Risk Factors For Septic Shock Research Articles

Prevention and treatment of septic shock following mini-percutaneous nephrolithotomy: a single-center retrospective study of 834 cases

To explore the risk factors, prevention, and management of the septic shock following the mini-percutaneous nephrolithotripsy (mini-PCNL). A total of 834 consecutive patients who underwent mini-PCNL from June 2004 to April 2012 were retrospectively analyzed. The causes, prevention, and treatment of septic shock following mini-PCNL were assessed. Twenty out of 834 patients developed septic shock, and 17 patients recovered without complications. Three patients progressed to multiple organ dysfunction syndromes and expired. Multivariable analysis showed that the following variables were independently related to septic shock following mini-PCNL: female, with an odds ratio (OR=1.055E8, P<0.001) and diabetes mellitus (OR=4.192, P=0.001). Female and diabetes mellitus are the risk factors for septic shock following mini-PCNL. Perioperative preventive measures can reduce the incidence of septic shock. Early recognition and timely bundle treatment may decrease the mortality.

Risk factors for septic shock in patients with solid organ transplantation and complication of bacteremias

To explore the risk factors for septic shock in patients with solid organ transplantation and complication of bacteremias. Clinical data of 98 solid organ transplant cases with complication of bacteremias were retrospectively studied. All episodes of bacteremias met the CDC criteria. Six possible risk factors contributing to septic shock were evaluated by univariate analysis and multivariate logistic regression analysis. Among the 98 patients, 133 times of bacteremias have been reported and 39 patients developed septic shock. Among the 39 patients with septic shock, 43.5%, 38.5%, 15.4% and 2.6% of bacteremias were induced by multiple bacteria, gram-negative bacteria, gram-positive bacteria and fungi, respectively. The lung was the main source of bacteremias (41.8%), followed by intraabdominal/ biliary focus (24.5%). Risk factors for developing septic shock included the bacteremias happened in the 2nd to 8th week post transplant (P=0.014), polymicrobial etiology (P=0.001), intra-abdominal/ biliary focus (P=0.011), and liver transplant (P=0.002). Only bacteremias occurred in the 2nd to 8th week post transplant and polymicrobial etiology were significant risk factors by multivariate analysis. Risk factors for developing septic shock in bacteremias after SOT are early-onset (the 2nd-8th week post transplant) and polymicrobial etiology.

Surgical Decompression is Associated with Decreased Mortality in Patients with Sepsis and Ureteral Calculi

The combination of sepsis and ureteral calculus is a urological emergency. Traditional teaching advocates urgent decompression with nephrostomy tube or ureteral stent placement, although published outcomes validating this treatment are lacking. National practice patterns for such scenarios are currently undefined. Using a retrospective study design, we defined the surgical decompression rate in patients admitted to the hospital with severe infection and ureteral calculi. We determined whether a mortality benefit is associated with this intervention. Patient demographics and hospital characteristics were extracted from the 2007 to 2009 Nationwide Inpatient Sample. We identified 1,712 patients with ureteral calculi and sepsis. Multivariate logistic regression was performed to determine the association between mortality and surgical decompression. Of the patients 78% underwent surgical decompression. Mortality was higher in those not treated with surgical decompression (19.2% vs 8.82%, p <0.001). Lack of surgical decompression was independently associated with an increased OR of mortality even when adjusting for patient demographics, comorbidities and geographic region of treatment (OR 2.6, 95% CI 1.9-3.7). Absent surgical decompression is associated with higher odds of mortality in patients with sepsis and ureteral calculi. Further research to determine predictors of surgical decompression is necessary to ensure that all patients have access to this life saving therapy.

Predictors of septic shock in patients with methicillin-resistant Staphylococcus aureus bacteremia

Risk factors for septic shock associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia are not well described. We designed this study to assess the independent predictors of septic shock in patients with MRSA bacteremia. This retrospective chart review included 234 patients with MRSA bacteremia admitted to a tertiary care academic medical center. Cases of septic shock and non-septic shock MRSA bacteremia were compared in terms of patient baseline characteristics and co-morbidities, modes of acquisition, and MRSA genotyping. Independent risk factors were determined by multivariable analysis. On univariate analysis the presence of chronic kidney disease, respiratory failure, acute renal failure, staphylococcal cassette chromosome (SCCmec) type II, and higher APACHE II scores were significantly correlated with the presence of septic shock. On multivariate analysis, baseline APACHE II score (adjusted odds ratio (AOR) for 1-point increase 1.13, 95% confidence interval (CI) 1.04-1.22, p=0.005), acute renal failure (AOR 2.57, 95% CI 1.02-6.48, p=0.045), and SCCmec type II (AOR 2.60, 95% CI 1.01-6.75, p=0.049) were independently associated with MRSA bacteremic septic shock. The development of septic shock associated with MRSA bacteremia was independently correlated with baseline severity of illness, presence of acute renal failure, and an MRSA genotyping consistent with nosocomially acquired MRSA infection.

Clinical characteristics and risk factors for septic shock in patients receiving emergency drainage for acute pyelonephritis with upper urinary tract calculi

BackgroundAcute pyelonephritis (APN) is a common complication of ureteral obstruction caused by urolithiasis, and it can be lethal if it progresses to septic shock. We investigated the clinical characteristics of patients undergoing emergency drainage and assessed risk factors for septic shock.MethodsA retrospective study was performed of 98 patients (101 events) requiring emergency drainage at our urology department for obstructive APN associated with upper urinary tract calculi from January 2003 to January 2011. Clinical characteristics were summarized, and risk factors for septic shock were assessed by logistic regression analysis.ResultsObjective evidence of sepsis was found in 64 (63.4%) events, and 21 events (20.8%) were categorized as septic shock. Ninety-six patients recovered, but 2 patients died of septic shock. Multivariate analysis revealed that age and the presence of paralysis were independent risk factors for septic shock.ConclusionsAPN associated with upper urinary tract calculi is a severe disease that should be treated with caution, particularly when risk factors are present.

Time to positivity of blood culture association with clinical presentation, prognosis and ESBL-production in Escherichia coli bacteremia

The time to positivity (TTP) of blood cultures has been associated with increased mortality in bacteremia caused by several microorganisms. The aim of this study is to evaluate the relationship between TTP and prognosis, clinical presentation and extended spectrum B-lactamase (ESBL)-production in patients with Escherichia coli bacteremia. This is a retrospective observational study involving 226 adult patients with E. coli bacteremia. Data collected included underlying diseases, clinical presentation, prognosis factors, TTP, ESBL-production and outcome. Thirty-one (14%) patients had severe sepsis and 29 (13%) septic shock at presentation. Thirty-three (14%) strains were ESBL-producers. Thirty-nine (17%) patients died during admission and 17 (7.5%) within 48 hours. The median TTP was 8.3 hours (range, 0.42–76.5). It was significantly shorter in patients with septic shock (6.23 h, range 1.12–47.29 h vs. 8.51 h, range 0.42–76.50 h; p = 0.018). Rapid growth of E. coli, Pitt index >1.5, non-urinary source and Charlson score >2 were selected as independent risk factors of in-hospital mortality by the multivariate analysis. ESBL-production was not associated with modifications in TTP. Lower TTP is an independent risk factor for septic shock and poor outcome in episodes of E. coli bacteremia. The TTP in E. coli bacteremia is not significantly modified by ESBL-production.

Pneumococcal pneumonia presenting with septic shock: host- and pathogen-related factors and outcomes

Background:Host- and pathogen-related factors associated with septic shock in pneumococcal pneumonia are not well defined. The aim of this study was to identify risk factors for septic shock and to...

Predictive factors of septic shock and mortality in neutropenic patients

Neutropenia is a major risk factor for developing a serious infection. Bacteremia still causes significant mortality among neutropenic patients with cancer. The purpose of this study was to identify risk factors for septic shock and for mortality in neutropenic patients with leukemia and bacteremia. Consecutive samples from 20 patients with acute myeloid leukemia and bacteremia were studied during a 1 year period (January–December 2003). All patients received empirical antibiotic therapies for febrile episodes using ceftazidime plus amikacin. About 110 neutropenic febrile episodes were noted: clinically documented 14.54%, microbiologically documented 16.36% and fever of unknown origin 69.09%. Gram-negative organism caused eight febrile episodes: Pseudomonas (5), Klebsiella (3). Gram-positive organism caused 10 episodes: Staphylococcus (6), Streptococci (2), Enterococci (2). Pulmonary infection accounted for 25% of clinically documented infections. About 14 of the 110 febrile episodes were associated with septic shock causing mortality in 7 patients. In a univariate analysis variables associated with septic shock were: pulmonary infection (OR = 17, p = 0.001), serum bicarbonate < 17 mmol/l (OR = 68, p < 0.001) and serum lactate >3 mmol/l (OR = 62, p < 0.001). Variables associated with mortality were: pulmonary infection (OR = 83, p < 0.001) and serum bicarbonate < 17 mmol/l (OR = 61, p < 0.001).In a multivariate analysis two variables were associated with septic shock: pulmonary infection (OR = 5, p = 0.043) and serum lactate >3 mmol/l (OR = 10, p = 0.003). An elevated serum lactate (>3 mmol/l) and low serum bicarbonate (< 17 mmol/l) at the onset of bacteremia are useful biomarkers in predicting septic shock and mortality in neutropenic patients.

Bacteraemia as a risk factor for septic shock in medical patients with fever

In patients with fever, shock is nearly always preceded by microbial infection, and particulary bacteraemia.

Risk factors for septic shock in the early management of bacteremia

purpose: Aggressive treatment of bacteremia in patients at high risk of septic shock may prove to be beneficial and cost-effective since these patients account for 50% of the mortality. The purpose of this study was to identify risk factors for septic shock in bacteremic patients. patients and methods: We retrospectively collected clinical, biologic, and radiologic data from medical records of patients who experienced one episode of bacteremia between March 1 and December 31, 1990, at the University Hospital of Dijon, France. Statistical analysis was univariate and multivariate (logistic regression). results: During the survey, 331 patients experienced one episode of bacteremia. Bacteremia due to gram-negative species was more frequently found in surgical units. Septic shocks were equally attributed to gram-negative and gram-positive bacteria. The do-not-resuscitate order was associated with nearly half of the deaths secondary to underlying diseases or poor general condition. Neither hospital-acquired bacteremia nor underlying diseases were associated with a high risk of septic shock. Multivariate analysis showed the following to be risk factors for septic shock: male gender and age older than 75 years (odds ratio = 2.91), creatinine level greater than 20 mg/L (odds ratio = 4.52), prothrombin time less than 60% (odds ratio = 4.86), and presence of an interstitial pattern on the chest radiograph involving more than half of both lung fields (odds ratio = 4.1). Our logistic model with these selected parameters allowed an overall classification of 77% of the studied patients, with a positive predictive value of 55% and a negative predictive value of 89%. conclusion: Our results provide a positive predictive value that is similar to that of the clinical scores of severity proposed by other authors in selected populations. Our classification, in conjunction with a clinical classification, would allow improvement in the prognosis of patients with bacteremia by early treatment of those at high risk for developing septic shock. Validation of these results with further studies involving a larger population that includes patients with suspected infections, as well as bacteremic patients, is needed.

Points: Subacute sclerosing panencephalitis

<h3>Background:</h3> Host- and pathogen-related factors associated with septic shock in pneumococcal pneumonia are not well defined. The aim of this study was to identify risk factors for septic shock and to ascertain patient outcomes. Serotypes, genotypes and antibiotic resistance of isolated strains were also analysed. <h3>Methods:</h3> Observational analysis of a prospective cohort of non-severely immunosuppressed hospitalised adults with pneumococcal pneumonia. Septic shock was defined as a systolic blood pressure of &lt;90 mm Hg and peripheral hypoperfusion with the need for vasopressors for &gt;4 h after fluid replacement. <h3>Results:</h3> 1041 patients with pneumococcal pneumonia diagnosed by Gram stain and culture of appropriate samples and/or urine antigen test were documented, of whom 114 (10.9%) had septic shock at admission. After adjustment, independent risk factors for shock were current tobacco smoking (OR, 2.11; 95% CI, 1.02 to 4.34; p = 0.044), chronic corticosteroid treatment (OR, 4.45; 95% CI, 1.75 to 11.32; p = 0.002) and serotype 3 (OR, 2.24; 95% CI, 1.12 to 4.475; p = 0.022). No significant differences were found in genotypes and rates of antibiotic resistance. Compared with the remaining patients, patients with septic shock required mechanical ventilation more frequently (37% vs 4%; p&lt;0.001) and had longer length of stay (11 vs 8 days; p&lt;0.001). The early (10% vs 1%; p&lt;0.001) and overall case fatality rates (25% vs 5%; p&lt;0.001) were higher in patients with shock. <h3>Conclusions:</h3> Septic shock is a frequent complication of pneumococcal pneumonia and causes high morbidity and mortality. Current tobacco smoking, chronic corticosteroid treatment and infection caused by serotype 3 are independent risk factors for this complication.