Canaloplasty ab interno (AbiC) - 2-Year-Results of a Novel Minimally Invasive Glaucoma Surgery (MIGS) Technique. / Kanaloplastik ab interno (AbiC) ­ 2-Jahres-Ergebnisse einer neuen minimalinvasiven Glaukomchirurgie (MIGS)-Technik.

PURPOSE: The aim of this study is to evaluate the long-term efficacy of a novel minimally invasive glaucoma surgery technique (MIGS), Ab interno Canaloplasty (AbiC). MATERIAL AND METHODS: For this retrospective cohort study, we analysed the data of 25 eyes of 23 patients with open angle glaucoma who underwent an AbiC (6 eyes) or in case of an additional cataract, a combined cataract-AbiC procedure ("phacocanaloplasty ab interno", 19 eyes), respectively. Postoperatively, we investigated the intraocular pressure (IOP) and the number of still required IOP-lowering medication, as well as surgery-related complications. RESULTS: Overall, the mean baseline IOP of 20.24 mmHg ± 5.92 (n = 25) was reduced to 10.64 mmHg ± 2.77 (n = 25, p < 0.001), 12.55 mmHg ± 3.33 (n = 22, p < 0.001) and 13.67 mmHg ± 2.15 (n = 21, p < 0.001) at 1 day, 1 year and 2 year follow-up visit, respectively. Compared to baseline, this implies a reduction in IOP of 47.4, 37.9 and 32.5%. An average glaucoma medication usage of 1.92 ± 1.04 was registered at baseline visit and was reduced to 0,05 ± 0,23 after 2 years of follow-up. 80% of patients were off medication. In 5 eyes (20%) further antiglaucomatous eye drops or surgical treatment were administered. The only surgical complications were hyphema in 5 eyes (20%) and a localized peripheral detachment of the Descemet's membrane in one eye (4%) with no late sequelae. CONCLUSION: AbiC performed independently or combined with cataract surgery seems to be a safe and effective MIGS-technique with good long-term regulation of IOP and low risk profile.

Sepsis in standard care: patients' characteristics, effectiveness of antimicrobial therapy and patient outcome--a cohort study.

PURPOSE: Fast diagnosis and initiation of appropriate antibiotic therapy is pivotal for the survival of sepsis patients. However, most studies on suspected sepsis patients are conducted in the intensive care unit or in the emergency room setting, neglecting the standard care setting. This study evaluated sepsis risk factors, microbiological accurateness of the initial empiric antimicrobial therapy and its effect on hospital mortality in standard care patients. METHODS: In this prospective observational cohort study, patients with clinically suspected sepsis meeting two or more SIRS criteria were screened on standard care wards. After hospital discharge, occurrence of an infection was assessed according to standardized criteria, and empirical antibiotic therapy was evaluated using antibiograms of recognized pathogens by expert review. RESULTS: Of the 2384 screened patients, 298 fulfilled two or more SIRS criteria. Among these were 28.2 % SIRS patients without infection, 46.3 % non-bacteremic/fungemic sepsis patients and 25.5 % bacteremic/fungemic sepsis patients. Occurrence of a malignant disease and chills were associated with a higher risk of patients having bacteremic/fungemic sepsis, whereas other described risk factors remained insignificant. In total, 91.1 % of suspected sepsis patients received empirical antimicrobial therapy, but 41.1 % of bacteremic sepsis patients received inappropriate therapy. Non-surviving bacteremic sepsis patients received a higher proportion of inappropriate therapy than those who survived (p = 0.022). CONCLUSIONS: A significant proportion of bacteremic sepsis patients receive inappropriate empiric antimicrobial therapy. Our results indicate that rapid availability of microbiological results is vital, since inappropriate antimicrobial therapy tended to increase the hospital mortality of sepsis patients.

Evaluation of the Septifast MGrade Test on Standard Care Wards--A Cohort Study.

BACKGROUND: The immediate need for appropriate antimicrobial therapy in septic patients requires the detection of the causative pathogen in a timely and reliable manner. In this study, the real-time PCR Septifast MGrade test was evaluated in adult patients meeting the systemic inflammatory response syndrome (SIRS) criteria that were treated at standard care wards. METHODS: Patients with clinical suspected infection, drawn blood cultures (BC), the Septifast M(Grade) test (SF) and sepsis biomarkers were prospectively screened for fulfillment of SIRS criteria and evaluated using the criteria of the European Centre of Disease Control (ECDC) for infection point prevalence studies. RESULTS: In total, 220 patients with SIRS were prospectively enrolled, including 56 patients with detection of bacteria in the blood (incidence: 25.5%). BC analysis resulted in 75.0% sensitivity (95% confidence interval, CI: 61.6%- 85.6%) with 97.6% specificity (CI: 93.9%- 99.3%) for detecting bacteria in the blood. In comparison to BC, SF presented with 80.4% sensitivity (CI: 67.6%- 89.8%) and with 97.6% specificity (CI: 93.9%- 99.3%). BC and SF analysis yielded comparable ROC-AUCs (0.86, 0.89), which did not differ significantly (p = 0.558). A trend of a shorter time-to-positivity of BC analysis was not seen in bacteremic patients with a positive SF test than those with a negative test result. Sepsis biomarkers, including PCT, IL-6 or CRP, did not help to explain discordant test results for BC and SF. CONCLUSION: Since negative results do not exclude bacteremia, the Septifast M(Grade) test is not suited to replacing BC, but it is a valuable tool with which to complement BC for faster detection of pathogens.

Utility of sepsis biomarkers and the infection probability score to discriminate sepsis and systemic inflammatory response syndrome in standard care patients.

Physicians are regularly faced with severely ill patients at risk of developing infections. In literature, standard care wards are often neglected, although their patients frequently suffer from a systemic inflammatory response syndrome (SIRS) of unknown origin. Fast identification of patients with infections is vital, as they immediately require appropriate therapy. Further, tools with a high negative predictive value (NPV) to exclude infection or bacteremia are important to increase the cost effectiveness of microbiological examinations and to avoid inappropriate antibiotic treatment. In this prospective cohort study, 2,384 patients with suspected infections were screened for suffering from two or more SIRS criteria on standard care wards. The infection probability score (IPS) and sepsis biomarkers with discriminatory power were assessed regarding their capacity to identify infection or bacteremia. In this cohort finally consisting of 298 SIRS-patients, the infection prevalence was 72%. Bacteremia was found in 25% of cases. For the prediction of infection, the IPS yielded 0.51 ROC-AUC (30.1% sensitivity, 64.6% specificity). Among sepsis biomarkers, lipopolysaccharide binding protein (LBP) was the best parameter with 0.63 ROC-AUC (57.5% sensitivity, 67.1% specificity). For the prediction of bacteremia, the IPS performed slightly better with a ROC-AUC of 0.58 (21.3% sensitivity, 65% specificity). Procalcitonin was the best discriminator with 0.78 ROC-AUC, 86.3% sensitivity, 59.6% specificity and 92.9% NPV. Furthermore, bilirubin and LBP (ROC-AUC: 0.65, 0.62) might also be considered as useful parameters. In summary, the IPS and widely used infection parameters, including CRP or WBC, yielded a poor diagnostic performance for the detection of infection or bacteremia. Additional sepsis biomarkers do not aid in discriminating inflammation from infection. For the prediction of bacteremia procalcitonin, and bilirubin were the most promising parameters, which might be used as a rule for when to take blood cultures or using nucleic acid amplification tests for microbiological diagnostics.