RESUMO
Bacteremia and sepsis are critically important syndromes with high mortality, morbidity, and associated costs. Bloodstream infections and sepsis are among the top causes of mortality in the US, with >600 deaths each day. Most septic patients can be found in emergency medicine departments or critical care units, settings in which rapid administration of targeted antibiotic therapy can reduce mortality. Unfortunately, routine blood cultures are not rapid enough to aid in the decision of therapeutic intervention at the onset of bacteremia. As a result, empiric, broad-spectrum treatment is common-a costly approach that may fail to target the correct microbe effectively, may inadvertently harm patients via antimicrobial toxicity, and may contribute to the evolution of drug-resistant microbes. To overcome these challenges, laboratorians must understand the complexity of diagnosing and treating septic patients, focus on creating algorithms that rapidly support decisions for targeted antibiotic therapy, and synergize with existing emergency department and critical care clinical practices put forth in the Surviving Sepsis Guidelines.
Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Hemocultura/instrumentação , Sistemas de Apoio a Decisões Clínicas/organização & administração , Choque Séptico/diagnóstico , Algoritmos , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bactérias/genética , Bactérias/isolamento & purificação , Tomada de Decisão Clínica/métodos , Serviços de Laboratório Clínico/economia , Serviços de Laboratório Clínico/organização & administração , Protocolos Clínicos , Cuidados Críticos/economia , Cuidados Críticos/organização & administração , DNA Bacteriano/isolamento & purificação , Sistemas de Apoio a Decisões Clínicas/economia , Farmacorresistência Bacteriana/genética , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Medicina de Emergência Baseada em Evidências/economia , Medicina de Emergência Baseada em Evidências/métodos , Medicina de Emergência Baseada em Evidências/organização & administração , Custos de Cuidados de Saúde , Humanos , Kit de Reagentes para Diagnóstico/economia , Choque Séptico/sangue , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia , Fatores de Tempo , Tempo para o TratamentoRESUMO
Foot wounds are the most common diabetes-related cause of hospitalization and frequently result in amputation. Although generally diagnosed clinically based on signs and symptoms of inflammation, empirical antibiotic treatment should be based on tissue cultures until resolution of infection. Advances in molecular detection over the past decade, including rapid chromogenic agar and real-time polymerase chain reaction, have improved diagnostic capabilities. However, chronic wounds may host biofilm bacteria not adequately detected by current microbiological testing. Enhanced DNA testing is required to identify these pathogens as well as evolving and previously underdiagnosed bacteria. Two options, nucleic acid fluorescent in situ hybridization and rDNA sequencing, are on the horizon for clinical use. Wound biofilms also necessitate more complex clinical management including debridement, augmenting host defenses, suppression of biofilms, and wound closure. Adopting these advances in diagnosis and treatment may help with overall prognosis and reduce health care costs.