Septic Shock
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2021 ◽  
Vol 46 ◽  
pp. S564
A.G. Pereira ◽  
N.A. Costa ◽  
I.N.A. Lima ◽  
Y.T.F. Silva ◽  
M.P.F.N. Silva ◽  

2021 ◽  
Daniel Schwarzkopf ◽  
Hendrik Rüddel ◽  
Alexander Brinkmann ◽  
Carolin Fleischmann-Struzek ◽  
Marcus E. Friedrich ◽  

Abstract BackgroundSepsis is one of the leading causes of preventable deaths in hospitals. This study presents the evaluation of a quality collaborative network, which aimed to decrease sepsis-related hospital mortality.MethodsThe German Quality Network Sepsis (GQNS) offers quality reporting based on claims data, peer reviews, and support for establishing continuous quality improvement and staff education to participating hospitals. The primary outcome of the evaluation was all-cause risk-adjusted hospital mortality among cases with sepsis per hospital. Sepsis was identified by ICD-10 codes in claims data for sepsis with organ dysfunction or septic shock according to the sepsis-1 definition. To evaluate the effect of the GQNS, the change in outcomes from a retrospective baseline (January 2014 – March 2016) to the intervention phase (April 2016 – June 2018) was compared between the hospitals in the GQNS and the national German diagnosis-related-groups statistics. Tests were conducted by interrupted time-series analyses using hierarchical models. Implementation processes and barriers were assessed by a survey of local leaders of quality improvement teams in autumn 2018.ResultsSeventy-four hospitals participated, of which 17 were university hospitals and 18 were tertiary care facilities. Observed mortality was 43.5% during baseline period and 42.7% during intervention period. Interrupted time-series analyses did not show effects on course or level of risk-adjusted mortality of cases with sepsis compared to the national DRG-statistics after the beginning of the intervention period (p=0.632, and p=0.512, respectively). There were also no significant effects in the subgroups of patients with septic shock or ventilation >24h or subgroups of hospitals. Surveys among 48 local quality improvement leaders revealed that most hospitals did not succeed in implementing a continuous quality improvement program or relevant measures to improve early recognition and treatment of sepsis. Barriers perceived most commonly were lack of time (77.6%), staff shortage (59.2%), and lack of participation of relevant departments (38.8%).ConclusionsAs long as hospital-wide sepsis quality improvement efforts will not become a high priority for the hospital leadership by assuring adequate resources and involvement of all pertinent stakeholders, voluntary initiatives to improve the quality of sepsis care will remain prone to failure.

Mariana Chumbita ◽  
Pedro Puerta-Alcalde ◽  
Carlota Gudiol ◽  
Nicole Garcia-Pouton ◽  
Júlia Laporte-Amargós ◽  

Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.

2021 ◽  
Vol 10 (15) ◽  
pp. e399101522919
Elizabeth Maria Bispo Beltrão ◽  
Érica Maria Oliveira ◽  
Crhisllane Rafaele dos Santos Vasconcelos Vasconcelos ◽  
Antônio Mauro Rezende ◽  
Ana Catarina de Souza Lopes

The present study objective to characterize the clinical aspects of a patient infected with two strains of P. mirabilis and the presence of resistance determinants in the two isolates from a patient at a public hospital in Recife-PE, Brazil. The total DNA of the isolates was extracted and submitted to PCR and amplicon sequencing for the investigation of resistance genes, blaKPC, blaOXA-10, blaOXA-23, blaOXA-48, blaOXA-58, blaVIM, blaIMP, blaSPM, blaGES, blaNDM, qnrD and aac(6')-Ib). Isolate P21-A2 harbored the aac(6')-Ib, blaOXA-10 and qnrD genes. One of the isolates, P20-A2, was selected for plasmid DNA sequencing. The results showed that the patient developed multiple infections with various pathogens including two strains of P. mirabilis. The patient was hospitalized for 103 days, had septic shock of skin, abdominal, pulmonary and ulcer focus, and died. Isolate P20-A2 harbored the genes blaNDM, qnrD, aph(3')-VI, blaKPC and blaOXA-10, and plasmids IncQ and Col3M, together with NTEKPC-IId. To our knowledge, this is the first report of P. mirabilis harboring NTEKPC-IId. Although P. mirabilis is standing out as a cause of nosocomial infections and a resistant multidrug pathogen, this species is still neglected, the emergence of these P. mirabilis isolates harboring aforementioned resistance determinants and the plasmids IncQ and Col3M demonstrate the potential for dissemination of important resistance genes, mainly in the case of P. mirabilis.

2021 ◽  
Vol 45 (9) ◽  
pp. 532-540
P. Guijo Gonzalez ◽  
M.A. Gracia Romero ◽  
A. Gil Cano ◽  
M. Garcia Rojo ◽  
M. Cecconi ◽  

2021 ◽  
Vol 11 (1) ◽  
Laura Alagna ◽  
Jennifer M. T. A. Meessen ◽  
Giacomo Bellani ◽  
Daniela Albiero ◽  
Pietro Caironi ◽  

Abstract Background The role of intravenous immunoglobulins (IVIG) during sepsis is controversial, as different trials on IVIG have observed inconsistent survival benefits. We aimed to elucidate the possible association and clinical significance between circulating levels of immunoglobulins. Methods In a subset of 956 patients with severe sepsis and septic shock of the multicentre, open-label RCT ALBIOS, venous blood samples were serially collected 1, 2, and 7 days after enrolment (or at ICU discharge, whichever came first). IgA, IgG and IgM concentrations were assayed in all patients on day 1 and in a subgroup of 150 patients on days 2 and 7. Ig concentrations were measured employing a turbidimetric assay, OSR61171 system. Results IgA on day 1 had a significant predictive value for both 28-day and 90-day mortality (28-day mortality, HR: 1.50 (95% CI 1.18–1.92); 90-day mortality, HR: 1.54 (95% CI 1.25–1.91)). IgG, but not IgM, on day 1 showed similar results for 28-day (HR 1.83 (95% CI 1.33–2.51) and 90-day mortality HR: 1.66 (95% CI 1.23–2.25)). In addition, lower levels of IgG but not of IgA and IgM, at day 1 were associated with significantly higher risk of secondary infections (533 [406–772] vs 600 [452–842] mg/dL, median [Q1–Q3], p = 0.007). Conclusions In the largest cohort study of patients with severe sepsis or septic shock, we found that high levels of IgA and IgG on the first day of diagnosis were associated with a decreased 90-day survival. No association was found between IgM levels and survival. As such, the assessment of endogenous immunoglobulins could be a useful tool to identify septic patients at high risk of mortality. Trial registration #NCT00707122,, registered 30 June 2008

2021 ◽  
Vol 21 (1) ◽  
Songchang Shi ◽  
Xiaobin Pan ◽  
Hangwei Feng ◽  
Shujuan Zhang ◽  
Songjing Shi ◽  

Abstract Background Identifying the biological subclasses of septic shock might provide specific targeted therapies for the treatment and prognosis of septic shock. It might be possible to find biological markers for the early prediction of septic shock prognosis. Methods The data were obtained from the Gene Expression Omnibus databases (GEO) in NCBI. GO enrichment and KEGG pathway analyses were performed to investigate the functional annotation of up- and downregulated DEGs. ROC curves were drawn, and their areas under the curves (AUCs) were determined to evaluate the predictive value of the key genes. Results 117 DEGs were obtained, including 36 up- and 81 downregulated DEGs. The AUC for the MME gene was 0.879, as a key gene with the most obvious upregulation in septic shock. The AUC for the THBS1 gene was 0.889, as a key downregulated gene with the most obvious downregulation in septic shock. Conclusions The upregulation of MME via the renin-angiotensin system pathway and the downregulation of THBS1 through the PI3K–Akt signaling pathway might have implications for the early prediction of prognosis of septic shock in patients with pneumopathies.

2021 ◽  
Vol 2021 (3) ◽  
Elaina Pasangha ◽  
Arkadeep Dhali ◽  
Christopher D'Souza ◽  
Soumya Umesh

Background: Blood groups are inherited traits that affect the susceptibility/severity of a disease. A clear relationship between coronavirus disease 2019 (COVID-19) and ABO blood groups is yet to be established in the Indian population. This study aimed to demonstrate an association of the distribution and severity of COVID-19 with ABO blood groups. Methods: A cross-sectional study was conducted after obtaining ethics approval (IEC 207/20) among hospitalized patients using in-patient records and analyzed on SPSS-25. Chi-square tests were used for the analysis of categorical data and independent sample t-test/Mann–Whitney U tests were used for continuous data. Results: The B blood group had the highest prevalence among COVID-19-positive patients. The AB blood group was significantly associated with acute respiratory distress syndrome (ARDS) (p = 0.03), sepsis (p = 0.02), and septic shock (p = 0.02). The O blood group was associated with significantly lower rates of lymphopenia and leucocytosis. However, no significant clinical association was seen in the O blood group. Conclusion: This study has demonstrated that blood groups have a similar distribution among patients hospitalized with COVID-19 in the South Indian population. Additionally, it preludes to a possible association between the AB blood group and ARDS, sepsis, and septic shock. Further studies having a larger representation of AB blood groups, especially in patients hospitalized for critical COVID-19, with adjustment for possible covariates, are warranted to provide a reliable estimate of the risk in the South Indian population.

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