Impact of Reducing Time-to-Antibiotics on Sepsis Mortality, Antibiotic Use, and Adverse Events

The protective role of kakkalide in sepsis-induced intestinal barrier dysfunction via inhibition of NF-κB pathway activation

Sepsis, a systemic inflammatory response often triggered by infection, can lead to multi-organ failure, with the intestine being one of the most vulnerable organs. The nuclear factor kappa-B (NF-κB) pathway plays a crucial role in immune responses, inflammation, and cell survival, making it central to sepsis-induced intestinal damage. Kakkalide (KA), a bioactive compound known for its anti-inflammatory, cardiovascular, neuroprotective, and anti-diabetic properties, has potential therapeutic effects. However, its impact on sepsis-induced intestinal injury remains unclear. In this study, murine sepsis models were used both in vivo and in vitro to evaluate the protective effects of KA on intestinal histopathology, apoptosis, and inflammation. Results showed that KA significantly reduced intestinal damage and apoptosis, as evidenced by hematoxylin-eosin and TUNEL staining. KA also improved intestinal barrier integrity, as indicated by reduced diamine oxidase activity, d-lactic acid content, and fluorescein isothiocyanate intensity, along with increased expression of zonula occludens-1. Furthermore, KA alleviates inflammation by reducing the levels of tumor necrosis factor-α, interleukin-1β, prostaglandin E2, inducible nitric oxide synthase, and cyclooxygenase-2. Immunofluorescence and Western blot analysis revealed that KA inhibited the sepsis-induced phosphorylation of inhibitor-kappaBα and RelA (P65) and prevented P65's translocation to the nucleus. These findings were confirmed in lipopolysaccharide-induced Caco-2 cells, suggesting that KA protected the intestinal barrier during sepsis by suppressing the NF-κB pathway.

Early antibiotics administration reduces mortality in sepsis patients in tertiary care hospital

INTRODUCTION

Early antibiotic administration is one of the core treatments of sepsis which associated with reduced mortality rate. However, the appropriate timing of antibiotics remains a controversial issue, especially in patients without septic shock. Here, we reported the outcomes of early antibiotic administration within one hour from the time of infection suspicion in a tertiary care hospital.

METHODS

We reviewed the medical records and sepsis protocols in Chulabhorn Hospital, Bangkok, Thailand, from January 2021 to December 2023 for patients presenting with sepsis. We had our own sepsis protocol which we used for early detection and treatment of sepsis patients. We compared the 28-day mortality, 90-day mortality, and the length of stay between patients with time-to-antibiotics (TTA) within one hour and patients with TTA more than one hour.

RESULTS

We recruited 1,506 patients into our study. The mean age is 68 years and 49.40% of patients is female. 90.97% of the patients have comorbidities. The most common comorbidities were cancer (68.66%), and hypertension (33.40%). The 28-day mortality rate and the 90-day mortality rate were significantly lower in the patients with TTA within one hour compared to those with TTA more than one hour (P = 0.009 and P = 0.042, respectively). Nonetheless, adjusted mortality rate was significantly lower in only 28-day mortality rate but not 90-day mortality rate. Subgroup analysis showed that the mortality rate was significantly lower in patients with ICD-10 diagnosis of infections (15.35% vs. 21.51%, P = 0.029), patients with cancer (17.29% vs. 24.11%, P = 0.016), and patients with solid cancer (20.86% vs. 28.18%, P = 0.036). However, subgroup analysis for the mortality rate at 90 days were not statistically significant.

CONCLUSION

Antibiotic administration within one hour from the time of infection suspicion is associated with lower mortality rates at 28 days but not at 90 days after adjusted analysis. Cancer patients, especially patients with solid cancer, will benefit more with time-to-antibiotics less than one hour.

Adsorption of amoxicillin by chitosan and alginate biopolymers composite beads

Due to its widespread use and incomplete breakdown in the human body, amoxicillin has been detected in receiving water bodies. This raises significant concerns, like the promotion of antibiotic resistance, toxicity towards aquatic life, disruption of the natural balance of microbial communities within these water bodies, and the struggle of effectively removal by the traditional wastewater treatment plants. Consequently, exploring new processes to complement the existing methods is crucial. Adsorption, a promising highly efficient, selective, and versatile technique, can effectively remove contaminants, making it useful in various industries such as water treatment, pharmaceuticals, and environmental remediation. Several adsorbents are documented in the literature for drug adsorption; however, their fabrication often involves more complex steps and substances compared to chitosan and alginate, which are natural polymers that are biocompatible, non-toxic, and biodegradable. Their tunable properties and ease of modification enhance their efficacy in environmental remediation. Therefore, the novelty of this article is to understand the interaction of amoxicillin with chitosan and alginate adsorbents easily synthetized using the dripping technique. This approach allows us to explore basic principles that can be applied to more complex systems in future studies. The optimal pH for both beads was found to be 4, with adsorption capacities of 74.2 ± 0.3 mg g-1 for alginate and 80.4 ± 0.2 mg g-1 for chitosan, using 1 g of adsorbent. Kinetics studies indicated that external diffusion governs adsorption for alginate, while internal diffusion governs adsorption for chitosan. This approach underscores the potential of chitosan and alginate beads as effective adsorbents for mitigating antibiotic contamination in water systems, offering a sustainable complement to traditional treatment methods.