjek på PubMed16 Phenotypic bacterial epidemiology and antimicrobial resistance profiles in neonatal sepsis at Jimma medical center, Ethiopia: Insights from prospective study
Daniel Geleta, Gemeda Abebe, Tsion Tilahun, Didimos Gezahegn, Netsanet Workneh, Getenet Beyene PLoS One Infectious Diseases, 17.09.2024 Tilføjet 17.09.2024 by Daniel Geleta, Gemeda Abebe, Tsion Tilahun, Didimos Gezahegn, Netsanet Workneh, Getenet Beyene Background Epidemiological profiles and the rundown crisis of antimicrobial resistance from bacterial isolates in neonatal sepsis compel regular surveillance to enhance data-driven decision-making. Accordingly, this study aimed to assess the phenotypic epidemiology and antimicrobial resistance profiles of bacteria isolated from clinically suspected neonatal sepsis in Ethiopia. Methods A total of 342 neonates suspected of clinical sepsis were randomly included in a prospective observational study conducted at the neonatal intensive care unit (NICU) of Jimma medical center (JMC) from May 2022 to July 2023. Blood samples were collected from each neonate and subjected to a culture test for identification of bacterial isolates and their antibiotic resistance profiles following the standardized guidelines. The laboratory results, along with relevant clinical data, were recorded using WHONET and analyzed using STATA software. Results Out of the 342 blood samples that were analyzed, 138 samples (40.4%, 95% CI: 35.1–45.6, P Læs mere Tjek på PubMed17 Clinical Phenotyping for Prognosis and Immunotherapy Guidance in Bacterial Sepsis and COVID-19
Karakike, Eleni; Metallidis, Simeon; Poulakou, Garyfallia; Kosmidou, Maria; Gatselis, Nikolaos K.; Petrakis, Vasileios; Rovina, Nikoletta; Gkeka, Eleni; Sympardi, Styliani; Papanikolaou, Ilias; Koutsodimitropoulos, Ioannis; Tzavara, Vasiliki; Adamis, Georgios; Tsiakos, Konstantinos; Koulouras, Vasilios; Mouloudi, Eleni; Antoniadou, Eleni; Vlachogianni, Gykeria; Anisoglou, Souzana; Markou, Nikolaos; Koutsoukou, Antonia; Panagopoulos, Periklis; Milionis, Haralampos; Dalekos, George N.; Kyprianou, Miltiades; Giamarellos-Bourboulis, Evangelos J. Critical Care Explorations, 16.09.2024 Tilføjet 16.09.2024 OBJECTIVES: It is suggested that sepsis may be classified into four clinical phenotypes, using an algorithm employing 29 admission parameters. We applied a simplified phenotyping algorithm among patients with bacterial sepsis and severe COVID-19 and assessed characteristics and outcomes of the derived phenotypes. DESIGN: Retrospective analysis of data from prospective clinical studies. SETTING: Greek ICUs and Internal Medicine departments. PATIENTS AND INTERVENTIONS: We analyzed 1498 patients, 620 with bacterial sepsis and 878 with severe COVID-19. We implemented a six-parameter algorithm (creatinine, lactate, aspartate transaminase, bilirubin, C-reactive protein, and international normalized ratio) to classify patients with bacterial sepsis intro previously defined phenotypes. Patients with severe COVID-19, included in two open-label immunotherapy trials were subsequently classified. Heterogeneity of treatment effect of anakinra was assessed. The primary outcome was 28-day mortality. MEASUREMENTS AND MAIN RESULTS: The algorithm validated the presence of the four phenotypes across the cohort of bacterial sepsis and the individual studies included in this cohort. Phenotype α represented younger patients with low risk of death, β was associated with high comorbidity burden, and δ with the highest mortality. Phenotype assignment was independently associated with outcome, even after adjustment for Charlson Comorbidity Index. Phenotype distribution and outcomes in severe COVID-19 followed a similar pattern. CONCLUSIONS: A simplified algorithm successfully identified previously derived phenotypes of bacterial sepsis, which were predictive of outcome. This classification may apply to patients with severe COVID-19 with prognostic implications. Læs mere Tjek på PubMed18 Multinational trends in sepsis mortality between 1985 and 2019: a temporal analysis of the WHO Mortality Database
Komorowski, M., Salciccioli, J. D., Shalhoub, J., Gordon, A. C., Marshall, D. C. BMJ Open, 13.09.2024 Tilføjet 13.09.2024 ObjectivesUnderstanding the burden of disease of sepsis is essential for monitoring the effectiveness of international strategies to improve sepsis care. Our objective was to describe the multinational trend of sepsis-related mortality for the period 1985–2019 from the WHO Mortality Database. DesignRetrospective analysis of the WHO Mortality Database. SettingWe included data from all countries defined by the WHO as having ‘high usability data’ and at least 10 years of total available data. ParticipantsFrom the WHO list of 50 countries with high usability data, 14 (28%) were excluded due to excessive missingness. We included and analysed data separately for male and female. Primary and secondary outcome measuresWe analysed age-standardised mortality rates (ASMR) (weighted average of the age-specific mortality rates per 100 000 people, where the weights are the proportions of people in the corresponding age groups of the WHO standard population). ResultsWe included 1104 country-years worth of data from 36 countries with high usability data, accounting for around 15% of the world’s population. The median ASMR for men decreased from 37.8 deaths/100 000 (IQR 28.4–46.7) in 1985–1987 to 25.8 deaths/100 000 (IQR 19.2–37) in 2017–2019, an approximately 12% absolute (31.8% relative) decrease. For women, the overall ASMR decreased from 22.9 deaths/100 000 (IQR 17.7–32.2) to 16.2 deaths/100 000 (IQR 12.6–21.6), an approximately 6.7% absolute decrease (29.3% relative decrease). The analysis of country-level data revealed wide variations in estimates and trends. ConclusionsWe observed a decrease in reported sepsis-related mortality across the majority of analysed nations between 1985 and 2019. However, significant variability remains between gender and health systems. System-level and population-level factors may contribute to these differences, and additional investigations are necessary to further explain these trends. Læs mere Tjek på PubMed19 Retrospective Analysis of Blood Biomarkers of Neurological Injury in Human Cases of Viral Infection and Bacterial Sepsis
Journal of Infectious Diseases, 12.09.2024 Tilføjet 12.09.2024 Abstract Background Blood biomarkers of neurological injury could provide a rapid diagnosis of central nervous system (CNS) injury caused by infections. An FDA-approved assay for mild traumatic brain injury (TBI) measures glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), which signal astrocyte and neuronal injury, respectively. Here, we assessed the applicability of this biomarker assay for determining infection-induced brain injury.Methods We measured serum levels of GFAP and UCH-L1 retrospectively in serum samples from three study populations: 1) human cases infected with Venezuelan equine encephalitis virus (VEEV) and Madariaga virus (MADV) (n = 73), 2) human sepsis patients who were severely ill or diagnosed with encephalitis (n = 66), and 3) sepsis cases that were subsequently evaluated for cognitive impairment (n = 64).Results In the virus infection group, we found elevated GFAP for VEEV (p = 0.014) and MADV (p = 0.011) infections, which correlated with seizures (p = 0.006). In the bacterial sepsis group, GFAP was elevated in cases diagnosed with encephalitis (p = 0.0007) and correlated with headaches (p = 0.0002). In the bacterial sepsis cases with a later cognitive assessment, elevated GFAP (p = 0.0057) at study enrollment was associated with cognitive impairment six months later with a positive prognostic capacity of 79% (CI: 66–95%; p = 0.0068).Conclusions GFAP and UCH-L1 levels measured using an FDA-approved assay for TBI may indicate brain injury resulting from viral or bacterial infections and could predict the development of neurological sequelae. Læs mere Tjek på PubMed20 Universal versus targeted treatment of neonatal herpes simplex virus among neonates presenting for sepsis evaluations
Dantuluri, Keerti L.; Ahmed, Amina Current Opinion in Infectious Diseases, 11.09.2024 Tilføjet 11.09.2024 Purpose of review The American Academy of Pediatrics recently published guidance for the evaluation and management of febrile infants. However, guidance on testing and empiric treatment for neonatal herpes simplex virus (HSV) remains less standardized and subject to clinical practice variation. Recent findings Recent reports reveal that high numbers of infants presenting for sepsis evaluations need to be treated empirically with acyclovir to capture one case of neonatal HSV. Clinical and laboratory risk factors for neonatal HSV identified in the literature can be used for a targeted approach to testing and treating infants for HSV to optimize resource utilization. Summary The literature supports a targeted approach to evaluation and empiric acyclovir treatment for neonatal HSV, but additional studies are needed to validate this approach given the rarity of disease. Læs mere Tjek på PubMed |
European Congress of Immunology (ECI) 2024
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