scholarly journals Central-line-related septic shock: early appropriate antimicrobial therapy and rapid source control reduce mortality

Critical Care ◽  
2008 ◽  
Vol 12 (Suppl 2) ◽  
pp. P397
Author(s):  
R Low ◽  
MW Ahsan ◽  
H Chou ◽  
M Bahrainian ◽  
A Singh ◽  
...  
Keyword(s):  
Septic Shock ◽  
Antimicrobial Therapy ◽  
Central Line ◽  
Source Control

scholarly journals The impact of delayed source control and antimicrobial therapy in 196 patients with cholecystitis-associated septic shock: a cohort analysis

2019 ◽  
Vol 62 (3) ◽  
pp. 189-198 ◽  
Author(s):  
Constantine J. Karvellas ◽  
Victor Dong ◽  
Juan G. Abraldes ◽  
Erica L.W. Lester ◽  
Anand Kumar
Keyword(s):  
Septic Shock ◽  
Antimicrobial Therapy ◽  
Cohort Analysis ◽  
Source Control ◽  
The Impact

scholarly journals 216. Are Automatic Antimicrobial Stop Orders an Effective Stewardship Tool for Urinary Tract and Intra-Abdominal Infections?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S110-S110
Author(s):  
Christina Maguire ◽  
Dusten T Rose ◽  
Theresa Jaso
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Therapy ◽  
Source Control ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
Before And After ◽  
The Difference ◽  
Tract Infections ◽  
Length Of Therapy ◽  
The Impact

Abstract Background Automatic antimicrobial stop orders (ASOs) are a stewardship initiative used to decrease days of therapy, prevent resistance, and reduce drug costs. Limited evidence outside of the perioperative setting exists on the effects of ASOs on broad spectrum antimicrobial use, discharge prescription duration, and effects of missed doses. This study aims to evaluate the impact of an ASO policy across a health system of adult academic and community hospitals for treatment of intra-abdominal (IAI) and urinary tract infections (UTI). ASO Outcome Definitions ASO Outcomes Methods This multicenter retrospective cohort study compared patients with IAI and UTI treated before and after implementation of an ASO. Patients over the age of 18 with a diagnosis of UTI or IAI and 48 hours of intravenous (IV) antimicrobial administration were included. Patients unable to achieve IAI source control within 48 hours or those with a concomitant infection were excluded. The primary outcome was the difference in sum length of antimicrobial therapy (LOT). Secondary endpoints include length and days of antimicrobial therapy (DOT) at multiple timepoints, all cause in hospital mortality and readmission, and adverse events such as rates of Clostridioides difficile infection. Outcomes were also evaluated by type of infection, hospital site, and presence of infectious diseases (ID) pharmacist on site. Results This study included 119 patients in the pre-ASO group and 121 patients in the post-ASO group. ASO shortened sum length of therapy (LOT) (12 days vs 11 days respectively; p=0.0364) and sum DOT (15 days vs 12 days respectively; p=0.022). This finding appears to be driven by a decrease in outpatient LOT (p=0.0017) and outpatient DOT (p=0.0034). Conversely, ASO extended empiric IV LOT (p=0.005). All other secondary outcomes were not significant. Ten patients missed doses of antimicrobials due to ASO. Subgroup analyses suggested that one hospital may have influenced outcomes and reduction in LOT was observed primarily in sites without an ID pharmacist on site (p=0.018). Conclusion While implementation of ASO decreases sum length of inpatient and outpatient therapy, it may not influence inpatient length of therapy alone. Moreover, ASOs prolong use of empiric intravenous therapy. Hospitals without an ID pharmacist may benefit most from ASO protocols. Disclosures All Authors: No reported disclosures

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

Septic Shock

1992 ◽  
Vol 7 (2) ◽  
pp. 90-100 ◽  
Author(s):  
Margaret M. Parker ◽  
Mitchell P. Fink
Keyword(s):  
Septic Shock ◽  
Supportive Care ◽  
Antimicrobial Therapy ◽  
Clinical Manifestations ◽  
Sepsis Syndrome ◽  
Adjunctive Treatment ◽  
Cardiovascular Changes ◽  
The Past ◽  
Sepsis And Septic Shock ◽  
Very High

The incidence of sepsis and septic shock has been increasing dramatically over the past 10 years. Despite advances in antimicrobial therapy, the mortality of septic shock remains very high. We review the clinical manifestations of sepsis and septic shock and describe the cardiovascular manifestations. Pathophysiology of the cardiovascular changes is discussed, and mediators believed to be involved in the pathogenesis are reviewed. Management of septic shock is also discussed, including antimicrobial therapy, supportive care, and adjunctive treatment aimed at affecting the mediators involved in producing the sepsis syndrome.

Postoperative Vasodilatory Shock

2020 ◽  
pp. 333-342
Author(s):  
Fiona Roberts ◽  
Alan Gaffney
Keyword(s):  
Septic Shock ◽  
Cardiac Output ◽  
Fluid Resuscitation ◽  
Antimicrobial Therapy ◽  
Pulse Pressure ◽  
Vasodilatory Shock ◽  
First Line ◽  
Treatment Interventions ◽  
Common Cause ◽  
Early Fluid

This chapter discusses vasodilatory shock. The hallmark of vasodilatory shock is hypotension with normal or increased cardiac output. The hyperdynamic circulatory state of vasodilatory shock results in a tachycardia and an increased pulse pressure. Radiological and biochemical investigations can assist with determining the diagnosis of shock. The causes of vasodilatory shock are diverse; they include sepsis, surgical insult, anaphylaxis, and others such as trauma, burns, and pancreatitis. However, sepsis is by far the most common cause of vasodilatory shock. The pathophysiology of vasodilatory shock is also complex and multifactorial. Although still not fully understood, it is widely accepted that it includes activation of several intrinsic vasodilatory pathways and a vascular hyporesponsiveness to vasopressors. Early fluid resuscitation and appropriate antimicrobial therapy are the most crucial treatment interventions in septic shock. Meanwhile, noradrenaline is the first-line vasopressor of choice in septic shock.

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