Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality*

Ames, Stefanie; Davis, Billie S.; Angus, Derek C.; Carcillo, Joseph A.; Kahn, Jeremy M.

doi:10.1097/pcc.0000000000001502

Cited by 60 publications

(49 citation statements)

References 44 publications

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“…Organization has recognized sepsis as a global health priority 5 . Despite significant advancement in our understanding of the pathophysiology of sepsis, treatment of sepsis is limited to antibiotics, aggressive fluid resuscitation, vasopressor administration, and supportive care, and no targeted therapeutics for sepsis are approved for usage in patients 6 .…”

Section: The World Healthmentioning

confidence: 99%

“…Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection [5][6][7] . The syndrome can be induced by a wide variety of microbes and, by definition, involves a maladaptive response to a pathogen 5 .…”

Section: The World Healthmentioning

confidence: 99%

“…The gastrointestinal (GI) tract has long been hypothesized to play an integral role in the pathophysiology of sepsis, by both driving and perpetuating multiple organ dysfunction 8,9 . The original concept of gut-derived sepsis proposed that the altered inflammatory milieu induced by overwhelming infection leads to intestinal hyperpermeability, allowing luminal contents, including intact microbes, and microbial products, to escape their natural environment where they can cause either local or distant injury 1,5,6,10 .…”

Section: The World Healthmentioning

confidence: 99%

“…The gut microbiome contains 40 trillion microorganisms, a similar number of cells as found in the human host. This includes up to 1000 different microbial species and 100 times more bacterial genes than human genes 6,[10][11][12][13] . The symbiotic relationship between microbiota and the host is mutually beneficial 14 .…”

Section: The World Healthmentioning

confidence: 99%

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Fecal microbiota transplantation reconstructs the gut microbiota of septic mice and protects the intestinal mucosal barrier

Gai

Wang

et al. 2020

Preprint

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The gastrointestinal (GI) tract has long been hypothesized to play an integral role in the pathophysiology of sepsis, and gut microbiota (GM) dysbiosis may be the key factor. Previous studies has confirmed that microbiome is markedly altered in critical illness. We aimed to confirm the existence of gut microbiota imbalance in the early stage of sepsis, observe the effect of fecal microbiota transplantation (FMT) on sepsis, and explore whether FMT can reconstruct the GM of septic mice and restore its protective function on the intestinal mucosal barrier. Through the study of flora, mucus layer, tight junction, immune barrier, and short-chain fatty acid changes in septic mice and fecal microbiota transplanted mice , we found that GM imbalance exists early in sepsis. FMT can improve morbidity and effectively reduce mortality in septic mice. After the fecal bacteria were transplanted, the abundance and diversity of the gut flora were restored, and the microbial characteristics of the donors changed. FMT can effectively reduce epithelial cell apoptosis, improve the composition of the mucus layer, upregulate the expression of tight junction proteins, and reduce intestinal permeability and the inflammatory response, thus protecting the intestinal barrier function. After FMT, Lachnospiraceae contributes the most to intestinal protection through enhancement of the L-lysine fermentation pathway, resulting in the production of acetate and butanoate, and may be the key bacteria for short-chain fatty acid metabolism and FMT success.

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Section: The World Healthmentioning

confidence: 99%

Section: The World Healthmentioning

confidence: 99%

Section: The World Healthmentioning

confidence: 99%

Section: The World Healthmentioning

confidence: 99%

See 2 more Smart Citations

Fecal microbiota transplantation reconstructs the gut microbiota of septic mice and protects the intestinal mucosal barrier

Gai

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…In accordance with the foregoing, the earliest possible diagnosis of the septic process in children is one of the main tasks for the clinician. Indeed, the sooner targeted treatment is started, which includes antibiotics and infusion therapy, the more chances there are to stop the development of sepsis (11).…”

Section: Introductionmentioning

confidence: 99%

Modern Diagnostics of Sepsis and Septic Shock in Children

et al. 2020

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Sepsis is still one of the leading causes of child mortality worldwide, despite advances in its diagnosis and treatment. Difficulties in recognizing the transition of a localized infectious-inflammatory process to a generalized one lead to a belated diagnosis and the beginning of therapy. Meanwhile, the earlier treatment is started, the higher the patients' chances of life. Early diagnosis of sepsis, which corresponds to modern ideas about this condition, is one of the main tasks for both scientists and practitioners. The aim of this review is to study modern recommendations for the diagnosis of sepsis and septic shock in children. The article reflects the epidemiology, etiological features, modern definitions and methods of diagnosis of pediatric sepsis.

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Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis

Kahn

Davis

Yabes

et al. 2019

JAMA

Self Cite

103

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Beginning in 2013, New York State implemented regulations mandating that hospitals implement evidence-based protocols for sepsis management, as well as report data on protocol adherence and clinical outcomes to the state government. The association between these mandates and sepsis outcomes is unknown. OBJECTIVE To evaluate the association between New York State sepsis regulations and the outcomes of patients hospitalized with sepsis. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of adult patients hospitalized with sepsis in New York State and in 4 control states (Florida, Maryland, Massachusetts, and New Jersey) using all-payer hospital discharge data (January 1, 2011-September 30, 2015) and a comparative interrupted time series analytic approach.

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Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality*

Cited by 60 publications

References 44 publications

Fecal microbiota transplantation reconstructs the gut microbiota of septic mice and protects the intestinal mucosal barrier

Fecal microbiota transplantation reconstructs the gut microbiota of septic mice and protects the intestinal mucosal barrier

Modern Diagnostics of Sepsis and Septic Shock in Children

Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis

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