Epidemiology of Sepsis in the Valencian Community (Spain), 1995–2004

2008 ◽  
Vol 29 (7) ◽  
pp. 630-634 ◽  
Author(s):  
Juan Carlos Andreu Ballester ◽  
Ferran Ballester ◽  
Antonio González Sánchez ◽  
Amadeo Almela Quilis ◽  
Enrique Colomer Rubio ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Organ Failure ◽  
Incidence Rates ◽  
Public Hospitals ◽  
Polymicrobial Sepsis ◽  
Gram Negative Bacteria ◽  
Gram Negative

Objective.To study the incidence of sepsis in the Valencian Community (Spain) during a period of 10 years (1995–2004).Methods.We downloaded data on discharge diagnoses of septicemia in all 26 public hospitals in the Valencian Community during the 10-year study period, as well as the additional discharge diagnoses of each patient.Results.We identified 33,767 cases of sepsis during the study period. The age-standardized incidence rates among men increased from 64.11 (95% confidence interval [CI], 60.37–67.85) cases per 100,000 population in 1995 to 114.02 (95% CI, 109.02–118.50) cases per 100,000 population in 2004 (P < .001), and those among women increased from 45.08 (95% CI, 42.01–48.15) cases per 100,000 population in 1995 to 83.62 (95% CI, 79.85–87.39) cases per 100,000 population in 2004 (P < .001). Gram-negative bacteria were the most frequently involved microorganisms (in 21.4% of cases), and there was a significant increase in the number of sepsis cases caused by these organisms from 1999 onward. The mortality rate was approximately 42.5% among patients hospitalized for sepsis, and mortality was associated with organ failure. In addition, mortality was associated with the microorganism responsible not being known, with infection due to fungi, and with polymicrobial sepsis.Conclusions.The rates of hospitalization both for sepsis overall and for severe sepsis in the Valencian Community (Spain) are lower than those in other countries but are increasing, by 5% each year. The increase in the number of cases in which gram-negative bacteria are the cause of sepsis is notable.

Clinical Experience with Drotrecogin Alfa in Treating Gram-Positive and -Negative Pathogens in Patients with Severe Sepsis

2004 ◽  
Vol 52 (7) ◽  
pp. 470-474 ◽  
Author(s):  
Lawrence A. Cone ◽  
Richard A. Stone ◽  
Kenneth Jesser ◽  
Richard Nelson
Keyword(s):  
Severe Sepsis ◽  
Mortality Rate ◽  
Organ Failure ◽  
Protein C ◽  
Antimicrobial Agents ◽  
Survival Rates ◽  
Activated Protein C ◽  
Gram Positive ◽  
Gram Negative ◽  
Local Disease

BackgroundNewer concepts in the management of severe sepsis and, in particular, in the understanding of the relationship between proinflammatory and procoagulant activities during severe infection have led to the introduction of activated protein C (drotrecogin) into the therapeutic program. The combination of effective antimicrobial therapy, aggressive supportive care, and efforts to antagonize procoagulants and inhibitors of fibrinolysis was used in this study.MethodsWe treated 12 patients with severe sepsis using this combination of antimicrobial agents and drotrecogin. All patients presented with hypotension and organ failure and some with multiple organ failure. Infected patients were separated into those with gram-positive and those with gram-negative infections.ResultsIn contrast to an expected mortality rate of nearly 40% in this group of patients, only 2 (9%) expired. Both deaths were due to infection by gram-negative organisms in patients with complicated abdominal infections and concurrent cancer. All patients with gram-positive organisms survived.ConclusionThose patients with infections caused by gram-positive organisms seemed to have a better prognosis than those with gram-negative infections, perhaps because their illnesses are less complicated by local disease. Although our study is small, it suggests that activated protein C will have a significant beneficial effect on the future treatment of severe sepsis and can reduce the mortality rate significantly. Further improvement in survival rates will require more effective treatment of local disease and associated noninfectious ailments.

scholarly journals Endotoxins and Anti-endotoxins (Their Relevance to the Anaesthetist and the Intensive Care Specialist)

1989 ◽  
Vol 17 (1) ◽  
pp. 49-55 ◽  
Author(s):  
J. G. Brock-Utne ◽  
S. L. Gaffin
Keyword(s):  
Intensive Care ◽  
Organ Failure ◽  
Disseminated Intravascular Coagulation ◽  
Systemic Circulation ◽  
Toxic Effects ◽  
Gram Negative Bacteria ◽  
Intestinal Ischaemia ◽  
Gram Negative ◽  
Intravascular Coagulation ◽  
Care Specialist

Endotoxins (lipopolysaccharides, LPS) are potent bacterial poisons always present within the intestines in considerable amounts. Several pathophysiological conditions such as hypovolaemia, hypoxia, intestinal ischaemia, burns and radiation lead to a breakdown in the barrier and depending upon the extent of the injury, endotoxins enter the systemic circulation in increasing amounts. Antibiotics do not inactivate the endotoxins which continue to exert their toxic effects leading to nausea, vomiting, diarrhoea, fever, disseminated intravascular coagulation, vascular collapse and organ failure. When nonabsorbable antibiotics are given prior to the insult, systemic endotoxaemia is prevented. Immunotherapy, using anti-lipopolysaccharide IgG, inactivates plasma endotoxins, destroys gram-negative bacteria and opsonises them and may become a major form of therapy. An outline of endotoxin and anti-lipopolysaccharide and its importance to the anaesthetist and intensive care specialist is presented.

scholarly journals Clinical pharmacokinetics of 3-h extended infusion of meropenem in adult patients with severe sepsis and septic shock: implications for empirical therapy against Gram-negative bacteria

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Amol T. Kothekar ◽  
Jigeeshu Vasishtha Divatia ◽  
Sheila Nainan Myatra ◽  
Anand Patil ◽  
Manjunath Nookala Krishnamurthy ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Modeling And Simulation ◽  
Empirical Therapy ◽  
Gram Negative Bacteria ◽  
Clinical Pharmacokinetics ◽  
Gram Negative ◽  
Arterial Blood ◽  
Days Of Therapy ◽  
Extended Infusion

Abstract Background Optimal anti-bacterial activity of meropenem requires maintenance of its plasma concentration (Cp) above the minimum inhibitory concentration (MIC) of the pathogen for at least 40% of the dosing interval (fT > MIC > 40). We aimed to determine whether a 3-h extended infusion (EI) of meropenem achieves fT > MIC > 40 on the first and third days of therapy in patients with severe sepsis or septic shock. We also simulated the performance of the EI with respect to other pharmacokinetic (PK) targets such as fT > 4 × MIC > 40, fT > MIC = 100, and fT > 4 × MIC = 100. Methods Arterial blood samples of 25 adults with severe sepsis or septic shock receiving meropenem 1000 mg as a 3-h EI eight hourly (Q8H) were obtained at various intervals during and after the first and seventh doses. Plasma meropenem concentrations were determined using a reverse-phase high-performance liquid chromatography assay, followed by modeling and simulation of PK data. European Committee on Antimicrobial Susceptibility Testing (EUCAST) definitions of MIC breakpoints for sensitive and resistant Gram-negative bacteria were used. Results A 3-h EI of meropenem 1000 mg Q8H achieved fT > 2 µg/mL > 40 on the first and third days, providing activity against sensitive strains of Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii. However, it failed to achieve fT > 4 µg/mL > 40 to provide activity against strains susceptible to increased exposure in 33.3 and 39.1% patients on the first and the third days, respectively. Modeling and simulation showed that a bolus dose of 500 mg followed by 3-h EI of meropenem 1500 mg Q8H will achieve this target. A bolus of 500 mg followed by an infusion of 2000 mg would be required to achieve fT > 8 µg > 40. Targets of fT > 4 µg/mL = 100 and fT > 8 µg/mL = 100 may be achievable in two-thirds of patients by increasing the frequency of dosing to six hourly (Q6H). Conclusions In patients with severe sepsis or septic shock, EI of 1000 mg of meropenem over 3 h administered Q8H is inadequate to provide activity (fT > 4 µg/mL > 40) against strains susceptible to increased exposure, which requires a bolus of 500 mg followed by EI of 1500 mg Q8H. While fT > 8 µg/mL > 40 require escalation of EI dose, fT > 4 µg/mL = 100 and fT > 8 µg/mL = 100 require escalation of both EI dose and frequency.

scholarly journals Relationship between Triclosan and Susceptibilities of Bacteria Isolated from Hands in the Community

2004 ◽  
Vol 48 (8) ◽  
pp. 2973-2979 ◽  
Author(s):  
Allison E. Aiello ◽  
Bonnie Marshall ◽  
Stuart B. Levy ◽  
Phyllis Della-Latta ◽  
Elaine Larson
Keyword(s):  
Confidence Interval ◽  
Antibiotic Susceptibility ◽  
Community Setting ◽  
Consumer Products ◽  
Hand Washing ◽  
Gram Negative Bacteria ◽  
Odds Ratios ◽  
Gram Negative ◽  
Increasing Trend

ABSTRACT The possible association between triclosan and bacterial susceptibility to antibiotic was examined among staphylococci and several species of gram-negative bacteria (GNB) isolated from the hands of individuals in a community setting. Hand cultures from individuals randomized to using either antibacterial cleaning and hygiene products (including a hand soap containing 0.2% triclosan) or nonantibacterial cleaning and hygiene products for a 1-year period were taken at baseline and at the end of the year. Although there was no statistically significant association between triclosan MICs and susceptibility to antibiotic, there was an increasing trend in the association the odds ratios (ORs) for all species were compared at baseline (OR = 0.65, 95% confidence interval [95%CI] = 0.33 to 1.27) versus at the end of the year (OR = 1.08, 95%CI = 0.62 to 1.97) and for GNB alone at baseline(OR = 0.66, 95%CI = 0.29 to 1.51) versus the end of year (OR = 2.69, 95%CI = 0.78 to 9.23) regardless of the hand-washing product used. Moreover, triclosan MICs were higher in some of the species compared to earlier reports on household, clinical, and industrial isolates, and some of these isolates had triclosan MICs in the range of concentrations used in consumer products. The absence of a statistically significant association between elevated triclosan MICs and reduced antibiotic susceptibility may indicate that such a correlation does not exist or that it is relatively small among the isolates that were studied. Still, a relationship may emerge after longer-term or higher-dose exposure of bacteria to triclosan in the community setting.

scholarly journals Antimicrobial Resistance in Hospitalized Surgical Patients: a Silently Emerging Public Health Concern in Benin.

2020 ◽  
Author(s):  
Carine Laurence YEHOUENOU ◽  
Arsène A. KPANGON ◽  
Dissou AFFOLABI ◽  
Hector RODRIGUEZ-VILLALOBOS ◽  
Françoise Van Bambeke ◽  
...  
Keyword(s):  
Gastrointestinal Surgery ◽  
Surgical Site Infections ◽  
Multidrug Resistant ◽  
Public Hospitals ◽  
Health Concern ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Strict Adherence ◽  
Gram Negative

Abstract Background: Surgical site infections are related to high morbidity, mortality and healthcare costs. As the emergence of multidrug-resistant bacterial pathogens in hospitals is becoming a worldwide challenge for surgeons who treat healthcare-associated infections, we wished to identify the causative agents involved in surgical site infections and their susceptibility pattern in six public hospitals in Benin. Methods: Using standard microbiological procedures, we processed pus specimens collected from obstetrics and gastrointestinal surgery wards. Mass spectrometry (MALDI-TOF) was used for confirmation. The antibiotic susceptibility test firstly used the Kirby-Bauer disc diffusion method. The secondary test by microdilution used the Beckton Dickinson Phoenix automated system (Becton Dickinson Diagnostic, USA). Results: We included 304 patients (mean age 32 ± 11 years), whose median length of stay was 9 days. A total of 259 wound swabs (85.2%) had positive aerobic bacterial growth. In obstetrics S. aureus (28.5%, n=42) was the most common isolate. In contrast, Gram-negative bacteria (GNB) were predominant in gastrointestinal surgery. The most dominant being E.coli (38.4%, n=31). Overall, 90.8% (n=208) of aerobic bacteria were multidrug resistant. Two-third of S. aureus (65.3%, n= 32) were methicillin-resistant Staphylococcus aureus (MRSA), three of which carried both MRSA and induced clindamycin resistance (ICR). GNB showed high resistance to ceftazidime, ceftriaxone and cefepime. Extended-spectrum beta-lactamases were presented by 69.4% of E.coli (n=43/62) and 83.3% of K. pneumoniae (n=25/30). Overall, twelve Gram negative bacteria (5.24%) isolates showed resistance to at least one carbapenem. No isolates showed a wild-type susceptible phenotype.Conclusion: This study shows the alarming prevalence of multidrug resistant organisms from surgical site infections in Benin hospitals. To reduce the spread of these multidrug-resistant bacteria, periodic surveillance of surgical site infections and strict adherence to good hand-hygiene practice are essential.

Evaluating Thrombocytopenia and Other Biomarkers in Multi-Organ Failure during Sickle Cell Crisis

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4858-4858
Author(s):  
Krithika Shanmugasundaram ◽  
Ixavier Higgins ◽  
Fuad A El Rassi ◽  
Morgan L. McLemore
Keyword(s):  
Platelet Count ◽  
Organ Failure ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Laboratory Data ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Time To Death ◽  
Multi Organ Failure ◽  
Sickle Cell Crisis

Background: In sickle cell anemia, very few markers of disease have been shown to correlate with activity and severity of crisis. We aimed to identify any patterns amongst biomarkers and co-morbidities that correlate with death from multi-organ failure when admitted for sickle cell crisis. Methods: We identified 20 patients with sickle cell anemia who died of multi-organ failure at Grady Memorial Hospital from 2010-2016. We described baseline characteristics, such as hemoglobin phenotype, age, gender as well as features at presentation such as vital signs, laboratory data, clinical signs and symptoms (I.e. worsening pain), and co-morbidities. We examined bivariate associations between clinical characteristics and the length of survival after multi-organ failure. In a secondary analysis, we investigated clinical and demographic features that most accurately predict infection with gram-negative bacteria. To achieve this, we fit a multivariate logistic regression model and perform leave-one-out cross validation to assess the predictive performance of the fitted model on unseen data. Results: At baseline, the average age of a patient is 43.8 years (sd=14.7 years). A majority of our cohort are women (60%), do not smoke (70%), and were not on hydroxyurea (80%). Time to death from multi-organ failure was 3.05 days (95% C.I.: 0.20, 5.90), and only 43% identified having "worsening pain." Among complications, 23% had a stroke and 25% had an infection with gram-negative bacteria. With regards to laboratory data, average WBC was 13.4 (95% C.I.: 11.04, 15.70), Platelets 155 (95% C.I.: 102.22, 208.38), d-dimer 12,892 (95% C.I.: -2498.47, 33437.87) and ferritin 3108 (95% C.I.: 795.07, 5421.63). When using a univariate analysis, we identified that stroke (p=0.008), age (p=0.022) and platelet count at the time of presentation (p=0.039) correlated with time to death. We also identified a statistically significant decrease in the platelet count from baseline to time of multi-organ failure (-105.6, p<0.001). Body mass index (BMI) and worsening pain jointly predict infection with gram-negative bacteria with small error (0.133). Conclusion: We have described a cohort of patients with sickle cell anemia who died of multi-organ failure and found that some factors may have correlated with time to death. The most poignant factors include age, platelet count, and drop in platelet count from baseline. It is also interesting that a proportion of these patients developed a gram-negative bacterial infection, which is a common cause of mortality in sepsis. Although our cohort is small, these data may help guide future studies with larger cohorts of patients to identify what puts these patients at risk of death from multi-organ failure. Disclosures No relevant conflicts of interest to declare.

Correlation Between Respiratory Colonization With Gram-Negative Bacteria and Development of Gram-Negative Bacterial Infection After Cardiac Surgery

2008 ◽  
Vol 29 (6) ◽  
pp. 546-548 ◽  
Author(s):  
Pranavi V. Sreeramoju ◽  
Sylvia Garcia-Houchins ◽  
Judith Bova ◽  
Cynthia C. Kelly ◽  
Jan E. Patterson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Relative Risk ◽  
Observational Study ◽  
Confidence Interval ◽  
Bacterial Infection ◽  
Gram Negative Bacteria ◽  
Subsequent Infection ◽  
Gram Negative

This pilot, observational study involving 286 patients who underwent cardiac surgery found that patients who had endotracheal colonization with gram-negative bacteria at 1 week after surgery were more likely to develop subsequent infection compared to those without colonization (8 of 23 vs. 4 of 40; relative risk 2.3 [95% confidence interval, 1.3–4.1;Pvalue < .05]).

Failure of Bland Soap Handwash to Prevent Hand Transfer of Patient Bacteria to Urethral Catheters

1991 ◽  
Vol 12 (11) ◽  
pp. 654-662 ◽  
Author(s):  
N. Joel Ehrenkranz ◽  
Blanca C. Alfonso
Keyword(s):  
Confidence Interval ◽  
Risk Ratio ◽  
Healthcare Workers ◽  
Isopropyl Alcohol ◽  
Gram Negative Bacteria ◽  
Patient Contact ◽  
Urinary Catheters ◽  
Gram Negative ◽  
High Burden ◽  
Direct Patient Contact

AbstractObjective:The study was designed to compare the efficacies of bland soap handwash and isopropyl alcohol hand rinse in preventing transfer of aerobic gram-negative bacilli to urinary catheters via transient hand colonization acquired from direct patient contact. Glove juice recovery of gram-negative bacteria was considered transient colonization; catheter recovery was considered transfer colonization.Design:The contact source for gram-negative bacteria was a single “high burden” groin skin carrier ( ≥ 104/ml cup scrub fluid). Using a two-period cross-over design, 6 healthcare workers had 2 15-second contacts for each hand followed by either soap handwash or alcohol hand rinse (12 experiments with each treatment). Between 4 to 5 minutes after contact, each hand manipulated a catheter; the catheter was then cultured and the hand was glove juice tested.Results:Soap handwash failed to prevent gram-negative bacteria transfer to the catheter in 11 of 12 (92%) experiments; alcohol hand rinse in 2 of 12 (17%) (p< .001). Soap handwash failed to prevent transient colonization in 12 of 12 (100%) experiments; alcohol in 5 of 12 (42%) (risk ratio 2.4,95% confidence interval 1.2-4.7). Single gram-negative bacteria species carried at source levels ≥ 5.5 × 103/ml (heavy contamination) established transient colonization in 23 of 30 (77%) exposures following soap handwash; single gram-negative bacteria species carried at levels ≤ 3.5 × 103/ml established colonization in 1 of 22 (5%) similar exposures (p<.001).Conclusions:Bland soap handwash was generally ineffective in preventing hand transfer of gram-negative bacteria to catheters following brief contact with a heavy-contamination patient source; alcohol hand rinse was generally effective.

A 5-Year Epidemiological Study of Nosocomial Bloodstream Infections in a Neurosurgery Department

2010 ◽  
Vol 31 (4) ◽  
pp. 414-417 ◽  
Author(s):  
Parmenion P. Tsitsopoulos ◽  
Elias Iosifidis ◽  
Charalampos Antachopoulos ◽  
Maria Tsivitanidou ◽  
Ioannis Anagnostopoulos ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Epidemiological Study ◽  
Antimicrobial Agents ◽  
Bloodstream Infections ◽  
Gram Negative Bacteria ◽  
Neurosurgical Department ◽  
Gram Negative ◽  
Overall Mortality

The characteristics of nosocomial bloodstream infections (BSIs) in a neurosurgical department were studied over a 5-year period. The rate of nosocomial BSI was 3.0%. Gram-negative bacteria were the most commonly isolated pathogens (65.9% of isolates). For all the pathogens isolated, the rate of resistance to commonly used antimicrobial agents was high. Of the 101 patients with nosocomial BSI, 50 (49.5%) died during their stay at the Department of Neurosurgery. At the same time, overall mortality rate among neurosurgical inpatients without nosocomial BSI was 5.4% (ie, 175 of 3,216 patients died).

scholarly journals Comparative Effects of Ciprofloxacin and Ceftazidime on Cytokine Production in Patients with Severe Sepsis Caused by Gram-Negative Bacteria

2004 ◽  
Vol 48 (8) ◽  
pp. 2793-2798 ◽  
Author(s):  
C. A. Gogos ◽  
A. Skoutelis ◽  
A. Lekkou ◽  
E. Drosou ◽  
I. Starakis ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Group Versus ◽  
Gram Negative Bacteria ◽  
Proinflammatory Response ◽  
Necrosis Factor Alpha ◽  
Gram Negative ◽  
Tnf Α ◽  
Factor Alpha ◽  
Anti Inflammatory ◽  
Necrosis Factor

ABSTRACT In the present study the effect of ciprofloxacin versus ceftazidime on concentrations of pro- and anti-inflammatory cytokines in the sera of patients with severe sepsis was evaluated. The study included 58 previously healthy patients suffering from severe sepsis caused by gram-negative bacteria, treated with either ciprofloxacin or ceftazidime after thorough clinical and microbiological evaluation and followed up for clinical outcome. Levels of the proinflammatory cytokines tumor necrosis factor alpha (TNF-α), interleukin-1b (IL-1b), IL-6, and IL-8 and of the anti-inflammatory cytokine IL-10, as well as of IL-1 receptor antagonist and soluble TNF receptors I and II, in serum were measured at baseline and 24 and 48 h after the first antimicrobial dose. Mean SAPS-II scores, development of septic shock, and mortality rates were similar in the two groups (43.2 ± 9.2, 21.4%, and 14.3% in the ceftazidime group versus 49.8 ± 11.3, 20%, and 13.3% in the ciprofloxacin group). Serum TNF-α and IL-6 levels at 24 and 48 h were significantly lower in the ciprofloxacin group, while the IL-10/TNF-α ratio was significantly higher, than those for the ceftazidime group. Among patients with high baseline TNF-α levels, there were significant increases in the IL-10/TNF-α ratio at both 24 and 48 h over that at admission for the ciprofloxacin group, while no differences were noted in the ceftazidime group. These results indicate that ciprofloxacin may have an immunomodulatory effect on septic patients by attenuating the proinflammatory response, while there is no evidence that differences in the cytokines measured have any impact on the final outcome.

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