scholarly journals Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis

2020 ◽  
Author(s):  
Ai-Min Jiang ◽  
Na Liu ◽  
Rui Zhao ◽  
Hao-Ran Zheng ◽  
Xue Chen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Clinical Outcomes ◽  
Hematological Malignancy ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Icu Admission ◽  
Predictors Of Mortality ◽  
Oncological Patients ◽  
Subgroup Analyses

Abstract Background The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. We performed the meta-analysis to investigate the prognosis and risk factors in BSIs caused by ESBL-PE in oncological patients. Methods PubMed and EMBASE were searched for related studies. All-cause mortality was considered as the primary outcome. Subgroup analyses, meta-regression analyses, and sensitivity analysis were used to investigate heterogeneity and reliability in results. Results 6729 patients from 25 studies were eligible. Six studies enrolled oncological patients with BSIs caused by ESBL-PE only, while 19 studies both enrolled ESBL-PE and non-ESBL-PE infections. The results showed that BSIs caused by ESBL-PE in patients with malignancy was associated with higher mortality than non-ESBL-PE infections (RR = 2.21, 95% CI: 1.60–3.06, P < 0.001), with a significant between-study heterogeneity (I2 = 78.3%, P < 0.001). Subgroup analyses showed that children (RR = 2.80, 95% CI: 2.29–3.43, P < 0.001) and hematological malignancy (RR =3.20, 95% CI: 2.54–4.03, P < 0.001) were associated with a higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality. Conclusions Our study identified that BSIs caused by ESBL-PE in patients with malignancy was associated with worse clinical outcomes compared with non-ESBL-PE infections. Furthermore, children and hematological malignancy were associated with higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.

scholarly journals Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ai-Min Jiang ◽  
Na Liu ◽  
Rui Zhao ◽  
Hao-Ran Zheng ◽  
Xue Chen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Clinical Outcomes ◽  
Hematological Malignancy ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Icu Admission ◽  
Predictors Of Mortality ◽  
Oncological Patients ◽  
Subgroup Analyses

Abstract Background The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. We performed the meta-analysis to investigate the prognosis and risk factors in BSIs caused by ESBL-PE in oncological patients. Methods PubMed, EMBASE, and Cochrane Library were searched for related studies. All-cause mortality was considered as the primary outcome. Subgroup analyses, meta-regression analyses, and sensitivity analysis were used to investigate heterogeneity and reliability in results. Results 6,729 patients from 25 studies were eligible. Six studies enrolled oncological patients with BSIs caused by ESBL-PE only, while 19 studies both enrolled ESBL-PE and non-ESBL-PE infections. The results showed that BSIs caused by ESBL-PE in patients with malignancy was associated with higher mortality than non-ESBL-PE infections (RR = 2.21, 95% CI: 1.60–3.06, P < 0.001), with a significant between-study heterogeneity (I2 =78.3%, P < 0.001). Subgroup analyses showed that children (RR = 2.80, 95% CI: 2.29–3.43, P < 0.001) and hematological malignancy (RR = 3.20, 95% CI: 2.54–4.03, P < 0.001) were associated with a higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality. Conclusions Our study identified that BSIs caused by ESBL-PE in patients with malignancy were associated with worse clinical outcomes compared with non-ESBL-PE infections. Furthermore, children and hematological malignancy were associated with higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.

scholarly journals Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis

2020 ◽  
Author(s):  
Ai-Min Jiang ◽  
Na Liu ◽  
Rui Zhao ◽  
Hao-Ran Zheng ◽  
Xue Chen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Clinical Outcomes ◽  
Hematological Malignancy ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Icu Admission ◽  
Predictors Of Mortality ◽  
Oncological Patients ◽  
Subgroup Analyses

Abstract Background: The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. We performed the meta-analysis to investigate the prognosis and risk factors in BSIs caused by ESBL-PE in oncological patients.Methods: PubMed, EMBASE, and Cochrane Library were searched for related studies. All-cause mortality was considered as the primary outcome. Subgroup analyses, meta-regression analyses, and sensitivity analysis were used to investigate heterogeneity and reliability in results.Results: 6,729 patients from 25 studies were eligible. Six studies enrolled oncological patients with BSIs caused by ESBL-PE only, while 19 studies both enrolled ESBL-PE and non-ESBL-PE infections. The results showed that BSIs caused by ESBL-PE in patients with malignancy was associated with higher mortality than non-ESBL-PE infections (RR = 2.21, 95 % CI: 1.60–3.06, P < 0.001), with a significant between-study heterogeneity (I2 = 78.3%, P < 0.001). Subgroup analyses showed that children (RR = 2.80, 95 % CI: 2.29–3.43, P < 0.001) and hematological malignancy (RR =3.20, 95 % CI: 2.54–4.03, P < 0.001) were associated with a higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.Conclusions: Our study identified that BSIs caused by ESBL-PE in patients with malignancy were associated with worse clinical outcomes compared with non-ESBL-PE infections. Furthermore, children and hematological malignancy were associated with higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

scholarly journals Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis

BMJ ◽  
2004 ◽  
Vol 329 (7464) ◽  
pp. 480 ◽  
Author(s):  
Djillali Annane ◽  
Eric Bellissant ◽  
Pierre Edouard Bollaert ◽  
Josef Briegel ◽  
Didier Keh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Meta Analysis ◽  
Sepsis And Septic Shock

scholarly journals Prompt admission to intensive care is associated with improved survival in patients with severe sepsis and/or septic shock

2018 ◽  
Vol 46 (10) ◽  
pp. 4071-4081 ◽  
Author(s):  
Qiang Li ◽  
Jiajiong Wang ◽  
Guomin Liu ◽  
Meng Xu ◽  
Yanguo Qin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Multivariable Model ◽  
Icu Admission ◽  
Survival Status ◽  
Healthcare Data ◽  
Multivariable Regression Model ◽  
Multivariable Regression

Objective To investigate the association between time from hospital admission to intensive care unit (ICU) admission (door to ICU time) and hospital mortality in patients with sepsis. Methods This retrospective observational study included routinely collected healthcare data from patients with sepsis. The primary endpoint was hospital mortality, defined as the survival status at hospital discharge. Door to ICU time was calculated and included in a multivariable model to investigate its association with mortality. Results Data from 13 115 patients were included for analyses, comprising 10 309 survivors and 2 806 non-survivors. Door to ICU time was significantly longer for non-survivors than survivors (median, 43.0 h [interquartile range, 12.4, 91.3] versus 26.7 h [7.0, 74.2]). In the multivariable regression model, door to ICU time remained significantly associated with mortality (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.006, 1.017) and there was a significant interaction between age and door to ICU time (OR 0.99, 95% CI 0.99, 1.00). Conclusion A shorter time from hospital door to ICU admission was shown to be independently associated with reduced hospital mortality in patients with severe sepsis and/or septic shock.

scholarly journals Intensity of Continuous Renal Replacement Therapies in Patients with Severe Sepsis and Septic Shock: A Systematic Review and Meta-Analysis

2011 ◽  
Vol 39 (3) ◽  
pp. 373-383 ◽  
Author(s):  
J. Latour-Pérez ◽  
E. Palencia-Herrejón ◽  
V. Gómez-Tello ◽  
A. Baeza-Román ◽  
M. á. García-García ◽  
...  
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Meta Analysis ◽  
Renal Replacement Therapies ◽  
Continuous Renal Replacement Therapies ◽  
Sepsis And Septic Shock

scholarly journals Tricuspid Annular Plane of Systolic Excursion (TAPSE) for the Evaluation of Patients with Severe Sepsis and Septic Shock

2020 ◽  
Vol 21 (2) ◽  
pp. 348-352
Author(s):  
Shadi Lahham ◽  
Clifton Lee ◽  
Qumber Ali ◽  
John Moeller ◽  
Chanel Fischetti ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Large Scale ◽  
Admission Rate ◽  
Hospital Length Of Stay ◽  
Point Of Care Ultrasound ◽  
Septic Cardiomyopathy ◽  
Icu Admission ◽  
Sepsis And Septic Shock

Introduction: Sepsis is a systemic infection that can rapidly progress into multi organ failure and shock if left untreated. Previous studies have demonstrated the utility of point of care ultrasound (POCUS) in the evaluation of patients with sepsis. However, limited data exists on the evaluation of the tricuspid annular plane of systolic excursion (TAPSE) in patients with sepsis. Methods: We prospectively enrolled patients who presented to the emergency department (ED) with concern for severe sepsis or septic shock in a pilot study. In patients that screened positive, the treating physician then performed POCUS to measure the TAPSE value. We compared the intensive care unit (ICU) admission rate, hospital length of stay, and morbidity with their respective TAPSE values. Results: We enrolled 24 patients in the study. Eight patients had TAPSE values less than 16 millimeters (mm), two patients had TAPSE values between 16mm-20mm, and fourteen patients had TAPSE values greater than 20mm. There was no statistically significant association between TAPSE levels and ICU admission (p=0.16), or death (p=0.14). The difference of length of stay (LOS) was not statistically significant in case of hospital LOS (p= 0.72) or ICU LOS. Conclusion: Our pilot data did not demonstrate a correlation between severe sepsis or septic shock and TAPSE values. This may be due to several factors including patient comorbidities, strict definitions of sepsis and septic shock, as well as the absence of septic cardiomyopathy (SCM) in patients with sepsis and septic shock. Future large-scale studies are needed to determine if TAPSE can be beneficial in the ED evaluation of patients with concern for SCM.

scholarly journals Predictors of mortality in renal transplant recipients with severe sepsis and septic shock

Critical Care ◽  
2013 ◽  
Vol 17 (Suppl 4) ◽  
pp. P36 ◽  
Author(s):  
Mônica de Carvalho ◽  
José Pestana ◽  
Flávio Freitas ◽  
Flávia Machado ◽  
Hélio Júnior
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Renal Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Predictors Of Mortality ◽  
Sepsis And Septic Shock

scholarly journals The Effect of Molecular Rapid Diagnostic Testing on Clinical Outcomes in Bloodstream Infections: A Systematic Review and Meta-analysis

2016 ◽  
Vol 64 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Tristan T. Timbrook ◽  
Jacob B. Morton ◽  
Kevin W. McConeghy ◽  
Aisling R. Caffrey ◽  
Eleftherios Mylonakis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Diagnostic Testing ◽  
Bloodstream Infections ◽  
Rapid Diagnostic Testing
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