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Time to antibiotic in sepsis

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https://www.readbyqxmd.com/read/29161668/patterns-of-c-reactive-protein-ratio-response-to-antibiotics-in-pediatric-sepsis-a-prospective-cohort-study
#1
Vanessa Soares Lanziotti, Pedro Póvoa, Arnaldo Prata-Barbosa, Lucas Berbet Pulcheri, Ligia S C F Rabello, José Roberto Lapa E Silva, Marcio Soares, Jorge I F Salluh
PURPOSE: Evaluate sequential C-reactive protein (CRP) measurements and patterns of CRP-ratio response to antibiotic therapy during first 7days in Pediatric Intensive Care Unit (PICU) of septic children. METHODS: Prospective, cohort study of children (1month-12years) admitted at 3 PICUs, with diagnosis of sepsis with <72h course. CRP-ratio was calculated in relation to D0_CRP value. Children were classified according to an individual pattern of CRP-ratio response: fast - CRP_D4 of therapy was <0...
November 11, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29158243/point-of-care-lactate-testing-for-sepsis-at-presentation-to-health-care-a-systematic-review-of-patient-outcomes
#2
Elizabeth Morris, David McCartney, Daniel Lasserson, Ann Van den Bruel, Rebecca Fisher, Gail Hayward
BACKGROUND: Lactate is measured in hospital settings to identify patients with sepsis and severe infections, and to guide initiation of early treatment. Point-of-care technology could facilitate measurement of lactate by clinicians in the community. However, there has been little research into its utility in these environments. AIM: To investigate the effect of using point-of-care lactate at presentation to health care on mortality and other clinical outcomes, in patients presenting with acute infections...
November 20, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/29153062/-diagnostic-accuracy-of-the-lightcycler%C3%A2-septifast-assay-in-the-childhood-febrile-neutropenia
#3
Esra Mimaroğlu, Elvan Çağlar Çıtak, Necdet Kuyucu, Gönül Arslan
Infection is the main problem among the patients receiving cancer therapy. The mortality rate can be reduced by the appropriate treatment in the right time. Although blood culture is the gold standard for the diagnoses of sepsis, many factors influence the results of blood culture in children. For this reason, real time polymerase chain reaction (Rt-PCR) has gained importance for the diagnoses of microbiological agents as it is faster than the conventional methods. In this study, we aimed to compare the efficacy of SeptiFast (SF) test with blood culture among children with neutropenic fever...
October 2017: Mikrobiyoloji Bülteni
https://www.readbyqxmd.com/read/29145711/timing-of-antibiotics-in-the-management-of-community-acquired-sepsis-can-a-randomised-controlled-trial-of-prehospital-therapy-provide-answers
#4
Andrew A Udy, Karen Smith, Stephen Bernard
Significant tension surrounds the application of antibiotics in suspected infection. Guidelines stress the importance of early empirical broad-spectrum therapy, with select observational data suggesting inferior outcomes when this is delayed. In contrast, microbiological resistance is an ever increasing global problem, with many advocating for a more restricted, culture-driven approach to antibiotic prescription. Controlled trial data are urgently needed, although many clinicians would find withholding of antibiotic therapy unethical...
November 16, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29125257/improving-door-to-needle-times-for-patients-with-suspected-neutropenic-sepsis
#5
Tracy Wild
Neutropenic sepsis is a potentially life-threatening complication of chemotherapy and has an associated mortality of 2% to 21%. Patients can deteriorate rapidly and are usually advised to attend their local emergency department (ED) for urgent assessment and antibiotic therapy within one hour of arrival. Delivery of this emergency care is, however, inconsistent, and at times suboptimal, due to a lack of awareness of the condition and of clinical expertise. This article discusses a collaborative project between an acute oncology service and an ED, which has improved and sustained compliance with this standard through a range of initiatives, including revised and integrated sepsis guidelines, education, sepsis champions and a fast-track patient pathway...
November 10, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/29116997/hospital-differences-drive-antibiotic-delays-for-black-patients-compared-with-white-patients-with-suspected-septic-shock
#6
Stephanie Parks Taylor, Colleen H Karvetski, Megan A Templin, Brice T Taylor
OBJECTIVE: Evaluate racial disparities in sepsis processes of care. DESIGN: Observational cohort study. SETTING: Nine hospitals in the Southeastern United States between 2014 and 2016. PATIENTS: Two thousand two hundred twenty-one white and 707 black patients treated in the emergency department through "code sepsis" pathway for suspected septic shock. MEASUREMENTS AND MAIN RESULTS: Black patients were less likely to receive timely antibiotics than were white patients using multiple definitions (1 hr from code sepsis activation [odds ratio, 0...
November 7, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29111416/evidence-that-a-regional-surgical-collaborative-can-transform-care-surgical-site-infection-prevention-practices-for-colectomy-in-michigan
#7
Joceline V Vu, Stacey D Collins, Elizabeth Seese, Samantha Hendren, Michael J Englesbe, Darrell A Campbell, Greta L Krapohl
BACKGROUND: Surgical site infections (SSI) after colectomy are associated with increased morbidity and health care use. Since 2012, the Michigan Surgical Quality Collaborative (MSQC) has promoted a "bundle" of care processes associated with lower SSI risk, using an audit-and-feedback system for adherence, face-to-face meetings, and support for quality improvement projects at participating hospitals. The purpose of this study was to determine whether practices changed over time. STUDY DESIGN: We previously found 6 processes of care independently associated with SSI in colectomy...
October 28, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29109168/risk-factors-and-outcomes-for-ineffective-empiric-treatment-in-gram-negative-sepsis-stratification-by-onset-of-infection
#8
Scott T Micek, Nicholas Hampton, Marin Kollef
Sepsis and septic shock remain serious infections with reported mortality rates in excess of forty percent. Timely antibiotic therapy in sepsis and septic shock is recognized as an important determinant of outcome. However, the administration of ineffective empiric treatment (IET) (an initial antibiotic regimen that is not active against the identified pathogen(s) based on in vitro susceptibility testing) is associated with excess mortality compared to effective empiric treatment (EET). We examined all hospitalized patients between January 2010 and October 2015 at Barnes-Jewish Hospital with the presence of a sterile site (blood, or pleural, abdominal, cerebrospinal, synovial, and pericardial fluid) culture positive for Gram-negative (GN) bacteria combined with primary or secondary ICD-9-CM codes for severe sepsis (995...
November 6, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29105600/microbiology-in-burns-patients-with-blood-stream-infections-trends-over-time-and-during-the-course-of-hospitalization
#9
Dolores Sousa, Alejandra Ceniceros, Rita Galeiras, Sonia Pértega-Díaz, José-María Gutiérrez-Urbón, María Rodríguez-Mayo, Eugenia López-Suso, Mónica Mourelo-Fariña, Pedro Llinares
BACKGROUND: Bloodstream infections (BSI) are a major cause of mortality in burns patients. Knowledge of the microbiology is crucial to direct empirical therapy. We sought to determine the causative microorganisms and antibiotic resistance in burns patients with BSI. METHODS: All consecutive BSI episodes in a tertiary hospital burns unit from 2000 to 2014 were included. The following three subperiods were compared: 2000-2004, 2005-2009 and 2010-2014. Changes in BSI occurring during early and late hospitalization periods were evaluated...
November 6, 2017: Infectious Diseases
https://www.readbyqxmd.com/read/29095181/intravenous-push-cephalosporin-antibiotics-in-the-emergency-department-a-practice-improvement-project
#10
Julie M McLaughlin, Robin A Scott, Stephanie L Koenig, Scott W Mueller
Delays in administration of appropriate antibiotics to patients with septic shock are associated with increased mortality. To improve the care of patients with sepsis within our 73-bed emergency department (ED), a "first-dose" intravenous push (IVP) cephalosporin antibiotic protocol was initiated. This project was aimed at improving the time from provider order of antibiotic to administration, which follows the Sepsis Core Measure of timely antibiotic administration.This was a single-center, retrospective analysis of a practice improvement study...
October 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29091053/multiscale-network-representation-of-physiological-time-series-for-early-prediction-of-sepsis
#11
Supreeth Prajwal Shashikumar, Qiao Li, Gari D Clifford, Shamim Nemati
Sepsis, a dysregulated immune-mediated host response to infection, is the leading cause of morbidity and mortality in critically ill patients. Indices of heart rate variability and complexity (such as entropy) have been proposed as surrogate markers of Neuro-immune system dysregulation with diseases such as sepsis. However, these indices only provide an average, one dimensional description of complex neuro-physiological interactions. We propose a novel multiscale network construction and analysis method for multivariate physiological time series, and demonstrate its utility for early prediction of sepsis...
November 1, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/29078714/impact-of-a-combination-antibiotic-bag-on-compliance-with-surviving-sepsis-campaign-goals-in-emergency-department-patients-with-severe-sepsis-and-septic-shock
#12
Michael P Lorenzo, Lindsay MacConaghy, Christopher D Miller, Gregory Meola, Luke A Probst, Brian Pratt, Jeff Steele, Robert W Seabury
BACKGROUND: Severe sepsis and septic shock represent common presentations in the emergency department (ED) and have high rates of mortality. Guideline-recommended goals of care have been shown to benefit these patients, but can be difficult to provide. OBJECTIVE: To determine whether the use of a premixed bag consisting of 2 g cefepime and 1 g vancomycin in 1000 mL of normal saline increases the probability of patients receiving Surviving Sepsis Campaign (SSC) recommendations for the initiation of antimicrobials and fluid challenge...
October 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29048513/sepsis-national-hospital-inpatient-quality-measure-sep-1-multistakeholder-work-group-recommendations-for-appropriate-antibiotics-for-the-treatment-of-sepsis
#13
Edward J Septimus, Craig M Coopersmith, Jessica Whittle, Caleb P Hale, Neil O Fishman, Thomas J Kim
The Center for Medicare and Medicaid Services adopted the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) performance measure to the Hospital Inpatient Quality Reporting Program in July 2015 to help address the high mortality and high cost associated with sepsis. The SEP-1 performance measure requires, among other critical interventions, timely administration of antibiotics to patients with sepsis or septic shock. The multistakeholder workgroup recognizes the need for SEP-1 but strongly believes that multiple antibiotics listed in the antibiotic tables for SEP-1 are not appropriate and the use of these antibiotics, as called for in the SEP-1 measure, is not in alignment with prudent antimicrobial stewardship...
October 16, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29046121/cefepime-intravenous-push-versus-intravenous-piggyback-on-time-to-administration-of-first-dose-vancomycin-in-the-emergency-department
#14
Ann Tran, David O'Sullivan, Michelle Krawczynski
STUDY OBJECTIVE: The combination of cefepime and vancomycin is commonly used as an empiric antimicrobial regimen. Time to first-dose antibiotics is associated with survival benefit. The objective of this study is to evaluate whether cefepime intravenous push (IVP) is associated with a shorter time to vancomycin administration in the emergency department (ED) compared with cefepime intravenous piggyback (IVPB) infusion. METHODS: This was a retrospective chart review of records of patients who were treated with the vancomycin-cefepime combination in the ED...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29038965/low-risk-of-complications-in-patients-with-first-time-acute-uncomplicated-diverticulitis
#15
Abbas Chabok, Kalle Andreasson, Maziar Nikberg
PURPOSE: First-time acute uncomplicated diverticulitis (AUD) has been considered to have an increased risk of complication, but the level of evidence is low. The aim of the present study was to evaluate the risk of complications in patients with first-time AUD and in patients with a history of diverticulitis. METHODS: This paper is a population-based retrospective study at Västmanland's Hospital, Västerås, Sweden, where all patients were identified with a diagnosis of colonic diverticular disease ICD-10 K57...
October 16, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/29032850/impact-of-penicillin-allergy-on-time-to-first-dose-of-antimicrobial-therapy-and-clinical-outcomes
#16
Erin L Conway, Ken Lin, John A Sellick, Kari Kurtzhalts, James Carbo, Michael C Ott, Kari A Mergenhagen
PURPOSE: The objective of this study was to evaluate the impact of a listed penicillin allergy on the time to first dose of antibiotic in a Veterans Affairs hospital. Additional clinical outcomes of patients with penicillin allergies were compared with those of patients without a penicillin allergy. METHODS: A retrospective chart review of veterans admitted through the emergency department with a diagnosis of pneumonia, urinary tract infection, bacteremia, and sepsis from January 2006 to December 2015 was conducted...
October 9, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/29025165/impact-of-an-emergency-department-electronic-sepsis-surveillance-system-on-patient-mortality-and-length-of-stay
#17
Jonathan S Austrian, Catherine T Jamin, Glenn R Doty, Saul Blecker
Objective: The purpose of this study was to determine whether an electronic health record-based sepsis alert system could improve quality of care and clinical outcomes for patients with sepsis. Materials and Methods: We performed a patient-level interrupted time series study of emergency department patients with severe sepsis or septic shock between January 2013 and April 2015. The intervention, introduced in February 2014, was a system of interruptive sepsis alerts triggered by abnormal vital signs or laboratory results...
August 28, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29023316/septic-shock-resuscitation-in-the-first-hour
#18
Nicholas Simpson, Francois Lamontagne, Manu Shankar-Hari
PURPOSE OF REVIEW: We reviewed the recent advances in the initial approach to resuscitation of sepsis and septic shock patients. RECENT FINDINGS: Sepsis and septic shock are life-threatening emergencies. Two key interventions in the first hour include timely antibiotic therapy and resuscitation. Before any laboratory results, the need for resuscitation is considered if a patient with suspected infection has low blood pressure (BP) or impaired peripheral circulation found at clinical examination...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29020203/empirical-antibiotic-treatment-does-not-improve-outcomes-in-catheter-associated-urinary-tract-infection-prospective-cohort-study
#19
Tanya Babich, Oren Zusman, Michal Elbaz, Haim Ben-Zvi, Mical Paul, Leonard Leibovici, Tomer Avni
Background: Catheter associated urinary tract infection (CAUTI) is the most common healthcare-associated acquired infection. We aimed to describe the short- and long-term survival of patients with CAUTI and the impact of the empirical antibiotic treatment on survival rates. Methods: In this prospective observational study we included consecutive adult patients with a chronic indwelling catheter-associated UTI and sepsis hospitalized in medical departments. The primary outcomes were 30-days all-cause mortality and long-term survival at end of the follow-up...
August 2, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28993363/rare-postoperative-complication-clostridium-perfringens-septic-shock-following-elective-abdominal-surgery
#20
Michael Bath, Mark McKelvie, Khalid Canna
Postoperative infections are one of the most common complications in general surgery, and while rates have reduced with the routine administration of perioperative antibiotics, around 5% of patients undergoing a surgical procedure will develop an infective complication.(1) The Gram-positive, obligate anaerobe, Clostridium perfringens, is a well-known pathogen that forms part of both the environmental and gastrointestinal flora.(2) While more commonly associated with food poisoning, anaerobic cellulitis and traumatic gas gangrene, rare cases of spontaneous non-traumatic gas gangrene of abdominal viscera have also been recorded...
October 9, 2017: BMJ Case Reports
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