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Sepsis protocol

David Sweet, Julian Marsden, Kendall Ho, Christina Krause, James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: BC medical journal: BCMJ
Antonella Cotoia, Lucia Mirabella, Sabrina Altamura, Rachele Villani, Flavia Marchese, Giuseppe Ferrara, Karim Mariano, Tullo Livio, Gilda Cinnella
BACKGROUND: Sepsis caused by complicated intra-abdominal infection is associated with high mortality. Loss of endothelial barrier integrity, inflammation, and impaired cellular oxygen have been shown to be primary contributors to sepsis. To date, little is known regarding the pathway for the mobilization of endothelial progenitor cells (EPCs) from the bone marrow in sepsis whereas stromal-cell-derived factor 1a (SDF-1a) and hypoxia inducible factor 1 (HIF-1) seem to have a role in the EPC response to hypoxic microenvironments...
March 12, 2018: Trials
Andrew N Claxton, Paul M Dark
Sepsis is a medical emergency, which requires the initiation of broad-spectrum antimicrobial agents as early as possible. In the absence of positive microbiological cultures providing targeted antimicrobial advice, broad-spectrum antibiotics are commonly continued until there is clinical evidence of infection resolution. With an absence of robust evidence to inform when it is safe to stop antimicrobial agents in sepsis, the duration of antimicrobial courses may be longer than is required. Prolonged courses of potent broad-spectrum antimicrobials increase the risk of adverse drug events and contribute to the growing emergence of multidrug resistant pathogens, which is a global public health emergency...
March 2, 2018: British Journal of Hospital Medicine
Xiang Wu, Chenbo Yu, Tao Li, Le Lin, Qiong Xu, QingGuo Zhu, Liefu Ye, Xiangxun Gao
To detect the best antibiotic protocol for prostate biopsy and to assess the potential risk factors postbiopsy in Chinese patients.A total of 1526 patients underwent biopsy were assessed retrospectively. The effect of 3 antibiotic protocols was compared, including fluoroquinolone (FQ) monotherapy, third-generation cephalosporin combined with FQ and targeted antibiotics according to the prebiopsy rectal swab culture result. Postbiopsy infection (PBI) was defined as fever and/or active urinary tract symptoms such as dysuria or frequency with pyuria and/or leucocytosis, sepsis is defined as the presence of clinically or microbiologically documented infection in conjunction with systemic inflammatory response syndrome...
January 2018: Medicine (Baltimore)
Matthew N Simmons, Andrew D Neeb, Marta Johnson-Mitchell
OBJECTIVE: To compare 3 prophylactic regimens to assess their impact on post-biopsy sepsis incidence. METHODS: Data was reviewed for 829 consecutive patients who underwent prostate biopsy in a community practice setting between January 2013 and October 2017. Group 1 patients received ciprofloxacin 500mg PO BID for 4 days starting the day prior to biopsy and gentamicin 80mg IM 20 minutes prior to biopsy. From April 2015 to October 2017 two groups of patients were followed in parallel in a randomized manner...
February 27, 2018: Urology
Daniel Johannes Cornelis Berkhout, Hendrik Johannes Niemarkt, Nanne Klaas de Boer, Marc Alexander Benninga, Timotheüs Gualtherus Jacob de Meij
Although the exact pathophysiological mechanisms of both necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in preterm infants are yet to be elucidated, evidence is emerging that the gut microbiota plays a key role in their pathophysiology. Areas covered: In this review, initial microbial colonization and factors influencing microbiota composition are discussed. For both NEC and LOS, an overview of studies investigating preclinical alterations in gut microbiota composition and fecal volatile organic compounds (VOCs) is provided...
February 28, 2018: Expert Review of Gastroenterology & Hepatology
Santosh Kumar Mishra, Soumen Choudhury
Sepsis is the systemic inflammatory response syndrome that occurs during infection and is exacerbated by the inappropriate immune response encountered by the affected individual. Despite extensive research, sepsis in humans is one of the biggest challenges for clinicians. The high mortality rate in sepsis is primarily due to hypoperfusion-induced multiorgan dysfunctions , resulting from a marked decrease in peripheral resistance. Vascular dysfunctions are further aggravated by sepsis-induced impairment in myocardial contractility...
2018: Methods in Molecular Biology
Wei Jiang, Xiangyou Yu, Tongwen Sun, Yanfen Chai, Ping Chang, Zhongqing Chen, Jingye Pan, Zhiyong Peng, Ruilan Wang, Xiaozhi Wang, Yuan Xu, Li Yu, Qingshan Zheng, Bin Du
BACKGROUND: Sepsis is a major challenge in critical care and is associated with high mortality. Current management of sepsis and septic shock remains mainly supportive. Both basic and clinical research has shown that ulinastatin can improve the prognosis of sepsis. The aim of this trial is to evaluate the efficacy and safety profiles of ulinastatin compared with placebo. METHODS/DESIGN: In this multi-center, double-blind, randomized placebo-controlled trial we are recruiting a total of 348 subjects meeting "The Third International Consensus Definitions for Sepsis and Septic Shock" (Sepsis-3)...
February 21, 2018: Trials
Gabriella Comunián-Carrasco, Guiomar E Peña-Martí, Arturo J Martí-Carvajal
BACKGROUND: Gonorrhoea is a sexually transmitted infection that is caused by Neisseria gonorrhoeae, and is a major public health challenge today. N gonorrhoeae can be transmitted from the mother's genital tract to the newborn during birth, and can cause gonococcal ophthalmia neonatorum as well as systemic neonatal infections. It can also cause endometritis and pelvic sepsis in the mother. This review updates and replaces an earlier Cochrane Review on antibiotics for treating this infectious condition...
February 21, 2018: Cochrane Database of Systematic Reviews
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
Alexandros Rovas, Alexander-Henrik Lukasz, Hans Vink, Marc Urban, Jan Sackarnd, Hermann Pavenstädt, Philipp Kümpers
BACKGROUND: Deterioration of the endothelial glycocalyx (eGC), a protective carbohydrate-rich layer lining the luminal surface of the endothelium, plays a key role in vascular barrier dysfunction and eventually organ-failure in systemic inflammatory response syndrome and sepsis. Early detection of glycocalyx damage could thus become an important goal in critical care. This study was designed to determine the feasibility and reproducibility of quantitative, real-time glycocalyx measurements performed at bedside in the emergency room (ER) and intensive care unit (ICU)...
February 14, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Seoh Wei Teh, Pooi Ling Mok, Munirah Abd Rashid, Mae-Lynn Catherine Bastion, Normala Ibrahim, Akon Higuchi, Kadarkarai Murugan, Rajan Mariappan, Suresh Kumar Subbiah
Ocular microbial infection has emerged as a major public health crisis during the past two decades. A variety of causative agents can cause ocular microbial infections; which are characterized by persistent and destructive inflammation of the ocular tissue; progressive visual disturbance; and may result in loss of visual function in patients if early and effective treatments are not received. The conventional therapeutic approaches to treat vision impairment and blindness resulting from microbial infections involve antimicrobial therapy to eliminate the offending pathogens or in severe cases; by surgical methods and retinal prosthesis replacing of the infected area...
February 13, 2018: International Journal of Molecular Sciences
Sherry LeBlanc, Jamie Haushalter, Carl Seashore, Karen S Wood, Michael J Steiner, Ashley G Sutton
BACKGROUND AND OBJECTIVE: Neonatal hypoglycemia is a common problem, often requiring management in the NICU. Nonpharmacologic interventions, including early breastfeeding and skin-to-skin care (SSC), may prevent hypoglycemia and the need to escalate care. Our objective was to maintain mother-infant dyads in the mother-infant unit by decreasing hypoglycemia resulting in NICU transfer. METHODS: Inborn infants ≥35 weeks' gestation with at least 1 risk factor for hypoglycemia were included...
February 8, 2018: Pediatrics
Seung Mok Ryoo, JungBok Lee, Yoon-Seon Lee, Jae Ho Lee, Kyoung Soo Lim, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Won Young Kim
OBJECTIVES: This study aimed to compare the prognostic value of lactate level and lactate clearance at 6 hours after septic shock recognition. And, we performed it to determine lactate kinetics in the Sepsis-3 defined septic shock. DESIGN: This retrospective study was performed from a prospective septic shock registry. SETTINGS: This study was performed at single urban tertiary center. And, all patients were treated with protocol-driven resuscitation bundle therapy between 2010 and 2016...
February 9, 2018: Critical Care Medicine
Thorsten Brenner, Sebastian O Decker, Silke Grumaz, Philip Stevens, Thomas Bruckner, Thomas Schmoch, Mathias W Pletz, Hendrik Bracht, Stefan Hofer, Gernot Marx, Markus A Weigand, Kai Sohn
BACKGROUND: Sepsis remains a major challenge, even in modern intensive care medicine. The identification of the causative pathogen is crucial for an early optimization of the antimicrobial treatment regime. In this context, culture-based diagnostic procedures (e.g., blood cultures) represent the standard of care, although they are associated with relevant limitations. Accordingly, culture-independent molecular diagnostic procedures might be of help for the identification of the causative pathogen in infected patients...
February 2018: Medicine (Baltimore)
Alessandra Fabiane Lago, Anamaria Siriani de Oliveira, Hugo Celso Dutra de Souza, João Santana da Silva, Anibal Basile-Filho, Ada Clarice Gastaldi
INTRODUCTION: Septic shock is a potentially fatal organ dysfunction caused by an imbalance of the host response to infection. The changes in microcirculation during sepsis can be explained by the alterations in the endothelial barrier function. Endothelial progenitor cells (EPCs) are a potential recovery index of endothelial function and it an increase in response to neuromuscular electrical stimulation (NMES) was demonstrated. Therefore, the objective of this study is to investigate the effects of NMES in patients with septic shock...
February 2018: Medicine (Baltimore)
Christian Krautz, Sarah L Maier, Maximilian Brunner, Melanie Langheinrich, Evangelos J Giamarellos-Bourboulis, Charalambos Gogos, Apostolos Armaganidis, Frank Kunath, Robert Grützmann, Georg F Weber
BACKGROUND: B cell function and antibody production are crucial factors in host protection during inflammation. We aimed to synthesize the available evidence on the association between the reduction of circulating B cells and plasma immunoglobulin (IgM) levels and decreased survival during sepsis. METHODS: We performed a systematic search in PubMed, Embase, ISI Web of Knowledge, Cochrane Central Register of Controlled Trials, BioMed Central, and Science Direct. We selected studies with data on circulating B cells and plasma IgM levels within the initial 24 h after sepsis onset...
January 31, 2018: Journal of Critical Care
Hallie C Prescott, Tara M Cope, Foster C Gesten, Tatiana A Ledneva, Marcus E Friedrich, Theodore J Iwashyna, Tiffany M Osborn, Christopher W Seymour, Mitchell M Levy
OBJECTIVES: Under "Rory's Regulations," New York State Article 28 acute care hospitals were mandated to implement sepsis protocols and report patient-level data. This study sought to determine how well cases reported under state mandate align with discharge records in a statewide administrative database. DESIGN: Observational cohort study. SETTING: First 27 months of mandated sepsis reporting (April 1, 2014, to June 30, 2016). PATIENTS: Hospitalizations with sepsis at New York State Article 28 acute care hospitals...
February 5, 2018: Critical Care Medicine
Thibaut Girardot, Thomas Rimmelé, Guillaume Monneret, Julien Textoris, Fabienne Venet
BACKGROUND: Sepsis-associated hyperlactatemia is a widely used biomarker, associated with initial severity and poor outcomes. This increased circulating lactate concentration has been proposed to result in part from a mismatch between oxygen delivery and demand in organs. However, other mechanisms may participate. In particular, a metabolic reprogramming similar to the Warburg effect initially described in cancer cells could lead to increased lactate production by immune cells such as T lymphocytes after sepsis...
February 5, 2018: Intensive Care Medicine Experimental
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