Empiric Antibiotic Prescribing for Suspected Sepsis: A Stewardship Balancing Act

Pulia, Michael S.; Redwood, Robert

doi:10.1016/j.amjms.2020.08.030

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…Sepsis is associated with high morbidity and mortality [1]. Adequate antibiotic therapy in time could decrease mortality and reduce the length of stay in ICU for patients with sepsis or septic shock [2][3][4][5]. As reported in the previous study, the mortality rate of patients increased approximately 7.6% for every hour delayed [3].…”

Section: Introductionmentioning

confidence: 71%

Species-specific bacterial detector for fast pathogen diagnosis of severe pneumonia patients in the intensive care unit

Wang

Liang

Jiang

et al. 2022

Preprint

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Rapid diagnosis of pathogens is the cornerstone of appropriate therapy and is also a great challenge to be overcome. Although NGS and some other PCR-based pathogen detection methods were applied to improve the speed and accuracy of clinical diagnosis, it was still a long way from the clinical needs of rapid and accurate diagnostic therapy in the intensive care unit (ICU). In this study, we aimed at developing a new rapid diagnostic tool, Species-Specific Bacterial Detector (SSBD), to evaluate the existence and quantification of 10 most usual pathogenic bacteria in ICU in 4 hours. Briefly, the species-specific genome fragments of each bacterium were identified by our algorithm using 1791 microbe genomes from 232 species and then used to combine with CRISPR/Cas12 to establish diagnosis tools. Based on the tests of 77 samples, SSBD demonstrated 100% sensitivity and 87% specificity compared with conventional culture test (CCT). Later on, an interventional random-grouped study was applied to evaluate the clinical benefits of SSBD. Briefly, SSBD demonstrated more accurate and faster diagnosis results and led to earlier antibiotics adjustment than CCT. Based on the results acquired by SSBD, cultivation results could deviate from the real pathogenic situation with polymicrobial infections. In addition, nosocomial infections were found widely in ICU, which should deserve more attention.

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Section: Introductionmentioning

confidence: 71%

Species-specific bacterial detector for fast pathogen diagnosis of severe pneumonia patients in the intensive care unit

Wang

Liang

Jiang

et al. 2022

Preprint

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show abstract

“…Sepsis is associated with high morbidity and mortality ( Singer et al, 2016 ). Adequate antibiotic therapy in time could decrease mortality and reduce the length of stay in ICU for patients with sepsis or septic shock ( Ferrer et al, 2018 ; Kumar et al, 2006 ; Pulia and Redwood, 2020 ; Seymour et al, 2017 ). As reported in the previous study, the mortality rate of patients increased approximately 7.6% for every hour delayed ( Kumar et al, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

Novel fast pathogen diagnosis method for severe pneumonia patients in the intensive care unit: randomized clinical trial

Wang

Liang

Jiang

et al. 2022

eLife

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Background:Severe pneumonia is one of the common acute diseases caused by pathogenic bacteria infection, especially by pathogenic bacteria, leading to sepsis with a high morbidity and mortality rate. However, the existing bacteria cultivation method cannot satisfy current clinical needs requiring rapid identification of bacteria strain for antibiotic selection. Therefore, developing a sensitive liquid biopsy system demonstrates the enormous value of detecting pathogenic bacterium species in pneumonia patients.Methods:In this study, we developed a tool named Species-Specific Bacterial Detector (SSBD, pronounce as "speed") for detecting selected bacterium. Newly designed diagnostic tools combining specific DNA-tag screened by our algorithm and CRISPR/Cas12a, which were first tested in the lab to confirm the accuracy, followed by validating its specificity and sensitivity via applying on bronchoalveolar lavage fluid (BALF) from pneumonia patients. In the validation I stage, we compared the SSBD results with traditional cultivation results. In the validation II stage, a randomized and controlled clinical trial was completed at the ICU of Nanjing Drum Tower Hospital to evaluate the benefit SSBD brought to the treatment.Results:In the validation stage I, 77 BALF samples were tested, and SSBD could identify designated organisms in 4 hours with almost 100% sensitivity and over 87% specific rate. In validation stage II, the SSBD results were obtained in 4 hours, leading to better APACHE II scores (p=0.0035, ANOVA test). Based on the results acquired by SSBD, cultivation results could deviate from the real pathogenic situation with polymicrobial infections. In addition, nosocomial infections were found widely in ICU, which should deserve more attention.Funding:National Natural Science Foundation of China. The National Key Scientific Instrument and Equipment Development Project. Project number: 81927808.Clinical trial:This study was registered at ClinicalTrilas.gov (NCT04178382).

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Diagnostic uncertainty in infectious diseases: Advocacy for a nosological framework

Roger

Keïta-Perse

Mainardi

2023

Infectious Diseases Now

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Empiric Antibiotic Prescribing for Suspected Sepsis: A Stewardship Balancing Act

Cited by 3 publications

References 17 publications

Species-specific bacterial detector for fast pathogen diagnosis of severe pneumonia patients in the intensive care unit

Species-specific bacterial detector for fast pathogen diagnosis of severe pneumonia patients in the intensive care unit

Novel fast pathogen diagnosis method for severe pneumonia patients in the intensive care unit: randomized clinical trial

Diagnostic uncertainty in infectious diseases: Advocacy for a nosological framework

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