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Time to antibiotic in sepsis

Jaime Fernández-Sarmiento, Joseph A Carcillo, Claudia M Salinas, Edgar F Galvis, Paula A López, Andrés Jagua-Gualdrón
OBJECTIVES: To evaluate adherence to the sepsis bundle before and after an educational strategy and its impact on hospital stay. DESIGN: A prospective, analytic, before-and-after study of children with severe sepsis and septic shock who presented to the emergency department. SETTING: Carried out from January to December 2014 in the emergency department of a quaternary care hospital. PATIENTS: Of a total of 19,836 children who presented to the emergency department, 4,383 had an infectious pathology, with 203 of these showing severe sepsis and septic shock (124 pre intervention, and 79 post intervention)...
March 14, 2018: Pediatric Critical Care Medicine
Allan J C Calsavara, Priscila A Costa, Vandack Nobre, Antonio L Teixeira
This study aimed to assess cognition in patients with severe sepsis or septic shock and whether cognitive impairment was associated with clinical and laboratory parameters. We conducted a cohort study of patients with severe sepsis and septic shock evaluated within 24 h and one year after ICU discharge. Demographic, clinical and laboratory data were analyzed, and the following neuropsychological tests were applied: Consortium to Establish Registry for Alzheimer's Disease, Mini-Mental State Examination, and Trail Making Test forms A and B...
March 14, 2018: Scientific Reports
Natalie Yu Yi Ng, Hannah Hui En Ang, Jacqueline Chieh Ling Tan, Weng Hoe Ho, Win Sen Kuan, Mui Teng Chua
PURPOSE: We aim to determine whether the combination of regional tissue oxygen saturation (StO2 ) measurement using near-infrared spectroscopy (NIRS), inferior vena cava (IVC) collapsibility and ejection fraction (EF) is able to detect occult sepsis. METHODS: We included adult patients in the emergency department with at least one of the following: fever; any one component of the quick sepsis-related organ function assessment (SOFA) score; heart rate≥100 beats per minute; or white cell count <4...
February 27, 2018: American Journal of Emergency Medicine
Rowena L McMullan, Adrienne Gordon
BACKGROUND: Late-onset sepsis is associated with increased rates of mortality and morbidity in newborn infants, in addition to poorer long-term developmental outcomes and increased length of stay and hospital costs. Central line-associated blood stream infection (CLABSI) is the most common cause of late-onset sepsis in hospitalised infants, and prevention of CLABSI is a key objective in neonatal care. Increased frequency of CLABSI around the time of removal of central venous catheters (CVCs) has been reported, and use of antibiotics at the time of removal may reduce the incidence and impact of late-onset sepsis in vulnerable newborn infants...
March 7, 2018: Cochrane Database of Systematic Reviews
Mahipal G Sinnollareddy, Michael S Roberts, Jeffrey Lipman, Sandra L Peake, Jason A Roberts
Background: Piperacillin is a β-lactam penicillin antibiotic commonly used for the empirical therapy of sepsis and other hospital-acquired infections. However, knowledge regarding the effect of sustained low-efficiency diafiltration (SLED-f), a technique increasingly being used in ICUs, on piperacillin pharmacokinetics (PK) and dosing in critically ill patients is lacking. Objectives: To describe the PK of piperacillin during SLED-f and compare the results with those reported for other forms of renal replacement therapies...
March 1, 2018: Journal of Antimicrobial Chemotherapy
Elisa Jiménez, Nicolás Valls, Patricio Astudillo, Cristian Valls, Gabriel Cavada, Alejandra Sandoval, Angélica Alegría, Gabriela Ortega, Daniela Núñez, Patricia Mena
BACKGROUND: Antibiotics (ATB) are drugs widely used in hospitalized newborns. The indiscriminate use of ATBs promote the rise of resistant bacteria to the most commonly indicated antimicrobials. In addition, ATB prescription presents associations to morbidity, such as bronchopulmonary dysplasia, necrotizing enterocolitis, late sepsis and even death. All of the above leads to an increase in health care costs. AIM: To record and to evaluate trends of antibiotic use over time in hospitalized NB in the Neonatology Unit at Dr...
December 2017: Revista Chilena de Infectología: órgano Oficial de la Sociedad Chilena de Infectología
Allison C Brunsman
PURPOSE: Results of a study to apply lean methodology to an inpatient pharmacy workflow to optimize timely administration of Centers for Medicare and Medicaid Services (CMS)-approved antibiotics for patients with severe sepsis or septic shock are presented. METHODS: This quasi-experimental study was conducted at an 802-bed institution using lean methodology to assess the inpatient pharmacy workflow for dispensing antibiotics to adult patients. The preintervention and postintervention phases occurred from February to September, 2015, and from October 2015 to May 2016, respectively...
March 1, 2018: American Journal of Health-system Pharmacy: AJHP
Siddharth Mehrotra, Naimish Mehta, Prashantha S Rao, Shailendra Lalwani, Vivek Mangla, Samiran Nundy
INTRODUCTION: Acute liver failure (ALF) is an indication for emergency liver transplantation (LT). Although centers performing only deceased donor liver transplants (DDLT) have shown improved outcomes in this situation, they still have relatively long waiting lists. An alternative would be living donor liver transplantation (LDLT), which has shown equivalent outcomes in the elective situation but there is limited evidence of its results in ALF. AIM: The purpose of this study was to assess the outcomes in patients with ALF undergoing emergency LDLT in our center in Delhi, India...
February 17, 2018: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Niek B Achten, J Wendelien Dorigo-Zetsma, Paul D van der Linden, Monique van Brakel, Frans B Plötz
Significant overtreatment with antibiotics for suspected early onset sepsis (EOS) constitutes a persisting clinical problem, generating unnecessary risks, harms, and costs for many newborns. We aimed to study feasibility and impact of a sepsis calculator to help guide antibiotic for suspected EOS in a European setting. In this single-center study, the sepsis calculator was implemented as an addition to and in accordance with existing protocols. One thousand eight hundred seventy-seven newborns ≥ 35 weeks of gestational age were prospectively evaluated; an analogous retrospective control group (n = 2076) was used for impact analysis...
February 18, 2018: European Journal of Pediatrics
Djoney Rafael Dos-Santos, Ulisses Luiz Tasca Roman, André Pereira Westphalen, Keli Lovison, Fernando Antonio C Spencer Neto
OBJECTIVE: to analyze the profile of patients with Fournier's gangrene treated in a public tertiary hospital in western Paraná State. METHODS: we conducted a cross-sectional, retrospective and descriptive study of patients with Fournier's gangrene treated between January 2012 and November 2016. RESULTS: there were 40 patients with Fournier's gangrene treated in the period, 29 (72.5%) men and 11 (27.5%) women. The mean age was 51.7±16.3 years...
2018: Revista do Colégio Brasileiro de Cirurgiões
Patawut Bovonratwet, Daniel D Bohl, Glenn S Russo, Nathaniel T Ondeck, Denis Nam, Craig J Della Valle, Jonathan N Grauer
BACKGROUND: Patients with geriatric hip fractures may be at increased risk for postoperative Clostridium difficile colitis, which can cause severe morbidity and can influence hospital quality metrics. However, to our knowledge, no large database study has calculated the incidence of, factors associated with, and effect of C. difficile colitis on geriatric patients undergoing hip fracture surgery. QUESTIONS/PURPOSES: To use a large national database with in-hospital and postdischarge data (National Surgical Quality Improvement Program [NSQIP®]) to (1) determine the incidence and timing of C...
March 2018: Clinical Orthopaedics and related Research
Roshan Ramasamy, Louise Willis, Seilesh Kadambari, Dominic F Kelly, Paul T Heath, Simon Nadel, Andrew J Pollard, Manish Sadarangani
OBJECTIVE: To quantify delays during management of children with suspected meningitis. DESIGN: Multicentre prospective cohort study. SETTING: Three UK tertiary paediatric centres; June 2011-June 2012 PATIENTS: 388 children aged <16 years hospitalised with suspected meningitis or undergoing lumbar puncture (LP) during sepsis evaluation. MAIN OUTCOME MEASURES: Time of prehospital and in-hospital assessments, LP, antibiotic treatment and discharge; types of prehospital medical assessment and microbiological results...
February 7, 2018: Archives of Disease in Childhood
Niveditha Dannapaneni, Tejopratap Oleti, Tarakeswari Surapaneni, Deepak Sharma, Srinivas Murki
Background & objectives: With the use of early and appropriate use of antibiotics, outcomes have improved in the mother-infant dyads exposed to preterm pre-labour rupture of membranes (PPROM). This study was undertaken to evaluate immediate neonatal outcomes in infants born before 33 completed weeks of gestation to mothers with PPROM versus without PPROM. Methods: During the study period from January 2013 to December 2013, a total of 182 mother-infant dyads were prospectively included in the study...
October 2017: Indian Journal of Medical Research
Katharina Boehm, Fabian P Siegel, Laila Schneidewind, Jennifer Kranz, Philipp Spachmann, Tanja Frank, Nina Huck, Florian Imkamp, Alexandre Pelzer
Purpose: Prostate biopsy (pbx) is the most common outpatient procedure in urology. Complications are urinary tract infections, including hospitalization and sepsis. Recommendations on antibiotic prophylaxis (apx) are scarce, and healthcare data are not available. The study addressed the following endpoints: the duration and spectrum of antimicrobial prophylaxis in transrectal and transperineal pbx in the hospital and the practice setting. Methods: A questionnaire compiled data about age, gender, board certification, and place of work...
2018: Frontiers in Surgery
Veerapong Vattanavanit, Theerapat Buppodom, Bodin Khwannimit
Background: The timing of intravenous antibiotic administration and lactate measurement is associated with survival of septic shock patients. Septic shock patients were admitted to the medical intensive care unit (MICU) from 2 major sources: hospital ward and emergency department (ED). This study aimed to compare the timing of antibiotic administration and lactate measurement between hospital wards and the ED. Patients and methods: Medical data were collected from adult patients admitted to the MICU with septic shock from January 2015 to December 2016...
2018: Infection and Drug Resistance
Tanvi Shah, Ethan Sterk, Megan A Rech
Recent literature has highlighted the importance of early identification and treatment of sepsis; however, limited data exists to help recognize sepsis in the emergency department (ED) through use of a screening tool. The purpose of this study was to evaluate the impact of a sepsis screening tool implemented in an academic medical center ED on compliance with the 3-hour sepsis bundle. This was a retrospective cohort study that included a total of 115 patients, of which 58 were in the pre-tool group and 57 were in the post-tool group...
January 28, 2018: American Journal of Emergency Medicine
Amar H Kelkar, Kavitha S Jacob, Eman B Yousif, John J Farrell
RATIONALE: Herein, we present a case of seemingly unprovoked portal vein thrombosis (PVT) occurring in the context of an acute cytomegalovirus (CMV) infection and prolonged debilitating fatigue. PATIENT CONCERNS: A 46-year-old male airline pilot presented with a 2 week history of abdominal pain, nausea, vomiting, watery diarrhea, and daily recurrent fevers. This was in the context of progressive, debilitating fatigue for 3 months forcing the patient to leave his job...
December 2017: Medicine (Baltimore)
D C Richter, A Heininger, T Brenner, M Hochreiter, M Bernhard, J Briegel, S Dubler, B Grabein, A Hecker, W A Kruger, K Mayer, M W Pletz, D Storzinger, N Pinder, T Hoppe-Tichy, S Weiterer, S Zimmermann, A Brinkmann, M A Weigand, C Lichtenstern
The mortality of patients with sepsis and septic shock is still unacceptably high. An effective calculated antibiotic treatment within 1 h of recognition of sepsis is an important target of sepsis treatment. Delays lead to an increase in mortality; therefore, structured treatment concepts form a rational foundation, taking relevant diagnostic and treatment steps into consideration. In addition to the assumed infection and individual risks of each patient, local resistance patterns and specific problem pathogens must be taken into account during the selection of anti-infective treatment...
January 30, 2018: Der Anaesthesist
Anthony J Lewis, John E Griepentrog, Xianghong Zhang, Derek C Angus, Christopher W Seymour, Matthew R Rosengart
OBJECTIVES: Sepsis, the acute organ dysfunction caused by a dysregulated host response to infection, poses a serious public health burden. Current management includes early detection, initiation of antibiotics and fluids, and source control as necessary. Although observational data suggest that delays of even a few hours in the initiation of antibiotics or IV fluids is associated with survival, these findings are controversial. There are no randomized data in humans, and prior animal studies studied time from experimental manipulation, not from the onset of clinical features of sepsis...
January 23, 2018: Critical Care Medicine
Christina Sakarikou, Anna Altieri, Maria Cristina Bossa, Silvia Minelli, Camilla Dolfa, Micol Piperno, Cartesio Favalli
Rapid pathogen identification (ID) and antimicrobial susceptibility testing (AST) in bacteremia cases or sepsis could improve patient prognosis. Thus, it is important to provide timely reports, which make it possible for clinicians to set up appropriate antibiotic therapy during the early stages of bloodstream infection (BSI). This study evaluates an in-house microbiological protocol for early ID as well as AST on Gram negative bacteria directly from positive monomicrobial and polymicrobial blood cultures (BCs)...
March 2018: Journal of Microbiological Methods
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