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Sepsis and septic shock

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https://www.readbyqxmd.com/read/28919283/clinical-manifestations-risk-factors-and-prognosis-of-patients-with-morganella-morganii-sepsis
#1
David Erlanger, Marc Victor Assous, Yonit Wiener-Well, Amos Moshe Yinnon, Eli Ben-Chetrit
BACKGROUND: There are few studies of Morganella bacteremia. We evaluated risk factors and outcome of patients with Morganella bacteremia. METHODS: Medical records of patients with Morganella bacteremia were reviewed (1997-2014). Control group patients with Escherichiacoli sepsis were matched by year of diagnosis and infection acquisition site. RESULTS: The study group included 136 adult patients. Mean age and gender of study and control groups were similar...
September 6, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/28918911/mortality-of-severe-septic-patients-between-physician-s-high-and-low-care-volumes
#2
Chun-Yao Lin, Jo-Chi Tseng, Chih-Yu Huang, Chien-Ming Chu, Huang-Pin Wu
BACKGROUND: Patients with severe sepsis frequently require intensive care unit (ICU) admission and different ICU care models may influence their outcomes. The mortality of severe septic patients between physician's high and low care volume remains unclear. METHODS: We analyzed the data from a three-year prospective observation study, which was performed in an adult medical ICU of Chung Gung Memorial Hospital, Keelung. The data included initial bundle therapies based on the Surviving Sepsis Campaign (SSC) guidelines for patients with severe sepsis...
August 2017: Biomedical Journal
https://www.readbyqxmd.com/read/28916973/myeloperoxidase-can-differentiate-between-sepsis-and-non-infectious-sirs-and-predicts-mortality-in-intensive-care-patients-with-sirs
#3
Irene T Schrijver, Hans Kemperman, Mark Roest, Jozef Kesecioglu, Dylan W de Lange
BACKGROUND: Systemic inflammatory response syndrome (SIRS) is a clinical syndrome following inflammation. Clinically, it is difficult to distinguish SIRS following an infection, i.e., sepsis, from non-infectious SIRS. Myeloperoxidase is a hemeprotein stored in the neutrophil azurophilic granules and is one of the main pillars of neutrophil attack. Therefore, we hypothesized that myeloperoxidase can differentiate between sepsis and non-infectious SIRS in patients with systemic inflammatory response syndrome in the intensive care unit (ICU)...
September 15, 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28916121/controversies-in-corticosteroid-use-for-sepsis
#4
Brit Long, Alex Koyfman
BACKGROUND: Severe sepsis and septic shock are potentially deadly conditions managed in the emergency department (ED). Management centers on source control, fluid resuscitation, broad-spectrum antimicrobials, and vasopressors as needed. The use of corticosteroids is controversial. OBJECTIVE: To evaluate the evidence behind corticosteroid therapy in patients with septic shock. DISCUSSION: Septic shock is associated with severe mortality and morbidity...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28916120/does-early-and-appropriate-antibiotic-administration-improve-mortality-in-emergency-department-patients-with-severe-sepsis-or-septic-shock
#5
Robert Sherwin, Michael E Winters, Gary M Vilke, Gabriel Wardi
BACKGROUND: Severe sepsis and septic shock remain significant public health concerns. Appropriate emergency department management includes early recognition, hemodynamic resuscitation, source control, and prompt antibiotic administration. Current international guidelines strongly recommend administration of early and appropriate antibiotics for patients with severe sepsis and septic shock. Interestingly, a recent Cochrane Review found insufficient evidence to provide a similar recommendation on antibiotic administration...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28915394/overcoming-the-warburg-effect-is-it-the-key-to-survival-in-sepsis
#6
REVIEW
David Bar-Or, Matthew Carrick, Allen Tanner, Mark J Lieser, Leonard T Rael, Edward Brody
Sepsis is a leading cause of mortality in the U.S. and Europe. Sepsis and septic shock are the results of severe metabolic abnormalities following infection. Aerobic glycolysis (the Warburg Effect) is as much a hallmark of sepsis as it is of cancer. Warburg observed that cancer cells generated energy through glycolysis (generation of ATP through degradation of glucose, usually associated with anaerobic conditions) rather than through oxidative phosphorylation (generation of ATP through the mitochondrial inner membrane via the tricarboxylic acid cycle, usually associated with aerobic conditions)...
September 8, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28915308/mutilating-purpura-fulminans-in-an-adult-with-meningococcal-sepsis
#7
María Elena Arnáiz-García, Ana María Arnáiz-García, Francisco Gutierrez-Diez, Juan Francisco Nistal, Jose María González-Santos, Ivana Pulitani, Carlos Amado-Diago, Javier Arnáiz
We report a dramatic case of meningococcal sepsis manifesting as purpura fulminans in an elderly diabetic woman. Hemodynamic instability and severe bilateral cutaneous lesions involving her hands and feet developed rapidly. Specific antibiotic therapy and the administration of inotropic and vasopressor drugs were initiated. The severity and extension of the cutaneous lesions (attributed to purpura fulminans) worsened because of the need for vasoconstrictors for the treatment of septic shock. Bilateral transmetatarsal and metacarpal amputations were required to stabilize the patient...
September 2017: Puerto Rico Health Sciences Journal
https://www.readbyqxmd.com/read/28914622/ce-assessing-patients-during-septic-shock-resuscitation
#8
Elizabeth Bridges
How to integrate capillary refill time and skin mottling score into the six-hour bundle. ABSTRACT: In 2015, the Surviving Sepsis Campaign six-hour bundle was updated. The revised version now recommends documenting the reassessment of volume status and tissue perfusion after initial fluid resuscitation through a repeated focused examination. This article addresses the practice and interpretation of two components of this examination in adults: capillary refill time and skin mottling score...
September 13, 2017: American Journal of Nursing
https://www.readbyqxmd.com/read/28912777/class-a-cpg-oligonucleotide-priming-rescues-mice-from-septic-shock-via-activation-of-platelet-activating-factor-acetylhydrolase
#9
Yoshinari Yamamoto, Ryu Sugimura, Takafumi Watanabe, Suguru Shigemori, Takuma Okajima, Shireen Nigar, Fu Namai, Takashi Sato, Tasuku Ogita, Takeshi Shimosato
Sepsis is a life-threatening, overwhelming immune response to infection with high morbidity and mortality. Inflammatory response and blood clotting are caused by sepsis, which induces serious organ damage and death from shock. As a mechanism of pathogenesis, platelet-activating factor (PAF) induces excessive inflammatory responses and blood clotting. In this study, we demonstrate that a Class A CpG oligodeoxynucleotide (CpG-A1585) strongly induced PAF acetylhydrolase, which generates lyso-PAF. CpG-A1585 rescued mice from acute lethal shock and decreased fibrin deposition, a hallmark of PAF-induced disseminated intravascular coagulation...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28906287/racial-disparities-in-sepsis-related-in-hospital-mortality-using-a-broad-case-capture-method-and-multivariate-controls-for-clinical-and-hospital-variables-2004-2013
#10
Jenna M Jones, Kathryn R Fingar, Melissa A Miller, Rosanna Coffey, Marguerite Barrett, Thomas Flottemesch, Kevin C Heslin, Darryl T Gray, Ernest Moy
OBJECTIVES: As sepsis hospitalizations have increased, in-hospital sepsis deaths have declined. However, reported rates may remain higher among racial/ethnic minorities. Most previous studies have adjusted primarily for age and sex. The effect of other patient and hospital characteristics on disparities in sepsis mortality is not yet well-known. Furthermore, coding practices in claims data may influence findings. The objective of this study was to use a broad method of capturing sepsis cases to estimate 2004-2013 trends in risk-adjusted in-hospital sepsis mortality rates by race/ethnicity to inform efforts to reduce disparities in sepsis deaths...
September 12, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28906284/effect-of-transfusion-on-mortality-and-other-adverse-events-among-critically-ill-septic-patients-an-observational-study-using-a-marginal-structural-cox-model
#11
Claire Dupuis, Maité Garrouste-Orgeas, Sébastien Bailly, Christophe Adrie, Dany Goldgran-Toledano, Elie Azoulay, Stéphane Ruckly, Guillaume Marcotte, Bertrand Souweine, Michael Darmon, Yves Cohen, Carole Schwebel, Guillaume Lacave, Lila Bouadma, Jean-Francois Timsit
OBJECTIVES: RBC transfusion is often required in patients with sepsis. However, adverse events have been associated with RBC transfusion, raising safety concerns. A randomized controlled trial validated the 7 g/dL threshold, but previously transfused patients were excluded. Cohort studies led to conflicting results and did not handle time-dependent covariates and history of treatment. Additional data are thus warranted to guide patient's management. DESIGN: To estimate the effect of one or more RBC within 1 day on three major outcomes (mortality, ICU-acquired infections, and severe hypoxemia) at day 30, we used marginal structural models...
September 12, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28903154/incidence-and-trends-of-sepsis-in-us-hospitals-using-clinical-vs-claims-data-2009-2014
#12
Chanu Rhee, Raymund Dantes, Lauren Epstein, David J Murphy, Christopher W Seymour, Theodore J Iwashyna, Sameer S Kadri, Derek C Angus, Robert L Danner, Anthony E Fiore, John A Jernigan, Greg S Martin, Edward Septimus, David K Warren, Anita Karcz, Christina Chan, John T Menchaca, Rui Wang, Susan Gruber, Michael Klompas
Importance: Estimates from claims-based analyses suggest that the incidence of sepsis is increasing and mortality rates from sepsis are decreasing. However, estimates from claims data may lack clinical fidelity and can be affected by changing diagnosis and coding practices over time. Objective: To estimate the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals. Design, Setting, and Population: Retrospective cohort study of adult patients admitted to 409 academic, community, and federal hospitals from 2009-2014...
September 13, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28894374/predicting-and-managing-sepsis-in-burn-patients-current-perspectives
#13
Omar Nunez Lopez, Janos Cambiaso-Daniel, Ludwik K Branski, William B Norbury, David N Herndon
Modern burn care has led to unprecedented survival rates in burn patients whose injuries were fatal a few decades ago. Along with improved survival, new challenges have emerged in the management of burn patients. Infections top the list of the most common complication after burns, and sepsis is the leading cause of death in both adult and pediatric burn patients. The diagnosis and management of sepsis in burns is complex as a tremendous hypermetabolic response secondary to burn injury can be superimposed on systemic infection, leading to organ dysfunction...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/28891912/postoperative-complications-affecting-survival-after-cardiac-arrest-in-general-surgery-patients
#14
Minjae Kim, Guohua Li
BACKGROUND: Postoperative cardiac arrest is uncommon but associated with a high mortality risk in general surgery patients and is often preceded by postoperative complications. The relationships between previous complications and mortality after cardiac arrest in general surgery patients have not been completely evaluated. METHODS: retrospective, observational cohort of general surgery in patients with cardiac arrest occurring after postoperative day (POD) #0 (and up to POD #30) was obtained from the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program...
September 7, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28889100/role-of-admission-troponin-t-and-serial-troponin-t-testing-in-predicting-outcomes-in-severe-sepsis-and-septic-shock
#15
Saraschandra Vallabhajosyula, Ankit Sakhuja, Jeffrey B Geske, Mukesh Kumar, Joseph T Poterucha, Rahul Kashyap, Kianoush Kashani, Allan S Jaffe, Jacob C Jentzer
BACKGROUND: Troponin-T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin-T testing in the prognostication of these patients. METHODS AND RESULTS: This was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin-T and significant delta troponin-T were defined as ≥0...
September 9, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28888058/increased-expression-of-programmed-cell-death-1-in-regulatory-t-cells-of-patients-with-severe-sepsis-and-septic-shock-an-observational-clinical-study
#16
Qiang Liu, Le An, Zhijiang Qi, Yongzhen Zhao, Chunsheng Li
While regulatory T-cells (Tregs) constitutively express programmed cell death-1 (PD-1), the role of PD-1 expression in Tregs of patients with sepsis remains unclear. Thus, we determined PD-1 expression in Tregs from the peripheral blood of patients with severe sepsis and septic shock Seventy-eight patients with severe sepsis and 40 with septic shock, as well as 21 healthy subjects, were enrolled in this study. The percentage of peripheral blood PD-1+ Tregs, as well as absolute Treg counts, were compared between these 3 groups...
September 9, 2017: Scandinavian Journal of Immunology
https://www.readbyqxmd.com/read/28887350/institutional-care-paths-development-implementation-and-evaluation
#17
Mandy C Leonard, Seth R Bauer, Christine Ahrens, Anita Reddy, Irene Katzan
PURPOSE: The Cleveland Clinic experience with care paths, including their creation and implementation, challenges overcome during development and testing, and outcomes of selected care path evaluations, is described. SUMMARY: Care paths are tools to assist healthcare professionals in practicing evidence-based medicine. The Cleveland Clinic health system has implemented or is developing approximately 100 care paths, including care paths designed to optimize management of sepsis and septic shock and to promote timely use of i...
September 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28884343/prognostic-impact-of-isolated-right-ventricular-dysfunction-in-sepsis-and-septic-shock-an-8-year-historical-cohort-study
#18
Saraschandra Vallabhajosyula, Mukesh Kumar, Govind Pandompatam, Ankit Sakhuja, Rahul Kashyap, Kianoush Kashani, Ognjen Gajic, Jeffrey B Geske, Jacob C Jentzer
BACKGROUND: Echocardiographic myocardial dysfunction is reported commonly in sepsis and septic shock, but there are limited data on sepsis-related right ventricular dysfunction. This study sought to evaluate the association of right ventricular dysfunction with clinical outcomes in patients with severe sepsis and septic shock. METHODS: Historical cohort study of adult patients admitted to all intensive care units at the Mayo Clinic from January 1, 2007 through December 31, 2014 for severe sepsis and septic shock, who had an echocardiogram performed within 72 h of admission...
September 7, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28882472/overwhelming-streptococcus-pyogenes-sepsis-in-an-elderly-patient-with-septic-arthritis
#19
Aarti Chadha, Wafaa Jamal, Abdul Raouf Abdul Aziz, Vincent O Rotimi
INTRODUCTION: The signs of Streptococcus pyogenes, group A streptococci (GAS) bacteremia are non-specific and patients can have wide presentations ranging from flu-like symptoms to life-threatening toxic-shock syndrome in just a few hours. CASE PRESENTATION: We report a case of fulminant S. pyogenes sepsis in an elderly woman with septic arthritis and remarkable past medical history/risk factors. She was febrile, hypotensive and had a swollen and tender right knee...
September 4, 2017: Journal of Infection and Public Health
https://www.readbyqxmd.com/read/28882016/new-sepsis-criteria-do-they-replace-or-complement-what-is-known-in-the-approach-to-the-infectious-patient
#20
REVIEW
J González Del Castillo, C Clemente, F J Candel, F J Martín-Sánchez
There have recently been profound changes in both the definitions of sepsis and septic shock and the diagnostic criteria established for daily clinical practice. In addition, a new screening tool known as qSOFA has been introduced to identify patients at risk of a poor short-term outcome. This score has been accompanied by some controversy due to presenting a lower sensitivity than the systemic inflammatory response criteria previously used to identify such patients. In this article, we shall summarise and analyse the most important recently published studies in relation to these new criteria...
September 2017: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
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