Nosocomial Sepsis Research Articles

Umbilical Catheter Extravasation Mimicking Necrotizing Enterocolitis in a Preterm Neonate: A Diagnostic Challenge.

Managing acute abdomen in very low birth weight (VLBW) and premature infants presents a diagnostic challenge, often necessitating a thorough assessment to discern underlying causes. Umbilical venous catheters (UVCs), commonly used in neonatal intensive care, are essential but not without risks. A 29-week premature male infant, born to a 23-year-old mother, was referred to our clinic on the 16th day of life with a suspected diagnosis of necrotizing enterocolitis (NEC). The infant had spent the first day intubated and received non-invasive respiratory support for 15 days. A 5 French UVC was inserted at the 2nd hour of life, and by the 3rd day of life, the infant transitioned to minimal enteral feeding. Between the 12th and 16th days of life, the infant initially diagnosed with NEC due to symptoms such as decreased stool passage and abdominal distension. The patient had been on a continuous course of antibiotic treatment throughout the entirety of his life, commencing on the very first day due to suspected early neonatal sepsis, followed by nosocomial sepsis during the hospitalization, and persisting with antibiotic therapy for suspected NEC. The case took a unique turn upon further evaluation after being referred to our unit. Despite a preliminary NEC diagnosis, further evaluation revealed umbilical catheter complications, leading to total parenteral nutrition extravasation. Removal of the catheter, drainage, and antibiotic adjustment resulted in improved clinical outcomes. In neonatal care, cautious management is vital when dealing with infants exhibiting abdominal symptoms. A nuanced approach, including differential diagnosis and careful antibiotic use, is essential.

In vitro and in vivo assessment of the competence of a novel lytic phage vB_EcoS_UTEC10 targeting multidrug resistant Escherichia coli with a robust biofilm eradication activity

Escherichia coli (E. coli) is a leading cause of human infections worldwide and is considered a major cause of nosocomial infections, sepsis, meningitis and diarrhea. Lately, there has been an alarming increase in the incidence of antimicrobial resistance among clinical E. coli isolates. In the current study, a novel bacteriophage (phage) vB_EcoS_UTEC10 was isolated and characterized. The isolated phage showed high stability over wide temperature and pH ranges beside its promising bacteriolytic activity against multidrug resistant (MDR) E. coli isolates. In addition, vB_EcoS_UTEC10 showed a marked antibiofilm capability against mature E. coli biofilms. Genomic investigation revealed that vB_EcoS_UTEC10 has a double stranded DNA genome that consists of 44,772 bp comprising a total of 73 open reading frames (ORFs), out of which 35 ORFs were annotated as structural or functional proteins, and none were related to antimicrobial resistance or lysogeny. In vivo investigations revealed a promising bacteriolytic activity of vB_EcoS_UTEC10 against MDR E. coli which was further supported by a significant reduction in bacterial load in specimens collected from the phage-treated mice. Histopathology examination demonstrated minimal signs of inflammation and necrosis in the tissues of phage-treated mice compared to the degenerative tissue damage observed in untreated mice. In summary, the present findings suggest that vB_EcoS_UTEC10 has a remarkable ability to eradicate MDR E. coli infections and biofilms. These findings could be further invested for the development of targeted phage therapies that offer a viable alternative to traditional antibiotics against resistant E. coli.

Sepsis caused by Phytobacter diazotrophicus complicated with galactosemia type 1 in China: a case report

BackgroundPhytobacter diazotrophicus (P. diazotrophicus) is an opportunistic pathogen that causes nosocomial outbreaks and sepsis. However, there are no reports of P. diazotrophicus isolated from human blood in China.Case presentationA 27-day-old female infant was admitted to our hospital with fever and high bilirubin levels. The clinical features included jaundice, abnormal coagulation, cholestasis, fever, convulsions, weak muscle tension, sucking weakness, ascites, abnormal tyrosine metabolism, cerebral oedema, abnormal liver function, clavicle fracture, and haemolytic anaemia. The strain isolated from the patient’s blood was identified as P. diazotrophicus by whole-genome sequencing (WGS). Galactosemia type 1 (GALAC1) was diagnosed using whole-exome sequencing (WES). Based on drug sensitivity results, 10 days of anti-infective treatment with meropenem combined with lactose-free milk powder improved symptoms.ConclusionP. diazotrophicus was successfully identified in a patient with neonatal sepsis combined with galactosemia. Galactosemia may be an important factor in neonatal sepsis. This case further expands our understanding of the clinical characteristics of GALAC1.

Trends in Causative Organisms and Antimicrobial Resistance in Late-onset Neonatal Sepsis.

The aim of this study was to evaluate the antibiotic resistance of microorganisms isolated in cases of culture-positive nosocomial late-onset neonatal sepsis in the neonatal intensive care unit. Infants admitted to our neonatal intensive care unit between October 2015 and June 2022 were retrospectively screened. A total of 458 different cultures from 386 sepsis incidents in 250 infants were analyzed. Over an 8-year period, 407 cases of culture-positive nosocomial late-onset neonatal sepsis were reviewed in a total of 4244 infants. Twenty-one cases were excluded due to insufficient data. The incidence of culture-positive nosocomial sepsis was 6.3%. Coagulase-negative Staphylococcus and Staphylococcus aureus were the most common gram-positive bacteria found in cultures. Resistance to ampicillin and cephalosporin treatments was high, while resistance to vancomycin, teicoplanin, and linezolid was low. Klebsiella spp. were the most frequent gram-negative bacteria isolated in cultures and showed high resistance to non-carbapenembased regimens. The only fungal microorganisms isolated in cultures were Candida spp., which had a high mortality rate despite their low resistance profile. The mortality rate due to nosocomial sepsis was 19.6%. Our study demonstrated that microorganisms and their antibiotic resistance profiles changed over time in the newborn intensive care unit. Gram-negative pathogens exhibited high antibiotic resistance, while fungi had high mortality rates. It is essential to adjust empirical antibiotic regimens for nosocomial sepsis based on thorough surveillance.

Ileocecal valve-preservation ileocecostomy (IVPI) in infants with extremely short distal ileum after primary stoma.

Preserving the ileocecal valve (ICV) has shown significant benefits. We present our experience with 18 infants who underwent ileocecal valve-preservation ileocecostomy (IVPI) with an extremely short distal ileum after primary ileostomy. A retrospective analysis was conducted on IVPI cases between 2014 and 2020. Medical records were reviewed, including birth weight, age, primary diseases, length of ileus stump, surgical time and procedure, time to enteral feeding, postoperative hospital stay, and complications. Eighteen patients (male: female = 12:6, median birth weight 1305 (750-4000) g, median gestational age 29 + 5 (27 + 6-39 + 6) weeks) were included in the analysis. Causes of surgery included necrotizing enterocolitis (13), ileocecal intestinal atresia (1), ileum volvulus (2), meconium peritonitis (1), and secondary intestinal fistula (1). The median corrected age of ileostomy closure was 3.2months (2.0-8.0months). The distance from the distal ileal stoma to the ICV ranged from 0.5 to 2cm. The median length of the residual bowel was 90cm (50-130cm). ICV-plasty was performed in 3 cases due to secondary ICV occlusion or stenosis. All patients resumed feeding within 6 to 11days after surgery. The postoperative hospital stay ranged from 12 to 108days (median: 16.5days). Complications included incisional infections in 2 cases, anastomotic stricture and adhesive ileus in 1 case, nosocomial sepsis and septic shock in 1 case. All children showed normal growth and development during a 6-65month follow-up. IVPI is safe and feasible for infants with an extremely short distal ileal stump. ICV-plasty could be applicable for cases with ileocecal occlusion/stenosis.

Bacteriological profile and their antimicrobial susceptibility pattern among clinical suspected adult septicemia admitted patients: A study from tertiary care and teaching hospital

Objectives: The objective of this study is to determine the bacteriological profile and their antimicrobial susceptibility pattern among clinically suspected adult septicemia admitted patients and to study the correlation between the clinical presentation and inflammatory biomarkers (C-reactive protein [CRP] and Procalcitonin [PCT]) in the final outcomes of nosocomial sepsis in adult septicemia patients. Material and Methods: This is a descriptive cross-sectional study of 1-year duration from November 2022 to November 2023. The study has been approved from the Institutional Ethical Committee. Adult patients with a clinical suspected diagnosis of sepsis were admitted to the medicine ward of the tertiary hospital. Blood samples of adult sepsis suspected patients samples were taken for as a part of septicemia screening. Blood culture and sensitivity were performed according to standard guidelines. The sepsis inflammatory prognostic markers CRP and PCT test were evaluated according to manufactures instruction. Results: Out of 300 clinically suspected adult septicemia patients, 93 (31%) patients were isolated culture-positive sepsis while 207 (69%) patients were culture-negative sepsis. Gram-positive organisms were more (69%) as compared to Gram-negative organisms (31%). Staphylococcus aureus was predominant among Gram-positive organisms while Acinetobacter baumanii complex (9%) followed by Enterobacter spp. (8%) isolated in Gram-negative bacilli. Culture-positive sepsis patients have CRP level ≥3.2 mg/dL (80%) and the majority (80%) of these patients have reactive PCT. Conclusions: Successful treatment of bloodstream infection depends on early diagnosis and appropriate use of antimicrobial agents. Rapid identification results and antimicrobial susceptibility tests are essential for guiding clinicians in the selection of the most appropriate treatment for patients with bloodstream infections.

The acceptability of a donor human milk bank and donated human milk among mothers in Limpopo Province, South Africa.

Breastfeeding is a crucial public health approach that reduces infant morbidity and mortality by providing essential nutrients and antibodies, and breast milk is easily digested. Breastfeeding and donated milk serve as a preventative measure against necrotising enterocolitis. Additionally, they protect against viruses and nosocomial sepsis. When a birthing parent's own milk is unavailable, alternative enteral nutrition for preterm or low-birth-weight infants is either donor human milk (DHM) or artificial formula. This study aimed to understand mothers' acceptance of the donor human milk bank (DHMB) and DHM. A qualitative phenomenological study was conducted in Limpopo Province, South Africa. The study used purposive sampling to select 23 mothers in postnatal and neonatal wards. Data collection was via in-depth interviews using a semistructured interview guide. Manual data analysis using an interpretative phenomenological analysis (IPA) framework was used to coding. Concepts were grouped to generate themes. Three themes and nine subthemes were generated: (1) DHMBs (2) cultural perspective of DHMB, and (3) health considerations of DHM. Participants were unaware of the DHMB. Hesitancy in accepting DHM due to fear of contracting HIV was observed. Cultural beliefs are an influencing factor for use, while donation was driven by altruistic reasons, preventing waste, helping othersand having previously benefited from DHM. The study found that mothers are willing to donate human milk. Willingness to donate can be increased by raising awareness about DHMB and addressing cultureand safety concerns at antenatal clinics.

Prevalence of Staphylococcus aureus on Noncritical Surfaces of the Laboratories of a Medical Laboratory Training Institution

Staphylococcus aureus is a Gram positive bacterium that is frequently encountered on surfaces such as benches and skin. This organism being a normal flora of the skin is usually nonpathogenic but becomes pathogenic when found outside its normal flora where it can cause varying number of infections such as nosocomial infections and sepsis which may even lead to death if left untreated. This research was therefore carried out to determine the prevalence of Staphylococcus aureus on noncritical surface areas including: Furniture, Doors and Windows of the laboratories of Federal College of Medical Laboratory Science & Technology Jos, Nigeria. Samples were processed, examined and analyzed accordingly. It was observed that out of the 120 samples examined, 8 were gram positive cocci in clusters under Gram staining examination Coagulase and catalase tests were positive indicating specific biochemical tests to identify the organisms in the 8 organisms as Stapylococcus aureus showing a prevalence rate of 6.67%. The 17 working Benches examined, 3(2.50%) were positive. Out of 75 Chairs examined, 5(4.17%) were positive. The 18 Windows examined, 10 Doors examined showed no growth for Staphylococcus aureus. Distribution according to laboratory sections showed that, out of the 95 samples in main laboratory, 6(5.00%) were positive. Out of the 14 samples examined in side laboratory one, 2(1.67%) were positive while none 0(0.0%) was positive out of 11 samples examined in side laboratory two. The isolation of Stapylococcus aureus from these locations stresses the urgent need for public enlightenment campaigns by the appropriate authorities to educate the laboratory workers as well as the masses on the etiological agents, the possible risk factors, routes of transmission and health implication of Stapylococcus aureus infection and ways of preventing these bacteria in the Laboratories especially in Federal College of Medical Laboratory Science and Technology Jos Nigeria.

Child deaths caused by Klebsiella pneumoniae in sub-Saharan Africa and south Asia: a secondary analysis of Child Health and Mortality Prevention Surveillance (CHAMPS) data

Klebsiella pneumoniae is an important cause of nosocomial and community-acquired pneumonia and sepsis in children, and antibiotic-resistant K pneumoniae is a growing public health threat. We aimed to characterise child mortality associated with this pathogen in seven high-mortality settings. We analysed Child Health and Mortality Prevention Surveillance (CHAMPS) data on the causes of deaths in children younger than 5 years and stillbirths in sites located in seven countries across sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and south Asia (Bangladesh) from Dec 9, 2016, to Dec 31, 2021. CHAMPS sites conduct active surveillance for deaths in catchment populations and following reporting of an eligible death or stillbirth seek consent for minimally invasive tissue sampling followed by extensive aetiological testing (microbiological, molecular, and pathological); cases are reviewed by expert panels to assign immediate, intermediate, and underlying causes of death. We reported on susceptibility to antibiotics for which at least 30 isolates had been tested, and excluded data on antibiotics for which susceptibility testing is not recommended for Klebsiella spp due to lack of clinical activity (eg, penicillin and ampicillin). Among 2352 child deaths with cause of death assigned, 497 (21%, 95% CI 20-23) had K pneumoniae in the causal chain of death; 100 (20%, 17-24) had K pneumoniae as the underlying cause. The frequency of K pneumoniae in the causal chain was highest in children aged 1-11 months (30%, 95% CI 26-34; 144 of 485 deaths) and 12-23 months (28%,22-34; 63 of 225 deaths); frequency by site ranged from 6% (95% CI 3-11; 11 of 184 deaths) in Bangladesh to 52%(44-61; 71 of 136 deaths) in Ethiopia. K pneumoniae was in the causal chain for 450 (22%, 95% CI 20-24) of 2023 deaths that occurred in health facilities and 47 (14%, 11-19) of 329 deaths in the community. The most common clinical syndromes among deaths with K pneumoniae in the causal chain were sepsis (44%, 95% CI 40-49; 221 of 2352 deaths), sepsis in conjunction with pneumonia (19%, 16-23; 94 of 2352 deaths), and pneumonia (16%, 13-20; 80 of 2352 deaths). Among K pneumoniae isolates tested, 121 (84%) of 144 were resistant to ceftriaxone and 80 (75%) of 106 to gentamicin. K pneumoniae substantially contributed to deaths in the first 2 years of life across multiple high-mortality settings, and resistance to antibiotics used for sepsis treatment was common. Improved strategies are needed to rapidly identify and appropriately treat children who might be infected with this pathogen. These data suggest a potential impact of developing and using effective K pneumoniae vaccines in reducing neonatal, infant, and child deaths globally. Bill & Melinda Gates Foundation.

Construction and validation of an interprofessional simulated scenario for the identification and management of sepsis.

Build and validate a realistic interprofessional simulation scenario for the identification and management of sepsis by doctors and nurses. Methodological study developed in 2021, in two stages: construction of the guide and content validation by expert judges; and development of the simulation and validation of the scenario by doctors and nurses. 15 specialists participated in the research in the first stage and eight care professionals in the second stage. 0.8 was adopted as a parameter for the Content Validation Index (CVI). The scenario guide addressed nosocomial sepsis with an abdominal focus in an adult patient and its validation obtained a total CVI of 0.97. All areas evaluated in the simulation scenario obtained agreement indices greater than 0.8. The construction and validation of the guide allowed the elaboration of guiding material for the development of an interprofessional simulated scenario, whose execution and validation process demonstrated its suitability in approaching the identification and management of sepsis by doctors and nurses. It is recommended to carry out future research evaluating its applicability to other situational contexts.

Role of procalcitonin in predicting newborn hospital-acquired sepsis: a case–control study

BackgroundNeonatal sepsis is a leading cause of newborn mortality in the developing world. Most of the newborn babies admitted to a neonatal ICU for different reasons acquire hospital-acquired infections. Early and optimal management is pivotal for successful outcomes. However, most of the places lack advanced automated culture facilities. Procalcitonin could potentially be used for early diagnosis of such infection.ObjectiveTo study the diagnostic role of serum procalcitonin in newborn hospital-acquired sepsis.Materials and methodsA case–control study was conducted in a tertiary care hospital in northern India.ResultsCulture-positive nosocomial sepsis group consisted of 59 patients and the control group of 41 patients. Gram-negative organisms were the most commonly isolated organisms (91.5%). The baseline median and interquartile range (IQR) serum PCT of the study population was 0.3 (0.18–.44) ng/ml. The median (IQR) serum PCT values at the time of clinical deterioration in the nosocomial sepsis and the sepsis-like illness groups are 4 (6.5) ng/ml and 1.2 (1.6) ng/ml, respectively (p = 000). The area under the ROC curve for the prediction of bacterial infection for PCT was 0.864. On the ROC curve, the PCT level that combined the greatest sensitivity and comparatively good specificity was 1.95 ng/ml, with a sensitivity of 88%, and specificity of 79%.ConclusionWe conclude that serum procalcitonin is a reliable marker for the diagnosis of neonatal nosocomial sepsis.

Evaluation of the Kinetics of Pancreatic Stone Protein as a Predictor of Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia (VAP) is a severe condition. Early and adequate antibiotic treatment is the most important strategy for improving prognosis. Pancreatic Stone Protein (PSP) has been described as a biomarker that increases values 3-4 days before the clinical diagnosis of nosocomial sepsis in different clinical settings. We hypothesized that serial measures of PSP and its kinetics allow for an early diagnosis of VAP. The BioVAP study was a prospective observational study designed to evaluate the role of biomarker dynamics in the diagnosis of VAP. To determine the association between repeatedly measured PSP and the risk of VAP, we used joint models for longitudinal and time-to-event data. Of 209 patients, 43 (20.6%) patients developed VAP, with a median time of 4 days. Multivariate joint models with PSP, CRP, and PCT did not show an association between biomarkers and VAP for the daily absolute value, with a hazard ratio (HR) for PSP of 1.01 (95% credible interval: 0.97 to 1.05), for CRP of 1.00 (0.83 to 1.22), and for PCT of 0.95 (0.82 to 1.08). The daily change of biomarkers provided similar results, with an HR for PSP of 1.15 (0.94 to 1.41), for CRP of 0.76 (0.35 to 1.58), and for PCT of 0.77 (0.40 to 1.45). Neither absolute PSP values nor PSP kinetics alone nor in combination with other biomarkers were useful in improving the prediction diagnosis accuracy in patients with VAP. Registered retrospectively on August 3rd, 2012. NCT02078999.

Neurodevelopmental outcome after nosocomial sepsis in preterm neonates: a retrospective cohort study

Background Nosocomial infections (NIs) are associated with significant mortality affecting up to 56% of all infants, as well as long-term morbidity, prolonged hospital stay, and increased healthcare costs. Objective This study aimed to compare neurodevelopmental outcomes at 18 months of age in preterm infants exposed to nosocomial sepsis (NS) during neonatal ICU admission with the outcomes in unexposed preterm infants. Study design This was a retrospective study in the follow-up clinic of the neonatal ICU of a tertiary hospital. Participants Preterm infants who met the criteria were divided into: group A exposed to NS and group B not exposed to NS. Intervention All infants were examined across the three domains of neurodevelopment: cognitive function, language, and motor function. The examination was done at 18 months of corrected age, using the Bayley Scales of Infant and Toddler Development (III). Outcome The neurodevelopment of preterm infants at 18 months of age. Results Among the 61 former preterm infants at 18 months of age, who met the criteria, 31 were exposed and 30 were not exposed to NS. Male infants, low birth weight, and low APGAR score were significantly higher in the nosocomial group. Gram-negative organisms accounted for 60% of cases. Staphylococci accounted for 16.7% of the cultures. The neurodevelopmental delay was more in the sepsis group than in the nonsepsis group in all functions examined, and the difference was significant, and sepsis cases accounted for about 2/3 of the cases that had neurodevelopmental impairment. Conclusion This study showed that neurodevelopmental impairment was significantly increased in neonates who developed NI despite treatment with effective antibiotic therapy.

Antimicrobial Activity of Acacia Nilotica and Ziziphus Mauritiana against Clinical Isolates of Escherichia Coli and Klebsiella Aerogenes

Klebsiella aerogenes is an opportunistic pathogen linked to several nosocomial illnesses, including pneumonia, sepsis, and infection of the urinary tract. Escherichia coli is frequently the source of numerous common bacterial illnesses, including bacteraemia, cholecystitis, cholangitis, urinary tract infections (UTI), traveler's diarrhoea, and other medical conditions such as meningitis in babies and pneumonia. This study aimed at determining the antimicrobial activity of Acacia nilotica and Ziziphus mauritania on clinical isolate of E. coli and K. aerogenes. The phytochemical constituents of Z. mauritiana and A. nilotica were determined. E. coli and K. aerogenes isolates were obtained from the Barau Dikko Teaching Hospital, Kaduna and reconfirmed using standard microbiological techniques. The antibacterial activity of Z. mauritiana and A. nilotica extracts against the isolates was determined using Agar well diffusion assay, the MIC and MBC was also determined and recorded. The findings of this study revealed that tannins, quinone, phenols, terpenoids, and steroids are present in Z. mauritiana extract while tannins, saponin, quinones, and terpenoids in A. nilotica extract. There was no activity of Z. mauritiana against any of the test isolates at all concentrations used in this study. Whereas A. nilotica exhibited an antibacterial activity against both E. coli and K. aerogenes recording respectively a zone of inhibition of 24 mm and 25 mm with MIC and MBC value of 600 mg/ml. This research displayed an antibacterial activity of A. nilotica and no activity of Z. mauritiana against E. coli and K. aerogenes.

Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study

BackgroundNosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis.MethodsMatched 1:1 case–control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence.Results3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068–0.084) for medical admissions; 0.043 (95% CI 0.032–0.055) for elective surgical admissions; and 0.036 (95% CI 0.017–0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates.ConclusionThe impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.

Ogilvie Syndrome in Patients With Traumatic Pelvic and/or Acetabular Fractures: A Retrospective Cohort Study.

To assess the incidence, risk factors, and clinical outcomes of Ogilvie syndrome (OS) in patients with pelvic and/or acetabular fractures. Retrospective cohort study. Level 1 trauma center. One thousand sixty patients with pelvic and/or acetabular fractures treated at Rigshospitalet, Copenhagen, between 2009 and 2020. Interventions comprised the treatment of pelvic and/or acetabular fractures with emergency external and/or internal fixation. Outcomes included diagnosis of OS, perioperative complications, ICU stay and length, length of admission, and mortality. We identified 1060 patients with pelvic and/or acetabular fractures. Of these, 25 patients were diagnosed with OS perioperatively, corresponding to incidences of 1.6%, 2.7%, and 2.6% for acetabular, pelvic, and combined fractures, respectively. Risk factors included congestive heart failure, diabetes, concomitant traumatic lesions, head trauma, fractures of the cranial vault and/or basal skull, retroperitoneal hematomas and spinal cord injuries, and emergency internal fixation and extraperitoneal packing. Six (24%) patients underwent laparotomy, and all patients had ischemia or perforation of the cecum for which right hemicolectomy was performed. Ogilvie syndrome was associated with a significant increase in nosocomial infections, sepsis, pulmonary embolism, ICU stay, and prolonged hospital admission. Ogilvie syndrome in patients with pelvic and/or acetabular fractures is associated with increased risk of perioperative complications and prolonged hospital and ICU stays, resulting in an increased risk of morbidity and mortality. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Prospective flow cytometry analysis of leucocyte subsets in critically ill patients who develop sepsis: a pilot study.

Sepsis in critically ill patients with injury bears a high morbidity and mortality. Extensive phenotypic monitoring of leucocyte subsets in critically ill patients at ICU admission and during sepsis development is still scarce. The main objective of this study was to identify early changes in leukocyte phenotype which would correlate with later development of sepsis. Patients who were admitted in a tertiary ICU for organ support after severe injury (elective cardiac surgery, trauma, necessity of prolonged ventilation or stroke) were sampled on admission (T1) and 48-72h later (T2) for phenotyping of leukocyte subsets by flow cytometry and cytokines measurements. Those who developed secondary sepsis or septic shock were sampled again on the day of sepsis diagnosis (Tx). Ninety-nine patients were included in the final analysis. Nineteen (19.2%) patients developed secondary sepsis or septic shock. They presented significantly higher absolute monocyte counts and CRP at T1 compared to non-septic patients (1030/µl versus 550/µl, p = 0.013 and 5.1mg/ml versus 2.5mg/ml, p = 0.046, respectively). They also presented elevated levels of monocytes with low expression of L-selectin (CD62Lneg monocytes) (OR[95%CI] 4.5 (1.4-14.5), p = 0.01) and higher SOFA score (p < 0.0001) at T1 and low mHLA-DR at T2 (OR[95%CI] 0.003 (0.00-0.17), p = 0.049). Stepwise logistic regression analysis showed that both monocyte markers and high SOFA score (> 8) were independently associated with nosocomial sepsis occurrence. No other leucocyte count or surface marker nor any cytokine measurement correlated with sepsis occurrence. Monocyte counts and change of phenotype are associated with secondary sepsis occurrence in critically ill patients with injury.

Usefulness of pancreatic stone protein measurement to screen and diagnose sepsis in the context of the Surviving Sepsis Campaign recommendations.

Sepsis occurs yearly in 48.9 million people worldwide of whom 11 million will die. Sepsis is defined as a life-threatening dysregulated reaction of the body in response to a bacterial infection, leading to organ dysfunction. The Surviving Sepsis Campaign (SSC) made numerous recommendations for sepsis diagnosis and treatment using an evidence-based medicine approach. Frequently, levels of evidence of these recommendations are poor and lack clear clinical guidance. Interestingly, the SSC guidelines strongly recommend, with a moderate quality of evidence, screening of nosocomial sepsis in acutely ill hospitalized “high-risk patients”. The definition of acutely ill and high-risk patients is not specified, nor it is indicated which tools should be used. The diagnosis of infection and the subsequent administration of antibiotics relies solely on rapid clinical assessment, as recommended by the Best Practice Statement. Again, the elements used for clinical assessment are poorly defined, encompassing patient history, clinical examination, and tests for both infectious and non-infectious causes of acute illness. In the real world, only 30 to 40% of empiric broad-spectrum antibiotic administrations are appropriate, contributing to the emergence of antimicrobial resistant bacteria, toxicity related to antibiotic administration, and costs. The aim of this review article is to show that the use of biomarkers, such as the Pancreatic Stone Protein (PSP) as an example, helps in guiding the clinician to diagnose and manage sepsis. Over 600 peer-reviewed publications have studied the physiology of PSP and more than 50 evaluated its usefulness to screen for the development of nosocomial sepsis and diagnose sepsis.

Environmental Persistence of Staphylococcus capitis NRCS-A in Neonatal Intensive Care Units: Role of Biofilm Formation, Desiccation, and Disinfectant Tolerance.

The clone Staphylococcus capitis NRCS-A is responsible for late-onset sepsis in neonatal intensive care units (NICUs) worldwide. Over time, this clone has evolved into three subgroups that are increasingly adapted to the NICU environment. This study aimed to decipher the mechanisms involved in NRCS-A persistence in NICUs. Twenty-six S. capitis strains belonging to each of the three NRCS-A clone subgroups and two other non-NRCS-A groups from neonates (alpha clone) or from adult patients ("other strains") were compared based on growth kinetics and ability to form biofilm as well as tolerance to desiccation and to different disinfectants. S. capitis biofilm formation was enhanced in rich medium and decreased under conditions of nutrient stress for all strains. However, under conditions of nutrient stress, NRCS-A strains presented an enhanced ability to adhere and form a thin biofilm containing more viable and culturable bacteria (mean 5.7 log10 CFU) than the strains from alpha clone (mean, 1.1 log10 CFU) and the "other strains" (mean, 4.2 log10 CFU) (P < 0.0001). The biofilm is composed of bacterial aggregates with a matrix mainly composed of polysaccharides. The NRCS-A clone also showed better persistence after a 48-h desiccation. However, disinfectant tolerance was not enhanced in the NRCS-A clone in comparison with that of strains from adult patients. In conclusion, the ability to form biofilm under nutrient stress and to survive desiccation are two major advantages for clone NRCS-A that could explain its ability to persist and settle in the specific environment of NICU settings. IMPORTANCE Neonatal intensive care units (NICUs) host extremely fragile newborns, including preterm neonates. These patients are very susceptible to nosocomial infections, with coagulase-negative staphylococci being the species most frequently involved. In particular, a Staphylococcus capitis clone named NRCS-A has emerged worldwide specifically in NICUs and is responsible for severe nosocomial sepsis in preterm neonates. This clone is specifically adapted to the NICU environment and is able to colonize and maintain on NICU surfaces. The present work explored the mechanisms involved in the persistence of the NRCS-A clone in the NICU environment despite strict hygiene measures. The ability to produce biofilm under nutritional stress and to resist desiccation appear to be the two main advantages of NRCS-A in comparison with other strains. These findings are pivotal to provide clues for subsequent development of targeted methods to combat NRCS-A and to stop its dissemination.

Clinical Approach to Nosocomial Bacterial Sepsis.

Bacterial sepsis and septic shock are associated with a high mortality, and when clinically suspected, clinicians must initiate broad-spectrum antimicrobials within the first hour of diagnosis. Thorough review of prior cultures involving multidrug-resistant (MDR) pathogens along with other likely pathogens should be performed to provide an appropriate broad-spectrum empiric antibiotic coverage. The appropriate antibiotic loading dose followed by individualized modification of maintenance dose should be implemented based on the presence of hepatic or renal dysfunction. Use of procalcitonin is no longer recommended to determine need for initial antibacterial therapy and for de-escalation. Daily reevaluation of appropriateness of treatment is necessary based on the culture results and clinical response. All positive cultures should be carefully screened for possible contamination or colonization, which may not represent the true organism causing the sepsis. Culture negative sepsis accounts for one-half of all cases, and de-escalation of initial antibiotic regimen should be done gradually in these patients with close monitoring.