Characteristics and outcomes of patients with culture negative septic shock compared with patients with culture positive septic shock: a retrospective cohort study

Implementation of antibiotic stewardship is difficult in patients with sepsis because of severity of disease. We evaluated the impact of glycopeptide discontinuation (GD) in patients with culture negative severe sepsis or septic shock who received glycopeptides as initial empiric antibiotic therapy at admission. We conducted a single center retrospective cohort study between January 2010 and March 2018. GD was defined as discontinuation of initial empiric glycopeptides on availability of culture results, revealing the absence of identified pathogens. In 92 included patients, the leading causes of sepsis were pneumonia (34.8%) and intra-abdominal infection (23.9%); 28-day mortality and overall mortality were 14% and 21%, respectively. Glycopeptides were discontinued in 42/92 patients. After propensity score matching, baseline characteristics were not significantly different between the GD and non-GD (GND) groups. GND was associated with development of acute kidney injury (OR 5.54, 95% CI 1.49–20.6, P = 0.011). GD did not increase the 7-day, 14-day, and 28-day mortality compared with GND. The length of hospital stay was shorter in the GD group than in GND group (16.33 ± 17.11 vs. 25.05 ± 14.37, P = 0.082), though not statistically significant. GD may be safe and reduce adverse events of prolonged antibiotic use in patients with culture negative severe sepsis or septic shock receiving glycopeptides as initial empiric antibiotic therapy.

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Impact of individualized target mean arterial pressure for septic shock resuscitation on the incidence of acute kidney injury: a retrospective cohort study

Annals of Intensive Care ◽

10.1186/s13613-018-0468-5 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 7

Author(s):

Rajat N. Moman ◽

Stuart A. Ostby ◽

Abbasali Akhoundi ◽

Rahul Kashyap ◽

Kianoush Kashani

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Cohort Study ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Kidney Injury

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The accuracy of pulse oximetry in emergency department patients with severe sepsis and septic shock: a retrospective cohort study

BMC Emergency Medicine ◽

10.1186/1471-227x-10-9 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 50

Author(s):

Ben J Wilson ◽

Hamish J Cowan ◽

Jason A Lord ◽

Dan J Zuege ◽

David A Zygun

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Cohort Study ◽

Pulse Oximetry ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Emergency Department Patients ◽

Sepsis And Septic Shock

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Infection deteriorating hepatitis B virus related acute-on-chronic liver failure: a retrospective cohort study

BMC Gastroenterology ◽

10.1186/s12876-020-01473-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xing-Ran Zhai ◽

Jing-Jing Tong ◽

Hong-Min Wang ◽

Xiang Xu ◽

Xiu-Ying Mu ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Liver Failure ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Chronic Liver ◽

Chronic Liver Failure ◽

B Virus

Abstract Background Infection is common in acute-on-chronic liver failure (ACLF), which may worsen the clinical condition and prognosis. However, the characteristics of infection and its influence on prognosis in hepatitis B virus related ACLF (HBV-ACLF) as defined by the European Association for the Study of the Liver (EASL) have not been clarified. We aimed to investigate the characteristics of infection and its influence on mortality in patients with HBV-ACLF defined by EASL in China. Methods We performed a retrospective cohort study in patients with HBV-ACLF defined by EASL in a single center from January 2015 to December 2017. These patients were divided into two groups with and without infection. The incidence, sites of infection, isolated strains, and risk factors associated with mortality were evaluated. Results A total of 289 patients were included, among them 185 (64.0%) were diagnosed with an infection. The most common type of infection was pneumonia (55.7%), followed by spontaneous bacterial peritonitis (47.6%) and others. The gram-negative bacteria were the most frequent (58.3%). Patients with one, two, and three or more infection sites had a gradually increasing incidence of sepsis (P < 0.01), septic shock (P < 0.001), and ACLF-3 (P < 0.05). Also, patients with infection isolated one, two, and three or more strains showed a growing incidence of sepsis (P < 0.01) and septic shock (P < 0.001). Patients with infection showed a significantly higher 28-day mortality than those without (P < 0.01), especially in patients with ACLF-3. Infection was identified as an independent risk factor for 28-day mortality in all HBV-ACLF patients. Pneumonia and sepsis were identified as independent predictors of 28-day mortality for patients with infection. Conclusions Infection is associated with severe clinical course and high mortality in HBV-ACLF defined by EASL. The increased number of infection sites or isolated strains was associated with the occurrence of sepsis and septic shock. Pneumonia and sepsis were independent predictors for mortality in HBV-ACLF patients with infection.

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Delayed persistence of elevated monocytic MDSC associates with deleterious outcomes in septic shock: a retrospective cohort study

Critical Care ◽

10.1186/s13054-020-02857-y ◽

2020 ◽

Vol 24 (1) ◽

Cited By ~ 4

Author(s):

Louis Waeckel ◽

Fabienne Venet ◽

Morgane Gossez ◽

Céline Monard ◽

Thomas Rimmelé ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort

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Therapeutic Plasma Exchange in Neonatal Septic Shock: A Retrospective Cohort Study

American Journal of Perinatology ◽

10.1055/s-0039-1692184 ◽

2019 ◽

Vol 37 (09) ◽

pp. 962-969

Author(s):

Taylor Sawyer ◽

Zeenia Billimoria ◽

Sarah Handley ◽

Kendra Smith ◽

Larissa Yalon ◽

...

Keyword(s):

Septic Shock ◽

Cohort Study ◽

Plasma Exchange ◽

Retrospective Cohort Study ◽

Adjunctive Therapy ◽

Retrospective Cohort ◽

Life Support ◽

Therapeutic Plasma Exchange ◽

Convenience Sample ◽

Icu Discharge

Objective This study aimed to examine the use of therapeutic plasma exchange (TPE) as adjunctive therapy in neonatal septic shock. Study Design This retrospective cohort study was performed on a convenience sample of neonates in a quaternary children's hospital between January 2018 and February 2019. Results We identified three neonates with septic shock who received TPE. Two neonates had adenovirus sepsis, and one had group B streptococcal sepsis. All neonates were on extracorporeal life support (ECLS) when TPE was started. The median duration of TPE was 6 days (interquartile range [IQR]: 3–15), with a median of four cycles (IQR: 3–5). Lactate levels decreased significantly after TPE (median before TPE: 5.4 mmol/L [IQR: 2.4–6.1] vs. median after TPE: 1.2 mmol/L [IQR: 1.0–5.8]; p < 0.001). Platelet levels did not change (median before TPE: 73,000/mm3 [IQR: 49,000–100,000] vs. median after TPE: 80,000/mm3 (IQR: 62,000–108,000); p = 0.2). Organ failure indices improved after TPE in two of the three neonates. Hypocalcemia was seen in all cases despite prophylactic calcium infusions. One neonate died, and two survived to ICU discharge. Conclusion TPE can be safely performed in neonates with septic shock. TPE may have a role as an adjunctive therapy in neonates with septic shock requiring ECLS.

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