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Muacevic A, Adler JR, Hussaini H, Jones Amaowei EE, Rasuli SF, Hussain N, Kaddo S, Memon A. Systematic Review on the Effects of Prompt Antibiotic Treatment on Survival in Septic Shock and Sepsis Patients in Different Hospital Settings. Cureus 2022; 14:e32405. [PMID: 36636534 PMCID: PMC9831358 DOI: 10.7759/cureus.32405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
This study aims to determine the impact of prompt administration of antibiotics in evaluating the prognosis of patients with septic shock or sepsis. On January 1, 2022, we searched the Cochrane Library, EMBASE, and MEDLINE databases for English-language articles regarding when antibiotics should be administered to patients with septic shock or sepsis. These articles were required to be published between 2010 and 2021. The primary objective was sudden or expected death from any cause at a specified time. In the study, 154,330 patients from 35 sepsis trials were included. In 19 trials, the effectiveness of antibiotics administered to 20,062 patients was evaluated. Of those, 16,652 received the correct medications. In 24 studies, the length of time it took to administer antibiotics was associated with an increased mortality rate. In fourteen studies, the time limits associated with patient outcomes ranged from 1 to 125 minutes to three to six hours. In eight studies, there were hourly delays, and in two, the time it took to receive an antibiotic played a role. Separately analyzed, the outcomes for septic shock (12,756 patients in 11 trials) and sepsis (24,282 patients in six studies) were identical. Two-thirds of sepsis studies discovered a correlation between early antibiotic treatment and the patient's prognosis. However, antimicrobial timing metrics varied significantly between studies, and there were no clear time limits.
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Almeida NRCD, Pontes GF, Jacob FL, Deprá JVS, Porto JPP, Lima FRD, Albuquerque MRTCD. Analysis of trends in sepsis mortality in Brazil and by regions from 2010 to 2019. Rev Saude Publica 2022; 56:25. [PMID: 35476103 PMCID: PMC9004703 DOI: 10.11606/s1518-8787.2022056003789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/04/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To characterize the profile of inpatients and trend of sepsis mortality in the Brazilian Unified Health System (SUS), throughout Brazil, and in its regions separately, from 2010 to 2019. METHODS Observational, analytical and retrospective study of secondary data obtained through consultation to the Sistema de Informação Hospitalar (Hospital Information System). All incoming septicemia notifications from January 1, 2010 to December 31, 2019 were included. The following sociodemographic variables were used: sex, age, race, region and federative unit of residence. For data analysis, we used mortality and hospitalization coefficient, relative risk and Joinpoint regression. RESULTS There were a total of 1,044,227 cases of sepsis in Brazil, yielding a mean prevalence coefficient of 51.3/100 thousand inhabitants. There were 463,000 deaths from sepsis recorded, with a mean prevalence coefficient of 22.8 deaths/100,000 inhabitants. The highest rates occurred among the elderly, of brown race, and there was no significant difference between genders. The Southeast region accounted for the highest rates of hospitalization and deaths. A general trend toward increased mortality was observed in the period studied. CONCLUSION The heterogeneity of Brazil should be considered regarding socioeconomic and demographic characteristics, and differences in health investment and underreporting between regions, in order to understand the disease’s epidemiological course. Finally, these findings should be correlated with other studies, in an effort to understand the behavior of the disease, and provide inputs for public and private policies in order to reduce the expressiveness of cases and deaths from sepsis in Brazil.
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Affiliation(s)
| | | | - Felipe Lima Jacob
- Universidade do Estado do Pará. Faculdade de Medicina. Belém, PA, Brasil
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Caraballo C, Ascuntar J, Hincapié C, Restrepo C, Bernal E, Jaimes F. Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia. Rev Bras Ter Intensiva 2019; 31:47-56. [PMID: 30970091 PMCID: PMC6443304 DOI: 10.5935/0103-507x.20190011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/27/2018] [Indexed: 12/20/2022] Open
Abstract
Objective To determine the association between the primary site of infection and
in-hospital mortality as the main outcome, or the need for admission to the
intensive care unit as a secondary outcome, in patients with sepsis admitted
to the emergency department. Methods This was a secondary analysis of a multicenter prospective cohort. Patients
included in the study were older than 18 years with a diagnosis of severe
sepsis or septic shock who were admitted to the emergency departments of
three tertiary care hospitals. Of the 5022 eligible participants, 2510 were
included. Multiple logistic regression analysis was performed for
mortality. Results The most common site of infection was the urinary tract, present in 27.8% of
the cases, followed by pneumonia (27.5%) and intra-abdominal focus (10.8%).
In 5.4% of the cases, no definite site of infection was identified on
admission. Logistic regression revealed a significant association between
the following sites of infection and in-hospital mortality when using the
urinary infection group as a reference: pneumonia (OR 3.4; 95%CI, 2.2 - 5.2;
p < 0.001), skin and soft tissues (OR 2.6; 95%CI, 1.4 - 5.0; p = 0.003),
bloodstream (OR 2.0; 95%CI, 1.1 - 3.6; p = 0.018), without specific focus
(OR 2.0; 95%CI, 1.1 - 3.8; p = 0.028), and intra-abdominal focus (OR 1.9;
95%CI, 1.1 - 3.3; p = 0.024). Conclusions There is a significant association between the different sites of infection
and in-hospital mortality or the need for admission to an intensive care
unit in patients with sepsis or septic shock. Urinary tract infection shows
the lowest risk, which should be considered in prognostic models of these
conditions.
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Affiliation(s)
- César Caraballo
- Grupo Académico de Epidemiología Clínica, Universidad de Antioquia - Medellín, Colombia.,Center for Outcomes Research and Evaluation, Yale University School of Medicine - New Haven, CT, USA
| | - Johana Ascuntar
- Grupo Académico de Epidemiología Clínica, Universidad de Antioquia - Medellín, Colombia
| | - Carolina Hincapié
- Grupo Académico de Epidemiología Clínica, Universidad de Antioquia - Medellín, Colombia
| | - Camilo Restrepo
- Grupo Académico de Epidemiología Clínica, Universidad de Antioquia - Medellín, Colombia
| | - Elisa Bernal
- Servicio de Medicina Interna, Hospital Pablo Tobón Uribe - Medellín, Colombia
| | - Fabián Jaimes
- Grupo Académico de Epidemiología Clínica, Universidad de Antioquia - Medellín, Colombia.,Dirección de Investigaciones, Hospital San Vicente Fundación - Medellín, Colombia
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Zhang Z, Smischney NJ, Zhang H, Van Poucke S, Tsirigotis P, Rello J, Honore PM, Sen Kuan W, Ray JJ, Zhou J, Shang Y, Yu Y, Jung C, Robba C, Taccone FS, Caironi P, Grimaldi D, Hofer S, Dimopoulos G, Leone M, Hong SB, Bahloul M, Argaud L, Kim WY, Spapen HD, Rocco JR. AME evidence series 001-The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital. J Thorac Dis 2016; 8:2654-2665. [PMID: 27747021 PMCID: PMC5059246 DOI: 10.21037/jtd.2016.08.03] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for clinical use of different diagnostic tools rely on the Grades of Recommendation Assessment, Development and Evaluation (GRADE) framework. Because most of the studies were observational and did not allow a reliable assessment of these tools, a two-step inference approach was employed. Future trials need to confirm or refute a particular index test and should directly explore relevant patient outcome parameters.
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Affiliation(s)
- Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
- Department of Critical Care Medicine, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| | | | - Haibo Zhang
- Keenan Research Center for Biomedical Science of St. Michael’s Hospital, Departments of Anesthesia and Physiology, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Sven Van Poucke
- Departments of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Panagiotis Tsirigotis
- 2nd Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jordi Rello
- CIBERES, Vall d’Hebron Institut of Research, Universitat Autonoma de Barcelona, Spain
| | - Patrick M. Honore
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels, Brussels, Belgium
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore and the Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Juliet June Ray
- DeWitt Daughtry Family Department of Surgery, Jackson Memorial Hospital, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Jiancang Zhou
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical Collegue, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yuetian Yu
- Department of Critical Care Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
| | - Christian Jung
- University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Chiara Robba
- Neurosciences Critical Care Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pietro Caironi
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - David Grimaldi
- Intensive Care Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan Hofer
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - George Dimopoulos
- Department of Critical Care, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marc Leone
- Service d’anesthésie et de réanimation, Hôpital Nord, Assistance Publique – Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Herbert D. Spapen
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels, Brussels, Belgium
| | - Jose Rodolfo Rocco
- Department of Internal Medicine and Post-graduated Program, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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