• Artificial Intelligence
• Clinical
• Critical Care
• Decision Support Systems
• Medical Informatics Applications
• Sepsis

• 25.00208.5007.07/PD National Agency for Research and Development

• critical care
• infections

• Acute kidney injury
• Continuous infusion
• Intensive care unit
• Mortality
• Sepsis
• Vancomycin concentration

• Humans
• Adult
• Vancomycin/adverse effects
• Anti-Bacterial Agents/adverse effects
• Critical Illness
• Acute Kidney Injury/chemically induced
• Acute Kidney Injury/drug therapy
• Treatment Outcome
• Retrospective Studies

• antimicrobial resistance
• bacterial culture-positive
• empirical antibiotic therapy
• multidrug-resistant organism
• patient outcome

• the National Natural Science Foundation of China
• Guangdong Basic and Applied Basic Research Foundation

• complex infections
• differential diagnosis
• hematological malignancy
• hemophagocytic lymphohistiocytosis
• management

• No. 81973995 and No. 82170131 National Natural Science Foundation of China
• 202117 Young Top-notch Talent Cultivation Program of Hubei Province

• Anti-Bacterial Agents
• Antibiotic Prophylaxis
• Bacterial
• Blood Culture
• C-Reactive Protein
• Cefazolin
• Discitis
• Drug Combinations
• Drug Resistance
• Guideline
• Serum Amyloid A Protein
• Surgical Wound Infection
• Vancomycin.

• antimicrobial resistance
• cattle
• critically important antimicrobials
• mortality

• Staphylococcus aureus
• antibiotics
• subinhibitory concentration
• virulence

• Animals
• Anti-Bacterial Agents/pharmacology
• Bacteremia/drug therapy
• Methicillin-Resistant Staphylococcus aureus
• Mice
• Microbial Sensitivity Tests
• Peritonitis/drug therapy
• Reproducibility of Results
• Staphylococcal Infections/drug therapy
• Staphylococcal Infections/microbiology
• Tetracycline/pharmacology
• Virulence Factors
• beta-Lactams/pharmacology

• FHB | Health and Medical Research Fund (HMRF)
• University Grants Committee (UGC)

• MALDI-TOF MS
• Staphylococcus aureus bacteremia
• antimicrobial susceptibility testing
• binning method
• machine learning
• methicillin-resistant Staphylococcus aureus

• PH-110-GP-02, PH-111-GP-02 National Health Research Institutes

Our objective was to examine whether empirical antimicrobial therapy (EAT) against methicillin-susceptible Staphylococcus aureus bacteremia (MS-SAB) with piperacillin-tazobactam (TZP), cefuroxime or combination therapy with one of these was differentially associated with 7-, 30-, and 90- day all-cause mortality or MS-SAB relapse. A multicenter retrospective cohort study of adults with MS-SAB from 2009 through 2018 was used, and 7-, 30-, 90-day mortality and relapse within 90 days were assessed and expressed as hazard ratio (HR) with a 95% confidence interval (95% CI) using Cox proportional hazard regression analysis. Matching of the two monotherapy groups was performed using propensity score matching. In total, 1158 MS-SAB cases were included and received one of three EAT regimens: TZP (n = 429), cefuroxime (n = 337), or TZP or cefuroxime with one or more additional effective antimicrobial (n = 392). The overall 30-day mortality was 28.0% (25.5 to 30.3%). After adjustment and matching, there was no significant difference in 7-, 30-, or 90-day mortality between the therapy groups. The matched HR of death was 0.81 (95% CI, 0.38 to 1.76) at 7 days, 0.82 (95% CI, 0.47 to 1.46) at 30 days, and 0.81 (95% CI, 0.50 to 1.32) at 90 days for TZP compared with cefuroxime. Adjusted HR of 90-day relapse was insignificant between the three therapy groups: TZP: 1.55 (95% CI, 0.54 to 4.43); combination therapy: 1.73 (95% CI, 0.62 to 4.80) compared to cefuroxime. There was no significant difference in 7-, 30-, or 90-day mortality or relapse between MS-SAB patients treated with empirical TZP or cefuroxime after adjustment and matching of covariables.

IMPORTANCE This multicenter retrospective matched cohort study evaluated the effect of empirical antimicrobial therapy on the clinical outcome of methicillin-susceptible Staphylococcus aureus bacteremia (MS-SAB) in >1100 adult patients. To the best of our knowledge, this is the largest study to date evaluating the effect of empirical treatment on the MS-SAB outcome. Importantly, the study found no significant difference in either short- or long-term mortality nor relapse between patients with MS-SAB receiving empirical treatment with cefuroxime or piperacillin-tazobactam. As such, this study provides crucial contemporary data supporting the widespread clinical practice of initiating empirical antimicrobial therapy of sepsis with β-lactam-β-lactamase-inhibitor.

• MS-SAB
• MSSA
• S. aureus
• bacteremia
• cefuroxime
• combination therapy
• empirical therapy
• pip-tazo
• piperacillin-tazobactam
• sepsis

• antibiotic therapy
• diagnosis
• management
• pathogenesis
• sepsis

• Autophagy
• Biomarkers
• Complement System Proteins/immunology
• Complement System Proteins/metabolism
• Disease Management
• Disease Susceptibility
• Endothelium/metabolism
• Gene Expression Regulation
• Host-Pathogen Interactions/genetics
• Host-Pathogen Interactions/immunology
• Humans
• Immunity, Innate
• Immunomodulation
• Molecular Diagnostic Techniques
• Organ Specificity
• Sepsis/diagnosis
• Sepsis/etiology
• Sepsis/metabolism
• Sepsis/therapy
• Severity of Illness Index

• Aged
• Anti-Bacterial Agents/administration & dosage
• Biomarkers/blood
• Cohort Studies
• Drug Administration Schedule
• Female
• Hospital Costs
• Humans
• Length of Stay
• Lipopolysaccharide Receptors/blood
• Male
• Peptide Fragments/blood
• Sepsis/blood
• Sepsis/drug therapy
• Sepsis/mortality

• carbapenem resistance
• carbapenem-resistant Enterobacteriaceae
• carbapenemase-producing Enterobacteriaceae
• intra-abdominal infections
• surgical infections

• Cytokine
• Imipenem
• Immune responses
• Inflammation
• Liver
• Sepsis

Background: Sepsis and septic shock are medical emergencies with a high risk of poor prognosis. We investigate the correspondence between Surviving Sepsis Campaign (SSC) guidelines and clinical practice in Poland, with special attention given to differences between ICU and non-ICU environments as well as regional variations within the country. Methods: A web-based questionnaire study was performed on a random sample of 60 hospitals from the three most populated regions in Poland—Masovia, Silesia, and Greater Poland. A 19-item questionnaire was built based on the most recent edition of SSC guidelines. Results: Sepsis diagnosis was primarily based on clinical evaluation (ICUs: 94%, non-ICUs: 62%; p = 0.02). There were significant differences between ICUs and non-ICUs regarding taking blood cultures for pathogen identification (2-times more frequent in ICUs) and having hospital-based operating procedures to adjust antimicrobial treatment to a clinical scenario (a difference of 17%). Modification of empiric antimicrobial treatment was required post-ICU admission in 70% of cases. ICUs differed from non-ICUs with regard to the methods of fluid responsiveness assessment and the types of catecholamines and fluids used to treat septic shock. The mean fluid load applied before the implementation of catecholamines was 25.8 ± 10.6 mL/kg. Norepinephrine was the first-line agent used to treat shock, and balanced crystalloids were preferred in both ICUs and non-ICUs. Conclusion: Compliance with SCC guidelines in Polish hospitals is insufficient, especially outside ICUs. There is a need for education among healthcare professionals to reach at least an acceptable level of knowledge and attitude in this field.

• Surviving Sepsis Campaign
• guidelines compliance comparison
• intensive care unit
• sepsis and septic shock management
• sepsis guidelines adherence

Delayed entry of patient blood culture samples into a microbial detection system is unavoidable at times, due to off-shift staffing or transporting samples to centralized laboratories. Pre-incubation time and temperature of blood culture bottles are the most critical factors impacting recovery and detection of microorganisms. A total of 1377 BACT/ALERT® (BTA) Fastidious Antimicrobial Neutralization (FAN® PLUS) bottles (FA PLUS, FN PLUS, and PF PLUS) were tested after delayed entry times of 24 and 36 h at 20–25 °C (room temperature, RT) prior to loading into the BACT/ALERT® VIRTUO® microbial detection system (VIRTUO). Clinically relevant organisms were inoculated into bottles with 5–84 colony forming units (CFU) per bottle, and human blood (0 to 10 mL), and then loaded into the VIRTUO. When bottles were loaded without delay, a mean time to detection (TTD) of 9.6 h was observed. For delayed bottles, the TTD reported by the VIRTUO was added to the 24-h and 36-h delay times and resulted in average time to results of 32.5 h and 42.5 h, respectively. The FAN PLUS bottles in conjunction with the VIRTUO produced acceptable results when delays up to 24 h at 20–25 °C occur in loading.

• BACT/ALERT®
• Blood culture
• Delayed entry
• Pre-incubation
• Sepsis
• VIRTUO®

The difference in sequential organ failure assessment (SOFA) scores from the baseline to sepsis is a known predictor of sepsis-3 outcome, but the prognostic value of drug-resistant organisms for mortality is unexplained. We employed sepsis stewardship and herein report an observational study. Study subjects were patients admitted to the Departments of Surgery/Chest Surgery from 2011 through 2018 with a diagnosis of sepsis and a SOFA score of 2 or more. Our sepsis stewardship methods included antimicrobial and diagnostic stewardship and infection control. We determined the primary endpoint as in-hospital death and the secondary endpoint as the annual trend of the risk-adjusted mortality ratio (RAMR). For mortality, we performed logistic regression analysis based on SOFA score, age, sex, comorbid disease, and the presence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase inhibitor–producing bacteria. In a total of 457 patients, two factors were significant predictors for fatality, i.e., SOFA score of 9 or more with an odds ratio (OR) 4.921 and 95% confidence interval [95% CI] 1.968–12.302 (P = 0.001) and presence of MRSA with an OR 1.83 and 95% CI 1.003–3.338 (P = 0.049). RAMR showed a decrease during the study years (P < 0.05). Early detection of MRSA may help patients survive surgical sepsis-3. Thus, MRSA-oriented diagnosis may play a role in expediting treatment with anti-MRSA antimicrobials.

• Methicillin-resistant Staphylococcus aureus
• Sepsis
• Sequential organ failure assessment score

• antibiotic resistance
• modeling
• sedimentation
• sepsis

• Anti-Bacterial Agents/therapeutic use
• Emergency Service, Hospital
• Humans
• Quality Improvement
• Sepsis/diagnosis
• Sepsis/therapy
• Triage
• United States

Delaying broad-spectrum antibiotics beyond 1-2 hours once the septic shock is diagnosed increases patients’ risk of death. However, what is the impact of already being on antibiotics when a septic shock is diagnosed?

We compared demographics, clinical characteristics and outcomes in septic shock patients on antibiotics initiated prior to versus after septic shock was diagnosed; whose initial antibiotics were considered appropriate for the offending organism(s); and who died in versus were discharged from the ICU.

Data were prospectively collected on 161 patients ≥ 14-years-old (female: male=1:1; mean age 61.1yrs) admitted to the ICU for septic shock, and followed for ≥30 days, or until hospital discharge or death.

Few inter-group differences were identified. Those treated early were more likely to have a nosocomial infection (p=0.03), skin or soft tissue source of their infection (p=0.01), or a diabetes-related limb amputation (p=0.02); but received fewer antibiotics (p=0.01). Those on appropriate antibiotics were more likely to be female (p=0.048), but less likely to have a skin or soft tissue source of infection (p=0.03). Neither starting antibiotics early, nor being on appropriate antibiotics impacted any outcome measure, including survival. Predictors of mortality were ≥1 co-morbid condition (p=0.03), more versus fewer co-morbid conditions (p=0.009), cardiovascular disease at baseline (p=03), requiring dialysis at baseline (p=0.008), and a higher day#1 SOFA score (p<0.001).

Our data fail to demonstrate any benefit to being on antibiotics prior to the diagnosis, irrespective of whether the ultimately-identified offending organism is sensitive or resistant.

• antibiotics
• mortality
• sepsis
• septic shock
• treatment

• Case fatality for tuberculosis septic shock
• Case report
• Tuberculosis and immune reconstitution
• Tuberculosis in intensive care unit
• Tuberculosis septic shock

• Animals
• Anti-Bacterial Agents/pharmacology
• Anti-Bacterial Agents/therapeutic use
• Antibodies, Monoclonal/pharmacology
• Antibodies, Monoclonal/therapeutic use
• Drug Resistance, Multiple, Bacterial/drug effects
• Gram-Negative Bacterial Infections/drug therapy
• Humans