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Van Heuverswyn J, Valik JK, Desirée van der Werff S, Hedberg P, Giske C, Nauclér P. Association Between Time to Appropriate Antimicrobial Treatment and 30-day Mortality in Patients With Bloodstream Infections: A Retrospective Cohort Study. Clin Infect Dis 2022; 76:469-478. [PMID: 36065752 PMCID: PMC9907509 DOI: 10.1093/cid/ciac727] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Effective antimicrobial treatment is key for survival in bloodstream infection (BSI), but the impact of timing of treatment remains unclear. Our aim was to assess the association between time to appropriate antimicrobial treatment and 30-day mortality in BSI patients. METHODS This was a retrospective cohort study using electronic health record data from a large academic center in Sweden. Adult patients admitted between the years 2012 and 2019, with onset of BSI at the emergency department or general wards, were included. Pathogen-antimicrobial drug combinations were classified as appropriate or inappropriate based on reported in vitro susceptibilities. To avoid immortal time bias, the association between appropriate therapy and mortality was assessed with multivariable logistic regression analysis at pre-specified landmark times. RESULTS We included 10 628 BSI-episodes, occurring in 9192 unique patients. The overall 30-day mortality was 11.8%. No association in favor of a protective effect between appropriate therapy and mortality was found at the 1, 3 and 6 hours landmark after blood culture collection. At 12 hours, the risk of death increased with inappropriate treatment (adjusted odds ratio 1.17 [95% confidence interval {CI}, 1.01-1.37]) and continued to increase gradually at 24, 48, and 72 hours. Stratifying by high or low SOFA score generated similar odds ratios, with wider confidence intervals. CONCLUSIONS Delays in appropriate antimicrobial treatment were associated with increased 30-day mortality after 12 hours from blood culture collection, but not at 1, 3, and 6 hours, in BSI. These results indicate a benchmark for providing rapid microbiological diagnostics of blood cultures.
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Affiliation(s)
| | - John Karlsson Valik
- Correspondence: J. K. Valik, Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden ()
| | - Suzanne Desirée van der Werff
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Hedberg
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Giske
- Clinical microbiology, Karolinska University Hospital, Stockholm, Sweden,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Aratani T, Tsukamoto H, Higashi T, Kodawara T, Yano R, Hida Y, Iwasaki H, Goto N. Association of methicillin resistance with mortality of hospital-acquired Staphylococcus aureus bacteremia. J Int Med Res 2021; 49:3000605211058872. [PMID: 34826374 PMCID: PMC8647257 DOI: 10.1177/03000605211058872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective Methicillin-resistant (MR) Staphylococcus aureus bacteremia (SAB) is associated with higher mortality rates than methicillin-susceptible (MS) SAB. This study assessed potential predictors of mortality and evaluated the association of methicillin resistance with mortality in patients with SAB. Methods We conducted a retrospective cohort study in patients with hospital-acquired SAB, from 2009 to 2018. Clinical features of patients with MR-SAB were compared with those of patients with MS-SAB and predictors of 30-day mortality were determined using Cox regression analysis. Results Among 162 patients, 56.8% had MR-SAB. Overall 30-day mortality was 19.1%; MR-SAB had higher mortality (25.0%) than MS-SAB (11.4%). Univariate analysis highlighted long-term hospitalization, prior antibiotics use, and delayed initiation of appropriate antibiotics as risk factors. Cox regression analysis showed that respiratory tract source, Pitt bacteremia score, Charlson comorbidity index, and appropriate antibiotic therapy within 24 hours were independently and significantly associated with 30-day mortality outcome. Conclusions Methicillin resistance was not an independent risk factor for mortality in patients with SAB. Early, appropriate antibiotic treatment is an important prognostic factor.
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Affiliation(s)
- Tomonori Aratani
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Hitoshi Tsukamoto
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan.,Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
| | - Takashi Higashi
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Takaaki Kodawara
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Ryoichi Yano
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Osaka, Japan
| | - Yukio Hida
- Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan.,Clinical Laboratory, University of Fukui Hospital, Fukui, Japan
| | - Hiromichi Iwasaki
- Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
| | - Nobuyuki Goto
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
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Brunkhorst FM, Weigand MA, Pletz M, Gastmeier P, Lemmen SW, Meier-Hellmann A, Ragaller M, Weyland A, Marx G, Bucher M, Gerlach H, Salzberger B, Grabein B, Welte T, Werdan K, Kluge S, Bone HG, Putensen C, Rossaint R, Quintel M, Spies C, Weiß B, John S, Oppert M, Jörres A, Brenner T, Elke G, Gründling M, Mayer K, Weimann A, Felbinger TW, Axer H; Deutsche Sepsis Gesellschaft e. V. [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version]. Med Klin Intensivmed Notfmed 2020; 115:37-109. [PMID: 32356041 DOI: 10.1007/s00063-020-00685-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Affiliation(s)
- Christopher A Guidry
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Critical Care, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, Michigan, USA
| | - Robert D Winfield
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Critical Care, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Schneider SM, Schaeg M, Gärtner BC, Berger FK, Becker SL. Do written diagnosis-treatment recommendations on microbiological test reports improve the management of Staphylococcus aureus bacteremia? A single-center, retrospective, observational study. Diagn Microbiol Infect Dis 2020; 98:115170. [PMID: 32911296 DOI: 10.1016/j.diagmicrobio.2020.115170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022]
Abstract
The objective of this study was to assess the impact of microbiological test reports that provide specific written recommendations on the appropriate management of Staphylococcus aureus bacteremia (SAB). We performed a retrospective analysis of laboratory and clinical data of all SAB patients treated at one German University hospital, 2012-2015. Among 467 included patients, methicillin-resistant S. aureus (MRSA) accounted for 15.2% of all SAB cases. All-cause in-hospital mortality was 25.2%, and was significantly elevated in individuals aged >55 years, in MRSA bacteremia and if the source of infection remained unidentified. Focus identification was achieved in 71.1%, with the most prevalent foci being catheter-associated bloodstream infection (23.1%), soft tissue infection (15.4%), osteomyelitis (5.1%) and endocarditis (4.9%). Standardized written recommendations on microbiological test reports led to a significant increase of transesophageal echocardiography, additional imaging studies for focus identification and more frequent follow-up blood cultures, but no significant effect on mortality was observed.
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Affiliation(s)
- Sarah M Schneider
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421 Homburg/Saar, Germany
| | - Mattias Schaeg
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421 Homburg/Saar, Germany
| | - Barbara C Gärtner
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421 Homburg/Saar, Germany
| | - Fabian K Berger
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421 Homburg/Saar, Germany
| | - Sören L Becker
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421 Homburg/Saar, Germany.
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Zasowski EJ, Bassetti M, Blasi F, Goossens H, Rello J, Sotgiu G, Tavoschi L, Arber MR, McCool R, Patterson JV, Longshaw CM, Lopes S, Manissero D, Nguyen ST, Tone K, Aliberti S. A Systematic Review of the Effect of Delayed Appropriate Antibiotic Treatment on the Outcomes of Patients With Severe Bacterial Infections. Chest 2020; 158:929-938. [PMID: 32446623 DOI: 10.1016/j.chest.2020.03.087] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients with severe bacterial infections often experience delay in receiving appropriate treatment. Consolidated evidence of the impact of delayed appropriate treatment is needed to guide treatment and improve outcomes. RESEARCH QUESTION What is the impact of delayed appropriate antibacterial therapy on clinical outcomes in patients with severe bacterial infections? STUDY DESIGN AND METHODS Literature searches of MEDLINE and Embase, conducted on July 24, 2018, identified studies published after 2007 reporting the impact of delayed appropriate therapy on clinical outcomes for hospitalized adult patients with bacterial infections. Where appropriate, results were pooled and analyzed with delayed therapy modeled three ways: delay vs no delay in receiving appropriate therapy; duration of delay; and inappropriate vs appropriate initial therapy. This article reports meta-analyses on the effect of delay and duration of delay. RESULTS The eligibility criteria were met by 145 studies, of which 37 contributed data to analyses of effect of delay. Mortality was significantly lower in patients receiving appropriate therapy without delay compared with those experiencing delay (OR, 0.57; 95% CI, 0.45-0.72). Mortality was also lower in the no-delay group compared with the delay group in subgroups of studies reporting mortality at 20 to 30 days, during ICU stay, or in patients with bacteremia (OR, 0.57 [95% CI, 0.43-0.76]; OR, 0.47 [95% CI, 0.27-0.80]; and OR, 0.54 [95% CI, 0.40-0.75], respectively). No difference was found in time to appropriate therapy between those who died and those who survived (P = .09), but heterogeneity between studies was high. INTERPRETATION Avoiding delayed appropriate therapy is essential to reduce mortality in patients with severe bacterial infections. CLINICAL TRIAL REGISTRATION PROSPERO; No.: CRD42018104669; URL: www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Evan J Zasowski
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Internal Medicine Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Herman Goossens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem and Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Jordi Rello
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Clinical Research and Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Mick R Arber
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Rachael McCool
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Jacoby V Patterson
- York Health Economics Consortium, University of York, York, United Kingdom
| | | | | | | | | | | | - Stefano Aliberti
- Respiratory Unit and Cystic Fibrosis Adult Center, Internal Medicine Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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Jiang J, Liang QL, Liu LH, Cai SQ, Du ZY, Kong JL, Chen YQ. Septic pulmonary embolism in China: clinical features and analysis of prognostic factors for mortality in 98 cases. BMC Infect Dis 2019; 19:1082. [PMID: 31881849 PMCID: PMC6935238 DOI: 10.1186/s12879-019-4672-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To investigate the clinical features of septic pulmonary embolism (SPE) cases and prognostic factors for in-hospital mortality in China. METHODS A retrospective analysis was conducted of SPE patients hospitalized between January 2007 and June 2018 in the Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University. RESULTS A total of 98 patients with SPE were identified. All patients had bilateral multiple peripheral nodules on chest computed tomography. The most common pathogen found in blood culture was Staphylococcus aureus (10/33, 30.3%). Transthoracic echocardiography was performed in 39 patients and 20 showed vegetations. Bronchoscopy was performed in 24 patients. Bronchoalveolar lavage fluid (BALF) was obtained from 15 patients (62.5%) and showed predominantly polymorphonuclear cell infiltration (52%, range of 48%~ 63%). Four patients received transbronchial lung biopsy, and histopathological examinations revealed suppurative pneumonia and organizing pneumonia. The in-hospital mortality rate was 19.4%. Age (odds ratio [OR] 1.100; 95% confidence interval [CI] 1.035-1.169), hypotension (OR 7.260; 95% CI 1.126-46.804) and ineffective or delay of empirical antimicrobial therapy (OR 7.341; 95% CI 1.145-47.045) were found to be independent risk factors for in-hospital mortality, whereas drainage treatment was found to be a protective factor (OR 0.33; 95% CI 0.002-0.677). CONCLUSIONS SPE cases presented with nonspecific clinical manifestations and radiologic features. Blood cultures and bronchoscopy are important measures for early diagnosis and differential diagnosis. There is relationship between primary infection sites and the type of pathogen. Maintaining normal blood pressure and providing timely and appropriate initial antimicrobial therapy for effective control of the infection could improve prognosis.
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Affiliation(s)
- Jing Jiang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Qiu-li Liang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Li-hua Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Shuang-qi Cai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Zhong-ye Du
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Jin-liang Kong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Yi-qiang Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
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Abstract
PURPOSE Exploratory study to examine inpatient medication administration patterns. METHODS Data from multiple sources were utilized for this study. The outcome was time difference between medication schedule and administration. A 3-level hierarchical linear regression approach, both unadjusted and adjusted, was considered for this study where medication administration events are nested within patients nested within nurses or units. Intraclass correlation coefficients (ICCs) were calculated and compared. RESULTS On average, medications were delayed by 12 (SD, 48.8) minutes. From the full model, patient ICCs decreased when "unit" replaced "nurse" as the 3rd level (0.541 vs 0.444). Patients who spoke Spanish had a significant 2.3- to 4.2-minute delay in medication administration. Certified nurses significantly give medications earlier compared with noncertified nurses by 1.6 minutes. DISCUSSION Optimal medication administration is a multifactorial concern with nurses playing a role. Nursing leaders should also consider patient demographics and unit conditions, such as culture, for medication administration optimization.
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Nambiar K, Seifert H, Rieg S, Kern WV, Scarborough M, Gordon NC, Kim HB, Song KH, Tilley R, Gott H, Liao CH, Edgeworth J, Nsutebu E, López-Cortés LE, Morata L, Walker AS, Thwaites G, Llewelyn MJ, Kaasch AJ. Survival following Staphylococcus aureus bloodstream infection: A prospective multinational cohort study assessing the impact of place of care. J Infect 2018; 77:516-525. [PMID: 30179645 DOI: 10.1016/j.jinf.2018.08.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/25/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Staphylococcus aureus bloodstream infection (SAB) is a common, life-threatening infection with a high mortality. Survival can be improved by implementing quality of care bundles in hospitals. We previously observed marked differences in mortality between hospitals and now assessed whether mortality could serve as a valid and easy to implement quality of care outcome measure. METHODS We conducted a prospective observational study between January 2013 and April 2015 on consecutive, adult patients with SAB from 11 tertiary care centers in Germany, South Korea, Spain, Taiwan, and the United Kingdom. Factors associated with mortality at 90 days were analyzed by Cox proportional hazards regression and flexible parametric models. RESULTS 1851 patients with a median age of 66 years (64% male) were analyzed. Crude 90-day mortality differed significantly between hospitals (range 23-39%). Significant variation between centers was observed for methicillin-resistant S. aureus, community-acquisition, infective foci, as well as measures of comorbidities, and severity of disease. In multivariable analysis, factors independently associated with mortality at 90 days were age, nosocomial acquisition, unknown infective focus, pneumonia, Charlson comorbidity index, SOFA score, and study center. The risk of death varied over time differently for each infective focus. Crude mortality differed markedly from adjusted mortality. DISCUSSION We observed significant differences in adjusted mortality between hospitals, suggesting differences in quality of care. However, mortality is strongly influenced by patient mix and thus, crude mortality is not a suitable quality indicator.
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Affiliation(s)
- Kate Nambiar
- Department of Microbiology and Infectious Diseases, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, United Kingdom
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine, University of Cologne, Goldenfelsstr. 19, 50935 Cologne, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg 79106, Freiburg, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg 79106, Freiburg, Germany
| | - Matt Scarborough
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation, Headington, Oxford, OX3 9DU, United Kingdom
| | - N Claire Gordon
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation, Headington, Oxford, OX3 9DU, United Kingdom
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Division of Infectious Diseases, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine and Division of Infectious Diseases, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Robert Tilley
- Department of Microbiology, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Crownhill, Plymouth, PL6 8DH, United Kingdom
| | - Hannah Gott
- Department of Research and Development, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Crownhill, Plymouth, PL6 8DH, United Kingdom
| | - Chun-Hsing Liao
- Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya South Road, Banchio District, New Taipei City 220, Taiwan; Department of Medicine, Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 112, Taiwan
| | - Jonathan Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Emmanuel Nsutebu
- Tropical & Infectious Disease Unit, Royal Liverpool and Broadgreen University Teaching Hospital, Prescot Street, Liverpool, L7 8XP, United Kingdom
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena /CSIC / Instituto de Biomedicina de Sevilla (IBiS), Avda Dr Fedriani, s/n. 41003 Seville, Spain
| | - Laura Morata
- Service of Infectious Diseases, Hospital Clínic of Barcelona, Barcelona, Spain
| | - A Sarah Walker
- Medical Research Council Clinical Trials Unit at University College London, University College London, United Kingdom; Nuffield Department of Medicine, University of Oxford, Level 7 Microbiology, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, United Kingdom
| | - Guy Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Martin J Llewelyn
- Department of Microbiology and Infectious Diseases, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, United Kingdom
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany.
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Holmes NE, Robinson JO, van Hal SJ, Munckhof WJ, Athan E, Korman TM, Cheng AC, Turnidge JD, Johnson PDR, Howden BP. Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia. BMC Infect Dis 2018; 18:107. [PMID: 29506483 PMCID: PMC5838938 DOI: 10.1186/s12879-018-3011-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 02/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure. METHODS Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012. RESULTS Treatment failure at 30-days was recorded in 14.4% of patients (30-day mortality 9.5%). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1% and 24.2% respectively. 45% experienced at least one in-hospital complication, including nephrotoxicity in 19.5%. CONCLUSIONS This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.
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Affiliation(s)
- Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, PO Box 5555, Heidelberg, VIC, 3084, Australia. .,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia.
| | - J Owen Robinson
- Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine-WA, Royal Perth Hospital, 197 Wellington Street, Perth, WA, 6000, Australia.,Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, School of Biomedical Sciences, Curtin University, Perth, WA, Australia
| | - Sebastiaan J van Hal
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia.,Department of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Wendy J Munckhof
- Infection Management Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.,Department of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Eugene Athan
- Department of Infectious Diseases, University Hospital Geelong, Barwon Health, Bellerine Street, Geelong, VIC, 3220, Australia.,Department of Medicine, Deakin University, Geelong, VIC, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Tony M Korman
- Department of Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Allen C Cheng
- Department of Infectious Diseases, Alfred Hospital, 55 Commercial Road, Prahran, VIC, 3181, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - John D Turnidge
- Australian Commission on Safety and Quality in Health Care, Level 5, 255 Elizabeth Street, Sydney, NSW, 2000, Australia.,Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Paul D R Johnson
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia.,Department of Microbiology, Monash University, Clayton, VIC, Australia
| | - Benjamin P Howden
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia.,Department of Microbiology, Monash University, Clayton, VIC, Australia.,Microbiological Diagnostic Unit, Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC, 3000, Australia
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Yamaga S, Shime N. Association between appropriate empiric antimicrobial therapy and mortality from bloodstream infections in the intensive care unit. J Infect Chemother 2017; 24:267-271. [PMID: 29292180 DOI: 10.1016/j.jiac.2017.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/26/2017] [Accepted: 11/29/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Empirical antimicrobial treatment for patients presenting with bloodstream infections is considered to affect patients' outcome. METHOD We conducted a single-center, retrospective study of critically-ill patients hospitalized in the intensive care unit, to examine whether the appropriateness of antimicrobial therapy is associated with mortality from bloodstream infections. The primary study endpoints were the mortality and survival time up to 60 days after the sampling of the blood cultures. RESULTS We enrolled 62 patients with bloodstream infection, of whom 46 received appropriate and 16 received inappropriate, empirical, antimicrobial therapy. The 60-day mortality of appropriately treated (35%) was significantly lower than that of inappropriately treated (88%) patients (p = .0003), with an adjusted odds ratio of dying = 0.043 (95% confidence interval 0.0047-0.23; p = .0011). Survival time differed significantly between the two groups (p = .0004), with an adjusted hazard ratio = 0.34 (95% confidence interval 0.16-0.70; p = .0043). CONCLUSION Appropriate antimicrobial therapy administered to critically-ill patients presenting with bloodstream infections was associated with a lower 60-day mortality than inappropriate therapy.
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Affiliation(s)
- Satoshi Yamaga
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
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Affiliation(s)
- Mervyn Singer
- Bloomsbury Institute of Intensive Care MedicineUniversity College LondonLondon, United Kingdom
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Harris P, Mcnamara J, Lye D, Davis J, Bernard L, Cheng A, Doi Y, Fowler V, Kaye K, Leibovici L, Lipman J, Llewelyn M, Munoz-price S, Paul M, Peleg A, Rodríguez-baño J, Rogers B, Seifert H, Thamlikitkul V, Thwaites G, Tong S, Turnidge J, Utili R, Webb S, Paterson D. Proposed primary endpoints for use in clinical trials that compare treatment options for bloodstream infection in adults: a consensus definition. Clin Microbiol Infect 2017; 23:533-41. [DOI: 10.1016/j.cmi.2016.10.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 01/02/2023]
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15
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Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45:486-552. [PMID: 28098591 DOI: 10.1097/ccm.0000000000002255] [Citation(s) in RCA: 1864] [Impact Index Per Article: 266.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." DESIGN A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
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Coulter S, Roberts JA, Hajkowicz K, Halton K. The Use of Bloodstream Infection Mortality to Measure the Impact of Antimicrobial Stewardship Interventions: Assessing the Evidence. Infect Dis Rep 2017; 9:6849. [PMID: 28458799 PMCID: PMC5391541 DOI: 10.4081/idr.2017.6849] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/14/2016] [Accepted: 12/28/2016] [Indexed: 12/19/2022] Open
Abstract
This review sets out to evaluate the current evidence on the impact of inappropriate therapy on bloodstream infections (BSI) and associated mortality. Based on the premise that better prescribing practices should result in better patient outcomes, BSI mortality may be a useful metric to evaluate antimicrobial stewardship (AMS) interventions. A systematic search was performed in key medical databases to identify papers published in English between 2005 and 2015 that examined the association between inappropriate prescribing and BSI mortality in adult patients. Only studies that included BSIs caused by ESKAPE (Enterococcus faecium/faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species) organisms were included. Study quality was assessed using the GRADE criteria and results combined using a narrative synthesis. We included 46 studies. Inappropriate prescribing was associated with an overall increase in mortality in BSI. In BSI caused by resistant gram positive organisms, such as methicillin resistant S. aureus, inappropriate therapy resulted in up to a 3-fold increase in mortality. In BSI caused by gram negative (GN) resistant organisms a much greater impact ranging from 3 to 25 fold increase in the risk of mortality was observed. While the overall quality of the studies is limited by design and the variation in the definition of appropriate prescribing, there appears to be some evidence to suggest that inappropriate prescribing leads to increased mortality in patients due to GN BSI. The highest impact of inappropriate prescribing was seen in patients with GN BSI, which may be a useful metric to monitor the impact of AMS interventions.
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Affiliation(s)
- Sonali Coulter
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane
| | - Jason A Roberts
- Burns Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, The University of Queensland, Brisbane.,Royal Brisbane and Women's Hospital, Brisbane
| | | | - Kate Halton
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Jokinen E, Laine J, Huttunen R, Rahikka P, Huhtala H, Vuento R, Vuopio J, Syrjänen J. Comparison of outcome and clinical characteristics of bacteremia caused by methicillin-resistant, penicillin-resistant and penicillin-susceptible Staphylococcus aureus strains. Infect Dis (Lond) 2017; 49:493-500. [PMID: 28276799 DOI: 10.1080/23744235.2017.1292046] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the association of methicillin resistance and penicillinase production with clinical characteristics and outcome of Staphylococcus aureus bacteremia. METHODS For 126 patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, 378 age- and gender-matched controls with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia were selected. Of controls, 126 had bacteremia caused by penicillin-susceptible strains (PSSA) and 252 by penicillinase-producing strains (PRSA). Underlying diseases, clinical course and mortality were retrospectively assessed. RESULTS Patients with MRSA bacteremia were more often smokers than patients with MSSA bacteremia (OR 2.34, 95% CI 1.27-4.32). MRSA bacteremia was more often healthcare-associated (OR 4.23, 95% CI 2.47-7.24), associated with central venous catheters (OR 2.09, 95% CI 1.27-3.47), glucocorticoid therapy (OR 1.82, 95% CI 1.12-2.93) and prior surgery (OR 2.32, 95% CI 1.43-3.76). Patients with MRSA bacteremia received appropriate empiric antibiotic (31%) less often than controls (98%). Mortality within 28 days was higher in MRSA bacteremia (26.8%) than in MSSA bacteremia (15.5%) (OR 2.00, 95% CI 1.20-3.34), PRSA bacteremia (17.0%) (OR 1.79 95% CI 1.04-3.09) or PSSA bacteremia (12.5%) (OR 2.56 95% CI 1.27-5.15). The difference remained after adjusting for underlying diseases and foci. There was no significant difference in clinical course between PRSA and PSSA bacteremias. CONCLUSIONS MRSA bacteremia was associated with poorer outcome than either PRSA or PSSA bacteremia. We corroborated several risk factors found in previous studies.
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Affiliation(s)
- Elina Jokinen
- a Department of Internal Medicine , Infectious Disease Unit, Tampere University Hospital , Tampere , Finland
| | - Janne Laine
- a Department of Internal Medicine , Infectious Disease Unit, Tampere University Hospital , Tampere , Finland
| | - Reetta Huttunen
- a Department of Internal Medicine , Infectious Disease Unit, Tampere University Hospital , Tampere , Finland
| | - Pekka Rahikka
- b The Health Centre of Heinola , Doctagon OY , Heinola , Finland
| | - Heini Huhtala
- c Faculty of Social Sciences , University of Tampere , Tampere , Finland
| | - Risto Vuento
- d Department of Clinical Microbiology , Fimlab Laboratories , Tampere , Finland
| | - Jaana Vuopio
- e Department of Infectious Diseases , National Institute for Health and Welfare , Helsinki , Finland.,f Department of Medical Microbiology and Immunology , University of Turku , Turku , Finland
| | - Jaana Syrjänen
- a Department of Internal Medicine , Infectious Disease Unit, Tampere University Hospital , Tampere , Finland.,g School of Medicine , University of Tampere , Tampere , Finland
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18
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Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43:304-377. [PMID: 28101605 DOI: 10.1007/s00134-017-4683-6] [Citation(s) in RCA: 3651] [Impact Index Per Article: 521.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". DESIGN A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
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Braquet P, Alla F, Cornu C, Goehringer F, Piroth L, Chirouze C, Revest M, Lechiche C, Duval X, Le Moing V. Factors associated with 12 week case-fatality in Staphylococcus aureus bacteraemia: a prospective cohort study. Clin Microbiol Infect 2016; 22:948.e1-948.e7. [PMID: 27515395 DOI: 10.1016/j.cmi.2016.07.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/24/2016] [Accepted: 07/31/2016] [Indexed: 12/21/2022]
Abstract
Staphylococcus aureus bacteraemia (SAB) is a frequent and deadly disease. Given the lack of a randomized trial, optimal first-line antibiotic treatment is still debated. Our aim was to identify prognostic factors in SAB patients and to analyse the impact of first-line antibiotics. The VIRSTA prospective cohort study was conducted in eight tertiary care centres in France. Consecutive incident adults in whom a blood culture drawn in participating centres grew S. aureus between April 2009 and October 2011 were prospectively followed for 12 weeks. Factors associated with 12-week case-fatality were identified by multivariate logistic regression. We enrolled 2091 patients and analysed survival in 1972 (median age 67.8 years, interquartile range 55.5-78.9; females 692/1972, 35.1%). SAB was nosocomial or healthcare-related in 1372/1972 (69.6%) of cases and the primary focus was unknown in 414/1972 (21.0%) of cases. Week 12 case-fatality rate was 671/1972 (34.0%). The main independent prognostic factors on multivariate analysis were age (adjusted OR by 10-year increment 1.56; 95% CI 1.44-1.69), septic shock (OR 5.11; 95% CI 3.84-6.80), metastatic cancer (OR 4.28; 95% CI 2.88-6.38), and unknown primary focus (OR 2.62; 95% CI 2.02-3.41). In the 1538 patients with methicillin-sensitive S. aureus (MSSA) bacteraemia, first-line empiric antistaphylococcal penicillins (OR 0.40; 95% CI 0.17-0.95) and vancomycin (OR 0.37; 95% CI 0.17-0.83), alone or combined with an aminoglycoside, were associated with better outcome compared with other antibiotics. There are few modifiable prognostic factors for SAB. Initiating empiric antibiotics with antistaphylococcal penicillins or vancomycin may be associated with better outcome in MSSA bacteraemia.
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Affiliation(s)
- P Braquet
- Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche sur le Développement, Montpellier, France.
| | - F Alla
- Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, Nancy, France; INSERM, CIC-EC, CIE6, Nancy, France; CHU Nancy, Nancy, France
| | - C Cornu
- INSERM, CIC1407, Lyon, France; CHU Lyon, Service de Pharmacologie Clinique, Lyon, France; Université Lyon, UMR 5558, Lyon, France
| | - F Goehringer
- Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Nancy, France
| | - L Piroth
- CHU de Dijon, UMR 1347-MERS, Université de Bourgogne, Dijon, France
| | - C Chirouze
- UMR CNRS 6249 Chrono-environnement, Université de Bourgogne Franche-Comté, CHU de Besançon, Besançon, France
| | - M Revest
- Infectious Diseases and Intensive Care Unit, Centre Hospitalier Universitaire de Rennes, France
| | - C Lechiche
- Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - X Duval
- Université Paris Diderot Sorbonne, Paris, France; IAME, INSERM, UMR 1137, CIC 1425, Paris, France; AP-HP, Hôpital Bichat Claude Bernard, Paris, France
| | - V Le Moing
- Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche sur le Développement, Montpellier, France.
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21
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Welte T. Die schwere Pneumonie auf der Intensivstation. Med Klin Intensivmed Notfmed 2016; 111:279-89. [DOI: 10.1007/s00063-016-0165-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
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Yilmaz M, Elaldi N, Balkan İİ, Arslan F, Batırel AA, Bakıcı MZ, Gozel MG, Alkan S, Çelik AD, Yetkin MA, Bodur H, Sınırtaş M, Akalın H, Altay FA, Şencan İ, Azak E, Gündeş S, Ceylan B, Öztürk R, Leblebicioglu H, Vahaboglu H, Mert A. Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study. Ann Clin Microbiol Antimicrob 2016; 15:7. [PMID: 26860463 PMCID: PMC4748515 DOI: 10.1186/s12941-016-0122-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/01/2016] [Indexed: 12/20/2022] Open
Abstract
Background Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals. Methods Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010–2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis. Results A total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality. Conclusions The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.
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Affiliation(s)
- Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.
| | - Nazif Elaldi
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
| | - İlker İnanç Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Ferhat Arslan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.
| | - Ayşe Alga Batırel
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
| | - Mustafa Zahir Bakıcı
- Department of Medical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
| | - Mustafa Gokhan Gozel
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Trakya University, Edirne, Turkey.
| | - Aygül Doğan Çelik
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Trakya University, Edirne, Turkey.
| | - Meltem Arzu Yetkin
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Hürrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Melda Sınırtaş
- Department of Medical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey.
| | - Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey.
| | - Fatma Aybala Altay
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - İrfan Şencan
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - Emel Azak
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Sibel Gündeş
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Bahadır Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.
| | - Recep Öztürk
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University, Samsun, Turkey.
| | - Haluk Vahaboglu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Ali Mert
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.
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Kaasch AJ, Fätkenheuer G, Prinz-Langenohl R, Paulus U, Hellmich M, Weiß V, Jung N, Rieg S, Kern WV, Seifert H. Early oral switch therapy in low-risk Staphylococcus aureus bloodstream infection (SABATO): study protocol for a randomized controlled trial. Trials 2015; 16:450. [PMID: 26452342 PMCID: PMC4600306 DOI: 10.1186/s13063-015-0973-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 09/23/2015] [Indexed: 01/04/2023] Open
Abstract
Background Current guidelines recommend that patients with Staphylococcus aureus bloodstream infection (SAB) are treated with long courses of intravenous antimicrobial therapy. This serves to avoid SAB-related complications such as relapses, local extension and distant metastatic foci. However, in certain clinical scenarios, the incidence of SAB-related complications is low. Patients with a low-risk for complications may thus benefit from an early switch to oral medication through earlier discharge and fewer complications of intravenous therapy. The major objective for the SABATO trial is to demonstrate that in patients with low-risk SAB a switch from intravenous to oral antimicrobial therapy (oral switch therapy, OST) is non-inferior to a conventional course of intravenous therapy (intravenous standard therapy, IST). Methods/Design The trial is designed as randomized, parallel-group, observer-blinded, clinical non-inferiority trial. The primary endpoint is the occurrence of a SAB-related complication (relapsing SAB, deep-seated infection, and attributable mortality) within 90 days. Secondary endpoints are the length of hospital stay; 14-day, 30-day, and 90-day mortality; and complications of intravenous therapy. Patients with SAB who have received 5 to 7 full days of adequate intravenous antimicrobial therapy are eligible. Main exclusion criteria are polymicrobial bloodstream infection, signs and symptoms of complicated SAB (deep-seated infection, hematogenous dissemination, septic shock, and prolonged bacteremia), the presence of a non-removable foreign body, and severe comorbidity. Patients will receive either OST or IST with a protocol-approved antimicrobial and are followed up for 90 days. Four hundred thirty patients will be randomized 1:1 in two study arms. Efficacy regarding incidence of SAB-related complications is tested sequentially with a non-inferiority margin of 10 and 5 percentage points. Discussion The SABATO trial assesses whether early oral switch therapy is safe and effective for patients with low-risk SAB. Regardless of the result, this pragmatic trial will strongly influence the standard of care in SAB. Trial registration ClinicalTrials.gov NCT01792804 registered 13 February 2013; German Clinical trials register DRKS00004741 registered 4 October 2013, EudraCT 2013-000577-77. First patient randomized on 20 December 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0973-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Achim J Kaasch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19-21, D-50935, Köln, Germany.
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, 50924, Cologne, Germany. .,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany.
| | | | - Ursula Paulus
- Clinical Trial Center Cologne, University of Cologne, 50924, Cologne, Germany.
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Straße 62, 50924, Cologne, Germany.
| | - Verena Weiß
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Straße 62, 50924, Cologne, Germany.
| | - Norma Jung
- Department I of Internal Medicine, University Hospital of Cologne, 50924, Cologne, Germany.
| | - Siegbert Rieg
- Department of Medicine, Center for Infectious Diseases and Travel Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Winfried V Kern
- Department of Medicine, Center for Infectious Diseases and Travel Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19-21, D-50935, Köln, Germany. .,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany.
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López-Cortés LE, Velasco C, Retamar P, del Toro MD, Gálvez-Acebal J, de Cueto M, García-Luque I, Caballero FJ, Pascual A, Rodríguez-Baño J. Is reduced vancomycin susceptibility a factor associated with poor prognosis in MSSA bacteraemia? J Antimicrob Chemother 2015; 70:2652-60. [DOI: 10.1093/jac/dkv133] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 04/21/2015] [Indexed: 11/13/2022] Open
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McDanel JS, Perencevich EN, Diekema DJ, Herwaldt LA, Smith TC, Chrischilles EA, Dawson JD, Jiang L, Goto M, Schweizer ML. Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals. Clin Infect Dis 2015; 61:361-7. [PMID: 25900170 DOI: 10.1093/cid/civ308] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 04/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies indicate that vancomycin is inferior to beta-lactams for treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections. However, it is unclear if this association is true for empiric and definitive therapy. Here, we compared beta-lactams with vancomycin for empiric and definitive therapy of MSSA bloodstream infections among patients admitted to 122 hospitals. METHODS This retrospective cohort study included all patients admitted to Veterans Affairs hospitals from 2003 to 2010 who had positive blood cultures for MSSA. Hazard ratios (HR) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression. Empiric therapy was defined as starting treatment 2 days before and up to 4 days after the first MSSA blood culture was collected. Definitive therapy was defined as starting treatment between 4 and 14 days after the first positive blood culture was collected. RESULTS Patients who received empiric therapy with a beta-lactam had similar mortality compared with those who received vancomycin (HR, 1.03; 95% CI, .89-1.20) after adjusting for other factors. However, patients who received definitive therapy with a beta-lactam had 35% lower mortality compared with patients who received vancomycin (HR, 0.65; 95% CI, .52-.80) after controlling for other factors. The hazard of mortality decreased further for patients who received cefazolin or antistaphylococcal penicillins compared with vancomycin (HR, 0.57; 95% CI, .46-.71). CONCLUSIONS For patients with MSSA bloodstream infections, beta-lactams are superior to vancomycin for definitive therapy but not for empiric treatment. Patients should receive beta-lactams for definitive therapy, specifically antistaphylococcal penicillins or cefazolin.
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Affiliation(s)
- Jennifer S McDanel
- Department of Epidemiology, College of Public Health Department of Internal Medicine, Carver College of Medicine, University of Iowa Iowa City Veterans Affairs Health Care System
| | - Eli N Perencevich
- Department of Epidemiology, College of Public Health Department of Internal Medicine, Carver College of Medicine, University of Iowa Iowa City Veterans Affairs Health Care System
| | - Daniel J Diekema
- Department of Internal Medicine, Carver College of Medicine, University of Iowa Department of Pathology, Carver College of Medicine, University of Iowa Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospitals and Clinics
| | - Loreen A Herwaldt
- Department of Epidemiology, College of Public Health Department of Internal Medicine, Carver College of Medicine, University of Iowa Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospitals and Clinics
| | - Tara C Smith
- Department of Epidemiology, College of Public Health
| | | | - Jeffrey D Dawson
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City
| | - Lan Jiang
- Iowa City Veterans Affairs Health Care System
| | - Michihiko Goto
- Department of Internal Medicine, Carver College of Medicine, University of Iowa Iowa City Veterans Affairs Health Care System
| | - Marin L Schweizer
- Department of Epidemiology, College of Public Health Department of Internal Medicine, Carver College of Medicine, University of Iowa Iowa City Veterans Affairs Health Care System
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26
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Chen SY, Hsueh PR, Chiang WC, Huang EPC, Lin CF, Chang CH, Chen SC, Chen WJ, Chang SC, Lai MS, Chie WC. Predicting high vancomycin minimum inhibitory concentration isolate infection among patients with community-onset methicillin-resistant Staphylococcus aureus bacteraemia. J Infect 2014; 69:259-65. [DOI: 10.1016/j.jinf.2014.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 04/24/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
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Affiliation(s)
- Gerd Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
| | - Achim J Kaasch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany
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28
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Abstract
The advent of modern antimicrobial therapy following the discovery of penicillin during the 1940s yielded remarkable improvements in case fatality rate of serious infections including septic shock. Since then, pathogens have continuously evolved under selective antimicrobial pressure resulting in a lack of significant improvement in clinical effectiveness in the antimicrobial therapy of septic shock despite ever more broad-spectrum and potent drugs. In addition, although substantial effort and money has been expended on the development novel non-antimicrobial therapies of sepsis in the past 30 years, clinical progress in this regard has been limited. This review explores the possibility that the current pathophysiologic paradigm of septic shock fails to appropriately consider the primacy of the microbial burden of infection as the primary driver of septic organ dysfunction. An alternate paradigm is offered that suggests that has substantial implications for optimizing antimicrobial therapy in septic shock. This model of disease progression suggests the key to significant improvement in the outcome of septic shock may lie, in great part, with improvements in delivery of existing antimicrobials and other anti-infectious strategies. Recognition of the role of delays in administration of antimicrobial therapy in the poor outcomes of septic shock is central to this effort. However, therapeutic strategies that improve the degree of antimicrobial cidality likely also have a crucial role.
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Affiliation(s)
- Anand Kumar
- Section of Critical Care Medicine; Section of Infectious Diseases; Health Sciences Centre; Winnipeg, MB Canada
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Skvarc M, Stubljar D, Rogina P, Kaasch AJ. Non-culture-based methods to diagnose bloodstream infection: Does it work? Eur J Microbiol Immunol (Bp) 2013; 3:97-104. [PMID: 24265925 DOI: 10.1556/eujmi.3.2013.2.2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/18/2013] [Indexed: 12/11/2022] Open
Abstract
Bloodstream infections are a major cause of morbidity and mortality worldwide. Molecular methods for the detection of pathogens in blood have been developed. The clinical utility of these methods and their integration into the clinical workflow is discussed.
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