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Patients with septic shock have a high mortality. This study used the Surviving Sepsis Campaign (SSC) database to compare characteristics, treatments and outcomes of septic shock patients diagnosed in the emergency department (ED) to patients developing septic shock on hospital floors (HF).
The studied population included patients admitted to the i...
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Background:
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Citations
... Also, patients discharged to care facilities had a higher risk for readmission compared to patients who were discharged home 2,6,7 . Complicated urinary tract infection is a common nosocomial infection that is responsible for a major share of hospital admissions, and account for 20% to 40% of severe sepsis cases 8,9 . These infections are associated with catheterization and anatomical or functional modification of the urinary tract and thus a subject to frequent re-hospitalizations 10 . ...
Hospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013–2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55–80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005–1.03), diabetes mellitus (OR 1.63, 95% CI 1.04–2.55), cancer (OR 1.7, 95% CI 1.05–2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14–2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07–2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67–8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.
... • Zhen et al 18 showed that septic patients identified from the emergency department had lower in-patient mortality, less mechanical ventilation in the first 24 hours following onset of shock, and a shorter time to achieve a target ScvO 2 than those identified later. ...
The development and resolution of cardiopulmonary instability take time to become clinically apparent, and the treatments provided take time to have an impact. The characterization of dynamic changes in hemodynamic and metabolic variables is implicit in physiologic signatures. When primary variables are collected with high enough frequency to derive new variables, this data hierarchy can be used to develop physiologic signatures. The creation of physiologic signatures requires no new information; additional knowledge is extracted from data that already exist. It is possible to create physiologic signatures for each stage in the process of clinical decompensation and recovery to improve outcomes.
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Objectives The prognosis differs considerably between patients with psychogenic hyperventilation syndrome (HVS) and those with urinary tract infection (UTI)-associated sepsis; however, the nonspecific symptoms and signs make the diagnosis and management difficult. We herein report the utility of a blood gas analysis for distinguishing HVS from UTI with suspected sepsis.
Methods This single-center retrospective cohort study was conducted in a tertiary-care hospital in Japan. Patients ≥18 years old with a quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2 and HVS or UTIs were included. The results of an arterial blood gas (ABG) or venous blood gas (VBG) analysis of the two groups were compared using the Mann-Whitney U test. We used a receiver-operating characteristic curve (ROC) analysis of the arterial pH and arterial PCO2 to assess the ability of these analyses to distinguish HVS from UTI with suspected sepsis.
Results A total of 64 patients with HVS (ABG, n=14; VBG, n=50) and 53 with UTI with suspected sepsis (ABG, n=35; VBG, n=18) were included. Patients with HVS had alkalemia and lower PCO2 levels than patients with UTI with suspected sepsis, but the serum lactate levels were similar between the groups. The ROC analysis determined the pH cut-off value to be 7.509 (sensitivity: 0.91; specificity: 0.86) and the PCO2 cut-off value to be 21.6 mmHg (sensitivity: 1.00; specificity: 0.64).
Conclusion Elevated serum lactate levels alone cannot be used to differentiate between patients with HVS and those with UTI with suspected sepsis, but the degree of pH and PCO2 abnormality can help with the differential diagnosis.
Objectives
To evaluate the impact of a code sepsis (CS) activation, complying with recommendations, the evolution of patients with severe sepsis in the emergency room and determine independent factors associated to mortality.
Method
All patients attending the emergency room with severe sepsis during a 6-month period were included. Complying with Surviving Sepsis Campaign recommendations, patients’ average stay, intensive care admissions and 30-day mortality were assessed. Two groups were compared: CS activation (A) and no activation (NA).
Results
A total of 114 episodes were found, 61.4% belonging to group A and 38.6% to NA. Patients in group A presented hypotension more frequently (61.5% vs. 34.4%; p = .005). Patients in group NA more frequently had lactate levels of >3 mmol/l (48.3% vs. 80%; p = .01), and abdominal focus of sepsis (34.3% vs. 13%; p = .01). In group A, blood cultures were more frequently drawn in the first hour (95% vs. 41.7%; p < .001), early antibiotic was administered (76.9% vs. 25%; p = .005) and fluid replacement carried out (54.5% vs. 18.2%; p = .01). Global achievement of CS objectives was higher in group A (31.4% vs. 9.1%; p = .006). In group NA more patients were admitted to the intensive care unit (10% vs. 36.4%; p < .001), had longer average stays (10.2 days SD 6.9 vs. 14.4 days SD 5.8; p < .001) and a higher mortality rate (4.3% vs. 34.1%; p < .001).
CRP >200 mg/l (OR 33.7; p < .001) and the no activation of CS (OR 13.3; p = .001) resulted in being independent factors associated with mortality.
Conclusions
The implementation of a CS improves compliance with SSC recommendations and decreases intensive care admissions, average stays and mortality.
Purpose
We investigated whether the recently established biomarkers of acute kidney injury, neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1), may help to diagnose acute urinary tract infections (UTI) in adults and are able to distinguish between upper or lower localization.
Methods
NGAL levels were measured in blood and urine, and KIM-1 concentrations in urine of 97 subjects. We recruited age- and gender-matched groups of 30 patients with acute upper UTI and 29 patients with acute lower UTI as well as 38 healthy controls. NGAL and KIM-1 were determined by ELISA, serum and urine creatinine applying the Jaffé’s method.
Results
Urinary NGAL (uNGAL) was significantly increased in patients with upper as well as with lower UTI compared with the healthy controls (P
Sepsis is a clinical syndrome that complicates severe infection. The incidence of sepsis is increasing worldwide. Aim of the study was evaluation of demographic data and clinical picture of patients hospitalized in Infectious Diseases Ward with a diagnosis of sepsis and severe sepsis. MATERIAL AND METHODS The retrospective study included 107 patients with sepsis and severe sepsis hospitalized in 1997-2010.
Sepsis was diagnosed in 48.6% of patients and severe sepsis - in 51.4% ofpatients. The mortality rate in patients with severe sepsis was 30.9%. Blood cultures were positive in 55.1% cases. Gram-positive bacteria were isolated most frequently - 71.7%. The most common source of infection overall was pneumonia (21.5%). Odontogenic infections (25%) and urinary tract infections (21.2%) dominated in patients with sepsis. 25.2% of patients developed bacterial meningitis.
Despite advances in diagnostics and treatment sepsis is still a major medical problem with high mortality. Patients with severe sepsis and meningitis should be treated in ICU setting. Decayed teeth should be considered as a potential source of sepsis of unknown origin.
The urinary tract is a common source for life-threatening infections. Most patients with sepsis or septic shock from a urinary source have complicated urinary tract infection. This article explains the epidemiology, risk factors, and treatment. Effective management, appropriate collection of microbiology specimens, prompt initiation of antimicrobial therapy, source control, and supportive therapy are described.
