Mortality Of Severe Infection Research Articles

Predicting Mortality in Sepsis: The Role of Dynamic Biomarker Changes and Clinical Scores-A Retrospective Cohort Study.

The prognostic value of baseline inflammatory markers in sepsis remains controversial, with conflicting evidence regarding their association with mortality. The dynamic changes in these markers over time might offer additional insights into disease progression and patient outcomes. This retrospective observational study included 138 patients with severe infections. The inflammatory biomarkers procalcitonin (PCT), C-reactive protein (CRP), and lactate (LAC) were measured at three time points: upon hospital admission (baseline), approximately 24-48 h after admission (second measurement; M2), and 48-72 h after admission (third measurement; M3). The primary outcome was 30-day mortality. A Mann-Whitney U test was used to compare the biomarker levels between the survivors and non-survivors. A Spearman's correlation was used to assess the relationships between the baseline parameters. A logistic regression and a receiver operating characteristic (ROC) curve analysis were employed to evaluate the prognostic value of the baseline markers and their dynamic changes. The baseline LAC and SOFA score were significantly associated with 30-day mortality. The percentage decrease in PCT, CRP, and LAC from the baseline to M3 emerged as strong predictors of survival, with the ROC curve analysis demonstrating superior discriminatory ability compared to the baseline values. CRP_Delta exhibited the highest AUC (0.903), followed by PCT_Delta (0.843) and LAC_Delta (0.703). The dynamic changes in these inflammatory biomarkers, particularly PCT, CRP, and LAC, offer valuable prognostic information beyond their baseline levels in predicting 30-day mortality in severe infections. These findings highlight the importance of monitoring biomarker trends for early risk stratification and potential treatment guidance.

English

BACKGROUND Neonatal sepsis refers to systemic infections affecting infants within 28 days of life, 1 characterised by invasion of bloodstream by pathogens and possible involvement of multiple organ systems. Neonatal sepsis can present as bloodstream infections (BSI) or septicaemia, pneumonia, meningitis, urinary tract, and bone / joint infections but does not as superficial infections. We wanted to evaluate the rationale of administering intravenous immune globulin (IVIG) with antimicrobials to improve the therapeutic significance of sepsis in preterm neonates. METHODS One hundred preterm neonates with sepsis were randomly assigned into study and control categories at SNCU, Department of Paediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Study-category was given IVIG in addition to standard treatment. RESULTS Total 100 sick new-borns were registered, 50 in study, and 50 in control categories. There were no differences in sex ratio (male 50 %, female 50 %) of sick new-borns who were registered. This was also apparent in the study (males 47.7 %, females 52.3 %) and control category (males 52.3 %, females 47.7 %). CONCLUSIONS The cause of increased morbidity and mortality in severe infection of preterm neonates was the low level of immunity. IVIG use in conjunction with the antimicrobials and other sympathetic therapy can change the end result. KEY WORDS IVIG, Neonatal Sepsis, Preterm Babies

The Association Between Empirical Antibiotic Treatment and Mortality in Severe Infections Caused by Carbapenem-resistant Gram-negative Bacteria: A Prospective Study.

Empirical colistin should be avoided. We aimed to evaluate the association between covering empirical antibiotics (EAT) and mortality for infections caused by carbapenem-resistant gram-negative bacteria (CRGNB). This was a secondary analysis of a randomized controlled trial, including adults with bloodstream infections, pneumonia, or urosepsis caused by CRGNB. All patients received EAT followed by covering targeted therapy. The exposure variable was covering EAT in the first 48 hours. The outcome was 28-day mortality. We adjusted the analyses by multivariable regression analysis and propensity score matching. The study included 406 inpatients with severe CRGNB infections, mostly Acinetobacter baumannii (312/406 [77%]). Covering EAT was given to 209 (51.5%) patients, mostly colistin (n = 200). Patients receiving noncovering EAT were older, more frequently unconscious and dependent, carrying catheters, and mechanically ventilated with pneumonia. Mortality was 84 of 197 (42.6%) with noncovering vs 96 of 209 (45.9%) with covering EAT (P = .504). Covering EAT was not associated with survival in the adjusted analysis; rather, there was a weak association with mortality (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.02-1.84). Results were similar for colistin monotherapy and colistin-carbapenem combination EAT. In the propensity score-matched cohort (n = 338) covering antibiotics were not significantly associated with mortality (OR, 1.42; 95% CI, .91-2.22). Similar results were obtained in an analysis of 14-day mortality. Empirical use of colistin before pathogen identification, with or without a carbapenem, was not associated with survival following severe infections caused by CRGNBs, mainly A. baumannii.

Susceptibility of bone marrow-derived macrophages to influenza virus infection is dependent on macrophage phenotype.

The role of the macrophage in influenza virus infection is complex. Macrophages are critical for resolution of influenza virus infections but implicated in morbidity and mortality in severe infections. They can be infected with influenza virus and consequently macrophage infection is likely to have an impact on the host immune response. Macrophages display a range of functional phenotypes, from the prototypical pro-inflammatory classically activated cell to alternatively activated anti-inflammatory macrophages involved in immune regulation and wound healing. We were interested in how macrophages of different phenotype respond to influenza virus infection and therefore studied the infection of bone marrow-derived macrophages (BMDMs) of classical and alternative phenotype in vitro. Our results show that alternatively activated macrophages are more readily infected and killed by the virus than classically activated. Classically activated BMDMs express the pro-inflammatory markers inducible nitric oxide synthase (iNOS) and TNF-α, and TNF-α expression was further upregulated following infection. Alternatively activated macrophages express Arginase-1 and CD206; however, following infection, expression of these markers was downregulated whilst expression of iNOS and TNF-α was upregulated. Thus, infection can override the anti-inflammatory state of alternatively activated macrophages. Importantly, however, this results in lower levels of pro-inflammatory markers than those produced by classically activated cells. Our results showed that macrophage phenotype affects the inflammatory macrophage response following infection, and indicated that modulating the macrophage phenotype may provide a route to develop novel strategies to prevent and treat influenza virus infection.

Point-of-Care-Monitoring – Mikrobiologische POC-Diagnostik

It is well known that the early initiation of a specific antiinfective therapy is crucial to reduce the mortality in severe infection. Procedures culturing pathogens are the diagnostic gold standard in such diseases. However, these methods yield results earliest between 24 to 48 hours. Therefore, severe infections such as sepsis need to be treated with an empirical antimicrobial therapy, which is ineffective in an unknown fraction of these patients. Today's microbiological point of care tests are pathogen specific and therefore not appropriate for an infection with a variety of possible pathogens. Molecular nucleic acid diagnostics such as polymerase chain reaction (PCR) allow the identification of pathogens and resistances. These methods are used routinely to speed up the analysis of positive blood cultures. The newest PCR based system allows the identification of the 25 most frequent sepsis pathogens by PCR in parallel without previous culture in less than 6 hours. Thereby, these systems might shorten the time of possibly insufficient antiinfective therapy. However, these extensive tools are not suitable as point of care diagnostics. Miniaturization and automating of the nucleic acid based method is pending, as well as an increase of detectable pathogens and resistance genes by these methods. It is assumed that molecular PCR techniques will have an increasing impact on microbiological diagnostics in the future.

Periocular Necrotizing Fasciitis with Visual Loss: Pathogenesis and Treatment

To illustrate the role of clinically necessary aggressive subcutaneous debridement with limited excision of necrotic skin in treating necrotizing faciitis, while demonstrating the histopathologic basis of orbital spread and blindness complicating this disorder. Observational retrospective case series. Seven consecutive patients cared for by the Eye Plastic and Orbital Surgery Services at the University of Michigan and University of Iowa. Retrospective review of ocular findings, systemic features, management, outcome, and histopathology of debrided tissue from 7 patients with periocular necrotizing fasciitis. Patient survival and morbidity. Bilateral involvement was present in 6 of the 7 patients. Five patients suffered ophthalmic or central retinal artery occlusion with loss of vision. All patients underwent extensive debridement of subcutaneous tissue with sparing of overlying nonnecrotic skin and intensive systemic antibiotic therapy. Four patients required unilateral exenteration. After a mean follow-up of 38 months, 6 patients were alive; 1 died perioperatively due to septic shock. Histopathology, not previously described, showed inflammation to spread preferentially along eyelid fibrofatty-fascial tissue planes into the orbit and along orbital fibrous septae, leading to intense perivascular inflammation, thrombosis, and ocular infarction. Necrotizing fasciitis is a potentially fatal disease that often causes blindness when affecting the periocular region. To reduce morbidity and mortality in severe infections, prompt subcutaneous debridement and limited resection of necrotic skin are usually necessary.

Paracetamol: use in children

Summary It is sensible to use paracetamol to reduce the discomfort caused by minor acute infections, surgical procedures and triple antigen. It is also sensible to use paracetamol to reduce fever in patients with cardiac or respiratory failure. However, there is little evidence to support the use of paracetamol to treat fever in patients without heart or lung disease, or to prevent febrile convulsions. Paracetamol may prolong infection and reduce the antibody response in mild disease, and increase morbidity and mortality in severe infection. The dose in children is 10-15 mg/kg 4 hourly, to a maximum of 100mg/kg/day, and no patient should receive more than 4 g/day.

Prevention of Coccidiosis in the Chukar Partridge (Alectoris chukar) by Medication with Sulfadimethoxine and Ormetoprim (Rofenaid®)

Rofenaid® (a 5:3 mixture of sulfadimethoxine and ormetoprim) was effective in preventing coccidiosis of chukar partridges. Levels of .0100 or .0125% sulfadimethoxine, with the corresponding level of ormetoprim in the ration, gave the best results. These levels markedly reduced mortality in severe infections (over 75% mortality in unmedicated chukars) and eliminated mortality in medicated groups when infections produced 52% mortality or less in unmedicated controls. In the latter infections, Rofenaid also protected against the depression in weight gain seen 6 days postinoculation in unmedicated chukars. Studies in uninoculated chukars showed that Rofenaid has a wide safety margin and did not produce adverse effects even at levels of .0300% sulfadimethoxine. Rofenaid should, therefore, be an effective medication for the prevention of coccidiosis in chukars in the field. Data from the present studies are being submitted to the IR-4 Program of the Food and Drug Administration for consideration of approval for the use of Rofenaid in chukar partridges.