Sepsis In Hospital Research Articles

Incidence of death and its predictors among neonates admitted with sepsis in referral hospitals, northwest Ethiopia, a prospective cohort study.

Each year, approximately 2.7 million neonates die in their first month of life worldwide, and the majority of these deaths occur in low-income countries. According to the Global Burden of Disease estimation, 1.3 million annual incident cases of neonatal sepsis were reported worldwide, resulting in 203,000 sepsis-attributable deaths. Little is known about the time to death of neonates and predictors after admission with a diagnosis of sepsis. This study aimed to assess the incidence and predictors of death among neonates admitted to the neonatal intensive care unit with a diagnosis of sepsis in referral hospitals in Northwest Ethiopia. A multicenter prospective follow-up study was conducted from November 11 to December 7, 2021. A stratified random sampling technique was employed to select 412 neonates. Neonates admitted with sepsis were followed until they develop event for a maximum of 28 days of age. A face-to-face interview was conducted with the mother of the neonate using a pretested and structured questionnaire, and neonatal charts were reviewed to collect baseline factors. Data were entered into Epi-data version 4.6 and exported to STATA version 14 for analysis. A bivariable and multivariable exponential Cox regression model was fitted to identify predictors of death. The adjusted hazard ratio (AHR) with 95% CI was calculated, and statistical significance was declared at a P-value of 0.05 in the multivariable analysis. A total of 75 (18.47%) neonates died during the study period, with a 95% CI of 14.82-22.60. The incidence rate of death was 28 (95% CI, 22, 35) per 1,000 person-days of observation, with a total follow-up time of 2,677 person-days of observation. Birth weight (<2,500 g) (AHR = 2.12, 95% CI: 1.01, 4.43), prematurity (AHR = 2.06, 95% CI: 1.02, 4.15), duration of labor >24 h (AHR = 3.89, 95% CI: 1.38, 11.01), breast feeding (AHR = 0.43, 95% CI: 0.23, 0.80), having respiratory distress syndrome (AHR = 1.77, 95% CI: 1.02, 306), oxygen saturation less than 90% (AHR = 2.23, 95% CI: 1.02, 306) were significant predictors of death among neonates admitted with sepsis. The incidence of neonatal mortality in this study was high. Early detection and appropriate management of patients' presentations like respiratory distress syndrome and low oxygen saturation are necessary to reduce neonatal sepsis-related mortality. Special attention should be given to low birth weight and premature neonates and mothers should be encouraged to breastfeed their newborns after delivery.

Prevalence of acute kidney injury and its characteristics among neonates with suspected sepsis in a tertiary hospital in Kenya.

Unique aspects of neonatal renal physiology enhance the occurrence of Acute Kidney Injury (AKI) as a complication of neonatal sepsis. The study sought to determine prevalence of AKI and its characteristics in neonates with suspected sepsis. A cross-sectional study was conducted at Kenyatta National Hospital among neonates aged 0-28 days. AKI was defined as serum creatinine of more than 100µmmol/l. Among 332 neonates included 120 had AKI giving a prevalence of 36.1% (95% CI 31 to 41.6). Based on RIFLE criteria the commonest AKI presentation was Failure 72 (62.6%, 95% CI 53.6 to 71.6), followed by Injury 26 (22.6%, 95% CI 14.8 to 30.4) and then Risk 17 (14.8%, 95% CI 8.2 to 21.3). AKI was more common in neonates with suspected late onset sepsis (p=0.004). Maternal fever in the preceding week to delivery and presence of either puerperal sepsis or post-partum hemorrhage were significantly associated with severe AKI (p=0.004 and p=0.038). Prevalence of AKI was high; those with suspected late onset sepsis were more likely to develop AKI compared to early onset sepsis. Presence of maternal fever preceding delivery and presence of either puerperal sepsis or postpartum hemorrhage were associated with severe forms of AKI.

Descriptive Study of neonatal sepsis in the Post Graduated Hospital Khost Afghanistan

Introduction: Since neonatal Sepsis are causes a large number of neonatal hospitalizations and considered one of the most common problems of NICUs worldwide, also a large number of neonatal morbidity and mortality occurs in developing and developed countries. 1.6 million to 4 million deaths occur in the world, 40% of newborns in the first week. Diagnosis of the disease in newborns is determined by the level and equipment of the clinic and is based on the detection of antenatal and postnatal risk factors, respiratory and general symptoms, radiological signs, markers of the systemic inflammatory response syndrome / bacterial infections, and the results of etiological diagnosis. The combination of ampicillin with gentamicin is used for initial therapy of early pneumonia in newborns. In case of late neonatal pneumonia that occurred in a hospital, primary therapy must necessarily include anti pseudomonas and anti-staphylococcal antibiotics. Gram-negative antibiotics are given to treat community-acquired pneumonia in newborns.&#x0D; Research Question: What is the frequency and pattern of neonatal sepsis in Khost provincial specialized hospitals?&#x0D; Methodology: Our research is descriptive type that based on a case series, which took place from the first date of hamal 1400 to the last date of hoot, During this year 2311 patients were hospitalized in Khost post graduate Hospital, 821 patients were newborns, out of these 821 patients, 314 patients were diagnosed neonatal sepsis

Descriptive statistics and risk factor analysis of children with community-acquired septic shock

BackgroundChildren with community-acquired septic shock can rapidly deteriorate and die in acute-care hospitals. This study aimed to describe the mortality, timing, and risk factors in children with community-acquired septic shock.MethodsThis is a retrospective cohort study using a national inpatient database in Japan. The study population included children (age < 20 years) who were admitted to acute-care hospitals with a diagnosis of sepsis from July 2010 to March 2020, who were treated with antibiotics, and who were supported with vasoactive drugs within three days of hospitalization. We used a Cox proportional-hazards regression model to identify risk factors for earlier death.ResultsAmong 761 eligible children, the median age was 3 (interquartile range, 0–11) years and 57.2% had underlying conditions. Among these, 67.1% were admitted to accredited intensive care units within three days of hospitalization and 38.6% were transported from other hospitals. The median hospital volume, defined as the number of eligible children in each hospital over the study period, was 4 (interquartile range, 2–11). Overall, 244 children died (in-hospital mortality rate, 32.1%). Among them, 77 (31.6%) died on the first day, and 156 (63.9%) died within three days of hospitalization. A Cox proportional-hazards regression model showed that earlier death was associated with lower hospital volume and age 1–5 years, whereas it was inversely associated with admission to an accredited intensive care unit and transport from other hospitals. Among 517 survivors, 178 (34.4%) were discharged with comorbidities.ConclusionsChildren with community-acquired septic shock had high mortality, and early death was common. Our findings may warrant future efforts to enhance the quality of initial resuscitation for sepsis in low-volume hospitals and to ensure a healthcare system in which children with sepsis can be treated in accredited intensive care units.

A cross-sectional study of clinical features of bacterial meningitis among neonates presumed to have sepsis in a tertiary hospital, Dar es Salaam, Tanzania.

Identifying meningitis among neonates is usually challenging given the non-specific presentation and overlap with neonatal sepsis. This study was aimed at determining the pertinent clinical features that would suggest bacterial meningitis among infants with signs of possible serious bacterial infection and their outcomes. This hospital-based cross-sectional study was conducted among neonates presenting with clinical features of sepsis admitted at Muhimbili National Hospital (MNH) between May and December 2015. Detailed clinical features, blood cultures, and cerebrospinal fluid were obtained. The specimens were tested at the Central Pathology Laboratory at MNH. Short-term clinical outcome was also determined for recruited participants. One hundred and twenty-six neonates met the inclusion criteria and were recruited, males were 67 (53.2%) and the mean age of participants was 10.4 ± 7.9 days. Features of meningitis were noted among 19% (24/126) and very low birth weight neonates were observed to have a statistically higher prevalence of meningitis (p=0.038). Bacterial isolates from cerebrospinal fluid (CSF) culture were Klebsiella spp and E. coli, while predominant isolates from blood culture were Klebsiella spp (35%) and E. coli (20.6%). There was high resistance to ampicillin (91.2%), cloxacillin (94.1%), gentamycin (50%), and ceftriaxone (50%). A high mortality of 24.9% was noted. Neonatal meningitis is common among neonates with sepsis, and bacterial isolates were resistant to routinely used antibiotics. High mortality attributed to meningitis was noted at Muhimbili National Hospital.

The effectiveness of empirical antibiotics treatment in neonatal sepsis: a retrospective study

Objective: This study aimed to investigate the effectiveness of empirical antibiotics in neonatal sepsis in Maternity and Children Hospital, Makkah, Saudi Arabia. Methods: This retrospective study was conducted among neonates at the neonatal intensive care unit (NICU) of the Maternity and Children Hospital between the period from November, 2021 to January, 2022. The collected data included demographics and clinical data of neonates, antibiotic administrated, and blood culture results, white blood cells count, and C-reactive protein (CRP) before and after antibiotic administration. Results: The data of 164 neonates were included with the mean age of 17.5±7.8 days. There was a male dominancy (51.8%), and 43.3% had normal body weight. Around 14.6% positive cultures were found with dominancy of Coagulase-negative (COG –ve) staphylococcus (4.9%). Empirical antibiotics revealed significant improvement in WBCs (P=0.002) and CRP (P=0.000). Conclusion: The most causative agents of neonatal sepsis were COG -ve Staphylococcus and E. Coil. Empirical therapy was effective in improving the laboratory markers associated with neonatal sepsis.

Bacteriological profiles and antibiotic susceptibility of neonatal sepsis in a university hospital of Northern India.

Knowledge of epidemiology of bacterial isolates and their anti-biograms in hospital settings is necessary for prompt empirical anti-microbial therapy of neonatal sepsis. To study risk factors, bacteriological profiles, and anti-biograms of blood culture isolates of both early and late onset neonatal sepsis. It is a prospective observational study conducted from January 2020 till July 2021 at our tertiary care center. Neonates (0-28 days) admitted to this neonatal intensive care unit clinically suspected with sepsis were subjected to blood cultures, and the isolates were identified both biochemically and by the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system. Antibiotic susceptibility testing (AST) was performed as per CLSI guidelines. Chi-square test was used. Out of 280 suspected cases of neonatal sepsis, 43 (15.3%) cases showed positive blood culture. Of these, the majority (30, 69.8%) had late-onset neonatal sepsis. Major pre-disposing risk factors were pre-term birth and a low birth weight (26, 60.5%). Gram-negative bacteria and Gram-positive bacteria were isolated in 25 (58.1%) and 18 (41.9%) blood cultures, respectively. Klebsiella pneumoniae (37.5%) was the most predominant pathogen in both early-onset (23.1%) and late-onset (46.7%) sepsis. Coagulase negative Staphylococcus (34.8%) was the second most common organism and was more common in late onset (23.2%) neonatal sepsis. A high level of antibiotic resistance was noted in Klebsiella pneumoniae isolates, even to amikacin (76.5%) and carbapenems (66.7%). Increased resistance in bacterial isolates of neonatal sepsis emphasizes the need of AST of bacterial isolates for proper antibiotic administration.

Clinical-epidemiological characteristics of early-onset neonatal sepsis in a public hospital, Lima, Peru

Objective: To determine the clinical-epidemiological characteristics of newborns with early-onset neonatal sepsis in a public hospital in Lima, Peru, 2016-2017. Materials and methods: An observational, retrospective study of 303 newborns born in Hospital Nacional Dos de Mayo, diagnosed with early-onset neonatal sepsis (2016-2017) and with complete medical records. Maternal variables: age, education, marital status, prenatal care, PROM, type of delivery, UTI, chorioamnionitis, anemia; neonatal variables: sex, gestational age, weight, Apgar, clinical signs, hemoculture, isolated organism, treatment, antibiotic sensitivity. Data processed in Excel and analyzed in SPSS Statistics V25. The incidence of early-onset neonatal sepsis was determined. Results: Incidence of early-onset neonatal sepsis: 67.08/1,000 (2016) and 127.85/1,000 (2017) live births. Incidence of confirmed early-onset neonatal sepsis: 2.98 (2016) and 4.7 (2017). Out of all mothers, 45 % received no adequate prenatal checkup or no checkups; 25 % presented anemia, UTI, history of abortion. Newborns had tachypnea (52.80 %), tachycardia (17.50 %), hypotonia (18.20 %), fever (9.20 %). The therapy included ampicillin-amikacin for probable (86.54 %) and confirmed (85 %) sepsis. Germs, mostly gram positive, were isolated from 8.4 % of the newborns. Coagulase-negative Staphylococcus was the most common bacteria, resistant to clindamycin, oxacillin, ampicillin, cefotaxime, gentamicin, and sensitive to linezolid, vancomycin. Burkholderia gladioli was the only identified gramnegative organism, sensitive to levofloxacin, ciprofloxacin, ceftriaxone but resistant to gentamicin, amikacin. Conclusions: The clinical presentation of neonatal sepsis included tachypnea, tachycardia, hypotonia and fever. Grampositive bacteria were the most commonly isolated species, prevailing coagulase-negative Staphylococci.

Epidemiology of sepsis in Beijing from 2012 to 2018: analysis of hospital homepage databases derived from the Beijing Public Health System

BackgroundWe aimed to evaluate the epidemiology of sepsis in secondary and tertiary hospitals in Beijing, China between 2012 and 2018 using information derived from the Beijing Public Health System.MethodsThe Beijing Public Health System accessed hospital homepage databases and identify patients who diagnosed sepsis or associated condition according to the International Classification of Diseases, 10th Edition, Clinical Modification codes. There are 125 hospitals involved in this study, including 61 secondary hospitals, accounting for 49.2%, and 63 tertiary hospitals, accounting for 50.8%. Patients were stratified by age as minors (0–17 years old), adults (18–64 years old), seniors (65–84 years old), and the elderly (≥ 85 years old). Patient’s demographic information, treatments, outcomes, and all-cause hospitalization cost were evaluated.ResultsThis study involved 8,597 patients. Patients treated in tertiary hospitals or received blood transfusion decreased with age, while patients who were male, received ventilation, or took Traditional Chinese Medicine, and in-hospital mortality and hospitalization cost, increased with age. There were 2,729 (31.7%) deaths in this study. A slight increase in in-hospital mortality occurred from 2012 to 2018. Median hospitalization cost for all patients was ¥29,453 (15,011, 65,237). Hospitalization cost showed no significant change from 2012 to 2016, but increased in 2017 and 2018.ConclusionSepsis is associated with high mortality and cost. From 2012 to 2018, in-hospital mortality and hospitalization cost of sepsis in Beijing increased significantly with age, and slightly by year.

Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021.

Neonatal sepsis is a life-threatening emergency, and empirical antimicrobial prescription is common. In this cross-sectional study of neonates admitted with suspected sepsis in a teaching hospital in Ghana from January–December 2021, we described antimicrobial prescription patterns, compliance with national standard treatment guidelines (STG), blood culture testing, antimicrobial resistance patterns and treatment outcomes. Of the 549 neonates admitted with suspected sepsis, 283 (52%) were males. Overall, 529 (96%) received empirical antimicrobials. Most neonates (n = 407, 76.9%) were treated empirically with cefuroxime + gentamicin, while cefotaxime was started as a modified treatment in the majority of neonates (46/68, 67.6%). Only one prescription complied with national STGs. Samples of 257 (47%) neonates underwent blood culture testing, of which 70 (27%) were positive. Isolates were predominantly Gram-positive bacteria, with coagulase-negative Staphylococcus and Staphylococcus aureus accounting for 79% of the isolates. Isolates showed high resistance to most penicillins, while resistance to aminoglycosides and quinolones was relatively low. The majority of neonates (n = 497, 90.5%) were discharged after successfully completing treatment, while 50 (9%) neonates died during treatment. Strengthening of antimicrobial stewardship programmes, periodic review of STGs and increased uptake of culture and sensitivity testing are needed to improve management of sepsis.

Time to decision in sepsis.

This study aimed to identify the common barriers leading to delayed initial management, microbiological diagnosis, and appropriate empirical antimicrobial treatment in sepsis. A cross-sectional study was performed by the application of a population-based survey. Four different surveys were designed, targeting the healthcare personnel located in main hospital areas [emergency department (SEMES); infectious diseases and clinical microbiology-microbiological diagnosis (SEIMC-M); intensive care and infectious diseases, (SEMICYUC-GTEIS); and infectious diseases and clinical microbiology-clinical diagnosis, (SEIMC-C)]. A total of 700 valid surveys were collected from June to November 2019: 380 (54.3%) of SEMES, 127 (18.1%) of SEIMC-M, 97 (13.9%) de SEMICYUC-GTEIS and 96 (13.7%) of SEIMC-C, in 270 hospitals of all levels of care. The qSOFA score was used as a screening tool. The most used biomarker was procalcitonin (n=92, 39.8%). The sepsis code was implemented in 157 of 235 participating centers (66.2%), particularly in tertiary level hospitals. The mean frequency of contaminated blood cultures was 8.9% (8.7). In 85 (78.7%) centers, positive results of blood cultures were available within the first 72 hours and were communicated to the treating physician effectively by phone or e-mail in 76 (81.7%) cases. The main reason for escalating treatment was clinical deterioration, and the reason for de-escalating antimicrobials was significantly different between the specialties. Quality indicators were not frequently monitored among the different participating centers. There are significant barriers that hinder adequate management processes in sepsis in Spanish hospitals.

Does lactate enhance the prognostic accuracy of the quick Sequential Organ Failure Assessment for adult patients with sepsis? A systematic review

ObjectivesTo investigate whether adding lactate to the quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) improves the prediction of mortality in adult hospital patients, compared with qSOFA alone.DesignSystematic review in accordance...

Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study

BackgroundHospital-onset sepsis is associated with a higher in-hospital mortality rate than community-onset sepsis. Many hospitals have implemented rapid response teams (RRTs) for early detection and timely management of at-risk hospitalized patients. However, the effectiveness of an all-day RRT over a non-all-day RRT in reducing the risk of in-hospital mortality in patient with hospital-onset sepsis is unclear. We aimed to determine the effect of the RRT’s operating hours on in-hospital mortality in inpatient patients with sepsis.MethodsWe conducted a nationwide cohort study of adult patients with hospital-onset sepsis prospectively collected from the Korean Sepsis Alliance (KSA) Database from 16 tertiary referral or university-affiliated hospitals in South Korea between September of 2019 and February of 2020. RRT was implemented in 11 hospitals, of which 5 (45.5%) operated 24-h RRT (all-day RRT) and the remaining 6 (54.5%) had part-day RRT (non-all-day RRT). The primary outcome was in-hospital mortality between the two groups.ResultsOf the 405 patients with hospital-onset sepsis, 206 (50.9%) were admitted to hospitals operating all-day RRT, whereas 199 (49.1%) were hospitalized in hospitals with non-all-day RRT. A total of 73 of the 206 patients in the all-day group (35.4%) and 85 of the 199 patients in the non-all-day group (42.7%) died in the hospital (P = 0.133). After adjustments for co-variables, the implementation of all-day RRT was associated with a significant reduction in in-hospital mortality (adjusted odds ratio 0.57; 95% confidence interval 0.35–0.93; P = 0.024).ConclusionsIn comparison with non-all-day RRTs, the availability of all-day RRTs was associated with reduced in-hospital mortality among patients with hospital-onset sepsis.

A national inpatient sample analysis for CAR-T cell therapy administration.

e19501 Background: Chimeric antigen receptor T-cell therapies (CAR-T) improve relapse free survival and durable remission rates in patients with relapsed/refractory large B-cell lymphoma (LBCL) and received US FDA approval in 2017. The cytokine release syndrome (CRS) and immune-effector cell associated neurotoxicity (ICANS) due to CAR-T cell therapy require close inpatient monitoring. Real world data are lacking regarding the cost of hospitalization, length of stay (LOS), toxicity, and mortality associated with CAR-T. The goal of this study was to analyze the clinical outcomes of inpatient CAR-T utilizing a national database. Methods: Data was collected from the 2018 version of the Nationwide Inpatient Sample (NIS) database. Patients who received CAR-T were identified with ICD-10 disease and procedure codes . Complex weights were used to enable appropriate national projections. The association between toxicity (particularly related to CRS and ICANS) and outcomes was examined using logistic regression analyses (p &lt; 0.05 statistically significant). SAS v9.4 (SAS Institute, Cary, NC) was used for data analysis. Results: 306 patients met selection criteria. Demographic criteria were as follows: 61.1% males, 62.4% white, median age 58.0 years old (IQR 45.2-65.0), and private insurance (56.9%). A majority received care at urban teaching (97.7%) and large hospitals (73.2%). Relevant complications during hospitalization included hypotension (24.5%), pneumonia (8.5%), sepsis (9.8%), seizure (5.9%), neutropenia (24.5%), thrombocytopenia (8.8%), tumor lysis syndrome (TLS) (3.3%), and acute kidney injury (AKI) (14.1%). Median LOS was 16 days (IQR 12.0-22.0), median charge for hospitalization was $493,887 USD (IQR 143,400.0-1,182,940.0), and inpatient mortality was 5.2%. On multivariate regression analysis, inpatient mortality was significantly higher in those with intubation (OR 30.1, 95%CI 3.45-262), sepsis (OR 9.49, 95%CI 1.48-60.7), TLS (OR 18.9, 95%CI 2.52-140), AKI (OR 24.7, 95% CI 1.37-447) and thrombocytopenia (OR 53.4, 95% CI 2.19-1,298). LOS was higher in those with blood transfusion (OR 1.29, 95% CI 1.08-1.53), sepsis (OR 2.04, 95% CI 1.59-2.61), pancreatitis (OR 2.03, 95% CI 1.09-3.77), pneumonia (OR 1.39, 95%CI 1.04-1.87) and treatment in urban teaching hospitals (OR 1.53, 95%CI 1.02-2.30). Increased hospitalization charges were associated with hypotension (OR 1.54, 95%CI 1.14-2.08) and with treatment at urban teaching hospitals (OR 7.46, 95%CI 4.67-11.9) and medium size hospitals (OR 1.49, 95%CI 1.04-2.15). Conclusions: Inpatient mortality, median LOS, and hospitalization charges in inpatients treated with CAR-T can be significantly increased not only by inpatient complications, but also by the size and type of the treating facility. These findings highlight the financial burden of CAR-T cell therapy in the real world and can be used to shape future healthcare policy.

Neonatal Sepsis in a Resource-Limited Setting: Causative Microorganisms and Antimicrobial Susceptibility Profile.

Background Empiric treatment of suspected neonatal sepsis must be based on data on setting-specific causative pathogens and their respective susceptibilities to antimicrobials, as well as universal treatment guidelines. This approach will ensure better therapeutic outcomes and reduce mortality. Objectives The objectives of this study were to determine the bacteriological profile and antibiotic susceptibility pattern of isolated microorganisms responsible for neonatal sepsis in a regional hospital in Ghana. Methods This was a retrospective study that assessed causative microorganisms and antimicrobial susceptibility profiles of neonates suspected of sepsis at the Greater Accra Regional Hospital from January 2018 to December 2019. Blood culture was done using a fully automated BACTEC 9240 blood culture system. Bacteria isolates were identified by Gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was done by Kirby–Bauer's disc diffusion method, and interpretations were carried out according to clinical and laboratory standards. Culture and antibiotic sensitivity reports were obtained and the data subsequently analyzed. Results Of 2514 blood samples collected from neonates suspected of neonatal sepsis, 528 (21.0%) of the samples were found to be culture-positive. The majority of these positive cultures were from male neonates (68.9%). A total of 11 different pathogens were isolated, of which Gram-positive organisms had a preponderance of 72.0% over Gram-negative organisms (28.0%). Staphylococcus epidermidis was the most common pathogen identified, accounting for 60.0% of isolates. The most prevalent Gram-negative bacteria were Klebsiella spp. (13.6%). Most Gram-positive microorganisms showed sensitivity to amikacin, meropenem, vancomycin, and piperacillin/tazobactam. Gram-positive isolates were found to be resistant to ampicillin and penicillin, but moderately susceptible to flucloxacillin. Most Gram-negative isolates were sensitive to meropenem. Conclusion The prevalence of culture-proven sepsis was 21.0%. The most prevalent Gram-negative bacteria were Klebsiella spp. As there is some level of antibiotic resistance observed in the current study, it is necessary for routine microbial analysis of samples and their antibiogram.

Current situation of sepsis care in Spanish emergency departments

ObjetivoDescribir el abordaje que se realiza a los pacientes con sospecha de sepsis en los servicios de urgencias hospitalarios (SUH) españoles y analizar si existen diferencias atendiendo al tamaño del hospital y la afluencia a urgencias en el territorio.MétodoEncuesta estructurada a los responsables de los 282 SUH públicos que atienden adultos 24 horas/día, 365 días/ año. Se preguntó sobre asistencia y manejo en urgencias en la atención a pacientes con sospecha de sepsis. Los resultados se comparan según tamaño del hospital (grande ≥ 500 camas vs medio-pequeño < 500) y afluencia en urgencias (alta ≥ 200 visitas/día vs media-baja < 200).ResultadosRespondieron 250 SUH españoles (89%). En 163 (65%) SUH se dispone de protocolos de sepsis. La mediana de sepsis semanales atendidas variaban desde 0-5 por semana en 39 (71%) SUH, 6-10 por semana en 10 (18%), 11-15 por semana en 4 (7%), y más de 15 activaciones por semana en 3 centros (3,6%). Los criterios utilizados para la activación del código sepsis (CS) fueron el qSOFA/SOFA en 105 (63,6%) de los hospitales, SIRS en 6 (3,6%), mientras que en 49 (29,7%) utilizaban ambos criterios de forma simultanea. En 79 centros el CS estaba informatizado y en 56 existían herramientas de ayuda a la toma de decisiones. Un 48% (79 de 163) de los SUH disponían de datos de cumplimiento de medidas. En el 61% (99 de 163) de SUH existía formación en sepsis y en el 56% (55 de 99) ésta era periódica. Atendiendo al tamaño del hospital, los hospitales grandes participaban más frecuentemente como receptores de enfermos con CS y disponían de servicio/unidad de infecciosas, de sepsis y de corta estancia, microbiólogo e infectólogo de guardia.Conclusiónla mayoría de los SUH disponen de protocolos de CS, pero existe margen de mejora. La informatización y desarrollo de alertas para el diagnóstico y tratamiento tienen aún un gran recorrido en los SUH.

A New Class of Cell Wall-Recycling l,d-Carboxypeptidase Determines β-Lactam Susceptibility and Morphogenesis in Acinetobacter baumannii.

ABSTRACTThe hospital-acquired pathogen Acinetobacter baumannii possesses a complex cell envelope that is key to its multidrug resistance and virulence. The bacterium, however, lacks many canonical enzymes that build the envelope in model organisms. Instead, A. baumannii contains a number of poorly annotated proteins that may allow alternative mechanisms of envelope biogenesis. We demonstrated previously that one of these unusual proteins, ElsL, is required for maintaining a characteristic short rod shape and for withstanding antibiotics that attack the septal cell wall. Curiously, ElsL is composed of a leaderless YkuD-family domain usually found in secreted, cell wall-modifying l,d-transpeptidases (LDTs). Here, we show that, rather than being an LDT, ElsL is actually a new class of cytoplasmic l,d-carboxypeptidase (LDC) that provides a critical step in cell wall recycling previously thought to be missing from A. baumannii. Absence of ElsL impairs cell wall integrity, morphology, and intrinsic resistance due to buildup of murein tetrapeptide precursors, toxicity of which is bypassed by preventing muropeptide recycling. Multiple pathways in the cell become sites of vulnerability when ElsL is inactivated, including l,d-cross-link formation, cell division, and outer membrane lipid homoeostasis, reflecting its pleiotropic influence on envelope physiology. We thus reveal a novel class of cell wall-recycling LDC critical to growth and homeostasis of A. baumannii and likely many other bacteria.

Predictive Score Model of Clinical Outcomes Sepsis in Intensive Care Unit Tertier Referral Hospital of Eastern Indonesia

AIM: This study aimed to design a predictive score model of clinical outcome sepsis and bacterial profiles of blood and sputum cultures in the intensive care unit (ICU) of a tertiary referral hospital. METHODS: An observational retrospective study was conducted in 2017–2020 using medical record data in the ICU of Dr. Soetomo Hospital as tertiary referral hospital. The predictor of sepsis prognosis was Acute Physiology and Chronic Health Evaluation II (APACHE II), blood and sputum culture results, procalcitonin (PCT) levels, and antimicrobial resistance in blood and sputum cultures. The model was prepared by logistic regression analysis and receiver operating characteristic (ROC) curves. RESULTS: Data from 355 subjects showed that predictor score was APACHE II, blood and sputum culture results; besides PCT levels were found to contribute significantly to predictive score of sepsis clinical output (p&lt;0.05), while the predictor test of antimicrobial resistance in blood and sputum cultures was not significant to predictive score of sepsis clinical output (p &gt; 0.05). The resulting scores to predict sepsis clinical outcomes include PCT level &gt;2 ng/mL (1.61), APACHE score &gt;20 (1), sputum culture as true pathogen (1.1), and blood culture as true pathogen (1.35). When the total score ≥3, the patient will die, while when the score &lt;3, the patient will survive. ROC curves analysis obtained area under curve 0.859 (p &lt; 0.05) which indicates that the equation is statistically significant in predicting the sepsis clinical outcome. Probability scores and death outcomes indicate that the higher the predictive score, the higher the probability of dying, with a score &gt;3 the probability of dying is above 95.27%, whereas if the score is 5, the probability of dying is above 99%. The bacterial profile of blood cultures leading to mortality is predominately Gram-positive (34.4%), consisting of coagulase-negative Staphylococcus (22.9%), and Staphylococcus aureus (4.3%), while Gram-negative is only 14.7%, which consists of Enterobacteriaceae group (8.7%), Acinetobacter baumannii (4%), polymicrobial infection (2%), Burkholderia cepacia (0.8%), and Pseudomonas aeruginosa (0.4%). Sputum culture profile of patients with sepsis who died in the ICU of a tertiary referral RSUD Soetomo is dominated by Gram-negative, namely, A. baumannii (22.1%), Enterobacteriaceae group (20.6%), P. aeruginosa (11.1%), while Gram-positive is S. aureus (22.9%). CONCLUSION: The predictive score model for sepsis clinical outcomes in the ICU of a tertiary referral hospitals can be used as a basis for determining of patient management and the profile of the bacteria that causes sepsis that results in death.

Sepsis epidemiology in Australian Public Hospitals, a nationwide longitudinal study (2013-2018)

Introduction: Sepsis is a life-threatening condition that contributes considerably to the global burden of disease in the population. This study aimed to determine the incidence and mortality of sepsis in Australian public hospitals and to investigate variations in sepsis incidence and mortality.Methods: Patients admitted to 739 Australian public hospitals from 2013-14 to 2017-18 were included in this study. Sepsis patients were identified based on the recorded diagnosis codes. Age standardised sepsis incidence and mortality rates were calculated. Generalised estimating equations were applied to examine changes in mortality rates over time.Results: Among 23,827,061 hospitalisations, 437,354 (1.8%) had a coded diagnosis of sepsis and 12.0% of these sepsis patients (n=52,297) died in hospital, which was 11 times higher than non-sepsis patients (1.1%). Overall age standardised sepsis incidence was 1,162.8 cases/100,000 population. Despite the increase in sepsis incidence over the study period, sepsis mortality rates remained relatively stable after adjusting for relevant risk factors and hospital clustering. The youngest patients experienced the highest sepsis incidence rate. Those living in very remote areas were hospitalised for sepsis at around 1.7 times the rate as those living in major cities. The sepsis incidence rate among Indigenous people was also 1.7 times higher than among other Australians.Conclusion: This is the first national study on hospitalisations and in-hospital deaths associated with sepsis across all Australian public hospitals. Despite an increase in awareness and clinical initiatives related to sepsis, it remains a significant health problem that affects certain groups in the population more than others. Introduction: Sepsis is a life-threatening condition that contributes considerably to the global burden of disease in the population. This study aimed to determine the incidence and mortality of sepsis in Australian public hospitals and to investigate variations in sepsis incidence and mortality. Methods: Patients admitted to 739 Australian public hospitals from 2013-14 to 2017-18 were included in this study. Sepsis patients were identified based on the recorded diagnosis codes. Age standardised sepsis incidence and mortality rates were calculated. Generalised estimating equations were applied to examine changes in mortality rates over time. Results: Among 23,827,061 hospitalisations, 437,354 (1.8%) had a coded diagnosis of sepsis and 12.0% of these sepsis patients (n=52,297) died in hospital, which was 11 times higher than non-sepsis patients (1.1%). Overall age standardised sepsis incidence was 1,162.8 cases/100,000 population. Despite the increase in sepsis incidence over the study period, sepsis mortality rates remained relatively stable after adjusting for relevant risk factors and hospital clustering. The youngest patients experienced the highest sepsis incidence rate. Those living in very remote areas were hospitalised for sepsis at around 1.7 times the rate as those living in major cities. The sepsis incidence rate among Indigenous people was also 1.7 times higher than among other Australians. Conclusion: This is the first national study on hospitalisations and in-hospital deaths associated with sepsis across all Australian public hospitals. Despite an increase in awareness and clinical initiatives related to sepsis, it remains a significant health problem that affects certain groups in the population more than others.

Risk Factors for Neonatal Sepsis in Secondary and Tertiary Care Hospitals of a District in Sri Lanka: A Case–Control Study

Abstract Objective The aim of this study was to determine the risk factors for neonatal sepsis. Methods A case–control study was performed in secondary and tertiary care hospitals of a district in Sri Lanka. Neonates who diagnosed with sepsis based on clinical criteria or culture positivity were taken as the case group (n = 240) and neonates born during the same period who had not been diagnosed with sepsis were taken as the control group (n = 240). The controls were recruited from the community. The study instruments were, pretested interviewer administered questionnaire, a check list and record sheets. Multiple logistic regression analysis was performed. The results were expressed as odds ratios (OR) with the 95% confidence intervals (CI). Results The independent risk factors for neonatal sepsis were history of abortions, still birth, and early neonatal deaths (OR: 6.78; 95% CI: 3.2–14.3), registration of pregnancy after 8 weeks of gestation (OR: 1.91; 95% CI: 1.07–3.4), total antenatal clinic visits ≤4 (OR: 7.18; 95% CI: 2.1–24.5), history of maternal fever prior to the week of delivery (OR: 2.74; 95% CI: 1.25–6.0) leaking amniotic fluid &gt;18 hours (OR: 10.0; 95% CI: 2.1–47.4), performed &gt;3 vaginal examinations before delivery (OR: 3.28; 95% CI: 2.1–24.5), meconium stained amniotic fluid (OR: 10.57; 95% CI: 3.7–29.7), mode of delivery by cesarean section, forceps or vacuum (OR: 2.33; 95% CI: 1.4–3.9), time of birth of the neonate being during on-call hours (OR: 2.12; 95% CI: 1.3–3.5), being a male baby (OR: 1.74; 95% CI: 1.1–2.8), and birth weight &lt;2,500 g (OR: 5.17; 95% CI: 2.8–9.6) of neonates. Conclusion Most of the identified risk factors for neonatal sepsis were modifiable. Stringent implementation of guidelines and protocols would prevent neonatal sepsis.