Microbiological Etiology Research Articles

Fluid Bolus Therapy-Based Resuscitation for Severe Sepsis in Hospitalized Children: A Systematic Review.

To review systematically data from randomized and nonrandomized studies of fluid bolus therapy in hospitalized children with septic shock. Medline, EMBASE, and Cochrane Central Register of Controlled Trials. We searched for randomized controlled studies of fluid bolus therapy in children with severe sepsis. We identified retrospective, prospective, and observational studies. We excluded studies of severe sepsis/septic shock due to a specific microbiological etiology, neonatal studies, and studies where advanced supportive therapies were unavailable. Two authors screened articles for inclusion. We identified and analyzed three randomized controlled trials and eight nonrandomized studies. Heterogeneity precluded meta-analysis. Two single-center Indian studies and one Brazilian study assessed three different fluid bolus therapy regimens in small cohorts with different populations, physiological triggers, and physiological and clinical outcomes. No randomized controlled trials compared fluid bolus therapy with alternative interventions, such as vasopressors. The nonrandomized studies were heterogeneous in populations, methodology, and outcome measures. No observed physiological differences were identified based on volume of fluid bolus therapy. There are only limited data to support the use of fluid bolus therapy in hospitalized children. Prospective observational data and randomized controlled trials are urgently needed to evaluate this therapy in resource rich settings.

COPD patients with ventilator-associated pneumonia: implications for management.

Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.

The "Tree-in-Bud" Pattern on Chest CT: Radiologic and Microbiologic Correlation.

Tree-in-bud (TIB) is a radiologic pattern seen on high-resolution chest CT reflecting bronchiolar mucoid impaction occasionally with additional involvement of adjacent alveoli. Its microbiologic significance has not been systematically evaluated. We aimed to establish the incidence of the TIB pattern as a proportion of all patients undergoing chest CT and to identify its etiology wherever possible. We included all patients with TIB pattern detected on chest CT in our institution from January 2007 to June 2012 and correlated this radiologic finding to the microbiologic etiology, which were available, for each patient. During the study period, TIB pattern was described in 326 patients, which is 1.8% of all chest CTs. Of these, 220 (67.5%) patients had an infectious etiology and 34 (10.4%) had aspiration pneumonia. Other presumptive etiologies were in 13 (4%) lung malignancy, 31 (9.5%) other malignancies, 20 cases (6%) inconclusive etiology or incidental findings, and 8 (2.5%) had other inflammatory disorders. The relative incidence of the various organisms isolated reflected the overall incidence of these bacteria in community- or hospital-acquired populations independent of the TIB pattern. No correlation was found between distribution of TIB, the immune status, and the organism isolated. TIB pattern reflects endobronchiolar inflammation due mainly but not exclusively to an infectious cause. The microbiologic etiology in patients with this finding is similar to that of the general population (community acquired versus hospital acquired).

Abstract P193: Infection Type and Severity are Risk Factors for Hospital-Acquired Venous Thromboembolism in Medical Inpatients

Introduction: Hospital-acquired venous thromboembolism (HAVTE) leads to increased length of stay, cost, morbidity, and is a target of government quality measures. How infection relates to HAVTE risk is unknown. We wished to identify infection-related risk factors for HAVTE to help identify at-risk patients and to guide prevention efforts. Hypothesis: We hypothesized that increased infection severity, affected organ system, and positive microbiology culture results were associated with HAVTE in medical inpatients. Methods: HAVTE between 2009-2012 were identified by ICD-9 codes with confirmatory imaging at a 500 bed teaching hospital. ICD-9 codes, microbiology results, lab and vital sign data, and medication records were used to classify infections as presented in the Table. Logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) for HAVTE adjusting for known HAVTE risk factors in the MITH score, a previously developed HAVTE risk score for medical inpatients. Models incorporated known HAVTE risk factors and assessed each variable from the Table individually. Results: In 20,327 medical admissions there were 113 hospital-acquired HAVTE (incidence: 0.56%). The table presents the association between infection-related risk factors and HAVTE. Septic shock (OR 7.48), sepsis (OR 5.9), and MSSA culture isolate (OR 6.39) had the greatest point-estimates of HAVTE after adjusting for known HAVTE risk factors. Conclusions: Infection severity, affected organ system, and microbiologic etiology were risk factors for HAVTE after adjusting for known risk factors. The relationship between these risk factors and thrombosis is likely complex, but these risk factors are easily measureable using the electronic health record. These results may help facilitate HAVTE prevention by further identifying high risk patients.

Honey: A realistic antimicrobial for disorders of the skin.

Resistance of pathogenic microorganisms to antibiotics is a serious global health concern. In this review, research investigating the antimicrobial properties of honeys from around the world against skin relevant microbes is evaluated. A plethora of in vitro studies have revealed that honeys from all over the world have potent microbicidal activity against dermatologically important microbes. Moreover, in vitro studies have shown that honey can reduce microbial pathogenicity as well as reverse antimicrobial resistance. Studies investigating the antimicrobial properties of honey in vivo have been more controversial. It is evident that innovative research is required to exploit the antimicrobial properties of honey for clinical use and to determine the efficacy of honey in the treatment of a range of skin disorders with a microbiological etiology.

Clinical presentation and microbiological diagnosis in paediatric respiratory tract infection: a systematic review.

Antibiotic prescribing decisions for respiratory tract infection (RTI) in primary care could be improved if clinicians could target bacterial infections. However, there are currently no evidence-based diagnostic rules to identify microbial aetiology in children presenting with acute RTIs. To analyse evidence of associations between clinical symptoms or signs and detection of microbes from the upper respiratory tract (URT) of children with acute cough. Systematic review and meta-analysis. A literature search identified articles reporting relationships between individual symptoms and/or signs, and microbes detected from URT samples. Associations between pathogens and symptoms or signs were summarised, and meta-analysis conducted where possible. There were 9984 articles identified, of which 28 met inclusion criteria. Studies identified 30 symptoms and 41 signs for 23 microbes, yielding 1704 potential associations, of which only 226 (13%) have presently been investigated. Of these, relevant statistical analyses were presented for 175 associations, of which 25% were significant. Meta-analysis demonstrated significant relationships between respiratory syncytial virus (RSV) detection and chest retractions (pooled odds ratio [OR] 1.9, 95% confidence interval [CI] = 1.6 to 2.3), wheeze (pooled OR 1.7, 95% CI = 1.5 to 2.0), and crepitations/crackles (pooled OR 1.7, 95% CI = 1.3 to 2.2). There was an absence of evidence for URT pathogens other than RSV. The meta-analysis identified clinical signs associated with RSV detection, suggesting clinical presentation may offer some, albeit poor, diagnostic value. Further research is urgently needed to establish the value of symptoms and signs in determining microbiological aetiology and improve targeting of antibiotics in primary care.

A retrospective study of septic arthritis in a tertiary hospital in West Texas with high rates of methicillin-resistant Staphylococcus aureus infection.

Septic arthritis is an important concern for rheumatologists in the evaluation of joint disease. Very few studies have addressed the microbiologic epidemiology and outcomes of septic arthritis in the USA since the year 2000. We performed a retrospective study of septic arthritis in a tertiary hospital in West Texas from the year 2000 to 2013. We recorded data on patient demographics, microbiologic etiology, treatment patterns, and outcomes. The most common causative organisms were Staphylococcus aureus and Streptococcus spp. Methicillin-resistant Staphylococcus aureus (MRSA) caused septic arthritis in 22.6% of the cases. MRSA septic arthritis was associated with low rates of adequate empiric antimicrobial therapy. The mortality due to sepsis in our study was 5.5%. Patients with septic arthritis had a mean length of stay of 13.5±12.1days and required 2.1±1.4 joint operations. Many patients (29.2%) had readmissions due to complications, and these patients had high rates of home health utilization and transfers to other facilities post hospital discharge. In our logistic regression analysis model, factors associated with poor outcomes in septic arthritis were MRSA, older age, and prosthetic joint infection. Septic arthritis is associated with significant mortality, morbidity, and health care costs, and more studies are needed to improve outcomes, especially considering the increasing rates of MRSA as the pathogen.

Infections after lung transplantation: time of occurrence, sites, and microbiologic etiologies.

Background/AimsInfections are major causes of both early and late death after lung transplantation (LT). The development of prophylaxis strategies has altered the epidemiology of post-LT infections; however, recent epidemiological data are limited. We evaluated infections after LT at our institution by time of occurrence, site of infections, and microbiologic etiologies.MethodsAll consecutive patients undergoing lung or heart-lung transplantation between October 2008 and August 2014 at our institution were enrolled. Cases of infections after LT were initially identified from the prospective registry database, which was followed by a detailed review of the patients' medical records.ResultsA total of 108 episodes of post-LT infections (56 bacterial, 43 viral, and nine fungal infections) were observed in 34 LT recipients. Within 1 month after LT, the most common bacterial infections were catheter-related bloodstream infections (42%). Pneumonia was the most common site of bacterial infection in the 2- to 6-month period (28%) and after 6 months (47%). Cytomegalovirus was the most common viral infection within 1 month (75%) and in the 2- to 6-month period (80%). Respiratory viruses were the most common viruses after 6 months (48%). Catheter-related candidemia was the most common fungal infection. Invasive pulmonary aspergillosis developed after 6 months. Survival rates at the first and third years were 79% and 73%, respectively.ConclusionsAlthough this study was performed in a single center, we provide valuable and recent detailed epidemiology data for post-LT infections. A further multicenter study is required to properly evaluate the epidemiology of post-LT infections in Korea.

Microorganisms in periradicular tissues: Do they exist? A perennial controversy.

There is no greater association between the basic science and the practice of endodontics than that of microbiology. One of the strongest factors contributing to the controversies often encountered in the endodontic field is the lack of understanding that the disease processes of the pulp and periradicular tissues generally have a microbiological etiology. The vast majority of diseases of dental pulp and periradicular tissues are associated with microorganisms. After the microbial invasion of these tissues, the host responds with both nonspecific inflammatory responses and with specific immunologic responses to encounter such infections. The aim of this study is to fill the gaps in our knowledge regarding the role of microorganisms in endodontics and to discuss in depth whether their presence in periradicular lesions is a myth or a reality. An electronic search was carried out on PubMed database (custom range of almost 50 years) and Google using specific keywords and phrases. Inclusion and exclusion criteria were specified and around 50 articles were found suitable for inclusion. Full text of all the articles was retrieved and studied. Appropriate data were extracted and pooled and finally synthesized. It is important to understand the close relationship between the presence of microorganisms and endodontic disease process to develop an effective rationale for treatment.

Analyses of microbiology and antibiotic susceptibility in prosthetic knee infections

To explore the microbiological etiology of prosthetic knee infections during two-staged revision and analyze antibiotic susceptibility of bacteria so as to provide clinical recommendations for empiric antibiotic therapy. A retrospective review was performed for 78 hospitalized patients for prothetic knee infections undergoing two-staged revision between January 1, 2007 and February 28, 2014.Suspicious intra-operative tissues were collected and cultured. Microbiological data sets and antibiotic susceptibility of bacteria were analyzed. Micro-organisms were isolated from 65 patients. The negative culture rate was 16.7%. The most common genus encountered was Gram-positive isolates (75.7%), followed by Gram-negative isolates (20.5%) and fungi isolates (2.7%). Polymicrobialinfections accounted for 15.4% of patients. The most common causative organism of infection was coagulase-negative staphylococci (46.6%) and followed by Staphylococcus aureus (20.5%). The detection rate of methicillin-resistant staphylococcus(MRS) was 34.3% (25/73) and it accounted for 47.5% of staphylococcus.Gram-negative isolates were dominated by Escherichia coli (4/15) and Acinetobacter baumannii (4/15). All A.baumanniiscame from polymicrobial infection. Coagulase-negative staphylococci and A. baumannii were the most common causative organisms of polymicrobial infection. The results of antibiotic susceptibility showed cefazolin and cefuroxime were poorly susceptible to isolates. The drug resistance rates were 43.5% and 53.6%.Some third or fourth generation cephalosporins also have problems of bacterial resistance.Some antibiotics such as vancomycin, linezolid, imipenem, rifampin, cefoperazone/sulbactam and levofloxacin had high rates of drug sensitivity. Most infections are caused by staphylococci. The proportion of isolated MRS is high.Empiric prophylacticantibiotics therapy may include vancomycin and cefoperazone/sulbactam to cover Gram-positive and Gram-negative organisms.Empiric therapeutic antibiotics therapy includes vancomycin and carbapenems. After the results of antibiotic susceptibility, antibiotics should be timely adjusted.

Community-acquired pneumonia in patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Patients with COPD are at increased risk for community-acquired pneumonia (CAP). COPD has been reported as a comorbidity in at least one third of the hospitalized patients with CAP. There is a controversy that the presence of concomitant COPD and CAP is associated with a greater risk of death when compared to either condition alone. Risk factors, clinical and immunological characteristics, microbiological etiology, as well as prognosis and treatment of COPD patients with CAP are reviewed in this article.

Ecthyma gangrenosum and ecthyma-like lesions: review article.

The generally accepted definition of ecthyma gangrenosum (EG) states that this condition is pathognomonic of Pseudomonas septicemia (Pseudomonas aeruginosa) and that it should usually be seen in immunocompromised patients, particularly those with underlying malignant disease. The cases described in the literature present a somewhat different picture. Our objective was to analyze this controversy. The review analyzes 167 cases of EG that were described in the literature from 1975 to 2014. All articles on EG cases with EG-specific tissue defect that had signs of general and/or local infection and skin necrosis were included and analyzed, whatever the etiology detected. Necrotic lesions of the skin diagnosed as EG have various microbiological etiology, can occur in immunocompetent or even healthy persons, and are not necessarily connected with septicemia. In published cases, P. aeruginosa was detected in 123 cases (73.65%); of them, there were only 72 cases (58.5%) with sepsis. Other bacterial etiology was detected in 29 cases (17.35%) and fungi were detected in 15 cases (9%). While the clinical picture of the disease and the treatment strategy remain the same, there is no need to invent two separate definitions for Pseudomonas and non-Pseudomonas cases. We suggest accepting a broader definition of EG.

S42 Safety And Acceptability Of Bedside Ultrasound-guided Transthoracic Lung Needle Aspiration (tlna) In Pneumonia

Given the increasing importance of establishing a microbiological aetiology in pneumonia, we undertook a study assessing the safety and acceptability of bedside ultrasound-guided TLNA (REC No. 09/H0605/12). TLNA has previously reported to have been predominantly undertaken without radiological control. Methods Participants with community- or hospital-acquired pneumonia completed a baseline assessment of chest pain and pain associated with phlebotomy using a 10 cm visual analogue scale (VAS). Post procedure, participants assessed pain associated with TLNA, and undertook a Likert-based evaluation of the procedure. Up to 3 mg/kg lidocaine was used to anaesthetise the skin and pleura. An ultrafine 25G needle, attached to a 20 ml luer lock syringe containing 3.5 ml 0.9% sodium chloride solution was inserted into consolidated lung under direct ultrasound guidance by a Respiratory Physician. 0.5 ml of the sodium chloride was injected followed by aspiration with gentle agitation (3 mL of sodium chloride remaining in the syringe as a carrier solution). The needle was then withdrawn. Any pleural fluid present was also aspirated separately. Samples underwent culture and 16S rRNA gene analysis. All participants had follow-up chest X-rays post procedure to evaluate for pneumothorax. Participants were systematically assessed while inpatient, and again at 30 days, to assess for any adverse events. Results 28 participants underwent TLNA, 27 using ultrasound (and one using CT-guidance). No patients experienced haemoptysis or pneumothorax. All patients either ‘strongly agreed’ (most commonly) or ‘agreed’ with the statements: ‘The lung fluid sample to diagnose your pneumonia was tolerable’; and ‘I would have the lung fluid sample again if my doctors thought it was essential’. The VAS-assessed pain of TLNA was significantly lower than any pre-existing chest pain, being similar to any pain associated with venesection (see Figure). At day 30, one patient had mild ongoing pain at the site of both TLNA and subsequent chest tube insertion, although the relative contribution of each procedure to this pain was unclear. TLNA increased culture or sequencing-based aetiological diagnosis from 3/28 to 14/28 (18/28 when including pleural fluid analysis). Conclusions Physician-performed bedside ultrasound-guided TLNA appears safe and well-tolerated.

Prognostic determinants of community-acquired bloodstream infection in type 2 diabetic patients in ED

ObjectivesThe objective of the study is to describe the epidemiology and outcome of community-acquired bloodstream infection (BSI) in type 2 diabetic patients in emergency department (ED). MethodsAll patients admitted to the ED of the university hospital from June 2010 to June 2011 with a history of type 2 diabetes mellitus and microbiologically documented BSI were retrospectively enrolled. Demographic characteristics, Charlson comorbidity index, antibiotic therapy, clinical severity, microbiological etiology, and diabetes-related complications were recorded in a standardized form. The major outcome measure was 30-day survival. χ2 Or Student t test was used for univariate analysis, and Cox proportional hazards models were used for multivariate analysis. ResultsAmong 250 enrolled emergency patients with BSI, the overall 30-day mortality rate was 15.5%. Twenty-seven patients (10.7%) developed diabetic ketoacidosis (DKA), and 22 patients (8.8%) developed hyperosmolar hyperglycemic state. On univariate analysis, DKA rather than hyperosmolar hyperglycemic state was associated with adverse outcome. Other risk factors include higher mean glycated hemoglobin level, presence of underlying malignancy, long-term use of steroids, lower respiratory tract infection, and higher Charlson scores. Multivariate analysis identified 3 independent risk factors for early mortality when severity, comorbidity, age, and sex were under control: DKA (hazard ratio, 3.89; 95% confidence interval, 1.6-8.9), inappropriate antibiotics (2.25, 1.05-4.82), and chronic use of steroid (3.89, 1.1-13.2). ConclusionIn type 2 diabetic patients with BSI, a substantial proportion of patients developed DKA. This condition was probably underrecognized by clinicians and constituted an independent risk factor for short-term mortality. Other identified risk factors are potentially correctable and may allow preventive efforts to individuals at greatest potential benefit.

THU0300 Septic Arthritis in the Central Part of Denmark

BackgroundSeptic arthritis (SA) is a serious condition which can lead to rapid cartilage destruction and irreversible joint damage and is asociated with a significant mortality. SA is an uncommon condition...

Vitamin D deficiency in community-acquired pneumonia: low levels of 1,25(OH)2 D are associated with disease severity.

ObjectivesWe aimed to explore the association between vitamin D levels and the severity, mortality and microbiological etiology of community-acquired pneumonia.MethodsVitamin D levels (both, the reservoir form 25-OH and the activated form 1,25-OH2) of 300 randomly selected patients with community-acquired pneumonia due to pre-specified pathogens included in the German competence network (CAPNETZ) study were measured. Prior to statistical analysis, values of 25-OH and 1,25-OH2 were power-transformed to achieve parametric distribution. All further analyses were performed with seasonally and age adjusted values.ResultsThere was only a modest (Spearman Coefficient 0.38) positive correlation between 25-OH and 1,25-OH2. For 1,25-OH2 but not 25-OH, the general linear model revealed a significant inverse correlation between serum concentration and CURB score (p = 0.011). Liver and respiratory co-morbidity were associated with significantly lower 25-OH values and renal co-morbidity with significantly lower 1,25-OH2 values. No significant differences of 1,25-OH2 or 25-OH between different pathogens (influenza virus, Legionella spp., Streptococcus pneumoniae) were detected.ConclusionFor 1,25-OH2, we found a significant and independent (controlled for age, season and pathogen) negative correlation to pneumonia severity. Therefore, supplementation of non-activated vitamin D to protect from pneumonia may be non-sufficient in patients that have a decreased capacity to hydroxylate 25-OH to 1,25-OH2.

Hospitalisations for pelvic inflammatory disease temporally related to a diagnosis of Chlamydia or gonorrhoea: a retrospective cohort study.

ObjectivesThe presence and severity of pelvic inflammatory disease (PID) symptoms are thought to vary by microbiological etiology but there is limited empirical evidence. We sought to estimate and compare the rates of hospitalisation for PID temporally related to diagnoses of gonorrhoea and chlamydia.MethodsAll women, aged 15–45 years in the Australian state of New South Wales (NSW), with a diagnosis of chlamydia or gonorrhoea between 01/07/2000 and 31/12/2008 were followed by record linkage for up to one year after their chlamydia or gonorrhoea diagnosis for hospitalisations for PID. Standardised incidence ratios compared the incidence of PID hospitalisations to the age-equivalent NSW population.ResultsA total of 38,193 women had a chlamydia diagnosis, of which 483 were hospitalised for PID; incidence rate (IR) 13.9 per 1000 person-years of follow-up (PYFU) (95%CI 12.6–15.1). In contrast, 1015 had a gonorrhoea diagnosis, of which 45 were hospitalised for PID (IR 50.8 per 1000 PYFU, 95%CI 36.0–65.6). The annual incidence of PID hospitalisation temporally related to a chlamydia or gonorrhoea diagnosis was 27.0 (95%CI 24.4–29.8) and 96.6 (95%CI 64.7–138.8) times greater, respectively, than the age-equivalent NSW female population. Younger age, socio-economic disadvantage, having a diagnosis prior to 2005 and having a prior birth were also associated with being hospitalised for PID.ConclusionsChlamydia and gonorrhoea are both associated with large increases in the risk of PID hospitalisation. Our data suggest the risk of PID hospitalisation is much higher for gonorrhoea than chlamydia; however, further research is needed to confirm this finding.

Nosocomial Drug-Resistant Bacteremia in 2 Cohorts with Cryptococcal Meningitis, Africa

Nosocomial Drug-Resistant Bacteremia in 2 Cohorts with Cryptococcal Meningitis, Africa

Aetiology, antimicrobial therapy and outcome of patients with community acquired severe sepsis: a prospective study in a Norwegian university hospital

BackgroundSevere sepsis is recognized as an inflammatory response causing organ dysfunction in patients with infection. Antimicrobial therapy is the mainstay of treatment. There is an ongoing demand for local surveillance of sepsis aetiology and monitoring of empirical treatment recommendations. The present study was established to describe the characteristics, quality of handling and outcome of patients with severe sepsis admitted to a Norwegian university hospital.MethodsA one year prospective, observational study of adult community acquired case-defined severe sepsis was undertaken. Demographics, focus of infection, microbiological findings, timing and adequacy of empirical antimicrobial agents were recorded. Clinical diagnostic practice was evaluated. Differences between categorical groups were analysed with Pearson’s chi-squared test. Predictors of in-hospital mortality were identified in a multivariate stepwise backward logistic regression model.ResultsIn total 220 patients were identified, yielding an estimated annual incidence of 0.5/1000 inhabitants. The focus of infection was established at admission in 69%. Respiratory tract infection was present in 52%, while genitourinary, soft tissue and abdominal infections each were found in 12-14%. Microbiological aetiology was identified in 61%; most prevalent were Streptococcus pneumoniae, Escherichia coli and Staphylococcus aureus. Independent predictors of in-hospital mortality were malignancy, cardiovascular disease, endocarditis, abdominal infections, undefined microbiological aetiology, delay in administration of empirical antimicrobial agents ≥ 6 hours and use of inadequate antimicrobial agents. In patients ≥ 75 years, antimicrobial therapy was less in compliance with current recommendations and more delayed.ConclusionsCommunity acquired severe sepsis is common. Initial clinical aetiology is often revised. Compliance with recommendations for empirical antimicrobial treatment is lowest in elderly patients. Our results emphasizes that quick identification of correct source of infection, proper sampling for microbiological analyses, and fast administration of adequate antimicrobial agents are crucial points in the management of severe sepsis.

Acute Exacerbation and Respiratory InfectionS in COPD (AERIS): protocol for a prospective, observational cohort study

IntroductionThe aetiology of acute exacerbations of chronic obstructive pulmonary disease (COPD) remains incompletely understood and strategies for treatment and prevention have not altered significantly for many years. Improved understanding of...