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https://www.readbyqxmd.com/read/29352339/effect-of-time-to-operation-on-value-of-care-in-acute-care-surgery
#1
Tyler J Loftus, Martin D Rosenthal, Chasen A Croft, R Stephen Smith, Philip A Efron, Frederick A Moore, Alicia M Mohr, Scott C Brakenridge
BACKGROUND: As reimbursement models evolve, there is increasing emphasis on maximizing value-based care for inpatient conditions. We hypothesized that longer intervals between admission and surgery would be associated with worse outcomes and increased costs for acute care surgery patients, and that these associations would be strongest among patients with high-risk conditions. METHODS: We performed a 5-year retrospective analysis of three risk cohorts: appendectomy (low-risk for morbidity and mortality, n = 618), urgent hernia repair (intermediate-risk, n = 80), and laparotomy for intra-abdominal sepsis with temporary abdominal closure (sTAC; high-risk, n = 102)...
January 19, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29351876/vital-signs-analysis-algorithm-detects-inflammatory-response-in-premature-infants-with-late-onset-sepsis-and-necrotizing-enterocolitis
#2
Leena B Mithal, Ram Yogev, Hannah L Palac, Daniel Kaminsky, Ilan Gur, Karen K Mestan
BACKGROUND: Nonspecific clinical signs and suboptimal diagnostic tests limit accurate identification of late onset sepsis (LOS) and necrotizing enterocolitis (NEC) in premature infants, resulting in significant morbidity and antibiotic overuse. An infant's systemic inflammatory response may be identified earlier than clinical suspicion through analysis of multiple vital signs by a computerized algorithm (RALIS). AIM: To evaluate the revised RALIS algorithm for detection of LOS and NEC in preterm infants...
January 16, 2018: Early Human Development
https://www.readbyqxmd.com/read/29347908/management-and-outcomes-of-patients-presenting-with-sepsis-and-septic-shock-to-the-emergency-department-during-nursing-handover-a-retrospective-cohort-study
#3
Sami Alsolamy, Atheer Al-Sabhan, Najla Alassim, Musharaf Sadat, Eman Al Qasim, Hani Tamim, Yaseen M Arabi
BACKGROUND: Clinical handover is an important process for the transition of patient-care responsibility to the next healthcare provider, but it may divert the attention of the team away from active patients. This is challenging in the Emergency Department (ED) because of highly dynamic patient conditions and is likely relevant in conditions that requires time-sensitive therapies, such as sepsis. We aimed to examine the management and outcomes of patients presenting with sepsis and septic shock to the ED during nursing handover...
January 18, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29343506/how-to-use%C3%A2-procalcitonin
#4
Philip Robinson, Surjo Kiran De
Diagnosing bacterial infection in the unwell or febrile child is a common challenge faced by all paediatricians. Despite the advent of novel molecular techniques, there is ongoing need for diagnostic assays with adequate performance and turnaround time to facilitate safe clinical decision-making when bacterial sepsis is suspected, such as whether to commence empirical treatment with antibiotics. Procalcitonin is an established marker of infection that has a potential role in the diagnosis and exclusion of serious or invasive bacterial infection in neonates and children...
January 17, 2018: Archives of Disease in Childhood. Education and Practice Edition
https://www.readbyqxmd.com/read/29343134/implementation-of-vaginal-cleansing-prior-to-cesarean-delivery-to-decrease-endometritis-rates
#5
Laura Felder, Amanda Paternostro, Johanna Quist-Nelson, Jason Baxter, Vincenzo Berghella
BACKGROUND: Endometritis is a postpartum complication that is more common after cesarean delivery. It frequently requires intravenous antibiotic administration, prolonged hospital stays, and carries a risk of sepsis or abscess formation. Precesarean vaginal preparation has been shown to decrease the risk of endometritis in patients who have labored or have ruptured membranes. OBJECTIVE: The objective of this study was to assess the practical implementation of a protocol for vaginal cleansing prior to cesarean delivery and the subsequent effect on endometritis rates in a clinical setting...
January 17, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29341844/empiric-antibiotics-for-sepsis
#6
Sara A Buckman, Isaiah R Turnbull, John E Mazuski
BACKGROUND: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Early recognition and treatment are the cornerstones of management. METHODS: Review of the English-language literature. RESULTS: For both sepsis and septic shock "antimicrobials [should be] be initiated as soon as possible and within one hour" (Surviving Sepsis Campaign). The risk of progression from severe sepsis to septic shock increases 8% for each hour before antibiotics are started...
January 17, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29341498/review-article-sepsis-in-the-emergency-department-part-2-investigations-and-monitoring
#7
REVIEW
Amith Shetty, Stephen Pj Macdonald, Gerben Keijzers, Julian M Williams, Benjamin Tang, Bas de Groot, Kelly Thompson, John F Fraser, Simon Finfer, Rinaldo Bellomo, Jonathan Iredell
Sepsis is characterised by organ dysfunction resulting from infection, with no reliable single objective test and current diagnosis based on clinical features and results of investigations. In the ED, investigations may be conducted to diagnose infection as the cause of the presenting illness, identify the source, distinguish sepsis from uncomplicated infection (i.e. without organ dysfunction) and/ or risk stratification. Appropriate sample collection for microbiological testing remains key for subsequent confirmation of diagnosis and rationalisation of antimicrobials...
January 16, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29340851/comparison-of-antibiotic-dosing-recommendations-for-neonatal-sepsis-from-established-reference-sources
#8
T B Y Liem, E M A Slob, J U M Termote, T F W Wolfs, A C G Egberts, C M A Rademaker
Background Incorrect dosing is the most frequent prescribing error in neonatology, with antibiotics being the most frequently prescribed medicines. Computer physician order entry and clinical decision support systems can create consistency contributing to a reduction of medication errors. Although evidence-based dosing recommendations should be included in such systems, the evidence is not always available and subsequently, dosing recommendations mentioned in guidelines and textbooks are often based on expert opinion...
January 16, 2018: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/29338914/prophylactic-antibiotics-following-radical-cystectomy-reduces-urinary-tract-infections-and-readmission-for-sepsis-from-a-urinary-source
#9
Ryan P Werntz, Ann Martinez-Acevedo, Hamed Amadi, Ryan Kopp, Jeffrey La Rochelle, Theresa Koppie, Christopher Amling, Kamran P Sajadi
INTRODUCTION: Urinary tract infections (UTI) and sepsis contribute significantly to the morbidity associated with cystectomy and urinary diversion in the first 30 days. We hypothesized that continuous antibiotic prophylaxis decreased UTIs in the first 30 days following radical cystectomy. METHODS: Patients with urothelial carcinoma of the bladder who underwent a radical cystectomy with urinary diversion for bladder cancer at Oregon Health and Science University from January 2014 to May 2015 were included in the study...
January 12, 2018: Urologic Oncology
https://www.readbyqxmd.com/read/29333818/community-acquired-methicillin-resistant-staphylococcus-aureus-infections-hospitalization-and-case-fatality-risk-in-10-pediatric-facilities-in-argentina
#10
Ángela Gentile, Julia Bakir, Gabriela Ensinck, Aldo Cancellara, Enrique V Casanueva, Verónica Firpo, Martín Caruso, María F Lución, Alejandro Santillán Iturres, Fabiana Molina, Héctor J Abate, Andrea Gajo Gane, Santiago López Papucci
INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are prevalent both in Argentina and worldwide, and they may have a severe clinical course. OBJECTIVES: To estimate the hospitalization rate and case fatality risk factors of CA-MRSA infection. METHODS: Cross-sectional, analytical study. All patients < 15 years old with community-acquired Staphylococcus aureus (CA-SA) infections admitted to 10 pediatric facilities between January 2012 and December 2014 were included...
February 1, 2018: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/29332972/clinical-utility-and-measurement-of-procalcitonin
#11
REVIEW
Intan Samsudin, Samuel D Vasikaran
Procalcitonin (PCT), regarded as a biomarker specific for bacterial infections, is used in a variety of clinical settings including primary care, emergency department and intensive care. PCT measurement aids in the diagnosis of sepsis and to guide and monitor antibiotic therapy. This article gives a brief overview of PCT and its use in guiding antibiotic therapy in various clinical settings, as well as its limitations. PCT performance in comparison with other biomarkers of infection in particular CRP is also reviewed...
April 2017: Clinical Biochemist. Reviews
https://www.readbyqxmd.com/read/29331324/rectal-culture-directed-antibiotic-prophylaxis-before-transrectal-prostate-biopsy-reduced-infectious-complications-and-healthcare-costs
#12
J V Baldissera-Aradas, L Rodríguez-Villamil, R Blanco-Fernández, C Pérez-García, G Viejo de la Guerra, I González-Rodríguez, J Mosquera-Madera
BACKGROUND: Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP. MATERIAL AND METHODS: The GP group was studied prospectively (June 2013 to July 2014)...
January 10, 2018: Actas Urologicas Españolas
https://www.readbyqxmd.com/read/29330406/adjuvant-role-of-septifast-to-improve-the-diagnosis-of-sepsis-in-a-large-cohort-of-hematological-patients
#13
Raffaella Greco, Maria Chiara Barbanti, Nicasio Mancini, Lara Crucitti, Chiara Oltolini, Alessandra Forcina, Francesca Lorentino, Luca Vago, Carlo Messina, Daniela Clerici, Mara Morelli, Fabio Giglio, Maria Teresa Lupo Stanghellini, Laura Infurnari, Matteo G Carrabba, Sarah Marktel, Andrea Assanelli, Paolo Scarpellini, Massimo Bernardi, Jacopo Peccatori, Consuelo Corti, Massimo Clementi, Fabio Ciceri
Febrile neutropenia and sepsis are common and life-threatening complications in hematological diseases. This study was performed retrospectively in 514 patients treated for febrile neutropenia at our institute, to investigate the clinical usefulness of a molecular tool, LightCycler® SeptiFast test (SF), to promptly recognize pathogens causing sepsis in hematological patients. We collected 1837 blood samples of 514 consecutive hematological patients. The time of processing is short. Overall, 757 microorganisms in 663 episodes were detected by molecular test and standard blood cultures (BC): 73...
January 12, 2018: Bone Marrow Transplantation
https://www.readbyqxmd.com/read/29329118/ce-managing-sepsis-and-septic-shock-current-guidelines-and-definitions
#14
Mary Beth Flynn Makic, Elizabeth Bridges
Recent updates emphasize early recognition and prompt intervention. ABSTRACT: Sepsis is a leading cause of critical illness and hospital mortality. Early recognition and intervention are essential for the survival of patients with this syndrome. In 2002, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) launched the Surviving Sepsis Campaign (SSC) to reduce overall patient morbidity and mortality from sepsis and septic shock by driving practice initiatives based on current best evidence...
January 11, 2018: American Journal of Nursing
https://www.readbyqxmd.com/read/29324733/antibiotics-dispensed-to-privately-insured-pregnant-women-with-urinary-tract-infections-united-states-2014
#15
Elizabeth C Ailes, April D Summers, Emmy L Tran, Suzanne M Gilboa, Kathryn E Arnold, Dana Meaney-Delman, Jennita Reefhuis
Urinary tract infections (UTIs) occur in about 8% of pregnant women, and untreated UTIs can have serious consequences, including pyelonephritis, preterm labor, low birth weight, and sepsis (1). Pregnant women are typically screened for UTIs during early pregnancy, and those with bacteriuria are treated with antibiotics (1,2). Antibiotic stewardship is critical to improving patient safety and to combating antibiotic resistance. Because of the potential risk for birth defects, including anencephaly, heart defects, and orofacial clefts, associated with use of sulfonamides and nitrofurantoin during pregnancy (3), a 2011 committee opinion from the American College of Obstetricians and Gynecologists (ACOG) recommended that sulfonamides and nitrofurantoin may be prescribed in the first trimester of pregnancy only when other antimicrobial therapies are deemed clinically inappropriate (4)...
January 12, 2018: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/29324599/risk-factors-incidence-and-morbidity-associated-with-obstetric-clostridium-difficile-infection
#16
Jacob Ruiter-Ligeti, Sophie Vincent, Nicholas Czuzoj-Shulman, Haim Arie Abenhaim
OBJECTIVE: To evaluate the risk factors, incidence, and morbidity associated with the diagnosis of obstetric Clostridium difficile infection. METHODS: We performed a retrospective cohort study on women admitted for delivery using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from the United States. The delivery admission records of pregnant women were reviewed between 1999 and 2013. After adjusting for demographic and clinical characteristics, we assessed risk factors for the diagnosis of C difficile infection using unconditional logistic regression...
January 9, 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29322872/a-collaborative-approach-to-improve-consistent-use-of-procalcitonin-in-lower-respiratory-tract-infections
#17
Alexander R Levine, Robyn Riggott, Kristela Vulaj, Tera R Falcetti, Syed Ali, Gagandeep Singh
BACKGROUND: Procalcitonin (PCT) is a biomarker that can help differentiate bacterial from viral infections and has been extensively studied in patients with sepsis and pneumonia to guide antibiotic therapy. However, there is poor adherence to prescribed algorithms when used to discontinue antibiotics in the real world. A quality improvement project was implemented to increase consistent use of PCT. OBJECTIVE: To evaluate use of PCT and impact on antibiotic length of therapy (LOT) preimplementation and postimplementation of a quality improvement initiative...
January 1, 2018: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29321120/evaluating-vancomycin-and-piperacillin-tazobactam-in-emergency-department-patients-with-severe-sepsis-and-septic-shock
#18
Christina Le, Frank Chu, Ronald Dunlay, Julian Villar, Peter Fedullo, Gabriel Wardi
STUDY OBJECTIVE: To determine the frequency and cause of inadequate initial antibiotic therapy with vancomycin and piperacillin-tazobactam in patients with severe sepsis and septic shock in the emergency department (ED), characterize its impact on patient outcomes, and identify patients who would benefit from an alternative initial empiric regimen. METHODS: Retrospective cohort study conducted between 2012 and 2015 in which 342 patients with culture-positive severe sepsis or septic shock who received initial vancomycin and piperacillin-tazobactam were reviewed to determine appropriateness of antimicrobial therapy, risk factors for inappropriate use, and outcome data...
December 29, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29321098/spondylodiscitis-diagnosis-and-treatment-options
#19
Christian Herren, Norma Jung, Miguel Pishnamaz, Marianne Breuninger, Jan Siewe, Rolf Sobottke
BACKGROUND: A recent population-based study from Denmark showed that the incidence of spondylodiscitis rose from 2.2 to 5.8 per 100 000 persons per year over the period 1995-2008; the age-standardized incidence in Germany has been estimated at 30 per 250 000 per year on the basis of data from the Federal Statistical Office (2015). The early diagnosis and treatment of this condition are essential to give the patient the best chance of a good outcome, but these are often delayed because it tends to present with nonspecific manifestations, and fever is often absent...
December 25, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/29316136/transrectal-prostate-biopsy-sepsis-rate-following-reduced-quinolone-antibiotic-prophylaxis-from-six-doses-to-single-dose
#20
Haider K Bangash, Cynthia Hawks, Steve P McCombie, Matthew Brown, Dickon Hayne
BACKGROUND: This study aimed to evaluate the rates of infective complication related to transrectal prostate biopsy (TRPB) as our centre changed its protocol from six doses over 3 days to a single pre-procedure prophylactic dose. METHODS: This prospective cohort study identified infective complication in patients who attended and subsequently underwent TRPB at the time of their one-stop prostate clinic at our public tertiary hospital between August 2011 and April 2017...
January 8, 2018: ANZ Journal of Surgery
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