scholarly journals Rapid Detection of Sepsis using CESDA: the Caenorabditis elegans Sepsis Detection Assay

2017 ◽  
Author(s):  
Ling Fei Tee ◽  
Toh Leong Tan ◽  
Hui-min Neoh ◽  
Rahman Jamal
Keyword(s):  
Urine Samples ◽  
University Hospital ◽  
Antibiotic Administration ◽  
Suspected Sepsis ◽  
Clinical Criteria ◽  
C Elegans ◽  
Sepsis Diagnosis ◽  
Detection Assay ◽  
Threatening Condition ◽  
Sepsis Detection

AbstractSepsis is a life-threatening condition which could be alleviated by rapid diagnosis and appropriate antibiotic administration. However, currently available laboratory tests for sepsis diagnosis lacks sensitivity and specificity; they also have long turn-around times. In this proof-of-concept study, the nematode Caenorhabditis elegans was used as a biological sensor to detect urine of sepsis patients in an assay designated as the C. elegans Sepsis Detection Assay (CESDA). From January to June 2016, 45 patients who were admitted to the Emergency Department of a university hospital due to suspected sepsis were included into the study. Urine samples were obtained from these patients and healthy controls and spotted onto CESDA assay plates. Subsequently, C. elegans were aliquoted onto the centre of the plates and allowed to migrate freely. Number of worms found in either spots or quadrants of the plates containing control or suspected sepsis samples were scored in 10 minute intervals in a 60-minute duration. The CESDA index was then calculated for each sample, where an index near +1 represented attraction of the worms towards the sample, while an index near -1 signified repulsion. Confirmatory diagnosis for suspected sepsis samples was determined using a combination of clinical criteria assessment and standard laboratory protocols. All patients who were positive for sepsis were found to have a CESDA index of > 0.1 (positive predictive value, PPV ≥87%). In addition, the worms were able to differentiate urine of sepsis patients from control as early as 20 minutes (p=0.012). Interestingly, the assay was also able to identify infection within 40 minutes of the test (AUROC = 0.80, p= 0.016). The rapidity of CESDA in sepsis and infection identification as well as the usability of urine samples which are non-invasive towards the patient in this method makes it an interesting protocol to be further explored for sepsis diagnosis.

scholarly journals Differences in Hypotensive vs. Non-Hypotensive Sepsis Management in the Emergency Department: Door-to-Antibiotic Time Impact on Sepsis Survival

2018 ◽  
Vol 6 (4) ◽  
pp. 91
Author(s):  
Leonor Ballester ◽  
Rafael Martínez ◽  
Juan Méndez ◽  
Gloria Miró ◽  
Manel Solsona ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Sepsis ◽  
Clinical Laboratory ◽  
University Hospital ◽  
Antibiotic Administration ◽  
Process Of Care ◽  
Sepsis Management ◽  
Initial Management ◽  
Sepsis Diagnosis ◽  
Community Onset

Background: Sepsis diagnosis can be incorrectly associated with the presence of hypotension during an infection, so the detection and management of non-hypotensive sepsis can be delayed. We aimed to evaluate how the presence or absence of hypotension, on admission at the emergency department, affects the initial management and outcomes of patients with community-onset severe sepsis. Methods: Demographic, clinical, laboratory, process of care, and outcome variables were recorded for all patients, at the emergency department of our university hospital, who presented with community-onset severe sepsis, between 1 March and 31 August in three consecutive years. Patient management consisted of standardized bundled care with five measures: Detection, blood cultures and empirical antibiotics, oxygen supplementation and fluid resuscitation (if needed), clinical monitoring, and noradrenalin administration (if needed). We compared all variables between patients who had hypotension (mean arterial pressure <65 mmHg), on admission to the emergency department, and those who did not. Results: We identified 153 episodes (84 (54.5%) men; mean age 73.6 ± 1.2; mean Sequential Organ Failure Assessment (SOFA) score 4.9 ± 2.7, and 41.2% hospital mortality). Hypotension was present on admission to the emergency department in 57 patients (37.2%). Hemodynamic treatment was applied earlier in patients who presented hypotension initially. Antibiotics were administered 48 min later in non-hypotensive sepsis (p = 0.08). A higher proportion of patients without initial hypotension required admission to the intensive care unit (ICU) (43.1% for patients initially hypotensive vs. 56.9% in those initially non-hypotensive, p < 0.05). Initial hypotension was not associated with mortality. A delay in door-to-antibiotic administration time was associated with mortality [OR 1.150, 95%CI: 1.043–1.268). Conclusions: Initial management of patients with community-onset severe sepsis differed according to their clinical presentation. Initial hypotension was associated with early hemodynamic management and less ICU requirement. A non-significant delay was observed in the administration of antibiotics to initially non-hypotensive patients. The time of door-to-antibiotic administration was related to mortality.

scholarly journals DIAGNOSTIC UTILITY OF PRESEPSIN AND PROCALCITONIN IN CRITICALLY ILL PATIENTS WITH SUSPECTED SEPSIS: COMPARISON WITH RECENT CLINICAL CRITERIA OF SEPSIS-3

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Babak Alikiaie ◽  
Sarah Mousavi ◽  
Mohammad Nasri
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Diagnostic Value ◽  
Suspected Sepsis ◽  
Clinical Sepsis ◽  
Clinical Criteria ◽  
Decision Tools ◽  
Sepsis Diagnosis ◽  
Previous Definition ◽  
Definition Of

Background: In this study, we aimed to investigate the diagnostic and prognostic utilities of presepsin and procalcitonin (PCT) in critically ill patients with suspected sepsis, for whom sepsis was diagnosed clinically based on the Survival Sepsis Campaign (SSC) criteria and to compare it with recent criteria of Sepsis-3. Methods: Blood samples for biomarker measurements of presepsin and PCT were drawn on days 1, 3 and 7 of ICU admission in a total of 26 patients. All patients were followed-up until death or discharge. All studied biomarkers were analyzed according to the diagnosis and severity of sepsis and for prognosis (all-cause mortality) at days 1, 3 and 7. Agreement between the diagnosis of clinical sepsis and presepsin or PCT-based sepsis was assessed using Cohen’s kappa Results: Clinical sepsis (based on Sepsis-3) and presepsin or PCT-based sepsis showed poor agreement (Kappa<0.4). Presepsin levels at day1 correlated significantly with mortality (r=0.45, P; 0.02). The diagnostic value of both presepsin and PCT to diagnose sepsis was weak (Area under curve (AUC) <0.75). The overall agreement in sepsis diagnosis was fair to good based on the both clinical criteria (P<0.05, Kappa: 0.5-0.75). More than 80% of patients (N=21) had sepsis based on presepsin upon admission. Both clinical criteria predicated that less than 20% of patients (N=5) had sepsis upon admission. Conclusion: Based on our findings, the overall agreement between the diagnosis of clinical sepsis and presepsin or PCT-based sepsis was poor. Also, our results show that the new Sepsis-3 definitions were accurate and equal to the previous definition of SSC guideline. Although, availability of diagnostic assays is variable in Iran, but, it seems that addition of developing decision tools that utilize biomarkers to help aid the rapid diagnosis of sepsis is necessary and may  improve patient outcomes. Keywords: Presepsin, Pro Calcitonin, Sepsis, Diagnosis

Post-Operative Infection Following Hand Surgery

1995 ◽  
Vol 20 (5) ◽  
pp. 685-690 ◽  
Author(s):  
A. J. PLATT ◽  
R. E. PAGE
Keyword(s):  
Wound Infection ◽  
Infection Rate ◽  
Hand Surgery ◽  
Fold Increase ◽  
Antibiotic Use ◽  
Postal Questionnaire ◽  
British Society ◽  
Antibiotic Administration ◽  
Clinical Criteria ◽  
Operative Wound

An audit was designed to analyse the risk factors for developing post-operative wound infection following hand surgery. 249 consecutive patients were prospectively entered into the study. 236 (95%) patients were available for follow-up. Infection was diagnosed by clinical criteria. There was an infection rate of 10.7% in elective operations and 9.7% in emergency operations. There was no significant reduction in infection rate in the elective group with the use of antibiotics ( P=0.5). In the emergency group of patients peri-operative antibiotic administration was associated with an 8.5-fold reduction in infection rate ( P=0.014). The presence of a dirty wound was associated with a 13.4-fold increase in post-operative wound infection rate ( P=0.002). A postal questionnaire of members of the British Society for Surgery of the Hand revealed a wide variation in antibiotic usage. Guidelines for antibiotic use in patients undergoing hand surgery are presented.

scholarly journals Circulating Heme Oxygenase-1: Not a Predictor of Preeclampsia but Highly Expressed in Pregnant Women Who Subsequently Develop Severe Preeclampsia

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Valéria C. Sandrim ◽  
Mayara Caldeira-Dias ◽  
Heloisa Bettiol ◽  
Marco Antonio Barbieri ◽  
Viviane Cunha Cardoso ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Heme Oxygenase ◽  
Clinical Symptoms ◽  
Severe Preeclampsia ◽  
Urine Samples ◽  
University Hospital ◽  
Enzyme Linked Immunosorbent Assay ◽  
Heme Oxygenase 1 ◽  
Study Cohort ◽  
Potential Biomarker

Preeclampsia is the major cause of maternal and fetal deaths worldwide. Circulating biomarker concentrations to predict preeclampsia must be determined. Therefore, the objective was to evaluate heme oxygenase-1 (HO-1) concentration in both plasma and urine samples from pregnant women before the development of preeclampsia and to identify a potential biomarker for preeclampsia development. We performed a case-control study nested in a prospective study cohort at University Hospital of the Ribeirao Preto Medical School, University of São Paulo (HCFMRP-USP), Ribeirao Preto, Brazil. Of 1400 pregnant women evaluated at 20–25 weeks of gestation, 460 delivered in hospitals outside our institution. Of 940 pregnant women who completed the protocol, 30 developed preeclampsia (cases, 14 cases of severe preeclampsia and 16 cases of mild preeclampsia). Healthy pregnant women (controls, n=90) were randomly selected from the remaining 910 participants. HO-1 concentration was evaluated in plasma/urine samples by using a commercial enzyme-linked immunosorbent assay kit. We found similar HO-1 levels in the plasma and urine for case and control groups. In the subgrouped preeclampsia, lower plasma HO-1 levels were found in mild compared with severe preeclampsia. We conclude that plasma HO-1 levels were not altered at 20–25 weeks of gestation before the manifestation of preeclampsia symptoms. Pregnant women who subsequently develop severe preeclampsia show higher expression of HO-1. This may be indicative of important underlying pathophysiologic mechanisms that differentiate between mild and severe preeclampsia and may possibly be related to a higher prooxidative status even before the development of clinical symptoms.

scholarly journals Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study

2021 ◽  
Vol 18 (21) ◽  
pp. 11534
Author(s):  
Stefano Sartini ◽  
Laura Massobrio ◽  
Ombretta Cutuli ◽  
Paola Campodonico ◽  
Cristina Bernini ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Adverse Outcome ◽  
University Hospital ◽  
Rt Pcr ◽  
Threatening Condition ◽  
Life Threatening ◽  
Group A ◽  
Group B ◽  
The University

COVID-19 respiratory failure is a life-threatening condition. Oxygenation targets were evaluated in a non-ICU setting. In this retrospective, observational study, we enrolled all patients admitted to the University Hospital of Genoa, Italy, between 1 February and 31 May 2020 with an RT-PCR positive for SARS-CoV-2. PaO2, PaO2/FiO2 and SatO2% were collected and analyzed at time 0 and in case of admission, patients who required or not C-PAP (groups A and B) were categorized. Each measurement was correlated to adverse outcome. A total of 483 patients were enrolled, and 369 were admitted to hospital. Of these, 153 required C-PAP and 266 had an adverse outcome. Patients with PaO2 <60 and >100 had a higher rate of adverse outcome at time 0, in groups A and B (OR 2.52, 3.45, 2.01, respectively). About the PaO2/FiO2 ratio, the OR for < 300 was 3.10 at time 0, 4.01 in group A and 4.79 in group B. Similar odds were found for < 200 in any groups and < 100 except for group B (OR 11.57). SatO2 < 94% showed OR 1.34, 3.52 and 19.12 at time 0, in groups A and B, respectively. PaO2 < 60 and >100, SatO2 < 94% and PaO2/FiO2 ratio < 300 showed at least two- to three-fold correlation to adverse outcome. This may provide simple but clear targets for clinicians facing COVID-19 respiratory failure in a non ICU-setting.

scholarly journals HLA Class II-DRB,-DQA and –DQB Genotypes in Peripheral Blood Shows Shifts During the Course of Sepsis

2019 ◽  
Vol 73 (1) ◽  
pp. 10-16
Author(s):  
Linda Bāra ◽  
Jeļena Eglīte ◽  
Pēteris Ošs ◽  
Vinita Cauce ◽  
Vilnis Lietuvietis ◽  
...  
Keyword(s):  
Human Leukocyte ◽  
Class Ii ◽  
Hla Class Ii ◽  
University Hospital ◽  
Control Group ◽  
Hla Dr ◽  
Group Data ◽  
Threatening Condition ◽  
Life Threatening ◽  
Genetically Determined

Abstract Undeniably, sepsis is still a profoundly damaging and life-threatening condition for many individuals. With multiple changes in sepsis patients it is difficult to precisely classify an individual’s response in sepsis as proinflammatory or immunosuppressed. The aim of this study was to investigate genetically determined predisposition to developed sepsis by analysis of distribution of human leukocyte antigen (HLA) class II genes. Samples from patients with sepsis were collected at Pauls Stradiņš Clinical University Hospital, Latvia, in an intensive care unit between October 2016 and May 2017. The study group included 62 patients with sepsis, who were genotyped for HLA-DR; DQ using real time polymerase chain reaction – sequence specific primer (RT PCR-SSP). As a control group, data of 100 individuals were taken from the genetic bank of RSU Joint Laboratory of Clinical Immunology and Immunogenetics. The summarised results showed that the frequency of alleles DRB1*04:01 (OR = 5.54; 95% CI = 1.88–16.29); DRB1*07:01 (OR = 19.03; 95% CI = 2/37–152.82); DQA1*05:01 (OR = 14.17; 95% CI = 5.67–35.4); and DQB1*02:01 (OR = 50.00; 95% CI = 2.90–861.81) were significantly increased in patients with sepsis compared to the control group patients. The frequency of DRB1*16:01 (OR = 0.17, 95% CI = 0.04–0.59); DRB1*17:01 (OR = 0.04; 95% CI = 0.00–0.69); DQA1*01:01 (OR = 0.04; 95% CI = 0.00–0.31); DQA1*01:02 (OR = 0.03; 95% CI = 0.00–0.23); DQB1*02:02 (OR = 0.12; 95% CI = 0.03–0.42) alleles was lower in sepsis patients than in control subjects. The most frequent HLA-DRB1/DQA1/DQB1 haplotypes that was significantly increased in patients with sepsis were: DRB1*01:01/DQA1*05:01/DQB1*03:01 (OR = 12.6; 95% CI = 1.51–105.0; p < 0.003). Sepsis patients with pneumonia and alleles and DRB1 04:01; 07:01, DQB1 02:01 had the highest mortality rate. Undoubtedly, our preliminary data showed that development of sepsis can be associated with alleles and haplotypes of HLA class II genes. For more precise conclusion the research should be continued to include a larger patient group.

scholarly journals Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital.

2016 ◽  
Vol 43 (4) ◽  
pp. 225-234 ◽  
Author(s):  
MARISE GOUVÊA ◽  
CRISTIANE DE OLIVEIRA NOVAES ◽  
ANTONIO CARLOS IGLESIAS
Keyword(s):  
Antibiotic Prophylaxis ◽  
Prophylactic Antibiotic ◽  
University Hospital ◽  
Surgical Patients ◽  
Antibiotic Administration ◽  
Surgical Antibiotic Prophylaxis ◽  
The Right

ABSTRACT Objective : to evaluate the antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital - HUGG. Methods : we conducted a rospective study of a cohort of 256 patients undergoing elective operations between January and September 2014. We collected data on demographics, use or not of prophylactic antibiotic and the antibiotic prophylaxis following characteristics: type of antibiotic used, moment of administration and duration of postoperative use. The analyzed outcomes were "justified use or non-use of antibiotic prophylaxis", "correct antibiotic choice," "administration of the antibiotic at the right time" and "discontinuation of the antibiotic at the right time." Results : antibiotic prophylaxis was used in 91.8% of cases. The use or non-use of antibiotic prophylaxis was justified in 78.9% of patients, the choice of the administered antibiotic was considered correct in 97.9%, antibiotic administration was made at the right time in only 27.2% of patients and discontinuation of the antibiotic was performed at the correct time in 95.7% of cases. Conclusion : the surgical antibiotic prophylaxis was not fully adequately performed in the sample.

Atraumatic idiopathic splenic rupture induced by granulocyte-colony stimulating factor (G-CSF) for the treatment of pancytopenia, managed successfully by laparoscopic splenectomy

2020 ◽  
Vol 13 (4) ◽  
pp. e232411 ◽  
Author(s):  
Ugochukwu Chinyere Chinaka ◽  
Joshua Fultang ◽  
Jelizaveta Pereca ◽  
Abdulmajid Ali
Keyword(s):  
Laparoscopic Splenectomy ◽  
Splenic Rupture ◽  
University Hospital ◽  
Haemodynamic Instability ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Threatening Condition ◽  
Life Threatening ◽  
Stimulating Factor ◽  
Factor G

Splenic rupture is a potentially life-threatening condition and an uncommon short-term complication of granulocyte-colony stimulating factor (G-CSF) administration. It may present as acute abdominal pain or suddenly precipitously worsening anaemia with haemodynamic instability that requires urgent operative intervention for survival. We present a case of an atraumatic idiopathic splenic rupture in University Hospital, Ayr in a patient who received G-CSF treatment for chemotherapy-induced (methotrexate) pancytopenia and was successfully managed by laparoscopic splenectomy.

scholarly journals 781. Nurse-Driven Time-of-Triage Sepsis Screening Tool Improves Timely Intervention in Ambulatory Emergency Department (ED) Patients with Suspected Sepsis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S346-S347
Author(s):  
Catalina Howland ◽  
Arthur Chang ◽  
Stephen Selvanayagam ◽  
Stacy Kim ◽  
Mark Bounthavong ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Screening Tool ◽  
Early Recognition ◽  
Average Length ◽  
Primary Outcome Measure ◽  
Medical Attention ◽  
Time Interval ◽  
Antibiotic Administration ◽  
Suspected Sepsis ◽  
Sepsis Screening

Abstract Background Sepsis is a potentially life-threatening, systemic complication of infection. Rapid intervention is critical to reduce morbidity and mortality; however, early recognition of sepsis is challenging due to a highly variable and nonspecific presentation. Recognition is particularly problematic in ambulatory (walk-in) patients who receive minimal to no medical attention prior to ED presentation. There is limited literature addressing sepsis intervention among the ambulatory population in the ED. Our organization has employed an electronic, nurse-driven sepsis screening tool into the triage process for all ambulatory patients who present to the ED. Methods This was a retrospective, quasi-experimental study conducted from November 2015 to May 2018 in three consecutive timeframes: pre-implementation (12 months), implementation (7 months), and post-implementation (12 months). Adult ambulatory ED patients were included if they had a coded diagnosis of sepsis, septic shock, or an infectious syndrome, had fever or hypothermia and systemic inflammatory response syndrome signs on presentation. The primary outcome measure was hourly time interval to antibiotic administration from time of ED registration. Results A total of 902 patients were included with 286, 208, and 408 patients in the pre-implementation, implementation and post-implementation cohorts, respectively. Baseline characteristics including comorbid conditions and infection source were similar between cohorts. The primary outcome of hourly time interval to antibiotic administration was significantly different (P = 0.044) between the three cohorts with the most substantial increase in administration specifically in the less than 1-hour interval. Between the pre-implementation, implementation, and post-implementation cohorts, significant decreases were observed in mean time to fluids (3.6, 3.0, and 2.5 hours, respectively, P = 0.003) and average length of stay (5.5, 5.8, and 4.2 days, respectively, P < 0.001) and a significant increase was observed in ED sepsis alert activations (26%, 48%, 51%, respectively, P < 0.001). Conclusion A nurse-driven electronic time-of-triage sepsis screening tool improved timely recognition and intervention in ambulatory ED patients with suspected sepsis. Disclosures All authors: No reported disclosures.

Over-expression of miR-486/miR-150 in sepsis: marker in myocardial depression function

2015 ◽  
Vol 3 (3) ◽  
pp. 463-475 ◽  
Author(s):  
Robert Thron
Keyword(s):  
Acute Phase Proteins ◽  
Myocardial Depression ◽  
Reactive Protein ◽  
Expression Of Genes ◽  
Potential Marker ◽  
Non Coding Rna ◽  
Threatening Condition ◽  
Life Threatening ◽  
Novel Biomarkers ◽  
Sepsis Detection

Numerous biomarkers have been studied to identify the cause and severity of sepsis MicroRNAs (miRNAs) are non-coding RNA transcripts that regulate the expression of genes by repressing translation or degrading mRNA. Sepsis is a life-threatening condition and the major cause of mortality among patients in intensive care units, including acute phase proteins such as C-reactive protein (CRP). However, the lack of specifity of these more frequently used biomarkers impedes the significant requirement to identify novel biomarkers for early sepsis detection. The role of miR-146a in the physiopathology of sepsis in myocardial depression continues to be poorly understood. miR-486/miR-150 may be used as a potential marker to difference sepsis induces myocardail function from non-sepsis causes.

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