Timing to antibiotic therapy in septic oncologic patients presenting without hypotension

Morneau, Kathleen; Chisholm, Gary B.; Tverdek, Frank P.; Bruno, Jeffrey J.; Toale, Katy M.

doi:10.1007/s00520-017-3754-0

Cited by 16 publications

(11 citation statements)

References 29 publications

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“…In this regard, Morneau et al, identified, in adult patients with cancer, a 16 % increase in hypotension for every hour of delay. 30 In other similar studies, the validated pediatric mortality scales at the PICU, regardless of the scale, were permanently included in the prognostic models. 19,[21][22][23] For our cohort, we selected the PIM2 score, which remained independent in all final prognostic models, which added consistency to the reported evidence and allowed to ponder over the predictive ability of %FO.…”

Section: Resultsmentioning

confidence: 99%

Relation between fluid overload and mortality in children with septic shock

et al. 2019

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Section: Resultsmentioning

confidence: 99%

Relation between fluid overload and mortality in children with septic shock

et al. 2019

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“…Cancer patients, in particular, are at a very high risk of developing infections due to malfunctioning of the immune system, a consequence of both the disease itself and its associated therapies 3. One of the main causes of mortality in this group of patients is infections, which often evolve into systemic forms, particularly sepsis and septic shock 4. Yet diagnostic tools for sepsis, such as the sequential organ failure assessment and the quick sequential organ failure assessment, do not seem to work well in this group of patients, in particular in terms of sensitivity 5…”

Section: Introductionmentioning

confidence: 99%

Risk factors for bloodstream infections in gynecological cancer

Franza

Costantini

Corrado

et al. 2020

Int J Gynecol Cancer

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ObjectiveInfections are a threat to frail patients as they have a higher risk of developing serious complications from bloodstream pathogens. The aim of this study was to determine which factors can predict or diagnose bloodstream infections in patients with an underlying gynecologic malignancy.Materials and MethodsBetween July 2016 and December 2017, 68 patients visiting the emergency room with an underlying gynecologic malignancy were evaluated. Variables concerning underlying disease, invasive procedures, and laboratory and clinical parameters were analyzed. Patients were divided into three groups based on their blood and urine specimens (positive blood specimens, positive urine specimens, and no positive specimens; patients who had both positive blood and urine specimens were included in the group of positive blood specimens). Risk factors for surgical site infections, recent (<30 days) surgery, and chemotherapy were studied separately.Results68 patients were included in the analysis. Mean age was 55.6 years (standard deviation 14.1). 44% of patients had ovarian cancer, 35% cervical cancer, 12% endometrial cancer, and 9% had other cancer types. In total, 96% of all patients had undergone surgery. Patients who had been treated with chemotherapy were at a higher risk of developing bloodstream infection (P=0.04; odds ratio (OR)=7.9). C reactive protein, bilirubin, and oxygen saturation (SO2) were significantly different between patients with an underlying infection and those who had none. Only C reactive protein maintained its significance in a linear model, with a cut-off of 180 mg/L (linear regression, P=0.03; OR=4).ConclusionsChemotherapy is a risk factor for the development of bloodstream infections in patients with an underlying gynecologic malignancy; C reactive protein could be a useful tool in making this diagnosis.

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“…Patients were eligible for the pathway if two or more of the systemic inflammatory response syndrome (SIRS) criteria or a systolic blood pressure of <100 mm Hg were present in a ward setting. Key components of the pathway included establishing intravenous access, drawing two sets of blood cultures prior to administration of antibiotics, and performing venous lactate measurements and a full blood examination (Burrell et al, ; Kumar, Jordan, Caesar, & Miller, ; Mattison, Bilney, Haji‐Michael, & Cooksley, ; Morneau, Chisholm, Tverdek, Bruno, & Toale, ; Box ). Following organisation‐wide education and development of a dedicated checklist for pathway components (embedded in patient medical record), the program was implemented across all wards in March 2013.…”

Section: Methodsmentioning

confidence: 99%

“…Key components of the pathway included establishing intravenous access, drawing two sets of blood cultures prior to administration of antibiotics, and performing venous lactate measurements and a full blood examination Kumar, Jordan, Caesar, & Miller, 2015;Mattison, Bilney, Haji-Michael, & Cooksley, 2016;Morneau, Chisholm, Tverdek, Bruno, & Toale, 2017; Box 1).…”

Section: Development Of Sepsis Pathwaymentioning

confidence: 99%

Impact of a hospital‐wide sepsis pathway on improved quality of care and clinical outcomes in surgical patients at a comprehensive cancer centre

et al. 2019

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Purpose Sepsis is a significant complication following cancer surgery. Although standardised care bundles improve sepsis outcomes in other populations, the benefits in cancer patients are unclear. The objectives of this study were to describe the epidemiology of sepsis in cancer patients post‐surgery, and to evaluate the impact of a clinical sepsis pathway on management and clinical outcomes. Methods A standardised hospital‐wide sepsis pathway was developed in 2013, and all cases of sepsis at the Peter MacCallum Cancer Centre in 2014 were retrospectively evaluated. Inclusion criteria were sepsis onset during the 100‐day period following a surgical procedure for cancer diagnosis. Patients were identified using ICD‐10‐AM sepsis discharge codes, audit documentation and the hospital’s antimicrobial approval system. Sepsis episodes were classified as managed on‐ or off‐pathway. Results A total of 119 sepsis episodes were identified. Of these, 71 (59.7%) were managed on the sepsis pathway. Episodes managed on‐pathway resulted more frequently in administration of appropriate antibiotics compared to those off‐pathway (94.4% vs. 66.7%, p < 0.001), and had shorter time to first‐dose antibiotics (median 85 vs. 315 min, p < 0.001). Pathway utilisation was associated with significant reductions in need for inotropes (7% vs. 13%, p = 0.023), ventilation (3% vs. 10%, p = 0.006) and length of hospitalisation (median 15 vs. 30 days, p = 0.008). The most frequent source of infection was organ‐space surgical site infection (24.4% of instances). Conclusions A dedicated hospital‐wide sepsis pathway had significant impact on the quality of care and clinical outcomes of sepsis in cancer surgery patients. Cost‐benefit analysis of sepsis pathways for cancer patients is required.

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Timing to antibiotic therapy in septic oncologic patients presenting without hypotension

Cited by 16 publications

References 29 publications

Relation between fluid overload and mortality in children with septic shock

Relation between fluid overload and mortality in children with septic shock

Risk factors for bloodstream infections in gynecological cancer

Impact of a hospital‐wide sepsis pathway on improved quality of care and clinical outcomes in surgical patients at a comprehensive cancer centre

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