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Latest & greatest articles for sepsis
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on sepsis or other clinical topics then use Trip today.
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Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis: A Systematic Review and Meta-analysis Although corticosteroids are widely used for adults with sepsis, both the overall benefit and potential risks remain unclear.To conduct a systematic review and meta-analysis of the efficacy and safety of corticosteroids in patients with sepsis.MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception until March 20, 2018 (...) , and updated on August 10, 2018. The terms corticosteroids, sepsis, septic shock, hydrocortisone, controlled trials, and randomized controlled trial were searched alone or in combination. Randomized clinical trials (RCTs) were included that compared administration of corticosteroids with placebo or standard supportive care in adults with sepsis.Meta-analyses were conducted using a random-effects model to calculate risk ratios (RRs) and mean differences (MDs) with corresponding 95% CIs. Two independent
Blood test could shorten antibiotic treatment in newborns with suspected sepsis Blood test could shorten antibiotic treatment in newborns with suspected sepsis Discover Portal Discover Portal Blood test could shorten antibiotic treatment in newborns with suspected sepsis Published on 28 November 2017 doi: Measuring procalcitonin levels in newborns with suspected sepsis in the first days of life reduced antibiotic duration by 10 hours compared with standard care. There was no increase (...) in the risk of re-infection or death. Systemic infection can be rapidly life-threatening in newborn babies, so those with risk factors are often treated pre-emptively with intravenous antibiotics. If sepsis is not confirmed by blood culture the decision whether to discontinue antibiotics needs to be made, but results of the blood culture takes time. Procalcitonin is released into the blood in response to inflammation, and low levels may give an earlier indication that there is no serious infection
Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis Discover Portal Discover Portal Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis Published on 31 January 2018 doi: The risk of death in adults with sepsis was 30% lower when each dose of antibiotic was given intravenously over three hours compared to a bolus or less (...) than 60 minutes. This systematic review included adults on intensive care units with a range of ages, severity of sepsis and other symptoms. A variety of antibiotics of the anti-pseudomonal beta-lactam class were used in the trials. These included carbapenems, penicillins and cephalosporins. In the UK, current guidance for intravenous use of these drugs is to give them over a period of up to 30 minutes. This review provides high-quality evidence that suggests that all patients should be given
A focus on treating fever does not improve survival in sepsis A focus on treating fever does not improve survival in sepsis Discover Portal Discover Portal A focus on treating fever does not improve survival in sepsis Published on 27 June 2017 doi: Specifically treating fever in adults with sepsis did not reduce the number of people dying within 28 days. It also had no effect on the frequency of hospital-acquired infections, reversing septic shock, lowering heart rate or improving breathing (...) . Sepsis is a rare complication of an infection. Among the 123,000 people a year in England who develop sepsis around 30% will die from it, so improving our understanding of how to treat sepsis is clearly important. Early treatment of sepsis is important for a number of reasons, but the findings of this review imply that it is not necessary to specifically treat fever. We don’t know whether there might be benefits for people with very high temperatures. Share your views on the research. Why
Giving immediate antibiotics reduces deaths from sepsis Giving immediate antibiotics reduces deaths from sepsis Discover Portal Discover Portal Giving immediate antibiotics reduces deaths from sepsis Published on 18 April 2017 doi: Giving immediate antibiotics (defined as within one hour) when people present to emergency departments with suspected sepsis reduces their risk of dying by a third compared with later administration. This meta-analysis of observational data from 23,596 people (...) in emergency department settings confirmed that giving antibiotics within one hour was linked to a lower risk of in-hospital mortality compared with giving antibiotics later. This adds weight to recommendations from NICE and other organisations that antibiotics should be administered straight away in people with suspected sepsis. However, in practice up to a third of people in the UK do not receive antibiotics within the hour. NHS England and the UK Sepsis Trust have recently launched a campaign
Adding the extra antibiotic rifampicin did not improve cure rates after sepsis Adding the extra antibiotic rifampicin did not improve cure rates after sepsis Discover Portal Discover Portal Adding the extra antibiotic rifampicin did not improve cure rates after sepsis Published on 17 April 2018 doi: Adding the antibiotic rifampicin did not improve cure rates or reduce deaths for people with bacterial blood infections caused by Staphylococcus aureus . It increased the risk of adverse reactions (...) of the most common causes of sepsis world-wide. Lack of evidence about the best treatment regime has led to wide variations in practice. Mortality rates in the UK range from 10% to 30%. The usual treatment is with a penicillin or glycopeptide but varies by the subgroup of S. aureus and whether the strain is methicillin-resistant. Case series show around 30% of people treated for S. aureus bacteraemia in the UK also received rifampicin, despite a lack of evidence for its use. The drug can cause liver
Ethanol locks in catheters for dialysis may prevent sepsis Ethanol locks in catheters for dialysis may prevent sepsis Discover Portal Discover Portal Ethanol locks in catheters for dialysis may prevent sepsis Published on 25 September 2018 doi: In patients with tunnelled central venous catheters used for dialysis, ethanol locks may reduce catheter-related bloodstream infections when compared with other locks, mainly saline. There was no increase in the risk of catheter blockage with ethanol
Sepsis associated acute kidney injury. Sepsis is defined as organ dysfunction resulting from the host's deleterious response to infection. One of the most common organs affected is the kidneys, resulting in sepsis associated acute kidney injury (SA-AKI) that contributes to the morbidity and mortality of sepsis. A growing body of knowledge has illuminated the clinical risk factors, pathobiology, response to treatment, and elements of renal recovery that have advanced our ability to prevent (...) , detect, and treat SA-AKI. Despite these advances, SA-AKI remains an important concern and clinical burden, and further study is needed to reduce the acute and chronic consequences. This review summarizes the relevant evidence, with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of SA-AKI. In addition to literature pertaining to SA-AKI specifically, pertinent sepsis and acute kidney injury literature relevant to SA-AKI was included.Published
Liberal versus conservative fluid therapy in adults and children with sepsis or septic shock. Sepsis and septic shock are potentially life-threatening complications of infection that are associated with high morbidity and mortality in adults and children. Fluid therapy is regarded as a crucial intervention during initial treatment of sepsis. Whether conservative or liberal fluid therapy can improve clinical outcomes in patients with sepsis and septic shock remains unclear.To determine whether (...) liberal versus conservative fluid therapy improves clinical outcomes in adults and children with initial sepsis and septic shock.We searched CENTRAL, MEDLINE, Embase, intensive and critical care conference abstracts, and ongoing clinical trials on 16 January 2018, and we contacted study authors to try to identify additional studies.We planned to include all randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs comparing liberal fluid therapy versus conservative fluid therapy for adults
Meningococcal Meningitis and Sepsis Guidance Note Diagnosis and Treatment in General Practice 1 Endorsed by the BMA Updated in line with NICE Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management CG102, NICE Sepsis: recognition, diagnosis and early management NG51, and NICE Fever in under 5s: assessment and initial management CG160. Meningococcal Meningitis and Sepsis Guidance Notes Diagnosis and Treatment in General Practice 2018 edition UK2 (...) -saving treatment. However, if a patient is seen during the early, prodromal phase of meningitis or sepsis* it may be impossible to distinguish them from someone with a milder self-limiting illness 5 . For this reason, it is important to provide a ‘safety net’ when a patient with a non-specific febrile illness is seen in primary care 6 . Safety net: The NICE guideline on Fever in under 5s 6 and the NICE guideline on Sepsis 7 highlight the importance of a safety net when a febrile child is sent home
The anticoagulant treatment for sepsis induced disseminated intravascular coagulation; network meta-analysis The benefits and harm caused by anticoagulant treatments for sepsis induced disseminated intravascular coagulation (DIC) remain unclear. Therefore, we performed a network meta-analysis to assess the effect of available anticoagulant treatments on patient mortality, DIC resolution and the incidence of bleeding complication in patients with septic DIC.We considered all studies from four
A trial of probiotics for treating sepsis in very premature babies poses more questions than it answers A trial of probiotics for treating sepsis in very premature babies poses more questions than it answers Discover Portal Discover Portal A trial of probiotics for treating sepsis in very premature babies poses more questions than it answers Published on 23 December 2015 doi: Contrary to a previous review of trials, this large, NIHR-funded trial found that probiotic treatment did not prevent (...) two common life-threatening conditions in very premature babies. The conditions were necrotising enterocolitis, which is a severe gut inflammation/infection that can result in the death of intestinal tissue, and sepsis (blood poisoning) from bacteria that have crossed from the gut into the bloodstream. This trial used a single strain of a harmless bacterium, known as a “probiotic”, prepared to high quality standards fit for medicines, and chosen because it is commonly used in dietary supplements
Validation of a Host Response Assay, SeptiCyte LAB, for Discriminating Sepsis from Systemic Inflammatory Response Syndrome in the ICU A molecular test to distinguish between sepsis and systemic inflammation of noninfectious etiology could potentially have clinical utility.This study evaluated the diagnostic performance of a molecular host response assay (SeptiCyte LAB) designed to distinguish between sepsis and noninfectious systemic inflammation in critically ill adults.The study employed (...) a prospective, observational, noninterventional design and recruited a heterogeneous cohort of adult critical care patients from seven sites in the United States (n = 249). An additional group of 198 patients, recruited in the large MARS (Molecular Diagnosis and Risk Stratification of Sepsis) consortium trial in the Netherlands ( www.clinicaltrials.gov identifier NCT01905033), was also tested and analyzed, making a grand total of 447 patients in our study. The performance of SeptiCyte LAB was compared
Is Early Goal-Directed Therapy or Standard Therapy More Effective in Decreasing Mortality Among Patients With Sepsis? TAKE-HOME MESSAGE Time to antibiotic administration is the main factor explaining mortality differences between sepsis patients treated with early goal-directed therapy versus standard care in recent observational trials. Early goal-directed therapy was associated with increased mortality risk in patients with severe sepsis. IsEarlyGoal-DirectedTherapyorStandardTherapy More (...) Effective in Decreasing Mortality Among Patients With Sepsis? EBEM Commentators Melinda J. Morton Hamer, MD, MPH Department of Emergency Medicine George Washington University School of Medicine Washington, DC Department of Emergency Medicine Fort Belvoir Community Hospital Fort Belvoir, VA Sara K. Faught, DO Department of Emergency Medicine Fort Belvoir Community Hospital Fort Belvoir, VA Results In the systematic review, 19,998 patients were included from 6 randomized trials (n¼4,342) and 31
Are qSOFA Criteria Better Than the Systemic Inflammatory Response Syndrome Criteria for Diagnosing Sepsis and Predicting Inhospital Mortality? (SRS Prognosis) TAKE-HOME MESSAGE Systemic in?ammatory response syndrome (SIRS) criteria are more sensitive for diagnosing sepsis, while quickSequential[Sepsis-related]Organ Failure Assessment (qSOFA) criteria are marginally more accurate for predicting inhospital mortality among patients identi?ed with sepsis. AreqSOFACriteriaBetterThantheSystemic (...) In?ammatoryResponseSyndromeCriteriafor DiagnosingSepsisandPredictingInhospitalMortality? EBEM Commentators Brit Long, MD Michael D. April, MD, DPhil Department of Emergency Medicine San Antonio Uniformed Services Health Education Consortium Fort Sam, Houston, TX Results Results of included trials. Outcome: SIRS vs qSOFA No. of Studies No. of Subjects Standard Mean Difference (95% CI) Favors Heterogeneity (I 2 ), % Sensitivity for diagnosis of sepsis 7 228,105 1.32 (0.40–2.24) SIRS 100 AUROC for hospital mortality 7 226,677 0.03
Valuable prognostic indicators for severe burn sepsis with inhalation lesion: age, platelet count, and procalcitonin Severe burn sepsis can lead to high mortality. We explored the valuable prognostic indicators for severe burn sepsis with inhalation lesion.Thirty-eight severe burn patients with sepsis who were admitted to the Third Affiliated Hospital of Soochow University from August 2014 to December 2017 were retrospectively analyzed. Among them, 22 patients were assigned to the death group (...) and 16 patients to the survival group. Their general information, vital signs, and blood index including serum procalcitonin (PCT) and C-reactive protein (CRP) levels at admission, diagnosis of sepsis, and 1-week post-diagnosis of sepsis were compared.Patients in the death group were older and had lower platelet count (PLT) at diagnosis of sepsis and 1-week post-diagnosis as well as higher PCT level at 1-week post-diagnosis than patients in the survival group (all p < 0.05). According to receiver
Effect of Human Recombinant Alkaline Phosphatase on 7-Day Creatinine Clearance in Patients With Sepsis-Associated Acute Kidney Injury: A Randomized Clinical Trial. Sepsis-associated acute kidney injury (AKI) adversely affects long-term kidney outcomes and survival. Administration of the detoxifying enzyme alkaline phosphatase may improve kidney function and survival.To determine the optimal therapeutic dose, effect on kidney function, and adverse effects of a human recombinant alkaline (...) phosphatase in patients who are critically ill with sepsis-associated AKI.The STOP-AKI trial was an international (53 recruiting sites), randomized, double-blind, placebo-controlled, dose-finding, adaptive phase 2a/2b study in 301 adult patients admitted to the intensive care unit with a diagnosis of sepsis and AKI. Patients were enrolled between December 2014 and May 2017, and follow-up was conducted for 90 days. The final date of follow-up was August 14, 2017.In the intention-to-treat analysis, in part
Sepsis in adults Sepsis in adults - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Sepsis in adults Last reviewed: February 2019 Last updated: October 2018 Important updates 18 Sep 2018 Corticosteroids reduce mortality but increase neuromuscular weakness in sepsis and septic shock Corticosteroids reduce mortality (by approximately 2%) but increase the risk of neuromuscular weakness in patients with sepsis or septic (...) shock, according to an international panel that reviewed conflicting recent evidence. The panel concluded that the overall body of evidence offers weak support for the use of corticosteroids in patients with sepsis with or without shock but said a no-steroid approach remained reasonable. Patient values and preferences may help guide the decision on whether or not to use corticosteroids. Patients who would prioritise living over quality-of-life would likely choose to have corticosteroid treatment
Sepsis in children Sepsis in children - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Sepsis in children Last reviewed: February 2019 Last updated: October 2018 Summary Initial clinical presentation may be non-specific (especially in younger age groups). Given the time-critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to initiate sepsis investigations (...) and treatment, including administering antibiotics and fluid resuscitation. These should continue until sepsis has been excluded. Progression to organ failure and shock is often very rapid, so early recognition and treatment is crucial. Empirical broad-spectrum antibiotic therapy (based on the most probable pathogens) should be administered as soon as possible, and always within the first hour following recognition. Other treatments are primarily supportive, and should be delivered according
Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. Acute kidney injury is the most frequent complication in patients with septic shock and is an independent risk factor for death. Although renal-replacement therapy is the standard of care for severe acute kidney injury, the ideal time for initiation remains controversial.In a multicenter, randomized, controlled trial, we assigned patients with early-stage septic shock who had severe acute kidney injury