Sepsis Infozentrale – Aktuelles Wissen rund um Sepsis
Unsere Sepsis Infozentrale bietet fundierte und unabhängige Informationen zur Prävention, Diagnostik, Behandlung und Nachsorge von Sepsis und auf die Versorgungsforschung rund um das Thema: Wie häufig ist Sepsis? Wie wird sie versorgt? Wie sind die Ergebnisse? Was erleben Patientinnen und Patienten?.
Ein zentrales Element ist unsere Literaturdatenbank, die eine qualifizierte Auswahl aktueller wissenschaftlicher Erkenntnisse aus renommierten Quellen bereitstellt. Durch regelmäßige, systematische Recherchen in der Medline-Datenbank der National Library of Medicine wird sie wöchentlich aktualisiert und erweitert – für stets aktuelle, evidenzbasierte Informationen.
Bleiben Sie informiert und vertiefen Sie Ihr Wissen rund um Sepsis!
Unsere Wissens- und Literatur-Datenbank richtet sich an Ärztinnen und Ärzte, die in die Prävention, Diagnostik, Behandlung und Nachsorge der Sepsis eingebunden sind, an medizinische Fachkräfte, Patientinnen und Patienten sowie Selbsthilfegruppen. Sie dient auch zur Information anderer Organisationen des Gesundheitswesens und der interessierten Fachöffentlichkeit.
Informationen zur Literaturdatenbank
Die Datenbank bietet eine qualifizierte Auswahl aktueller, unabhängiger Informationen zur Prävention, Diagnostik, Behandlung und Nachsorge von Sepsis. Auf Grund der äußerst engen pathophysiologischen Verknüpfungen der COVID-19-Erkrankung und der Sepsis werden auch diesbezügliche Publikationen unabhängig von einem septischen Verlauf der SARS-CoV-2-Infektion eingeschlossen. Die vorliegende Liste berücksichtigt Publikationen, die aus Literaturverzeichnissen von Leitlinien, internationalen Fachgesellschaften und Organisationen, sowie aus systematischen Reviews ausgewählt wurden, ergänzt durch Expertenempfehlungen. Die Datenbank wird wöchentlich durch systematische Literatursuche in der Medline-Datenbank der National Library of Medicine aktualisiert und die Ergebnisse vom Redaktionsteam hinsichtlich der Relevanz bewertet. Die gelisteten Publikationen werden nach wissenschaftlicher Qualität und Evidenz ausgewählt, jedoch ohne systematische Quantifizierung der Evidenz. Die Datenbank erhebt nicht den Anspruch auf Vollständigkeit. Der wissenschaftliche Beirat der Sepsis-Stiftung überprüft die Auswahl jährlich. Ein Klick auf den im Pfeil integrierten DOI-Link öffnet das jeweilige Abstract oder den Volltext der entsprechenden Publikation in einem neuen Tab.
What Clinicians Think About When They Think About Sepsis: Results From a Survey Across the University of Maryland Medical System.
★★☆☆☆
2024
What Clinicians Think About When They Think About Sepsis: Results From a Survey Across the University of Maryland Medical System.
Baghdadi Jonathan D, Dowling Dorsey, Kenaa Blaine, Kim David J, King Samantha, Leekha Surbhi, Smedley Angela, Tisherman Samuel A, Wu Connie, Yang Jerry M — Critical care explorations
★★☆☆☆
2024
Abstract
Sepsis, a leading cause of death in the hospital, is a heterogeneous syndrome without a defined or specific set of symptoms. We conducted a survey of clinicians in practice to understand which clinical findings they tend to associate with sepsis. A survey was distributed to physicians and advanced practice providers…
Sepsis, a leading cause of death in the hospital, is a heterogeneous syndrome without a defined or specific set of symptoms. We conducted a survey of clinicians in practice to understand which clinical findings they tend to associate with sepsis. A survey was distributed to physicians and advanced practice providers across a multihospital health system during April 2022 and May 2022 querying likelihood of suspecting sepsis and initiating sepsis care in response to various normal and abnormal clinical findings. Strength of association between clinical findings and suspicion of sepsis were based on median and interquartile range of complete responses. Comparisons between individual questions were performed using Wilcoxon rank-sum testing. Among 179 clinicians who opened the survey, 68 (38%) completed all questions, including 53 (78%) attending physicians representing six different hospitals. Twenty-nine respondents (43%) worked primarily in the ICU, and 16 (24%) worked in the emergency department. The clinical findings most strongly associated with suspicion of sepsis were hypotension, tachypnea, coagulopathy, leukocytosis, respiratory distress, and fever. The abnormal clinical findings least likely to prompt suspicion for sepsis were elevated bilirubin, elevated troponin, and abdominal examination suggesting ileus. On average, respondents were more likely to suspect sepsis with high temperature than with low temperature (p = 0.008) and with high WBC count than with low WBC count (p = 0.003). Clinicians in practice tend to associate the diagnosis of sepsis with signs of severe illness, such as hypotension or respiratory distress, and systemic inflammation, such as fever and leukocytosis. Except for coagulopathy, nonspecific laboratory indicators of organ dysfunction have less influence on decision-making.
Weniger anzeigen
Themen:
Diagnostische Aspekte der Sepsis, Gesundheitskompetenz und Sepsiswissen
Kommentar
Sepsis and underlying comorbidities in intensive care unit patients : Analysis of the cause of death by different clinicians-a pilot study
Daniel O Thomas-Rüddel, Daniel Schwarzkopf, Frank Bloos, Holger Fröhlich, Reimer Riessen — Medizinische Klinik, Intensivmedizin und Notfallmedizin
★★☆☆☆
2024
Abstract
Background: There is an ongoing debate as to whether death with sepsis is
primarily caused by sepsis or, more often, by the underlying disease. There are
no data on the influence of a researcher’s background on such an assessment.
Therefore, the aim of this analysis was to assess the cause of death in…
Background: There is an ongoing debate as to whether death with sepsis is
primarily caused by sepsis or, more often, by the underlying disease. There are
no data on the influence of a researcher’s background on such an assessment.
Therefore, the aim of this analysis was to assess the cause of death in sepsis
and the influence of an investigator’s professional background on such an
assessment. Materials and methods: We performed a retrospective observational
cohort study of sepsis patients treated in the medical intensive care unit (ICU)
of a tertiary care center. For deceased patients, comorbidities and severity of
illness were documented. The cause of death (sepsis or comorbidities or both
combined) was independently assessed by four assessors with different
professional backgrounds (medical student, senior physician in the medical ICU,
anesthesiological intensivist, and senior physician specialized in the
predominant comorbidity). Results: In all, 78 of 235 patients died in hospital.
Agreement between assessors about cause of death was low (κ 0.37, 95% confidence
interval 0.29-0.44). Depending on the assessor, sepsis was the sole cause of
death in 6-12% of cases, sepsis and comorbidities in 54-76%, and comorbidities
alone in 18-40%. Conclusions: In a relevant proportion of patients with sepsis
treated in the medical ICU, comorbidities contribute significantly to mortality,
and death from sepsis without relevant comorbidities is a rare event.
Designation of the cause of death in sepsis patients is highly subjective and
may be influenced by the professional background of the assessor. Keywords:
Cause of death, Comorbidity, Multimorbidity, Sepsis, Septic shock
Weniger anzeigen
Chen-Wei Yen, Chih-Ho Chen, Chun-Che Chiu, Chun-Ting Mu, Han-Pi Chang, Jainn-Jim Lin, Oi-Wa Chan, Shao-Hsuan Hsia, Ya-Ting Su, Ying-Jui Lin — BMC emergency medicine
★★☆☆☆
2024
Abstract
Objective: Given the scarcity of studies analyzing the clinical predictors of
pediatric septic cases that would progress to septic shock, this study aimed to
determine strong predictors for pediatric emergency department (PED) patients
with sepsis at risk for septic shock and mortality. Methods: We conducted chart
reviews of patients with ≥ 2 age-adjusted quick…
Objective: Given the scarcity of studies analyzing the clinical predictors of
pediatric septic cases that would progress to septic shock, this study aimed to
determine strong predictors for pediatric emergency department (PED) patients
with sepsis at risk for septic shock and mortality. Methods: We conducted chart
reviews of patients with ≥ 2 age-adjusted quick Sequential Organ Failure
Assessment score (qSOFA) criteria to recognize patients with an infectious
disease in two tertiary PEDs between January 1, 2021, and April 30, 2022. The
age range of included patients was 1 month to 18 years. The primary outcome was
development of septic shock within 48 h of PED attendance. The secondary outcome
was sepsis-related 28-day mortality. Initial important variables in the PED and
hemodynamics with the highest and lowest values during the first 24 h of
admission were also analyzed. Results: Overall, 417 patients were admitted
because of sepsis and met the eligibility criteria for the study. Forty-nine
cases progressed to septic shock within 48 h after admission and 368 were
discharged without progression. General demographics, laboratory data, and
hemodynamics were analyzed by multivariate analysis. Only the minimum diastolic
blood pressure/systolic blood pressure ratio (D/S ratio) during the first 24 h
after admission remained as an independent predictor of progression to septic
shock and 28-day mortality. The best cutoff values of the D/S ratio for
predicting septic shock and 28-day mortality were 0.52 and 0.47, respectively.
Conclusions: The D/S ratio is a practical bedside scoring system in the PED and
had good discriminative ability in predicting the progression of septic shock
and in-hospital mortality in PED patients. Further validation is essential in
other settings.
Weniger anzeigen
Bhupinder Singh, Jaskaran Munjal, Lovish Gupta, Maazen Naduthra Subair, Rohit Jain, Vasu Bansal, Vasu Gupta — Acute and critical care
★★☆☆☆
2024
Abstract
Post-intensive care syndrome (PICS) refers to persistent or new onset physical,
mental, and neurocognitive complications that can occur following a stay in the
intensive care unit. PICS encompasses muscle weakness; neuropathy; cognitive
deficits including memory, executive, and attention impairments; post-traumatic
stress disorder; and other mood disorders. PICS can last long after hospital
admission and can…
Post-intensive care syndrome (PICS) refers to persistent or new onset physical,
mental, and neurocognitive complications that can occur following a stay in the
intensive care unit. PICS encompasses muscle weakness; neuropathy; cognitive
deficits including memory, executive, and attention impairments; post-traumatic
stress disorder; and other mood disorders. PICS can last long after hospital
admission and can cause significant physical, emotional, and financial stress
for patients and their families. Several modifiable risk factors, such as
duration of sepsis, delirium, and mechanical ventilation, are associated with
PICS. However, due to limited awareness about PICS, these factors are often
overlooked. The objective of this paper is to highlight the pathophysiology,
clinical features, diagnostic methods, and available preventive and treatment
options for PICS.
Weniger anzeigen
Bangwei Wu, Haocheng Ma, Jintao Hu, Lei Jin, Peidong Chen, Rongchen Liu, Rongjiao Shao, Shen Zhang, Weiguo Liang, Weizhuo Liu — Critical care (London, England)
★★☆☆☆
2024
Abstract
Background: Sepsis-induced myocardial injury is a serious complication of
sepsis. QT prolongation is a proarrhythmic state which reflects myocardial
injury in a group of heterogeneous disorders. However, the study on the clinical
value of QT prolongation in sepsis is limited. Methods: We aimed to investigate
the clinical characteristics and predictors of new-onset QT prolongation…
Background: Sepsis-induced myocardial injury is a serious complication of
sepsis. QT prolongation is a proarrhythmic state which reflects myocardial
injury in a group of heterogeneous disorders. However, the study on the clinical
value of QT prolongation in sepsis is limited. Methods: We aimed to investigate
the clinical characteristics and predictors of new-onset QT prolongation in
sepsis and its impact on the outcome in a multicenter retrospective cohort
study. Electrocardiographic and clinical data were collected from patients with
sepsis from the wards and intensive care units of four centers after exclusion
of QT-influencing medications and electrolyte abnormalities. Clinical outcomes
were compared between patients with and without QT prolongation (QTc > 450 ms).
Multivariate analysis was performed to ascertain whether QT prolongation was an
independent predictor for 30-day mortality. The factors predicting QT
prolongation in sepsis were also analyzed. Results: New-onset QT prolongation
occurred in 235/1024 (22.9%) patients. The majority demonstrated similar pattern
as type 1 long QT syndrome. Patients with QT prolongation had a higher 30-day
in-hospital mortality (P < 0.001), which was also associated with increased
tachyarrhythmias including paroxysmal atrial fibrillation or tachycardia (P <
0.001) and ventricular arrhythmia (P < 0.001) during hospitalization. QT
prolongation independently predicted 30-day mortality (P = 0.044) after
multivariate analysis. History of coronary artery disease (P = 0.001), septic
shock (P = 0.008), acute respiratory (P < 0.001), heart (P = 0.021) and renal
dysfunction (P = 0.013) were independent predictors of QT prolongation in
sepsis. Conclusions: New-onset QT prolongation in sepsis was associated with
increased mortality as well as atrial and ventricular arrhythmias, which was
predicted by disease severity and organ dysfunction.
Weniger anzeigen
Hanjin Cho, Jong-Hak Park, Sejoong Ahn, Sukyo Lee, Sungjin Kim, Sungwoo Moon, Young Duck Cho — Clinical and experimental emergency medicine
★★☆☆☆
2024
Abstract
Objective: Many studies have examined the July effect. However, little is known
regarding the July effect in sepsis. We hypothesized that the July effect would
result in worse outcomes in patients with sepsis. Methods: Prospectively
collected patients with sepsis between January 2018 and December 2021 were used.
In Korea, the new academic year starts…
Objective: Many studies have examined the July effect. However, little is known
regarding the July effect in sepsis. We hypothesized that the July effect would
result in worse outcomes in patients with sepsis. Methods: Prospectively
collected patients with sepsis between January 2018 and December 2021 were used.
In Korea, the new academic year starts on March 1, so the „July effect“ appears
in March. The primary outcome was 30-day mortality. Secondary outcomes included
adherence to the Surviving Sepsis Campaign bundle. Outcomes were compared
between March and other months. Multivariate Cox proportional hazard regression
was performed to adjust confounders. Results: Total 843 patients were included.
There were no significant differences in sepsis severity. The 30-day mortality
in March was higher (49% vs. 28.5%; P < 0.001). However, there was no difference
in bundle adherence in March (42.2% vs. 48.0%; P = 0.264). Multivariate Cox
proportional hazard regression showed that July effect was associated with
mortality in patients with sepsis [adjusted hazard ratio, 1.925; 95% confidence
interval, 1.405-2.638; P < 0.001]. Conclusion: July effect was associated with
30-day mortality in patients with sepsis. However, bundle adherence was not
different. These results suggest that the increase in mortality during the
turnover period may be related to unmeasured in-hospital management. Intensive
supervision and education of residents in care of patients with sepsis is needed
in the beginning of training.
Weniger anzeigen
Erin Warren, Joseph Kohn, Majdi N Al-Hasan, P Brandon Bookstaver, Utpal Mondal — Infection
★★☆☆☆
2024
Abstract
Background: The incidence of metastatic complications in Gram-negative
bloodstream infection (GN-BSI) remains undefined. This retrospective cohort
study examines the incidence and predictors of complications within 90 days of
GN-BSI. Methods: Patients with GN-BSIs hospitalized at two Prisma
Health-Midlands hospitals in Columbia, South Carolina, USA from 1 January 2012
through 30 June 2015 were included. Complications…
Background: The incidence of metastatic complications in Gram-negative
bloodstream infection (GN-BSI) remains undefined. This retrospective cohort
study examines the incidence and predictors of complications within 90 days of
GN-BSI. Methods: Patients with GN-BSIs hospitalized at two Prisma
Health-Midlands hospitals in Columbia, South Carolina, USA from 1 January 2012
through 30 June 2015 were included. Complications of GN-BSI included
endocarditis, septic arthritis, osteomyelitis, spinal infections, deep-seated
abscesses, and recurrent GN-BSI. Kaplan-Meier analysis and multivariate Cox
proportional hazards regression were used to examine incidence and risk factors
of complications, respectively. Results: Among 752 patients with GN-BSI, median
age was 66 years and 380 (50.5%) were women. The urinary tract was the most
common source of GN-BSI (378; 50.3%) and Escherichia coli was the most common
bacteria (375; 49.9%). Overall, 13.9% of patients developed complications within
90 days of GN-BSI. The median time to identification of these complications was
5.2 days from initial GN-BSI. Independent risk factors for complications were
presence of indwelling prosthetic material (hazards ratio [HR] 1.73, 95%
confidence intervals [CI] 1.08-2.78), injection drug use (HR 6.84, 95% CI
1.63-28.74), non-urinary source (HR 1.98, 95% CI 1.18-3.23), BSI due to S.
marcescens, P. mirabilis or P. aeruginosa (HR 1.78, 95% CI 1.05-3.03), early
clinical failure criteria (HR 1.19 per point, 95% CI 1.03-1.36), and persistent
GN-BSI (HR 2.97, 95% CI 1.26-6.99). Conclusions: Complications of GN-BSI are
relatively common and may be predicted based on initial clinical response to
antimicrobial therapy, follow-up blood culture results, and other host and
microbiological factors.
Weniger anzeigen
Alexander M Friedman, Dena Goffman, Jean-Ju Sheen, Lilly Y Liu, Lisa Nathan, Mary E D'Alton, Timothy Wen, Uma M Reddy — American journal of perinatology
★★☆☆☆
2024
Abstract
Objective: This study aimed to evaluate trends, risk factors, and outcomes
associated with infections and sepsis during delivery hospitalizations in the
United States. Study design: The 2000-2020 National Inpatient Sample was used
for this repeated cross-sectional analysis. Delivery hospitalizations of
patients aged 15 to 54 with and without infection and sepsis were identified.
Common infection…
Objective: This study aimed to evaluate trends, risk factors, and outcomes
associated with infections and sepsis during delivery hospitalizations in the
United States. Study design: The 2000-2020 National Inpatient Sample was used
for this repeated cross-sectional analysis. Delivery hospitalizations of
patients aged 15 to 54 with and without infection and sepsis were identified.
Common infection diagnoses during delivery hospitalizations analyzed included
(i) pyelonephritis, (ii) pneumonia/influenza, (iii) endometritis, (iv)
cholecystitis, (v) chorioamnionitis, and (vi) wound infection. Temporal trends
in sepsis and infection during delivery hospitalizations were analyzed. The
associations between sepsis and infection and common chronic health conditions
including asthma, chronic hypertension, pregestational diabetes, and obesity
were analyzed. The associations between clinical, demographic, and hospital
characteristics, and infection and sepsis were determined with unadjusted and
adjusted logistic regression models with unadjusted odds ratio (OR) and adjusted
odds ratios with 95% confidence intervals as measures of association. Results:
An estimated 80,158,622 delivery hospitalizations were identified and included
in the analysis, of which 2,766,947 (3.5%) had an infection diagnosis and 32,614
had a sepsis diagnosis (4.1 per 10,000). The most common infection diagnosis was
chorioamnionitis (2.7% of deliveries) followed by endometritis (0.4%), and wound
infections (0.3%). Infection and sepsis were more common in the setting of
chronic health conditions. Evaluating trends in individual infection diagnoses,
endometritis and wound infection decreased over the study period both for
patients with and without chronic conditions, while risk for pyelonephritis and
pneumonia/influenza increased. Sepsis increased over the study period for
deliveries with and without chronic condition diagnoses. Risks for adverse
outcomes including mortality, severe maternal morbidity, the critical care
composite, and acute renal failure were all significantly increased in the
presence of sepsis and infection. Conclusion: Endometritis and wound infections
decreased over the study period while risk for sepsis increased. Infection and
sepsis were associated with chronic health conditions and accounted for a
significant proportion of adverse obstetric outcomes including severe maternal
morbidity. Key points: · Sepsis increased over the study period for deliveries
with and without chronic condition diagnoses.. · Endometritis and wound
infection decreased over the study period.. · Infection and sepsis accounted for
a significant proportion of adverse obstetric outcomes..
Weniger anzeigen
