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Latest & greatest articles for sepsis
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Effect of case management on neonatal mortality due to sepsis and pneumonia Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Existing models fail to predict sepsis in an obstetric population with intrauterine infection Multiple scoring systems exist to identify inpatients who are at risk for clinical deterioration. None of these systems have been evaluated in an obstetric population. We examined the Systemic Inflammatory Response syndrome (SIRS) and Modified Early Warning score (MEWS) criteria in pregnant women with chorioamnionitis.This was an 18-month retrospective analysis of patients with chorioamnionitis. SIRS (...) and MEWS scores were calculated; clinical outcomes were ascertained, and test characteristics were calculated for the primary outcome of sepsis, intensive care unit transfer, or death.Nine hundred thirteen women with chorioamnionitis were identified. Five women experienced sepsis; there was 1 death. Five hundred seventy-five of the 913 women (63%) met SIRS criteria (95% confidence interval, 59.8-66.2%; positive predictive value, 0.9%). Ninety-two of the 913 women (10.3%) had a MEWS score of ≥ 5 (95
Clinical manifestations but not cytokine profiles differentiate adult-onset Still`s disease and sepsis To analyze clinical manifestations, serum ferritin, and serum cytokine levels in patients with adult-onset Still's disease (AOSD) or bacterial sepsis and to evaluate their potential use for differential diagnosis.Twenty-two consecutive patients with the first flare of AOSD and 6 patients with an established diagnosis of AOSD under immunosuppressive therapy were compared with 14 patients (...) with bacterial sepsis. Clinical manifestations were scored in a Pouchot AOSD activity score including elevated serum ferritin levels to obtain a modified Pouchot score. Serum cytokine profiles were analyzed from each patient.The scores of clinical manifestations using a modified Pouchot activity score were significantly higher in patients with active untreated AOSD (mean 5.60 ± 1.93) compared with patients with chronic AOSD (mean 1.16 ± 0.98; p < 0.001) and patients with sepsis (mean 2.38 ± 1.19; p < 0.001
Sepsis toolkit Clinical Excellence Commission - index | Toggle navigation Search 2019 Patient Experience Symposium 29 & 30 April Download our Quality Improvement Tools Get Involved in Upcoming Events Quality Improvement The CEC’s Quality Improvement Academy aims to enhance leadership and improve frontline capability and capacity in safety and quality. We’re developing a critical mass of clinical leaders and clinical teams to undertake quality improvement. Patient Safety Our initiatives
Treatment of neonatal sepsis with intravenous immune globulin. Neonatal sepsis is a major cause of death and complications despite antibiotic treatment. Effective adjunctive treatments are needed. Newborn infants are relatively deficient in endogenous immunoglobulin. Meta-analyses of trials of intravenous immune globulin for suspected or proven neonatal sepsis suggest a reduced rate of death from any cause, but the trials have been small and have varied in quality.At 113 hospitals in nine (...) immune globulin and in 677 of 1734 infants (39.0%) who received placebo (relative risk, 1.00; 95% confidence interval, 0.92 to 1.08). Similarly, there were no significant differences in the rates of secondary outcomes, including the incidence of subsequent sepsis episodes. In follow-up of 2-year-old infants, there were no significant differences in the rates of major or nonmajor disability or of adverse events.Therapy with intravenous immune globulin had no effect on the outcomes of suspected
De-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock. Mortality rates among patients with sepsis, severe sepsis or septic shock ranges from 27% to 54%. Empirical broad-spectrum antimicrobial treatment is aimed at achieving adequate antimicrobial therapy and thus reducing mortality. However, there is a risk that empirical broad-spectrum antimicrobial treatment can expose patients to overuse of antimicrobials. De-escalation has been proposed as a strategy (...) to replace empirical broad-spectrum antimicrobial treatment with a narrower antimicrobial therapy. This is done by either changing the pharmacological agent or discontinuing a pharmacological combination according to the patient's microbial culture results.To evaluate the effectiveness and safety of de-escalation antimicrobial treatment for adult patients diagnosed with sepsis, severe sepsis or septic shock caused by any micro-organism.We searched the Cochrane Central Register of Controlled Trials
Long-term cognitive impairment and functional disability among survivors of severe sepsis. Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients' long-term cognitive and functional limitations after sepsis is unknown.To determine the change in cognitive impairment and physical functioning among patients who survive severe sepsis (...) , controlling for their presepsis functioning.A prospective cohort involving 1194 patients with 1520 hospitalizations for severe sepsis drawn from the Health and Retirement Study, a nationally representative survey of US residents (1998-2006). A total of 9223 respondents had a baseline cognitive and functional assessment and had linked Medicare claims; 516 survived severe sepsis and 4517 survived a nonsepsis hospitalization to at least 1 follow-up survey and are included in the analysis.Personal interviews
Early versus late pre-intensive care unit admission broad spectrum antibiotics for severe sepsis in adults. Severe sepsis and septic shock have recently emerged as particularly acute and lethal challenges amongst critically ill patients presenting to the emergency department (ED). There are no existing data on the current practices of management of patients with severe sepsis comparing early versus late administration of appropriate broad spectrum antibiotics as part of the early goal-directed (...) therapy that is commenced in the first few hours of presentation.To assess the difference in outcomes with early compared to late administration of antibiotics in patients with severe sepsis in the pre-intensive care unit (ICU) admission period. We defined early as within one hour of presentation to the ED.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009); MEDLINE (1990 to February 2010); EMBASE (1990 to February 2010); and ISI web of Science
A randomised, controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin in Long Line Total Parenteral Nutrition (HILLTOP) trial Infections are common complications of neonatal long lines. Heparin has been shown to prolong the effective duration of neonatal long lines and to reduce the ability of bacteria to adhere to foreign surfaces, but the effect of heparin on rates of infection is uncertain.The goal of this study (...) was to evaluate the effect of heparin on the frequency of episodes of catheter-related sepsis (CRS) in infants receiving total parenteral nutrition (TPN) through a neonatal long line.This randomised, controlled, double blind, single-centre clinical trial compared heparin at 0.5 IU/ml with no heparin in TPN infused through a neonatal long line, with episodes of CRS as the primary outcome.210 infants were enrolled (TPN with heparin n=102, TPN without heparin n=108). There was a statistically significant
Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Infection rate and acute organ dysfunction risk as explanations for racial differences in severe sepsis. Severe sepsis, defined as infection complicated by acute organ dysfunction, occurs more frequently and leads to more deaths in black than in white individuals. The optimal approach to minimize these disparities is unclear.To determine the extent to which higher severe sepsis rates in black than in white patients are due to higher infection rates or to a higher risk of acute organ (...) dysfunction.Analysis of infection-related hospitalizations from the 2005 hospital discharge data of 7 US states and infection-related emergency department visits from the 2003-2007 National Hospital Ambulatory Care Survey.Age- and sex-standardized severe sepsis and infection hospitalization rates and the risk of acute organ dysfunction.Of 8,661,227 non-childbirth-related discharges, 2,261,857 were associated with an infection, and of these, 381,787 (16.8%) had severe sepsis. Black patients had a 67% higher age
Plasma proteome to look for diagnostic biomarkers of early bacterial sepsis after liver transplantation: a preliminary study While outcome continuously improves after liver transplantation, sepsis remains the leading cause of early postoperative mortality. Diagnosis of infections remains particularly difficult in these patients. This study used plasma profiling coupling Proteinchip array with surface-enhanced laser desorption ionization time-of-fly mass spectrometry to search for biomarkers (...) of postoperative sepsis in patients who underwent liver transplantation.Diagnosis of sepsis at day 5 relied on widely accepted clinical signs and positive culture of microbiologic samples. Profiles of day 5 plasma were obtained from SELDI-TOF CM10 chip (BioRad, Marnes-la-Coquette, France) analysis. Mean peak intensity of proteins was compared between septic and nonseptic plasma by U test followed by analysis of the area under the receiver-operating characteristic for the significant peaks. Diagnostic
Oral lactoferrin for the prevention of sepsis and necrotizing enterocolitis in preterm infants. Lactoferrin, a normal component of human colostrum, milk, tears and saliva can enhance host defence and may be effective in the prevention of sepsis and necrotizing enterocolitis (NEC) in preterm neonates.To assess the safety and effectiveness of oral lactoferrin in the prevention of sepsis and NEC in preterm neonates.The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library (...) evaluating oral lactoferrin at any dose or duration for the prophylaxis of sepsis or NEC in preterm neonates.Data collection and analysis were performed according to the standard methods of the CNRG.One trial (Manzoni 2008) that randomized 472 very low birth weight infants was eligible. A statistically significant reduction in late-onset sepsis was observed in the groups that received either lactoferrin alone (RR 0.34, 95% CI 0.17, 0.70; RD -0.11, 95% CI -0.18, -0.05; NNT 9, 95% CI 5, 20
Outcome of early-onset sepsis in a national cohort of very low birth weight infants Early-onset sepsis (EOS) is associated with significant morbidity and mortality among infants with a very low birth weight (VLBW); however, there is a sparse amount of complete data on large cohorts.To evaluate the mortality and major morbidities among VLBW infants with EOS.This was a population-based observational study. Data were prospectively collected by the Israel Neonatal Network on all VLBW infants born
Phase 2 trial of eritoran tetrasodium (E5564), a toll-like receptor 4 antagonist, in patients with severe sepsis Endotoxin is a potent stimulus of proinflammatory response and systemic coagulation in patients with severe sepsis. Endotoxin is a component of Gram-negative bacteria that triggers an innate immune response through Toll-like receptor 4 signaling pathways in myeloid cells. We evaluated safety and tolerability of two dose regimens of eritoran tetrasodium (E5564), a synthetic Toll-like (...) receptor 4 antagonist, and explored whether it decreases 28-day mortality rate in subjects with severe sepsis.Prospective, randomized, double-blind, placebo-controlled, multicenter, ascending-dose phase II trial.Adult intensive care units in the United States and Canada.Three hundred adults within 12 hrs of recognition of severe sepsis, with Acute Physiology and Chronic Health Evaluation (APACHE) II-predicted risk of mortality between 20% and 80%.Intravenous eritoran tetrasodium (total dose of either
Activated Protein C (Xigris) for Severe Sepsis Activated Protein C (Xigris) for Severe Sepsis – TheNNTTheNNT Drotrecogin alfa (Activated Protein C/Xigris) for Severe Sepsis 55 for major bleeding In Summary, for those who took the Xigris: Benefits in NNT 100% saw no benefit None were helped (life saved) Harms in NNT 1.4% of all patients were harmed by serious bleeding 1.9% of adult patients were harmed by serious bleeding 1 in 70 were harmed (serious bleeding) 1 in 55 adults were harmed (serious (...) bleeding) View As: NNT % Source: Efficacy Endpoints: Mortality Harm Endpoints: Major bleeding event (intracranial bleeding, fatal bleeding, or bleeding requiring transfusion) Narrative: Severe sepsis is a common condition, with an incidence of 176 per 100,000 in the United States according to a Centers for Disease Control and Prevention study from 2001 . It is also often fatal, with mortality ranging from 20-80%. Current treatment practices including early goal directed therapy have had a significant
Steroids for Sepsis Steroids for Sepsis – TheNNTTheNNT Systemic Steroids for Sepsis Syndromes No benefit found In Summary, for those who received the steroids: Benefits in NNT 100% saw no benefit 0% were helped by being saved from death None were helped (preventing death) Harms in NNT 0% were harmed by death, medication side effects None were harmed (increased risk of death, medication side effects) View As: NNT % Source: Efficacy Endpoints: 28-day all cause mortality, hospital mortality, ICU (...) mortality Harm Endpoints: Gastrointestinal bleeding, superinfection, hyperglycemia Narrative: Sepsis is a common and often fatal condition. A 2001 study found an incidence of 176 per 100,000 in the United States , while mortality is approximately 60% . Studies on the biological mechanisms of shock have suggested that corticosteroids may potentially be beneficial. This review examined the effect of corticosteroid therapy for severe sepsis and septic shock. 'Severe sepsis' meant documented infection
Meningococcal sepsis RACGP - Meningococcal sepsis Search the RACGP website Latest issue December 2017 Vol 46(12) 881-960 Articles in the December issue discuss various health issues affecting school-aged children, including acne, eczema and growth disorders. Australian Family Physician Childhood emergencies May 2010 / / / / Focus Childhood emergencies Meningococcal sepsis Pages 276-278 Shabna Rajapaksa Mike Starr Background Meningococcal disease remains a significant illness with an overall (...) mortality of around 8%. The majority of deaths occur in the first 24 hours, before the commencement of specialist care. Missing a diagnosis of meningococcal disease is a fear among health care practitioners. Objective/s This article presents a guide to identifying the salient features of meningococcal sepsis and initial management strategies in the primary care setting. Discussion Initial presentation is often nonspecific and therefore it is important to have a high index of suspicion in children