Prearrest sepsis has been associated with particularly poor outcomes among children who suffer in-hospital cardiac arrest (IHCA), but there is a paucity of dedicated studies on the topic. In this study of children receiving cardiopulmonary resuscitation (CPR) in the ICU, our objective was to determine the associations of sepsis with IHCA outcomes and intraarrest physiology. Prospectively designed secondary analysis of the ICU Resuscitation Project clinical trial (NCT02837497). The 18 pediatric and pediatric cardiac ICUs at ten children’s hospitals in the United States. Children (≤ 18 yr) with an index IHCA event. None. The primary exposure was a prearrest diagnosis of sepsis. The primary survival outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline). The primary physiologic outcome was average diastolic blood pressure (DBP) during CPR. Multivariable regression models controlling for a priori covariates assessed the relationship between sepsis and outcomes. Of 1129 children with index IHCAs, 184 (16.3%) had prearrest sepsis. Patients with sepsis had greater prearrest comorbidities, higher prearrest severity of illness, and higher Vasoactive-Inotropic Scores than patients without sepsis. They more frequently had hypotension as the cause of IHCA, had longer durations of CPR, and more frequently received epinephrine and sodium bicarbonate during CPR. They less frequently achieved survival with favorable neurologic outcome (52/184 [28.3%] vs. 552/945 [58.4%]; p < 0.001; adjusted relative risk, 0.54; 95% CI, 0.43-0.68; p < 0.001). Intraarrest DBPs did not differ between patients with vs. without sepsis. Following IHCA, event survivors with sepsis had higher vasoactive requirements, more frequently experienced hypotension, and continued to have greater mortality rates through 48 hours postarrest. Children with prearrest sepsis had worse survival outcomes, similar intraarrest DBPs, and greater pre and postarrest severity of illness than children without sepsis. Weniger anzeigen

PurposeThe aim of this study was to describe seasonal variation in the incidence and outcomes of sepsis in the United States.MethodsThis is a retrospective study using National Inpatient Sample database from 2017-2019. Adult sepsis patients were identified based on the CMS SEP-1 measure codes. Monthly sepsis incidence, in-hospital mortality, and organ failure patterns were analyzed. Multivariable logistic regression was used to assess in-hospital mortality by month. We also analyzed the monthly variation in each type of organ failure to uncover patterns that could account for the observed differences in sepsis incidence and outcomes.Main ResultsThere were 57,019,369 hospitalizations due to sepsis during the study period. The incidence of sepsis hospitalizations was highest in January. January also had the highest in-hospital mortality rate (10.66%), while July had the lowest (8.66%). A multivariable logistic regression analysis showed that January had a significantly higher mortality rate compared to July (odds ratio of 1.22, p < 0.001). The relationship between month and in-hospital mortality for sepsis followed a U-shaped pattern (from January to December), both in raw and adjusted analysis. Respiratory failure similarly followed the U-shaped pattern, with January having the highest incidence, and July and August the lowest. Other organ failures showed consistent patterns throughout the year. The relationship between sepsis due to pneumonia was also U-shaped, especially in the Southern region.ConclusionsThis study revealed a U-shaped relationship between both incidence and in-hospital mortality of sepsis, and month throughout the year, with a peak during winter months. Respiratory failure significantly increased in winter, while other organ failures remained constant throughout the year. These data suggest that respiratory infection and respiratory failure appear to mediate the seasonal variation observed in sepsis incidence and mortality, respectively. Weniger anzeigen

Maternal septicemia and other maternal infections (MSMIs) continue to pose considerable challenges to public health on a global scale. However, comprehensive data on their impacts and trends are limited, particularly in BRICS countries, which include Brazil, Russian Federation, India, China, and South Africa. This study aims to compare the global epidemiological trends of MSMIs from 1990 to 2021 to MSMIs trends in BRICS countries and examine the relationship of disease burden with age and social development. Using data from the Global Burden of Disease database, this study analyzed the prevalence, incidence, death, and disability-adjusted life years (DALYs) of MSMIs from 1990 to 2021 globally and in BRICS countries. Temporal trends were assessed through estimated annual percentage change (EAPC) and percentage change. Joinpoint regression analysis was employed to rigorously evaluate time trends, allowing for the calculation of annual percentage change (APC) and average annual percentage change (AAPC), with corresponding 95% confidence intervals (CI). In 2021, South Africa showed the highest prevalence of MSMIs (156.54 per 100,000), while the Russian Federation exhibited the highest incidence (1,001.51 per 100,000). Deaths and DALYs of MSMIs were lowered in BRICS countries compared to global averages. Between 1990 and 2019, India experienced the greatest decline in both incidence (EAPC = -2.68%) and prevalence (EAPC = -2.65%). Despite the global decline, regional variations in incidence were observed. In China, the incidence increased significantly between 2010 and 2014 (APC = 4.15%; 95% CI: 3.59-4.71%; P < 0.001). Similarly, in the Russian Federation, the incidence rose during three distinct periods: 2000-2004 (APC = 2.52%; 95% CI: 2.0-3.05%; P < 0.001), 2004-2010 (APC = 5.2%; 95% CI: 4.95-5.44%; P < 0.001), and 2010-2015 (APC = 1.79%; 95% CI: 1.46-2.12%; P < 0.001). MSMIs remain prevalent globally, imposing a substantial disability burden, particularly in BRICS countries. While China exhibits relatively low disease burdens, South Africa faces high prevalence, and global deaths and DALYs from MSMIs remain elevated. Weniger anzeigen

This study evaluates the time to blood culture positivity among neonates evaluated for sepsis to determine when antibiotics may be safely discontinued. Retrospective review of clinically relevant blood culture time to positivity from infants in a neonatal intensive care unit. The primary endpoint was overall median time to blood culture positivity. Secondary endpoints compared time to positivity among gram-positive versus gram-negative organisms, early versus late onset sepsis, and a sub-analysis excluding contaminants. Among 151 cultures, the overall median time to positivity was 17 h (IQR 12-23). Most (47/48, 97.9%) gram-negative organisms resulted within 24 h and most (88/94, 93.6%) gram-positive by 36 h. All (13/13, 100%) early onset cultures resulted within 24 h and most (132/138, 95.7%) late onset by 36 h. Antibiotics for neonatal sepsis evaluation may be safely discontinued in well-appearing infants without an identified infection source with negative cultures at 36 h. Weniger anzeigen

Over the last century infectious diseases have been kept under control in industrialized countries thanks to advances in hygiene, prevention and antimicrobial treatments. However, the emergence of HIV, the COVID-19 pandemic, and the rise of resistant bacteria exemplify that infectious diseases continue to pose a global threat. A comprehensive understanding of the caseload, spectrum of infectious diseases and the economic impact they pose is required to develop strategies for managing infectious diseases in a resilient healthcare system. (i) to determine the proportion of adult patients discharged from German hospitals with primary diagnoses classified as an infectious disease, (ii) to describe the clinical spectrum of these diagnoses, case characteristics, and hospital settings, and (iii) to estimate the total economic burden that these cases contribute to the in-patient sector of the healthcare system. A retrospective case-control study was performed using publicly available data on ICD10 codes assigned as primary diagnoses, case characteristics, treatment settings, and cost weights from all patients discharged from German hospitals in 2022. 1,728,824 adult patients (12% of all adult patients) were discharged with a primary diagnosis classified as an infectious disease. They were assigned 912 individual ICD10 codes. The 15 and 79 most frequently used codes comprised 40% (top 40% ID population) and 80% (top 80% ID population) of all infectious disease cases, respectively. In the top 80% ID population, patients were older, were more likely to be male, and had higher complexity and comorbidity levels than the reference population, which consisted of all adult patients minus the patients in the top 80% ID population. The mean length of stay of patients forming the top 80% ID population was 8.0 days vs. 6.1 days in the reference population. The median (IQR) cost weight was 0.663 (0.544-1.030) translating into €2,541 per case. In Germany, patients with infectious diseases constitute a significant proportion of all inpatients, with a broad spectrum of conditions. These patients are generally older, more severely ill, and require longer hospital stays than those without a primary infectious disease diagnosis, contributing substantially to the overall economic burden on the healthcare system. Weniger anzeigen

Studies on procalcitonin (PCT) for identifying sepsis were published as early as 1993 and since then, PCT has been the topic of over 8,500 studies. Several studies show PCT to be superior to CRP in differentiating invasive infections such as sepsis from viral infections, especially early in the disease course. However, its actual use in clinical practice is poorly documented. Our aim was to study the use of PCT in febrile children attending the ED across Europe and compare this to the use of CRP. The MOFICHE/PERFORM study, a prospective multicenter study, took place at 12 European EDs in eight countries and included febrile children < 18 years. In this secondary analysis of nine participating EDs that used PCT, descriptive analyses were performed, describing the use of PCT in all febrile children and for different age groups, foci of fever and fever duration. In total, 31,612 pediatric febrile episodes were available for analyses. Blood tests were performed in 15,812 (50.0%, range 9.6-92.6%)) febrile episodes. CRP was included in 98.3% of blood tests (range between hospitals 80-100%), while PCT was included in only 3.9% (range 0.1-86%). PCT was most often performed in children below 3 months (12.0% versus 3.6% in older children, p < 0.001). PCT was used slightly more often in children with fever less than 24 h in comparison to children with a duration of fever ≥ 24 h (4.9% versus 3.4%, p < 0.001). Regarding clinical alarming signs, PCT was used most often in children with meningeal signs (7.0%) or a non-blanching rash (10.9%). Actual PCT use in febrile children at European EDs is limited and varies largely between hospitals. Possible explanations include lack of guidelines, limited availability, higher costs and lack of readiness to adapt new clinical strategies. Weniger anzeigen

Long-COVID has mostly been investigated in clinical settings. We aimed to assess the risk, subtypes, persistence, and determinants of long-COVID in a prospective population-based study of adults with a history of SARS-CoV-2 infection in Catalonia. We examined 2764 infected individuals from a population-based cohort (COVICAT) established before the pandemic and followed up three times across the pandemic (2020, 2021, 2023). We assessed immunoglobulin (Ig)G levels against SARS-CoV-2, clinical, vaccination, sociodemographic, and lifestyle factors. Long-COVID risk and subtypes were defined based on participant-reported symptoms and electronic health records. We identified a total of 647 long-COVID cases and compared them with 2117 infected individuals without the condition. Between 2021 and 2023, 23% of infected subjects developed long-COVID symptoms. In 56% of long-COVID cases in 2021, symptoms persisted for 2 years. Long-COVID presented clinically in three subtypes, mild neuromuscular, mild respiratory, and severe multi-organ. The latter was associated with persistent long-COVID. Risk was higher among females, participants under 50 years, of low socioeconomic status, severe COVID-19 infection, elevated pre-vaccination IgG levels, obesity, and prior chronic disease, particularly asthma/chronic obstructive pulmonary disease and mental health conditions. A lower risk was associated to pre-infection vaccination, infection after omicron became the dominant variant, higher physical activity levels, and sleeping 6-8 h. Vaccination during the 3 months post-infection was also protective against long-COVID. Long-COVID persisted for up to 2 years in half of the cases, and risk was influenced by multiple factors. Weniger anzeigen

Sepsis and septic shock are associated with microcirculatory dysfunction, significantly impacting patient outcomes. This study aimed to evaluate the effects of a 20 % albumin bolus on microcirculation compared to crystalloid resuscitation in fluid-responsive patients (ClinicalTrials.govID:NCT05357339). We conducted a single-centre randomised controlled trial, enrolling 103 patients (Albumin n = 52, Control n = 51). Fluid responsiveness was assessed, and fluid was administered in boluses of 100 ml to clinical effect. Microcirculation was measured using the Side stream Dark Field camera and AVA 4.3 software. Baseline characteristics, macrohaemodynamics, and microcirculation parameters were recorded. Three patients were excluded from analysis. The final cohort comprised 100 patients, 35 (35 %) females with a mean age of 58 years (range: 18-86). The mean APACHE score was 28 (range: 7-45), and the mean SOFA score was 9.4 (range: 1-17). No significant differences in APACHE (26.24 vs. 29.4, p = 0.069) or SOFA (9.08 vs. 9.78, p = 0.32) scores were found for albumin and control group respectively. The albumin group had worse microcirculation at baseline but demonstrated significant improvements in microvascular density and activity at 15 min and 60 min (p < 0.005), while the control group exhibited no significant changes. Additionally, both groups were fluid responsive, with a mean pulse pressure variability of 17 % at admission. There were no significant differences in overall fluid balances, vasopressor days, length of ICU stay, or mortality between groups. This study demonstrates that a 20 % albumin bolus significantly enhances microcirculation in fluid-responsive patients with septic shock. These findings underscore the potential benefits of targeted microcirculation therapy in critically ill patients. Weniger anzeigen

Increasing evidence has suggested the benefits of dexmedetomidine in patients with sepsis. Dexmedetomidine may increase vasopressor sensitivity, which may be of interest in the setting of refractory septic shock. The α2 Agonist Dexmedetomidine for REfractory Septic Shock (ADRESS) pilot study aimed to evaluate the effect of dexmedetomidine on the vasopressor response in patients with refractory septic shock. This study was a multicenter, randomized, placebo-controlled, double-blind pilot trial. The study was conducted in 5 ICUs in France. Inclusion criteria were septic shock (Sepsis-3 definition) and norepinephrine requirement greater than or equal to 0.25 µg/kg/min (0.5 µg/kg/min of norepinephrine tartrate) with persistent circulatory failure (defined by lactate > 2 mmol/L, oliguria, or skin mottling) and invasive mechanical ventilation. The arterial pressure response to phenylephrine was measured before starting the treatment (0 hr), at 6 hours (primary outcome), and 12 hours. In the treatment arm, dexmedetomidine was given at a fixed dose of 1 µg/kg/hr. Inclusions were stopped early because of higher mortality in the dexmedetomidine arm. Thirty-two patients of the 36 planned were included. Response to phenylephrine at 6 hours was lower in the dexmedetomidine group than in the placebo group (1.26 ± 0.23 vs. 1.45 ± 0.26; p = 0.048), although this difference was also observed at baseline (p = 0.029). There were no significant differences between the groups in terms of cumulative norepinephrine dose, lactatemia, Sequential Organ Failure Assessment score, fluid balance, ventilation-free days, or occurrence of bradycardia. Mortality on day 3 was higher in the dexmedetomidine group than in the placebo group, with a difference that diminished and was no longer significant on 30 and 90 days. Patients in the dexmedetomidine arm had a significantly lower response to phenylephrine at all study times including baseline, which might have contributed to higher early mortality in the dexmedetomidine arm and preclude to conclude on dexmedetomidine efficacy in refractory septic shock. However, heart rate was not decreased in the dexmedetomidine arm. Weniger anzeigen

Pneumonia continues to be one of the leading causes of death. During the COVID pandemic, pre-existing anticoagulant therapy with direct oral anticoagulants (DOACs) appeared to be beneficial. The present study aimed to investigate the impact of pre-existing DOAC therapy on mortality from community-acquired, non-COVID pneumonia. The study utilized data from the eICU Collaborative Research Database, a comprehensive, multi-institutional critical care database. We included all adult patients with community-acquired pneumonia, selecting for patients with a primary admission diagnosis of pneumonia or pulmonary sepsis who were admitted to the ICU <24 h after admission to the hospital. To adjust for confounders, we performed propensity score matching, matching patients receiving DOACs to an equivalent cohort of patients not receiving DOAC therapy. Our primary outcome was overall survival. Secondary outcomes included all-cause in-hospital mortality, all-cause in-ICU mortality, intubation within 24 h following ICU admission, incidence of acute kidney injury and renal replacement therapy, vasopressor administration, and mechanical ventilation days. Our final matched cohort included 198 DOAC patients matched to 594 patients without DOAC therapy. Survival was significantly higher in DOAC patients with a hazard ratio of 0.56 [95% CI = 0.36-088]. Both all-cause in-unit mortality (6.1% [95% CI = 2.7-9.4%] vs. 13.3% [95% CI = 10.6-16.0%],  = 0.008) and all-cause in-hospital mortality (11.6% [95% CI = 7.2-16.1%] vs. 19.7% [95% CI = 16.5-22.9%],  = 0.013) were significantly lower in patients receiving DOACs. This study demonstrates a positive association between the pre-existing intake of direct oral anticoagulants and the survival of community acquired pneumonia. Future prospective studies should evaluate supportive therapy with DOACs. Weniger anzeigen