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Song JU, Lee J. The impact of antimicrobial de-escalation therapy in culture-negative pneumonia: a systematic review and meta-analysis. Korean J Intern Med 2023; 38:704-713. [PMID: 37586813 PMCID: PMC10493446 DOI: 10.3904/kjim.2023.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/07/2023] [Accepted: 06/09/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND/AIMS Antimicrobial de-escalation (ADE) remains a challenging strategy in the treatment of pneumonia. We investigated the outcomes of ADE as measured by mortality and duration of the use of antibiotics in patients with culture- negative pneumonia. METHODS We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. The primary outcome was inpatient mortality. RESULTS We examined six studies comprising 11,933 subjects, of whom 1,152 received ADE. Overall, the ADE strategy was associated with a statistically lower risk of in-hospital mortality compared with non-ADE (risk ratio [RR] = 0.60, 95% confidence interval [CI] = 0.38 to 0.93). Although substantial heterogeneity was found among the included studies (I2 = 66%), a meta-regression analysis could not reveal plausible sources of heterogeneity. And ADE was associated with a shorter duration of total and initial antibiotic therapies and total length of hospital stay compared with non-ADE. CONCLUSION Our findings suggest that ADE seems to be significantly associated with better clinical outcomes compared with non-ADE. Caution is demanded when interpreting data of this study because of substantial between-study heterogeneity.
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Affiliation(s)
- Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju,
Korea
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2
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Samuel L. Direct-from-Blood Detection of Pathogens: a Review of Technology and Challenges. J Clin Microbiol 2023; 61:e0023121. [PMID: 37222587 PMCID: PMC10358183 DOI: 10.1128/jcm.00231-21] [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] [Indexed: 05/25/2023] Open
Abstract
Blood cultures have been the staple of clinical microbiology laboratories for well over half a century, but gaps remain in our ability to identify the causative agent in patients presenting with signs and symptoms of sepsis. Molecular technologies have revolutionized the clinical microbiology laboratory in many areas but have yet to present a viable alternative to blood cultures. There has been a recent surge of interest in utilizing novel approaches to address this challenge. In this minireview, I discuss whether molecular tools will finally give us the answers we need and the practical challenges of incorporating them into the diagnostic algorithm.
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Affiliation(s)
- Linoj Samuel
- Division of Clinical Microbiology, Department of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, Michigan, USA
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3
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Kim DH, Park SJ, Jhang WK. Comparison of the clinical characteristics and clinical outcomes of culture-positive septic shock and culture-negative septic shock among pediatric patients. PLoS One 2023; 18:e0288615. [PMID: 37450547 PMCID: PMC10348532 DOI: 10.1371/journal.pone.0288615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Among pediatric patients with septic shock, culture-negative septic shock (CNSS) is common but there have been limited data on its clinical characteristics and prognosis. We compared the clinical characteristics and clinical outcomes between culture-positive septic shock (CPSS) and CNSS in pediatric patients. DESIGN Retrospective single-center study. SETTING Pediatric intensive care unit (PICU) of a tertiary referral hospital. PATIENTS All pediatric patients who were admitted to the PICU due to septic shock between January 2010 and November 2021, except for those with fungal or viral infections and those who expired on the day of admittance to the PICU. The primary outcome was 30-day mortality and in-hospital mortality. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 294 patients (CPSS group, n = 185 [62.9%]; CNSS group, n = 109 [37.1%]) were included. The rates of 30-day mortality and in-hospital mortality (30-day mortality 22.7% vs 22%, in-hospital mortality 29.7% vs 25.7%) were not significantly different between the CPSS group and the CNSS group. The two groups showed comparable results in clinical outcomes such as the requirement for mechanical ventilator and renal replacement therapy, PICU stay duration, and the duration of MV and vasopressor/inotrope support. Among the CPSS group, 98 (53%) patients who were infected with multi-drug resistance (MDR) bacteria had significantly higher rates of 30-day mortality and in-hospital mortality than those infected with non-MDR bacteria. CONCLUSIONS Among pediatric patients, the CPSS group and CNSS group did not show significant differences in clinical features and mortality. Among the CPSS group, those with MDR bacteria had poorer prognosis.
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Affiliation(s)
- Da Hyun Kim
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Jong Park
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Kyoung Jhang
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
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4
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Abdelaleem OO, Mohammed SR, El Sayed HS, Hussein SK, Ali DY, Abdelwahed MY, Gaber SN, Hemeda NF, El-Hmid RGA. Serum miR-34a-5p and miR-199a-3p as new biomarkers of neonatal sepsis. PLoS One 2022; 17:e0262339. [PMID: 34990478 PMCID: PMC8735601 DOI: 10.1371/journal.pone.0262339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/22/2021] [Indexed: 01/06/2023] Open
Abstract
Background Neonatal sepsis is a serious condition. Recent clinical studies have indicated that microRNAs (miRNAs) are key players in the pathogenesis of sepsis, which could be used as biomarkers for this condition. Patients and methods A total of 90 neonates with sepsis and 90 healthy neonates were enrolled in this study. qRT-PCR was performed to measure the expression levels of serum miR-34a-5p and miR-199a-3p. Results miR-34a-5p and miR-199a-3p serum levels were significantly reduced in neonates with sepsis compared with those in healthy neonates (P = 0.006 and P = 0.001, respectively). Significant correlations of miR-34a-5p and miR-199a-3p with each of TLC, RDW, RBS, and C-reactive protein (CRP) as well as SNAPII were observed, indicating their associations with the severity of neonatal sepsis. Conclusion miR-34a-5p and miR-199a-3p may be useful as novel biomarkers in neonatal sepsis and may provide a new direction for its treatment.
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Affiliation(s)
- Omayma O. Abdelaleem
- Faculty of Medicine, Departments of Medical Biochemistry and Molecular Biology, Fayoum University, Fayoum, Egypt
- * E-mail:
| | - Shereen Rashad Mohammed
- Faculty of Medicine, Departments of Medical Biochemistry and Molecular Biology, Fayoum University, Fayoum, Egypt
| | - Hassan S. El Sayed
- Faculty of Medicine, Departments of Medical Biochemistry and Molecular Biology, Fayoum University, Fayoum, Egypt
| | | | - Doaa Y. Ali
- Faculty of Medicine, Departments of Clinical Pathology, Fayoum University, Fayoum, Egypt
| | | | - Sylvana N. Gaber
- Faculty of Medicine, Departments of Microbiology and Immunology, Fayoum University, Fayoum, Egypt
| | - Nada F. Hemeda
- Faculty of Agriculture, Department of Genetics, Fayoum University, Fayoum, Egypt
| | - Rehab G. Abd El-Hmid
- Faculty of Medicine, Departments of Pediatrics, Fayoum University, Fayoum, Egypt
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5
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Taramasso L, Magnasco L, Portunato F, Briano F, Vena A, Giacobbe DR, Dentone C, Robba C, Ball L, Loconte M, Patroniti N, Frisoni P, D'Angelo R, Dettori S, Mikulska M, Pelosi P, Bassetti M. Clinical presentation of secondary infectious complications in COVID-19 patients in intensive care unit treated with tocilizumab or standard of care. Eur J Intern Med 2021; 94:39-44. [PMID: 34511338 PMCID: PMC8403658 DOI: 10.1016/j.ejim.2021.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/17/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The hypothesis of this study is that tocilizumab should affect common signs of infection due to its immunosuppressive properties. Primary aim of the study was to investigate whether the administration of tocilizumab to critically ill patients with COVID-19, led to a different clinical presentation of infectious complications compared to patients who did not receive tocilizumab. Secondary aim was investigating differences in laboratory parameters between groups. METHODS Single-centre retrospective study, enrolling COVID-19 patients who developed a microbiologically confirmed infectious complication [ventilator associated pneumonia or bloodstream infection] after intensive care unit [ICU] admission and either treated with tocilizumab or not [controls]. RESULTS A total of 58 patients were included, 25 treated with tocilizumab and 33 controls. Median time from tocilizumab administration to infection onset was 10 days [range 2-26]. Patients were 78% male, with median age 65 years [range 45-79]. At first clinical presentation of the infectious event, the frequency of hypotension [11/25, 44% vs. 11/33, 33%], fever [8/25, 32% vs. 10/33, 30%] or hypothermia [0/25,0%, vs. 2/33, 6%], and oxygen desaturation [6/25, 28% vs 4/33, 12%], as well as the frequency of SOFA score increase of ≥ 2 points [4/25, 16%,vs. 4/33, 12%] was similar in tocilizumab treated patients and controls [p>0.1 for all comparisons]. Among laboratory parameters, C-Reactive Protein elevation was reduced in tocilizumab treated patients compared to controls [8/25, 32% vs. 22/33, 67%, p=0.009]. CONCLUSION The clinical features of infectious complications in critically ill patients with COVID-19 admitted to ICU were not affected by tocilizumab.
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Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
| | - Laura Magnasco
- Infectious Diseases Unit, Department of Internal Medicine, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Federica Portunato
- Infectious Diseases Unit, Department of Internal Medicine, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Federica Briano
- Infectious Diseases Unit, Department of Health Sciences [DISSAL], University of Genoa, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Unit, Department of Internal Medicine, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Daniele R Giacobbe
- Infectious Diseases Unit, Department of Internal Medicine, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy; Infectious Diseases Unit, Department of Health Sciences [DISSAL], University of Genoa, Genoa, Italy
| | - Chiara Dentone
- Infectious Diseases Unit, Department of Internal Medicine, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics [DISC], University of Genoa, Genoa, Italy
| | - Maurizio Loconte
- Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Nicolò Patroniti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics [DISC], University of Genoa, Genoa, Italy
| | - Paolo Frisoni
- Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Raffaele D'Angelo
- Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Silvia Dettori
- Infectious Diseases Unit, Department of Health Sciences [DISSAL], University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit, Department of Internal Medicine, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy; Infectious Diseases Unit, Department of Health Sciences [DISSAL], University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics [DISC], University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Department of Internal Medicine, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy; Infectious Diseases Unit, Department of Health Sciences [DISSAL], University of Genoa, Genoa, Italy
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Kirsch N, Ha J, Kang HT, Frisch T, Yoo JW, Grossman C, Oroomchi N, Shigemitsu H, Cross CL, Kioka MJ. Factors associated with the appropriate use of ultra-broad spectrum antibiotics, meropenem, for suspected healthcare-associated pneumonia. Medicine (Baltimore) 2021; 100:e27488. [PMID: 34622881 PMCID: PMC8500636 DOI: 10.1097/md.0000000000027488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/14/2021] [Indexed: 01/05/2023] Open
Abstract
Pneumonia is a common disease-causing hospitalization. When a healthcare-associated infection is suspected, antibiotics that provide coverage for multi-drug resistant (MDR) or extended-spectrum beta-lactamase (ESBL) bacteria are frequently prescribed. Limited data is available for guidance on using meropenem as a first-line empiric antimicrobial in hospitalized patients with risk factors for MDR/ESBL bacterial infections.This was a single-center, retrospective study designed and conducted to identify factors associated with positive cultures for MDR/ESBL pathogens in hospitalized patients with suspected healthcare-associated pneumonia.Of the 246 patients, 103 patients (41%) received meropenem. Among patients prescribed meropenem, MDR/ESBL pathogens were detected in only 20 patients (13%). Patients admitted from a skilled nursing facility/long-term acute care (SNF/LTAC) or with a history of a positive culture for MDR/ESBL pathogens were significantly associated with positive cultures of MDR/ESBL pathogens during the hospitalization (odds ratio [95% confidence intervals], 31.40 [5.20-189.6] in SNF/LTAC and 18.50 [2.98-115.1] in history of culture-positive MDR/ESBL pathogen). There was no significant difference in mortality between the 3 antibiotic groups.Admission from a SNF/LTAC or having a history of cultures positive for MDR/ESBL pathogens were significantly associated with a positive culture for MDR/ESBL pathogens during the subsequent admission. We did not detect significant association between meropenem use as a first-line drug and morbidity and mortality for patients admitted to the hospital with suspected healthcare-associated pneumonia, and further prospective studies with larger sample size are needed to confirm our findings.
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Affiliation(s)
- Nathan Kirsch
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada, Las Vegas, NV
| | - Jane Ha
- Department of Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Tina Frisch
- Department of Pharmacy University Medical Center, Las Vegas, NV
| | - Ji Won Yoo
- Division of Geriatrics, Department of Internal Medicine, University of Nevada, Las Vegas, NV
| | - Craig Grossman
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada, Las Vegas, NV
| | - Neema Oroomchi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada, Las Vegas, NV
| | - Hidenobu Shigemitsu
- Department of Intensive Care Medicine, Tokyo Medical Dental University, Tokyo, Japan
| | - Chad L. Cross
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV
| | - Mutsumi John Kioka
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada, Las Vegas, NV
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7
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Narayana Iyengar S, Dietvorst J, Ferrer-Vilanova A, Guirado G, Muñoz-Berbel X, Russom A. Toward Rapid Detection of Viable Bacteria in Whole Blood for Early Sepsis Diagnostics and Susceptibility Testing. ACS Sens 2021; 6:3357-3366. [PMID: 34410700 PMCID: PMC8477386 DOI: 10.1021/acssensors.1c01219] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
![]()
Sepsis is a serious
bloodstream infection where the immunity of
the host body is compromised, leading to organ failure and death of
the patient. In early sepsis, the concentration of bacteria is very
low and the time of diagnosis is very critical since mortality increases
exponentially with every hour after infection. Common culture-based
methods fail in fast bacteria determination, while recent rapid diagnostic
methods are expensive and prone to false positives. In this work,
we present a sepsis kit for fast detection of bacteria in whole blood,
here achieved by combining selective cell lysis and a sensitive colorimetric
approach detecting as low as 103 CFU/mL bacteria in less
than 5 h. Homemade selective cell lysis buffer (combination of saponin
and sodium cholate) allows fast processing of whole blood in 5 min
while maintaining bacteria alive (100% viability). After filtration,
retained bacteria on filter paper are incubated under constant illumination
with the electrochromic precursors, i.e., ferricyanide and ferric
ammonium citrate. Viable bacteria metabolically reduce iron(III) complexes,
initiating a photocatalytic cascade toward Prussian blue formation.
As a proof of concept, we combine this method with antibiotic susceptibility
testing to determine the minimum inhibitory concentration (MIC) using
two antibiotics (ampicillin and gentamicin). Although this kit is
used to demonstrate its applicability to sepsis, this approach is
expected to impact other key sectors such as hygiene evaluation, microbial
contaminated food/beverage, or UTI, among others.
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Affiliation(s)
- Sharath Narayana Iyengar
- Division of Nanobiotechnology, Department of Protein Science, Science for Life Laboratory, KTH Royal Institute of Technology, Stockholm 17165, Sweden
- AIMES - Center for the Advancement of Integrated Medical and Engineering Sciences at Karolinska Institutet and KTH Royal Institute of Technology, Stockholm 17165, Sweden
| | - Jiri Dietvorst
- Instituto de Microelectrónica de Barcelona (IMB-CNM, CSIC), Universitat Autónoma de Barcelona, Cerdanyola del vallès, Barcelona 08193, Spain
| | - Amparo Ferrer-Vilanova
- Instituto de Microelectrónica de Barcelona (IMB-CNM, CSIC), Universitat Autónoma de Barcelona, Cerdanyola del vallès, Barcelona 08193, Spain
| | - Gonzalo Guirado
- Department de Química, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona 08193, Spain
| | - Xavier Muñoz-Berbel
- Instituto de Microelectrónica de Barcelona (IMB-CNM, CSIC), Universitat Autónoma de Barcelona, Cerdanyola del vallès, Barcelona 08193, Spain
| | - Aman Russom
- Division of Nanobiotechnology, Department of Protein Science, Science for Life Laboratory, KTH Royal Institute of Technology, Stockholm 17165, Sweden
- AIMES - Center for the Advancement of Integrated Medical and Engineering Sciences at Karolinska Institutet and KTH Royal Institute of Technology, Stockholm 17165, Sweden
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8
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Nasser BA, Mesned AR, Tageldein M, Kabbani MS, Sayed NS. Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery? Avicenna J Med 2021; 7:182-188. [PMID: 29119086 PMCID: PMC5655650 DOI: 10.4103/ajm.ajm_51_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Infection is a common serious complication postpediatric cardiac surgery. Diagnosis of infection after cardiopulmonary bypass (CPB) is difficult in the presence of surgical stress, hemodynamic instability, and inflammatory reaction. Aim: The purpose of this study is to investigate the value of available inflammatory biomarkers and its validity to differentiate infection from inflammation postpediatric cardiac surgery and to find the trend and the change in the level of these biomarkers shortly after cardiac surgery. Methods: We conducted a prospective study that included all children who underwent cardiac surgery in Prince Sultan Cardiac Centre-Qassim from November 2013 to October 2015. C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and neutrophil count were measured for all patients presurgery, 4 consecutive days postsurgery, and predischarge. Patients were divided into two groups (the infected and the noninfected group). We compared the level of biomarkers between both groups. Then, we further analyzed the effects of CPB and preoperative steroid on postoperative inflammatory biomarker levels. Collected data were then reviewed and analyzed. Results: There were 134 pediatric cardiac patients included during the study period. Group 1 (bacterial negative culture group) had 125 cases and Group 2 (bacterial positive culture group) had nine cases. We found no statistically significant difference in inflammatory biomarker elevation between both groups. Only Group 2 had higher (RACHS) Risk adjustment for congenital heart surgery score, more ventilator days, and more drop in platelet count on the 2nd and 3rd postoperative days in comparison with the noninfected group 1. Both groups of patients who were in on and off CPB had the same level of inflammatory biomarkers with no significant differences. Giving corticosteroid preoperatively did not affect the trend of biomarker elevation and made no difference when it was compared to the group of patients who did not receive corticosteroid before surgery. Conclusion: Common inflammatory biomarkers cannot differentiate between infection and inflammation within the first 5 days postpediatric cardiac surgery as these reflect the inflammatory process rather than infection. Trend is more important than single reading.
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Affiliation(s)
- Bana Agha Nasser
- Prince Sultan Cardiac Center, Pediatric Cardiac Intensive Care, Qassim, Kingdom of Saudi Arabia
| | - Abdu Rahman Mesned
- Prince Sultan Cardiac Center, Pediatric Cardiac Intensive Care, Qassim, Kingdom of Saudi Arabia
| | - Mohamad Tageldein
- Prince Sultan Cardiac Center, Pediatric Cardiac Surgery, Qassim, Kingdom of Saudi Arabia
| | - Mohamed S Kabbani
- Department of Cardiac Sciences, Pediatric Cardiac Intensive Care, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Nada Siddig Sayed
- Prince Sultan Cardiac Center, Pediatric Cardiac Surgery, Qassim, Kingdom of Saudi Arabia
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9
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Shallcross L, Rockenschaub P, Blackburn R, Nazareth I, Freemantle N, Hayward A. Antibiotic prescribing for lower UTI in elderly patients in primary care and risk of bloodstream infection: A cohort study using electronic health records in England. PLoS Med 2020; 17:e1003336. [PMID: 32956399 PMCID: PMC7505443 DOI: 10.1371/journal.pmed.1003336] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Research has questioned the safety of delaying or withholding antibiotics for suspected urinary tract infection (UTI) in older patients. We evaluated the association between antibiotic treatment for lower UTI and risk of bloodstream infection (BSI) in adults aged ≥65 years in primary care. METHODS AND FINDINGS We analyzed primary care records from patients aged ≥65 years in England with community-onset UTI using the Clinical Practice Research Datalink (2007-2015) linked to Hospital Episode Statistics and census data. The primary outcome was BSI within 60 days, comparing patients treated immediately with antibiotics and those not treated immediately. Crude and adjusted associations between exposure and outcome were estimated using generalized estimating equations. A total of 147,334 patients were included representing 280,462 episodes of lower UTI. BSI occurred in 0.4% (1,025/244,963) of UTI episodes with immediate antibiotics versus 0.6% (228/35,499) of episodes without immediate antibiotics. After adjusting for patient demographics, year of consultation, comorbidities, smoking status, recent hospitalizations, recent accident and emergency (A&E) attendances, recent antibiotic prescribing, and home visits, the odds of BSI were equivalent in patients who were not treated with antibiotics immediately and those who were treated on the date of their UTI consultation (adjusted odds ratio [aOR] 1.13, 95% CI 0.97-1.32, p-value = 0.105). Delaying or withholding antibiotics was associated with increased odds of death in the subsequent 60 days (aOR 1.17, 95% CI 1.09-1.26, p-value < 0.001), but there was limited evidence that increased deaths were attributable to urinary-source BSI. Limitations include overlap between the categories of immediate and delayed antibiotic prescribing, residual confounding underlying differences between patients who were/were not treated with antibiotics, and lack of microbiological diagnosis for BSI. CONCLUSIONS In this study, we observed that delaying or withholding antibiotics in older adults with suspected UTI did not increase patients' risk of BSI, in contrast with a previous study that analyzed the same dataset, but mortality was increased. Our findings highlight uncertainty around the risks of delaying or withholding antibiotic treatment, which is exacerbated by systematic differences between patients who were and were not treated immediately with antibiotics. Overall, our findings emphasize the need for improved diagnostic/risk prediction strategies to guide antibiotic prescribing for suspected UTI in older adults.
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Affiliation(s)
- Laura Shallcross
- Institute of Health Informatics, University College London, London, United Kingdom
- * E-mail:
| | - Patrick Rockenschaub
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Ruth Blackburn
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Andrew Hayward
- Institute of Epidemiology & Healthcare, University College London, London, United Kingdom
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10
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Denny KJ, Gartside JG, Alcorn K, Cross JW, Maloney S, Keijzers G. Appropriateness of antibiotic prescribing in the Emergency Department. J Antimicrob Chemother 2020; 74:515-520. [PMID: 30445465 PMCID: PMC6337898 DOI: 10.1093/jac/dky447] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022] Open
Abstract
Background Antibiotics are some of the most commonly prescribed drugs in the Emergency Department (ED) and yet data describing the overall appropriateness of antibiotic prescribing in the ED is scarce. Objectives To describe the appropriateness of antibiotic prescribing in the ED. Methods A retrospective, observational study of current practice. All patients who presented to the ED during the study period and were prescribed at least one antibiotic were included. Specialists from Infectious Disease, Microbiology and Emergency Medicine and a Senior Pharmacist assessed antibiotic appropriateness against evidence-based guidelines. Results A total of 1019 (13.6%) of patient presentations involved the prescription of at least one antibiotic. Of these, 640 (62.8%) antibiotic prescriptions were assessed as appropriate, 333 (32.7%) were assessed as inappropriate and 46 (4.5%) were deemed to be not assessable. Adults were more likely to receive an inappropriate antibiotic prescription than children (36.9% versus 22.9%; difference 14.1%, 95% CI 7.2%–21.0%). Patients who met quick Sepsis-related Organ Failure Assessment (qSOFA) criteria were more likely to be prescribed inappropriate antibiotics (56.7% versus 36.1%; difference 20.5%, 95% CI, 2.4%–38.7%). There was no difference in the incidence of appropriate antibiotic prescribing based on patient gender, disposition (admitted/discharged), reason for antibiotic administration (treatment/prophylaxis) or time of shift (day/night). Conclusions Inappropriate administration of antibiotics can lead to unnecessary adverse events, treatment failure and antimicrobial resistance. With over one in three antibiotic prescriptions in the ED being assessed as inappropriate, there is a pressing need to develop initiatives to improve antibiotic prescribing to prevent antibiotic-associated patient and community harms.
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Affiliation(s)
- Kerina J Denny
- Gold Coast University Hospital, Gold Coast, Australia.,Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | | | - Kylie Alcorn
- Gold Coast University Hospital, Gold Coast, Australia
| | - Jack W Cross
- Gold Coast University Hospital, Gold Coast, Australia
| | | | - Gerben Keijzers
- Gold Coast University Hospital, Gold Coast, Australia.,School of Medicine, Bond University, Gold Coast, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
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11
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Lertwattanachai T, Montakantikul P, Tangsujaritvijit V, Sanguanwit P, Sueajai J, Auparakkitanon S, Dilokpattanamongkol P. Clinical outcomes of empirical high-dose meropenem in critically ill patients with sepsis and septic shock: a randomized controlled trial. J Intensive Care 2020; 8:26. [PMID: 32318268 PMCID: PMC7158081 DOI: 10.1186/s40560-020-00442-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Appropriate antimicrobial dosing is challenging because of changes in pharmacokinetics (PK) parameters and an increase in multidrug-resistant (MDR) organisms in critically ill patients. This study aimed to evaluate the effects of an empirical therapy of high-dose versus standard-dose meropenem in sepsis and septic shock patients. Methods We performed a prospective randomized open-label study to compare the changes of modified sequential organ failure assessment (mSOFA) score and other clinical outcomes of the high-dose meropenem (2-g infusion over 3 h every 8 h) versus the standard-dose meropenem (1-g infusion over 3 h every 8 h) in sepsis and septic shock patients. Patients' characteristics, clinical and microbiological outcomes, 14 and 28-day mortality, vasopressor- and ventilator-free days, intensive care unit (ICU) and hospital-free days, percent of the time of antibiotic concentrations above the minimum inhibitory concentration (%T>MIC), and safety were assessed. Results Seventy-eight patients were enrolled. Median delta mSOFA was comparable between two groups (- 1 in the high-dose group vs. - 1 in the standard-dose group; P value = 0.75). There was no difference between the two groups regarding clinical and microbiological cure, 14- and 28-day mortality, vasopressor- and ventilator-free days, and ICU- and hospital-free days. In patients admitted from the emergency department (ED) with a mSOFA score ≥ 7, the high-dose group demonstrated significantly better microbiological cure compared with the standard-dose group (75% (9/12 patients) vs. 20% (2/10 patients); P value = 0.03). Likewise, the high-dose group presented higher microbiological cure rate in patients admitted from ED who had either APACHE II score > 20 (83.3% (10/12) vs. 28.6% (2/7); P value = 0.045) or on mechanical ventilator (87.5% (7/8) vs. 23.1% (3/13); P value = 0.008) than the standard-dose group. Adverse events were comparable between the two groups. Conclusions Empirical therapy with the high-dose meropenem presented comparable clinical outcomes to the standard-dose meropenem in sepsis and septic shock patients. Besides, subgroup analysis manifested superior microbiological cure rate in sepsis or septic shock patients admitted from ED. Trial registration ClinicalTrials.gov, NCT03344627, registered on November 17, 2017.
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Affiliation(s)
- Tospon Lertwattanachai
- 1Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400 Thailand
| | - Preecha Montakantikul
- 1Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400 Thailand
| | - Viratch Tangsujaritvijit
- 2Department of Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Piyavate Hospital, Bangkok, Thailand
| | - Pitsucha Sanguanwit
- 4Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jetjamnong Sueajai
- 5Toxicology Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Saranya Auparakkitanon
- 5Toxicology Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Sigakis MJG, Jewell E, Maile MD, Cinti SK, Bateman BT, Engoren M. Culture-Negative and Culture-Positive Sepsis: A Comparison of Characteristics and Outcomes. Anesth Analg 2020; 129:1300-1309. [PMID: 30829670 DOI: 10.1213/ane.0000000000004072] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The primary objective of this study was to compare the characteristics of culture-positive and culture-negative status in septic patients. We also determined whether culture status is associated with mortality and whether unique variables are associated with mortality in culture-positive and culture-negative patients separately. METHODS Utilizing patient records from intensive care units, emergency department, and general care wards in a large academic medical center, we identified adult patients with suspected infection and ≥2 systemic inflammatory response syndrome criteria between January 1, 2007, and May 31, 2014. We compared the characteristics between culture-positive and culture-negative patients and used binary logistic regression to identify variables independently associated with culture status and mortality. We also did sensitivity analyses using patients with Sequential Organ Failure Assessment and quick Sequential Organ Failure Assessment criteria for sepsis. RESULTS The study population included 9288 culture-negative patients (89%) and 1105 culture-positive patients (11%). Culture-negative patients received more antibiotics during the 48 hours preceding diagnosis but otherwise demonstrated similar characteristics as culture-positive patients. After adjusting for illness severity, a positive culture was not independently associated with mortality (odds ratio = 1.01 [95% CI, 0.81-1.26]; P = .945). The models predicting mortality separately in culture-negative and culture-positive patients demonstrated very good and excellent discrimination (C-statistic ± SD, 0.87 ± 0.01 and 0.92 ± 0.01), respectively. In the sensitivity analyses using patients with sepsis by Sequential Organ Failure Assessment and quick Sequential Organ Failure Assessment criteria, after adjustments for illness severity, positive cultures were still not associated with mortality (odds ratio = 1.13 [95% CI, 0.86-1.43]; P = .303; and odds ratio = 1.05 [95% CI, 0.83-1.33]; P = .665), respectively. In all models, physiological derangements were associated with mortality. CONCLUSIONS While culture status is important for tailoring antibiotics, culture-negative and culture-positive patients with sepsis demonstrate similar characteristics and, after adjusting for severity of illness, similar mortality. The most important factor associated with negative cultures is receipt of antibiotics during the preceding 48 hours. The risk of death in patients suspected of having an infection is most associated with severity of illness. This is aligned with the Sepsis-3 definition using Sequential Organ Failure Assessment score to better identify those suspected of infection at highest risk of a poor outcome.
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Affiliation(s)
- Matthew J G Sigakis
- From the Division of Critical Care Medicine, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Elizabeth Jewell
- From the Division of Critical Care Medicine, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Michael D Maile
- From the Division of Critical Care Medicine, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Sandro K Cinti
- Division of Infectious Disease, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brian T Bateman
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Milo Engoren
- From the Division of Critical Care Medicine, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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13
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Almajidy A, Jasim A, Almajidy R. Analysis Of Blood Culture Results Of Burn Septicaemia Patients Over A Period Of Nine Years In The Baghdad Burn Medical Centre. ANNALS OF BURNS AND FIRE DISASTERS 2020; 33:27-32. [PMID: 32523492 PMCID: PMC7263722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/19/2020] [Indexed: 06/11/2023]
Abstract
Burn is one of the most devastating traumas that someone can encounter in their life. Burn wound sepsis is still the leading cause of death in burned patients. Appropriate knowledge of the causative pathogen in burn sepsis is important for successful patient management and for the reduction of the incidence of antibiotic resistance. A retrospective study was conducted between 2010 and 2018 at the Burn Specialty Hospital in Baghdad. A total of 320 blood culture samples were obtained from patients with sepsis or suspected of having sepsis. Patient age ranged between 9 months to 70 years old, with a mean total burn surface area of 45.26%. The most common microorganisms isolated from those patients who had sepsis or suspicion of sepsis were Klebsiella (48 cases) followed by Pseudomonas (36 cases), Staphylococcus species (26 cases), Enterococcus (8 cases), Acinetobacter (11 cases), E-Coli (11 cases), Candida (4 cases), Proteus (2 cases), and Salmonella, Streptococcus pneumonia, Monilia, and Seriata one case for each. The most commonly isolated organism was Klebsiella: it was sensitive to Imipenem followed by Amikacin, Nitrofurantoin, Piperacillin, Ciprofloxacin, Co-trimoxazole, Chloramphenicol, Tetracycline, Azithromycin and Cefotaxime. Microbiological surveillance of burn patients with sepsis or suspicion of having sepsis over a period of 9 years in our hospital has shown that the most common microorganism isolated from blood cultures was Klebsiella. Klebsiella was sensitive to Imipenem mainly according to sensitivity testing using the disk diffusion method.
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Affiliation(s)
| | - A.K. Jasim
- Department of Surgery, College of Medicine, University of Baghdad, Iraq
| | - R.K. Almajidy
- Department of Neurosurgery, University Medical Centre Freiburg and Faculty of Medicine, University of Freiburg, Germany
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Elmassry MM, Mudaliar NS, Colmer-Hamood JA, San Francisco MJ, Griswold JA, Dissanaike S, Hamood AN. New markers for sepsis caused by Pseudomonas aeruginosa during burn infection. Metabolomics 2020; 16:40. [PMID: 32170472 PMCID: PMC7223005 DOI: 10.1007/s11306-020-01658-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/05/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Sepsis is a leading cause of mortality in burn patients. One of the major causes of sepsis in burn patients is Pseudomonas aeruginosa. We hypothesized that during dissemination from infected burn wounds and subsequent sepsis, P. aeruginosa affects the metabolome of the blood resulting in changes to specific metabolites that would serve as biomarkers for early diagnosis of sepsis caused by P. aeruginosa. OBJECTIVES To identify specific biomarkers in the blood after sepsis caused by P. aeruginosa infection of burns. METHODS Gas chromatography with time-of-flight mass spectrometry was used to compare the serum metabolome of mice that were thermally injured and infected with P. aeruginosa (B-I) to that of mice that were neither injured nor infected, mice that were injured but not infected, and mice that were infected but not injured. RESULTS Serum levels of 19 metabolites were significantly increased in the B-I group compared to controls while levels of eight metabolites were significantly decreased. Thymidine, thymine, uridine, and uracil (related to pyrimidine metabolism), malate and succinate (a possible sign of imbalance in the tricarboxylic acid cycle), 5-oxoproline (related to glutamine and glutathione metabolism), and trans-4-hydroxyproline (a major component of the protein collagen) were increased. Products of amino acid metabolism were significantly decreased in the B-I group, including methionine, tyrosine, indole-3-acetate, and indole-3-propionate. CONCLUSION In all, 26 metabolites were identified, including a unique combination of five metabolites (trans-4-hydroxyproline, 5-oxoproline, glycerol-3-galactoside, indole-3-acetate, and indole-3-propionate) that could serve as a set of biomarkers for early diagnosis of sepsis caused by P. aeruginosa in burn patients.
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Affiliation(s)
- Moamen M Elmassry
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Nithya S Mudaliar
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Caris Life Sciences, Phoenix, AZ, USA
| | - Jane A Colmer-Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, 3601 4th Street STOP 6591, Lubbock, TX, 79430-6591, USA
- Department of Medical Education, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Michael J San Francisco
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, USA
- Honors College, Texas Tech University, Lubbock, TX, USA
| | - John A Griswold
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Abdul N Hamood
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, 3601 4th Street STOP 6591, Lubbock, TX, 79430-6591, USA.
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Liu G, Liu W, Guo J. Clinical significance of miR-181a in patients with neonatal sepsis and its regulatory role in the lipopolysaccharide-induced inflammatory response. Exp Ther Med 2020; 19:1977-1983. [PMID: 32104257 DOI: 10.3892/etm.2020.8408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/30/2019] [Indexed: 12/16/2022] Open
Abstract
Neonatal sepsis (NS) poses a serious threat to the health of neonates worldwide. The present study aimed to investigate the diagnostic value of microRNA (miR)-181a in patients with NS and the regulatory role of miR-181a in lipopolysaccharide (LPS)-induced inflammation. A total of 102 neonates with NS and 50 neonates without sepsis were enrolled in the present study. The serum levels of miR-181a were estimated using reverse transcription-quantitative PCR. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic value of miR-181a for NS. The effect of miR-181a on the expression of Toll-like receptor (TLR)4 was assessed after modification of the expression of miR-181a in monocytes isolated from the blood of neonates in vitro. An ELISA was used to measure the concentration of inflammatory cytokines tumor necrosis factor (TNF)-α and interleukin (IL)-8 in the supernatant of monocytes. The serum levels of miR-181a were decreased in patients with NS compared with those in the controls. The area under the ROC curve of miR-181a was 0.893 with a sensitivity of 83.3% and a specificity of 84.0%. LPS stimulation in monocytes also led to a decrease in the expression of miR-181a. TLR4 was proven to be a direct target gene of miR-181a, according to the results of a luciferase reporter assay, and overexpression of miR-181a suppressed TLR4 expression in monocytes. Regarding LPS-induced inflammation, it was revealed that the upregulated levels of TNF-α and IL-8 induced by LPS were reduced by overexpression of miR-181a in monocytes. In conclusion, decreased serum levels of miR-181a may serve as a diagnostic biomarker in patients with NS and overexpression of miR-181a inhibits the LPS-induced inflammatory response at least partially by targeting TLR4. Aberrant miR-181a may be a non-invasive biomarker for NS patients, and provide a novel insight into the pathologic mechanisms of action behind the development of NS.
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Affiliation(s)
- Guozhi Liu
- Department of Neonatology, Yidu Central Hospital of Weifang, Weifang, Shandong 262500, P.R. China
| | - Wei Liu
- Department of Neonatology, Yidu Central Hospital of Weifang, Weifang, Shandong 262500, P.R. China
| | - Jie Guo
- Department of Neonatology, Yidu Central Hospital of Weifang, Weifang, Shandong 262500, P.R. China
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Abstract
BAKGROUND Systemic inflammatory response syndrome, which is marked by fever, is a possible complication after open-heart surgery for CHD. The inflammatory response following the use of cardiopulmonary bypass shows similar clinical signs with sepsis. Therefore serial measurements of procalcitonin, an early infection marker, can be helpful to differentiate between sepsis and systemic inflammatory response syndrome. OBJECTIVES To evaluate serial levels of procalcitonin in children who underwent open-heart surgery for cyanotic and acyanotic CHD, and identify factors associated with elevated level of procalcitonin. METHODS Children and infants who had open-heart surgery and showed fever within 6 hours after surgery were recruited. Procalcitonin levels were serially measured along with leukocyte and platelet count. Other data were also recorded, including diagnosis, age, body weight, axillary temperature, aortic clamp time, bypass time, duration of mechanical ventilation, risk adjustment for congenital heart surgery score-1, and length of stay in Cardiac ICU. The patients were categorised into cyanotic and acyanotic CHD groups. RESULTS High mean of procalcitonin level suggested the presence of bacterial infection. Cyanotic CHD group had significantly higher mean of procalcitonin level compared to acyanotic CHD group in the first two measurements. Both groups had no leukocytosis, though platelet count results were significantly different between the two groups. There was no significant difference of procalcitonin level observed in culture results and adverse outcomes. CONCLUSION Serial procalcitonin measurement can be helpful to determine the cause of fever. Meanwhile other conventional markers such as leukocyte and platelet should be assessed thoroughly.
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17
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Abstract
Procalcitonin is a biomarker that is generally elevated in bacterial infections. This review describes a conceptual framework for biomarkers using lessons from the history of troponin, applies this framework to procalcitonin with a review of observational studies and randomized trials in and out of the intensive care unit, and concludes with clinical recommendations and thoughts on how to test a test.
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Valiña L, Andrade BL, Bauça JM. Atypical Hemolytic Uremic Syndrome: Genetic Landscape Challenge. EJIFCC 2019; 30:340-345. [PMID: 31695590 PMCID: PMC6803772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Laura Valiña
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain,Institut d’Investigació Sanitària de les Illes Balears (IdlSBa), Spain,Corresponding author: Laura Valiña Amado Hospital Universitari Son Espases Ctra. de Valldemossa, 79, module J-0 07010 Palma, Balearic Islands Spain E-mail: laura
| | - Bernardo López Andrade
- Department of Hematology and Hemotherapy, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain
| | - Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain,Institut d’Investigació Sanitària de les Illes Balears (IdlSBa), Spain
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Epidemiology of Community-Acquired Sepsis in Adult Patients: A Six Year Observational Study. ACTA ACUST UNITED AC 2019; 39:59-66. [PMID: 30110265 DOI: 10.2478/prilozi-2018-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection and it is a major cause of morbidity and mortality worldwide. The aim of this study is to describe epidemiology of community-acquired sepsis in the Intensive care unit (ICU) of the Macedonian tertiary care University Clinic for Infectious Diseases. A prospective observational study was conducted over a 6-year period from January, 2011 to December, 2016. All consecutive adults with community-acquired sepsis or septic shock were included in the study. Variables measured were incidence of sepsis, age, gender, comorbidities, season, source of infection, complications, interventions, severity indexes, length of stay, laboratory findings, blood cultures, 28-day and in hospital mortality. Of 1348 admissions, 277 (20.5%) had sepsis and septic shock. The most common chronic condition was heart failure (26.4%), and the most frequent site of infection was the respiratory tract (57.4%). Median Simplified Acute Physiology Score (SAPS II) was 50.0, and median Sequential Organ Failure Assessment (SOFA) score was 8.0. Blood cultures were positive in 22% of the cases. Gram-positive bacteria were isolated in 13% and Gram-negatives in 9.7% of patients with sepsis. The overall 28-day and in hospital mortality was 50.5% and 56.3% respectively. The presence of chronic heart failure, occurrence of ARDS, septic shock and the winter period may influence an unfavorable outcome. Mortality compared to previous years is unchanged but patients that we have been treating these last 6 years have had more severe illnesses. Better adherence to the Surviving Sepsis guidelines will reduce mortality in this group of severely ill patients.
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Park KS, Svennerholm K, Shelke GV, Bandeira E, Lässer C, Jang SC, Chandode R, Gribonika I, Lötvall J. Mesenchymal stromal cell-derived nanovesicles ameliorate bacterial outer membrane vesicle-induced sepsis via IL-10. Stem Cell Res Ther 2019; 10:231. [PMID: 31370884 PMCID: PMC6676541 DOI: 10.1186/s13287-019-1352-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022] Open
Abstract
Background Sepsis remains a source of high mortality in hospitalized patients despite proper antibiotic approaches. Encouragingly, mesenchymal stromal cells (MSCs) and their produced extracellular vesicles (EVs) have been shown to elicit anti-inflammatory effects in multiple inflammatory conditions including sepsis. However, EVs are generally released from mammalian cells in relatively low amounts, and high-yield isolation of EVs is still challenging due to a complicated procedure. To get over these limitations, vesicles very similar to EVs can be produced by serial extrusions of cells, after which they are called nanovesicles (NVs). We hypothesized that MSC-derived NVs can attenuate the cytokine storm induced by bacterial outer membrane vesicles (OMVs) in mice, and we aimed to elucidate the mechanism involved. Methods NVs were produced from MSCs by the breakdown of cells through serial extrusions and were subsequently floated in a density gradient. Morphology and the number of NVs were analyzed by transmission electron microscopy and nanoparticle tracking analysis. Mice were intraperitoneally injected with Escherichia coli-derived OMVs to establish sepsis, and then injected with 2 × 109 NVs. Innate inflammation was assessed in peritoneal fluid and blood through investigation of infiltration of cells and cytokine production. The biodistribution of NVs labeled with Cy7 dye was analyzed using near-infrared imaging. Results Electron microscopy showed that NVs have a nanometer-size spherical shape and harbor classical EV marker proteins. In mice, NVs inhibited eye exudates and hypothermia, signs of a systemic cytokine storm, induced by intraperitoneal injection of OMVs. Moreover, NVs significantly suppressed cytokine release into the systemic circulation, as well as neutrophil and monocyte infiltration in the peritoneum. The protective effect of NVs was significantly reduced by prior treatment with anti-interleukin (IL)-10 monoclonal antibody. In biodistribution study, NVs spread to the whole mouse body and localized in the lung, liver, and kidney at 6 h. Conclusions Taken together, these data indicate that MSC-derived NVs have beneficial effects in a mouse model of sepsis by upregulating the IL-10 production, suggesting that artificial NVs may be novel EV-mimetics clinically applicable to septic patients. Electronic supplementary material The online version of this article (10.1186/s13287-019-1352-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyong-Su Park
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, 40530, Gothenburg, Sweden.
| | - Kristina Svennerholm
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, Sweden
| | - Ganesh V Shelke
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, 40530, Gothenburg, Sweden
| | - Elga Bandeira
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, 40530, Gothenburg, Sweden
| | - Cecilia Lässer
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, 40530, Gothenburg, Sweden
| | - Su Chul Jang
- Codiak BioSciences Inc, 500 Technology Square, 9th floor, Cambridge, MA, 02139, USA
| | - Rakesh Chandode
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, 40530, Gothenburg, Sweden
| | - Inta Gribonika
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, 40530, Gothenburg, Sweden
| | - Jan Lötvall
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, 40530, Gothenburg, Sweden
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Hyoju SK, Zaborin A, Keskey R, Sharma A, Arnold W, van den Berg F, Kim SM, Gottel N, Bethel C, Charnot-Katsikas A, Jianxin P, Adriaansens C, Papazian E, Gilbert JA, Zaborina O, Alverdy JC. Mice Fed an Obesogenic Western Diet, Administered Antibiotics, and Subjected to a Sterile Surgical Procedure Develop Lethal Septicemia with Multidrug-Resistant Pathobionts. mBio 2019; 10:e00903-19. [PMID: 31363025 PMCID: PMC6667615 DOI: 10.1128/mbio.00903-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/08/2019] [Indexed: 12/22/2022] Open
Abstract
Despite antibiotics and sterile technique, postoperative infections remain a real and present danger to patients. Recent estimates suggest that 50% of the pathogens associated with postoperative infections have become resistant to the standard antibiotics used for prophylaxis. Risk factors identified in such cases include obesity and antibiotic exposure. To study the combined effect of obesity and antibiotic exposure on postoperative infection, mice were allowed to gain weight on an obesogenic Western-type diet (WD), administered antibiotics and then subjected to an otherwise recoverable sterile surgical injury (30% hepatectomy). The feeding of a WD alone resulted in a major imbalance of the cecal microbiota characterized by a decrease in diversity, loss of Bacteroidetes, a bloom in Proteobacteria, and the emergence of antibiotic-resistant organisms among the cecal microbiota. When WD-fed mice were administered antibiotics and subjected to 30% liver resection, lethal sepsis, characterized by multiple-organ damage, developed. Notable was the emergence and systemic dissemination of multidrug-resistant (MDR) pathobionts, including carbapenem-resistant, extended-spectrum β-lactamase-producing Serratia marcescens, which expressed a virulent and immunosuppressive phenotype. Analysis of the distribution of exact sequence variants belonging to the genus Serratia suggested that these strains originated from the cecal mucosa. No mortality or MDR pathogens were observed in identically treated mice fed a standard chow diet. Taken together, these results suggest that consumption of a Western diet and exposure to certain antibiotics may predispose to life-threating postoperative infection associated with MDR organisms present among the gut microbiota.IMPORTANCE Obesity remains a prevalent and independent risk factor for life-threatening infection following major surgery. Here, we demonstrate that when mice are fed an obesogenic Western diet (WD), they become susceptible to lethal sepsis with multiple organ damage after exposure to antibiotics and an otherwise-recoverable surgical injury. Analysis of the gut microbiota in this model demonstrates that WD alone leads to loss of Bacteroidetes, a bloom of Proteobacteria, and evidence of antibiotic resistance development even before antibiotics are administered. After antibiotics and surgery, lethal sepsis with organ damage developed in in mice fed a WD with the appearance of multidrug-resistant pathogens in the liver, spleen, and blood. The importance of these findings lies in exposing how the selective pressures of diet, antibiotic exposure, and surgical injury can converge on the microbiome, resulting in lethal sepsis and organ damage without the introduction of an exogenous pathogen.
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Affiliation(s)
- Sanjiv K Hyoju
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Alexander Zaborin
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Robert Keskey
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Anukriti Sharma
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Wyatt Arnold
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Fons van den Berg
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sangman M Kim
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Neil Gottel
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Cindy Bethel
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | | | - Peng Jianxin
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
- Guangdong Province Hospital of Chinese Medicine, China
| | - Carleen Adriaansens
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emily Papazian
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Jack A Gilbert
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Olga Zaborina
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - John C Alverdy
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
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Safety of antimicrobial de-escalation for culture-negative severe pneumonia. J Crit Care 2019; 54:14-19. [PMID: 31319347 PMCID: PMC7126337 DOI: 10.1016/j.jcrc.2019.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/17/2022]
Abstract
Purpose This study investigated the outcomes of antimicrobial de-escalation (ADE) based on mortality and the incidence of multi-drug resistant (MDR) pathogen occurrence in patients with culture-negative pneumonia presenting with sepsis and septic shock. Materials and Methods We retrospectively analyzed patients diagnosed with severe pneumonia requiring intensive care unit (ICU) admission and possessing negative microbiological culture results at a tertiary referral hospital in South Korea from March 2008 to July 2018. Results We identified 107 patients with culture-negative pneumonia. The Acute Physiologic and Chronic Health Evaluation (APACHE) II and Sepsis-related Organ Failure Assessment (SOFA) mean scores were 20.3 ± 8.6 and 9.6 ± 3.3, respectively. Among the patients, 40 (37.4%) underwent ADE. The APACHE II, SOFA, and follow-up SOFA scores did not differ significantly between the groups, and no differences were found in ICU mortality and MDR pathogen occurrence (27.5% vs 41.8%, P = .137 and 15.0% vs 16.9% P = .794, respectively). Conclusions We observed similar ICU mortality and MDR pathogen occurrence in patients with culture-negative pneumonia presenting with sepsis/shock regardless of whether they received ADE. Additionally, ADE lowered the antimicrobial burden. MDR pathogen occurrence was not reduced in patients who underwent ADE. ADE was not significantly associated with increased ICU mortality. Antimicrobial burden was significantly lower in ADE group.
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Cervellin G, Schuetz P, Lippi G. Toward a holistic approach for diagnosing sepsis in the emergency department. Adv Clin Chem 2019; 92:201-216. [PMID: 31472754 DOI: 10.1016/bs.acc.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | - Philipp Schuetz
- Department of Internal Medicine, Kantonsspital Aarau and University of Basel, Basel, Switzerland
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy.
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Todorovic Markovic M, Pedersen C, Gottfredsson M, Todorovic Mitic M, Gaini S. Focus of infection and microbiological etiology in community-acquired infections in hospitalized adult patients in the Faroe Islands. BMC Infect Dis 2019; 19:16. [PMID: 30612543 PMCID: PMC6322335 DOI: 10.1186/s12879-018-3650-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of the present study was to gain national data on the clinical and microbiological characteristics of community-acquired infections in the Faroe Islands and to compare these data with data from other geographical areas. METHODS A prospective, observational study involving all patients > = 16 years admitted at the Department of Medicine at the National Hospital, Torshavn, Faroe Islands from October 2013 until April 2015. RESULTS Of 5279 admissions, 1054 cases were with community-acquired infection and were included in the study. Out of these 1054 cases, 471 did not meet the criteria for SIRS (Systemic Inflammatory Response Syndrome), while the remaining 583 cases had sepsis. Mean age was 68 years. At least one comorbidity was found in 80% of all cases. Documented infections were present in 75%, and a plausible pathogen was identified in 29% of all cases. The most common gram-positive pathogen was Staphylococcus aureus, and the most frequent gram-negative pathogen was Escherichia coli. The most common focus of infection was lower respiratory tract, followed by urinary tract, and skin-soft tissue/bone-joint. Bacteremia was found in 10% of the cases. CONCLUSION In community-acquired infections in hospitalized patients in the Faroe Islands the lower respiratory tract and the urinary tract were the most frequent foci of infection. Gram-negative pathogens and Escherichia coli were the most frequent pathogens in infection without Systemic Inflammatory Response Syndrome, in sepsis and in bacteremia. Our data on clinical characteristics and microbiological etiology provide new information which may be used to develop local guidelines for the managing of patients admitted with community-acquired infections.
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Affiliation(s)
- Marija Todorovic Markovic
- Medical Department, Infectious Diseases Division, National Hospital of the Faroe Islands, JC. Svabosgøta 41-49, Tórshavn, Faroe Islands
- Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Magnús Gottfredsson
- Department of Infectious Diseases, Landspitali University Hospital, Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Shahin Gaini
- Medical Department, Infectious Diseases Division, National Hospital of the Faroe Islands, JC. Svabosgøta 41-49, Tórshavn, Faroe Islands
- Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark
- Centre of Health Research and Department of Science and Technology, University of the Faroe Islands, Torshavn, Faroe Islands
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25
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Dhas BB, Dirisala VR, Bhat BV. Expression Levels of Candidate Circulating microRNAs in Early-Onset Neonatal Sepsis Compared With Healthy Newborns. GENOMICS INSIGHTS 2018; 11:1178631018797079. [PMID: 30202206 PMCID: PMC6122238 DOI: 10.1177/1178631018797079] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/01/2018] [Indexed: 01/09/2023]
Abstract
The high mortality rate of neonatal sepsis is directly connected with
time-consuming diagnostic methods that have low sensitivity and specificity. The
need of the hour is to develop novel diagnostic techniques that are rapid and
more specific. In this study, we estimated the expression levels of circulating
microRNAs (miRNAs) that are involved in regulating immune response genes and
underlying inflammatory responses, which may be used for sepsis diagnosis. The
total circulating miRNA was isolated and the candidate miRNAs (miR-132,
miR-146a, miR-155, and miR-223) were quantified by real-time polymerase chain
reaction technique. Statistical analysis revealed that miR-132
(P < .01) and miR-223 (P < .05) were
downregulated in septic newborns compared with healthy babies. The decrease in
expression of miR-132 and miR-223 may be associated with increased expression of
immune-related genes involved in TLR (Toll-like receptor) signaling pathway.
Further case-control studies with large sample size are required to identify the
potential of miRNAs in neonatal sepsis diagnosis.
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Affiliation(s)
- Benet B Dhas
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.,Department of Biotechnology, Vignan's Foundation for Science, Technology & Research, Guntur, India
| | - Vijaya R Dirisala
- Department of Biotechnology, Vignan's Foundation for Science, Technology & Research, Guntur, India
| | - B Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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26
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Zhang Y, Li W, Zhou Y, Johnson A, Venable A, Hassan A, Griswold J, Pappas D. Detection of sepsis in patient blood samples using CD64 expression in a microfluidic cell separation device. Analyst 2018; 143:241-249. [DOI: 10.1039/c7an01471f] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A microfluidic affinity separation device was developed for the detection of sepsis in critical care patients.
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Affiliation(s)
- Ye Zhang
- Department of Chemistry and Biochemistry
- Texas Tech University
- Lubbock
- USA
| | - Wenjie Li
- Department of Chemistry and Biochemistry
- Texas Tech University
- Lubbock
- USA
| | - Yun Zhou
- Department of Chemistry and Biochemistry
- Texas Tech University
- Lubbock
- USA
| | - Amanda Johnson
- Clinical Research Institute
- Texas Tech Health Sciences Center
- Lubbock
- USA
| | - Amanda Venable
- Clinical Research Institute
- Texas Tech Health Sciences Center
- Lubbock
- USA
| | - Ahmed Hassan
- Department of Surgery
- Texas Tech Health Sciences Center
- Lubbock
- USA
| | - John Griswold
- Department of Surgery
- Texas Tech Health Sciences Center
- Lubbock
- USA
| | - Dimitri Pappas
- Department of Chemistry and Biochemistry
- Texas Tech University
- Lubbock
- USA
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27
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Enhanced capture of bacteria and endotoxin by antimicrobial WLBU2 peptide tethered on polyethylene oxide spacers. Biointerphases 2017; 12:05G603. [DOI: 10.1116/1.4997049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ahn SS, Yoo BW, Jung SM, Lee SW, Park YB, Song JJ. Application of the 2016 EULAR/ACR/PRINTO Classification Criteria for Macrophage Activation Syndrome in Patients with Adult-onset Still Disease. J Rheumatol 2017; 44:996-1003. [PMID: 28412707 DOI: 10.3899/jrheum.161286] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the clinical significance of the 2016 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR)/Pediatric Rheumatology International Trials Organization (PRINTO) classification criteria for macrophage activation syndrome (MAS) in patients with adult-onset Still disease (AOSD). METHODS We performed a retrospective analysis of patients with AOSD with fever who were admitted to Severance Hospital between 2005 and 2016. The patients with AOSD were evaluated for MAS using the 2016 classification criteria for MAS. Clinical features, laboratory findings, and overall survival were analyzed. Logistic regression analysis was used to evaluate the factors associated with in-hospital mortality. RESULTS Among 64 patients with AOSD, 36 (56.3%) were classified as having MAS. The overall survival rate was significantly lower in patients with MAS than in those without (67% vs 100%, p < 0.001). Multivariate analysis showed that a low erythrocyte sedimentation rate, a low albumin level, an increase in ferritin of over 2 folds, and the development of MAS on admission were significantly associated with mortality in patients with AOSD. CONCLUSION The 2016 EULAR/ACR/PRINTO classification criteria for MAS are potentially useful for the identification of patients with AOSD at high risk for a poor outcome. Febrile patients with AOSD should be monitored with the 2016 classification criteria for MAS in the early diagnosis and proper treatment of MAS.
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Affiliation(s)
- Sung Soo Ahn
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine
| | - Byung-Woo Yoo
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine
| | - Seung Min Jung
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine
| | - Sang-Won Lee
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine
| | - Yong-Beom Park
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine
| | - Jason Jungsik Song
- From the Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea. .,S.S. Ahn, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; B.W. Yoo, MD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.M. Jung, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; S.W. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; Y.B. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine; J.J. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and the Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine.
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29
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Urine metabolomics in neonates with late-onset sepsis in a case-control study. Sci Rep 2017; 7:45506. [PMID: 28374757 PMCID: PMC5379623 DOI: 10.1038/srep45506] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/28/2017] [Indexed: 12/19/2022] Open
Abstract
Although late-onset sepsis (LOS) is a major cause of neonatal morbidity and mortality, biomarkers evaluated in LOS lack high diagnostic accuracy. In this prospective, case-control, pilot study, we aimed to determine the metabolic profile of neonates with LOS. Urine samples were collected at the day of initial LOS evaluation, the 3rd and 10th day, thereafter, from 16 septic neonates (9 confirmed and 7 possible LOS cases) and 16 non-septic ones (controls) at respective time points. Urine metabolic profiles were assessed using non-targeted nuclear magnetic resonance spectroscopy and targeted liquid chromatography-tandem mass spectrometry analysis. Multivariate statistical models with data from either analytical approach showed clear separation between the metabolic profiles of septic neonates (both possible and confirmed) and the controls. Metabolic changes appeared to be related to disease progression. Overall, neonates with confirmed or possible LOS exhibited comparable metabolic profiles indicating similar metabolic alternations upon the onset of clinical manifestations. This methodology therefore enabled the discrimination of neonates with LOS from non-septic individuals, providing potential for further research toward the discovery of LOS-related biomarkers.
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30
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Abstract
Identifying sources of infection and establishing source control is an essential component of the workup and treatment of sepsis. Investigation with history, physical examination, laboratory tests, and imaging can in identifying sources of infection. All organ systems have the potential to develop sources of infection. However, there are inherent difficulties presented by some that require additional diligence, namely, urinalysis, chest radiographs, and intraabdominal infections. Interventions include administration of antibiotics and may require surgical or other specialist intervention. This is highlighted by the Surviving Sepsis Campaign with specific recommendations for time to antibiotics and expeditious time to surgical source control.
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Affiliation(s)
- Zeke P Oliver
- Emergency Medicine, Department of Emergency Medicine, Carilion Clinic Virginia Tech School of Medicine, 1 Riverside Circle, 4th Floor, Roanoke, VA 24014, USA.
| | - Jack Perkins
- Emergency Medicine, Department of Emergency Medicine, Carilion Clinic Virginia Tech School of Medicine, 1 Riverside Circle, 4th Floor, Roanoke, VA 24014, USA
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31
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O'Dwyer MJ, Starczewska MH, Schrenzel J, Zacharowski K, Ecker DJ, Sampath R, Brealey D, Singer M, Libert N, Wilks M, Vincent JL. The detection of microbial DNA but not cultured bacteria is associated with increased mortality in patients with suspected sepsis-a prospective multi-centre European observational study. Clin Microbiol Infect 2016; 23:208.e1-208.e6. [PMID: 27890455 DOI: 10.1016/j.cmi.2016.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/13/2016] [Accepted: 11/14/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Blood culture results inadequately stratify the mortality risk in critically ill patients with sepsis. We sought to establish the prognostic significance of the presence of microbial DNA in the bloodstream of patients hospitalized with suspected sepsis. METHODS We analysed the data collected during the Rapid Diagnosis of Infections in the Critically Ill (RADICAL) study, which compared a novel culture-independent PCR/electrospray ionization-mass spectrometry (ESI-MS) assay with standard microbiological testing. Patients were eligible for the study if they had suspected sepsis and were either hospitalized or were referred to one of nine intensive care units from six European countries. The blood specimen for PCR/ESI-MS assay was taken along with initial blood culture taken for clinical indications. RESULTS Of the 616 patients recruited to the RADICAL study, 439 patients had data on outcome, results of the blood culture and PCR/ESI-MS assay available for analysis. Positive blood culture and PCR/ESI-MSI result was found in 13% (56/439) and 40% (177/439) of patients, respectively. Either a positive blood culture (p 0.01) or a positive PCR/ESI-MS (p 0.005) was associated with higher SOFA scores on enrolment to the study. There was no difference in 28-day mortality observed in patients who had either positive or negative blood cultures (35% versus 32%, p 0.74). However, in patients with a positive PCR/ESI-MS assay, mortality was significantly higher in comparison to those with a negative result (42% versus 26%, p 0.001). CONCLUSIONS Presence of microbial DNA in patients with suspected sepsis might define a patient group at higher risk of death.
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Affiliation(s)
- M J O'Dwyer
- Department of Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - M H Starczewska
- Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Schrenzel
- Genomic Research Laboratory, Department of Internal Medicine, Service of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland
| | - K Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - D J Ecker
- Ibis Biosciences, Abbott, Carlsbad, CA, USA
| | - R Sampath
- Ibis Biosciences, Abbott, Carlsbad, CA, USA
| | - D Brealey
- Division of Critical Care, University College London Hospitals NIHR Biomedical Research Centre and Bloomsbury Institute of Intensive Care Medicine, University College Hospital, London, United Kingdom
| | - M Singer
- Division of Critical Care, University College London Hospitals NIHR Biomedical Research Centre and Bloomsbury Institute of Intensive Care Medicine, University College Hospital, London, United Kingdom
| | - N Libert
- Department of Anaesthesiology and Critical Care, Val de Grâce Military Hospital, Paris, France
| | - M Wilks
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Barts Health NHS Trust, London, UK
| | - J-L Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Contou D, Roux D, Jochmans S, Coudroy R, Guérot E, Grimaldi D, Ricome S, Maury E, Plantefève G, Mayaux J, Mekontso Dessap A, Brun-Buisson C, de Prost N. Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:360. [PMID: 27816060 PMCID: PMC5097846 DOI: 10.1186/s13054-016-1537-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
Background The lack of a patent source of infection after 24 hours of management of shock considered septic is a common and disturbing scenario. We aimed to determine the prevalence and the causes of shock with no diagnosis 24 hours after its onset, and to compare the outcomes of patients with early-confirmed septic shock to those of others. Methods We conducted a pragmatic, prospective, multicenter observational cohort study in ten intensive care units (ICU) in France. We included all consecutive patients admitted to the ICU with suspected septic shock defined by clinical suspicion of infection leading to antibiotic prescription plus acute circulatory failure requiring vasopressor support. Results A total of 508 patients were admitted with suspected septic shock. Among them, 374 (74 %) had early-confirmed septic shock, while the 134 others (26 %) had no source of infection identified nor microbiological documentation retrieved 24 hours after shock onset. Among these, 37/134 (28 %) had late-confirmed septic shock diagnosed after 24 hours, 59/134 (44 %) had a condition mimicking septic (septic shock mimicker, mainly related to adverse drug reactions, acute mesenteric ischemia and malignancies) and 38/134 (28 %) had shock of unknown origin by the end of the ICU stay. There were no differences between patients with early-confirmed septic shock and the remainder in ICU mortality and the median duration of ICU stay, of tracheal intubation and of vasopressor support. The multivariable Cox model showed that the risk of day-60 mortality did not differ between patients with or without early-confirmed septic shock. A sensitivity analysis was performed in the subgroup (n = 369/508) of patients meeting the Sepsis-3 definition criteria and displayed consistent results. Conclusions One quarter of the patients admitted in the ICU with suspected septic shock had no infection identified 24 hours after its onset and almost half of them were eventually diagnosed with a septic shock mimicker. Outcome did not differ between patients with early-confirmed septic shock and other patients. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1537-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Damien Contou
- Service de réanimation Médicale, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France. .,INSERM U955, Institut Mondor de Recherche Biomedicale, Equipe 8, Faculté de Médecine de Créteil, Université Paris Est-Créteil, Créteil, France.
| | - Damien Roux
- Service de réanimation médico-chirurgicale, Centre Hospitalier Universitaire Louis Mourier, Assistance Publique-Hôpitaux de Paris, 178 rue des Renouillers, Colombes, 92700, France
| | - Sébastien Jochmans
- Service de réanimation, Centre Hospitalier Marc Jacquet, 2 rue Fréteau de Peny, Melun, 77011, France
| | - Rémi Coudroy
- Service de réanimation médicale, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, Poitiers, 86021, France
| | - Emmanuel Guérot
- Service de réanimation médicale, Centre Hospitalier Universitaire Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, Paris, 75015, France
| | - David Grimaldi
- Service de réanimation médico-chirurgicale, Centre Hospitalier André Mignot, 177 rue de Versailles, Le Chesnay, 78150, France
| | - Sylvie Ricome
- Service de réanimation, Centre Hospitalier Robert Ballanger, Boulevard Robert Ballanger, Aulnay-sous-Bois, 93600, France
| | - Eric Maury
- Service de réanimation médicale, Centre Hospitalier Universitaire Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75012, France
| | - Gaëtan Plantefève
- Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, 69 rue du Lieutenant-Colonel Prudhon, Argenteuil, 95107, France
| | - Julien Mayaux
- Service de réanimation médicale, Centre Hospitalier Universitaire Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, Paris, 75013, France
| | - Armand Mekontso Dessap
- Service de réanimation Médicale, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.,INSERM U955, Institut Mondor de Recherche Biomedicale, Equipe 8, Faculté de Médecine de Créteil, Université Paris Est-Créteil, Créteil, France
| | - Christian Brun-Buisson
- Service de réanimation Médicale, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.,INSERM U955, Institut Mondor de Recherche Biomedicale, Equipe 8, Faculté de Médecine de Créteil, Université Paris Est-Créteil, Créteil, France
| | - Nicolas de Prost
- Service de réanimation Médicale, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.,INSERM U955, Institut Mondor de Recherche Biomedicale, Equipe 8, Faculté de Médecine de Créteil, Université Paris Est-Créteil, Créteil, France
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Lakshmikanth CL, Jacob SP, Kudva AK, Latchoumycandane C, Yashaswini PSM, Sumanth MS, Goncalves-de-Albuquerque CF, Silva AR, Singh SA, Castro-Faria-Neto HC, Prabhu SK, McIntyre TM, Marathe GK. Escherichia coli Braun Lipoprotein (BLP) exhibits endotoxemia - like pathology in Swiss albino mice. Sci Rep 2016; 6:34666. [PMID: 27698491 PMCID: PMC5048175 DOI: 10.1038/srep34666] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/15/2016] [Indexed: 02/08/2023] Open
Abstract
The endotoxin lipopolysaccharide (LPS) promotes sepsis, but bacterial peptides also promote inflammation leading to sepsis. We found, intraperitoneal administration of live or heat inactivated E. coli JE5505 lacking the abundant outer membrane protein, Braun lipoprotein (BLP), was less toxic than E. coli DH5α possessing BLP in Swiss albino mice. Injection of BLP free of LPS purified from E. coli DH5α induced massive infiltration of leukocytes in lungs and liver. BLP activated human polymorphonuclear cells (PMNs) ex vivo to adhere to denatured collagen in serum and polymyxin B independent fashion, a property distinct from LPS. Both LPS and BLP stimulated the synthesis of platelet activating factor (PAF), a potent lipid mediator, in human PMNs. In mouse macrophage cell line, RAW264.7, while both BLP and LPS similarly upregulated TNF-α and IL-1β mRNA; BLP was more potent in inducing cyclooxygenase-2 (COX-2) mRNA and protein expression. Peritoneal macrophages from TLR2−/− mice significantly reduced the production of TNF-α in response to BLP in contrast to macrophages from wild type mice. We conclude, BLP acting through TLR2, is a potent inducer of inflammation with a response profile both common and distinct from LPS. Hence, BLP mediated pathway may also be considered as an effective target against sepsis.
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Affiliation(s)
| | - Shancy Petsel Jacob
- Department of Studies in Biochemistry, University of Mysore, Manasagangothri, Mysore - 570 006, Karnataka, India
| | - Avinash Kundadka Kudva
- Department of Veterinary and Biomedical Sciences, Center for Molecular Immunology and Infectious Disease and Center for Molecular Toxicology and Carcinogenesis, 115 Henning Building, The Pennsylvania State University, University Park, PA 16802, USA
| | - Calivarathan Latchoumycandane
- Department of Cellular and Molecular Medicine, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | | | - Mosale Seetharam Sumanth
- Department of Studies in Biochemistry, University of Mysore, Manasagangothri, Mysore - 570 006, Karnataka, India
| | | | - Adriana R Silva
- Laboratótio de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Sridevi Annapurna Singh
- Department of Protein Chemistry &Technology, Central Food Technological Research Institute/CSIR, Mysore - 570 020, Karnataka, India
| | - Hugo C Castro-Faria-Neto
- Laboratótio de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Sandeep Kumble Prabhu
- Department of Veterinary and Biomedical Sciences, Center for Molecular Immunology and Infectious Disease and Center for Molecular Toxicology and Carcinogenesis, 115 Henning Building, The Pennsylvania State University, University Park, PA 16802, USA
| | - Thomas M McIntyre
- Department of Cellular and Molecular Medicine, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Gopal Kedihithlu Marathe
- Department of Studies in Biochemistry, University of Mysore, Manasagangothri, Mysore - 570 006, Karnataka, India
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Bicart-See A, Rottman M, Cartwright M, Seiler B, Gamini N, Rodas M, Penary M, Giordano G, Oswald E, Super M, Ingber DE. Rapid Isolation of Staphylococcus aureus Pathogens from Infected Clinical Samples Using Magnetic Beads Coated with Fc-Mannose Binding Lectin. PLoS One 2016; 11:e0156287. [PMID: 27275840 PMCID: PMC4898724 DOI: 10.1371/journal.pone.0156287] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022] Open
Abstract
Here we describe how Staphylococcus aureus bacteria can be rapidly isolated from clinical samples of articular fluid and synovial tissue using magnetic beads coated with the engineered chimeric human opsonin protein, Fc-mannose-binding lectin (FcMBL). The FcMBL-beads were used to capture and magnetically remove bacteria from purified cultures of 12 S. aureus strains, and from 8 articular fluid samples and 4 synovial tissue samples collected from patients with osteoarthritis or periprosthetic infections previously documented by positive S. aureus cultures. While the capture efficiency was high (85%) with purified S. aureus strains grown in vitro, direct FcMBL-bead capture from the clinical samples was initially disappointing (< 5% efficiency). Further analysis revealed that inhibition of FcMBL binding was due to coating of the bacteria by immunoglobulins and immune cells that masked FcMBL binding sites, and to the high viscosity of these complex biological samples. Importantly, capture of pathogens using the FcMBL-beads was increased to 76% efficiency by pretreating clinical specimens with hypotonic washes, hyaluronidase and a protease cocktail. Using this approach, S. aureus bacteria could be isolated from infected osteoarthritic tissues within 2 hours after sample collection. This FcMBL-enabled magnetic method for rapid capture and concentration of pathogens from clinical samples could be integrated upstream of current processes used in clinical microbiology laboratories to identify pathogens and perform antibiotic sensitivity testing when bacterial culture is not possible or before colonies can be detected.
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Affiliation(s)
- A. Bicart-See
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, United States of America
- Hospital Joseph-Ducuing, Toulouse, France
| | - M. Rottman
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, United States of America
- Universite de Versailles, St Quentin, France
| | - M. Cartwright
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, United States of America
| | - B. Seiler
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, United States of America
| | - N. Gamini
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, United States of America
| | - M. Rodas
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, United States of America
| | | | | | | | - M. Super
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, United States of America
| | - D. E. Ingber
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, United States of America
- Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts, United States of America
- * E-mail:
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