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Bassi E, Tomazini BM, Carneiro BV, Siqueira ARDO, Siqueira SRDO, Guimarães T, Novo FDCF, Utiyama EM, Pelosi P, Malbouisson LMS. Impact of withholding early antibiotic therapy in nonseptic surgical patients with suspected nosocomial infection: a retrospective cohort analysis. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744431. [PMID: 36965628 PMCID: PMC11148499 DOI: 10.1016/j.bjane.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Systemic inflammatory responses mimicking infectious complications are often present in surgical patients. METHODS The objective was to assess the association between withholding early antimicrobial therapy while investigating alternative diagnoses and worse outcomes in nonseptic patients with suspected nosocomial infection in a retrospective cohort of critically ill surgical patients. The initiation of antibiotic therapy within 24 h of the suspicion of infection was defined as the Early Empirical Antibiotic strategy (EEA) group and the initiation after 24 h of suspicion or not prescribed was defined as the Conservative Antibiotic strategy (CA) group. Primary outcome was composite: death, sepsis, or septic shock within 14 days. Main exclusion criteria were sepsis or an evident source of infection at inclusion. RESULTS Three hundred and forty patients were eligible for inclusion (74% trauma patients). Age, sex, reason for hospital admission, SAPS3 score, SOFA score, and use of vasopressors or mechanical ventilation were not different between the groups. Within 14 days of inclusion, 100% (130/130) of EEA patients received antibiotics compared to 57% (120/210) of CA patients. After adjusting for confounding variables, there was no association between primary outcome and the groups. In a post hoc subgroup analysis including only patients with a posteriori confirmed infection (by microbiological cultures), delay in initiation of adequate antimicrobial therapy was independently associated with the primary outcome (Odds Ratio = 1.19 per day of delay; 95% CI 1.05-1.37). CONCLUSIONS Withholding early empiric antibiotic therapy was not associated with progression of organ dysfunction within 14 days in nonseptic surgical patients with suspected nosocomial infection without an obvious source.
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Affiliation(s)
- Estevão Bassi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil; Hospital Alemão Oswaldo Cruz, Unidade de Tratamento Intensivo, São Paulo, SP, Brazil.
| | - Bruno Martins Tomazini
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil; Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, SP, Brazil
| | - Bárbara Vieira Carneiro
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil
| | | | | | - Thais Guimarães
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Controle de Infecção, São Paulo, SP, Brazil
| | - Fernando da Costa Ferreira Novo
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil
| | - Edivaldo Massazo Utiyama
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil
| | - Paolo Pelosi
- University of Genoa, Department of Surgical Sciences and Integrated Diagnostics, Genoa, Italy; San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Anaesthesia and Intensive Care, Genoa, Italy
| | - Luiz Marcelo Sá Malbouisson
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Divisão de Anestesiologia, São Paulo, SP, Brazil
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Aiesh BM, Qashou R, Shemmessian G, Swaileh MW, Abutaha SA, Sabateen A, Barqawi AK, AbuTaha A, Zyoud SH. Nosocomial infections in the surgical intensive care unit: an observational retrospective study from a large tertiary hospital in Palestine. BMC Infect Dis 2023; 23:686. [PMID: 37833675 PMCID: PMC10576355 DOI: 10.1186/s12879-023-08677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Nosocomial infections or hospital-acquired infections are a growing public health threat that increases patient morbidity and mortality. Patients at the highest risk are those in intensive care units. Therefore, our objective was to provide a pattern analysis of nosocomial infections that occurred in an adult surgical intensive care unit (ICU). METHODS This study was a retrospective observational study conducted in a 6-bed surgical intensive care unit (SICU) at An-Najah National University Hospital (NNUH) to detect the incidence of nosocomial infections from January 2020 until December 2021. The study group included 157 patients who received antibiotics during their stay in the SICU. RESULTS The incidence of nosocomial infections, either suspected or confirmed, in the SICU was 26.9% (95 out of 352 admitted patients). Pneumonia (36.8%) followed by skin and soft tissue infections (35.8%) were the most common causes. The most common causative microorganisms were in the following order: Pseudomonas aeruginosa (26.3%), Acinetobacter baumannii (25.3%), extended-spectrum beta lactamase (ESBL)-Escherichia coli (23.2%) and Klebsiella pneumonia (15.8%). The average hospital stay of patients with nosocomial infections in the SICU was 18.5 days. CONCLUSIONS The incidence of nosocomial infections is progressively increasing despite the current infection control measures, which accounts for an increased mortality rate among critically ill patients. The findings of this study may be beneficial in raising awareness to implement new strategies for the surveillance and prevention of hospital-acquired infections in Palestinian hospitals and health care centers.
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Affiliation(s)
- Banan M Aiesh
- Infection Control Department, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Raghad Qashou
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Genevieve Shemmessian
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Mamoun W Swaileh
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Shatha A Abutaha
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Ali Sabateen
- Infection Control Department, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Abdel-Karim Barqawi
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of General Surgery, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Adham AbuTaha
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Pathology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine
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Hajduczenia MM, Klefisch FR, Hopf AGM, Grubitzsch H, Stegemann MS, Pfäfflin F, Puhlmann B, Ocken M, Kretzler L, von Schöning D, Falk V, Moter A, Kikhney J. New Perspectives for Prosthetic Valve Endocarditis: Impact of Molecular Imaging by FISHseq Diagnostics. Clin Infect Dis 2023; 76:1050-1058. [PMID: 36318608 PMCID: PMC10029985 DOI: 10.1093/cid/ciac860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The microbial etiology of prosthetic valve infective endocarditis (PVE) can be difficult to identify. Our aim was to investigate the benefit of molecular imaging technique fluorescence in situ hybridization (FISH) combined with 16S rRNA-gene polymerase chain reaction (PCR) and sequencing (FISHseq) for the analysis of infected prosthetic heart valves. METHODS We retrospectively evaluated the diagnostic outcome of 113 prosthetic valves from 105 patients with suspected PVE, treated in 2003-2013 in the Department of Cardiac Surgery, Charité University Medicine Berlin. Each prosthetic valve underwent cultural diagnostics and was routinely examined by FISH combined with 16S rRNA gene PCR and sequencing. We compared classical microbiological culture outcomes (blood and valve cultures) with FISHseq results and evaluated the diagnostic impact of the molecular imaging technique. RESULTS Conventional microbiological diagnostic alone turned out to be insufficient, as 67% of preoperative blood cultures were noninformative (negative, inconclusive, or not obtained) and 67% of valve cultures remained negative. FISHseq improved the conventional cultural diagnostic methods in PVE in 30% of the cases and increased diagnostic accuracy. Of the valve culture-negative PVE cases, FISHseq succeeded in identifying the causative pathogen in 35%. CONCLUSIONS FISHseq improves PVE diagnostics, complementing conventional cultural methods. In addition to species identification, FISH provides information about the severity of PVE and state of the pathogens (eg, stage of biofilm formation, activity, and localization on and within the prosthetic material). As a molecular imaging technique, FISHseq enables the unambiguous discrimination of skin flora as contaminant or infectious agent.
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Affiliation(s)
- Maria M Hajduczenia
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frank R Klefisch
- Department of Internal Medicine and Intensive Care Medicine, Paulinen Hospital Berlin, Berlin, Germany
| | - Alexander G M Hopf
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Miriam S Stegemann
- Department for Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frieder Pfäfflin
- Department for Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Puhlmann
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michele Ocken
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lucie Kretzler
- Clinical Trial Unit, Clinical Study Center, Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dinah von Schöning
- Department of Microbiology, Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annette Moter
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- MoKi Analytics GmbH, Berlin, Germany
- Moter Diagnostics, Berlin, Germany
| | - Judith Kikhney
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- MoKi Analytics GmbH, Berlin, Germany
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Russo E, Di Bari S, Agnoletti V. Benefits of patient risk stratification and targeted interventions on multidrug resistant pathogens prevention and control. DISCOVER HEALTH SYSTEMS 2022; 1:6. [PMID: 37521116 PMCID: PMC9664758 DOI: 10.1007/s44250-022-00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Emanuele Russo
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
| | - Silvia Di Bari
- Anesthesia and Intensive Care Department, Alma Mater Studiorum - Università di Bologna, Azienda Ospedaliero-Universitaria di Bologna IRCCS, via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
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When not to start antibiotics: avoiding antibiotic overuse in the intensive care unit. Clin Microbiol Infect 2019; 26:35-40. [PMID: 31306790 DOI: 10.1016/j.cmi.2019.07.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/01/2019] [Accepted: 07/04/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Most intensive care unit (ICU) patients receive broad-spectrum antibiotics. While lifesaving in some, in others these treatments may be unnecessary and place patients at risk of antibiotic-associated harms. OBJECTIVES To review the literature exploring how we diagnose infection in patients in the ICU and address the safety and utility of a 'watchful waiting' approach to antibiotic initiation with selected patients in the ICU. SOURCES A semi-structured search of PubMed and Cochrane Library databases for articles published in English during the past 15 years was conducted. CONTENT Distinguishing infection from non-infectious mimics in ICU patients is uniquely challenging. At present, we do not have access to a rapid point-of-care test that reliably differentiates between individuals who need antibiotics and those who do not. A small number of studies have attempted to compare early aggressive versus conservative antimicrobial strategies in the ICU. However, this body of literature is small and not robust enough to guide practice. IMPLICATIONS This issue will not likely be resolved until there are diagnostic tests that rapidly and reliably identify the presence or absence of infection in the ICU population. In the meantime, prospective trials that identify clinical situations wherein it is safe to delay or withhold antibiotic initiation in the ICU until the presence of an infection is proven are warranted.
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Dalfino L, Brienza N, Bruno F. Good antimicrobial practice: time to update the "Choosing wisely" top 5 list in Critical Care Medicine. Minerva Anestesiol 2018; 85:10-12. [PMID: 30328337 DOI: 10.23736/s0375-9393.18.13259-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lidia Dalfino
- Anesthesia and Intensive Care Unit II, Department of General Surgery, Gynecology, Obstetrics and Anesthesia, University Hospital Policlinic of Bari, Bari, Italy -
| | - Nicola Brienza
- Section of Anesthesia and Intensive Care, Emergency and Organ Transplantation Department, University of Bari, Bari, Italy
| | - Francesco Bruno
- Section of Anesthesia and Intensive Care, Emergency and Organ Transplantation Department, University of Bari, Bari, Italy
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Langley RJ, Wong HR. Early Diagnosis of Sepsis: Is an Integrated Omics Approach the Way Forward? Mol Diagn Ther 2018. [PMID: 28624903 DOI: 10.1007/s40291-017-0282-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sepsis remains one of the leading causes of death in the USA and it is expected to get worse as the population ages. Moreover, the standard of care, which recommends aggressive treatment with appropriate antibiotics, has led to an increase in multiple drug-resistant organisms. There is a dire need for the development of new antibiotics, improved antibiotic stewardship, and therapies that treat the host response. Development of new sepsis therapeutics has been a disappointment as no drugs are currently approved to treat the various complications from sepsis. Much of the failure has been blamed on animal models that do not accurately reflect the course of the disease. However, recent improvements in metabolomic, transcriptomic, genomic, and proteomic platforms have allowed for a broad-spectrum look at molecular changes in the host response using clinical samples. Integration of these multi-omic datasets allows researchers to perform systems biology approaches to identify novel pathophysiology of the disease. In this review, we highlight what is currently known about sepsis and how integrative omics has identified new diagnostic and predictive models of sepsis as well as novel mechanisms. These changes may improve patient care as well as guide future preclinical analysis of sepsis.
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Affiliation(s)
- Raymond J Langley
- Department of Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Hector R Wong
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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8
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Casaroto E, Marra AR, Camargo TZS, de Souza ARA, de Almeida CES, Pedroti EP, Victor EDS, dos Santos OFP, Edmond MB, Campos AH. Agreement on the prescription of antimicrobial drugs. BMC Infect Dis 2015; 15:248. [PMID: 26123222 PMCID: PMC4484637 DOI: 10.1186/s12879-015-0992-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 06/19/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is universal awareness of the difficulties faced by doctors when prescribing antimicrobials. METHODS Over a six-month period patients hospitalized in the ICU and under treatment with antibiotics and/or antifungals were eligible to participate in the study. The data were assessed by two infectious diseases specialists. Once completed, all case forms were sent independently to both evaluators (TZSC and ARM) by e-mail. Based on the data received, the evaluator completed a form automatically generated on the e-mail and returned it to the original mailbox for further analysis. We assessed the level of agreement between infectious disease specialists and the physicians directly responsible for the decision to begin antimicrobial therapy, as well as to assess the appropriateness of the regimen prescribed. RESULTS Among the antimicrobial regimens prescribed to the 177 patients, 36% were considered inappropriate by specialist #1 and 38% were considered inappropriate by specialist #2. We found 78% agreement by at least one of the infectious disease specialists with the prescribed antimicrobial regimen, and in 49% of cases both specialists agreed with the prescribed regimen. Both disagreed with the prescribed regimen in 22% of the cases and they disagreed between themselves in 29% of the cases. CONCLUSION This study highlights the difficulties in prescribing effective empirical antimicrobial therapy--they are of such magnitude that even two specialists in infectious diseases, well acquainted with our hospital's resistance patterns and our patients' profiles have considerable disagreement.
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Affiliation(s)
- Eduardo Casaroto
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - Alexandre R Marra
- Division of Medical Practice, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - 1st floor - Bloco A1 - Room 108 Morumbi, 05651-901, São Paulo, Brazil.
| | | | | | | | | | - Elivane da Silva Victor
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - Oscar Fernando Pavão dos Santos
- Division of Medical Practice, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - 1st floor - Bloco A1 - Room 108 Morumbi, 05651-901, São Paulo, Brazil.
| | - Michael B Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Alexandre Holthausen Campos
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Burgmann H. [First-line anti-infective treatment in sepsis]. Med Klin Intensivmed Notfmed 2014; 109:577-82. [PMID: 25344412 DOI: 10.1007/s00063-014-0378-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/16/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND The Surviving Sepsis Campaign strongly recommends that intravenous antibiotic therapy should be started as early as possible, ideally within the first hour of recognition of severe sepsis or septic shock. There is ample evidence that failure to initiate early antimicrobial treatment correlates with increased morbidity and mortality. OBJECTIVES The purpose of this work was to review the recent literature regarding optimal initial antimicrobial treatment in patients with severe sepsis and sepsis shock. MATERIALS AND METHODS A literature review was performed. RESULTS The most frequently quoted papers claiming the overriding prognostic importance of early administered antibiotics are retrospective data analyses. However, an equivalent number of studies report that a group of septic patients do not benefit from early administration of antibiotics, but can also be harmed. In these patients, watchful waiting with administration of a targeted antibiotic can be used, thus, avoiding the possible collateral damage from excessive treatment with antibiotics. Treatment with monotherapy is adequate in most cases. CONCLUSION The administration of antibiotics based on the local epidemiology should be initiated quickly in critically ill patients with severe sepsis and septic shock. In patients who are not in septic shock, treatment can be withheld, while awaiting further studies or clinical assessment to confirm the suspicion of infection.
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Affiliation(s)
- H Burgmann
- Innere Medizin I, Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich,
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10
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Langley RJ, Tipper JL, Bruse S, Baron RM, Tsalik EL, Huntley J, Rogers AJ, Jaramillo RJ, O'Donnell D, Mega WM, Keaton M, Kensicki E, Gazourian L, Fredenburgh LE, Massaro AF, Otero RM, Fowler VG, Rivers EP, Woods CW, Kingsmore SF, Sopori ML, Perrella MA, Choi AMK, Harrod KS. Integrative "omic" analysis of experimental bacteremia identifies a metabolic signature that distinguishes human sepsis from systemic inflammatory response syndromes. Am J Respir Crit Care Med 2014; 190:445-55. [PMID: 25054455 PMCID: PMC4214130 DOI: 10.1164/rccm.201404-0624oc] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/17/2014] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Sepsis is a leading cause of morbidity and mortality. Currently, early diagnosis and the progression of the disease are difficult to make. The integration of metabolomic and transcriptomic data in a primate model of sepsis may provide a novel molecular signature of clinical sepsis. OBJECTIVES To develop a biomarker panel to characterize sepsis in primates and ascertain its relevance to early diagnosis and progression of human sepsis. METHODS Intravenous inoculation of Macaca fascicularis with Escherichia coli produced mild to severe sepsis, lung injury, and death. Plasma samples were obtained before and after 1, 3, and 5 days of E. coli challenge and at the time of killing. At necropsy, blood, lung, kidney, and spleen samples were collected. An integrative analysis of the metabolomic and transcriptomic datasets was performed to identify a panel of sepsis biomarkers. MEASUREMENTS AND MAIN RESULTS The extent of E. coli invasion, respiratory distress, lethargy, and mortality was dependent on the bacterial dose. Metabolomic and transcriptomic changes characterized severe infections and death, and indicated impaired mitochondrial, peroxisomal, and liver functions. Analysis of the pulmonary transcriptome and plasma metabolome suggested impaired fatty acid catabolism regulated by peroxisome-proliferator activated receptor signaling. A representative four-metabolite model effectively diagnosed sepsis in primates (area under the curve, 0.966) and in two human sepsis cohorts (area under the curve, 0.78 and 0.82). CONCLUSIONS A model of sepsis based on reciprocal metabolomic and transcriptomic data was developed in primates and validated in two human patient cohorts. It is anticipated that the identified parameters will facilitate early diagnosis and management of sepsis.
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Hecker A, Uhle F, Schwandner T, Padberg W, Weigand MA. Diagnostics, therapy and outcome prediction in abdominal sepsis: current standards and future perspectives. Langenbecks Arch Surg 2013; 399:11-22. [PMID: 24186147 DOI: 10.1007/s00423-013-1132-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/07/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE In the perioperative phase, sepsis and sepsis-associated death are the most important problems for both the surgeon and the intensivist. Critically ill patients profit from an early identification and implementation of an interdisciplinary therapy. The purpose of this review on septic peritonitis is to give an update on the diagnosis and its evidence-based treatment. RESULTS Rapid diagnosis of sepsis is essential for patient´s survival. A bundle of studies was performed on early recognition and on new diagnostic tools for abdominal sepsis. Although surgical intervention is considered as an essential therapeutic step in sepsis therapy the time-point of source control is still controversially discussed in the literature. Furthermore, the Surviving Sepsis Campaign (SSC) guidelines were updated in 2012 to facilitate evidence-based medicine for septic patients. CONCLUSION Despite many efforts, the mortality of surgical septic patients remains unacceptably high. Permanent clinical education and further surgical trials are necessary to improve the outcome of critically ill patients.
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Affiliation(s)
- A Hecker
- Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany,
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