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1.
Chin J Nat Med ; 18(3): 226-233, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32245593

RESUMEN

Shenfu injection (SFI), a Chinese medicinal product, shows potent efficacy in treating sepsis. The aim of the present study was to clarify the protective effects of SFI against lipopolysaccharide (LPS)-induced myocardial inflammation and apoptosis. Experiments were carried out in Sprague-Dawley (SD) rats treated with LPS or LPS + SFI, and in H9C2 cardiomyocytes. The sepsis-associated myocardial inflammation and apoptosis was induced by the intraperitoneal injection of LPS (20 mg·kg-1). SFI attenuated the increased expression of tumor necrosis factor (TNF)-α and interleukin (IL)-1ß induced by LPS both in serum and heart. In LPS group, cell viability was reduced, and reversed after SFI administration. LPS treatment increased the expression levels of cleaved-caspase 3 and Bax, and those of Bcl2 and Bcl2/Bax. These two trends were reversed by SFI administration. The expression levels of phosphorylated mitogen-activated protein kinase kinase (p-MEK) and phosphorylated extracellular regulated protein kinases (p-ERK) were increased by LPS, and reversed by SFI. MEK inhibitor U0126 attenuated the apoptosis induced by LPS. These results indicate that SFI could treat LPS-induced cardiac dysfunction. In conclusion, SFI attenuates the inflammation and apoptosis induced by LPS via downregulating the MEK and ERK signaling pathways.


Asunto(s)
Apoptosis/efectos de los fármacos , Medicamentos Herbarios Chinos/farmacología , Sistema de Señalización de MAP Quinasas/efectos de los fármacos , Miocarditis/tratamiento farmacológico , Miocitos Cardíacos/efectos de los fármacos , Sepsis/tratamiento farmacológico , Animales , Caspasa 3/metabolismo , Interleucina-1beta/metabolismo , Lipopolisacáridos , Masculino , Miocardio/patología , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Ratas , Ratas Sprague-Dawley , Factor de Necrosis Tumoral alfa/metabolismo , Proteína X Asociada a bcl-2/metabolismo
2.
Bratisl Lek Listy ; 121(2): 154-158, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32115970

RESUMEN

OBJECTIVE: This study aimed to evaluate the effect of Coenzyme Q10 (CoQ10) administration to patients in the early phase of sepsis to determine its effect on the markers of inflammation and the clinical outcomes of septic patients. BACKGROUND: Previous studies showed that CoQ10 levels were decreased in septic patients and worsening of mitochondrial dysfunction was observed. METHODS: In this randomized controlled trial septic patients (n=40) received 100 mg CoQ10 twice a day for seven days added to standard treatment of sepsis. As a primary endpoint levels of Interleukin 6 (IL-6), Tumor Necrosis Factor-α (TNF-α), Glutathione peroxidase and malondialdehyde (MDA) were assessed at baseline, third and 7th day after the intervention. Secondary endpoints included assessment of clinical scores and     in-hospital mortality. RESULTS: There was no difference in baseline inflammatory and oxidative injury markers between the groups. TNF-α and MDA levels decreased significantly in the CoQ10 group on the 7th day of the study (P:0.003 for both). There was a significant difference in the in-hospital mortality in the CoQ10 group compared to the control group (P:0.01). CONCLUSION: These findings suggest that CoQ10 has a positive effect on clinical parameters as well as mitochondrial dysfunction when administered in the early phase of sepsis (Tab. 2, Fig. 1, Ref. 38).


Asunto(s)
Inflamación , Sepsis , Ubiquinona/análogos & derivados , Biomarcadores , Método Doble Ciego , Humanos , Inflamación/tratamiento farmacológico , Malondialdehído , Sepsis/tratamiento farmacológico , Sepsis/inmunología , Ubiquinona/uso terapéutico
3.
Life Sci ; 250: 117551, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-32179075

RESUMEN

AIMS: Increasing evidence indicates that FK866, a specific noncompetitive nicotinamide phosphoribosyl transferase inhibitor, exhibits a protective effect on acute lung injury (ALI). Autophagy plays a pivotal role in sepsis-induced ALI. However, the contribution of autophagy and the underlying mechanism by which FK866-confered lung protection remains elusive. Herein, we aimed to study whether FK866 could alleviate sepsis-induced ALI via the JNK-dependent autophagy. MAIN METHODS: Male C57BL/6 mice were subjected to cecal ligation and puncture (CLP) to establish the polymicrobial sepsis mice model, and treated with FK866 (10 mg/kg) at 24, 12 and 0.5 h before the CLP procedure. The lung protective effects were measured by lung histopathology, tissue edema, vascular leakage, inflammation infiltration, autophagy-related protein expression and JNK activity. A549 cells were stimulated with LPS (1000 ng/ml) to generate the ALI cell model, and pretreated with FK866 or SP600125 for 30 min to measure the autophagy-related protein expression and JNK activity. KEY FINDINGS: Our results demonstrated that FK866 reduced lung injury score, tissue edema, vascular leakage, and inflammatory infiltration, and upregulated autophagy. The protective effect of autophagy conferred by FK866 on ALI was further clarified by using 3-methyladenine (3MA) and rapamycin. Additionally, the activity of JNK was suppressed by FK866, and inhibition of JNK promoted autophagy and showed a benefit effect. SIGNIFICANCE: Our study indicates that FK866 protects against sepsis-induced ALI by induction of JNK-dependent autophagy. This may provide new insights into the functional mechanism of NAMPT inhibition in sepsis-induced ALI.


Asunto(s)
Acrilamidas/uso terapéutico , Lesión Pulmonar Aguda/tratamiento farmacológico , Autofagia , MAP Quinasa Quinasa 4/metabolismo , Piperidinas/uso terapéutico , Sepsis/tratamiento farmacológico , Células A549 , Lesión Pulmonar Aguda/complicaciones , Animales , Líquido del Lavado Bronquioalveolar , Permeabilidad Capilar , Modelos Animales de Enfermedad , Humanos , Pulmón/efectos de los fármacos , Masculino , Ratones , Ratones Endogámicos C57BL , Sepsis/complicaciones , Transducción de Señal , Regulación hacia Arriba
4.
BMC Infect Dis ; 20(1): 237, 2020 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-32192451

RESUMEN

BACKGROUND: Infections with multidrug-resistant organisms (MDRO) pose a serious threat to patients with dysregulated immunity such as in hemophagocytic lymphohistiocytosis (HLH), but such infections have rarely been comprehensively characterized. Here, we present a fatal case of HLH secondary to cytomegalovirus (CMV) infection complicated by both anti-viral drug resistance and sepsis from multiple MDROs including pandrug-resistant superbug bacteria. CASE PRESENTATION: A previously healthy, six-year-old boy presented with a 45-day history of fever prior to a diagnosis of hemophagocytic lymphohistiocytosis and hemorrhagic colitis, both associated with CMV. On hospital admission, the patient was found to be colonized with multiple, multidrug-resistant (MDR) bacteria including vancomycin-resistant enterococci (VRE) and carbapenamase-producing organisms (CPO). He eventually developed respiratory, urine and bloodstream infections with highly drug-resistant, including pandrug-resistant bacteria, which could not be controlled by antibiotic treatment. Antiviral therapy also failed to contain his CMV infection and the patient succumbed to overwhelming bacterial and viral infection. Whole genome sequencing (WGS) of the MDR bacteria and metagenomic analysis of his blood sample revealed an unusual accumulation of a wide range of antimicrobial resistance mechanisms in a single patient, including antiviral resistance to ganciclovir, and resistance mechanisms to all currently available antibiotics. CONCLUSIONS: The case highlights both the risk of acquiring MDR superbugs and the severity of these infections in HLH patients.


Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Citomegalovirus/efectos de los fármacos , Farmacorresistencia Bacteriana Múltiple/genética , Farmacorresistencia Viral Múltiple , Linfohistiocitosis Hemofagocítica/virología , Sepsis/mortalidad , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Antivirales/efectos adversos , Antivirales/uso terapéutico , Enterobacteriaceae Resistentes a los Carbapenémicos/efectos de los fármacos , Enterobacteriaceae Resistentes a los Carbapenémicos/genética , Niño , Citomegalovirus/genética , Citomegalovirus/inmunología , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/virología , Resultado Fatal , Ganciclovir/efectos adversos , Ganciclovir/uso terapéutico , Genotipo , Humanos , Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/tratamiento farmacológico , Masculino , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Enterococos Resistentes a la Vancomicina/genética
5.
Medicine (Baltimore) ; 99(11): e19446, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176076

RESUMEN

Clinical manifestations of sepsis differ between patients with and without diabetes mellitus (DM), and these differences could influence the clinical behaviors of medical staff. Therefore, we aimed to investigate whether pre-existing DM was associated with the time to antibiotics or sepsis care protocols.This was a retrospective cohort study.It conducted at 53 intensive care units (ICUs) in Japan.Consecutive adult patients with severe sepsis admitted directly to ICUs form emergency departments from January 2016 to March 2017 were included.The primary outcome was time to antibiotics.Of the 619 eligible patients, 142 had DM and 477 did not have DM. The median times (interquartile ranges) to antibiotics in patients with and without DM were 103 minutes (60-180 minutes) and 86 minutes (45-155 minutes), respectively (P = .05). There were no significant differences in the rates of compliance with sepsis protocols or with patient-centred outcomes such as in-hospital mortality. The mortality rates of patients with and without DM were 23.9% and 21.6%, respectively (P = .55). Comparing patients with and without DM, the gamma generalized linear model-adjusted relative difference indicated that patients with DM had a delay to starting antibiotics of 26.5% (95% confidence intervals (95%CI): 4.6-52.8, P = .02). The gamma generalized linear model-adjusted relative difference with multiple imputation for missing data of sequential organ failure assessment was 19.9% (95%CI: 1.0-42.3, P = .04). The linear regression model-adjusted beta coefficient indicated that patients with DM had a delay to starting antibiotics of 29.2 minutes (95%CI: 6.8-51.7, P = .01). Logistic regression modelling showed that pre-existing DM was not associated with in-hospital mortality (odds ratio, 1.26; 95%CI: 0.72-2.19, P = .42).Pre-existing DM was associated with delayed antibiotic administration among patients with severe sepsis or septic shock; however, patient-centred outcomes and compliance with sepsis care protocols were comparable.


Asunto(s)
Antibacterianos/uso terapéutico , Diabetes Mellitus/epidemiología , Servicio de Urgencia en Hospital , Sepsis/tratamiento farmacológico , Tiempo de Tratamiento , Anciano , Anciano de 80 o más Años , Femenino , Mortalidad Hospitalaria , Humanos , Japón/epidemiología , Masculino , Estudios Retrospectivos , Sepsis/mortalidad
6.
Artículo en Inglés | MEDLINE | ID: mdl-32178604

RESUMEN

From 1 January to 31 December 2018, thirty-six institutions around Australia participated in the Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP). The aim of ASSOP 2018 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to methicillin, and to characterise the molecular epidemiology of the methicillin-resistant isolates. A total of 2,673 S. aureus bacteraemia episodes were reported, of which 78.9% were community-onset. A total of 17.4% of S. aureus isolates were methicillin resistant. The 30-day all-cause mortality associated with methicillin-resistant SAB was 17.1% which was not significantly higher than the 13.6% mortality associated with methicillin-susceptible SAB (p = 0.1). With the exception of the ß-lactams and erythromycin, antimicrobial resistance in methicillin-susceptible S. aureus was rare. However in addition to the ß-lactams approximately 42% of methicillin-resistant S. aureus (MRSA) were resistant to erythromycin, 36% to ciprofloxacin and approximately 13% resistant to co-trimoxazole, tetracycline and gentamicin. When applying the EUCAST breakpoints teicoplanin resistance was detected in two S. aureus isolates. Resistance was not detected for vancomycin and linezolid. Resistance to non-beta-lactam antimicrobials was largely attributable to two healthcare-associated MRSA clones: ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA). The ST22-IV [2B] (EMRSA-15) clone is the predominant healthcare-associated clone in Australia. Seventy-eight percent of methicillin-resistant SAB episodes in 2018 were due to community-associated clones. Although polyclonal, approximately 76.3% of community-associated clones were characterised as ST93-IV [2B] (Queensland CA-MRSA), ST5-IV [2B], ST45-VT [5C2&5], ST1-IV [2B], ST30-IV [2B], ST78-IV [2B] and ST97-IV [2B]. Community-associated MRSA, in particular the ST45-VT [5C2&5] clone, has acquired multiple antimicrobial resistance determinants including ciprofloxacin, erythromycin, clindamycin, gentamicin and tetracycline. The ST45-VT [5C2&5] clone accounted for 11.7% of CA-MRSA. As CA-MRSA is well established in the Australian community, it is important that antimicrobial resistance patterns in community- and healthcare-associated SAB are monitored, as this information will guide therapeutic practices in treating S. aureus sepsis.


Asunto(s)
Antibacterianos , Staphylococcus aureus Resistente a Meticilina , Sepsis , Infecciones Estafilocócicas , Staphylococcus aureus , Antibacterianos/farmacología , Australia/epidemiología , Bacteriemia , Infección Hospitalaria/tratamiento farmacológico , Farmacorresistencia Bacteriana/efectos de los fármacos , Humanos , Resistencia a la Meticilina , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Sepsis/tratamiento farmacológico , Sepsis/etiología , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/efectos de los fármacos
7.
Medicine (Baltimore) ; 99(7): e18895, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049789

RESUMEN

BACKGROUND: Sepsis is the leading cause of death in critically ill patients. Ulinastatin (UTI), a protease inhibitor, and rhubarb, used as a traditional Chinese medication, are proved to be effective in treating sepsis, but the effect of the combination therapy of these two drugs on sepsis remains unclear. This study aimed to investigate the effect of the combination treatment of UTI and rhubarb on sepsis patients. METHODS: A total of 75 septic patients were randomly divided into control group, UTI group, Rhubarb group, and UTI plus Rhubarb group. Clinical data and score of Acute Physiology and Chronic Health Evaluation II (APACHE II) were collected; lymphocyte subtypes in the peripheral blood were analyzed before and after the 5-day treatment in the Intensive Care Unit. RESULTS: All the therapeutic interventions (UTI alone, rhubarb alone, or UTI plus rhubarb) significantly reduced the levels of C-Reactive protein, white blood cell density, lactic acid, and APACH II scores, and elevated the levels of CD4/CD8, but only UTI plus rhubarb treatment obviously decreased the level of procalcitonin. CONCLUSION: This study suggested that the combination of UTI and rhubarb may be a promising therapeutic scheme to ameliorate sepsis.


Asunto(s)
Medicamentos Herbarios Chinos/administración & dosificación , Glicoproteínas/administración & dosificación , Rheum/química , Sepsis/tratamiento farmacológico , Inhibidores de Tripsina/administración & dosificación , Anciano , Anciano de 80 o más Años , Enfermedad Crítica/mortalidad , Quimioterapia Combinada , Medicamentos Herbarios Chinos/uso terapéutico , Femenino , Glicoproteínas/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Inhibidores de Tripsina/uso terapéutico
8.
BMC Infect Dis ; 20(1): 169, 2020 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-32087679

RESUMEN

BACKGROUND: Antibiotic use contributes to the rates of sepsis and the associated mortality, particularly through lack of clearance of resistant infections following antibiotic treatment. At the same time, there is limited information on the effects of prescribing of some antibiotics vs. others on subsequent sepsis and sepsis-related mortality. METHODS: We used a multivariable mixed-effects model to relate state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2014 and 2015 to state-specific rates of mortality with sepsis (ICD-10 codes A40-41 present as either underlying or contributing causes of death on a death certificate) in different age groups of US adults between 2014 and 2015, adjusting for additional covariates and random effects associated with the ten US Health and Human Services (HHS) regions. RESULTS: Increase in the rate of prescribing of oral penicillins by 1 annual dose per 1000 state residents was associated with increases in annual rates of mortality with sepsis of 0.95 (95% CI (0.02,1.88)) per 100,000 persons aged 75-84y, and of 2.97 (0.72,5.22) per 100,000 persons aged 85 + y. Additionally, the percent of individuals aged 50-64y lacking health insurance, as well as the percent of individuals aged 65-84y who are African-American were associated with rates of mortality with sepsis in the corresponding age groups. CONCLUSIONS: Our results suggest that prescribing of penicillins is associated with rates of mortality with sepsis in older US adults. Those results, as well as the related epidemiological data suggest that replacement of certain antibiotics, particularly penicillins in the treatment of different syndromes should be considered with the aim of reducing the rates of severe outcomes, including mortality related to bacterial infections.


Asunto(s)
Antibacterianos/uso terapéutico , Prescripciones de Medicamentos , Penicilinas/uso terapéutico , Sepsis/epidemiología , Sepsis/mortalidad , Administración Oral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Certificado de Defunción , Femenino , Humanos , Seguro de Salud , Masculino , Persona de Mediana Edad , Resistencia a las Penicilinas , Penicilinas/administración & dosificación , Penicilinas/efectos adversos , Prevalencia , Sepsis/tratamiento farmacológico , Estados Unidos/epidemiología , Adulto Joven
9.
Mol Immunol ; 119: 123-131, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32014631

RESUMEN

We evaluated the anti-inflammatory activity of methanol extracts of Chinese medicinal plants from Beijing and determined which extract was the most effective. We found the methanol extract of Acalypha australis L. (AAL) to be the most effective. AAL has been used for clearing heat, toxic material, and hemostasia in Chinese medicine. Although these uses are closely related to inflammation, the anti-inflammatory effect of AAL has not yet been described and its underlying mechanism remains unclear. Therefore, we aimed to identify anti-inflammatory effect of AAL and its underlying mechanism in vitro and in vivo. In RAW 264.7 macrophages, cytotoxicity was evaluated by MTT assay and nitric oxide (NO) was measured with Griess reagent. To confirm the production of pro-inflammatory cytokines and its mRNA expression, enzyme immunoassay (EIA) and quantitative real-time PCR (qRT-PCR) were performed. Further, protein expression was analyzed by western blotting. Septic shock was induced by intraperitoneal injection of LPS (25 mg/kg) in mice. One hour before LPS injection, AAL (25 and 50 mg/kg) was administered orally. In LPS-stimulated macrophages, AAL inhibited NO production at concentrations without cytotoxicity. Additionally, AAL reduced not only inducible nitric oxide synthase (iNOS) expression but the production of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) by attenuating nuclear factor-kappa B (NF-κB)-related proteins (NF-κB p65, phosphorylation of inhibitor κB-α; p-IκB-α, phosphorylation of inhibitor κB kinase-α/ß; p-Ikk-α/ß). Moreover, AAL enhanced the survival rate of mice through the inhibition of iNOS expression and IL-6 and interleukin-1ß (IL-1ß) production in LPS-induced septic mice. Furthermore, AAL also reduced the expression of NF-κB-related proteins. These finding suggest that AAL is related to the modulation of inflammatory reactions by blocking NF-κB activation in LPS-stimulated RAW 264.7 macrophages and LPS-induced septic mice.


Asunto(s)
Acalypha/inmunología , Antiinflamatorios no Esteroideos/farmacología , FN-kappa B/antagonistas & inhibidores , Sepsis/tratamiento farmacológico , Animales , Antiinflamatorios no Esteroideos/uso terapéutico , Medicamentos Herbarios Chinos/farmacología , Regulación de la Expresión Génica/efectos de los fármacos , Lipopolisacáridos , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Ratones , FN-kappa B/metabolismo , Células RAW 264.7 , Sepsis/inducido químicamente , Transducción de Señal/efectos de los fármacos
10.
Nurs Clin North Am ; 55(1): 71-79, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32005367

RESUMEN

Sepsis is a deadly and costly condition, but effectively managing sepsis in the emergency department (ED) can help to improve patient outcomes. A key part of sepsis management is improving compliance with sepsis bundles, which can be challenging in the ED setting. Bedside nurses in the ED have a unique opportunity to facilitate early identification and treatment of patients with sepsis, which increases sepsis bundle compliance and improves patient outcomes. Interventions reviewed in this article can help to improve early identification and treatment, along with ways to standardize care, provide education, and implement feedback.


Asunto(s)
Antibacterianos/normas , Antibacterianos/uso terapéutico , Servicios Médicos de Urgencia/normas , Adhesión a Directriz , Guías de Práctica Clínica como Asunto , Mejoramiento de la Calidad/normas , Sepsis/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
11.
Mikrobiyol Bul ; 54(1): 163-170, 2020 Jan.
Artículo en Turco | MEDLINE | ID: mdl-32050887

RESUMEN

Meningococcal infections are important health problems causing high morbidity and mortality. Neisseria meningitidis have 13 serogroups. A, B, C, Y and W135 are the most common causes of invasive disease among those serogroups. The distribution of the serogroups differs according to the geographical regions and the age groups. In this case report, two cases of meningococcemia infected with serogroup C and Y of N.meningitidis rarely seen in our country were presented. First case was a two and a half year-old female patient who has admitted to our pediatric emergency unit with fever and rash spreading from lower extremities to her body. The patient had diffuse purpuric rash with generalized weakness and tendency to sleep at admission. The patient has been suspected as meningococcemia because of the skin rash, tendency to sleep and hypotension. Antibiotics treatment was started immediately and lumber puncture was performed. In blood tests, leukocyte count: 3600/mm3 (61% neutrophils), hemoglobin: 11.1 g/ dl, platelet count: 127.000/mm3 , C-reactive protein: 10 mg/dl, erythrocyte sedimentation rate: 6 mm/ hour, prothrombin time: 28.8 seconds (normal value= 11-16), prothrombin activity: 36%, international normalized ratio (INR): 2.13 (normal value= 1-1.5), activated partial thromboplastin time: 57.7 seconds (normal value= 25-35 sec), fibrinogen: 246 mg/dl (normal value= 200-400 mg/dl) and in cerebrospinal fluid protein: 21 mg/dl and glucose: 62 mg/dl were found. There were eight cells in the microscopic examination. Skin rashes were increased and the patient became hypotensive. No microorganisms were isolated in blood and cerebrospinal cultures. N.meningitidis serogroup C was isolated from the cerebrospinal fluid of the patient using polymerase chain reaction (PCR). The patient suffered from immune-mediated arthritis in the sixth day of treatment and nonsteroidal anti-inflammatory drugs were given. The patient has recovered with antibiotics, fresh frozen plasma and inotropic treatment. Second case was a 13 year-old male patient who has admitted three days after the first case with a pre-diagnosis of malignancy because of pancytopenia and fever. The patient had generalized weakness and a few petechial purpuric rashes at the facial region at admission. After the admission general status of the patient has worsened rapidly and he has died as a result of cardiovascular arrest. Blood tests in admission showed leukocyte count: 6000/mm3 (79% neutrophils), hemoglobin: 17.3 mg/dl, platelet count: 16.000/mm3 , C-reactive protein: 8.63 mg/dl, prothrombin time: 92.6 seconds, prothrombin activity: 10%, INR: 6.78, activated partial thromboplastin time: 231.5 seconds. Cerebrospinal fluid obtained from postmortem lumbar puncture showed no growth (protein: 95 mg/dl, glucose: 35 mg/dl) and N.meningitidis serogroup Y was detected by PCR. Two meningococcemia cases caused by two different serogroups which are rarely seen in our region in recent years were presented at the same time period in the same hospital. This case report pointed out that surveillance has a great importance in such diseases.


Asunto(s)
Infecciones Meningocócicas , Neisseria meningitidis , Adolescente , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Preescolar , Resultado Fatal , Femenino , Humanos , Masculino , Infecciones Meningocócicas/líquido cefalorraquídeo , Infecciones Meningocócicas/tratamiento farmacológico , Infecciones Meningocócicas/microbiología , Neisseria meningitidis/clasificación , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Serogrupo , Resultado del Tratamiento
12.
BJOG ; 127(6): 680-691, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31913562

RESUMEN

BACKGROUND: Early-onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria exist to identify eligible women for prophylaxis. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening-based protocol), whereas others employ risk-based protocols. OBJECTIVES: To compare the effectiveness of screening-based versus risk-based protocols in preventing EOGBS disease. SEARCH STRATEGY: Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture-based, risk-based. SELECTION CRITERIA: Studies were included if they investigated EOGBS disease incidence in newborn infants and compared screening or risk-based protocols with each other or with controls. DATA COLLECTION AND ANALYSIS: Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel-Haenszel analyses with random effects. MAIN RESULTS: Seventeen eligible studies were included. In this meta-analysis, screening was associated with a reduced risk for EOGBS disease compared either with risk-based protocols (ten studies, RR 0.43, 95% CI 0.32-0.56) or with no policy (four studies, RR 0.31, 95% CI 0.11-0.84). Meta-analysis could not demonstrate a significant effect of risk-based protocols versus no policy (seven studies, RR 0.86, 95% CI 0.61-1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31 versus 29%). CONCLUSIONS: Screening-based protocols were associated with lower incidences of EOGBS disease compared with risk-based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking. TWEETABLE ABSTRACT: Meta-analysis: general screening is associated with lower rates of early-onset group B strep. neonatal sepsis compared with risk-based protocols.


Asunto(s)
Profilaxis Antibiótica , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/diagnóstico , Sepsis/prevención & control , Infecciones Estreptocócicas/prevención & control , Streptococcus agalactiae/aislamiento & purificación , Femenino , Humanos , Recién Nacido , Servicio de Ginecología y Obstetricia en Hospital , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/microbiología , Medición de Riesgo , Factores de Riesgo , Sepsis/tratamiento farmacológico , Infecciones Estreptocócicas/tratamiento farmacológico
13.
Anesthesiology ; 132(2): 321-329, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31939847

RESUMEN

BACKGROUND: Tachycardia is a hallmark of sepsis. An elevated heart rate could impair ventricular filling and increase myocardial oxygen demand. ß-Blockers and ivabradine (a selective inhibitor of If channels in the sinoatrial node) are both able to control sinus tachycardia, with the latter drug being devoid of negative inotropic effect. This work aimed at assessing the hemodynamic effects of ivabradine as compared with a ß-blocker (atenolol) during murine peritonitis. METHODS: Ivabradine (3 µg/g), atenolol (3 µg/g), or placebo was administered intraperitoneally 2 h after induction of peritonitis (cecal ligation and puncture) in male C57BL6 mice. The authors used invasive (left ventricular catheterization) and noninvasive (transthoracic echocardiography) monitoring to assess hemodynamics 20 h after surgery, including heart rate, blood pressure, left ventricular systolic, and diastolic function (n = 10 mice/group). The authors also assessed overall mortality 30 and 60 h after surgery in a distinct subset of animals (n = 20 mice/group). Descriptive data are presented as median (25th to 75th percentile). RESULTS: As compared with placebo (601 beats/min [547 to 612]), ivabradine (447 beats/min [430 to 496]) and atenolol (482 beats/min [412 to 505]) blunted sepsis-induced tachycardia assessed by transthoracic echocardiography in awake animals (P < 0.001 and P = 0.004, respectively). Unlike ivabradine, atenolol reduced cardiac output, systolic blood pressure, and left ventricular systolic function (as assessed by ejection fraction, maximal left ventricular pressure rise, and anterior wall strain rate) as compared with septic mice receiving placebo. There was no difference in survival 60 h after sepsis induction with ivabradine (6 of 20, 30%) or atenolol (7 of 20, 35%), as compared with placebo (5 of 20, 25%; P = 0.224). CONCLUSIONS: Heart rate control could be similarly achieved by ivabradine or atenolol, with preservation of blood pressure, cardiac output, and left ventricular systolic function with the former drug.


Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Fármacos Cardiovasculares/uso terapéutico , Frecuencia Cardíaca/efectos de los fármacos , Ivabradina/uso terapéutico , Sepsis/tratamiento farmacológico , Antagonistas Adrenérgicos beta/farmacología , Animales , Fármacos Cardiovasculares/farmacología , Frecuencia Cardíaca/fisiología , Ivabradina/farmacología , Masculino , Ratones , Ratones Endogámicos C57BL , Distribución Aleatoria , Sepsis/fisiopatología
14.
PLoS One ; 15(1): e0228093, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31971961

RESUMEN

Multiple organ dysfunction induced by sepsis often involves kidney injury. Extracellular histones released in response to damage-associated molecular patterns are known to facilitate sepsis-induced organ dysfunction. Recombinant human soluble thrombomodulin (rhTM) and its lectin-like domain (D1) exert anti-inflammatory effects and neutralize damage-associated molecular patterns. However, the effects of rhTM and D1 on extracellular histone H3 levels and kidney injury remain poorly understood. Our purpose was to investigate the association between extracellular histone H3 levels and kidney injury, and to clarify the effects of rhTM and D1 on extracellular histone H3 levels, kidney injury, and survival in sepsis-induced rats. Rats in whom sepsis was induced via cecal ligation and puncture were used in this study. Histone H3 levels, histopathology of the kidneys, and the survival rate of rats at 24 h after cecal ligation and puncture were investigated. Histone H3 levels increased over time following cecal ligation and puncture. Histopathological analyses indicated that the distribution of degeneration foci among tubular epithelial cells of the kidney and levels of histone H3 increased simultaneously. Administration of rhTM and D1 significantly reduced histone H3 levels compared with that in the vehicle-treated group and improved kidney injury. The survival rates of rats in rhTM- and D1-treated groups were significantly higher than that in the vehicle-treated group. The results of this study indicated that rhTM and its D1 similarly reduce elevated histone H3 levels, thereby reducing acute kidney injury. Our findings also proposed that rhTM and D1 show potential as new treatment strategies for sepsis combined with acute kidney injury.


Asunto(s)
Espacio Extracelular/metabolismo , Histonas/metabolismo , Riñón/patología , Proteínas Recombinantes/uso terapéutico , Sepsis/tratamiento farmacológico , Trombomodulina/uso terapéutico , Animales , Ciego/patología , Creatinina/sangre , Histonas/sangre , Humanos , Riñón/efectos de los fármacos , Ligadura , Masculino , Dominios Proteicos , Punciones , Ratas Wistar , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/farmacología , Sepsis/sangre , Análisis de Supervivencia , Trombomodulina/administración & dosificación , Trombomodulina/química
15.
PLoS One ; 15(1): e0227652, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31968009

RESUMEN

BACKGROUND: Early recognition of sepsis is critical for timely initiation of treatment. The first objective of this study was to assess the timeliness of diagnostic procedures for recognizing sepsis in emergency departments. We define diagnostic procedures as tests used to help diagnose the condition of patients. The second objective was to estimate associations between diagnostic procedures and time to antibiotic treatment, and to estimate associations between time to antibiotic treatment and mortality. METHODS: This observational study from 24 emergency departments in Norway included 1559 patients with infection and at least two systemic inflammatory response syndrome criteria. We estimated associations using linear and logistic regression analyses. RESULTS: Of the study patients, 72.9% (CI 70.7-75.1) had documented triage within 15 minutes of presentation to the emergency departments, 44.9% (42.4-47.4) were examined by a physician in accordance with the triage priority, 44.4% (41.4-46.9) were adequately observed through continual monitoring of signs while in the emergency department, and 25.4% (23.2-27.7) received antibiotics within 1 hour. Delay or non-completion of these key diagnostic procedures predicted a delay of more than 2.5 hours to antibiotic treatment. Patients who received antibiotics within 1 hour had an observed 30-day all-cause mortality of 13.6% (10.1-17.1), in the timespan 2 to 3 hours after admission 5.9% (2.8-9.1), and 4 hours or later after admission 10.5% (5.7-15.3). CONCLUSIONS: Key procedures for recognizing sepsis were delayed or not completed in a substantial proportion of patients admitted to the emergency department with sepsis. Delay or non-completion of key diagnostic procedures was associated with prolonged time to treatment with antibiotics. This suggests a need for systematic improvement in the initial management of patients admitted to emergency departments with sepsis.


Asunto(s)
Servicio de Urgencia en Hospital , Sepsis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Diagnóstico Precoz , Servicio de Urgencia en Hospital/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Sepsis/tratamiento farmacológico , Sepsis/mortalidad , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/mortalidad , Tiempo de Tratamiento , Triaje , Adulto Joven
16.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(1): 1-6, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31948515

RESUMEN

Preterm infants are at higher risk of developing early-onset sepsis (EOS). Due to non-specific clinical manifestations and lack of laboratory tests for prompt diagnosis of EOS, inappropriate use of antibiotics is common in preterm infants. Prolonged exposure to antibiotics can lead to antibiotic resistance and significantly increases the risk of mortality and morbidity. Based on the latest progress in the diagnosis and treatment for EOS, both in China and overseas, and considering the current condition in Hunan Province, the expert panel of neonatologists in Hunan have reached this consensus after many discussions. This consensus clarifies the risk factors, proposes the diagnostic criteria, and recommends the antibiotic use strategies for EOS in preterm infants. It is emphasized that blood culture results and clinical manifestations are the main basis for the diagnosis of EOS and the duration of antibiotics use in preterm infants.


Asunto(s)
Recien Nacido Prematuro , Sepsis , Edad de Inicio , Antibacterianos , China , Consenso , Humanos , Recién Nacido , Factores de Riesgo , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico
17.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(1): 7-8, 2020 Jan.
Artículo en Chino | MEDLINE | ID: mdl-31948516

RESUMEN

At present, non-standard use of antibiotics remains a common phenomenon in the treatment of preterm infants with early-onset sepsis (EOS) in China. The expert panel of neonatologists in Hunan Province formulated a consensus on the diagnosis and use of antibiotics for EOS in preterm infant [Chin J Contemp Pediatr, 2020, 22(1): 1-6], which has a positive effect on the rational use of antibiotics. Based on this consensus, this article points out that in order to use antibiotics accurately, it is necessary to accurately identify EOS in preterm infants, accurately understand their clinical manifestations and medical history, and accurately evaluate the laboratory test results. Also, this article offers suggestions for the use of antibiotics in preterm infants with EOS.


Asunto(s)
Antibacterianos/uso terapéutico , Enfermedades del Prematuro , Sepsis , Edad de Inicio , China , Humanos , Recién Nacido , Recien Nacido Prematuro , Factores de Riesgo , Sepsis/tratamiento farmacológico
18.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(1): 9-11, 2020 Jan.
Artículo en Chino | MEDLINE | ID: mdl-31948517

RESUMEN

This paper is a comment on "Recommendation on the diagnosis and the use of antibiotics for early-onset sepsis in preterm infants: consensus of the expert panel from Hunan Province" [Chinese J Contemp Pediatr, 2020, 22(1): 1-6]. This consensus offers suggestions for the diagnosis and antibiotic therapy of early-onset sepsis (EOS) in preterm infants in Hunan Province, which is of great significance for reducing unreasonable and unnecessary use of antibiotics. Based on this consensus, this comment discusses the diagnosis of EOS and the use of antibiotics in preterm infants.


Asunto(s)
Antibacterianos/uso terapéutico , Recien Nacido Prematuro , Sepsis , Atención , Humanos , Recién Nacido , Factores de Riesgo , Sepsis/tratamiento farmacológico
19.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(1): 12-16, 2020 Jan.
Artículo en Chino | MEDLINE | ID: mdl-31948518

RESUMEN

OBJECTIVE: To evaluate the efficacy and safety of C-reactive protein (CRP)-guided antibiotic treatment strategy for neonates with suspected early-onset sepsis (EOS). METHODS: A total of 428 neonates, with a gestational age of >35 weeks, who were admitted to the Children's Hospital of Chongqing Medical University from February to July, 2019 and were suspected of EOS were enrolled as the observation group. The effect of antibiotic treatment was prospectively observed, and if clinical symptoms were improved and CRP was <10 mg/L in two consecutive tests, discontinuation of antibiotics was considered. A total of 328 neonates (gestational age of >35 weeks) who were admitted to this hospital from February to July, 2018 and were suspected of EOS were enrolled as the control group, and the use of antibiotics was analyzed retrospectively. The two groups were compared in terms of duration of antibiotic treatment, length of hospital stay, incidence rate of repeated infection and clinical outcome. RESULTS: Compared with the control group, the observation group had significantly shorter duration of antibiotic treatment and length of hospital stay (P<0.05). There were no significant differences in the incidence rate of repeated infection and clinical outcome between the two groups (P>0.05). CONCLUSIONS: For neonates with a gestational age of >35 weeks and a suspected diagnosis of EOS, CRP-guided antibiotic treatment strategy can shorten duration of antibiotic treatment and length of hospital stay and does not increase the incidence rate of repeated infection. Therefore, it holds promise for clinical application.


Asunto(s)
Antibacterianos/uso terapéutico , Sepsis , Proteína C-Reactiva , Edad Gestacional , Humanos , Recién Nacido , Estudios Retrospectivos , Sepsis/tratamiento farmacológico
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