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1.
Braz. j. biol ; 84: e253065, 2024. tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1350311

RESUMO

Abstract Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.


Resumo A cultura sanguínea de rotina é usada para a detecção de infecções na corrente sanguínea por bactérias aeróbias e anaeróbias e por leveduras patogênicas comuns. Estudo retrospectivo realizado em hospital público de Maceió-AL, por meio da coleta de dados de todos os prontuários com culturas sanguíneas positivas. Das 2.107 culturas sanguíneas realizadas, 17% foram positivas com Staphylococcus coagulase negativo (51,14%), seguido por Staphylococcus aureus (11,21%) e Klebsiella pneumoniae (6,32%). As bactérias Gram-positiva predominaram entre as culturas de sangue positivas, destacando-se o grupo das Staphylococcus coagulase-negativo. Enquanto as bactérias Gram-negativas apresentaram um número maior de espécies entre as culturas de sangue positivas.


Assuntos
Humanos , Sepse , Bactérias Gram-Negativas , Brasil , Estudos Retrospectivos , Hospitais
2.
Emerg Med J ; 39(4): 270-271, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34362823
3.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-49160

RESUMO

Uma doença grave, ainda pouco conhecida pela população. A sepse, também chamada de infecção generalizada, é uma enfermidade que se não tratada de forma precoce e imediata, se espalha rapidamente pelo corpo e afeta o sistema imunológico, dificultando o funcionamento dos órgãos.


Assuntos
Sepse/diagnóstico , Diagnóstico Precoce
4.
J Pediatr ; 247: 176-180, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-36058601
5.
Mol Med ; 28(1): 103, 2022 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-36058905

RESUMO

BACKGROUND: Acute kidney injury (AKI) is still a critical problem in clinical practice, with a heavy burden for national health system around the world. It is notable that sepsis is the predominant cause of AKI for patients in the intensive care unit and the mortality remains considerably high. The treatment for AKI relies on supportive therapies and almost no specific treatment is currently available. Spermidine is a naturally occurring polyamine with pleiotropic effects. However, the renoprotective effect of spermidine and the underlying mechanism remain elusive. METHODS: We employed mice sepsis-induced AKI model and explored the potential renoprotective effect of spermidine in vivo with different administration time and routes. Macrophage depleting was utilized to probe the role of macrophage. In vitro experiments were conducted to examine the effect of spermidine on macrophage cytokine secretion, NLRP3 inflammasome activation and mitochondrial respiration. RESULTS: We confirmed that spermidine improves AKI with different administration time and routes and that macrophages serves as an essential mediator in this protective effect. Meanwhile, spermidine downregulates NOD-like receptor protein 3 (NLRP3) inflammasome activation and IL-1 beta production in macrophages directly. Mechanically, spermidine enhances mitochondrial respiration capacity and maintains mitochondria function which contribute to the NLRP3 inhibition. Importantly, we showed that eukaryotic initiation factor 5A (eIF5A) hypusination plays an important role in regulating macrophage bioactivity. CONCLUSIONS: Spermidine administration practically protects against sepsis-induced AKI in mice and macrophages serve as an essential mediator in this protective effect. Our study identifies spermidine as a promising pharmacologic approach to prevent AKI.


Assuntos
Injúria Renal Aguda , Sepse , Injúria Renal Aguda/metabolismo , Animais , Modelos Animais de Doenças , Inflamassomos/metabolismo , Macrófagos , Camundongos , Camundongos Endogâmicos C57BL , Mitocôndrias/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Proteínas NLR/metabolismo , Fatores de Iniciação de Peptídeos/metabolismo , Fatores de Iniciação de Peptídeos/farmacologia , Fatores de Iniciação de Peptídeos/uso terapêutico , Respiração , Sepse/metabolismo , Espermidina/metabolismo , Espermidina/farmacologia , Espermidina/uso terapêutico
6.
Eur J Emerg Med ; 29(5): 348-356, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36062434

RESUMO

BACKGROUND AND IMPORTANCE: Sepsis is a common and potentially lethal syndrome, and early recognition is critical to prevent deterioration. Yet, currently available scores to facilitate recognition of sepsis lack prognostic accuracy. OBJECTIVE: To identify the optimal time-point to determine NEWS, qSOFA and SIRS for the prediction of clinical deterioration in early sepsis and to determine whether the change in these scores over time improves their prognostic accuracy. DESIGN: Post hoc analysis of prospectively collected data. SETTINGS AND PARTICIPANTS: This study was performed in the emergency department (ED) of a tertiary-care teaching hospital. Adult medical patients with (potential) sepsis were included. OUTCOME MEASURES AND ANALYSIS: The primary outcome was clinical deterioration within 72 h after admission, defined as organ failure development, the composite outcome of ICU-admission and death. Secondary outcomes were the composite of ICU-admission/death and a rise in SOFA at least 2. Scores were calculated at the ED with 30-min intervals. ROC analyses were constructed to compare the prognostic accuracy of the scores. RESULTS: In total, 1750 patients were included, of which 360 (20.6%) deteriorated and 79 (4.5%) went to the ICU or died within 72 h. The NEWS at triage (AUC, 0.62; 95% CI, 0.59-0.65) had a higher accuracy than qSOFA (AUC, 0.60; 95% CI, 0.56-0.63) and SIRS (AUC, 0.59; 95% CI, 0.56-0.63) for predicting deterioration. The AUC of the NEWS at 1 h (0.65; 95% CI, 0.63-0.69) and 150 min after triage (0.64; 95% CI, 0.61-0.68) was higher than the AUC of the NEWS at triage. The qSOFA had the highest AUC at 90 min after triage (0.62; 95% CI, 0.58-0.65), whereas the SIRS had the highest AUC at 60 min after triage (0.60; 95% CI, 0.56-0.63); both are not significantly different from triage. The NEWS had a better accuracy to predict ICU-admission/death <72 h compared with qSOFA (AUC difference, 0.092) and SIRS (AUC difference, 0.137). No differences were found for the prediction of a rise in SOFA at least 2 within 72 h between the scores. Patients with the largest improvement in any of the scores were more prone to deteriorate. CONCLUSION: NEWS had a higher prognostic accuracy to predict deterioration compared with SIRS and qSOFA; the highest accuracy was reached at 1 h after triage.


Assuntos
Deterioração Clínica , Escore de Alerta Precoce , Sepse , Adulto , Mortalidade Hospitalar , Humanos , Escores de Disfunção Orgânica , Prognóstico , Estudos Retrospectivos , Sepse/complicações , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
7.
J Nanobiotechnology ; 20(1): 405, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064371

RESUMO

BACKGROUND: Septic heart failure accounts for high mortality rates globally. With a strong reducing capacity, zero-valent iron nanoparticles (nanoFe) have been applied in many fields. However, the precise roles and mechanisms of nanoFe in septic cardiomyopathy remain unknown. RESULTS: NanoFe was prepared via the liquid-phase reduction method and functionalized with the biocompatible polymer sodium carboxymethylcellulose (CMC). We then successfully constructed a mouse model of septic myocardial injury by challenging with cecal ligation and puncture (CLP). Our findings demonstrated that nanoFe has a significant protective effect on CLP-induced septic myocardial injury. This may be achieved by attenuating inflammation and oxidative stress, improving mitochondrial function, regulating endoplasmic reticulum stress, and activating the AMPK pathway. The RNA-seq results supported the role of nanoFe treatment in regulating a transcriptional profile consistent with its role in response to sepsis. CONCLUSIONS: The results provide a theoretical basis for the application strategy and combination of nanoFe in sepsis and septic myocardial injury.


Assuntos
Insuficiência Cardíaca , Traumatismos Cardíacos , Nanopartículas , Sepse , Animais , Insuficiência Cardíaca/metabolismo , Ferro , Camundongos , Miocárdio/metabolismo , Sepse/metabolismo
8.
J Nanobiotechnology ; 20(1): 400, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064405

RESUMO

BACKGROUND: Sepsis is caused mainly by infection in the blood with a broad range of bacterial species. It can be diagnosed by molecular diagnostics once compounds in the blood that interfere with molecular diagnostics are removed. However, this removal relies on ultracentrifugation. Immunomagnetic separation (IMS), which typically uses antibody-conjugated silica-coated magnetic nanoparticles (Ab-SiO2-MNPs), has been widely applied to isolate specific pathogens in various types of samples, such as food and environmental samples. However, its direct use in blood samples containing bacteria is limited due to the aggregation of SiO2-MNPs in the blood and inability to isolate multiple species of bacteria causing sepsis. RESULTS: In this study, we report the synthesis of vancomycin-conjugated polydopamine-coated (van-PDA-MNPs) enabling preconcentration of multiple bacterial species from blood without aggregation. The presence of PDA and van on MNPs was verified using transmission electron microscopy, X-ray photoelectron spectroscopy, and energy disruptive spectroscopy. Unlike van-SiO2-MNPs, van-PDA-MNPs did not aggregate in the blood. Van-PDA-MNPs were able to preconcentrate several species of Gram-positive bacteria in the blood, lowering the limit of detection (LOD) to 10 colony forming units/mL by polymerase chain reaction (PCR) and quantitative PCR (qPCR). This is 10 times more sensitive than the LOD obtained by PCR and qPCR using van-SiO2-MNPs. CONCLUSION: These results suggest that PDA-MNPs can avoid aggregation in blood and be conjugated with receptors, thereby improving the sensitivity of molecular diagnostics of bacteria in blood samples.


Assuntos
Nanopartículas de Magnetita , Sepse , Bactérias , Bactérias Gram-Positivas , Humanos , Indóis , Nanopartículas de Magnetita/química , Patologia Molecular , Polímeros , Dióxido de Silício , Vancomicina/química
9.
Crit Care ; 26(1): 265, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064438

RESUMO

BACKGROUND: Adequate antibiotic dosing may improve outcomes in critically ill patients but is challenging due to altered and variable pharmacokinetics. To address this challenge, AutoKinetics was developed, a decision support system for bedside, real-time, data-driven and personalised antibiotic dosing. This study evaluates the feasibility, safety and efficacy of its clinical implementation. METHODS: In this two-centre randomised clinical trial, critically ill patients with sepsis or septic shock were randomised to AutoKinetics dosing or standard dosing for four antibiotics: vancomycin, ciprofloxacin, meropenem, and ceftriaxone. Adult patients with a confirmed or suspected infection and either lactate > 2 mmol/L or vasopressor requirement were eligible for inclusion. The primary outcome was pharmacokinetic target attainment in the first 24 h after randomisation. Clinical endpoints included mortality, ICU length of stay and incidence of acute kidney injury. RESULTS: After inclusion of 252 patients, the study was stopped early due to the COVID-19 pandemic. In the ciprofloxacin intervention group, the primary outcome was obtained in 69% compared to 3% in the control group (OR 62.5, CI 11.4-1173.78, p < 0.001). Furthermore, target attainment was faster (26 h, CI 18-42 h, p < 0.001) and better (65% increase, CI 49-84%, p < 0.001). For the other antibiotics, AutoKinetics dosing did not improve target attainment. Clinical endpoints were not significantly different. Importantly, higher dosing did not lead to increased mortality or renal failure. CONCLUSIONS: In critically ill patients, personalised dosing was feasible, safe and significantly improved target attainment for ciprofloxacin. TRIAL REGISTRATION: The trial was prospectively registered at Netherlands Trial Register (NTR), NL6501/NTR6689 on 25 August 2017 and at the European Clinical Trials Database (EudraCT), 2017-002478-37 on 6 November 2017.


Assuntos
COVID-19 , Sepse , Choque Séptico , Adulto , Antibacterianos , Ciprofloxacina/uso terapêutico , Estado Terminal/terapia , Humanos , Pandemias , Sepse/tratamento farmacológico , Choque Séptico/tratamento farmacológico
10.
Int J Nanomedicine ; 17: 3809-3820, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36072961

RESUMO

Introduction: Free radicals in oxidative stress are known to play a pathogenic role in sepsis. A major clinical challenge associated with sepsis is sepsis-associated encephalopathy (SAE). The rapid increase of free radicals in the brain promotes SAE progression. Here, macromolecule free radicals in the mouse brain were uniquely detected by immunospin trapping (IST) and magnetic resonance imaging (MRI). Methods: The new strategy uses spin trapping agent DEPMPO-biotin to capture macromolecule free radicals in lesions and form biotin-DEPMPO-radical adducts. Then, a targeting MRI probe, avidin-BSA@Gd-ESIO, was used to detect the radical adducts through the highly specific binding of avidin and biotin. The avidin-BSA@Gd-ESIO probe was synthesized and systematically characterized. The detection capability of the new strategy was evaluated in vitro and in vivo using a confocal microscope and a 7T MRI, respectively. Results: In reactive oxygen species (ROS)-induced microglial cells, the accumulation of the avidin-BSA@Gd-ESIO probe in the DEPMPO-biotin-treated group was significantly higher than that of control groups. In vivo MRI T1 signal intensities were significantly higher within the hippocampus, striatum, and medial cortex of the brain in mice with a mild or severe degree of sepsis compared with the sham control group. Histological analysis validated that the distribution of the avidin-BSA@Gd-ESIO probe in brain tissue slices was consistent with the MRI images. The fluorescence signals of ROS and avidin-BSA@Gd-ESIO probe were overlapped and visualized using immunofluorescent staining. By evaluating the T1 signal changes over time in different areas of the brain, we estimated the optimal MRI detection time to be 30 minutes after the probe administration. Discussion: This method can be applied specifically to assess the level of macromolecular free radicals in vivo in a simple and stable manner, providing a pathway for a more comprehensive understanding of the role of free radicals in SAE.


Assuntos
Encefalopatia Associada a Sepse , Sepse , Animais , Avidina , Biotina , Radicais Livres/química , Substâncias Macromoleculares , Imageamento por Ressonância Magnética/métodos , Camundongos , Espécies Reativas de Oxigênio , Sepse/complicações , Sepse/diagnóstico por imagem , Detecção de Spin/métodos
11.
Oxid Med Cell Longev ; 2022: 1328729, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36062193

RESUMO

Dysregulated host response to infection, which cause life-threatening organ dysfunction, was defined as sepsis. Sepsis can cause acute and long-term brain dysfunction, namely, sepsis-associated encephalopathy (SAE) and cognitive impairment. SAE refers to changes in consciousness without direct evidence of central nervous system infection. It is highly prevalent and may cause poor outcomes in sepsis patients. Cognitive impairment seriously affects the life quality of sepsis patients and increases the medical burden. The pathogenesis of sepsis-induced brain dysfunction is mainly characterized by the interaction of systemic inflammation, blood-brain barrier (BBB) dysfunction, neuroinflammation, microcirculation dysfunction, and brain dysfunction. Currently, the diagnosis of sepsis-induced brain dysfunction is based on clinical manifestation of altered consciousness along with neuropathological examination, and the treatment is mainly involves controlling sepsis. Although treatments for sepsis-induced brain dysfunction have been tested in animals, clinical treat sepsis-induced brain dysfunction is still difficult. Therefore, we review the underlying mechanisms of sepsis-induced brain injury, which mainly focus on the influence of systemic inflammation on BBB, neuroinflammation, brain microcirculation, and the brain function, which want to bring new mechanism-based directions for future basic and clinical research aimed at preventing or ameliorating brain dysfunction.


Assuntos
Lesões Encefálicas , Encefalopatia Associada a Sepse , Sepse , Animais , Encéfalo/patologia , Lesões Encefálicas/complicações , Inflamação/patologia , Sepse/complicações , Sepse/diagnóstico , Sepse/tratamento farmacológico , Encefalopatia Associada a Sepse/complicações , Encefalopatia Associada a Sepse/diagnóstico , Encefalopatia Associada a Sepse/terapia
12.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 44(4): 592-599, 2022 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-36065691

RESUMO

Objective To explore the prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) in predicting mortality within 28 days among sepsis patients,and to investigate the risk factors of hs-cTnT elevation. Methods The clinical and laboratory data of patients with sepsis or septic shock who were hospitalized at the Second Affiliated Hospital of Chongqing Medical University from December 2017 to September 2021 were collected and retrospectively analyzed.The patients were assigned into a hs-cTnT elevated group (hs-cTnT>0.1 ng/ml) and a hs-cTnT non-elevated group (hs-cTnT≤0.1 ng/ml).The prognosis was compared between the two groups and the risk factors of hs-cTnT elevation were determined. Results A total of 225 patients were included in this study,including 49 in hs-cTnT elevated group (21.8%) and 176 in hs-cTnT non-elevated group (78.2%).The receiver operating characteristic curve showed that maximum hs-cTnT had predictive value for death within 28 days (P<0.001).The maximum hs-cTnT showed the area under the receiver operating characteristic curve of 0.767 (95%CI=0.699-0.835),the sensitivity of 62.5%,and the specificity of 79.9%.The mortality within 28 days of hs-cTnT elevated group was higher than that of hs-cTnT non-elevated group (53.1% vs. 17.0%, χ2=26.595, P<0.001).Multivariate Logistic regression analysis revealed that the independent predictors of hs-cTnT elevation were age ≥75.5 years (OR=5.990, 95%CI=2.143-16.742, P=0.001),lactate ≥4.05 mmol/L (OR=4.982,95%CI=1.433-17.315,P=0.012),oxygenation index ≤169.15 mmHg (OR=5.052, 95%CI=1.888-13.514, P=0.001),B-type brain natriuretic peptide precursor ≥6 687.0 pg/ml (OR=5.991, 95%CI=2.226-16.128, P<0.001),fibrinogen ≤2.87 g/L (OR=3.325,95%CI=1.175-9.404, P=0.024),and International Society on Thrombosis and Haemostasis overt disseminated intravascular coagulation score ≥5.5 (OR=7.631, 95%CI=1.157-50.338, P=0.035). Conclusions hs-cTnT showed good performance in predicting mortality within 28 days among the patients with sepsis.Coagulation disorder,microthrombus formation,and myocardial oxygen supply-demand mismatch may be the risk factors of myocardial injury in sepsis.


Assuntos
Sepse , Troponina T , Idoso , Humanos , Peptídeo Natriurético Encefálico , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sepse/diagnóstico
13.
Med Sci Monit ; 28: e937784, 2022 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-36068726

RESUMO

BACKGROUND Acute kidney injury (AKI) is one of the most common organ failures. An early diagnosis of AKI using specific biomarkers is essential for effective treatment. This study determined the serum concentrations of selected amino acids and amines using targeted liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) in patients with AKI during sepsis and septic shock treated in the Intensive Care Unit (ICU). MATERIAL AND METHODS A sample of 41 patients was divided into 2 groups: (1) patients with sepsis and septic shock along required continuous renal replacement therapy (CRRT) due to AKI (n=13), and (2) patients with sepsis and septic shock but without AKI (n=28). LC-MS/MS was used to measure a serum concentration of 6 amino acids and amines: arginine, ornithine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), dimethylamine (DMA), and citrulline. RESULTS There was a statistically significantly higher median DMA level in AKI patients compared to those without AKI (8.1 vs 5.2 umol/L; P=0.022). The results for the remaining molecules showed no significant differences (P>0.05). Patients with DMA ≥14.95 umol/L (n=5; 100%) and treated with CRRT presented DMA level below the cut-off point (n=7; 20%). Subjects with creatinine levels ≥1.19 mg/dL (n=11; 28%) and treated with CRRT presented creatinine levels below the cut-off point (n=1; 3%). CONCLUSIONS In patients with sepsis, increased serum levels of DMA were significantly associated with AKI requiring CRRT. It remains unclear whether increased DMA concentrations are secondary to sepsis-induced AKI or are a cause.


Assuntos
Injúria Renal Aguda , Terapia de Substituição Renal Contínua , Sepse , Choque Séptico , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Aminas , Aminoácidos , Cromatografia Líquida , Creatinina , Dimetilaminas , Humanos , Unidades de Terapia Intensiva , Terapia de Substituição Renal , Estudos Retrospectivos , Sepse/complicações , Sepse/terapia , Choque Séptico/complicações , Espectrometria de Massas em Tandem
14.
Immunobiology ; 227(5): 152264, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36049364

RESUMO

BACKGROUND: Despite the dysregulation and function of G-quadruplex-forming sequence containing lncRNA (GSEC) have been widely reported in human cancers, there are few available data revealing its role in sepsis. OBJECTIVE: To assess the expression and function of GSEC in the development of sepsis and its potential molecular mechanism. MATERIALS AND METHODS: A total of 78 sepsis patients, 55 non-sepsis intensive care unit patients, and 42 healthy individuals were enrolled in this study. The expression of GSEC was evaluated in plasma and macrophage cells with polymerase chain reaction. The inflammation response of sepsis patients and macrophage cells was analyzed with an enzyme-linked immunosorbent assay. The diagnostic and prognostic value of GSEC in sepsis patients were estimated by receiver operator curve (ROC) and Cox analysis. The molecular mechanism underlying the function of GSEC was investigated in RAW264.7 cell with luciferase reporter assay and cell transfection. RESULTS: Significant upregulation of GSEC was observed in sepsis patients' plasma, which could discriminate sepsis patients from healthy and non-sepsis individuals. Upregulation of GSEC was positively correlated with inflammation cytokine levels and adverse prognosis of sepsis patients. In vitro, GSEC was found to modulate the expression level of miR-873-3p, which mediated the regulatory effect of GSEC on the inflammation and proliferation of RAW264.7. CONCLUSION: Upregulated GSEC could serve as a biomarker of sepsis pathogenesis and development. GSEC regulates the inflammation and proliferation of macrophage cells through modulating miR-873-3p.


Assuntos
MicroRNAs , RNA Longo não Codificante , Sepse , Animais , Proliferação de Células , Humanos , Inflamação/metabolismo , Camundongos , MicroRNAs/genética , Prognóstico , Células RAW 264.7 , RNA Longo não Codificante/genética , Sepse/diagnóstico , Sepse/genética
15.
Sci Rep ; 12(1): 14906, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36050403

RESUMO

The coronavirus disease (COVID-19) pandemic caused unprecedented research activity all around the world but publications from Central-Eastern European countries remain scarce. Therefore, our aim was to characterise the features of the pandemic in the intensive care units (ICUs) among members of the SepsEast (Central-Eastern European Sepsis Forum) initiative. We conducted a retrospective, international, multicentre study between March 2020 and February 2021. All adult patients admitted to the ICU with pneumonia caused by COVID-19 were enrolled. Data on baseline and treatment characteristics, organ support and mortality were collected. Eleven centres from six countries provided data from 2139 patients. Patient characteristics were: median 68, [IQR 60-75] years of age; males: 67%; body mass index: 30.1 [27.0-34.7]; and 88% comorbidities. Overall mortality was 55%, which increased from 2020 to 2021 (p = 0.004). The major causes of death were respiratory (37%), cardiovascular (26%) and sepsis with multiorgan failure (21%). 1061 patients received invasive mechanical ventilation (mortality: 66%) without extracorporeal membrane oxygenation (n = 54). The rest of the patients received non-invasive ventilation (n = 129), high flow nasal oxygen (n = 317), conventional oxygen therapy (n = 122), as the highest level of ventilatory support, with mortality of 50%, 39% and 22%, respectively. This is the largest COVID-19 dataset from Central-Eastern European ICUs to date. The high mortality observed especially in those receiving invasive mechanical ventilation renders the need of establishing national-international ICU registries and audits in the region that could provide high quality, transparent data, not only during the pandemic, but also on a regular basis.


Assuntos
COVID-19 , Síndrome do Desconforto Respiratório , Insuficiência Respiratória , Sepse , Adulto , COVID-19/epidemiologia , COVID-19/terapia , Humanos , Unidades de Terapia Intensiva , Masculino , Oxigênio , Sistema de Registros , Respiração Artificial , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos , SARS-CoV-2 , Sepse/epidemiologia
16.
Sci Rep ; 12(1): 14857, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36050405

RESUMO

Initial differential diagnosis and prognosis for patients admitted to intensive care with suspected sepsis remain arduous. Hepcidin has emerged as a potential biomarker for sepsis. Here we report data on the relevance of levels of hepcidin versus other biomarkers as a diagnostic and prognostic tool for sepsis. 164 adult patients admitted to the intensive care unit (ICU) within 24 h upon arrival to the hospital were included. Blood samples collected daily for seven consecutive days and hepcidin levels, heparin binding protein (HBP) levels and standard biomarkers were determined. Blood cultures were initiated at inclusion. Clinical scores were evaluated daily and mortality after 28- and 180-days was recorded. One hundred of the patients were found to fulfil the criteria for sepsis whereas 64 did not. Hepcidin levels at admission were significantly higher in the septic than in the non-septic patients. In septic patients hepcidin levels declined significantly already at 24 h followed by a steady decline. A significant negative correlation was observed between hepcidin levels and SAPS 3 in patients with sepsis. Hepcidin levels at inclusion were significantly higher among septic patients that survived 180-days and predicted mortality. Our data show that hepcidin levels are indicative of sepsis in patients admitted to the ICU and has a prognostic value for mortality.


Assuntos
Sepse , Choque Séptico , Adulto , Biomarcadores , Cuidados Críticos , Estado Terminal , Hepcidinas , Humanos , Unidades de Terapia Intensiva , Prognóstico
17.
Sci Rep ; 12(1): 14866, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36050427

RESUMO

Perianal abscesses are frequent diseases in general surgery. Principles of standard patient care are surgical drainage with exploration and concomitant treatment of fistula. Antiinfective therapy is frequently applied in cases of severe local disease and perianal sepsis. However, the role of microbiologic testing of purulence from perianal abscesses is disputed and the knowledge concerning bacteriology and bacterial resistances is very limited. A retrospective cohort study was performed of consecutive patients (≥ 12 years of age) from a tertiary care hospital, who underwent surgical treatment for perianal abscess from 01/2008 to 12/2019. Subdividing the cohort into three groups regarding microbiological testing results: no microbiological testing of purulence (No_Swab, n = 456), no detection of drug resistant bacteria [DR(-), n = 141] or detection of bacteria with acquired drug resistances from purulence [DR(+), n = 220]. Group comparisons were performed using Kruskall-Wallis test and, if applicable, followed by Dunn´s multiple comparisons test for continuous variables or Fishers exact or Pearson's X2 test for categorical data. Fistula persistence was estimated by Kaplan Meier and compared between the groups using Log rank test. Corralation analysis between perioperative outcome parameters and bacteriology was performed using Spearman´s rho rank correlation. Higher pretherapeutic C-reactive protein (p < 0.0001) and white blood cell count (p < 0.0001), higher rates of supralevatoric or pararectal abscesses (p = 0.0062) and of complicated fistula-in-ano requiring drainage procedure during index surgery (p < 0.0001) reflect more severe diseases in DR(+) patients. The necessity of antibiotic therapy (p < 0.0001), change of antibiotic regimen upon microbiologic testing results (p = 0.0001) and the rate of re-debridements during short-term follow-up (p = 0.0001) were the highest, the duration until definitive fistula repair was the longest in DR(+) patients (p = 0.0061). Escherichia coli, Bacteroides, Streptococcus and Staphylococcus species with acquired drug resistances were detected frequently. High rates of resistances against everyday antibiotics, including perioperative antibiotic prophylaxis were alarming. In conclusion, the knowledge about individual bacteriology is relevant in cases of complex and severe local disease, including locally advanced infection with extended soft tissue affection and perianal sepsis, signs of systemic inflammatory response as well as the need of re-do surgery for local debridements during short-term and fistula repair during long-term follow-up. Higher rates of acquired antibiotic resistances are to be expected in patients with more severe diseases.


Assuntos
Doenças do Ânus , Sepse , Dermatopatias , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Antibacterianos/uso terapêutico , Doenças do Ânus/diagnóstico , Doenças do Ânus/tratamento farmacológico , Doenças do Ânus/cirurgia , Bactérias , Humanos , Estudos Retrospectivos , Sepse/tratamento farmacológico , Dermatopatias/tratamento farmacológico , Resultado do Tratamento
18.
Sci Rep ; 12(1): 14846, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36050441

RESUMO

Pediatric osteomyelitis is an insidious disease that can lead to permanent sequelae, the management of which still relies on lengthy intravenous antibiotic therapy. The purpose of this study is to report and describe the clinical course and outcome of pediatric bacterial osteomyelitis in our experience. We reported the clinical, diagnostic, and treatment characteristics of all cases of osteomyelitis in children younger than 18 years of age who were hospitalized between January 2010 and December 2021 at the Bambino Gesù Children's Hospital in Rome, Italy, we compared patients with and without complications at follow-up, to identify any predictive factor for sequelae. The study sample included 319 cases of pediatric bacterial osteomyelitis. The median age was 7.77 years. Males (60.8%) were more affected than females. The most affected bones were the femur, tibia, and spine. Etiology was identified in 40.1% of cases, with S.aureus as the most common causative agent. Sequelae were reported in 43 cases (13.5%). The main predictors of sequelae were sepsis on admission and hypergammaglobulinemia. Our results show that a severe presentation with sepsis and hypergammaglobulinemia on admission may be associated with a higher frequency of late sequelae. Early recognition and aggressive treatment of this subgroup of patients may lead to a reduction in complications.


Assuntos
Infecções Bacterianas , Osteomielite , Sepse , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Criança , Progressão da Doença , Feminino , Humanos , Hipergamaglobulinemia/complicações , Hipergamaglobulinemia/tratamento farmacológico , Lactente , Masculino , Osteomielite/complicações , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Estudos Retrospectivos , Sepse/complicações , Staphylococcus aureus
19.
Biomed Pharmacother ; 153: 113442, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36076557

RESUMO

Sepsis caused by infection could induce systemic inflammation and various organ damages. Bioactivities of peptides derived from eggs were proved by lots of researchers; hence they might be further developed for therapeutic use. In this study, the hydrolysate named "PEP" was obtained by enzymatic hydrolysis and purification. Rats were divided into control, LPS, PEP1 and PEP2 groups. The rat model was established using lipopolysaccharide (LPS) at 10 mg/kg by intraperitoneal injection. The results of blood counts, pro-inflammatory cytokines (TNF-α and IL-6), BUN and Cr levels and pathological damage in tissue or serum suggested that PEP alleviated LPS-induced injuries. Plasma metabolites of PEP were analyzed and identified using UPLC-MS/MS, which revealed that seven pathways might play critical roles in the protection process, involved in oxidative stress, energy and amino acid metabolism. Our data suggest that PEP ameliorated LPS-induced acute liver and kidney injuries, which is helpful for further development and research.


Assuntos
Lipopolissacarídeos , Sepse , Animais , Cromatografia Líquida , Rim , Lipopolissacarídeos/farmacologia , Fígado , Hidrolisados de Proteína/uso terapêutico , Ratos , Sepse/complicações , Sepse/tratamento farmacológico , Espectrometria de Massas em Tandem
20.
Neurol India ; 70(4): 1610-1614, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36076666

RESUMO

Background: Despite decades of research, there is inadequate evidence on the etiological factors of brain injury in preterm infants. Objective: To study the perinatal risk factors for preterm brain injury and to assess their strength of association. Methods: In this retrospective cohort study, we included infants born at <32 weeks' gestation and had either magnetic resonance imaging (MRI) or cranial ultrasound (CUS) performed at term equivalent age. Significant brain injury was diagnosed based on Kidokoro global brain injury score was ≥4 in MRI or cystic periventricular leukomalacia in CUS. Results: Among the 698 infants, 48 had significant brain injury and 650 were taken as controls. In multiple logistic regression, intraventricular hemorrhage (IVH) grade 3-4 [adjusted odds ratio, 92.892 (19.495-442.619)], culture-positive sepsis [4.162 (1.729-10.021)], prolonged ventilation [3.688 (1.087-12.510)], and small for gestational age (SGA) [2.645 (1.181-5.924] were associated with greater risk of preterm brain injury. Conclusion: Severe IVH, culture-positive sepsis, prolonged ventilation and SGA were significant risk factors for preterm brain injury with severe IVH being the most significant contributing factor.


Assuntos
Lesões Encefálicas , Doenças do Prematuro , Sepse , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/etiologia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Estudos Retrospectivos , Sepse/complicações
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