Sepsis Infection Research Articles

Trends and predictions of maternal sepsis and other maternal infections among women of childbearing age: a systematic analysis for the global burden of disease study 2019

BackgroundMaternal sepsis and other maternal infections (MSMIs) are major public health concerns worldwide. However, comprehensive data on their global burden and evolving trends remain sparse. This study aims to explore the epidemiological trends of MSMIs in women of childbearing age (WCBA) from 1990 to 2019, investigate the relationship between disease burden and age, period, and birth cohorts, and then provide a prediction of MSMIs incidence and deaths.MethodsThe estimates and 95% uncertainty intervals (UIs) for the incidence and death number of MSMIs in seven age groups (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49 years) were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The age-standardized incidence and mortality rates of MSMIs in WCBA were estimated utilizing the age standardization by direct method. Joinpoint regression analysis was employed to investigate the changing trends of age-standardized incidence and mortality rates from 1990 to 2019. Age-period-cohort analysis was utilized to estimate the independent effects of age, period, and birth cohorts. Furthermore, a Nordpred age-period-cohort analysis was implemented to predict the global epidemiological trends through 2044.ResultsIn 2019, the estimated global age-standardized incidence and mortality rates of MSMIs in WCBA were 1072.90 (95% UI: 725.93 to 1483.46) and 0.86 (95% UI: 0.69 to 1.05), respectively. The highest disease burden existed in the African Region. From 1990 to 2019, the estimated global age-standardized incidence and mortality rates of MSMIs (AAPC: -1.32, 95% CI: −1.34 to −1.30; AAPC: -3.39, 95% CI: −4.28 to −2.48) in WCBA both demonstrated significant declining trends. The changing trends varied significantly across 6 regions and 204 countries. The effects of age, period, and cohort on incidence and mortality rates differed. From 2020 to 2044, the global age-standardized incidence rate of MSMIs in WCBA was predicted to decrease whereas the case number increases slowly.ConclusionThe global trends in MSMIs incidence and mortality generally showed a decline with considerable heterogeneity, indicating both the effectiveness and unevenness of global management of MSMIs. Moreover, the predicted increased case number highlights prominent challenges in the control of MSMIs.

Synergy of bacteriophage depolymerase with host immunity rescues sepsis mice infected with hypervirulent Klebsiella pneumoniae of capsule type K2.

The hypervirulent Klebsiella pneumoniae (hvKp) with K1 and K2 capsular types causes liver abscess, pneumonia, sepsis, and invasive infections with high lethality. The presence of capsular polysaccharide (CPS) resists phagocytic engulfment and contributes to excessive inflammatory responses. Bacteriophage depolymerases can specifically target bacterial CPS, neutralizing its defense. Based on our previous research, we expressed and purified a bacteriophage depolymerase (Dep1979) targeting hvKp with capsule type K2. Interestingly, although Dep1979 lacked direct bactericidal activity in vitro, it exhibited potent antibacterial activity in vivo. Low-dose Dep1979 (0.1 mg/kg) improved the 7-day survival of immunocompetent mice to 100%. Even at 0.01 mg/kg, mice achieved 100% survival at 5 days, although efficacy sharply declined at doses as low as 0.001 mg/kg. Following Dep1979 treatment, reduced expression of inflammatory factors and no apparent tissue damage were observed. However, therapeutic efficacy significantly diminished in immunosuppressed mice. These findings underscore the critical role of Dep1979 in disarming CPS, which synergizes with host immunity to enhance antibacterial activity against hvKp.

New therapeutic approaches for S.aureus infections treatment

Staphylococcus aureus (S. aureus) is an opportunistic pathogen that causes a range of diseases, from mild skin and soft tissue infections and food poisoning to serious conditions such as pneumonia, endocarditis, sepsis, and hospital-acquired infections. Due to the aggressive nature of the disease, limitations of existing treatments, and the spread of antibiotic-resistant strains, the development of alternative strategies to combat bacterial infections has progressed faster than the development of new antibiotics. In this review, we analyze the epidemiological situation of morbidity and mortality associated with S. aureus infection, as well as antimicrobial resistance of this organism on a global scale. We reviewed the pathogenesis and virulent factors of S. aureus, their mechanisms of antibiotic resistance, and the importance of diagnosing staphylococcal infections to ensure timely intervention. This review also discusses the latest approaches to combating antibiotic resistance in Staphylococcus aureus, including preventive and therapeutic antimicrobial strategies. Such methods as the use of bacteriophages in treatment, antimicrobial peptides, probiotic microorganisms and their metabolites, and the use of inhibitors to suppress bacterial communication are considered.

Predictive Factors of Emergency Department Length of Stay: Analyzing National Emergency Department Data.

This study aimed to identify and analyze the factors influencing Emergency Department Length of Stay (ED LOS) using a nationwide database to improve emergency care efficiency. This retrospective study utilized data from the National Emergency Department Information System (NEDIS) in South Korea, covering 25,578,263 ED visits from 2018 to 2022. Patient demographics, clinical characteristics, and ED operational variables were examined. The study employed univariate and multivariate logistic regression analyses to assess the association between these factors and prolonged ED LOS, defined as six hours or more. Among the 25,578,263 patients included, median ED LOS was 2.1 hours (interquartile range [IQR], 1.050 - 3.830 hours), with 12.6% experienced a prolonged ED LOS. Elderly patients (aged ≥ 65 years) were significantly more likely to experience prolonged ED LOS (adjusted odds ratio [aOR]: 1.415, 95% confidence interval [CI]: 1.411-1.419). Patients transferred from other hospitals (aOR: 1.469, 95% CI: 1.463-1.474) and those arriving by 119 ambulances (aOR: 1.093, 95% CI: 1.077-1.108) also had higher odds of prolonged LOS. Conversely, pediatric patients had a lower likelihood of extended stays (aOR: 0.682, 95% CI: 0.678-0.686). Severe illness, including sepsis (aOR: 1.324, 95% CI: 1.311-1.340) and COVID-19 infection (aOR: 1.413, 95% CI: 1.399-1.427), were strongly associated with prolonged LOS. Prolonged ED LOS is influenced by a combination of patient demographics, clinical severity, and systemic factors. Targeted interventions focusing on older adults, severe illness, and operational inefficiencies, such as hospital transfers, are essential for reducing ED LOS and improving overall emergency care delivery.

Exploring the circulating metabolome of sepsis: metabolomic and lipidomic profiles sampled in the ambulance

BackgroundSepsis is defined as a dysfunctional host response to infection. The diverse clinical presentations of sepsis pose diagnostic challenges and there is a demand for enhanced diagnostic markers for sepsis as well as an understanding of the underlying pathological mechanisms involved in sepsis. From this perspective, metabolomics has emerged as a potentially valuable tool for aiding in the early identification of sepsis that could highlight key metabolic pathways and underlying pathological mechanisms.ObjectiveThe aim of this investigation is to explore the early metabolomic and lipidomic profiles in a prospective cohort where plasma samples (n = 138) were obtained during ambulance transport among patients with infection according to clinical judgement who subsequently developed sepsis, patients who developed non-septic infection, and symptomatic controls without an infection.MethodsMultiplatform metabolomics and lipidomics were performed using UHPLC–MS/MS and UHPLC–QTOFMS. Uni- and multivariable analysis were used to identify metabolite profiles in sepsis vs symptomatic control and sepsis vs non-septic infection.ResultsUnivariable analysis disclosed that out of the 457 annotated metabolites measured across three different platforms, 23 polar, 27 semipolar metabolites and 133 molecular lipids exhibited significant differences between patients who developed sepsis and symptomatic controls following correction for multiple testing. Furthermore, 84 metabolites remained significantly different between sepsis and symptomatic controls following adjustment for age, sex, and Charlson comorbidity score. Notably, no significant differences were identified in metabolites levels when comparing patients with sepsis and non-septic infection in univariable and multivariable analyses.ConclusionOverall, we found that the metabolome, including the lipidome, was decreased in patients experiencing infection and sepsis, with no significant differences between the two conditions. This finding indicates that the observed metabolic profiles are shared between both infection and sepsis, rather than being exclusive to sepsis alone.

Infective Endocarditis by Listeria Species—A Systematic Review

Infective endocarditis (IE) is a disease associated with significant morbidity and mortality. It is more commonly caused by Gram-positive cocci, but Gram-positive bacilli may seldom cause the disease. Listeria monocytogenes is an aerobic Gram-positive coccobacillus and a foodborne and opportunistic pathogen most commonly causing gastrointestinal infections, even though bacteremia, sepsis, meningitis, and fetal infections may also occur. Listeria IE has rarely been described, with most reports being case reports or case series. Thus, the characteristics of this disease remain largely unknown. This systematic review aimed to present all published Listeria IE studies and describe their characteristics. A search of PubMed, Scopus, and the Cochrane Library for studies providing information on epidemiology, clinical findings, treatment, and outcome of Listeria IE cases was performed. A total of 54 studies containing data from 62 patients were included. Among all patients, 64.5% were male; the median age was 69 years. Among all patients, 54.8% had a history of a prosthetic valve. The aortic valve was the most commonly affected, followed by the mitral. Fever, heart failure, and embolic phenomena were the most commonly encountered clinical findings. The only isolated species was L. monocytogenes. Antimicrobial resistance was relatively low for aminopenicillins and aminoglycosides, the most commonly used antimicrobials for treating L. monocytogenes IE. Surgery was performed in 27.4% of patients. Mortality was 37.1%. Patients who survived were more likely to have had a prosthetic valve, to have necessitated transesophageal echocardiography for the diagnosis, to have mitral valve IE, and to have had surgical management; however, no factor was identified in a multivariate logistic regression model as an independent factor for overall mortality.

Fast and label-free detection of procalcitonin in human serum for sepsis using a WTex-based extended-gate field-effect transistor biosensor.

In this article, we present the first instance of depositing WTex-sensitive films with varying thicknesses (3, 4, and 5nm) onto flexible polyimide substrates using radio-frequency sputtering. These films were used to create an extended-gate field-effect transistor (EGFET) for pH sensing and detecting procalcitonin (PCT) in the sera of patients with sepsis or bacterial infections. Among the films, the 4nm WTex film exhibited high sensitivity (59.57mV/pH), minimal hysteresis (∼0.8mV), and a low drift rate (0.14mV/h). Additionally, this WTex-based EGFET sensor retained a pH sensitivity of 59.2mV/pH even after 180 days of operation and exhibited excellent mechanical flexibility, enduring 500 bending cycles without degradation. Moreover, PCT antibodies, activated using 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide and N-hydroxysuccinimide, were immobilized on the WTex film functionalized with 3-aminopropyl triethoxysilane. This effective immobilization enabled the specific binding of PCT antigens. The WTex-based EGFET biosensor demonstrated high sensitivity (18.12 mV/pCPCT) across a wide dynamic range (1fg/mL to 1μg/mL). Furthermore, the PCT concentrations in patient sera, whether from individuals with or without sepsis or bacterial infections, measured by our biosensor were comparable to results obtained using clinical enzyme-linked immunosorbent assay kits.

Antibiotic Resistance in Morganella morganii Species: Mechanisms, Prevalence and Clinical Implication

: Morganella morganii, a member of the Enterobacteriaceae family, has gained increasing recognition as an important pathogen due to its multidrug resistance. In addition to its intrinsic resistance, it carries various resistance genes and mobile genetic elements, facilitating the spread of resistance genes. M. morganii develops its mechanisms of resistance through different genetic elements, and its pathogenicity is supported by several virulence factors. Its rate of resistance has attended high levels in a number of studies. The global prevalence of M. morganii-associated infections is observed with nosocomial and healthcare-associated infections. The spectrum of diseases caused by M. morganii is diverse, ranging from sepsis and urinary tract infections, abscess, purple urine bag syndrome, chorioamnionitis, and cellulitis to wound infections and bacteremia. Mortality rates associated with M. morganii infections remain high, emphasizing the need for effective treatment strategies. Thus, this article aimed to provide an overview of the evolving multidrug resistance, resistance genes, risk factors, spectrum diseases, and clinical significance of M. morganii, and the challenges associated with the diagnosis and treatment of M. morganii infections.

Distribution of TEM and SHV Genes in ESBL-Producing Klebsiella pneumoniae Strains Isolated From Various Clinical Samples in Al-Basrah Province, Iraq

Klebsiella pneumonia is an opportunistic pathogen causes several diseases including sepsis, pneumonia, and wound infections. Antimicrobial resistance (AMR) in MDR K.pneumonia carrying genes for extended-spectrum β-lactams (ESBLs) has been considered a risk for health problems around the world, which has greatly limited treatment options. The current study relied on n=26 Klebsiella pneumoniae isolates that were previously isolated by the studies of master’s student “Intithar Mahdi Mozan" between October 2022 and December 2022,the samples were collected from three hospitals in Al-Basrah province,Iraq. K. pneumoniae isolates reactivated and re-identified by cultivating isolates on MacConkey agar and Klebsiella pneumoniae chromogenic media and then re-identified K. pneumoniae isolates through diagnostic gene 16S rDNA by PCR technique, the results revealed that all n= 26 isolates of K. pneumoniae had a molecular weight of approximately 130 bp at a 100%. Double disk approximation test (DAM) was used to detected produced extended-spectrum β-lactams (ESBLs), the result of current study was showed positive results for the ESBLs. Extended-spectrum β-lactamses (ESBLs) genes was detected by using three specific primers: blaTEM, blaSHV and, blaCTX-M. Out of n=26 K. pneumoniae isolates results was shown the 23 (88.46%) K. pneumoniae isolates had gave positive results for the blaTEM gene. While 3 (11.538%) K. pneumoniae isolates revealed negative results for blaTEM gene. On other hand results were shown that only 5 (19.23%) K. pneumoniae isolates had positive results for blaSHV gene and 21 (80.769%) K. pneumoniae isolates had negative results for the blaSHV gene. Also the results shown the 5(19.23%)K. pneumoniae isolates had positive results for blaTEM and blaSHV genes.

The Utility of C-Reactive Protein, Procalcitonin, and Leukocyte Values in Predicting the Prognosis of Patients with Pneumosepsis and Septic Shock

Background and Objectives: The predictive value of changes in C-reactive protein (CRP), procalcitonin, and leukocyte levels, which are commonly used in the diagnosis of infection in sepsis and septic shock, remains a topic of debate. The aim of this study was to evaluate the effectiveness of changes in CRP, procalcitonin, and leukocyte counts on the prognosis of 230 patients admitted to the intensive care unit (ICU) with the diagnosis of sepsis and pneumonia-related septic shock between 1 April 2022 and 31 December 2023, and to investigate whether any of these markers have a superior predictive value over the others in forecasting prognosis. Materials and Methods: This single-center, retrospective, cross-sectional observational study included patients who developed sepsis and septic shock due to community-acquired pneumonia and were admitted to the ICU. Demographic data, 1-month and 90-day mortality rates, length of stay in the ICU, discharge to the ward or an outside facility, need for dialysis after sepsis, need for invasive or noninvasive mechanical ventilation during the ICU stay and the duration of this support, whether patients admitted with sepsis or septic shock required inotropic agent support during their stay in the ICU and whether they received monotherapy or combination therapy with antibiotics during their admission to the ICU, the Comorbidity Index score (CCIS), CURB-65 score (confusion, uremia, respiratory rate, BP, age ≥ 65), and Acute Physiology and Chronic Health Evaluation II (APACHE-II) score were analyzed. Additionally, CRP, procalcitonin, and leukocyte levels were recorded, and univariate and multivariate logistic regression analyses were performed to evaluate their effects on 1- and 3-month mortality outcomes. In all statistical analyses, a p-value of <0.05 was accepted as a significant level. Results: According to multivariate logistic regression analysis, low BMI, male gender, and high CCIS, CURB-65, and APACHE-II scores were found to be significantly associated with both 1-month and 3-month mortality (p < 0.05). Although there was no significant relationship between the first-day levels of leukocytes, CRP, and PCT and mortality, their levels on the third day were observed to be at their highest in both the 1-month and 3-month mortality cases (p < 0.05). Additionally, a concurrent increase in any two or all three of CRP, PCT, and leukocyte values was found to be higher in patients with 3-month mortality compared with those who survived (p = 0.004). Conclusions: In patients with pneumoseptic or pneumonia-related septic shock, the persistent elevation and concurrent increase in PCT, CRP, and leukocyte values, along with male gender, advanced age, low BMI, and high CCIS, CURB-65, and APACHE-II scores, were found to be significantly associated with 3-month mortality.

High mortality of Acinetobacter baumannii infection is attributed to macrophage-mediated induction of cytokine storm but preventable by naproxen

The continuous emergence of multidrug-resistant (MDR) Acinetobacter baumannii (Ab) strains poses further challenges in its control and clinical management. It is necessary to decipher the mechanisms underlying the high mortality of Ab infections to explore unconventional strategies for controlling outbreaks of drug-resistant infections. The immune responses of Ab sepsis infection were investigated using flow cytometry, RNA-seq, qRT-PCR, and ELISA and scRNA-seq. The detailed pathways mediating Ab immune responses were also depicted and a specific therapy was developed based on the understanding of the mechanisms underlying Ab-induced cytokine storms. The results highlighted the critical role of alveolar and interstitial macrophages as targets of Ab during the infection process. These cells were found to undergo polarization towards the M1 phenotype, triggering a cytokine storm that eventually caused the death of the host. The polarization and excessive inflammatory response mediated by macrophages were mainly regulated by the TLR2/Myd88/NF-κB signaling pathway. Suppression of Ab-triggered inflammatory responses and M1 polarization by the drug naproxen (NPXS) was shown to confer full protection of mice from lethal infections. The findings in this work depict the major mechanisms underlying the high mortality rate of Ab infections and highlight the clinical potential application of anti-inflammatory drugs or immunosuppressants in reducing the mortality of such infections, including those caused by MDR strains. Funding sources are described in the acknowledgments section.

Catheter Selection in Home Parenteral Nutrition Patients and Noteworthy Definitions in The Diagnosis of Catheter Infections

The rising number of patients in need of long-term parenteral nutrition has necessitated home parenteral nutrition. Extended usage of central venous catheters and parenteral nutrition has given rise to its own complications. Among them, catheter-related bloodstream infections (CRBSI) are linked to life-threatening complications, especially sepsis, septic shock, and metastatic infections. The principal objective of this review is to define diagnostic methods, notable clinical and laboratory findings, and catheter salvage strategies towards preventing CRBSI, which include defining and interpreting blood culture and its results, its confounding variables and common shortcomings in routine practice. We will discuss the types and relative advantages and disadvantages of differing methods of central venous access and compare the common diagnostic definitions used by existing guidelines. CRBSI remains a serious complication, and we aim to debate when timely intervention will be necessary in light of the existing literature.

Interleukin-10: Genetic association and biochemical prediction of sepsis-induced AKI in ICU critically ill patients: A cross-sectional study.

Sepsis is a potentially life-threatening condition that eventually causes multi-organ dysfunction in critically ill patients. Acute kidney injury (AKI) is a widespread and severe threatening complication of sepsis, a condition termed sepsis-induced AKI (S-AKI), with poor clinical outcomes and high mortality rates. Inflammatory and immunological responses are important variables in S-AKI. This study aimed to examine the relationship of rs1518111 polymorphism in the interleukin-10 (IL-10) gene and serum/urine IL-10 levels with sepsis-induced AKI in critically ill patients in the ICU. In this cross-sectional study, 310 critically ill adult patients were recruited, of whom, 197 developed S-AKI. Real-time PCR was performed to detect the rs1518111 polymorphism. Circulating blood and urine IL-10 levels of IL-10 were measured. For rs1518111 SNP, the presence of at least one T allele increased the risk of occurrence of S-AKI in critically ill patients with sepsis (OR: 1.34, 95% CI: 1.07-3.17; p ˂ 0.001), regardless of the type of infection and severity of sepsis. Blood and urine IL-10 levels were an excellent prediction of S-AKI (AUC: 0.881 and 0.953 and sensitivity: 90.2% and 97.6% at cutoff 133.5 and 5.67 pg/mL, respectively). Regression analysis showed that WBC count and increased blood and urine IL-10 levels, in addition to the presence of TT genotype, are independent risk factors for AKI. rs1518111 polymorphism in the IL-10 gene is a risk factor for sepsis-induced AKI in the ICU. Serum/urine IL-10 markers may be used as early predictors of S-AKI in critically ill patients with sepsis, thereby improving early management.

Perforated Peptic Ulcer in Lagos. Risk Factors and Management Outcome

Abstract Background: Complications of peptic ulcers, such as bleeding, gastric outlet obstruction, and perforation, can be life-threatening and may require surgical intervention. Perforated peptic ulcer (PPU) presents mostly as a surgical emergency and is one of the leading causes of secondary peritonitis with significant morbidity and mortality. The clinical outcome of surgical treatment of peptic ulcers varies due to the varying patterns of presentations and interventions between countries. There are few documented series on PPU in Nigeria. This paper reviews the management outcome of PPU in our institution. Materials and Methods: A retrospective review of the available medical records of patients managed for PPU between February 2008 and February 2023 was conducted. All patients had a single anterior peptic ulcer perforation managed by a modified Graham’s patch. Data analysis was performed using IBM SPSS for Windows, Version 23 (IBM Corp., Armonk, NY, USA). Results: There were 107 PPU patients comprising 93 males and 14 females. The mean age of all patients was 41 years. The peak prevalence of PPU was found among patients aged 30–39 years. Delayed presentation was recorded in about half of the patients. Ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) was the most common risk factor for PPU. Among the 93 documented cases, perforated gastric ulcers (71 cases) were found in a much higher proportion than duodenal ulcers (22 cases). Large ulcer (10–30 mm) was the main perforation size category found in 47 out of 83 recorded PPU cases. PPU size was not associated with the incidence of complications or mortality. The median duration of hospital stays was 13 (1–19) days. Surgical site infection was the most common complication after surgery. Conclusion: PPU is present in our predominantly male patients in their fourth decade of life. Ingestion of NSAIDs is a major risk factor. Duodenal ulcers were the predominant type seen in our patients. Documented perforated ulcer sizes in our patients are predominantly in the large category. Surgical site infection, systemic sepsis, and superficial wound infection were major complications in our patients.

Cefotaxime Versus Ceftriaxone: A Comprehensive Comparative Review.

Cefotaxime and ceftriaxone are two prominent third-generation cephalosporin antibiotics, which are a class of antimicrobial agents with overlapping antibacterial spectra and therapeutic indications, commonly used in treating severe bacterial infections, including meningitis, sepsis, and respiratory tract infections. Despite their shared antibacterial coverage, these antibiotics differ significantly in their pharmacokinetic characteristics such as half-life, protein binding, and tissue penetration. This comprehensive review systematically compares the pharmacokinetic profiles, pharmacological attributes, clinical efficacy, and safety profiles of cefotaxime and ceftriaxone. It further highlights the importance of understanding the nuanced differences between cefotaxime and ceftriaxone, particularly in clinical settings such as intensive care units or during pediatric treatment, where rapid bactericidal action or prolonged drug activity might influence therapeutic outcomes. While their overlapping spectrums offer versatility, clinicians should consider these distinct pharmacokinetic attributes and associated clinical outcomes to guide optimal antibiotic selection.

The Open Abdomen After Intra-abdominal Contamination in Emergency General Surgery

IntroductionDelayed fascial closure (DFC) is an increasingly utilized technique in emergency general surgery (EGS), despite a lack of data regarding its benefits. We aimed to compare the clinical outcomes of DFC versus immediate fascial closure (IFC) in EGS patients with intra-abdominal contamination. MethodsThis retrospective study was conducted using the 2013-2020 American College of Surgeons National Surgical Quality Improvement Program database. Adult EGS patients who underwent an exploratory laparotomy with intra-abdominal contamination [wound classification III (contaminated) or IV (dirty)] were included. Patients with agreed upon indications for DFC were excluded. A propensity-matched analysis was performed. The primary outcome was 30-d mortality. ResultsWe identified 36,974 eligible patients. 16.8% underwent DFC, of which 51.7% were female, and the median age was 64 y. After matching, there were 6213 pairs. DFC was associated with a higher risk of mortality (15.8% versus 14.2%, P = 0.016), pneumonia (11.7% versus 10.1%, P = 0.007), pulmonary embolism (1.9% versus 1.6%, P = 0.03), and longer hospital stay (11 versus 10 d, P < 0.001). No significant differences in postoperative sepsis and deep surgical site infection rates between the two groups were observed. Subgroup analyses by preoperative diagnosis (diverticulitis, perforation, and undifferentiated sepsis) showed that DFC was associated with longer hospital stay in all subgroups, with a higher mortality rate in patients with diverticulitis (8.1% versus 6.1%, P = 0.027). ConclusionsIn the presence of intra-abdominal contamination, DFC is associated with longer hospital stay and higher rates of mortality and morbidity. DFC was not associated with decreased risk of infectious complications. Further studies are needed to clearly define the indications of DFC.

Effect of Xuebijing injection on acute gastrointestinal injury in patients with sepsis: a retrospective cohort study

To observe the effect of Xuebijing injection on sepsis combined with acute gastrointestinal injury (AGI), and analyze the risk factors of sepsis combined with AGI. A retrospective cohort study was conducted. Patients with non-gastrointestinal origin admitted to the department of intensive care medicine of the First Hospital of Qinhuangdao from May 1, 2021 to October 30, 2023 were enrolled. The baseline data, source of sepsis infection, vital signs, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), laboratory tests, comorbidities, interventions during treatment, and the 28-day prognosis were collected. The patients were divided into Xuebijing group and non-Xuebijing group according to whether Xuebijing injection was used or not. According to whether AGI was merged or not, patients were divided into merged AGI group and non-merged AGI group. The main observational indexes were the difference in the incidence of AGI between the Xuebijing group and non-Xuebijing group and the difference in the magnitude of the decline in procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) at 7 days after admission, and the difference in the 28-day morbidity and mortality. Risk factors for AGI in septic patients were explored by univariate analysis, and statistically significant indicators were screened and included in binary Logistic regression analysis to determine independent risk factors. A total of 129 patients with sepsis of non-gastrointestinal origin were enrolled, including 57 patients in the Xuebijing group and 72 patients in the non-Xuebijing group. Among 129 patients, 80 patients in the merged AGI group and 49 patients in the non-merged AGI group. There were no statistically significant differences between Xuebijing group and non-Xuebijing group in gender, age, body mass index (BMI), underlying disease, source of infection, vital sign, APACHE II score, SOFA score, and clinical intervention, and there were no statistically significant differences in laboratory tests except for aspartate aminotransferase (AST) and blood urea nitrogen (BUN). The incidence of AGI was significantly lower in the Xuebijing group than that in the non-Xuebijing group [50.87% (29/57) vs. 70.83% (51/72), P < 0.05], and the 28-day mortality was slightly lower than that in the non-Xuebijing group [24.56% (14/57) vs. 30.56% (22/72), P > 0.05]. In the Xuebijing group, the decreases in CRP, PCT and WBC at 7 days after admission were greater than those in the non-Xuebijing group, with statistically significant differences in the decreases of CRP and PCT [CRP (mg/L): 47.12±67.34 vs. 7.76±111.03, PCT (μg/L): 14.08 (-1.22, 50.40) vs. 2.94 (-1.27, 14.80), all P < 0.05]. Univariate analysis showed that the use of acid suppressants, the use of analgesic sedation, the non-use of Xuebijing injections, pulmonary infections, and urinary tract infections were the risk factors for the development of AGI in patients with sepsis. Binary Logistic regression analysis further showed that the use of acid suppressants [odds ratio (OR) = 2.450, 95% confidence interval (95%CI) was 1.021-5.883, P = 0.045], use of analgesic sedatives (OR = 2.521, 95%CI was 1.074-5.918, P = 0.034), and urinary tract infection (OR = 4.011, 95%CI was 1.085-14.831, P = 0.037) were independent risk factors for sepsis combined with AGI, in which the use of Xuebijing injection was a protective factor (OR = 0.315, 95%CI was 0.137-0.726, P = 0.007). Xuebijing injection reduced the incidence of AGI in patients with non-gastrointestinal sepsis. PCT and CRP decreased more markedly than in patients who did not use Xuebijing injection. The use of acid-suppressing agents, analgesic and sedative agents, and urinary tract infections were independent risk factors for sepsis in combination with AGI, while the use of Xuebijing injection is a protective factor.

DUSP6 protein action and related hub genes prevention of sepsis-induced lung injury were screened by WGCNA and Venn

During a sepsis infection, the lung is extremely susceptible to damage. A condition known as acute respiratory distress syndrome (ARDS) may develop in extreme circumstances. The primary objective of this research is to identify important genes that are related with both sepsis and lung injury. These genes have the potential to act as novel biomarkers in the investigation of sepsis-induced lung injury prevention strategies. It was possible to download from GEO data both the sepsis-related dataset (GSE64457) and the lung injury-related dataset (GSE40839). In the GSE64457 dataset, using the “limma” package in R revealed 429 differentially expressed genes (DEGs) with logFC values more than or equal to −1 and p values <0.05. There were 266 genes that were up-regulated and 163 genes that were down-regulated. Through the use of Gene Ontology (GO), it was discovered that the majority of the DEGs were associated with the inflammatory response (BP terms), a particular granule lumen (CC terms), and protein binding (MF terms). By doing a pathway enrichment analysis using the Kyoto Encyclopedia of Genes and Genomes (KEGG), researchers were able to identify DEGs that were mostly associated with the NOD-like receptor signalling pathway, the TNF signalling pathway, and Epstein-Barr virus infection. Within the GSE40839 dataset, Weighted Gene Co-Expression Network Analysis (WGCNA) yielded a total of 7 modules, from which it was possible to screen out 2 critical modules and 693 key genes. The important genes and DEGs were both subjected to a Venn analysis. Finally, 14 genes that overlapped (ARL4A, LAIR1, MTHFD2, TSPAN13, DUSP6, PECR, CBS, TES, ASNS, SYNE1, FGF13, LCN2, KLF10, BCAT1) were closely associated to the incidence and development of sepsis-induced lung injury. This indicates that these genes are the essential genes to avoid the occurrence of sepsis-induced lung injury. This study provides novel strategies for preventing lung harm brought on by sepsis.

From Lab to Clinic: The Potential of Nanobubble Ozone Stored in Liposome with Pantothenic Acid (NOSLIP) in Treating Vaginal Infections with Long-lasting Effectiveness

Every year, 5-10 million women apply to various centers for sexually transmitted diseases due to infectious vaginitis (1). The three most notable causes of infectious vaginitis are bacterial vaginosis (BV), trichomoniasis, and vulvovaginal candidiasis (VVC). BV and VVC, which are endogenous genital infections, are the agents most responsible for the etiology of vaginal discharge (2). The most common symptoms of infectious vaginitis are vaginal discharge, itching, and a burning sensation. However, some cases are asymptomatic and are untreated (3). Group B streptococci (Streptococcus agalactiae; GBS) are gram-positive encapsulated bacteria that can colonize the intestinal and vaginal flora in 10-30% of healthy adults (4). Streptococcus agalactiae causes serious infections such as meningitis, sepsis, skin and soft tissue infections, pneumonia, urinary tract infections, and postpartum endometritis in newborns, pregnant women and adults with underlying diseases (4-6). Ozone is a highly reactive form of oxygen composed of three oxygen atoms. It is generated through the interaction of UV light and high-pressure diatomic oxygen. Ozone is widely acknowledged for its potent antibacterial properties due to its strong oxidative nature. Ozone therapy has garnered growing interest in recent years and is widely recognized for its beneficial impact on infection, reperfusion injury, cancer, and dental caries (7-8). At present, ozone therapy is an emerging approach in the clinical management of vaginitis. The medical ozone therapy device utilizes an ozone generator to produce a specific concentration of ozone, which is subsequently combined with filtered tap water to create ozonated water. Ozone and reactive chemicals exist in a liquid state and have a significant impact on vaginal sterilization (9).

Initiation of Haploidentical Stem Cell Transplantation With Post-Transplant Cyclophosphamide in Children: A Low-Middle-Income Country Institutional Experience.

Haploidentical hematopoietic stem cell transplant (HSCT) is a curative treatment especially for countries where bone marrow registries are nonexistent. We present our experience with haploidentical HSCT in pediatric patients. Retrospective data collected and analyzed for patients ≤18 years, from January 2017 to December 2022. The cohort consisted of 20 patients with median age at transplant of 61.5 (IQR: 124) months. Fourteen (70%) were malignant and 6 (30%) were benign diseases. Donors were father in majority (9/20; 45%). Stem cell source was peripheral blood 8, marrow 8, and combined 4. c-specific antibodies were positive in 6 (30%). Median CD34 cell dose infused: 9.35 × 106/kg. Median engraftment time: 15 (IQR: 17) days. Acute and chronic graft-versus-host disease (GVHD) occurred in 12/20 (60%) and 5/20 (25%), respectively. Complications included infection/sepsis (14/20; 70%), cytomegalovirus reactivation (14/20; 70%), sinusoidal obstruction syndrome (1/20; 5%), primary graft failure (PGF) (6/20; 30%), and secondary graft failure (4/20; 20%). PGF was more common in benign conditions (p = 0.003) and less prevalent in cases with aGVHD (p = 0.007). aGVHD was more common in malignant conditions (p = 0.007). Overall survival (OS), relapse-free survival (RFS), and treatment-related mortality (TRM) were 40%, 50%, and 35%, respectively. Median time of survival and relapse were 8 (IQR: 15) and 9 (IQR: 13) months, respectively. OS was comparable to that of other low-middle-income countries. GVHD was a major challenge, along with sepsis and CMV infection. Half of the leukemias relapsed. Graft failure was a major concern in nonmalignant diseases.