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1.
BMC Infect Dis ; 22(1): 34, 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34991517

RESUMO

BACKGROUND: Sepsis is a leading cause of pediatric morbidity and mortality worldwide. The aim of this study was to explore the association of decreased mitochondrial respiratory chain enzyme activities with the risk for pediatric sepsis, and explore their association with mortality among affected children. METHODS: A total of 50 incident cases with sepsis and 49 healthy controls participated in this study. The level of serum coenzyme Q10 was measured by high-performance liquid chromatography, and selected mitochondrial respiratory chain enzymes in WBC were measured using spectrophotometric. Logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (CI). RESULTS: The levels of CoQ10, complex II, complex I + III and FoF1-ATPase were significantly higher in healthy controls than in children with sepsis (p < 0.001, = 0.004, < 0.001 and < 0.001, respectively). In children with sepsis, levels of CoQ10 and complex I + III were significantly higher in survived cases than in deceased cases (p < 0.001). Per 0.05 µmol/L, 50 nmol/min.mg and 100 nmol/min.mg increment in CoQ10, complex I + III and FoF1-ATPase were associated with significantly lowered risk of having sepsis, even after adjusting for confounding factors (OR = 0.85, 0.68 and 0.04, p = 0.001, < 0.001 and < 0.001, respectively). Per 0.05 µmol/L and 50 nmol/min.mg increment in CoQ10 and complex I + III was associated with significantly lowered risk of dying from sepsis during hospitalization, and significance retained after adjustment (OR = 0.73 and 0.76, 95% CI: 0.59 to 0.90 and 0.64 to 0.89, p = 0.004 and 0.001, respectively) in children with sepsis. CONCLUSIONS: Our findings indicate the promising predictive contribution of low serum CoQ10 and complex I + III to the risk of pediatric sepsis and its associated mortality during hospitalization among Chinese children. Trial registration The trial was registered with www.chictr.org.cn , number ChiCTR-IOR-15006446 on May 05, 2015. Retrospectively registered.


Assuntos
Sepse , Criança , China/epidemiologia , Transporte de Elétrons , Humanos , Sepse/epidemiologia
2.
Pediatrics ; 149(1)2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34913059

RESUMO

BACKGROUND: Children with sickle cell disease (SCD) are at increased risk for bloodstream infections (BSIs), mainly because of functional asplenia. Immunizations and antibiotic prophylaxis have reduced the prevalence of invasive bacterial infections, but contemporary analysis of BSI in children with SCD is limited. METHODS: We conducted a retrospective cohort study of children aged <18 years with SCD who had blood cultures collected at our institution from 2010 to 2019 to identify BSI. Probable contaminant organisms were identified and not included as BSI. We calculated the annual incidence of BSI at our institution with 95% confidence intervals (CIs) and used multivariate logistic regression to evaluate associations. RESULTS: There were 2694 eligible patients with 19 902 blood cultures. Excluding repeated cultures and contaminant cultures, there were 156 BSI episodes in 144 patients. The median age at BSI was 7.5 years. The average incidence rate of BSI was 0.89 per 100 person-years (95% CI 0.45-1.32). The most common pathogens were Streptococcus pneumoniae (16.0%), Streptococcus viridans group (9.0%), Escherichia coli (9.0%), Staphylococcus aureus (7.7%), Bordetella holmesii (7.7%), Haemophilus influenzae (7.1%), and Salmonella species (6.4%). Odds of BSI were higher with sickle cell anemia genotypes (odds ratio [OR] 1.88; 95% CI 1.20-2.94) and chronic transfusions (OR 2.66; 95% CI 1.51-4.69) and lower with hydroxyurea (OR 0.57; 95% CI 0.39-0.84). CONCLUSIONS: BSI remains a risk for children with SCD. Overall incidence, risk factors, and spectrum of pathogens are important considerations to guide prevention and empirical treatment of suspected infection in SCD.


Assuntos
Anemia Falciforme/complicações , Sepse/epidemiologia , Sepse/microbiologia , Adolescente , Anemia Falciforme/genética , Anemia Falciforme/mortalidade , Criança , Feminino , Genótipo , Georgia/epidemiologia , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , Sepse/mortalidade
3.
Drugs ; 82(1): 43-54, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34914085

RESUMO

OBJECTIVE: To determine the association between angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) use and coronavirus disease 2019 (COVID-19) severity and outcomes in US veterans. PATIENTS AND METHODS: We retrospectively examined 27,556 adult US veterans who tested positive for COVID-19 between March to November 2020. Logistic regression and Cox proportional hazards models using propensity score (PS) for weight, adjustment, and matching were used to examine the odds of an event within 60 days following a COVID-19-positive case date and time to death, respectively, according to ACEI and/or ARB prescription within 6 months prior to the COVID-19-positive case date. RESULTS: The overlap PS weighted logistic regression model showed lower odds of an intensive care unit (ICU) admission (odds ratio [OR] 95% CI 0.77, 0.61-0.98) and death within 60 days (0.87, 0.79-0.97) with an ACEI or ARB prescription. Veterans with an ARB-only prescription also had lower odds of an ICU admission (0.64, 0.44-0.92). The overlap PS weighted model similarly showed a lower risk of time to all-cause mortality in veterans with an ACEI or ARB prescription (HR [95% CI]: 0.87, 0.79-0.97) and an ARB only prescription (0.78, 0.67-0.91). Veterans with an ACEI prescription had higher odds of experiencing a septic event within 60 days after the COVID-19-positive case date (1.22, 1.02-1.46). CONCLUSION: In this study of a national cohort of US veterans, we found that the use of an ACEI/ARB in patients with COVID-19 was not associated with increased mortality and other worse outcomes. Future studies should examine underlying pathways and further confirm the relationship of ACEI prescription with sepsis.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , COVID-19/epidemiologia , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Receptores de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , COVID-19/mortalidade , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Modelos de Riscos Proporcionais , Estudos Retrospectivos , SARS-CoV-2 , Sepse/epidemiologia , Veteranos
5.
Theriogenology ; 177: 103-115, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34688970

RESUMO

The neonatal period in dogs remains associated with high mortality rates. Sepsis is the main cause of neonatal losses during the first three weeks of life. Additionally, failure in the clinical assessment and early diagnosis of sick newborns is still common, leading to inadequate care, which contributes to a high mortality rate. Thus, the objective of this study was to describe the incidence of sepsis in canine newborns, the clinical aspects involved, the main isolated bacterial agents and mortality rates to facilitate clinicians' early recognition of this condition. Of the 152 litters and 762 neonates evaluated, 14.8% (113/762) had sepsis or septic shock, and the mortality rate among affected puppies was 25.6% (29/113). Among the puppies with sepsis that died, early mortality (0-2 days of age) occurred in 69% (20/29) of affected neonates, and late mortality (3-30 days of age) occurred in 31% (9/29) of affected neonates. Significant differences (p < 0.0001) in clinical parameters (heart and respiratory rates, blood glucose, body temperature, peripheral oxygen saturation and reflexes) were noted among healthy neonates and neonates with sepsis and septic shock. The main and most relevant clinical signs were apathy, a reduced sucking reflex, diarrhea, the neonatal triad, failure to gain weight, bradycardia, dyspnea, cyanotic mucous membranes, body erythema, reduced peripheral oxygen saturation, cyanosis and tissue necrosis in the extremities. The mother may have been the main source of infection for 87.6% (99/113) of neonates with sepsis. Most infections were transmitted during pregnancy (68%, 77/113) in cases of neonatal sepsis. The major source of infection for neonates was the uterus, followed by breast milk and maternal oropharyngeal secretions. The most frequently isolated bacterial agent was Escherichia coli, accounting for 25.6% (29/113) of sepsis cases. The morbidity and mortality of neonatal sepsis in dogs is high. The clinical evaluation and diagnosis of sepsis in neonates differ from those in adult animals. Thus, knowledge of the neonatal particularities of sepsis is essential for proper clinical management and greater survival of these patients.


Assuntos
Doenças do Cão , Sepse Neonatal , Sepse , Animais , Doenças do Cão/diagnóstico , Doenças do Cão/epidemiologia , Cães , Escherichia coli , Feminino , Incidência , Sepse Neonatal/epidemiologia , Sepse Neonatal/veterinária , Gravidez , Sepse/epidemiologia , Sepse/veterinária
6.
Microb Pathog ; 162: 105313, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34902538

RESUMO

Bacterial septicemia causes huge economic losses in the poultry industry and there is no systematic research available in India on the connection of various pathogens associated with septicemia. The present molecular epidemiological study was conducted to investigate the association of different bacterial and immunosuppressive viral pathogens in septicemia suspected chickens. A total of 443 chicken carcasses with septicemic conditions from 71 different flocks were included in this study. Heart blood swabs were subjected to bacterial culture for Salmonella spp., Pasteurella multocida, Escherichia coli, and Gallibacterium anatis. Of these 51 flocks tested for E. coli, 49 (96.1%) flocks were found positive. Among flocks tested for Salmonella spp., 2 flocks were found positive. All tested flocks were found negative for G. anatis and P. multocida as well as air sac swabs tested negative for Mycoplasma spp. Bacterial cultural examination revealed that majority of septicemic chickens were found to be infected with E. coli and these E. coli isolates showed the highest resistance to vancomycin (60%), followed by erythromycin (50%) and cefotaxime (38%) and maximum sensitivity to cefotaxime and clavulanic acid combinations (81.5%), followed by chloramphenicol (69.6%) and ertapenem (67.2%). Among the 5 avian pathogenic E. coli (APEC) virulence genes were detected in 36 flocks and highest frequency of iss (100%), followed by ompT or iutA (97.2%), hly (61.1%) and iroN (47.2%) genes. On polymerase chain reaction (PCR) screening, 10.5, 4.5, 52.2, 19.4, 9.0, 4.5, 20.1 and 19.4% of the flocks were positive for G. anatis, Ornithobacterium rhinotracheale, APEC, Salmonella spp., Mycoplasma gallisepticum, Mycoplasma synoviae, chicken infectious anemia virus and Marek's disease virus, respectively. To our knowledge, the present study is first on the etiology of septicemia in chicken flocks in India. The present study infers that the majority of septicemic deaths in broiler chickens less than 8 weeks have been connected with APEC and majority of E. coli isolates are multidrug resistance, suggesting the need for surveillance and intervention to curb the inadvertent use of antibiotics. Although, incidence of G. anatis association with septicemia was reported, still requires a rigorous epidemiological study to determine the actual prevalence. However, more detailed studies encompassing vast geographical area with large sample size and long duration of the studies are necessary to provide a clear picture of the interaction of different pathogens causing septicemia in chicken.


Assuntos
Infecções por Escherichia coli , Doenças das Aves Domésticas , Sepse , Animais , Galinhas , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/veterinária , Doenças das Aves Domésticas/epidemiologia , Sepse/epidemiologia , Sepse/veterinária
7.
Br J Nurs ; 30(19): S16-S22, 2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34723657

RESUMO

OBJECTIVE: To reduce the incidence of central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters (PICC) through the introduction of an antimicrobial (AM) catheter as recommended in evidence-based guidelines and standards. DESIGN: Quality improvement project comparing incidence of infections pre-implementation and postimplementation of the new catheter. SETTING: A 582-bed community teaching hospital in Northwest Indiana. METHODS: Pre-implementation analysis of surveillance data indicated that 50% of CLABSIs occurred inpatients with PICCs in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an AM catheter was supported in each of the documents consulted. After introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures. RESULTS: After 30 months of data collection, the PICC CLABSI incidence reduced from a baseline rate of 1.83/1000 PICC days to 0.162/1000 PICC days (91.15% reduction, P=0.0002). CONCLUSION: Combined with continued compliance with basic prevention strategies (ie use of a central line insertion checklist/insertion bundle) and optimization of device selection and lumen justification, the introduction of an antimicrobial/antithrombogenic (AM/AT) PICC was associated with a significant reduction in CLABSI.


Assuntos
Anti-Infecciosos , Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Sepse , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Humanos , Incidência , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia , Sepse/prevenção & controle
8.
Arch Esp Urol ; 74(8): 775-781, 2021 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34605419

RESUMO

OBJECTIVE: This study aims to compare infectious complications after a prostate biopsy in patients with or without chronic idiopathic constipation (CIC). METHODS: Six hundred and sixty-three patients who underwent a transrectal ultrasound-guided biopsy (TRUSBx) of the prostate between 2012 and 2018 were evaluated prospectively. Patients were divided into two groups according to their CIC status and monitored for complications. CIC was defined by the Rome III criteria. Multivariate analysis was performed to assess the risk factors. RESULTS: Thirty-five patients (5.8%) developed a urinary tract infection (UTI) while sepsis occurred in only three cases (0.5%). CIC was found as a risk factor for infection. Infection occurred in 18.1% of the men with CIC compared to 2.3% of those without CIC (p=0.001). Sepsis occurred in 1.4% of the men with CIC compared to vs 0.2% of those without CIC (p=0.68). In multivariate analysis, CIC (OR of 9.27 and 95% CI 4.40-19.54, p<0.05) and Diabetes Mellitus (OR of 3.11 and 95% CI 1.52-6.36, p=0.002) were associated with an increased risk factor of UTI and sepsis. CONCLUSIONS: We demonstrated that CIC is an important risk factor of infection after a prostate biopsy. Prevention is important to minimize complications after this very common worldwide procedure.


Assuntos
Sepse , Infecções Urinárias , Biópsia , Constipação Intestinal/etiologia , Humanos , Biópsia Guiada por Imagem , Masculino , Próstata , Sepse/epidemiologia , Sepse/etiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
9.
PLoS One ; 16(10): e0258114, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618858

RESUMO

BACKGROUND: Enterobacter species are an important cause of healthcare-associated bloodstream infections (BSI) in children. Up to 19% of adult patients with Enterobacter BSI have recurrence of infection resistant to third-generation cephalosporins (3GCs) while on therapy with a 3GC. Data are lacking regarding the incidence of and risk factors for recurrence of infection in children with Enterobacter BSI. METHODS: We conducted a retrospective case-control study of patients aged ≤21 years old admitted to Texas Children's Hospital from January 2012 through December 2018 with Enterobacter BSI. The primary outcome was microbiologic failure from 72 hours to 30 days after the initial BSI (cases). The secondary outcome was isolation of a 3GC non-susceptible Enterobacter sp. from a patient with an initial 3GC-susceptible isolate. RESULTS: Twelve patients (6.7%) had microbiologic failure compared to 167 controls without microbiologic failure. Of the 138 patients (77.1%) with an Enterobacter sp. isolate that was initially susceptible to 3GCs, 3 (2.2%) developed a subsequent infection with a non-susceptible isolate. Predictors of microbiologic failure were having an alternative primary site of infection besides bacteremia without a focus or an urinary tract infection (OR, 9.64; 95% CI, 1.77-52.31; P < 0.01) and inadequate source control (OR, 22.16; 95% CI, 5.26-93.36; P < 0.001). CONCLUSIONS: Source of infection and adequacy of source control are important considerations in preventing microbiologic failure. In-vitro susceptibilities can be used to select an antibiotic regimen for the treatment of Enterobacter BSI in children.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Enterobacter/patogenicidade , Infecções por Enterobacteriaceae/tratamento farmacológico , Sepse/tratamento farmacológico , Adolescente , Adulto , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Enterobacter/genética , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , Sepse/epidemiologia , Sepse/microbiologia , Adulto Jovem
10.
J Infect Public Health ; 14(11): 1630-1634, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34624718

RESUMO

BACKGROUND: Neonatal infection is infection of the newborn or neonate acquired in first four weeks of life or during prenatal development. Microorganism associated neonatal infections caused severe mortality in recent years. It is developed either prenatally or within 28 days of neonatal period. This infection is mainly transmitted from mother to child through placenta. It has been well associated with the premature rupture of membranes which markedly enhances the risk of neonatal sepsis. METHODS: The present experiment was designed to analyze bacteria, their antibiotic resistance pattern and possible risk factors among neonatal patients with sepsis. The neonates specimen was subjected for the isolation of bacteria and antibiotic susceptibility test. Neonates were analyzed with previous clinical history such as, previous admission in hospitals, mode of delivery, birth weight, and feeding type in accordance with questionnaire. RESULTS: Gram-positive bacteria isolates were found to be high (79 strains, 64.22%) than the Gram-negative bacteria (44 strains, 32.5%). Staphylococcus aureus (33 strains, 26.9%) was the major Gram-positive groups of bacteria. Multidrug resistance analysis accounted more S. aureus (26.9%) and 5 strains (15.15%) showed methicillin resistance, whereas 84.9% were found to be sensitive to methicillin. CONCLUSION: In this study, S. aureus and K. pneumoniae were the highest frequency of isolates. The overall percentage of multidrug resistant isolates was high in this study. Highest degree of resistance was observed in ampicillin against all isolates. Hence much attention is required while diagnosing sepsis among neonates. To analyze the risk for neonatal sepsis, it is not preferable for caesarian mode of delivery. Moreover, frequent screening of mother, suitable prenatal care of newborns with proper clinical interventions isthe key elements to control sepsis.


Assuntos
Sepse , Staphylococcus aureus , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Meticilina , Testes de Sensibilidade Microbiana , Gravidez , Sepse/epidemiologia
12.
J Infect Public Health ; 14(11): 1585-1589, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34627055

RESUMO

BACKGROUND: Sepsis is one of the leading causes of morbidity and mortality in the pediatric population worldwide. This study aimed to establish a correlation between platelet count and outcomes of severe sepsis/septic shock in pediatric patients. METHODS: This retrospective cohort study was conducted in the pediatric intensive care unit (PICU) in a pediatric tertiary care medical hospital. Pediatric patients from newborns to 14-year-olds with a diagnosis of sepsis or septic shock who were admitted to the PICU between April 2015 and February 2018 were enrolled. Patients were classified into two groups based on the presence of thrombocytopenia: thrombocytopenia group (TG) with a platelet count <150,000/µL during the first seven days after admission, and non-thrombocytopenia group (NTG) with a platelet count >150,000/µL. RESULTS: Overall, 206 children were enrolled, including 82 (39.8%) in the TG and 124 (60.2%) in the NTG. Thrombocytopenia was more common in patients with a negative bacterial blood culture (93.9%, P = 0.007). NTG was associated with a higher mortality rate (29%) than the TG (12.2%, P = 0.005). Multiorgan dysfunction syndrome (MODS) at the onset of sepsis (time zero) was found to be more prevalent in NTG than in TG (P = 0.001), while the progression of MODS over the three days remained the same in both groups. CONCLUSION: Thrombocytopenia was more associated with non-bacterial sepsis/septic shock, and it may indicate a better outcome of sepsis in pediatric patients.


Assuntos
Sepse , Choque Séptico , Criança , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Contagem de Plaquetas , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Sepse/epidemiologia , Choque Séptico/epidemiologia
13.
Scand J Trauma Resusc Emerg Med ; 29(1): 144, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34593001

RESUMO

BACKGROUND: There is little evidence of which sepsis screening tool to use in the ambulance setting. The primary aim of the current study was to compare the performance of NEWS2 (National Early Warning score 2) and RETTS (Rapid Emergency Triage and Treatment System) with respect to identification of sepsis among ambulance patients with clinically suspected infection. The secondary aim was to compare the performance of the novel Predict Sepsis screening tools with that of NEWS2, RETTS and clinical judgment. METHODS: Prospective cohort study of 323 adult ambulance patients with clinically suspected infection, transported to hospitals in Stockholm, during 2017/2018. The sensitivity, specificity, and AUC (Area Under the receiver operating Curve) were calculated and compared by using McNemar´s test and DeLong's test. RESULTS: The prevalence of sepsis in the current study population was 44.6% (144 of 323 patients). No significant difference in AUC was demonstrated between NEWS2 ≥ 5 and RETTS ≥ orange. NEWS2 ≥ 7 demonstrated a significantly greater AUC than RETTS red. The Predict Sepsis screening tools ≥ 2 demonstrated the highest sensitivity (range 0.87-0.91), along with RETTS ≥ orange (0.83), but the lowest specificity (range 0.39-0.49). The AUC of NEWS2 (0.73) and the Predict Sepsis screening tools (range 0.75-0.77) was similar. CONCLUSIONS: The results indicate that NEWS2 could be the better alternative for sepsis identification in the ambulance, as compared to RETTS. The Predict Sepsis screening tools demonstrated a high sensitivity and AUCs similar to that of NEWS2. However, these results need to be interpreted with caution as the Predict Sepsis screening tools require external validation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03249597 .


Assuntos
Ambulâncias , Sepse , Adulto , Humanos , Julgamento , Estudos Prospectivos , Sepse/diagnóstico , Sepse/epidemiologia , Triagem
14.
BMC Infect Dis ; 21(1): 1108, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34706677

RESUMO

BACKGROUND: Neonatal sepsis is a global concern with increasing morbidity and mortality. The burden of neonatal sepsis is highest in developing countries, especially in those lacking proper surveillance systems. The causative pathogens and their drug-resistance levels vary between countries with emergence of multidrug resistance organisms. Thus, accurate records on the recent trends of organisms causing neonatal sepsis will provide vital information for appropriate intervention. We aimed to investigate neonatal sepsis, identify its associated factors and causative pathogens and to assess the antibiotic susceptibility patterns in Sana'a city, Yemen. METHODS: A cross-sectional study was conducted on neonates admitted to intensive care units of six hospitals in Sana'a city, Yemen, in the period from January 15, to March 30, 2020. Natal and prenatal medical data were collected using well-structured questionnaire. Neonates were subjected to sepsis work-up including blood culture, complete blood count and C-reactive protein. Organisms were identified by Gram staining and analyzed by the VITEK II system for bacterial bio-typing and antibiotic susceptibility testing. FINDINGS: Of the 199-neonates with suspected neonatal sepsis, 154 (77.38%) had culture-proven sepsis. Early-onset neonatal sepsis (EOS) was higher (50.25%; 100/199) than late-onset neonatal sepsis (LOS) (27.13%; 54/199). Multivariable analysis identified vaginal delivery as an independent risk factor for neonatal sepsis p = 0.005. Majority of isolated bacteria (74.39%) were gram-negative with Burkholderia cepacia (39%) and Klebsiella oxytoca (13%) being the most common pathogens of EOS and LOS. The most common gram-positive pathogens were Staphylococcus haemolyticus (9.1%) and Staphylococcus epidermidis (7.1%). B. cepacia showed multidrug resistance except for cefepime. All Klebsiella species isolates (100%) and most Pantoea species (93%) were ESBL and carbapenemase positive. All Escherichia coli and Acinetobacter baumannii isolates were ESBL positive. A significant number of gram-positive bacteria showed resistance to vancomycin. CONCLUSION: The study findings show a high proportion of neonatal sepsis among neonates admitted to hospitals in Sana'a city with antibiotic-resistant B. cepacia being the single most common pathogen causing EOS and LOS. Findings also emphasize the emerging threat of multidrug-resistant bacteria in neonatal units and will help develop evidence-based management of neonatal sepsis in Yemen.


Assuntos
Burkholderia cepacia , Sepse Neonatal , Sepse , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Testes de Sensibilidade Microbiana , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Gravidez , Sepse/tratamento farmacológico , Sepse/epidemiologia , Iêmen/epidemiologia
15.
PLoS One ; 16(9): e0256515, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34496000

RESUMO

BACKGROUND: The epidemiological transition, touted as occurring in Ghana, requires research that tracks the changing patterns of diseases in order to capture the trend and improve healthcare delivery. This study examines national trends in mortality rate and cause of death at health facilities in Ghana between 2014 and 2018. METHODS: Institutional mortality data and cause of death from 2014-2018 were sourced from the Ghana Health Service's District Health Information Management System. The latter collates healthcare service data routinely from government and non-governmental health institutions in Ghana yearly. The institutional mortality rate was estimated using guidelines from the Ghana Health Service. Percent change in mortality was examined for 2014 and 2018. In addition, cause of death data were available for 2017 and 2018. The World Health Organisation's 11th International Classification for Diseases (ICD-11) was used to group the cause of death. RESULTS: Institutional mortality decreased by 7% nationally over the study period. However, four out of ten regions (Greater Accra, Volta, Upper East, and Upper West) recorded increases in institutional mortality. The Upper East (17%) and Volta regions (13%) recorded the highest increase. Chronic non-communicable diseases (NCDs) were the leading cause of death in 2017 (25%) and 2018 (20%). This was followed by certain infectious and parasitic diseases (15% for both years) and respiratory infections (10% in 2017 and 13% in 2018). Among the NCDs, hypertension was the leading cause of death with 2,243 and 2,472 cases in 2017 and 2018. Other (non-ischemic) heart diseases and diabetes were the second and third leading NCDs. Septicaemia, tuberculosis and pneumonia were the predominant infectious diseases. Regional variations existed in the cause of death. NCDs showed more urban-region bias while infectious diseases presented more rural-region bias. CONCLUSIONS: This study examined national trends in mortality rate and cause of death at health facilities in Ghana. Ghana recorded a decrease in institutional mortality throughout the study. NCDs and infections were the leading causes of death, giving a double-burden of diseases. There is a need to enhance efforts towards healthcare and health promotion programmes for NCDs and infectious diseases at facility and community levels as outlined in the 2020 National Health Policy of Ghana.


Assuntos
Diabetes Mellitus/mortalidade , Instalações de Saúde , Cardiopatias/mortalidade , Hipertensão/mortalidade , Doenças não Transmissíveis/mortalidade , Pneumonia/mortalidade , Sepse/mortalidade , Tuberculose/mortalidade , Causas de Morte/tendências , Doença Crônica/epidemiologia , Doença Crônica/mortalidade , Atenção à Saúde , Diabetes Mellitus/epidemiologia , Feminino , Gana/epidemiologia , Carga Global da Doença , Cardiopatias/epidemiologia , Humanos , Hipertensão/epidemiologia , Masculino , Doenças não Transmissíveis/epidemiologia , Pneumonia/epidemiologia , População Rural , Sepse/epidemiologia , Tuberculose/epidemiologia , População Urbana
16.
Tuberk Toraks ; 69(3): 349-359, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34581156

RESUMO

Introduction: The aim of this study was to reveal the effect of the individual's lifestyle and personality traits on the disease process in patients with sepsis and to have clinical predictions about these patients. Materials and Methods: The study was planned as a multi-center, prospective, observational study after obtaining the approval of the local ethics committee. Patients were hospitalized in different intensive care units. Besides demographics and personal characteristics of patients, laboratory data, length of hospital and ICU stay, and mortality was recorded. Two hundred and fifty-nine patients were followed up in 11 different intensive care units. Mortality rates, morbidities, blood analyses, and personality traits were evaluated as primary outcomes. Result: Of the 259 patients followed up, mortality rates were significantly higher in men than in women (p= 0.008). No significant difference was found between the patients' daily activity, tea and coffee consumption, reading habits, smoking habits, blood groups, atopy histories and mortality rates. Examining the personal traits, it was seen that 90 people had A-type personality structure and 51 (56.7%) of them died with higher mortality rate compared to type B (p= 0.038). There was no difference between personalities, in concomitant ARDS occurrence, need for sedation and renal replacement therapies. Conclusions: Among individuals diagnosed with sepsis/septic shock, mortality increased significantly in patients with A-type personality trait compared to other personality traits. These results showed that personal traits may be useful in predicting the severity of disease and mortality in patients with sepsis/septic shock.


Assuntos
Sepse , Choque Séptico , Feminino , Humanos , Tempo de Internação , Masculino , Personalidade , Estudos Prospectivos , Sepse/epidemiologia
17.
Crit Care Med ; 49(12): 2058-2069, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34582410

RESUMO

OBJECTIVES: To provide updated information on the burdens of sepsis during acute inpatient admissions for Medicare beneficiaries. DESIGN: Analysis of paid Medicare claims via the Centers for Medicare and Medicaid Services DataLink Project. SETTING: All U.S. acute-care hospitals, excluding federally operated hospitals (Veterans Administration and Defense Health Agency). PATIENTS: All Medicare beneficiaries, January 2012-February 2020, with an explicit sepsis diagnostic code assigned during an inpatient admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The count of Medicare Part A/B (fee-for-service) plus Medicare Advantage inpatient sepsis admissions rose from 981,027 (CY2012) to 1,700,433 (CY 2019). The proportion of total admissions with sepsis in the Medicare Advantage population rose from 21.43% to 35.39%, reflecting the increasing beneficiary proportion enrolled in Medicare Advantage. In CY2019, 6-month mortality rates in Medicare fee-for-service beneficiaries for sepsis continued to decline, but remained high: 59.9% for septic shock, 35.5% for severe sepsis, 30.8% for sepsis attributed to a specific organism, and 26.5% for unspecified sepsis. Total fee-for-service-only inpatient hospital costs rose from $17.79B (CY2012) to $22.98B (CY2019). We estimated that the aggregate cost of sepsis hospital care for the entire U.S. population was at least $57.47B in 2019. Inclusion of 14 months' (January 2019-February 2020) newer data exposed new trends: the cost per patient, number of admissions, and fraction of patients with sepsis labeled as present on admission inflected around November 2015, coincident with the change to International Classification of Diseases, 10th Edition, and introduction of the Severe Sepsis and Septic Shock Management Bundle (SEP-1) metric. CONCLUSIONS: Sepsis among Medicare beneficiaries precoronavirus disease 2019 imposed immense burdens upon patients, their families, and the taxpayers.


Assuntos
Medicare/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sepse/diagnóstico , Planos de Pagamento por Serviço Prestado/economia , Hospitalização/estatística & dados numéricos , Humanos , Sepse/economia , Sepse/epidemiologia , Estados Unidos/epidemiologia
18.
Rev Bras Enferm ; 75(1): e20201338, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34586197

RESUMO

OBJECTIVES: to analyze factors associated with sepsis and septic shock in cancer patients in the Intensive Care Unit. METHODS: cross-sectional, retrospective study with a quantitative approach, with a sample of 239 patients in an oncology hospital. Secondary data from medical records were used. The outcome variable was "presence of sepsis and/or septic shock"; and exposures: sex, length of stay, origin, use of invasive procedures and primary tumor site. Descriptive, bivariate analyzes and multiple logistic regression models were performed. RESULTS: the prevalence of sepsis was 95% CI: 14.7-24.7 and septic shock of 95% CI: 37.7-50.3. In the multiple analysis, sepsis and/or septic shock were associated with hospital stay longer than seven days, being from the Emergency Department, presence of invasive procedures and hematological site. CONCLUSIONS: sepsis and/or septic shock in cancer patients were associated with clinical characteristics and health care factors.


Assuntos
Sepse , Choque Séptico , Estudos Transversais , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Prevalência , Estudos Retrospectivos , Sepse/complicações , Sepse/epidemiologia , Choque Séptico/complicações , Choque Séptico/epidemiologia
19.
BMJ Open ; 11(9): e051502, 2021 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521676

RESUMO

OBJECTIVES: There is minimal literature examining the association of sepsis with out-of-hospital cardiac arrest (OHCA). Using a large national database, we aimed to quantify the risk of OHCA among sepsis patients after hospital discharge. DESIGN: Population-based cohort study. SETTING: Nationwide sepsis cohort retrieved from the National Health Insurance Research Database of Taiwan between 2000 and 2013. PARTICIPANTS: We included 17 304 patients with sepsis. After hospital discharge, 144 patients developed OHCA within 30 days and 640 between days 31 and 365. PRIMARY AND SECONDARY OUTCOME MEASURES: The main outcomes were OHCA events following hospital discharge for sepsis. To evaluate the independent association between sepsis and OHCA after a sepsis hospitalisation, we constructed two non-sepsis comparison cohorts using risk set sampling and propensity score matching techniques (non-infection cohort, non-sepsis infection cohort). We plotted the daily number and daily risk of OHCA within 1 year of hospital discharge between sepsis and matched non-sepsis cohorts. We used Cox regression to evaluate the risk of early and late OHCA, comparing sepsis to non-sepsis patients. RESULTS: Compared with non-infected patients, sepsis patients had a higher rate of early (HR 1.66, 95% CI: 1.27 to 2.16) and late (HR 1.19, 95% CI: 1.06 to 1.33) OHCA events. This association was independent of age, sex or cardiovascular history. Compared with non-sepsis patients with infections, sepsis patients had a higher rate of both early (HR 1.28, 95% CI: 1.00 to 1.63) and late (HR 1.13, 95% CI: 1.01 to 1.27) OHCA events, especially among patients with cardiovascular disease (OR 1.35, 95% CI: 1.01 to 1.81). CONCLUSIONS: Sepsis patients had increased risk of OHCA compared with matched non-sepsis controls, which lasted up to 1 year after hospital discharge.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Sepse , Estudos de Coortes , Humanos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Sepse/epidemiologia , Sobreviventes , Taiwan/epidemiologia
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