scholarly journals Septic Shock Attributed to Candida Infection: Importance of Empiric Therapy and Source Control

2012 ◽  
Vol 54 (12) ◽  
pp. 1739-1746 ◽  
Author(s):  
M. Kollef ◽  
S. Micek ◽  
N. Hampton ◽  
J. A. Doherty ◽  
A. Kumar
Keyword(s):  
Septic Shock ◽  
Empiric Therapy ◽  
Candida Infection ◽  
Source Control

scholarly journals Ceftolozane/Tazobactam for Treatment of Severe ESBL-Producing Enterobacterales Infections: A Multicenter Nationwide Clinical Experience (CEFTABUSE II Study)

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Matteo Bassetti ◽  
Antonio Vena ◽  
Daniele Roberto Giacobbe ◽  
Marco Falcone ◽  
Giusy Tiseo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Clinical Outcome ◽  
Standard Dose ◽  
Clinical Signs ◽  
Empiric Therapy ◽  
Source Control ◽  
Clinical Failure ◽  
Common Diagnosis ◽  
Definitive Therapy ◽  
Tract Infections

Abstract Background Few data are reported in the literature about the outcome of patients with severe extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) infections treated with ceftolozane/tazobactam (C/T), in empiric or definitive therapy. Methods A multicenter retrospective study was performed in Italy (June 2016–June 2019). Successful clinical outcome was defined as complete resolution of clinical signs/symptoms related to ESBL-E infection and lack of microbiological evidence of infection. The primary end point was to identify predictors of clinical failure of C/T therapy. Results C/T treatment was documented in 153 patients: pneumonia was the most common diagnosis (n = 46, 30%), followed by 34 cases of complicated urinary tract infections (22.2%). Septic shock was observed in 42 (27.5%) patients. C/T was used as empiric therapy in 46 (30%) patients and as monotherapy in 127 (83%) patients. Favorable clinical outcome was observed in 128 (83.7%) patients; 25 patients were considered to have failed C/T therapy. Overall, 30-day mortality was reported for 15 (9.8%) patients. At multivariate analysis, Charlson comorbidity index >4 (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9–3.5; P = .02), septic shock (OR, 6.2; 95% CI, 3.8–7.9; P < .001), and continuous renal replacement therapy (OR, 3.1; 95% CI, 1.9–5.3; P = .001) were independently associated with clinical failure, whereas empiric therapy displaying in vitro activity (OR, 0.12; 95% CI, 0.01–0.34; P < .001) and adequate source control of infection (OR, 0.42; 95% CI, 0.14–0.55; P < .001) were associated with clinical success. Conclusions Data show that C/T could be a valid option in empiric and/or targeted therapy in patients with severe infections caused by ESBL-producing Enterobacterales. Clinicians should be aware of the risk of clinical failure with standard-dose C/T therapy in septic patients receiving CRRT.

RAPIDITY OF SOURCE CONTROL IMPLEMENTATION FOLLOWING ONSET OF HYPOTENSION IS A MAJOR DETERMINANT OF SURVIVAL IN HUMAN SEPTIC SHOCK

2004 ◽  
Vol 32 (Supplement) ◽  
pp. A158 ◽  
Author(s):  
Anand Kumar ◽  
Murtaza Kazmi ◽  
John Ronald ◽  
Mustafa Seleman ◽  
Dan Roberts ◽  
...  
Keyword(s):  
Septic Shock ◽  
Major Determinant ◽  
Source Control ◽  
Human Septic Shock ◽  
Control Implementation

Impact of Pharmacist Intervention on Selection and Timing of Appropriate Antimicrobial Therapy in Septic Shock

2017 ◽  
Vol 31 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Melanie E. Laine ◽  
Jeremy D. Flynn ◽  
Alexander H. Flannery
Keyword(s):  
Septic Shock ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Empiric Therapy ◽  
Pharmacist Intervention ◽  
Entire Cohort ◽  
Sepsis Bundle ◽  
Selection Of ◽  
Antimicrobial Administration

Background: Current guidelines for septic shock management recommend administration of appropriate, broad-spectrum antimicrobials within 1 hour of recognition. Objective: To evaluate the interventions pharmacists make as part of a sepsis response team and to determine if these interventions increase the proportion of patients with appropriate empiric antimicrobial therapy. Methods: A retrospective cohort study was undertaken reviewing adult patients in a large, academic medical center with confirmed septic shock who had an order for a “sepsis bundle,” which includes notification of a pharmacist to assess adequacy of empiric therapy. Pharmacist interventions with regard to selection of empiric antimicrobials were documented. The proportion of patients with initial successful selection of antimicrobial therapy (SSAT) before and after pharmacist intervention was assessed as well as the time to first antimicrobial administration and time to appropriate antimicrobial administration. Results: A total of 76 patients were included. Pharmacist intervention increased the proportion of patients with SSAT from 66% to 80% ( P = .04). Median time to first antimicrobial administration was 43 minutes, and time to appropriate antimicrobial therapy was 1 hour, 34 minutes for the entire cohort, with pharmacist intervention decreasing the latter time significantly in patients without SSAT on initiation of the “sepsis bundle” ( P < .001). Conclusion: Pharmacist assessment of patients in septic shock offers the opportunity to improve SSAT. Systems designed to use a pharmacist responder for the care of patients with septic shock maximize the selection of antimicrobials, facilitate rapid administration, and improve surrogate outcomes for mortality in septic shock.

Source control in the management of severe sepsis and septic shock: An evidence-based review

2004 ◽  
Vol 32 (Supplement) ◽  
pp. S513-S526 ◽  
Author(s):  
John C. Marshall ◽  
Ronald V. Maier ◽  
Maria Jimenez ◽  
E Patchen Dellinger
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Source Control ◽  
Evidence Based ◽  
Sepsis And Septic Shock
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