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2.
BMC Infect Dis ; 19(1): 1082, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881849

RESUMO

BACKGROUND: To investigate the clinical features of septic pulmonary embolism (SPE) cases and prognostic factors for in-hospital mortality in China. METHODS: A retrospective analysis was conducted of SPE patients hospitalized between January 2007 and June 2018 in the Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University. RESULTS: A total of 98 patients with SPE were identified. All patients had bilateral multiple peripheral nodules on chest computed tomography. The most common pathogen found in blood culture was Staphylococcus aureus (10/33, 30.3%). Transthoracic echocardiography was performed in 39 patients and 20 showed vegetations. Bronchoscopy was performed in 24 patients. Bronchoalveolar lavage fluid (BALF) was obtained from 15 patients (62.5%) and showed predominantly polymorphonuclear cell infiltration (52%, range of 48%~ 63%). Four patients received transbronchial lung biopsy, and histopathological examinations revealed suppurative pneumonia and organizing pneumonia. The in-hospital mortality rate was 19.4%. Age (odds ratio [OR] 1.100; 95% confidence interval [CI] 1.035-1.169), hypotension (OR 7.260; 95% CI 1.126-46.804) and ineffective or delay of empirical antimicrobial therapy (OR 7.341; 95% CI 1.145-47.045) were found to be independent risk factors for in-hospital mortality, whereas drainage treatment was found to be a protective factor (OR 0.33; 95% CI 0.002-0.677). CONCLUSIONS: SPE cases presented with nonspecific clinical manifestations and radiologic features. Blood cultures and bronchoscopy are important measures for early diagnosis and differential diagnosis. There is relationship between primary infection sites and the type of pathogen. Maintaining normal blood pressure and providing timely and appropriate initial antimicrobial therapy for effective control of the infection could improve prognosis.


Assuntos
Mortalidade Hospitalar , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Choque Séptico/diagnóstico , Choque Séptico/mortalidade , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/mortalidade , Staphylococcus aureus/isolamento & purificação , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia , China , Cuidados Críticos , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico por imagem , Pneumonia/tratamento farmacológico , Prognóstico , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/microbiologia , Estudos Retrospectivos , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
3.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(10): 1219-1223, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31771718

RESUMO

OBJECTIVE: To observe the effects of abnormal body temperature and the area under temperature curve on the prognosis of patients with septic shock. METHODS: A retrospective cohort study was conducted. Patients with septic shock admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from September 2013 to June 2019 were enrolled. Data were obtained from the hospital case database, including the gender, age, infection source, the length of ICU stay, sequential organ failure assessment (SOFA) score, 21-day prognosis; within the first 24 hours and throughout the period in ICU, the maximum temperature (24 h Tmax, Tmax), lowest temperature (24 h Tmin, Tmin), and the temperature range (24 h Tmax-min, Tmax-min) were aggregated. The area under temperature curve when body temperature was higher than T (A> T), or lower than T (A< T), and area section between T1 and T2 (AT1-T2) was calculated respectively. Patients were divided into survival group and death group according to 21-day prognosis. Binary Logistic regression was used to analyze the effect of the above temperature indices on the prognosis. RESULTS: 635 septic shock patients were enrolled in the study. 476 patients were survived and 159 died within 21 days. Compared with the survival group, the age, SOFA score were higher in the death group, while the length of ICU stay was shorter. There was no significant difference in gender or infection source between two groups. After adjusting for gender, age, the length of ICU stay and SOFA score, binary Logistic regression analysis showed that the increase of Tmax, decrease of Tmin, and increase of Tmax-min were risk factors for 21-day mortality [Tmax: odds ratio (OR) = 2.959, 95% confidence interval (95%CI) was 1.620-5.398, P > 0.001; Tmin: OR = 0.329, 95%CI was 0.140-0.790, P = 0.012; Tmax-min: OR = 3.258, 95%CI was 1.840-5.471, P > 0.001], while 24 h Tmax, 24 h Tmin and 24 h Tmax-min were not related to prognosis. A< 36.0 centigrade (OR = 1.335, 95%CI was 1.102-1.745, P = 0.014), and A> 38.0 centigrade (OR = 1.041, 95%CI was 1.019-1.077, P = 0.001) showed positive correlation with 21-day mortality. When the T level was set at 38.0-40.0 centigrade, for every 1 centigrade×hour increase in A> T, the 21-day relative risk of death increased by 4.1%-83.2%. CONCLUSIONS: When the body temperature of patients with septic shock is lower than 36.0 centigrade, or higher than 38.0 centigrade, the 21-day relative risk of death rose with the increase of the magnitude and duration of abnormal body temperature.


Assuntos
Temperatura Corporal , Choque Séptico/diagnóstico , Humanos , Unidades de Terapia Intensiva , Prognóstico , Estudos Retrospectivos , Sepse , Temperatura Ambiente
4.
BMC Infect Dis ; 19(1): 968, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718563

RESUMO

BACKGROUND: This study investigated the clinical value of interleukin-6 (IL-6), pentraxin 3 (PTX3), and procalcitonin (PCT) in patients with sepsis and septic shock diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). METHODS: Serum levels of IL-6, PTX3, and PCT were measured in 142 enrolled subjects (51 with sepsis, 46 with septic shock, and 45 as controls). Follow-up IL-6 and PTX3 levels were measured in patients with initial septic shock within 24 h of hospital discharge. Optimal cut-off values were determined for sepsis and septic shock, and prognostic values were evaluated. RESULTS: Serum IL-6 levels could discriminate sepsis (area under the curve [AUC], 0.83-0.94, P <  0.001; cut-off value, 52.60 pg/mL, 80.4% sensitivity, 88.9% specificity) from controls and could distinguish septic shock (AUC, 0.71-0.89; cut-off value, 348.92 pg/mL, 76.1% sensitivity, 78.4% specificity) from sepsis. Twenty-eight-day mortality was significantly higher in the group with high IL-6 (≥ 348.92 pg/mL) than in the group with low IL-6 (< 348.92 pg/mL) (P = 0.008). IL-6 was an independent risk factor for 28-day mortality among overall patients (hazard ratio, 1.0004; 95% confidence interval, 1.0003-1.0005; p = 0.024). In septic shock patients, both the initial and follow-up PTX3 levels were consistently significantly higher in patients who died than in those who recovered (initial p = 0.004; follow-up P <  0.001). CONCLUSIONS: The diagnostic and prognostic value of IL-6 was superior to those of PTX3 and PCT for sepsis and septic shock.


Assuntos
Proteína C-Reativa/análise , Interleucina-6/sangue , Pró-Calcitonina/sangue , Sepse/diagnóstico , Componente Amiloide P Sérico/análise , Choque Séptico/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Fatores de Risco , Sensibilidade e Especificidade , Sepse/mortalidade , Sepse/patologia , Índice de Gravidade de Doença , Choque Séptico/mortalidade , Choque Séptico/patologia
5.
Med. intensiva (Madr., Ed. impr.) ; 43(8): 464-473, nov. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-185883

RESUMO

Purpose: To determine the differences in short- and long-term mortality in elderly septic patients with multiorgan dysfunction syndrome and establish the factors related to non-survival. Materials and methods: A retrospective cohort study was made of 206 patients over 65 years of age with septic and septic shock criteria admitted to the ICU of Rio Hortega Hospital between January 2011 and February 2017. Study variables were obtained from electronic database records. Results: A total of 206 patients were included, divided into three groups of age (65-74, 75-85, >85 years). There were no significant differences in mortality according to age group after 28 days, 90 days or one year (28.6%, 32.1% and 45.2% in the 65-74 years age group; 32.5%, 38.6% and 45.8% in the 75-85 years age group, 41%, 48.7% and 56.4% in the >85 years age group). The factors related to mortality were: chronic heart failure, non-haematological cancer, liver dysfunction and central nervous system dysfunction. Conclusions: The results indicate that there is no significant difference in mortality among the different age groups. About 50% of the elderly patients survive a septic process. There is a close relationship between the number of affected organs and days of dysfunction, the use of interventional techniques and long-term mortality


Objetivo: Determinar las diferencias en la mortalidad a corto y largo plazo en pacientes sépticos ancianos con síndrome de disfunción multiorgánica, y cuáles son los factores de riesgo determinantes de esta. Materiales y métodos: Estudio retrospectivo de cohortes de 206 pacientes mayores de 65 años con criterios de shock séptico y sepsis admitidos en la UCI del Hospital Río Hortega entre enero de 2011 y febrero de 2017. Los datos analizados se obtuvieron a través de los registros de bases de datos electrónicas de la unidad. Resultados: Se incluyeron 206 pacientes divididos en 3 grupos de edad (65-74; 75-85; >85). No encontramos diferencias estadísticas en la mortalidad por grupo de edad al cabo de 28 días, 90 días y un año (28,6, 32,1 y 45,2% en el grupo de 65-74 años; 32,5, 38,6 y 45,8% en el grupo de 75-85 años; 41, 48,7 y 56,4% en el grupo de edad >85) Los factores relacionados con la mortalidad fueron: insuficiencia cardíaca crónica, cáncer no hematológico, disfunción hepática y disfunción del sistema nervioso central. Conclusión: Los resultados indican que no hay una diferencia significativa en la mortalidad entre los diferentes grupos de edad. Alrededor del 50% de los pacientes ancianos sobreviven ante un proceso séptico. Existe una estrecha relación entre el número de órganos disfuncionantes, los días de disfunción, el uso de técnicas de intervención y la mortalidad a largo plazo


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Insuficiência de Múltiplos Órgãos/mortalidade , Fatores de Risco , Estudos de Coortes , Insuficiência de Múltiplos Órgãos/epidemiologia , Estudos Retrospectivos , Choque Séptico/diagnóstico , Sepse/complicações , Unidades de Terapia Intensiva , Registros de Mortalidade , Registros Eletrônicos de Saúde
6.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(9): 1078-1082, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31657328

RESUMO

OBJECTIVE: To study the risk factors of prognosis in patients with septic shock, and to provide a reliable evidence to evaluate severity. METHODS: A retrospective analysis was conducted. The data of 185 patients with septic shock admitted to the intensive care unit (ICU) of Anhui Provincial Hospital Affiliated to Anhui Medical University from March 2016 to December 2018 were enrolled. Routine blood test, blood biochemistry, blood gas analysis, myoglobin (Myo), cardiac troponin I (cTnI), blood lactic acid (Lac), procalcitonin (PCT) and ratio of C-reactive protein and albumin (CRP/ALB) of patients on the day of septic shock diagnosis were collected. Glasgow coma scale (GCS), quick sequential organ failure assessment (qSOFA), acute physiology and chronic health evaluation II (APACHE II) and multiple organ dysfunction score (MODS) as well as the time from hospitalization to septic shock and duration of mechanical ventilation were recorded. The patients were divided into death group and survival group according to whether they survived or not on 28 days. According to Myo level, the patients were divided into two groups: Myo elevation group (Myo > 98 µg/L) and Myo normal group (Myo ≤ 98 µg/L). Patients with Myo elevation were divided into survival subgroup and death subgroup according to the prognosis of 28 days. The clinical data were compared among the groups, and the influencing factors of prognosis in septic shock patients were screened by multivariate Logistic regression analysis. RESULTS: 185 patients were all enrolled in the final analysis, there were 106 deaths and 79 survivors on 28 days, 154 patients with elevated Myo and 31 patients with normal Myo. (1) Compared with the patients with septic shock in the survival group, the death group had older patients, increased qSOFA, APACHE II, MODS scores and blood Myo, Lac, PCT levels, faster heart rate, decreased GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. However, there was no significant difference in cTnI or CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.037, 95% confidence interval (95%CI) was 1.010-1.065, P = 0.007], heart rate (OR = 1.020, 95%CI was 1.003-1.037, P = 0.023), qSOFA score (OR = 2.839, 95%CI was 1.321-6.102, P = 0.008), Myo (OR = 1.492, 95%CI was 1.088-2.045, P = 0.013), time from hospitalization to septic shock (OR = 0.938, 95%CI was 0.898-0.980, P = 0.004) and duration of mechanical ventilation (OR = 0.936, 95%CI was 0.899-0.975, P = 0.001) were independent risk factors for prognosis in patients with septic shock. (2) Compared with Myo normal group, the Myo elevation group had higher 28-day mortality [61.0% (94/154) vs. 38.7% (12/31), χ2 = 5.259, P = 0.022]. Compared with the survival patients with elevated Myo, the death patients were older, and had higher PCT and qSOFA score, faster heart rate, lower GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. But there was no significant difference in CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that qSOFA score (OR = 2.796, 95%CI was 1.270-6.153, P = 0.011), time from hospitalization to septic shock (OR = 0.925, 95%CI was 0.884-0.967, P = 0.001) and duration of mechanical ventilation (OR = 0.931, 95%CI was 0.884-0.980, P = 0.006) were independent risk factors for the prognosis in the septic shock patients with elevated blood Myo. CONCLUSIONS: Age, heart rate, qSOFA score, Myo, time from hospitalization to septic shock, duration of mechanical ventilation were independent risk factors for the prognosis of patients with septic shock. The 28-day mortality in patients with elevated blood Myo was significantly higher than that in those with normal blood Myo. The qSOFA score, time from hospitalization to septic shock and duration of mechanical ventilation were independent risk factors for the prognosis of septic shock patients with elevated blood Myo.


Assuntos
Choque Séptico/diagnóstico , Humanos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sepse
7.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 311-317, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184120

RESUMO

Objetivos. El diagnóstico correcto de la sepsis en urgencias es clave para iniciar el tratamiento de forma adecuada. Para ello, se han estudiado múltiples biomarcadores que podrían ser de utilidad. El objetivo principal de este estudio fue evaluar la capacidad diagnóstica de presepsina en sangre, en comparación con procalcitonina (PCT), proteína C reactiva (PCR) y lactato, para predecir sepsis o shock séptico según la definición de Sepsis-3. El objetivo secundario fue valorar la capacidad de estos biomarcadores para predecir bacteriemia, independientemente del diagnóstico final de sepsis o shock séptico. Método. Estudio prospectivo de cohorte observacional, realizado en un único servicio de urgencias (SU) de un hospital universitario. Se incluyeron pacientes con sospecha clínica de infección y al menos dos criterios de síndrome de respuesta inflamatoria sistémica. En todos los pacientes se determinó en sangre presepsina, PCT, PCR y lactato en el momento de la visita en el SU. Resultados. Se analizaron 359 pacientes, de los que 228 (63,5%) presentaban criterios de sepsis y 20 (5,6%) de shock séptico. PCT y presepsina fueron los mejores biomarcadores para predecir la sepsis/shock séptico con un área bajo la curva (ABC) de la capacidad operativa del receptor (ROC) de 0,711 (IC 95% 0,660-0,758; p < 0,001) y 0,709 (IC 95% 0,658-0,756; p < 0,001). La PCR obtuvo una ABC de 0,635 (IC 95% 0,582-0,686; p < 0,05), y el lactato una ABC de 0,61 (IC 95% 0,556-0,661; p < 0,05). Se utilizó un punto de decisión de 0,25 ng/ml para PCT y de 500 pg/ml para presepsina. La odds ratio de presepsina para predecir sepsis fue de 3,19 (IC 95% 1,91-5,31) y para PCT de 2,51 (IC 95% 1,53-4,12). El diagnóstico de sepsis/shock séptico no mejoró al combinar presepsina y PCT (el ABC-ROC fue de 0,714, IC 95% 0,66-0,76; p < 0,001) en comparación con PCT aislada. La PCT fue el predictor más preciso de bacteriemia en pacientes con infección con un ABC-ROC de 0,835 (IC 95% 0,79-0,87; p < 0,001). Conclusión. La presepsina y la PCT son los biomarcadores con mejor rendimiento para el diagnóstico de sepsis y shock séptico en el SU


Objectives. An accurate diagnosis of sepsis in the emergency department must be made before appropriate treatment can be started. Many biomarkers that are potentially useful have been studied. The main aim of this study was to compare the diagnostic accuracy of blood levels of presepsin, lactate, C-reactive protein (CRP), and procalcitonin (PCT) for predicting sepsis as defined by the Sepsis-3 criteria. The secondary aim was to evaluate the diagnostic accuracy of these biomarkers for predicting bacteremia whether or not sepsis or septic shock was present. Methods. Single-center, prospective, observational cohort study in the emergency department of a university hospital. Consecutive patients suspected of having infection were enrolled prospectively if they had at least 2 criteria for systemic inflammatory response syndrome. We measured presepsin, PCT, CRP, and lactate in blood extracted on admission. Results. Blood samples from 359 patients were analyzed; 228 (63.5%) met the criteria for sepsis and 20 (5.6%) met the criteria for septic shock. PCT and presepsin levels were the best predictors of sepsis and septic shock with areas under the receiver operating characteristic curve (AUC) of 0.711 (95% CI, 0.660-0.758) and 0.709 (95% CI, 0.658-0.756), respectively (P<.001, both comparisons). The AUCs for CRP and lactate concentrations were, respectively, 0.63 (95% CI, 0.58-0.69) and 0.61 (95% CI, 0.56-0.66) (P<.05, both comparisons). On applying the diagnostic cut points of 0.25 ng/mL for PCT and 500 pg/mL for presepsin, the odds ratios were 2.51 (95% CI, 1.53-4.12) for PCT and 3.19 (95% CI, 1.91-5.31) for presepsin. The diagnostic accuracy of the combination of presepsin and PCT results (AUC, 0.71; 95% CI 0.66-0.76; P<.001) was no better than the accuracy of PCT alone. The most accurate predictor of bacteremia was PCT (AUC, 0.835; 95% CI, 0.79-0.87; P<.001). Conclusion. Presepsin and PCT seem to be the best predictors of a diagnosis of sepsis or septic shock in emergency department patients


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Sepse/complicações , Sepse/diagnóstico , Choque Séptico/diagnóstico , Biomarcadores , Bacteriemia/diagnóstico , Pró-Calcitonina/administração & dosagem , Estudos Prospectivos , Hospitais Universitários , Curva ROC
8.
Scand J Immunol ; 90(6): e12823, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489646

RESUMO

Sepsis is associated with significant mortality. Early diagnosis and prognosis of patients with sepsis is still a difficult clinical challenge. In this study, the ability of plasma PTX3 (pentraxin 3), MCP1 (monocyte chemoattractant protein 1) and Ang (angiopoietin)1/2 was investigated to evaluate the severity of sepsis. Blood samples were obtained from 43 patients with sepsis. A total of 33 post-surgery patients with infections and 25 healthy individuals served as controls. The results showed that plasma PTX3, MCP1 and Ang2 significantly increased in patients on the first day of septic shock onset, while sepsis patients had significantly higher Ang2 level, compared with controls. Furthermore, PTX3, MCP1 and Ang2 had high AUROC values in patients with septic shock on the first day of sepsis onset. The findings suggest that PTX3, MCP1 and Ang2 maybe early predictors to evaluate the severity of sepsis and septic shock with the latest Sepsis 3.0 definitions.


Assuntos
Angiopoietina-2/sangue , Proteína C-Reativa , Quimiocina CCL2/sangue , Sepse/sangue , Sepse/diagnóstico , Componente Amiloide P Sérico , Choque Séptico/sangue , Choque Séptico/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Estudos de Casos e Controles , Humanos , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Sepse/terapia , Índice de Gravidade de Doença , Choque Séptico/terapia
9.
Georgian Med News ; (292-293): 65-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31560665

RESUMO

Infection of the mediastinum is typically polymicrobial in nature resulting from a disruption of normal mucosal and tissue barriers. Infection may result from a rupture of the esophagus or trachea or from surgical intervention. Medaistinal abscess is the most lethal form of mediastinitis. A case report is presented: sepsis - induced polyorganic insufficiency with underlying severe somatic pathological condition and violation of hemodynamics. Clinically the insufficiency of all the organic systems developed at the background of cardio-respiratory-cerebral insufficiency, with functional insufficiency of all the organ systems and violation of buffer system. With reasonable pathognomic and symptomatic treatment eradication of vicious circle was possible. The patient was discharged from the clinic with positive clinical-laboratory recovery. The condition was stable. Neurological status -contacted, adequate, with high capacity to work. The fistula on the anterior wall of the trachea as well as stoma were removed.


Assuntos
Abscesso , Mediastinite/diagnóstico , Mediastino/patologia , Sepse/diagnóstico , Choque Séptico/diagnóstico , Abscesso/patologia , Abscesso/cirurgia , Humanos
10.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439551

RESUMO

A 58-year-old man presented with necrotising fasciitis and septic shock requiring urgent surgical debridement. Idarucizumab was used preoperatively to reverse the effects of dabigatran, which he was taking for chronic atrial fibrillation. He developed multiorgan failure including an oliguric acute kidney injury and was given continuous venovenous haemodiafiltration. Adjunctive intravenous immunoglobulin therapy was used in addition to his antibiotic therapy for necrotising fasciitis. Significant clinical and laboratory coagulopathy continued for over 12 days with evidence of a persistent dabigatran effect. Here, we discuss the potential impact of the immunoglobulin therapy, the patient's weight on the degree of redistribution of dabigatran seen and the oliguria in the context of an acute kidney injury on the apparent lack of the effectiveness of idarucizumab.


Assuntos
Antitrombinas/efeitos adversos , Dabigatrana/efeitos adversos , Fasciite Necrosante/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Choque Séptico/diagnóstico , Infecções Estreptocócicas/diagnóstico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Diagnóstico Diferencial , Fasciite Necrosante/complicações , Fasciite Necrosante/tratamento farmacológico , Hemorragia Gastrointestinal/induzido quimicamente , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Diálise Renal , Choque Séptico/complicações , Choque Séptico/terapia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico
11.
BMC Infect Dis ; 19(1): 611, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299943

RESUMO

BACKGROUND: Bloodstream infections (BSI) due to Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) have become an important problem and they are associated with a high mortality rate. The aim of our study was to evaluate the clinical and epidemiological characteristics of KPC-Kp from BSIs. METHODS: In this retrospective cohort study, conducted in a tertiary referral center in Italy, 112 patients with KPC-Kp BSIs diagnosed between February 2011 and December 2015 were identified. We evaluated the mortality at 30 days from the first positive blood culture. Survivor and non-survivor subgroups were compared to identify predictors of mortality. RESULTS: The overall crude mortality was 35%. APACHE II score ≥ 15, septic shock at BSI onset, immunosuppressive therapy during the 30 days before the BSI onset, and the lack of a combination therapy with at least 2 active drugs emerged as independent predictors of mortality. Excluding patients with inadequate therapy, the mortality decreased to 25% while an APACHE II score ≥ 15 and the presence of septic shock remained independently associated with a negative outcome. Two different pulsotypes were identified: pulsotype A belonged to ST512 and carried KPC-3 and pulsotype B belonged to ST307 and carried KPC-2. CONCLUSIONS: This study confirmed a high mortality rate of KPC-Kp BSIs. The outcome is heavily influenced by the patient's clinical conditions. A therapeutic approach including a combination with at least two active drugs in vitro can improve the prognosis, unless patients received an appropriate therapy.


Assuntos
Proteínas de Bactérias/metabolismo , Infecções por Klebsiella/diagnóstico , Klebsiella pneumoniae/enzimologia , beta-Lactamases/metabolismo , Adulto , Idoso , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/genética , Feminino , Humanos , Itália/epidemiologia , Estimativa de Kaplan-Meier , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/mortalidade , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Choque Séptico/complicações , Choque Séptico/diagnóstico , Centros de Atenção Terciária
12.
Trials ; 20(1): 420, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296251

RESUMO

BACKGROUND: Septic shock is a life-threatening condition with underlying circulatory and cellular/metabolic abnormalities. Vitamin C and thiamine are potential candidates for adjunctive therapy; they are expected to improve outcomes based on recent experimental and clinical research. The aim of the Ascorbic Acid and Thiamine Effect in Septic Shock (ATESS) trial is to evaluate the effects of early combination therapy with intravenous vitamin C and thiamine on recovery from organ failure in patients with septic shock. METHODS: This study is a randomized, double-blind, placebo-controlled, multicentre trial in adult patients with septic shock recruited from six emergency departments in South Korea. Patients will be randomly allocated into the treatment or control group (1:1 ratio), and we will recruit 116 septic shock patients (58 per group). For the treatment group, vitamin C (50 mg/kg) and thiamine (200 mg) will be mixed in 50 ml of 0.9% saline and administered intravenously every 12 h for a total of 48 h. For the placebo group, an identical volume of 0.9% saline will be administered in the same manner. The primary outcome is the delta Sequential Organ Failure Assessment (SOFA) score (ΔSOFA = initial SOFA at enrolment - follow-up SOFA after 72 h). DISCUSSION: This trial will provide valuable evidence about the effectiveness of vitamin C and thiamine therapy for septic shock. If effective, this therapy might improve survival and become one of the main therapeutic adjuncts for patients with septic shock. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03756220 . Registered on 5 December 2018.


Assuntos
Ácido Ascórbico/administração & dosagem , Choque Séptico/tratamento farmacológico , Tiamina/administração & dosagem , Complexo Vitamínico B/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácido Ascórbico/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , República da Coreia , Choque Séptico/diagnóstico , Choque Séptico/mortalidade , Choque Séptico/fisiopatologia , Tiamina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Complexo Vitamínico B/efeitos adversos , Adulto Jovem
13.
Medicine (Baltimore) ; 98(29): e16365, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335682

RESUMO

RATIONALE: Complete small intestinal volvulus is a rare entity in adults, unlike partial intestinal volvulus. Although prompt surgical intervention is the mainstay of treatment, attention should also be paid to recovery of intestinal function postoperatively. Ignoring this issue during the postoperative recovery process can have serious consequences. We report the case of an 82-year-old woman with complete small intestinal volvulus at the root of the superior mesenteric vessel. PATIENTS CONCERNS: The patient was admitted for acute onset (22 hours) of abdominal pain and distention. Nausea and vomiting also developed during this period. DIAGNOSES: Abdominal physical examination was suspicious for peritoneal irritation. Computed tomography scan showed anticlockwise swirl of the mesenteric vessels at the lower margin of the pancreas with distension of the entire small intestine. A complete small intestinal volvulus was diagnosed. INTERVENTIONS: Laparotomy and detorsion of the volvulus were performed after early diagnosis. OUTCOMES: The patient developed intestinal wall edema because of ischemic-reperfusion damage. She exhibited severe abdominal distention and absent intestinal motility. Two days later, she went into septic shock; she died 19 days after surgical intervention. LESSONS: Because complete small intestinal volvulus involves the entire intestine, ischemic-reperfusion intestinal damage after detorsion may be severe and can predict prognosis.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Motilidade Gastrointestinal , Volvo Intestinal/cirurgia , Complicações Pós-Operatórias , Choque Séptico , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Evolução Fatal , Feminino , Humanos , Volvo Intestinal/diagnóstico , Volvo Intestinal/fisiopatologia , Intestino Delgado/fisiopatologia , Intestino Delgado/cirurgia , Laparotomia/efeitos adversos , Laparotomia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Choque Séptico/diagnóstico , Choque Séptico/etiologia
14.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(6): 680-683, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31315722

RESUMO

OBJECTIVE: To explore the correlation between major inflammatory factors and septic shock in intensive care unit (ICU) patients, and to provide a basis for the diagnosis and treatment of septic shock. METHODS: The patients admitted to ICU of the Third People's Hospital of Datong from March 2017 to August 2018 were selected as the research objects. According to the diagnostic criteria of septic shock, the patients were divided into septic shock group and non-septic group. The basic information and inflammatory factors levels of the two groups, including age, gender, body mass index (BMI), course of disease, acute physiology and chronic health evaluation II (APACHE II), infection site and pathogenic; and C-reactive protein (CRP), procalcitonin (PCT), neutrophil lymphocyte ratio (NLR), N-terminal pro-B-type natriuretic peptide (NT-proBNP), tumor necrosis factor-α (TNF-α), γ-interferon (IFN-γ), interleukins (IL-1ß, IL-2, IL-6, IL-8) at 8 hours after diagnosis, were compared. Logistic regression was used to analyze the influencing factors of septic shock in ICU patients. RESULTS: A total of 154 ICU patients were selected, of whom 74 had septic shock. The APACHE II score of septic shock group was significantly higher than that of non-sepsis group (23.42±3.64 vs. 15.67±2.26, P < 0.05). There was no significant difference in other baseline data between the two groups. The levels of CRP, NT-proBNP, TNF-α, IFN-γ, PCT, IL-6, IL-8 in the septic shock group were significantly higher than those in the non-septic group [CRP (mg/L): 164.3±22.6 vs. 52.3±16.2, NT-proBNP (ng/L): 426.3±288.9 vs. 167.3±80.6, TNF-α (ng/L): 193.4±39.3 vs. 88.1±20.3, IFN-γ (ng/L): 133.3±52.0 vs. 97.0±56.1, PCT (ng/L): 27.6±10.2 vs. 7.3±4.1, IL-6 (ng/L): 83.0±17.6 vs. 20.9±6.4, IL-8 (ng/L): 445.8±34.0 vs. 84.0±25.7, all P < 0.05]. It was shown by Logistic regression analysis that CRP, NT-proBNP, TNF-α, PCT, IL-6 were independent risk factors for septic shock [CRP: odds ratio (OR) = 1.662, 95% confidence interval (95%CI) = 1.132-2.567; NT-proBNP: OR = 14.688, 95%CI = 3.580-20.238; TNF-α: OR = 1.093, 95%CI = 1.043-1.343; PCT: OR = 6.378, 95%CI = 4.556-12.243; IL-6: OR = 9.641, 95%CI = 2.242-13.786; all P < 0.05]. CONCLUSIONS: The levels of inflammatory factors CRP, NT-proBNP, TNF-α, PCT and IL-6 were significantly increased, which were important factors for early diagnosis of septic shock.


Assuntos
Choque Séptico/diagnóstico , Choque Séptico/metabolismo , APACHE , Proteína C-Reativa/metabolismo , Feminino , Humanos , Unidades de Terapia Intensiva , Interleucina-6/metabolismo , Masculino , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Pró-Calcitonina/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
15.
BMC Infect Dis ; 19(1): 660, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340776

RESUMO

BACKGROUND: Rapid diagnosis and appropriate treatment is imperative in bacterial sepsis due increasing risk of mortality with every hour without appropriate antibiotic therapy. Atypical infections with fastidious organisms may take more than 4 days to diagnose leading to calls for improved methods for rapidly diagnosing sepsis. Capnocytophaga canimorsus is a slow-growing, fastidious gram-negative bacillus which is a common commensal within the mouths of dogs, but rarely cause infections in humans. C. canimorsus sepsis risk factors include immunosuppression, alcoholism and elderly age. Here we report on the application of emerging nanopore sequencing methods to rapidly diagnose an atypical case of C. canimorsus septic shock. CASE PRESENTATION: A 62 year-old female patient was admitted to an intensive care unit with septic shock and multi-organ failure six days after a reported dog bite. Blood cultures were unable to detect a pathogen after 3 days despite observed intracellular bacilli on blood smears. Real-time nanopore sequencing was subsequently employed on whole blood to detect Capnocytophaga canimorsus in 19 h. The patient was not immunocompromised and did not have any other known risk factors. Whole-genome sequencing of clinical sample and of the offending dog's oral swabs showed near-identical C. canimorsus genomes. The patient responded to antibiotic treatment and was discharged from hospital 31 days after admission. CONCLUSIONS: Use of real-time nanopore sequencing reduced the time-to-diagnosis of Capnocytophaga canimorsus in this case from 6.25 days to 19 h. Capnocytophaga canimorsus should be considered in cases of suspected sepsis involving cat or dog contact, irrespective of the patient's known risk factors.


Assuntos
Mordeduras e Picadas/complicações , Capnocytophaga/isolamento & purificação , Choque Séptico/diagnóstico , Animais , Antibacterianos/uso terapêutico , Capnocytophaga/efeitos dos fármacos , Capnocytophaga/genética , Gatos , Cães , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/imunologia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Nanoporos , Análise de Sequência de DNA , Choque Séptico/imunologia , Choque Séptico/microbiologia
16.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 505-513, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31290240

RESUMO

OBJECTIVE: To determine whether admission venous plasma lactate concentration, calculated lactate variables, or shock index (SI) could discriminate hospital survivors from nonsurvivors in dogs admitted with shock. DESIGN: Prospective investigation performed over a 19-month period. SETTING: Large urban private teaching hospital. ANIMALS: Twenty-three dogs consecutively admitted to the ICU from January 2008 to July 2009 with initial peripheral venous plasma lactate concentration >2 mmol/L (18.0 mg/dL) and clinical and hemodynamic parameters consistent with shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Heart rate, systolic blood pressure, and venous plasma lactate concentrations were serially recorded at predefined time points and used to calculate SI (SI = heart rate/systolic blood pressure) and lactate variables, including lactime (time lactate > 2.0 mmol/L), lactate clearance ([lactateinitial - lactatedelayed ]/lactateinitial × 100), and LACAREA (area under the lactate concentration versus time curve). Primary outcome was survival to discharge. Overall survival rate was 61%. Admission venous plasma lactate concentration did not differ between groups (P = 0.2). Lactime was shorter in survivors versus nonsurvivors (P = 0.02). Lactate clearance at 1, 10, 16, 24, and 36 hours, and final lactate clearance were greater in survivors versus nonsurvivors (P < 0.05). LACAREA at time intervals 0-1, 1-4, 4-10, 10-16, 16-24, 24-30, and 30-36 hours was larger in nonsurvivors versus survivors (P < 0.05). Total LACAREA did not differ between groups (P = 0.09). Admission SI and time to normalize SI (SI < 0.9) were not different between survivors and nonsurvivors (P > 0.05). CONCLUSIONS: While admission venous plasma lactate concentration could not discriminate between hospital survivors and nonsurvivors, lactate variables showed clinical utility to predict outcome in dogs with shock. Further studies are needed to determine SI reference ranges and optimal SI cut-off values to improve its prognostic ability in sick dogs.


Assuntos
Doenças do Cão/diagnóstico , Ácido Láctico/sangue , Choque Séptico/veterinária , Animais , Doenças do Cão/sangue , Doenças do Cão/mortalidade , Cães , Feminino , Masculino , New York , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Choque Séptico/sangue , Choque Séptico/diagnóstico , Análise de Sobrevida
17.
Dtsch Med Wochenschr ; 144(13): 884-891, 2019 07.
Artigo em Alemão | MEDLINE | ID: mdl-31252442

RESUMO

Diagnosing and managing patients in shock is a challenge for the treating clinicians in acute medicine. Early diagnosis and treatment are crucial. Mortality of septic shock is between 40 % and 60 %, and that of the cardiogenic shock about 40 %. This article provides an overview of diagnostic approaches to the patient in shock, different aetiologies and treatment strategies, and it guides the clinician through the management from first contact until definite treatment.


Assuntos
Anafilaxia , Choque Cardiogênico , Choque Séptico , Doença Aguda , Anafilaxia/diagnóstico , Anafilaxia/fisiopatologia , Anafilaxia/terapia , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Humanos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Choque Séptico/diagnóstico , Choque Séptico/fisiopatologia , Choque Séptico/terapia
19.
Jpn J Infect Dis ; 72(5): 347-349, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31155601

RESUMO

An 84-year-old man with chronic renal failure, anemia, and diabetes was admitted for hemodialysis initiation. His vital signs were stable until the eighteenth hospital day, before acquiring an influenza A virus infection. Three days later, he died of septic shock with severe liver impairment. His leukocyte count, prothrombin time (PT-INR), and liver enzyme levels such as aspartate transaminase and alanine aminotransferase, were significantly increased. Hypercytokinemia was also observed. Autopsy revealed bilateral diffuse pneumonia with neutrophil infiltration. The liver showed extensive centrilobular hepatocyte necrosis. Immunohistochemistry for influenza A nucleoprotein revealed positivity in the ciliated columnar epithelium of the bronchi and negativity in the trachea, lungs, and liver. Hypoxic hepatitis is characterized by an abrupt and massive increase in aminotransferase levels (> 20 times upper normal limit) due to anoxic centrilobular hepatocyte necrosis. The occurrence of hypoxic hepatitis requires a pre-existing, chronic condition, such as anemia, causing reduced oxygen supply to the liver, followed by an acute decrease in hepatic oxygen supply, such as septic shock. Therefore, this report suggests that hypoxic hepatitis can be an important causative factor for acute liver failure associated with influenza virus infection.


Assuntos
Influenza Humana/complicações , Falência Hepática Aguda/diagnóstico , Falência Hepática Aguda/patologia , Choque Séptico/diagnóstico , Choque Séptico/patologia , Idoso de 80 Anos ou mais , Anemia/complicações , Autopsia , Complicações do Diabetes , Evolução Fatal , Humanos , Vírus da Influenza A , Falência Renal Crônica/complicações , Masculino , Choque Séptico/complicações
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