Sepsis, Severe Sepsis, and Septic Shock

Munford, Robert S.; Suffredini, Anthony F.

doi:10.1016/b978-0-443-06839-3.00070-9

Cited by 64 publications

(64 citation statements)

References 371 publications

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“…Bloodstream infection is classified as primary or secondary based on the presence or the absence of knowledge focus outside the vascular system. The main focus of secondary infections is the lung, responsible for 50% of all cases 28 . Primary sepsis is usually (85%) related to a CVC, and shows a mortality rate between 12% and 25%, lengthening the patient ' s hospitalization time from ten to forty days 29,30 .…”

Section: Conflict Of Interest Referencesmentioning

confidence: 99%

Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance

Porto

Mantese

Arantes

et al. 2012

Rev. Soc. Bras. Med. Trop.

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Introduction: This study aimed to determine the epidemiology of the three most common nosocomial infections (NI), namely, sepsis, pneumonia, and urinary tract infection (UTI), in a pediatric intensive care unit (PICU) in a developing country and to define the risk factors associated with NI. Methods: We performed a prospective study on the incidence of NI in a single PICU, between August 2009 and August 2010. Active surveillance by National Healthcare Safety Network (NHSN) was conducted in the unit and in a case control approach, children with NI (cases) were compared with a matched controls without NI. Results: We analyzed 172 patients; 22.1% had NI, 71.1% of whom acquired it in the unit. The incidence densities of sepsis, pneumonia, and UTI per 1,000 patients/day were 17.9, 11.4, and 4.3, respectively. The most common agents in sepsis were Enterococcus faecalis and Escherichia coli (18% each); Staphylococcus epidermidis was isolated in 13% of cases. In pneumonias Staphylococcus aureus was the most common cause (3.2%), and in UTI the most frequent agents were yeasts (33.3%). The presence of NI was associated with a long period of hospitalization, use of invasive devices (central venous catheter, nasogastric tube), and use of antibiotics. The last two were independent factors for NI. Conclusions: The incidence of NI acquired in this unit was high and was associated with extrinsic factors. Keywords: Nosocomial infections. Pediatric ICU. Surveillance system. RESUMO Introdução:O objetivo deste estudo foi determinar a epidemiologia das três infecções hospitalares (IH) mais comuns -sepse, pneumonia e infecção do trato urinário (ITU) -em uma unidade de terapia intensiva pediátrica (UTIP) de um país em desenvolvimento e definir os fatores de risco associados com IH. Métodos: Nós desenvolvemos um estudo prospectivo de incidência de IH em uma única UTIP, entre agosto/2009 e agosto/2010. Foi conduzida uma vigilância ativa pelo National Healthcare Safety Network (NHSN) na Unidade e as crianças com IH (casos) foram comparadas com um grupo (controles) em um estudo caso-controle. Resultados: Nós analisamos 172 pacientes, 22,1% com IH, 71,1% adquirida na Unidade. A densidade de incidência de sepse, pneumonia e ITU por 1.000 pacientes/dia foram 17,9, 11,4, e 4,3, respectivamente. Os agentes mais comuns na sepse foram Enterococcus faecalis e Escherichia coli (18% cada), e Staphylococcus epidermidis foram isolados em 13% dos casos. Nas pneumonias Staphylococcus aureus foram os agentes mais comuns (3,2%), e nas ITUs os agentes mais frequentes foram os fungos (33,3%). A presença de IH foi associada com tempo de hospitalização prolongado, uso de procedimentos invasivos (CVC, sonda nasogástrica) e uso de antibióticos. Os dois últimos foram fatores independentes para o desenvolvimento de IH. Conclusões: A incidência de IH adquirida na Unidade foi alta, associada a fatores de risco extrínsecos. Palavras-chaves: Infecções hospitalares. UTI pediátrica. Sistema de vigilância.Nosocomial infection (NI) constitutes a major health pro...

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Section: Conflict Of Interest Referencesmentioning

confidence: 99%

Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance

Porto

Mantese

Arantes

et al. 2012

Rev. Soc. Bras. Med. Trop.

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“…Pada kondisi tersebut akan terjadi peningkatan produksi dari substansi ini akibat peningkatan dari produksi piruvat, gangguan bersihan hepatik (hepatic clearance), penurunan kerja dari PDH (pyruvate dehydrogenase), dan disfungsi mitokondrial. [16][17][18] Perubahan kadar laktat (kinetik laktat) pada pasien dengan sepsis berat menggambarkan perubahan dari kondisi metabolisme anaerob yang terutama dipengaruhi oleh perubahan kondisi penyakit dan intervensi yang diberikan pada pasien. Keterkaitan antara bersihan laktat terhadap kondisi penyakit dan pengobatan menjadikan parameter ini sebagai variabel yang potensial untuk menilai progresifitas penyakit dan adekuasi pengobatan yang diterima oleh pasien.…”

Section: Diskusiunclassified

Peran Bersihan Laktat pada Kesintasan Pasien Sepsis Berat

Hambali¹,

Chen²,

Widodo³

et al. 2016

JPDI

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ABSTRAKPendahuluan. Sepsis Berat merupakan masalah kesehatan dengan tingkat mortalitas yang tinggi serta insiden yang terus meningkat. Bersihan laktat menggambarkan kinetika metabolisme anaerob pasien sepsis berat dan merupakan parameter yang potensial untuk mengevaluasi kondisi penyakit dan intervensi pengobatan yang didapat pasien. Namun demikian, hubungan antara bersihan laktat terhadap terjadinya kematian pasien sepsis berat belum diketahui. Berdasarkan hal tersebut, penelitian ini dilakukan untuk mengetahui pengaruh bersihan laktat terhadap kesintasan pasien dengan sepsis berat, serta faktor-faktor perancu yang mempengaruhi hubungan tersebut.Metode. Penelitian ini merupakan penelitian kohort prospektif yang dilaksanakan di Unit Gawat Darurat dan ruang perawatan Rumah Sakit dr. Cipto Mangunkusumo (RSCM) pada bulan Maret-Mei 2011. Pasien termasuk dalam kelompok bersihan laktat tinggi bila terdapat perbedaan kadar laktat ≥10% dalam 6 jam pertama pengobatan, sedangkan perbedaan <10% termasuk ke dalam kelompok bersihan laktat rendah. Selanjutnya, dilakukan observasi terhadap terjadinya kematian dalam 10 hari pertama perawatan pada kedua kelompok. Data yang terkumpul selanjutnya dianalisis mengunakan uji statistik log-rank test, serta dicari nilai hazard ratio dengan menggunakan uji cox regression model. Selanjutnya, dilakukan analisis variabel perancu dengan menggunakan uji cox regression.Hasil. Laju kesintasan kelompok bersihan laktat tinggi dan rendah masing-masing sebesar 60,0% dan 26,7% (p=0,004). Median kesintasan yaitu 3 hari pada bersihan laktat rendah, sedangkan kematian tidak mencapai 50% pada bersihan laktat tinggi. Interkuartil I kedua kelompok berturut-turut sebesar 1 dan 4 hari. Dari analisis didapatkan hazard ratio sebesar 2,87 (IK 95%; 1,41-5,83). Pada analisis multivariat keberadaan syok sepsis, skor SOFA, penggunaan vasopresor/inotropik, transfusi dan cairan resusitasi, tidak ada yang mengubah nilai hazard ratio >10%. Oleh karena itu, tidak ada yang memenuhi syarat untuk disebut sebagai perancu.Simpulan. Pasien bersihan laktat tinggi memiliki kesintasan lebih tinggi dibandingkan pasien bersihan laktat rendah dan hubungan tersebut tidak dipengaruhi perancu.

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“…Empirical intravenous antibiotic therapy with optimal dosages should be initiated as soon as possible with the coverage of all possible pathogens (11,12). However, cultures from suspected infectious source, including blood cultures, have to be obtained prior to the initial antibiotic dose.…”

Section: Appropriate Empiric Antimicrobial Therapymentioning

confidence: 99%

“…Carbapenems are the most common antibiotics for the broad spectrum coverage (16). De-escalation strategy is safe and significantly associated with lower mortality (12,14,16,25). In one prospective, observational study, in 35% of the patients admitted to the ICU, de-escalation therapy was performed and found as a protective factor for the mortality (26).…”

Section: De-escalation Therapymentioning

confidence: 99%

Right first time!

Alp

2016

Ann. Transl. Med.

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Septic shock is still a lethal disease in intensive care units (ICU). The mortality can exceed 40% even with therapeutic management. The high mortality is clearly associated with the delay of appropriate antimicrobial therapy. Early diagnosis and identification of infectious source is the mainstay of optimal therapeutic management. On the other hand, source control and optimize antibiotic dosing according to pharmacokinetics (PK)/ pharmacodynamics (PD) properties of antibiotics and organ dysfunction of patients are required to get the best clinical outcome.

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Sepsis, Severe Sepsis, and Septic Shock

Cited by 64 publications

References 371 publications

Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance

Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance

Peran Bersihan Laktat pada Kesintasan Pasien Sepsis Berat

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