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    Platelets and Multi-Organ Failure in Sepsis.
    Int J Mol Sci 2017 Oct 20;18(10). Epub 2017 Oct 20.
    Department of Medical Science, University of Turin, 10126 Turin, Italy.
    Platelets have received increasing attention for their role in the pathophysiology of infectious disease, inflammation, and immunity. In sepsis, a low platelet count is a well-known biomarker for disease severity and more recently authors have focused their attention on the active role of platelets in the pathogenesis of multi-organ failure. Septic shock is characterised by a dysregulated inflammatory response, which can impair the microcirculation and lead to organ injury. Read More

    [Lung transplantation for connective tissue disease-associated interstitial lung disease recipient].
    Zhonghua Jie He He Hu Xi Za Zhi 2017 Oct;40(10):744-748
    Transplantation Center of Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China.
    Objective: To investigate the timing and complications of lung transplantation for the treatment of connective tissue disease-associated interstitial lung disease (CTD-ILD). Method: The clinical data of connective tissue-associated disease lung transplantation recipients from September, 2015 to February, 2017 were collected. Results: 11 patients with CTD-ILD were evaluated by lung transplantation and were treated with lung transplantation. Read More

    Analysis of PD-1 expression in the monocyte subsets from non-septic and septic preterm neonates.
    PLoS One 2017 19;12(10):e0186819. Epub 2017 Oct 19.
    Department of Paediatrics, Institute of Paediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
    Programmed death-1 (PD-1) receptor system represents a part of recently reported immunoregulatory pathway. PD-1 is an immune checkpoint molecule, which plays an important role in downregulating the immune system proinflammatory activity. Until recently, PD-1 expression was not established on immune cells of the preterm infants. Read More

    HDL Cholesterol Efflux is Impaired in Older Patients with Early Sepsis: A Subanalysis of a Prospective Pilot Study.
    Shock 2017 Oct 18. Epub 2017 Oct 18.
    *University of Florida, College of Medicine, Jacksonville, Department of Emergency Medicine †University of Florida, College of Medicine, Gainesville, Institute on Aging ‡UCLA, Department of Medicine, Molecular & Medical Pharmacology §University of Florida, College of Medicine, Gainesville, Department of Surgery.
    Background: Proper functioning of high density lipoprotein (HDL) is necessary for protection against sepsis. However, previous work has demonstrated that HDL becomes oxidized and dysfunctional (Dys-HDL) during sepsis. Older (age > 65 years) patients are at particularly high risk of sepsis and poor outcomes from sepsis. Read More

    Sepsis National Hospital Inpatient Quality Measure (SEP-1): Multistakeholder Work Group Recommendations for Appropriate Antibiotics for the Treatment of Sepsis.
    Clin Infect Dis 2017 Oct;65(9):1565-1569
    Infectious Diseases Society of America, Arlington, Virginia.
    The Center for Medicare and Medicaid Services adopted the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) performance measure to the Hospital Inpatient Quality Reporting Program in July 2015 to help address the high mortality and high cost associated with sepsis. The SEP-1 performance measure requires, among other critical interventions, timely administration of antibiotics to patients with sepsis or septic shock. The multistakeholder workgroup recognizes the need for SEP-1 but strongly believes that multiple antibiotics listed in the antibiotic tables for SEP-1 are not appropriate and the use of these antibiotics, as called for in the SEP-1 measure, is not in alignment with prudent antimicrobial stewardship. Read More

    Protective Effect of Argan and Olive Oils against LPS-Induced Oxidative Stress and Inflammation in Mice Livers.
    Int J Mol Sci 2017 Oct 19;18(10). Epub 2017 Oct 19.
    Laboratoire Bio-PeroxIL EA7270, Université Bourgogne Franche-Comté, UFR SVTE, Dijon 21000, France.
    Sepsis causes severe dysregulation of organ functions, via the development of oxidative stress and inflammation. These pathophysiological mechanisms are mimicked in mice injected with bacterial lipopolysaccharide (LPS). Here, protective properties of argan oil against LPS-induced oxidative stress and inflammation are explored in the murine model. Read More

    Heparin-binding protein (HBP) improves prediction of sepsis-related acute kidney injury.
    Ann Intensive Care 2017 Oct 18;7(1):105. Epub 2017 Oct 18.
    Division of Infection Medicine, Department of Clinical Sciences, Lund University, BMC B14, 221 84, Lund, Sweden.
    Background: Sepsis-related acute kidney injury (AKI) accounts for major morbidity and mortality among the critically ill. Heparin-binding protein (HBP) is a promising biomarker in predicting development and prognosis of severe sepsis and septic shock that has recently been proposed to be involved in the pathophysiology of AKI. The objective of this study was to investigate the added predictive value of measuring plasma HBP on admission to the intensive care unit (ICU) regarding the development of septic AKI. Read More

    [Sepsis-3 : What has been confirmed in therapy?]
    Internist (Berl) 2017 Oct 18. Epub 2017 Oct 18.
    Zentrum für Klinische Studien (ZKS), Universitätsklinikum Jena, Jena, Deutschland.
    Hugo Schottmüller realized already over 100 years ago that sepsis is a syndrome that occurs as a consequence of an infection defined by a systemic overreaction to a periodic invasion of bacilli. Consistent with this old concept, the term "systemic inflammatory response syndrome" (SIRS) was coined about 25 years ago and has been regularly used ever since. In 2016, a sepsis task force was formed to re-evaluate the current definition on a scientific basis. Read More

    Staphylococcus aureus Alpha-Toxin Induces the Formation of Dynamic Tubules Labeled with LC3 within Host Cells in a Rab7 and Rab1b-Dependent Manner.
    Front Cell Infect Microbiol 2017 4;7:431. Epub 2017 Oct 4.
    Laboratorio de Biología Celular y Molecular, Instituto de Histología y Embriología, Facultad de Ciencias Médicas, CONICET, Universidad Nacional de Cuyo, Mendoza, Argentina.
    Staphylococcus aureus is a pathogen that causes severe infectious diseases that eventually lead to septic and toxic shock. S. aureus infection is characterized by the production of virulence factors, including enzymes and toxins. Read More

    [Changes in blood oxygen metabolism indices and their clinical significance in children with septic shock].
    Zhongguo Dang Dai Er Ke Za Zhi 2017 Oct;19(10):1124-1128
    Department of Pediatrics, Second Hospital of Lanzhou University, Lanzhou 730000, China.
    The key to the treatment of septic shock is to provide adequate oxygen supply and improve tissue perfusion. Lactate and central venous oxygen saturation (ScvO2) are commonly used as the indices of oxygen metabolism, but tissue hypoxia may still exist even when lactate and ScvO2 are within the normal range. Arteriovenous difference in carbon dioxide partial pressure (CO2 gap) can accurately reflect oxygen delivery when ScvO2 is in the normal range. Read More

    First Report of Granulicatella sp. Endocarditis in a Kidney Transplant Patient.
    J Bras Nefrol 2017 Jul-Sep;39(3):341-344
    Universidade de São Paulo.
    Granulicatella and Abiotrophia are genera of fastidious Gram-positive cocci commensal of the oral, genitourinary, and intestinal flora. We report the first case of infective endocarditis caused by Granulicatella sp. in a kidney transplant recipient. Read More

    Cardiogenic Shock during First Infusion of Anthracycline Chemotherapy in a Patient with Hodgkin Lymphoma: An Unusual Event.
    Cardiology 2017 Oct 18;139(1):7-10. Epub 2017 Oct 18.
    Department of Cardiology, Ospedale G. Brotzu, Azienda Ospedaliera Brotzu, Cagliari, Italy.
    Introduction: Hodgkin lymphoma (HL) is one of the most common types of cancers of the lymphatic system. The currently available therapies enable a cure in approximately 80-85% of treated patients. However, the cardiotoxicity of HL treatment has become a major cause of morbidity and mortality in survivors mainly related to the use of anthracycline. Read More

    Toxic Shock Syndrome: Still a Timely Diagnosis.
    Pediatr Emerg Care 2017 Oct 16. Epub 2017 Oct 16.
    From the *Michael G. DeGroote School of Medicine and †Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University, Ontario, Canada.
    Background: Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has made headlines because of its high associated morbidity and mortality rate in previously healthy young females. Incidence peaked in the early 1980s owing to increased usage of ultra-absorbent tampons. Read More

    Importance of the Complement Alternative Pathway in Serum Chemotactic Activity During Sepsis.
    Shock 2017 Oct 16. Epub 2017 Oct 16.
    *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA †Department of Anesthesiology & Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD ‡Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
    Serum chemotactic activity is important in regulating neutrophil migration. The ability of neutrophils to migrate to infectious site is crucial for host effective pathogen control, but unregulated neutrophil activation can also cause tissue damage. During bacterial sepsis, the complement alternative pathway (AP) is massively activated in blood and tissues and reportedly contributes to sepsis pathogenesis. Read More

    Vasopressor Cumulative Dose Requirement and Risk of Early Death During Septic Shock: An Analysis from the Episs Cohort.
    Shock 2017 Oct 16. Epub 2017 Oct 16.
    *Department of Intensive Care, François Mitterrand University Hospital, Dijon, France. †INSERM CIC1432, Clinical Epidemiology, University of Burgundy, Dijon, France. ‡Lipness Team, INSERM Research Center LNC-UMR1231and LabExLipSTIC, University of Burgundy, Dijon, France.
    Septic shock is the primary cause of death in intensive care units, with about 20% of patients dying in the first 3 days. To design future trials focused on early mortality, we require knowledge of early indicators that can detect patients at high risk of early death from refractory septic shock.The aim of this study was to assess whether the cumulative dose of vasopressors (CDV), calculated as the cumulative dose of epinephrine + norepinephrine, is a predictor of early death (within 72 hours) attributable to refractory septic shock (EDASS). Read More

    Dihydromyricetin protects against lipopolysaccharide‑induced cardiomyocyte injury through the toll‑like receptor‑4/nuclear factor‑κB pathway.
    Mol Med Rep 2017 Oct 9. Epub 2017 Oct 9.
    Department of Cardiology, The First People's Hospital of Jingmen, Jingmen, Hubei 448000, P.R. China.
    Dihydromyricetin (DHM) is a bioactive flavonoid compound extracted from the stems and leaves of Ampelopsis grossedentata. Previous studies have indicated that DHM has antioxidation and antitumor capabilities, while the effect of DHM on lipopolysaccharide (LPS)‑induced cardiomyocyte injury has not been clarified. Therefore, the aim of the present study was to investigate the effect of DHM on LPS‑induced cardiomyocyte injury. Read More

    Considerations and Some Practical Solutions to Overcome Nanoparticle Interference with LAL Assays and to Avoid Endotoxin Contamination in Nanoformulations.
    Methods Mol Biol 2018 ;1682:23-33
    Cancer Research Technology Program¸ Nanotechnology Characterization Laboratory, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, P.O. Box B, Frederick, MD, 21702, USA.
    Monitoring endotoxin contamination in drugs and medical devices is required to avoid pyrogenic response and septic shock in patients receiving these products. Endotoxin contamination of engineered nanomaterials and nanotechnology-based medical products represents a significant translational hurdle. Nanoparticles often interfere with an in vitro Limulus Amebocyte Lysate (LAL) assay commonly used in the pharmaceutical industry for the detection and quantification of endotoxin. Read More

    NMI and IFP35 serve as proinflammatory DAMPs during cellular infection and injury.
    Nat Commun 2017 Oct 16;8(1):950. Epub 2017 Oct 16.
    National Laboratory of Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China.
    Damage-associated molecular patterns (DAMP) trigger innate immune response and exacerbate inflammation to combat infection and cellular damage. Identifying DAMPs and revealing their functions are thus of crucial importance. Here we report that two molecules, N-myc and STAT interactor (NMI) and interferon-induced protein 35 (IFP35) act as DAMPs and are released by activated macrophages during lipopolysaccharide-induced septic shock or acetaminophen-induced liver injury. Read More

    Lipopolysaccharide Potentiates Insulin-Driven Hypoglycemic Shock.
    J Immunol 2017 Oct 16. Epub 2017 Oct 16.
    Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599;
    Critically ill patients typically present with hyperglycemia. Treatment with conventional insulin therapy (targeting 144-180 mg/dl) improves patient survival; however, intensive insulin therapy (IIT) targeting normal blood glucose levels (81-108 mg/dl) increases the incidence of moderate and severe hypoglycemia, and increases mortality. Septic patients are especially prone to IIT-induced hypoglycemia, but the mechanism remains unknown. Read More

    Severe Sepsis and Acute Myocardial Dysfunction in an Adolescent with Chlamydia Trachomatis Pelvic Inflammatory Disease: A Case Report.
    J Pediatr Adolesc Gynecol 2017 Oct 13. Epub 2017 Oct 13.
    Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205; The Ohio State University, 410 W 10th Ave, Columbus, Ohio 43210; The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205.
    Background: Although generally asymptomatic, severe Chlamydia trachomatis (C. trachomatis) infections have been documented. C. Read More

    [Relationship between highly sensitive cardiac troponin T and sepsis and outcome in critically ill patients].
    Zhonghua Nei Ke Za Zhi 2017 Oct;56(10):738-742
    Intensive Care Unit, Fuxing Hospital, Capital Medical University, Beijing 100038, China.
    Objective: To investigate the prognostic value of highly sensitive cardiac Troponin T (hs-cTn T) for sepsis in critically ill patients. Methods: Patients estimated to stay in the ICU of Fuxing Hospital for more than 24h were enrolled at from March 2014 to December 2014. Serum hs-cTn T was tested within two hours. Read More

    Clinical relevance of early sublingual microcirculation monitoring in septic shock patients.
    Clin Hemorheol Microcirc 2017 Oct 7. Epub 2017 Oct 7.
    Department of Anaesthesia, Pain Management and Perioperative Medicine's, Faculty of Medicine, Dalhousie University, Halifax, Canada.
    Introduction: Although microcirculation dysfunction plays unique role in septic shock, translation of microcirculation to clinical practices is limited by current semi-quantities analysis and unclear clinical relevance of microcirculation monitoring. Our aim was to critically evaluate the characteristic nature and relevant clinical important of microcirculation.

    Evidence Acquisition: Pubmed (2000 to August 2015) were searched to identify observation, case-control, intervention and randomized clinical studies evaluating the relationship between microcirculation alterations and mortality, morbidity and drug responses. Read More

    Does SOFA predict outcomes better than SIRS in Brazilian ICU patients with suspected infection? A retrospective cohort study.
    Braz J Infect Dis 2017 Oct 13. Epub 2017 Oct 13.
    Hospital Moinhos de Vento, Departamento de Cuidados Intensivos, Porto Alegre, RS, Brazil.
    We compared the discriminatory capacity of the sequential organ failure assessment (SOFA) versus the systemic inflammatory response syndrome (SIRS) score for predicting ICU mortality, need for and length of mechanical ventilation (MV), ICU stay, and hospitalization in patients with suspected infection admitted to a mixed Brazilian ICU. We performed a retrospective analysis of a longitudinal ICU database from a tertiary hospital in Southern Brazil. Patients were categorized according to whether they met the criteria for sepsis according to SOFA (variation ≥2 points over the baseline clinical condition) and SIRS (SIRS score ≥2 points). Read More

    The Comparative Epidemiology of Pediatric Severe Sepsis.
    J Intensive Care Med 2017 Jan 1:885066617735783. Epub 2017 Jan 1.
    2 Division of Infectious Diseases, Department of Medicine, Washington University in St Louis, St Louis, MO, USA.
    Objective: To determine whether the coding strategies used to identify severe sepsis in administrative data sets could identify cases with comparable case mix, hospitalization characteristics, and outcomes as a cohort of children diagnosed with severe sepsis using strict clinical criteria.

    Methods: We performed a retrospective cohort study using data from 2005 to 2011 from the New York and Florida State Inpatient Databases, available from the US Healthcare Cost and Utilization Project. We compared 4 coding strategies: the single International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM) codes for (1) severe sepsis or (2) septic shock, and the algorithms developed by (3) Angus et al or (4) Martin et al, which use a combination of ICD-9-CM codes for infection and organ dysfunction. Read More

    An Unusual Presentation of Pyoderma Gangrenosum Leading to Systemic Inflammatory Response Syndrome.
    Case Rep Dermatol 2017 Sep-Dec;9(3):146-150. Epub 2017 Sep 11.
    Department of Dermatology, Fiona Stanley Hospital, Murdoch, Washington, Australia.
    This is a report of an atypical presentation of pyoderma gangrenosum (PG) in a 26-year-old male who had a negative septic screen. The patient had a life-threatening presentation requiring an intensive care unit (ICU) admission for vasopressor support. It was thought that the likely cause of circulatory collapse was an overwhelming cytokine reaction or systemic inflammatory response syndrome (SIRS) secondary to extensive PG lesions rather than septic shock. Read More

    A prospective study of ketamine as primary therapy for prehospital profound agitation.
    Am J Emerg Med 2017 Oct 7. Epub 2017 Oct 7.
    Department of Emergency Medicine, Hennepin County Medical Center, United States.
    Objective: We investigated the effectiveness of ketamine as a primary therapy for prehospital profound agitation.

    Methods: This was a prospective observational study of patients receiving 5mg/kg of intramuscular ketamine for profound agitation, defined as a score of +4 on the Altered Mental Status Scale (AMSS), a validated ordinal scale of agitation from -4 (unresponsive) to +4 (most agitated). The primary outcome was time to adequate sedation (AMSS<+1). Read More

    Heme Oxygenase-1 Protects the Liver from Septic Injury by Modulating TLR4-Mediated Mitochondrial Quality Control in Mice.
    Shock 2017 Oct 12. Epub 2017 Oct 12.
    School of Pharmacy, Sungkyunkwan University, Suwon, Gyonggi-do 16419, Republic of Korea.
    Mitochondrial dysfunction is involved in the pathogenesis of sepsis-induced multiple organ dysfunction syndrome (MODS). Mitochondrial quality control (QC) is characterized by self-recovering mitochondrial damage through mitochondrial biogenesis, mitophagy, and fission/fusion. Heme oxygenase (HO)-1 acts as a signaling molecule to modulate inflammation. Read More

    Mechanisms of Thrombocytopenia During Septic Shock: A Multiplex Cluster Analysis of Endogenous Sepsis Mediators.
    Shock 2017 Oct 12. Epub 2017 Oct 12.
    *Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, F-94010 France †Université Paris Est Créteil, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale, Groupe de Recherche Clinique CARMAS, Créteil, F-94010, France ‡Université Paris Est Créteil, Faculté de Médecine, Institut Mondor de Recherche Biomédicale, Equipe 16, Créteil, F-94010, France §Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service d'immunologie, Créteil, F-94010 France ¶Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service d'hématologie biologique, Créteil, F-94010 France.
    Background: Thrombocytopenia is a common feature of sepsis and may involve various mechanisms often related to the inflammatory response. This study aimed at evaluating factors associated with thrombocytopenia during human septic shock. In particular, we used a multiplex analysis to assess the role of endogenous sepsis mediators. Read More

    Descending necrotizing mediastinitis after a trigger point injection.
    Clin Exp Emerg Med 2017 Sep 30;4(3):182-185. Epub 2017 Sep 30.
    Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
    Descending necrotizing mediastinitis (DNM) is a rare form of mediastinal infection. Most cases are associated with esophageal rupture. DNM after a trigger point injection in the upper trapezius has not been described previously. Read More

    Korean Shock Society septic shock registry: a preliminary report.
    Clin Exp Emerg Med 2017 Sep 30;4(3):146-153. Epub 2017 Sep 30.
    Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
    Objective: To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED).

    Methods: This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. Read More

    A case of Vibrio vulnificus infection complicated with fulminant purpura: gene and biotype analysis of the pathogen.
    JMM Case Rep 2017 May 19;4(5):e005096. Epub 2017 May 19.
    Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan.
    Introduction.Vibrio vulnificus (V. vulnificus) causes a severe infection that develops in the compromised host. Read More

    Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay.
    J Am Med Inform Assoc 2017 Aug 28. Epub 2017 Aug 28.
    Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
    Objective: The purpose of this study was to determine whether an electronic health record-based sepsis alert system could improve quality of care and clinical outcomes for patients with sepsis.

    Materials And Methods: We performed a patient-level interrupted time series study of emergency department patients with severe sepsis or septic shock between January 2013 and April 2015. The intervention, introduced in February 2014, was a system of interruptive sepsis alerts triggered by abnormal vital signs or laboratory results. Read More

    Procalcitonin and Mr-Proadrenomedullin Combination with Sofa and Qsofa Scores for Sepsis Diagnosis and Prognosis: A Diagnostic Algorithm.
    Shock 2017 Oct 11. Epub 2017 Oct 11.
    *Internal Medicine Department, University Hospital Campus Bio-Medico, Rome, Italy †Department of Public Health and Infectious Diseases. University of Rome, 'Sapienza", Policlinico Umberto I, Rome, Italy ‡Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy.
    Purpose: The third Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as an organ dysfunction consequent to infection. A SOFA score ≥2 identifies sepsis. In this study, PCT and MR-proADM were evaluated along with SOFA and qSOFA scores in patients with sepsis or septic shock. Read More

    Septic shock resuscitation in the first hour.
    Curr Opin Crit Care 2017 Oct 11. Epub 2017 Oct 11.
    aIntensive Care Unit, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia bCentre de Recherche du CHU de Sherbrooke cFaculté de Médecine et des Sciences de la Santé, University of Sherbrooke, Sherbrooke, Québec, Canada dSt Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust eSchool of Immunology & Microbial Sciences, Kings College London, London, UK.
    Purpose Of Review: We reviewed the recent advances in the initial approach to resuscitation of sepsis and septic shock patients.

    Recent Findings: Sepsis and septic shock are life-threatening emergencies. Two key interventions in the first hour include timely antibiotic therapy and resuscitation. Read More

    Sepsis: A Review of Advances in Management.
    Adv Ther 2017 Oct 11. Epub 2017 Oct 11.
    CIBERES, Vall d'Hebron Institut of Research, Barcelona, Spain.
    Infections represent a common health problem in people of all ages. Usually, the response given to them is appropriate and so little treatment is needed. Sometimes, however, the response to the infection is inadequate and may lead to organ dysfunction; this is the condition known as sepsis. Read More

    Predicting Resistance to Piperacillin-Tazobactam, Cefepime and Meropenem in Septic Patients With Bloodstream Infection Due to Gram-Negative Bacteria.
    Clin Infect Dis 2017 Jul 10. Epub 2017 Jul 10.
    Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri.
    Background: Predicting antimicrobial resistance in gram-negative bacteria (GNB) could balance the need for administering appropriate empiric antibiotics while also minimizing the use of clinically unwarranted broad-spectrum agents. Our objective was to develop a practical prediction rule able to identify patients with GNB infection at low risk for resistance to piperacillin-tazobactam (PT), cefepime (CE), and meropenem (ME).

    Methods: The study included adult patients with sepsis or septic shock due to bloodstream infections caused by GNB admitted between 2008 and 2015 from Barnes-Jewish Hospital. Read More

    Time-Dependent Production of Endothelium-Related Biomarkers is Affected Differently in Hemorrhagic and Septic Shocks.
    Inflammation 2017 Oct 10. Epub 2017 Oct 10.
    Faculty of Medicine, Department of Medical Pharmacology, Ankara University, Sihhiye, 06100, Ankara, Turkey.
    Shock is associated with inflammation-induced endothelial dysfunction. The aim of this study was to determine time-dependent alteration of blood biomarkers related to endothelial function in hemorrhagic and septic shocks. Hemorrhagic shock was induced by bleeding the animals. Read More

    Epidemiology and antifungal susceptibility of candidemia isolates of non-albicans Candida species from cancer patients.
    Emerg Microbes Infect 2017 Oct 11;6(10):e87. Epub 2017 Oct 11.
    Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.
    Candidemia is a growing concern worldwide, and its species distribution has shifted toward non-albicans Candida in recent decades, especially in patients with malignancy. This study aimed to update the epidemiology and antifungal susceptibility of non-albicans candidemia isolates from the cancer patients. Adult cancer patients with non-albicans candidemia were recruited, and clinical data were retrospectively collected from five medical centers in Taiwan from 1 July 2011 to 30 June 2014. Read More

    Case Report: A Cluster of Three Leptospirosis Cases in a New York City Abattoir and an Unusual Complication in the Index Case.
    Am J Trop Med Hyg 2017 Oct 2. Epub 2017 Oct 2.
    Department of Infectious Diseases, NYU School of Medicine, New York, New York.
    We report the case of a 46-year-old man abattoir worker who developed myalgias, shortness of breath, and irritability 2 weeks after sustaining a laceration to the hand with a knife at work. During his hospital evaluation for septic shock he was noted to be febrile, hypotensive, profoundly jaundiced with aseptic meningitis, and renal failure, and was diagnosed with Leptospirosis interrogans infection confirmed by serum and urine polymerase chain reaction. After standard antibiotic therapy and recovery from severe clinical illness, he developed unilateral orchitis with pyuria secondary to leptospirosis, a well-established complication in the veterinary literature, but of which we offer the first report in humans in the English literature. Read More

    Rare postoperative complication: Clostridium perfringens septic shock following elective abdominal surgery.
    BMJ Case Rep 2017 Oct 9;2017. Epub 2017 Oct 9.
    Department of General Surgery, Bedford Hospital NHS Trust, Bedford, UK.
    Postoperative infections are one of the most common complications in general surgery, and while rates have reduced with the routine administration of perioperative antibiotics, around 5% of patients undergoing a surgical procedure will develop an infective complication.(1) The Gram-positive, obligate anaerobe, Clostridium perfringens, is a well-known pathogen that forms part of both the environmental and gastrointestinal flora.(2) While more commonly associated with food poisoning, anaerobic cellulitis and traumatic gas gangrene, rare cases of spontaneous non-traumatic gas gangrene of abdominal viscera have also been recorded. Read More

    Sepsis caused by bloodstream infection in patients in the intensive care unit: the impact of inactive empiric antimicrobial therapy on outcome.
    J Hosp Infect 2017 Oct 6. Epub 2017 Oct 6.
    School of Medicine, Glasgow University, G12 8QQ.
    Background: Sepsis is one of the leading causes of death in the UK.

    Aims: The aims of this study were to identify the rate of inactive antimicrobial therapy (AMT) in the ICU and whether inactive AMT had an effect on in hospital mortality, ICU mortality, 90-day mortality and length of hospital stay. Additionally, we wanted to identify risk factors for receiving inactive AMT. Read More

    Norepinephrine infusion improves hemodynamics in the preterm infants during septic shock.
    Acta Paediatr 2017 Oct 9. Epub 2017 Oct 9.
    Department of Pediatrics, CHU Ste-Justine, University of Montreal, 3175 chemin de la Côte Ste-Catherine, Montreal, Quebec, Canada, H3T 1C5.
    Aim: This study evaluated the clinical and hemodynamic effects of norepinephrine infusion in preterm infants.

    Methods: The effects of norepinephrine therapy for refractory hypotension were evaluated in preterm infants between April 2009 and April 2011 at the neonatal intensive care unit of Sainte-Justine Hospital, Montreal, Quebec. Changes in hemodynamics and clinical parameters were analyzed eight hours before and eight hours after the start of norepinephrine infusion, and eight hours after its cessation. Read More

    Evaluation of Vasopressin for Septic Shock in Patients on Chronic Renin-Angiotensin-Aldosterone System Inhibitors.
    Crit Care Med 2017 Oct 6. Epub 2017 Oct 6.
    1Department of Pharmacy, University of Alabama at Birmingham Hospital, Birmingham, AL. 2Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL. 3Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham Hospital, Birmingham, AL. 4Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL.
    Objectives: To compare the hemodynamic response in septic shock patients receiving vasopressin who were on chronic renin-angiotensin-aldosterone system inhibitor therapy with those who were not.

    Design: Single-center, retrospective cohort study.

    Setting: Medical and surgical ICUs at a 1,100-bed academic medical center. Read More

    The β-Blocker Esmolol Restores the Vascular Waterfall Phenomenon After Acute Endotoxemia.
    Crit Care Med 2017 Oct 6. Epub 2017 Oct 6.
    All authors: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
    Background: A vascular waterfall occurs when the critical closing pressure is greater than the mean systemic filling pressure. Because the waterfall phenomenon likely exists in the microcirculation, β1-receptor blockers such as esmolol could have some effect on microcirculation and vascular waterfall.

    Objectives: To determine whether a vascular waterfall exists during septic shock and to assess the effects of vasopressors and β-blockers on vascular waterfall. Read More

    Association Between Cardiac Surgery and Mortality Among Patients with Infective Endocarditis Complicated by Sepsis and Septic Shock.
    Shock 2017 Oct 4. Epub 2017 Oct 4.
    *University Hospital for Infectious Diseases "Fran Mihaljevic", Mirogojska cesta 8, Zagreb, Croatia †Emergency Medicine Institute of Varaždin County, Varaždin, Croatia ‡University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, Zagreb, Croatia.
    Background: Sepsis and septic shock are common presentations of infective endocarditis (IE), but little is known about clinical characteristics in this group of patients, use of surgical treatment, and their associations with outcome. We sought to determine the influence of cardiac surgery (CS) on the outcome of patients with IE in different stages of sepsis severity.

    Methods: Two hundred ninety four patients with definite IE native or prosthetic valve IE admitted between 2000 and 2011. Read More

    Is Inappropriate Response to Cosyntropin Stimulation Test an Indication of Corticosteroid Resistance in Septic Shock?
    Shock 2017 Oct 4. Epub 2017 Oct 4.
    *Service de Réanimation Médicale, Université Nice Sophia-Antipolis, Nice, France. †Service de Réanimation, Centre Hospitalier de Cannes, Cannes, France. ‡Service de Réanimation médico-chirurgicale, Université Nice Sophia-Antipolis, Nice, France. §Service de Réanimation, Hôpital de Fréjus Saint Raphaël, Fréjus, France. ||Service de Santé Publique, Université Nice Sophia-Antipolis, Nice, France. ¶Service de Biochimie et Hormonologie, Université Nice Sophia-Antipolis, Nice, France.
    Purpose: We recently published a comparison of two hydrocortisone dosage regimens in patients with septic shock. We compare the results conferred by the two regimens as a function of the response to cosyntropin stimulation test (CST).

    Method: Patients with septic shock were treated by one of two hydrocortisone regimens: either a 50-mg intravenous bolus every six hours during seven days (200 mg group; n = 49), or a 100-mg initial bolus followed by a continuous infusion of 300 mg daily for five days (300 mg group; n = 50). Read More

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