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Keighley C, Chen SCA, Marriott D, Pope A, Chapman B, Kennedy K, Bak N, Underwood N, Wilson HL, McDonald K, Darvall J, Halliday C, Kidd S, Nguyen Q, Hajkowicz K, Sorrell TC, Van Hal S, Slavin MA. Candidaemia and a risk predictive model for overall mortality: a prospective multicentre study. BMC Infect Dis 2019; 19:445. [PMID: 31113382 PMCID: PMC6528341 DOI: 10.1186/s12879-019-4065-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/02/2019] [Indexed: 01/21/2023] Open
Abstract
Background Candidaemia is associated with high mortality. Variables associated with mortality have been published previously, but not developed into a risk predictive model for mortality. We sought to describe the current epidemiology of candidaemia in Australia, analyse predictors of 30-day all-cause mortality, and develop and validate a mortality risk predictive model. Methods Adults with candidaemia were studied prospectively over 12 months at eight institutions. Clinical and laboratory variables at time of blood culture-positivity were subject to multivariate analysis for association with 30-day all-cause mortality. A predictive score for mortality was examined by area under receiver operator characteristic curves and a historical data set was used for validation. Results The median age of 133 patients with candidaemia was 62 years; 76 (57%) were male and 57 (43%) were female. Co-morbidities included underlying haematologic malignancy (n = 20; 15%), and solid organ malignancy in (n = 25; 19%); 55 (41%) were in an intensive care unit (ICU). Non-albicans Candida spp. accounted for 61% of cases (81/133). All-cause 30-day mortality was 31%. A gastrointestinal or unknown source was associated with higher overall mortality than an intravascular or urologic source (p < 0.01). A risk predictive score based on age > 65 years, ICU admission, chronic organ dysfunction, preceding surgery within 30 days, haematological malignancy, source of candidaemia and antibiotic therapy for ≥10 days stratified patients into < 20% or ≥ 20% predicted mortality. The model retained accuracy when validated against a historical dataset (n = 741). Conclusions Mortality in patients with candidaemia remains high. A simple mortality risk predictive score stratifying patients with candidaemia into < 20% and ≥ 20% 30-day mortality is presented. This model uses information available at time of candidaemia diagnosis is easy to incorporate into decision support systems. Further validation of this model is warranted. Electronic supplementary material The online version of this article (10.1186/s12879-019-4065-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Keighley
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia. .,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia. .,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia.
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - D Marriott
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW, Australia
| | - A Pope
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,School of Mathematics and Statistics, University of NSW, Sydney, NSW, Australia
| | - B Chapman
- Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - K Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - N Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - N Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - H L Wilson
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - K McDonald
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW, Australia
| | - J Darvall
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - C Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia
| | - S Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Q Nguyen
- National Centre for Clinical Excellence on Emerging Drugs of Concern (NCCRED), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - K Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - T C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - S Van Hal
- Department of Infectious Diseases and Microbiology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - M A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Melbourne, VIC, Australia
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Diet-dependent, microbiota-independent regulation of IL-10-producing lamina propria macrophages in the small intestine. Sci Rep 2016; 6:27634. [PMID: 27302484 PMCID: PMC4908404 DOI: 10.1038/srep27634] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/23/2016] [Indexed: 02/07/2023] Open
Abstract
Intestinal resident macrophages (Mϕs) regulate gastrointestinal homeostasis via production of an anti-inflammatory cytokine interleukin (IL)-10. Although a constant replenishment by circulating monocytes is required to maintain the pool of resident Mϕs in the colonic mucosa, the homeostatic regulation of Mϕ in the small intestine (SI) remains unclear. Here, we demonstrate that direct stimulation by dietary amino acids regulates the homeostasis of intestinal Mϕs in the SI. Mice that received total parenteral nutrition (TPN), which deprives the animals of enteral nutrients, displayed a significant decrease of IL-10-producing Mϕs in the SI, whereas the IL-10-producing CD4+ T cells remained intact. Likewise, enteral nutrient deprivation selectively affected the monocyte-derived F4/80+ Mϕ population, but not non-monocytic precursor-derived CD103+ dendritic cells. Notably, in contrast to colonic Mϕs, the replenishment of SI Mϕs and their IL-10 production were not regulated by the gut microbiota. Rather, SI Mϕs were directly regulated by dietary amino acids. Collectively, our study highlights the diet-dependent, microbiota-independent regulation of IL-10-producing resident Mϕs in the SI.
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Wang C, Gui Q, Zhang K. Functional polymorphisms in CD86 gene are associated with susceptibility to pneumonia-induced sepsis. APMIS 2015; 123:433-8. [PMID: 25912130 DOI: 10.1111/apm.12364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/17/2014] [Indexed: 11/30/2022]
Abstract
Sepsis is an illness in which the body has a severe response to bacteria or other germs. A bacterial infection in the body such as lungs may set off the response that leads to the disease. CD86 (B7-2) is expressed on various immune cells and plays critical roles in immune responses. Genetic polymorphisms in CD86 gene may affect the development of several diseases. Here, we evaluated the association between two CD86 polymorphisms (rs1915087C/T and rs2332096T/G) and susceptibility to pneumonia-induced sepsis. CD86 rs1915087C/T and rs2332096T/G were identified in 186 pneumonia-induced septic patients and 196 healthy controls in the Chinese population. Results revealed that subjects with rs1915087CT and TT genotypes had significantly lower risk of pneumonia-induced sepsis than those with CC genotype [odds ratio (OR) = 0.58, 95% confidence interval (CI), 0.37-0.91, p = 0.017, and OR = 0.40, 95%CI, 0.21-0.76, p = 0.005]. However, prevalence of rs2332096GG genotype and G allele were significantly increased in patients than in healthy controls (OR = 2.75, 95%CI, 1.46-5.16, p = 0.001, and OR = 1.65, 95%CI, 1.21-2.24, p = 0.001]. We further investigated functions of these two polymorphisms by assessing gene expression in peripheral blood mononuclear cells and in monocytes. Data showed subjects carrying rs2332096GG genotype had significantly decreased level of CD86 in monocytes than those carrying rs2332096TT genotype. These results indicate that CD86 polymorphisms are associated with susceptibility to pneumonia-induced sepsis and may affect gene expression in monocytes.
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Affiliation(s)
- Chenfei Wang
- Department of Emergency, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Demehri FR, Barrett M, Ralls MW, Miyasaka EA, Feng Y, Teitelbaum DH. Intestinal epithelial cell apoptosis and loss of barrier function in the setting of altered microbiota with enteral nutrient deprivation. Front Cell Infect Microbiol 2013; 3:105. [PMID: 24392360 PMCID: PMC3870295 DOI: 10.3389/fcimb.2013.00105] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 12/09/2013] [Indexed: 12/12/2022] Open
Abstract
Total parenteral nutrition (TPN), a commonly used treatment for patients who cannot receive enteral nutrition, is associated with significant septic complications due in part to a loss of epithelial barrier function (EBF). While the underlying mechanisms of TPN-related epithelial changes are poorly understood, a mouse model of TPN-dependence has helped identify several contributing factors. Enteral deprivation leads to a shift in intestinal microbiota to predominantly Gram-negative Proteobacteria. This is associated with an increase in expression of proinflammatory cytokines within the mucosa, including interferon-γ and tumor necrosis factor-α. A concomitant loss of epithelial growth factors leads to a decrease in epithelial cell proliferation and increased apoptosis. The resulting loss of epithelial tight junction proteins contributes to EBF dysfunction. These mechanisms identify potential strategies of protecting against TPN-related complications, such as modification of luminal bacteria, blockade of proinflammatory cytokines, or growth factor replacement.
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Affiliation(s)
- Farokh R Demehri
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System Ann Arbor, MI, USA
| | - Meredith Barrett
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System Ann Arbor, MI, USA
| | - Matthew W Ralls
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System Ann Arbor, MI, USA
| | - Eiichi A Miyasaka
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System Ann Arbor, MI, USA
| | - Yongjia Feng
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System Ann Arbor, MI, USA
| | - Daniel H Teitelbaum
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System Ann Arbor, MI, USA
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Kuperman EF, Showalter JW, Lehman EB, Leib AE, Kraschnewski JL. The impact of obesity on sepsis mortality: a retrospective review. BMC Infect Dis 2013; 13:377. [PMID: 23957291 PMCID: PMC3765286 DOI: 10.1186/1471-2334-13-377] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 07/17/2013] [Indexed: 01/30/2023] Open
Abstract
Background Recent sepsis guidelines have focused on the early identification and risk stratification of patients on presentation. Obesity is associated with alterations in multiple inflammatory regulators similar to changes seen in sepsis, suggesting a potential interaction between the presence of obesity and the severity of illness in sepsis. Methods We performed a retrospective chart review of patients admitted with a primary billing diagnosis of sepsis at a single United States university hospital from 2007 to 2010. Seven hundred and ninety-two charts were identified meeting inclusion criteria. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m2. The data recorded included age, race, sex, vital signs, laboratory values, length of stay, comorbidities, weight, height, and survival to discharge. A modified APACHE II score was calculated to estimate disease severity. The primary outcome variable was inpatient mortality. Results Survivors had higher average BMI than nonsurvivors (27.6 vs. 26.3 kg/m2, p = 0.03) in unadjusted analysis. Severity of illness and comorbid conditions including cancer were similar across BMI categories. Increased incidence of diabetes mellitus type 2 was associated with increasing BMI (p < 0.01) and was associated with decreased mortality, with an odds ratio of 0.53 compared with nondiabetic patients. After adjusting for age, gender, race, severity of illness, length of stay, and comorbid conditions, the trend of decreased mortality for increased BMI was no longer statistically significant, however diabetes continued to be strongly protective (odds ratio 0.52, p = 0.03). Conclusions This retrospective analysis suggests obesity may be protective against mortality in septic inpatients. The protective effect of obesity may be dependent on diabetes, possibly through an unidentified hormonal intermediary. Further prospective studies are necessary to elaborate the specific mechanism of this protective effect.
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Feng Y, Ralls MW, Xiao W, Miyasaka E, Herman RS, Teitelbaum DH. Loss of enteral nutrition in a mouse model results in intestinal epithelial barrier dysfunction. Ann N Y Acad Sci 2012; 1258:71-7. [PMID: 22731718 DOI: 10.1111/j.1749-6632.2012.06572.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Total parenteral nutrition (TPN) administration in a mouse model leads to a local mucosal inflammatory response, resulting in a loss of epithelial barrier function (EBF). Although, the underlying mechanisms are unknown, a major contributing factor is a loss of growth factors and subsequent critical downstream signaling. An important component of these is the p-Akt pathway. An additional contributing factor to the loss of EBF with TPN is an increase in proinflammatory cytokine abundance within the mucosal epithelium, including TNF-α and IFN-γ. Loss of critical nutrients, including glutamine and glutamate, may affect EBF, contributing to the loss of tight junction proteins. Finding protective modalities for the small intestine during TPN administration may have important clinical applications. Supplemental glutamine and glutamate may be examples of such agents.
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Affiliation(s)
- Yongjia Feng
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
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