Hospital-Onset Sepsis Warrants Expanded Investigation and Consideration as a Unique Clinical Entity

Ginestra, Jennifer C.; Coz Yataco, Angel O.; Dugar, Siddharth P.; Dettmer, Matthew R.

doi:10.1016/j.chest.2024.01.028

Cited by 3 publications

(2 citation statements)

References 75 publications

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“…Author details 1 Service d' Anesthésie-Réanimation et Médecine Péri-Opératoire, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France. 2 Univ Paris Est Créteil, Faculté de Santé, 94010 Créteil, France. 3 U955-IMRB, Equipe 03 "Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)", Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d' Alfort (EnVA), 94700 Maisons-Alfort, France.…”

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“…The impact of the healthcare system and of hospital or intensive care unit (ICU) organization has hardly been investigated. However, these factors potentially have a major effect on outcomes, both for community-acquired infections (with possible influence of a myriad of country-level factors, e.g., vaccination, incidence of obesity, number of general physicians, …) and for nosocomial infections (with possible influence of, e.g., hand hygiene measures, antibiotic stewardship programs…) [2].…”

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Outcome of hospital-acquired bloodstream infection: interplay between bacteria, host, and healthcare system organization

Mongardon,

Vincent

2024

Intensive Care Med

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Outcome of hospital-acquired bloodstream infection: interplay between bacteria, host, and healthcare system organization

Mongardon,

Vincent

2024

Intensive Care Med

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Septic Shock Requiring Three Vasopressors: Patient Demographics and Outcomes

Kwak,

Madushani,

Adhikari

et al. 2024

Critical Care Explorations

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OBJECTIVES: Septic shock is a common condition necessitating timely management including hemodynamic support with vasopressors. Despite the high prevalence and mortality, there is limited data characterizing patients who require three or more vasopressors. We sought to define the demographics, outcomes, and prognostic determinants associated with septic shock requiring three or more vasopressors. DESIGN: This is a multicenter retrospective cohort of two ICU databases, Medical Information Mart for Intensive Care IV (MIMIC-IV) and electronic ICU-Clinical Research Database, which include over 400,000 patients admitted to 342 ICUs. PATIENTS: Inclusion criteria entailed patients who were: 1) age 18 years old and older, 2) admitted to any ICU, 3) administered at least three vasopressors for at least 2 hours at any time during their ICU stay, and 4) identified to have sepsis based on the Sepsis-3 criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 3447 patients met inclusion criteria. The median age was 67 years, 60.5% were male, and 96.6% had full code orders at the time of the third vasopressor initiation. Septic shock requiring three or more vasopressors was associated with 57.6% in-hospital mortality. Code status changes occurred in 23.9% of patients following initiation of a third vasopressor. Elevated lactate upon ICU admission (odds ratio [95% CI], 2.79 [2.73–2.85]), increased duration of time between ICU admission and third vasopressor initiation (1.78 [1.69–1.87]), increased serum creatinine (1.61 [1.59–1.62]), and age above 60 years (1.47 [1.41–1.54]) were independently associated with an increased risk of mortality based on analysis of the MIMIC-IV database. Non-White race and Richmond Agitation-Sedation Scale scores were not associated with mortality. CONCLUSIONS: Septic shock requiring three vasopressors is associated with exceptionally high mortality. Knowledge of patients at highest risk of mortality in this population may inform management and expectations conveyed in shared decision-making.

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Predictors of mortality in patients with early versus late onset of septic shock. A prospective, observational and comparative pilot study

Botoș,

Pantiș,

Negrău

et al. 2024

Acta Marisiensis - Seria Medica

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Introduction Outcome and predictors of early- and late-onset septic shock are still controversial. The aim of the study was to compare the relevant predictors of 28-day mortality in early- and late-onset septic shock and other non-septic critical illnesses. Material and Methods We conducted a prospective, observational, pilot study. A group of 46 patients with early septic shock and 42 nonseptic critically ill patients from the emergency department and 56 patients with late septic shock from the hospital were enrolled. On admission to the ICU, the most important potential predictors of 28-day mortality were assessed. Results In terms of predicting 28-day mortality, a higher mNUTRIC score was the only common predictor for all three groups. Multi-drug resistant (MDR) bacterial aetiology was a common predictor in both forms of septic shock. Older age, female gender, increased neutrophilto-lymphocyte ratio (NLR) and increased need for vasoactive agents were common predictors in late septic shock and non-septic critically ill patients. Increased red blood cell distribution width coefficient of variation (RDW-CV) was predictor in early septic shock and non-septic critically ill patients. Central venous-arterial carbon dioxide difference (Pcv-aCO2) was predictor in patients with early septic shock. Inflammatory index and MDR carrier status were predictors in non-septic critically ill patients. Conclusions A higher mNUTRIC score is a predictor of 28-day mortality in early and late septic shock and in critically ill non-septic patients. MDR aetiology was predictive of 28-day all-cause mortality in both types of septic shock, and Pcv-aCO2 was predictive in patients with early septic shock.

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Hospital-Onset Sepsis Warrants Expanded Investigation and Consideration as a Unique Clinical Entity

Cited by 3 publications

References 75 publications

Outcome of hospital-acquired bloodstream infection: interplay between bacteria, host, and healthcare system organization

Outcome of hospital-acquired bloodstream infection: interplay between bacteria, host, and healthcare system organization

Septic Shock Requiring Three Vasopressors: Patient Demographics and Outcomes

Predictors of mortality in patients with early versus late onset of septic shock. A prospective, observational and comparative pilot study

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