The Effect of Time of Antimicrobial Administration on the Outcome of Septic Dogs.

To determine whether emergency staff and students can predict patient outcome within 24hours of admission, comparing the accuracy of clinician prognostication with outcome prediction by Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast scoring and identifying whether experience or mood would be associated with accuracy. Prospective observational study between April 2020 and March 2021. University teaching hospital. One hundred and sixty-one dogs admitted through an Emergency Service were assessed. Where data were available, an APPLEfast score was calculated per patient. An APPLEfast score of >25 was deemed a predictor for mortality. None. Emergency staff and students were asked to complete surveys about dogs admitted to the emergency room. All clinicopathological data were available for review, and the animals were available for examination. Data collected included opinions on whether the patient would be discharged from hospital, a mood score, position, and experience in Emergency and Critical Care. One-hundred and twenty-five dogs (77.6%) were discharged; 36 dogs (22.4%) died or were euthanized. Two hundred and sixty-six responses were obtained; 202 responses (75.9%) predicted the correct outcome. Students, interns, residents, faculty, and nurses predicted the correct outcome in 81.4%, 58.3%, 83.3%, 82.1%, and 65.5% of cases, respectively. Of 64 incorrect predictions, 43 (67.2%) predicted death in hospital. APPLEfast scores were obtained in 121 cases, predicting the correct outcome in 83 cases (68.6%). Of 38 cases in which APPLEfast was incorrect, 27 (71.1%) were dogs surviving to discharge. Mean APPLEfast score was 22.9(±6.2). There was no difference in outcome prediction accuracy between staff and APPLEfast scores (P=0.13). Neither experience nor mood score was associated with outcome prediction ability (P=0.55 and P=0.74, respectively). Outcome prediction accuracy by staff is not significantly different to APPLEfast scoring where a cutoff of >25 is used to predict mortality. When predictions were incorrect, they often predicted nonsurvival.

Acute Patient Physiologic and Laboratory Evaluation (APPLE) scores have not been reported in cats with diabetic ketoacidosis (DKA). In cats with DKA, APPLE scores will be significantly higher in non-survivors compared with survivors and these scores will predict mortality. Sixty-eight cats with DKA. Retrospective study. The APPLE scores, blood glucose concentration (BG), venous pH, and ketone concentrations were compared between survivors and non-survivors. Simple logistic regression was used to determine if these variables predict the binary variable of survival or non-survival, and if they did, an empirical optimal cut point for mortality prediction was calculated. The APPLEfast and APPLEfull scores were significantly higher in non-survivors (30 cats; and , respectively) compared with survivors (38 cats; and ; P = .01 and P = .02, respectively). The APPLEfast (P = .03) but not the APPLEfull scores (P = .06) predicted mortality. For every 1 unit increase in the APPLEfast score, the odds of death increased by 1.08 (95% confidence interval [CI], 1.006-1.17; P = .03). Median BG was significantly higher in non-survivors (431 mg/dL; range, 260-832 mg/dL) compared with survivors (343 mg/dL; range, 256-738 mg/dL; P = .01) and BG predicted mortality (P = .02). For every 1 mg/dL increase in BG, the odds of death increased by 1.004 (95% CI, 1.0006-1.008). Empirical optimal cut points for APPLEfast and BG mortality prediction were 24.5 and 358 mg/dL, respectively. The APPLEfast score and BG predict mortality in cats with DKA and can be used to stratify populations by risk of mortality in clinical trials of DKA in cats.

IntroductionApolipoprotein-A1 (Apo-A1) acts as a negative acute phase protein (APP) during inflammatory states, and has a potential prognostic value in people and dogs with sepsis. The aim of this retrospective study was to investigate the association of serum Apo-A1 concentration with disease severity, multiorgan dysfunction syndrome (MODS) and outcome in a population of dogs with sepsis, and to assess its correlation with major canine APPs.MethodsNinety-nine dogs with uncomplicated sepsis (n = 78) or septic shock (n = 21) were included. The serum concentration of Apo-A1, C-reactive protein (CRP) and serum amyloid A (SAA) were recorded, alongside the canine acute patient physiologic and laboratory evaluation fast (APPLEfast) score and the presence of MODS.ResultsDogs with septic shock had significantly lower serum Apo-A1 concentrations (106.3 ± 22.7 mg/dl; reference interval: 123.0–142.3 mg/dl), higher APPLEfast score (30, 13–38) and greater frequency of MODS (67%) compared to those with uncomplicated sepsis (117.9 ± 19.3 mg/dl; 25, 6–33 and 8%, respectively) (P = 0.0201; P = 0.0005; P < 0.0001, respectively). Similarly, dogs with MODS had significantly lower serum Apo-A1 concentrations (104.1 ± 4.6 mg/dl) and higher APPLEfast score values (31, 13–38) compared to those without MODS (118.32 ± 2.1 mg/dl and 26, 6–33, respectively) (P = 0.0050 and P = 0.0038, respectively). Conversely, neither CRP nor SAA were different between these groups. No difference in serum APPs concentrations was detected between survivors and non-survivors. Significant negative correlations were detected between serum Apo-A1 and SAA (P = 0.0056, r = −0.277), and between serum Apo-A1 and the APPLEfast score (P = 0.0027, r = −0.3). In this population, higher values of the APPLEfast score and the presence of MODS were independently associated with a higher risk of death.DiscussionOur study shows that Apo-A1 is a useful biomarker of sepsis severity in dogs, since it is decreased in those with septic shock and MODS. Further prospective investigations are deemed to evaluate the applicability of Apo-A1 to predict sepsis course and response to treatment in septic dogs.

To identify the prevalence of low serum 25-hydroxyvitamin D (25-OH-D) concentrations in critically ill dogs and determine whether vitamin D concentration measured at admission correlates with illness severity and patient outcome. Prospective observational study from December 2013 to July 2014. Private referral teaching hospital ICU. One hundred eleven critically ill dogs admitted to the ICU, and 28 apparently healthy control dogs. Measurement of 25-OH-D concentration and assessment of physiological parameters required to calculate illness severity scores. Blood was sampled to measure serum 25-OH-D concentration, point-of-care laboratory data (packed cell volume, total plasma protein, venous blood gas, electrolytes, plasma lactate, and blood glucose concentration), platelet count, and serum albumin within 12 hours of admission. Primary disease etiologies were determined. Mentation score, Acute Patient Physiologic and Laboratory Evaluation (APPLE) fast score, length of ICU hospitalization, and survival to discharge were recorded. Low serum 25-OH-D concentrations were detected in 25% (28/111) of the ICU cohort; 25-OH-D concentrations (median; IQR) (89.2; 26.3 ng/mL [222; 140.0 nmol/L]) were significantly lower in hospitalized dogs compared with the healthy cohort (127.5; 44.5 ng/mL [318; 111.0 nmol/L]) (P < 0.0001). Serum 25-OH-D concentrations had a weak positive correlation with albumin (r = 0.34, P = 0.0003), but not with any other blood analyte evaluated. Serum concentration of 25-OH-D was also weakly correlated with APPLEfast score (r = 0.31, P = 0.001). 25-OH-D concentrations (median; IQR) were significantly higher in ICU dogs that survived to discharge (95.5; 55 ng/mL [238; 137 nmol/L]) compared with nonsurvivors (60.0; 54 ng/mL [149; 135 nmol/L]; P < 0.001). Low serum 25-OH-D was recorded in one-quarter of critically ill dogs, and was significantly lower in nonsurvivors in comparison to survivors. There was weak correlation between serum 25-OH-D and illness severity. Further studies are required to clarify relationships between vitamin D status and outcome.

To determine whether admission venous plasma lactate concentration, serially calculated lactate variables, or the Acute Patient Physiologic and Laboratory Evaluation (APPLEfast ) score could discriminate hospital survivors from non-survivors in dogs presenting to the emergency department with clinical signs of shock. Prospective case series performed over a 24-month period. Large urban private teaching hospital. Seventy-one dogs admitted to the ICU with initial peripheral venous plasma lactate concentration>2.5mmol/L and clinical and hemodynamic parameters consistent with shock. None. Heart rate, systolic blood pressure, temperature, initial venous plasma lactate, and APPLEfast score were recorded at admission. Lactate concentrations were serially recorded at predefined time points and used to calculate lactate variables, including lactime (time lactate>2.5mmol/L), lactate clearance ([lactateinitial - lactatedelayed ]/ lactateinitial × 100), and LACAREA (area under the lactate concentration versus time curve). Primary outcome was survival to discharge. Overall survival rate was 61%. Admission plasma lactate did not differ between groups (P=0.28). Lactime was shorter in survivors vs non-survivors (P=0.03). Lactate clearance at hours (h) 1, 4, 10, and 16 was greater in survivors vs non-survivors (P<0.05). Final plasma lactate clearance differed between groups (P<0.05). LACAREA at time intervals 1 to 4hours, 4 to 10hours, 10 to 16hours, and 16 to 24hours was larger in non-survivors vs survivors (P<0.05). Total LACAREA did not differ between groups (P=0.51). Admission APPLEfast was not different between survivors and non-survivors (P=0.16). While neither single APPLEfast nor admission plasma lactate concentration could discriminate between hospital survivors and non-survivors, measures of lactate clearance can prognosticate survival in dogs with shock.

Neutrophil-to-lymphocyte ratio, nucleated red blood cells and erythrocyte abnormalities in canine systemic inflammatory response syndrome

Objective To study the therapeutic effect of ulinastatin on brain injury and prognosis of cardiopulmonary resuscitation. Methods A total of 84 cases in the emergency department were randomly divided into routine treatment group (group A) and ulinastatin treatment group (group B), with 42 cases in each group. The Glasgow Coma Scale (GCS), acute physiology and chronic health score (APACHE-Ⅱ) were performed at 1 d (T1), 3 D (T2), 7 d (T3), and acute physiology and chronic health score (GCS), respectively after cardiopulmonary resuscitation (CPR) and resuscitation (T0) and resuscitation. The incidence of hospitalization time, mechanical ventilation time, mortality and multiple organ dysfunction syndrome (MODS) were recorded in the two groups. Results At T0, T1, the GCS had no significant difference between the two groups(P>0.05); at T2, T3, there was significant difference between the two groups (P 0.05), APACHE-Ⅱ of T3 was significantly lower than that of T1 (P 0.05), group B were significantly lower than group A at T3, the difference was significant (P<0.05). The two groups had significant differences in hospitalization time and mechanical ventilation time (P<0.05), the fatality and incidence of MODS in group B were lower than those in group A, the differences were significant (P< 0.05). Conclusions Ulinastatin in treatment of brain injury after cardiopulmonary resuscitation can shorten the hospitalization time, increase the survival rate of the patients, improve the prognosis of patients, has good treatment effect. Key words: Ulinastatin; Cardiopulmonary resuscitation; Brain injury

BackgroundMedical staff should promptly administer antimicrobials to patients with febrile neutropenia (FN) to decrease the mortality related to cancer chemotherapy. Corticosteroids, which are used in cancer chemotherapy, have a fever-suppressive effect. This effect could lead to a blunt fever response and any local signs of infection, especially in patients receiving multiday corticosteroid administration. The aim of this study was to determine whether multiday corticosteroid administration in cancer chemotherapy delays the diagnosis of and antimicrobial treatment for FN.MethodsWe conducted a double-center retrospective study in Japanese patients with FN. The patients were divided into two groups based on the corticosteroid administration method, i.e., whether administration was multiday or not. To evaluate the degree of masking on FN by corticosteroids, we assessed the correlation between body temperature variation and time of antimicrobial administration after the initiation of chemotherapy. Risk factors for delayed antimicrobial administration were identified by multiple logistic regression analysis.ResultsTwo hundred thirteen patients were analyzed. The median time required to body temperature reaching 37.5 °C and for antimicrobial administration was longer in the multiday group than in the non-multiday group, with 0.64 and 0.60 days (P = 0.002 and P < 0.001), respectively. Multiday corticosteroid use was identified as an independent risk factor for delayed antimicrobial administration (odds ratio = 3.94; 95% confidence interval = 1.80–8.62; P < 0.001).ConclusionsMultiday corticosteroid administration in cancer chemotherapy delayed the diagnosis of and antimicrobial administration for FN. Furthermore, it was the only risk factor for delayed antimicrobial administration. We could thus provide evidence that the diagnosis of and antimicrobial administration for FN in patients receiving multiday corticosteroid administration should not be based on body temperature variation alone.

Clinical Measurement of Pulmonary Edema

To determine the association between the absence of an elevated temperature and mortality in dogs with septic peritonitis. This was a retrospective cohort study evaluating dogs treated surgically for septic peritonitis confirmed by abdominal effusion culture, cytology, or direct visualization intraoperatively at a private referral hospital (April 2022 to May 2025). Information collected included signalment, vitals, triage diagnostics, treatment timing (antibiotic administration, surgical intervention), diagnosis method, etiology, and survival. 22 of 60 dogs had elevated temperatures at presentation, 37 of 60 had a normal temperature, and 1 of 60 was hypothermic. The median Acute Patient Physiologic and Laboratory Evaluation (APPLEfast) score for all dogs was 23. There was no difference in APPLEfast score for dogs with or without elevated temperatures at presentation. The median time to injectable antibiotic therapy and surgical intervention for all dogs following presentation was 4 hours, with no difference between dogs with or without elevated temperatures. There was no significant correlation between temperature or APPLEfast score and time to injectable antibiotic therapy or time to surgery. Forty-nine of 60 dogs (82%) survived to discharge (18 of 22 [82%] with elevated temperature, 31 of 38 [82%] without elevated temperature). The absence of an elevated temperature, time to injectable antibiotic therapy, time to surgery, and APPLEfast score were not significantly associated with survival. Absence of an elevated temperature was not associated with mortality in dogs with septic peritonitis. In this study population, septic peritonitis carried an overall fair prognosis in dogs, but temperature at admission was not associated with mortality.

ObjectiveThe aim of this study was to investigate the distribution and drug resistance of pathogenic bacteria and the prognosis of patients with sepsis bloodstream infection with renal insufficiency.MethodsOne hundred and twelve patients with septicemic bloodstream infection with renal insufficiency and 112 patients with septic bloodstream infection without renal insufficiency were selected as study group and control group, respectively. We compare the distribution of pathogenic bacteria, analyze the drug resistance of major bacteria, and compare the efficacy, the incidence of septic shock, duration of mechanical ventilation, hospitalization time, and duration of antimicrobial drug administration between the two groups.ResultsA total of 140 pathogenic strains were isolated from blood cultures in the study group, and 136 strains were isolated from blood cultures in the control group. The sepsis bloodstream infection was mainly caused by Gram-negative bacteria, accounting for 59.42% (164/276). Among the gram-negative bacteria, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii had higher resistance rates to levofloxacin, ceftazidime, piperacillin sodium tazobactam, and amikacin. Among the gram-positive bacteria, Streptococcus pneumoniae, Enterococcus, and Staphylococcus aureus had high resistance rates to clindamycin, cefazolin, penicillin G, gentamicin, azithromycin, and levofloxacin. The rate of extended spectrum β-lactamase (ESBLs)-producing enterobacteria and multi-drug resistant Pseudomonas aeruginosa (MDR-PA) infection was significantly higher in the study group than in the control group; there was no difference in multi-drug resistant Acinetobacter baumannii (MDR-AB), vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) between the two groups. The duration of hospitalization and the duration of antimicrobial drug administration were longer in the study group than in the control group.ConclusionThe pathogenic bacteria in patients with sepsis bloodstream infection with renal insufficiency are mainly Gram-negative bacteria, are more difficult to be cured, have a longer course of treatment, and need to use antibacterial drugs for a long time.

To evaluate perioperative antimicrobial administration during tibial plateau leveling osteotomy (TPLO) in dogs at the Ontario Veterinary College Health Sciences Centre. Retrospective case series. Dogs (n = 184) that had TPLO (n = 226). Medical records were reviewed and data collected included timing and dosage of pre, intra, and postoperative antimicrobial administration, method of stifle inspection, duration of surgery, duration of anesthesia, development of surgical site infection (SSI), microbiological investigation, implant removal, and possible comorbidities. Univariable analysis was conducted, followed by stepwise forward logistic regression to determine factors associated with SSI. Of the 225 cases administered perioperative antimicrobials, 96 (42.5%) received appropriate perioperative antimicrobial prophylaxis based on target times for preoperative and intraoperative dosing. Postoperative antimicrobials were administered to 54 (23.9%) of cases. Surgical site infection was documented in 30 (13.3%) cases. Staphylococcus pseudintermedius was isolated from 15/17 (88.2%) SSI from which a bacterium was isolated, with 6/15 (40%) being methicillin-resistant Staphylococcus pseudintermedius (MRSP). Postoperative administration of antimicrobials was protective for SSI (OR 0.1367; P = .0001; 95% CI = 0.021, 0.50). Duration of anesthesia time was associated with the likelihood of development of SSI (OR = 1.0094; P = .001; 95% CI = 1.00, 1.02). Current practices for administration of antimicrobial prophylaxis during TPLO can be improved. There was no association between timing of antibiotic administration that was inconsistent with the target and development of SSI. Further study into risk factors of TPLO SSI is required.

Decreased serum apolipoprotein A1 (Apo-A1) concentration is associated with mortality in human sepsis. The diagnostic and prognostic role of serum Apo-A1 concentrations in canine sepsis was evaluated. Serum samples from septic dogs (n = 91) and healthy controls (n = 15) were retrospectively analyzed. According to the sepsis origin, four categories were identified: parvoviral enteritis (n = 26), pyometra (n = 20), septic peritonitis (n = 19), and miscellanea (n = 26). The canine acute patient physiologic and laboratory evaluation fast score (APPLEfast), serum C-reactive protein (CRP) and albumin concentrations were reviewed in all enrolled dogs. Increased CRP (252.6 ± 119.2 mg/L; Reference Interval: 0–8.5 mg/L) and significant lower serum albumin and Apo-A1 concentrations were documented in dogs with sepsis (22.8 ± 5.3 g/L and 1.17 ± 0.27 g/L, respectively) compared to healthy ones (33.1 ± 2.5 g/L and 1.32 ± 0.05 g/L, respectively) (P < 0.0001). According to the origin of sepsis, only the subgroup of dogs with septic peritonitis had significantly lower Apo-A1 (1.03 ± 0.26 g/L) concentrations compared to healthy dogs (P < 0.001). No significant differences were found in serum albumin and CRP concentrations, and in APPLEfast score values among the different subgroups of sepsis. Diagnosis of septic peritonitis was associated with a higher frequency of death (P = 0.006). In septic dogs, significant lower Apo-A1 concentrations were detected in non-survivors (1.02 ± 0.28 g/L; n = 27) compared to survivors (1.23 ± 0.24 g/L; n = 64; P = 0.0007). Moreover, significant higher values of the APPLEfast score were calculated in non-survivors (26 ± 4; n = 19) compared to survivors (23 ± 4; n = 51) (P = 0.0114). According to the area under the ROC curve analysis, Apo-A1 <96 mg/dl had a fair accuracy (AUC = 0.72) to correctly predict mortality (P = 0.0004). Apo-A1 might support a diagnosis of canine septic peritonitis with a potential prognostic significance. Further prospective studies are warranted.

To investigate the impact of continuous nursing care combined with health education on severe pneumonia paediatric cases and their families. The study was conducted at Children's Health Department of Tangshan Maternal and Child Health Hospital, China from May 2021 to May 2023, and comprised paediatric inpatients of either gender with severe pneumonia that was complicated by respiratory failure. The subjects were randomly assigned to either intervention group A receiving continuous nursing care combined with health education, or control group B receiving regular nursing care. Clinical data, such as symptom relief times, length of hospital stay, medication compliance, blood gas indicators, paediatric critical illness scores, acute physiology and chronic health evaluation scores, and paediatric quality of life scores, were noted. Data was analysed using SPSS 21. Of the 78 patients, 39(50%) were in intervention group A; 23(59%) boys and 16(41%) girls with mean age 3.64±0.53 years and mean disease duration 7.13±1.47 days. The other 39(50%) patients were in control group B; 21(54%) boys and 18(46%) girls with mean age 3.69±0.47 years and mean disease duration 7.23±1.31 days (p>0.05). Group A showed significantly shorter times for the disappearance of lung rales, hair forceps, dyspnoea, and length of hospital stay compared to group B (p<0.05). Both groups had significant increase in partial arterial oxygen pressure and blood oxygen saturation levels and decrease in partial carbon dioxide pressure levels after receiving nursing care (p<0.05). Group A had better outcomes than group B (p<0.05). Similar outcomes were noted for paediatric critical illness scores, acute physiology and chronic health evaluation scores, and paediatric quality of life scores (p<0.05). Continuous care combined with health education significantly reduced symptom relief and hospitalisation times, improved blood gas indicators and overall health in children with severe pneumonia and respiratory failure. This was due to better compliance behaviour and health awareness among their families.

BackgroundBacteraemia is a critical condition that generally leads to substantial morbidity and mortality. It is unclear whether delayed antimicrobial therapy (and/or source control) has a prognostic or defervescence effect on patients with source-control-required (ScR) or unrequired (ScU) bacteraemia.MethodsThe multicenter cohort included treatment-naïve adults with bacteraemia in the emergency department. Clinical information was retrospectively obtained and etiologic pathogens were prospectively restored to accurately determine the time-to-appropriate antibiotic (TtAa). The association between TtAa or time-to-source control (TtSc, for ScR bacteraemia) and 30-day crude mortality or delayed defervescence were respectively studied by adjusting independent determinants of mortality or delayed defervescence, recognised by a logistic regression model.ResultsOf the total 5477 patients, each hour of TtAa delay was associated with an average increase of 0.2% (adjusted odds ratio [AOR], 1.002; P < 0.001) and 0.3% (AOR 1.003; P < 0.001) in mortality rates for patients having ScU (3953 patients) and ScR (1524) bacteraemia, respectively. Notably, these AORs were augmented to 0.4% and 0.5% for critically ill individuals. For patients experiencing ScR bacteraemia, each hour of TtSc delay was significantly associated with an average increase of 0.31% and 0.33% in mortality rates for overall and critically ill individuals, respectively. For febrile patients, each additional hour of TtAa was significantly associated with an average 0.2% and 0.3% increase in the proportion of delayed defervescence for ScU (3085 patients) and ScR (1266) bacteraemia, respectively, and 0.5% and 0.9% for critically ill individuals. For 1266 febrile patients with ScR bacteraemia, each hour of TtSc delay respectively was significantly associated with an average increase of 0.3% and 0.4% in mortality rates for the overall population and those with critical illness.ConclusionsRegardless of the need for source control in cases of bacteraemia, there seems to be a significant association between the prompt administration of appropriate antimicrobials and both a favourable prognosis and rapid defervescence, particularly among critically ill patients. For ScR bacteraemia, delayed source control has been identified as a determinant of unfavourable prognosis and delayed defervescence. Moreover, this association with patient survival and the speed of defervescence appears to be augmented among critically ill patients.