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1.
Emergencias ; 37(1): 44-55, 2025 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-39898946

RESUMO

OBJECTIVE: Patients with suspected infections account for 15% to 35% of hospital emergency department (ED) caseloads in Spain and Latin America. The main objective of this systematic review was to compare evidence supporting the safety and efficacy of early (3 hours after triage) vs deferred ($ 3-6 hours) antibiotic therapy prescribed in EDs for adults with serious infections or sepsis. Efficacy and improved clinical course were defined by reduced progression to septic shock and short- and long-term mortality. METHODS: The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). PubMed, the Web of Sciencie, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase, and ClinicalTrials.gov were searched for the period from January 1, 2010, to December 31, 2023. No language restrictions were set. We used the following Medical English Subject Headings and strings: "Antibiotic OR Antibiotic Treatment OR Antibiotic Therapy OR Early Antibiotic Treatment OR Early Antibiotic Therapy," "Infection OR Bacterial Infection OR Sepsis," "Emergencies OR Emergency OR Emergency Department," "Timing," "Early," and "Adults." Observational cohort studies were included. To evaluate quality of research design and risk of bias, we applied the Newcastle-Ottawa Scale. Case-control studies, narrative reviews and other types of articles were excluded. We completed a narrative review of the findings and did not undertake meta-analysis. The review was registered in the PROSPERO database (CRD42024520687). RESULTS: The search yielded 1528 articles, of which 7 met the criteria for inclusion and analysis. The 7 studies comprised data for 118349 patients, 74141 of whom (62.6%) received early antibiotic treatment. Three studies were classified as high quality, 3 moderate, and 1 low. The 3 high-quality studies provided information on 2 aspects: 1) hospital and short-term mortality and 2) long-term mortality. One high-quality study showed a tendency for hospital and 30-day mortality to increase when antibiotics were administered more than 6 hours after triage vs within 1 hour of triage (hazard ratio, 2.25; 95% CI, 0.91-5.59; P = .08). Another reported an adjusted odds ratio of 1.09 (95% CI, 1.05-1.13; P = .024) for hospital mortality associated with each hour of therapeutic delay after triage. The third study reported that each additional hour of delay after triage was associated with a 10% increase (95% CI, 5%-14%; P .001) in the probability of 360-day mortality. Finally, the single low-quality study reported that each hour of delay in treatment was associated with an odds ratio of 1.08 (95% CI, 1.02-1.04; P .001) for increased risk of septic shock. CONCLUSIONS: Early initiation of antibiotic therapy, preferably within 3 hours of triage, can be recommended in cases of serious infection (sepsis or serious sepsis that do not meet the criteria for septic shock). In fact, based on a tendency for higher short- and long-term mortality associated with delay and a higher probability of developing septic shock with each hour of delay, therapy should start as soon as possible if infection is confirmed or suspected in the absence of an alternative diagnosis.


OBJETIVO: La atención de pacientes con sospecha de un proceso infeccioso en los servicios de urgencias hospitalarios (SUH) supone el 15%-35% de todas las atenciones en España y Latinoamérica. Esta revisión sistemática (RS) compara si la administración precoz de la antibioterapia (en 3 horas desde que el paciente se recibe en el triaje) en pacientes adultos atendidos en los SUH por infección grave o sepsis, en comparación con la administración diferida (> 3-6 horas), es más eficaz y segura y mejora la evolución clínica al disminuir la progresión a shock séptico (SS) y la mortalidad a corto y largo plazo. METODO: Se realiza una RS siguiendo la normativa PRISMA en las bases de datos de PubMed, Web of Sciencie, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase y ClinicalTrials.gov desde desde 1 de enero de 2010 hasta el 31 de diciembre de 2023 sin restricción de idiomas y utilizando una combinación de términos MESH: "Antibiotic OR Antibiotic Treatment OR Antibiotic Therapy OR Early Antibiotic Treatment OR Early Antibiotic Therapy", "Infection OR Bacterial Infection OR Sepsis", "Emergencies OR Emergency OR Emergency Department", "Timing", "Early" y "Adults". Se incluyeron estudios de cohortes observacionales. Para valorar la calidad del método empleado y el riesgo de sesgos de los artículos incluidos se utilizó la Newcastle-Ottawa Scale (NOS). No se incluyeron estudios de casos y controles, revisiones narrativas y otros tipos de artículos. No se realizaron técnicas de metanálisis, pero los resultados se compararon narrativamente. El protocolo de la RS se registró en PROSPERO (CRD42024520687). RESULTADOS: Se identificaron 1.528 artículos de los cuales se analizaron finalmente 7, que incluyen 118.349 pacientes, 74.141 de ellos (62,6%) con administración precoz de antibiótico (AB). Tres estudios fueron calificados de calidad alta, 3 moderada y 1 baja. En relación a los resultados de los estudios de calidad alta se encontró lo siguiente: 1) con la mortalidad hospitalaria y a corto plazo (30 días) en función del tiempo de administración del AB desde el triaje y la gravedad de la sepsis: el primer estudio de calidad alta publica una tendencia a aumentar la mortalidad cuando se administró el AB en > 6 horas desde el triaje en comparación con administración en 1 hora (HR = 2,25; IC 95%: 0,91-5,59; p = 0,08); el segundo muestra una OR ajustada para mortalidad hospitalaria por cada hora de tiempo de administración del AB desde el triaje de 1,09 (IC 95%: 1,05-1,13; p = 0,024); 2) con la mortalidad a largo plazo el tercer estudio muestra como cada hora adicional hasta el inicio del AB se asocia con un aumento del 10% (IC 95%: 5-14; p 0,001) de probabilidad de morir a los 360 días. Finalmente, un estudio de calidad baja muestra como el tiempo (en horas) hasta la primera administración del AB obtiene una OR de 1,03 (IC 95%: 1,02-1,04; p 0,001) para la progresión al SS. CONCLUSIONES: En los casos de infección grave (sepsis o sepsis grave) sin cumplir criterios de SS, se puede recomendar la administración precoz de la terapia antimicrobiana preferiblemente en las tres primeras horas (en realidad lo antes posible, en cuanto se pueda confirmar o se mantenga la sospecha sin encontrar otro diagnóstico distinto), ya que se ha confirmado la tendencia a aumentar la mortalidad a corto y a largo plazo y una mayor probabilidad de evolucionar a SS cuando se demora la administración del AB cada hora.


Assuntos
Antibacterianos , Serviço Hospitalar de Emergência , Sepse , Tempo para o Tratamento , Humanos , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Sepse/tratamento farmacológico , Sepse/mortalidade , Sepse/diagnóstico , Choque Séptico/tratamento farmacológico , Choque Séptico/mortalidade
2.
Alerta (San Salvador) ; 8(1): 22-27, ene. 22, 2025. ilus
Artigo em Espanhol | BISSAL, LILACS | ID: biblio-1586498

RESUMO

Presentación del caso. Un paciente masculino de 71 años con diagnóstico previo de cirrosis hepática, en quien inicialmente se sospechó peritonitis bacteriana espontánea. Intervención terapéutica. A medida que avanzaba la condición del paciente, se identificó la presencia de Listeria monocytogenes mediante la tecnología MALDI-TOF MS Biotyper. Se ajustó la terapia antibiótica utilizando ampicilina con sulbactam y dexametasona, junto con la administración de gentamicina. Evolución clínica. A pesar del tratamiento, el paciente falleció al octavo día de hospitalización. Se concluye que la realización temprana de cultivos es crucial en pacientes con antecedentes de alcoholismo y cirrosis para detectar infecciones poco comunes y reducir la mortalidad


Case presentation. A 71-year-old man with a previous diagnosis of liver cirrhosis, in whom spontaneous bacterial peritonitis was initially suspected. Treatment. As the patient's condition progressed, the presence of Listeria monocytogenes was identified by MALDI-TOF MS Biotyper technology. Antibiotic therapy was adjusted using ampicillin with sulbactam and dexamethasone, along with the administration of gentamicin. Outcome. Despite treatment, the patient died on the eight day of hospitalization. It is concluded that early culture is crucial in patients with a history of alcoholism and cirrhosis to detect rare infections and reduce mortality is concluded.


Assuntos
Peritonite , Sepse , Relatório de Pesquisa , Listeria monocytogenes , Meningite , El Salvador , Infecções , Listeria
3.
Vet Res Commun ; 49(2): 84, 2025 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-39826022

RESUMO

Southern right whales (Eubalaena australis) are mysticete cetaceans commonly observed in the coastal waters of Brazil, particularly in Santa Catarina State. There is limited understanding of the causes of calf mortality in this species, particularly concerning infectious diseases. We report a case of omphalophlebitis caused by Streptococcus equi subsp. zooepidemicus (S. zooepidemicus) that led to septicemia in a Southern right whale calf. Gross examination revealed an incompletely healed umbilicus with fibrin deposition and amorphous yellow material present in the lumen of the umbilical vein on the cut surface. The main histopathological findings showed fibrinosuppurative omphalophlebitis with numerous coccoid basophilic bacterial aggregates. These aggregates were also observed in the lamina propria, submucosa, and muscular layers of the small intestine and uterus, as well as in the interstitium of the kidneys and within blood vessels of the skin, skeletal muscle, heart, and ovaries. Tissue samples taken from the umbilicus and uterus were inoculated on 5% sheep blood agar and MacConkey agar. Small, transparent colonies that exhibited complete hemolysis were identified on blood agar. Gram staining revealed the presence of Gram-positive cocci arranged in chains. The bacterial isolate was analyzed using the MALDI-TOF technique, which confirmed its identity as S. zooepidemicus. The presence of S. equi antigen in the extra-umbilical aggregates was confirmed through immunohistochemistry. These findings underscore the significance of streptococcal infections in cetaceans and contribute valuable data regarding calf mortality in baleen whales. Furthermore, we provide new insights into the understanding of marine ecosystem health markers.


Assuntos
Infecções Estreptocócicas , Streptococcus equi , Animais , Infecções Estreptocócicas/veterinária , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/patologia , Streptococcus equi/isolamento & purificação , Baleias/microbiologia , Sepse/veterinária , Sepse/microbiologia , Sepse/patologia , Feminino , Brasil
4.
Neurotox Res ; 43(1): 5, 2025 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-39833594

RESUMO

Given ketamine's conflicting impacts on the central nervous system, investigating its effects within an inflammatory context becomes crucial. This study aimed to assess the impact of varying ketamine doses on neurotrophin and inflammatory cytokine levels within the brains of rats submitted to the sepsis model. Wistar rats were submitted to the cecal ligation and puncture (CLP) model of sepsis. Intraperitoneal ketamine injections (5, 15, or 25 mg/kg) or saline were administered daily for seven days, thirty days post-CLP. Rats were euthanized thirty minutes following the last injection for analysis of IL-1ß, IL-6, IL-10, TNF-α, BDNF, NGF, NT-3, and GDNF levels in the frontal cortex, hippocampus, and striatum. CLP-induced elevated IL-1𝛽, IL-6, IL-10, and TNF-α levels in the frontal cortex and hippocampus of rats, with reduced BDNF levels across all structures examined. Furthermore, reduced NGF and GDNF levels were observed solely in the hippocampus. Ketamine at 5 mg/kg normalized CLP-induced alterations and, in Sham animals, increased BDNF and NGF levels in the frontal cortex and/or hippocampus. At 15 mg/kg, ketamine elevated BDNF and NGF levels in Sham animals, while at 25 mg/kg, it exacerbated the inflammatory response initiated by CLP. These findings suggest variable effects of ketamine within a context of systemic inflammation, emphasizing the importance of considering individual inflammatory backgrounds when utilizing ketamine.


Assuntos
Ceco , Modelos Animais de Doenças , Ketamina , Fatores de Crescimento Neural , Ratos Wistar , Sepse , Animais , Ketamina/farmacologia , Ketamina/administração & dosagem , Sepse/metabolismo , Sepse/induzido quimicamente , Sepse/tratamento farmacológico , Masculino , Fatores de Crescimento Neural/metabolismo , Ceco/cirurgia , Ligadura , Ratos , Citocinas/metabolismo , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Punções , Fator Neurotrófico Derivado do Encéfalo/metabolismo
5.
World J Gastroenterol ; 31(1): 99987, 2025 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-39777244

RESUMO

Although the liver has a remarkable regenerative capacity, sepsis-associated liver injury (SLI) is a complication often seen in intensive care units. Due to its role in immune and inflammatory regulation, the liver is particularly vulnerable during severe infections. Understanding the global prevalence, causes, and management of SLI is essential to improve outcomes and reduce healthcare costs. This paper aims to explore these factors, with an emphasis on identifying effective strategies for clinical management. Zhang et al's bibliometric analysis of 787 publications (745 original articles and 42 reviews, mostly in animal models) from 2000 to 2023 highlights the growing interest in SLI, focusing on oxidative stress, gut microbiota, and inflammatory processes. Key components such as nuclear factor-kappa B and the NOD-like receptor thermal protein domain associated protein 3 inflammasome pathway, along with their links to gut microbiota imbalance and oxidative stress, are crucial for understanding SLI pathogenesis. The gut-liver axis, particularly the role of intestinal permeability and bacterial translocation in liver inflammation, is emphasized. In this context, bacterial translocation is especially relevant for critically ill patients, as it can exacerbate liver inflammation. The findings underscore the need for integrated care in intensive care units, prioritizing gut health and careful antibiotic use to prevent dysbiosis. Despite extensive research, there remains a lack of clinical trials to validate therapeutic approaches. The abundance of experimental studies highlights potential therapeutic targets, stressing the need for high-quality randomized clinical trials to translate these findings into clinical practice.


Assuntos
Disbiose , Microbioma Gastrointestinal , Fígado , Estresse Oxidativo , Sepse , Humanos , Sepse/complicações , Sepse/epidemiologia , Fígado/metabolismo , Fígado/patologia , Animais , Translocação Bacteriana , Hepatopatias/epidemiologia , Hepatopatias/microbiologia , Estado Terminal , Unidades de Terapia Intensiva/estatística & dados numéricos , Antibacterianos/uso terapêutico
6.
Clinics (Sao Paulo) ; 80: 100538, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39864312

RESUMO

BACKGROUND AND OBJECTIVE: The aim of this retrospective observational case-control study was to examine the significance of different renal Doppler marker variations within the initial 24-hour period as potential predictors of Acute Kidney Injury (AKI) in patients with sepsis. METHODS: A total of 198 sepsis patients were enrolled and categorized into two groups: the AKI group (n = 136) and the non-AKI group (n = 62). Three renal Doppler indices, Renal Resistive Index (RRI), Power Doppler Ultrasound (PDU) score and Renal Venous Stasis Index (RVSI), were measured within 6h (T0) and at 24h (T1) after ICU admission. RESULTS: The AKI group had more hypertension patients than the non-AKI group (p = 0.047). The cases of the AKI group showed higher levels of CRP (p = 0.001), PCT (p < 0.001), lactate (p < 0.001), AST (p = 0.003), ALT (p = 0.049), total bilirubin (p = 0.034), BNP (p = 0.019) and cTnI (p = 0.012). The RRI at T1 was significantly higher in the AKI group (p = 0.037). AKI group exhibited a lower incidence of reduced RRI at T1 compared with non-AKI group (p < 0.001). After controlling for age, sex, and BMI through partial correlation analysis, the results indicated significant associations between SA-AKI and CVP (r = -0.473), SOFA score (r = 0.425), lactate (r = 0.378), and RRI reduction (r = -0.344) in sepsis patients. The multivariate logistic regression analysis showed that variables including CVP, SOFA score, CRP, lactate, VIS, and RRI not reduced following 24h of ICU treatment were predictive indicators for early detection of SA-AKI in sepsis patients. CONCLUSION: CVP, SOFA score, CRP, lactate, VIS, and RRI not reduction following 24h of ICU treatment can be utilized as predictive indicators for early detection of SA-AKI in sepsis patients.


Assuntos
Injúria Renal Aguda , Sepse , Ultrassonografia Doppler , Humanos , Injúria Renal Aguda/diagnóstico por imagem , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/fisiopatologia , Masculino , Feminino , Sepse/diagnóstico por imagem , Sepse/complicações , Pessoa de Meia-Idade , Estudos de Casos e Controles , Estudos Retrospectivos , Idoso , Biomarcadores/sangue , Fatores de Tempo , Rim/diagnóstico por imagem , Rim/fisiopatologia , Valor Preditivo dos Testes , Adulto , Unidades de Terapia Intensiva
7.
J Matern Fetal Neonatal Med ; 38(1): 2453999, 2025 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39848634

RESUMO

OBJECTIVE: Maternal sepsis continues to be a maternal health problem associated with 75,000 deaths per year worldwide, representing a greater burden in low- and middle-income countries (LMICs). Although the Shock Index (SI) has been widely studied in postpartum hemorrhage and in non-obstetric populations, it has not yet been widely studied in sepsis. We aimed to identify the relationship between Shock Index and suspected sepsis in pregnant and postpartum patients to explore the use of Shock index in the context of maternal sepsis and its relationship with sepsis-related outcomes. METHODS: A single-center, retrospective, case-control study was conducted, including pregnant and postpartum patients attended between June 2015 and December 2020 in a high-complexity university hospital. This study was conducted in a High Obstetric Complexity Unit (UACO) in the southwest region of Colombia. Pregnant or postpartum women with infectious processes of obstetric or non-obstetric origins were included. Cases had sepsis diagnosis; controls showed infection process and systemic inflammatory response signs without confirmed sepsis. Those with unconfirmed infections and preterm conditions were excluded. A logistic regression model was conducted to examine the association between maternal factors and sepsis diagnosis, and significant variables were determined through univariate analysis and included in a multivariate model. RESULTS: A total of 640 patients were included (343 cases and 297 controls), sepsis was significantly associated with a higher shock index at admission SI ≥ 0.9 (85.4% vs 75%, p = 0.001). No correlation was found between the Shock Index and C-reactive protein (CRP), leukocyte count, or ICU length of stay. The area under the receiver operating characteristic curve (AUROC) analysis identified a Shock Index of 1 as the optimal cutoff point, while the cutoff point of 0.9 demonstrated the highest sensitivity (85%). An SI ≥ 0.9 increased the risk of sepsis 1.94 times (95% CI 1.31-2.91, p = 0.001) and remained significant in the adjustment model (OR_adj 2.18, 95% CI 1.42-3,32, p < 0.001). Incidence of maternal sepsis, incidence of maternal complications, and perinatal outcomes were measured with a SI ≥ 0.9. CONCLUSION: Our findings underscore the importance of using the Shock Index with a cutoff point of 0.9 as a predictive tool for sepsis in pregnant patients, emphasizing the need for timely intervention and continuous monitoring of patients.


Assuntos
Sepse , Humanos , Feminino , Gravidez , Adulto , Estudos Retrospectivos , Estudos de Casos e Controles , Sepse/diagnóstico , Sepse/epidemiologia , Sepse/sangue , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/sangue , Índice de Gravidade de Doença , Colômbia/epidemiologia , Adulto Jovem
8.
Med Intensiva (Engl Ed) ; 49(1): 1-7, 2025 01.
Artigo em Inglês | MEDLINE | ID: mdl-38403531

RESUMO

OBJECTIVE: To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in sepsis and septic shock. DESIGN: Retrospective cohort study. SETTING: Two intensive care units in Argentina. PATIENTS: Adult patients with a confirmed diagnosis of sepsis or septic shock and AKI, and had a urinary biochemistry within 24h of the AKI diagnosis. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis. RESULTS: 80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC=0.52, p=0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60-0.83; p=0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57-0.80; p=0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%. CONCLUSIONS: urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.


Assuntos
Injúria Renal Aguda , Íons , Potássio , Sepse , Sódio , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Injúria Renal Aguda/complicações , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/urina , Argentina , Potássio/urina , Estudos Retrospectivos , Curva ROC , Sensibilidade e Especificidade , Sepse/urina , Sepse/complicações , Choque Séptico/urina , Sódio/urina , Íons/urina
9.
J Pediatr ; 276: 114303, 2025 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-39278534

RESUMO

OBJECTIVES: To assess pediatric critical care transport (CCT) teams' performance in a simulated environment and to explore the impact of team and center characteristics on performance. STUDY DESIGN: This observational, multicenter, simulation-based study enlisted a national cohort of pediatric transport centers. Teams participated in 3 scenarios: nonaccidental abusive head injury, sepsis, and cardiac arrest. The primary outcome was teams' simulation performance score. Secondary outcomes were associations between performance, center and team characteristics. RESULTS: We recruited 78 transport teams with 196 members from 12 CCT centers. Scores on performance measures that were developed were 89% (IQR 78-100) for nonaccidental abusive head injury, 63.3% (IQR 45.5-81.8) for sepsis, and 86.6% (IQR 66.6-93.3) for cardiac arrest. In multivariable analysis, overall performance was higher for teams including a respiratory therapist (0.5 points [95% CI: 0.13, 0.86]) or paramedic (0.49 points [95% CI: 0.1, 0.88]) and dedicated pediatric teams (0.37 points [95% 0.06, 0.68]). Each year increase in program age was associated with an increase of 0.04 points (95% CI: 0.02, 0.06). CONCLUSIONS: Dedicated pediatric teams, inclusion of respiratory therapists and paramedics, and center age were associated with higher simulation scores for pediatric CCT teams. These insights can guide efforts to enhance the quality of care for children during interfacility transports.


Assuntos
Cuidados Críticos , Equipe de Assistência ao Paciente , Transporte de Pacientes , Humanos , Equipe de Assistência ao Paciente/organização & administração , Feminino , Criança , Masculino , Parada Cardíaca/terapia , Treinamento por Simulação , Sepse/terapia , Competência Clínica , Pré-Escolar , Traumatismos Craniocerebrais/terapia , Lactente , Maus-Tratos Infantis
10.
Notas enferm. (Córdoba) ; 25(43): 74-80, jun.2024.
Artigo em Espanhol | LILACS, BDENF - Enfermagem, UNISALUD, InstitutionalDB, BINACIS | ID: biblio-1561376

RESUMO

Objetivo: Determinar el nivel de conocimiento de los estudiantes de enfermería de la Universidad Técnica de Ambato sobre sepsis quirúrgica. Material y método: La presente investigación tiene un diseño de desarrollo observacional, de tipo descriptivo, cohorte transversal, con un enfoque cuantitativo, ya que el nivel de cono-cimiento se verá representado mediante tablas y gráficos para des-cribir la problemática del periodo octubre 2023 febrero 2024. Re-sultados: Se evidencia un alto porcentaje de respuestas incorrectas por cada ítem por parte de los estudiantes. La categoría Nivel de Conocimiento sobre Definición de Sepsis, fue respondida de ma-nera incorrecta con un porcentaje del 83,9%, la categoría Nivel de Conocimiento sobre Diagnóstico de Sepsis obtuvo 51,7% y, por úl-timo, la Nivel de Conocimiento sobre Tratamiento de Sepsis con el 29,2%. Conclusiones: El nivel de conocimiento de los estudiantes sobre Sepsis Quirúrgica es malo, debido a que existe una subesti-mación de la gravedad de la sepsis como afección potencialmente mortal, lo que puede traer un impacto negativo en los pacientes[AU]


Objective: Determine the level of knowledge of nursing students at the Technical University of Ambato about surgical sepsis. Mate-rials and methods: This research has an observational, descriptive, transversal development design, with a quantitative approach since the level of knowledge will be represented through tables and gra-phs to describe the problems of the period October 2023-February 2024. Results: A high percentage of incorrect answers for each item by the students is evident. The category Level of Knowledge about Definition of Sepsis was answered incorrectly with a percentage of 83.9%, the category Level of Knowledge about Diagnosis of Sepsis obtained 51.7% and, finally, the category Level of Knowledge about Treatment of Sepsis. Sepsis with 29.2%. Conclusions: The level of knowledge of students about Surgical Sepsis is poor because there is an underestimation of the severity of sepsis as a potentially fatal condition, which can have a negative impact on patients[AU]


Objetivo: Determinar o nível de conhecimento dos estudantes de enfermagem da Universidade Técnica de Ambato sobre sepse ci-rúrgica. Material e método: Esta pesquisa possui desenho de coor-te observacional, descritivo, transversal, com abordagem quantita-tiva, uma vez que o nível de conhecimento será representado por meio de tabelas e gráficos para descrever o problema no período de outubro de 2023 a fevereiro de 2024. Resultados: Uma parada. É evidente o percentual de respostas incorretas para cada item por parte dos alunos. A categoria Nível de Conhecimento sobre Defi-nição de Sepse foi respondida incorretamente com percentual de 83,9%, a categoria Nível de Conhecimento sobre Diagnóstico de Sepse obteve 51,7% e por fim, a categoria Nível de Conhecimen-to sobre Tratamento de Sepse com 29,2%. Conclusões: O nível de conhecimento dos estudantes sobre a Sepse Cirúrgica é baixo, pois há uma subestimação da gravidade da sepse como uma condição potencialmente fatal, que pode ter um impacto negativo nos pa-cientes[AU]


Assuntos
Humanos , Masculino , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Sepse/complicações , Sepse/diagnóstico , Equador
11.
Crit Care Sci ; 36: e20240090en, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-39630828

RESUMO

OBJECTIVE: To evaluate whether the perfusion index response to semiorthostatic stress can be used to monitor the sympathetic-vascular response in sepsis patients. METHODS: Three groups were studied: Group A (30 healthy patients), Group B (30 critically ill patients without sepsis), and Group C (92 septic patients). The patients underwent a semiorthostatic stress test (head elevation from 0 to 60 degrees), and hemodynamics, perfusion index values and cardiac ultrasound data were evaluated. SOFA scores were also evaluated in septic patients, comparing those with increased and decreased perfusion indices after the test. RESULTS: After the test, Group A presented significant reductions in stroke volume (p < 0.01) and the cardiac index (p < 0.05), with increases in heart rate (p < 0.05) and mean arterial pressure (p < 0.001). These responses were not observed in Groups B and C. In the individual analysis of Group A, there was a decrease in the perfusion index (p < 0,001), whereas in Groups B and C, the response was heterogeneous. Additionally, septic patients who had a reduced perfusion index after the test had a significant decrease in the SOFA score at 72 hours compared with the group with an increased perfusion index (p < 0.05). However, the delta-SOFA score did not differ between the groups. CONCLUSION: The perfusion index response to semiorthostatic stress in sepsis patients is a simple and inexpensive method that can be used to detect the sympathetic-microvascular response at the bedside and appears to have prognostic value.


Assuntos
Sepse , Humanos , Sepse/fisiopatologia , Sepse/tratamento farmacológico , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Índice de Perfusão , Adulto , Volume Sistólico/efeitos dos fármacos , Volume Sistólico/fisiologia , Estado Terminal , Escores de Disfunção Orgânica
12.
Crit Care Sci ; 36: e20240116en, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-39699389

RESUMO

OBJECTIVE: To investigate a cohort of sepsis survivors readmitted within 30 days postdischarge, explore the one-year mortality rate based on different causes of readmission and identify factors associated with increased one-year mortality risk among all sepsis survivors readmitted within this timeframe. METHODS: This was a single-center retrospective cohort study involving adult sepsis survivors who were readmitted within 30 days of discharge. Patients were categorized into 3 groups based on the cause of readmission: same-source infectious readmission, different-source infectious readmission, and noninfectious readmission. The outcome of interest was all-cause one-year mortality. Cox proportional hazard analysis was performed to compare factors associated with one-year mortality. RESULTS: Of the 1,666 patients admitted with sepsis, 243 (14.5%) were readmitted within 30 days. Readmissions were due to same-source infections (40.7%), different-source infections (21.4%), or noninfectious causes (37.9%). All-cause one-year mortality was 46.9%, with no difference between the groups. Age (HR 1.02; 95%CI: 1.003 - 1.04; p = 0.01), Sequential Organ Failure Assessment score (HR 1.1; 95%CI: 1.02 - 1.18; p = 0.01), discharge to a care facility during index admission (HR 1.6; 95%CI: 1.04 - 2.40; p = 0.03), and malignancy (HR 2.3; 95%CI: 1.5 - 3.7; p < 0.001) were associated with one-year mortality. CONCLUSION: Thirty-day readmission in sepsis survivors was common and was associated with a 46.9% one-year mortality rate regardless of readmission cause. Quality improvement patient safety initiatives based on local institutional factors may allow for targeted interventions to improve sepsis survivor outcomes.


Assuntos
Readmissão do Paciente , Sepse , Sobreviventes , Humanos , Sepse/mortalidade , Sepse/terapia , Estudos Retrospectivos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Feminino , Pessoa de Meia-Idade , Idoso , Sobreviventes/estatística & dados numéricos , Modelos de Riscos Proporcionais , Fatores de Risco , Escores de Disfunção Orgânica , Adulto , Alta do Paciente/estatística & dados numéricos
13.
Rev Assoc Med Bras (1992) ; 70(12): e20241038, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39699483

RESUMO

OBJECTIVE: In this study, we aimed to assess the effect of the BioFire FilmArray Blood Culture Identification 2 panel on agent identification and antimicrobial stewardship in patients with a critical state of sepsis secondary to bloodstream infection. METHODS: This study was designed as a prospective observational study. Patients who developed sepsis and septic shock secondary to bloodstream infection in the intensive care unit were included in the study. Concordance in both monomicrobial and polymicrobial results of Blood Culture Identification 2 panel and conventional blood culture, test result times, and antibiotherapy changes according to Blood Culture Identification 2 panel results were evaluated. RESULTS: In monomicrobial samples, sensitivity and specificity were 97.1% (95%CI 84.6-99.3) and 100% (95%CI 66.3-100), respectively, for gram-negative pathogens and 85.7% (95%CI 42.1-99.6) and 100% (95%CI 90.2-100), respectively, for gram-positive pathogens. In polymicrobial samples, Blood Culture Identification 2 panel results were 79% in concordance with conventional blood culture results. In this study, when the final turnaround time of the Blood Culture Identification 2 panel was compared with culture results, the Blood Culture Identification 2 panel was on average 1 day, 5 h, and 35 min faster than the culture (p<0.01). CONCLUSION: Blood Culture Identification 2 testing is a reliable tool for rapid pathogen and antimicrobial susceptibility detection in critically ill sepsis patients. The use of the Blood Culture Identification 2 panel in patients with sepsis and/or septic shock, where the transition to targeted antibiotherapy is critical, may improve patient outcomes.


Assuntos
Gestão de Antimicrobianos , Reação em Cadeia da Polimerase Multiplex , Sensibilidade e Especificidade , Sepse , Humanos , Estudos Prospectivos , Sepse/microbiologia , Sepse/tratamento farmacológico , Feminino , Masculino , Reação em Cadeia da Polimerase Multiplex/métodos , Pessoa de Meia-Idade , Hemocultura/métodos , Idoso , Unidades de Terapia Intensiva , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Adulto , Testes de Sensibilidade Microbiana
14.
Epidemiol Infect ; 152: e169, 2024 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-39668720

RESUMO

Our study aim was to identify high-risk areas of neonatal mortality associated with bacterial sepsis in the state of São Paulo, Southeast Brazil. We used a population-based study applying retrospective spatial scan statistics with data extracted from birth certificates linked to death certificates. All live births from mothers residing in São Paulo State from 2004 to 2020 were included. Spatial analysis using the Poisson model was adopted to scan high-rate clusters of neonatal mortality associated with bacterial sepsis (WHO-ICD10 A32.7, A40, A41, P36, P37.2 in any line of the death certificate). We found a prevalence of neonatal death associated with bacterial sepsis of 2.3/1000 live births. Clusters of high neonatal mortality associated with bacterial sepsis were identified mainly in the southeast region of the state, with four of them appearing as cluster areas for all birth weight categories (<1500 g, 1500 to <2500 g and ≥ 2500 g). The spatial analysis according to the birth weight showed some overlapping in the detected clusters, suggesting shared risk factors that need to be explored. Our study highlights the ongoing challenge of neonatal sepsis in the most developed state of a middle-income country and the importance of employing statistical techniques, including spatial methods, for enhancing surveillance and intervention strategies.


Assuntos
Mortalidade Infantil , Sepse Neonatal , Análise Espacial , Humanos , Recém-Nascido , Brasil/epidemiologia , Estudos Retrospectivos , Sepse Neonatal/mortalidade , Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , Lactente , Feminino , Fatores de Risco , Análise por Conglomerados , Prevalência , Sepse/mortalidade , Sepse/epidemiologia , Masculino
15.
Biochem Biophys Res Commun ; 739: 150966, 2024 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-39547122

RESUMO

The aim of the study was to evaluate the effect of metabolic syndrome (MetS) on female Swiss mice subjected to severe polymicrobial sepsis induced by cecal ligation and puncture (CLP). MetS was induced in neonatal Swiss mice by subcutaneous injection of monosodium glutamate (MSG) at 4 mg/g body weight from day 1 to day 5 after birth, while animals in the control group (CTL) were treated with equimolar saline solution at the same volume and period. On the 75th day of life, the CLP model was used to induce severe polymicrobial sepsis. For inflammatory parameters, we assessed nitric oxide (NO), determined by the cadmium/Griess technique, and quantified IL-6 and IL1ß using the ELISA technique. Glucose levels were measured 24 h before and after CLP using a glucose monitor, and the lipid profile was assessed using commercial kits. Cardiovascular parameters were measured using the CODA platform, and hematological evaluation was determined by standard counting. Unlike male mice, MetS did not alter the survival of females subjected to severe sepsis. Both CTL and MetS CLP groups exhibited hypotension and hypoglycemia, accompanied by leukopenia and increased inflammatory cytokine IL-6. The cytokine IL1ß Only increased in MetS CLP group compared to CTL CLP and MetS Sham. It was also observed that MetS attenuated some parameters during sepsis, such as hematological parameters and resistance to NO increase. We can conclude that the obesity paradox theory is not observed in females. Thus, our findings provide new insights for the literature linking MetS and sepsis.


Assuntos
Síndrome Metabólica , Sepse , Animais , Feminino , Sepse/sangue , Sepse/complicações , Sepse/metabolismo , Camundongos , Síndrome Metabólica/sangue , Síndrome Metabólica/metabolismo , Interleucina-1beta/sangue , Interleucina-1beta/metabolismo , Óxido Nítrico/metabolismo , Óxido Nítrico/sangue , Inflamação/sangue , Interleucina-6/sangue , Glicemia/metabolismo , Masculino
16.
BMC Emerg Med ; 24(1): 220, 2024 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-39563231

RESUMO

Emergency medical services often serve as the initial point of contact for septic patients, offering crucial pre-hospital intervention opportunities. However, the efficacy of pre-hospital interventions remains uncertain. From this perspective, we'll talk about the available evidence of pre-hospital sepsis and septic shock treatment and the barriers to its implementation.


Assuntos
Serviços Médicos de Emergência , Sepse , Humanos , Sepse/terapia , Serviços Médicos de Emergência/organização & administração , Choque Séptico/terapia
17.
Cambios rev. méd ; 23(2): 910, 30/11/2024. tabs, ilus.
Artigo em Inglês | LILACS | ID: biblio-1579726

RESUMO

INTRODUCTION. There is an important number of reports in Latin America, but there is a lack of data on acute promyelocytic leukemia (APL) in Ecuador., this is the main reason to carry out this study in the country, a disease that in recent decades has shown a significant improvement in survival. OBJECTIVES. To evaluate the overall survival (OS) and event-free survival (EFS), and also the demography, and the most relevant clinical and laboratorial findings. METHODS. We retrospectively reviewed the medical records of 48 patients with APL, diagnosed between January 2012 and December 2019. We collected the most relevant demographic, clinical and laboratorial characteristics, as well as data related to 30-day mortality, and 5 year­OS (overall survival) and EFS (event-free survival). RESULTS. Among the forty-eight (48) patients with acute promyelocytic leukemia, 44 patients received treatment, the mean number of days for the start of all trans retinoic acid (ATRA) and/or arsenic trioxide (ATO) was of 2.5 days from the moment of the diagnosis. 60.4% of patients were classified as low risk and 39.5% as high risk, according to the national comprehensive cancer network (NCCN). The early death rate was 31.2%, the main cause of which was sepsis, multidrug resistant (MDR) bacterias were isolated in 83% of the patients who took blood cultures and died of early sepsis. after a median follow-up of 35 months only one patient relapsed. the five-year OS and EFS was 51.2%; In the multivariate analysis, only age was identified as an adverse prognostic factor. DISCUSSION. Compared to prospective trials with ATRA-based regimens, we found an inferior OS, mainly because of a high-rate early death. if we compare our findings with other real-world reports, we will also show inferior results probably explained by the high rate of early death due to infection by MDR batteries, in addition to the early deaths caused by hemorrhages. CONCLUSION. The low rate of OS shown in this study, could be improved based on changes to optimize the ac-cess of the patients to an early diagnosis and treatment and the reduction of the unacceptably high rates of multidrug resistance bacterial infections in our setting.


INTRODUCCION. Existe un número importante de reportes en Latinoamérica, pero se carece de datos sobre la leucemia promielocítica aguda (LPA) en Ecuador, ésta es la principal razón para realizar este estudio en el país, enfermedad que en las últimas décadas ha mostrado una importante mejoría en la sobrevida. OBJETIVOS. Evaluar la sobrevida global (SG) y la sobrevida libre de eventos (SLE), así como la demografía y los hallazgos clínicos y laboratoriales más relevantes. MÉTODOS. Se revisaron retrospectivamente las historias clínicas de 48 pacientes con LPA, diagnosticados entre enero de 2012 y diciembre de 2019. Se recogieron las características demográficas, clínicas y datos de laboratorio más relevantes, así como datos relacionados con la mortalidad a 30 días, y a 5 años-OS (supervivencia global) y EFS (supervivencia libre de eventos). RESULTADOS. De los cuarenta y ocho (48) pacientes con leucemia promielocítica aguda, 44 pacientes recibieron tratamiento, la media de días para el inicio de ácido transretinoico total (ATRA) y/o trióxido de arsénico (ATO) fue de 2,5 días desde el momento del diagnóstico. El 60,4% de los pacientes fueron clasificados como de bajo riesgo y el 39,5% de alto riesgo, según la red nacional integral del cáncer (NCCN). La tasa de mortalidad precoz fue del 31,2%, cuya causa principal fue la sepsis, aislándose bacterias multirresistentes (MDR) en el 83% de los pacientes que se sometieron a hemocultivos y fallecieron por sepsis precoz. Tras una mediana de seguimiento de 35 meses, sólo un paciente sufrió una recaída, la SG y la SSC a cinco años fue del 51,2%; en el análisis multivariante, sólo la edad se identificó como factor pronóstico adverso. DISCUSIÓN. En comparación con los ensayos prospectivos con regímenes basados en ATRA, encontramos una SG inferior, principalmente debido a una alta tasa de muerte temprana. Si comparamos nuestros hallazgos con otros informes del mundo real, también mostraremos resultados inferiores probablemente explicados por la alta tasa de muerte temprana debida a infección por baterías MDR, además de las muertes tempranas causadas por hemorragias. CONCLUSIONES. La baja tasa de SG mostrada en este estudio, podría mejorarse en base a cambios para optimizar el acceso de los pacientes a un diagnóstico y tratamiento precoz y la reducción de las inaceptablemente altas tasas de infecciones bacterianas multirresistentes en nuestro medio.


Assuntos
Humanos , Masculino , Feminino , Sobrevida , Infecções Bacterianas , Leucemia Promielocítica Aguda , Sepse , Farmacorresistência Bacteriana Múltipla , Enterobacteriáceas Resistentes a Carbapenêmicos , Atenção Terciária à Saúde , Equador
18.
Rev Gaucha Enferm ; 45: e20230223, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-39356925

RESUMO

OBJECTIVE: Build and validate a realistic interprofessional simulation scenario for the identification and management of sepsis by doctors and nurses. METHOD: Methodological study developed in 2021, in two stages: construction of the guide and content validation by expert judges; and development of the simulation and validation of the scenario by doctors and nurses. 15 specialists participated in the research in the first stage and eight care professionals in the second stage. 0.8 was adopted as a parameter for the Content Validation Index (CVI). RESULTS: The scenario guide addressed nosocomial sepsis with an abdominal focus in an adult patient and its validation obtained a total CVI of 0.97. All areas evaluated in the simulation scenario obtained agreement indices greater than 0.8. CONCLUSION: The construction and validation of the guide allowed the elaboration of guiding material for the development of an interprofessional simulated scenario, whose execution and validation process demonstrated its suitability in approaching the identification and management of sepsis by doctors and nurses. It is recommended to carry out future research evaluating its applicability to other situational contexts.


Assuntos
Sepse , Humanos , Sepse/terapia , Sepse/diagnóstico , Treinamento por Simulação , Adulto , Feminino , Infecção Hospitalar , Masculino , Simulação de Paciente
19.
PLoS One ; 19(10): e0301948, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39453928

RESUMO

BACKGROUND: Sepsis is a common admission diagnosis in the intensive care unit (ICU). The Sepsis-3 consensus associates sepsis diagnosis with acute organ dysfunction. In these patients troponin elevation is a well-established phenomenon, but its clinical significance is not settled, as no systematic review has addressed the prognostic significance of the increasingly prevalent high-sensitivity troponin assays in acute organ dysfunction setting. This study aims to clarify the association between early serum troponin levels in high-sensitivity assays with short-term mortality risk in septic patients with acute organ dysfunction. METHODS: We will systematically search PubMed, Scopus and Embase for original articles; additionally, a manual search will be carried out through relevant literature. Generally, studies will be deemed eligible for inclusion if they evaluate the association between high-sensitivity troponin in the first 24 hours of admission and ICU, 30-days, or In-hospital mortality; in patients with septic shock or sepsis related to acute organ dysfunction. Two reviewers will independently select studies and extract the data. A meta-analysis for mortality outcome will be performed for comparative data regarding two effect measures: Odd ratios and Standardized Mean differences. DISCUSSION: This study will provide further evidence about the role of high-sensitivity troponin assays in predicting mortality in septic patients; potentially helping to guide further research and yielding valuable information for patient assessment. Conclusion about the certainty of evidence will be presented in a ´Summary of findings´ table. TRIAL REGISTRATION: PROSPERO registration: (CRD42024468883).


Assuntos
Sepse , Troponina , Humanos , Biomarcadores/sangue , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Prognóstico , Sepse/mortalidade , Sepse/sangue , Sepse/diagnóstico , Revisões Sistemáticas como Assunto , Troponina/sangue , Metanálise como Assunto
20.
Braz J Med Biol Res ; 57: e13457, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39417448

RESUMO

Sepsis is a systemic inflammatory response syndrome in which the host response to infection is dysregulated, leading to circulatory dysfunction and multi-organ damage. It has a high mortality rate and its incidence is increasing year by year, posing a serious threat to human life and health. Mesenchymal stem cells (MSC) have the following properties: hematopoietic support, provision of nutrients, activation of endogenous stem/progenitor cells, repair of tissue damage, elimination of inflammation, immunomodulation, promotion of neovascularization, chemotaxis and migration, anti-apoptosis, anti-oxidation, anti-fibrosis, homing, and many other effects. A large number of studies have confirmed that MSC from different sources have their own characteristics. This article reviews the pathogenesis of sepsis, the biological properties of MSC, and the advantages and disadvantages of different sources of MSC for the treatment of sepsis and their characteristics.


Assuntos
Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Sepse , Humanos , Sepse/terapia , Transplante de Células-Tronco Mesenquimais/métodos
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