#Incidence, #trends, and #outcomes of #infection sites among #hospitalizations of #sepsis: A nationwide study (PLOS One, abstract)

[Source: PLOS One, full page: (LINK). Abstract, edited.]


Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study

Eric H. Chou, Shaynna Mann, Tzu-Chun Hsu, Wan-Ting Hsu, Carolyn Chia-Yu Liu, Toral Bhakta, Dahlia M. Hassani, Chien-Chang Lee


Published: January 13, 2020 / DOI: https://doi.org/10.1371/journal.pone.0227752




To determine the trends of infection sites and outcome of sepsis using a national population-based database.

Materials and methods

Using the Nationwide Inpatient Sample database of the US, adult sepsis hospitalizations and infection sites were identified using a validated approach that selects admissions with explicit ICD-9-CM codes for sepsis and diagnosis/procedure codes for acute organ dysfunctions. The primary outcome was the trend of incidence and in-hospital mortality of specific infection sites in sepsis patients. The secondary outcome was the impact of specific infection sites on in-hospital mortality.


During the 9-year period, we identified 7,860,687 admissions of adult sepsis. Genitourinary tract infection (36.7%), lower respiratory tract infection (36.6%), and systemic fungal infection (9.2%) were the leading three sites of infection in patients with sepsis. Intra-abdominal infection (30.7%), lower respiratory tract infection (27.7%), and biliary tract infection (25.5%) were associated with highest mortality rate. The incidences of all sites of infections were trending upward. Musculoskeletal infection (annual increase: 34.2%) and skin and skin structure infection (annual increase: 23.0%) had the steepest increase. Mortality from all sites of infection has decreased significantly (trend p<0.001). Skin and skin structure infection had the fastest declining rate (annual decrease: 5.5%) followed by primary bacteremia (annual decrease: 5.3%) and catheter related bloodstream infection (annual decrease: 4.8%).


The anatomic site of infection does have a differential impact on the mortality of septic patients. Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients.


Citation: Chou EH, Mann S, Hsu T-C, Hsu W-T, Liu CC-Y, Bhakta T, et al. (2020) Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study. PLoS ONE 15(1): e0227752. https://doi.org/10.1371/journal.pone.0227752

Editor: Florian B. Mayr, University of Pittsburgh, UNITED STATES

Received: June 5, 2019; Accepted: December 27, 2019; Published: January 13, 2020

Copyright: © 2020 Chou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Sepsis; USA.


#Epidemiology and clinical #outcomes of hospitalizations for acute respiratory or febrile illness and laboratory-confirmed #influenza among #pregnant women during six influenza seasons, 2010-2016 (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Epidemiology and clinical outcomes of hospitalizations for acute respiratory or febrile illness and laboratory-confirmed influenza among pregnant women during six influenza seasons, 2010-2016

Fatimah S Dawood, Shikha Garg, Rebecca V Fink, Margaret L Russell, Annette K Regan, Mark A Katz, Stephanie Booth, Hannah Chung, Nicola P Klein, Jeffrey C Kwong, Avram Levy, Allison Naleway, Dan Riesel, Mark G Thompson, Brandy E Wyant, Deshayne B Fell on behalf of the PREVENT workgroup

The Journal of Infectious Diseases, jiz670, https://doi.org/10.1093/infdis/jiz670

Published: 26 December 2019




Pregnant women are at increased risk of seasonal influenza hospitalizations, but data about the epidemiology of severe influenza among pregnant women remain largely limited to pandemics.


To describe the epidemiology of hospitalizations for acute respiratory infection or febrile illness (ARFI) and influenza-associated ARFI among pregnant women, administrative and electronic health record data were analyzed from retrospective cohorts of pregnant women hospitalized with ARFI who had testing for influenza viruses by RT-PCR in Australia, Canada, Israel and the United States during 2010-2016.


Of 18,048 ARFI-coded hospitalizations, 1,064 (6%) included RT-PCR testing for influenza viruses, of which 614 (58%) were influenza-positive. Of 614 influenza-positive ARFI hospitalizations, 35% were in women with low socioeconomic status, 20% with underlying conditions, and 67% in their third trimesters. The median length of influenza-positive hospitalizations was 2 days (IQR 1-4), 18% (95% confidence interval (CI) 15-21%) resulted in delivery, 10% (95% CI 8-12%) included a pneumonia diagnosis, 5% (95% CI 3-6%) required intensive care, 2% (95% CI 1-3%) included a sepsis diagnosis, and <1% (95% CI 0-1%) resulted in respiratory failure.


Our findings characterize seasonal influenza hospitalizations among pregnant women and can inform assessments of the public health and economic impact of seasonal influenza on pregnant women.

Influenza, Pregnant, Hospitalization

This content is only available as a PDF.

Published by Oxford University Press for the Infectious Diseases Society of America 2019. This work is written by (a) US Government employee(s) and is in the public domain in the US.

This work is written by (a) US Government employee(s) and is in the public domain in the US.

Keywords: Seasonal Influenza; Pregnancy; Pneumonia; Intensive care; Sepsis.


Successful rescue #treatment of #sepsis due to a #PDR, #NDM-producing #Klebsiella pneumoniae using #aztreonam powder for nebulizer solution as IV therapy in combination with #ceftazidime/avibactam (J Antimicrob Chemother., summary)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Summary, edited.]

Successful rescue treatment of sepsis due to a pandrug-resistant, NDM-producing Klebsiella pneumoniae using aztreonam powder for nebulizer solution as intravenous therapy in combination with ceftazidime/avibactam

Elske Sieswerda, Marre van den Brand, Roland B van den Berg, Joris Sträter, Leo Schouls, Karin van Dijk, Andries E Budding

Journal of Antimicrobial Chemotherapy, dkz495, https://doi.org/10.1093/jac/dkz495

Published: 02 December 2019



Pandrug-resistant Klebsiella pneumoniae that produces New Delhi MBL (NDM) is increasingly reported worldwide.1 These strains contain multiple β-lactamase genes but also may have acquired resistance to last-resort options such as colistin and tigecycline. Combining aztreonam and avibactam is potentially effective in MDR, NDM-producing Enterobacterales.2 Avibactam inhibits class A, C and D ESBLs, cephalosporinases and carbapenemases, while aztreonam is stable to hydrolysis by class B MBLs such as NDM. Until this drug combination becomes available, one could combine aztreonam and ceftazidime/avibactam to treat serious infections with such strains. A small number of studies have reported on 13 patients with serious infections with NDM-producing Enterobacterales who were successfully treated with aztreonam and ceftazidime/avibactam.3–7 Evidence of clinical efficacy and safety is therefore limited at present. Also, aztreonam for IV use is not registered and readily available in many countries, including the Netherlands. We describe successful rescue treatment of a patient with sepsis due to a pandrug-resistant, NDM-producing K. pneumoniae using aztreonam powder for nebulizer solution as IV therapy in combination with ceftazidime/avibactam.




We presented this study in March 2019 at the Scientific Spring Meeting 2019 from the Dutch Society of Medical Microbiology, Arnhem, the Netherlands.


This study was carried out as part of our routine work.

Transparency declarations

None to declare.

Keywords: Antibiotics; Drugs Resistance; NDM; Klebsiella pneumoniae; Sepsis; Aztreonam; Ceftazidime; Avibactam.


#Epidemiology and #complications of late-onset #sepsis: an #Italian area-based study (PLOS One, abstract)

[Source: PLOS One, full page: (LINK). Abstract, edited.]


Epidemiology and complications of late-onset sepsis: an Italian area-based study

Alberto Berardi , Francesca Sforza, Lorenza Baroni, Caterina Spada, Simone Ambretti, Giacomo Biasucci, Serenella Bolognesi, Mariagrazia Capretti, Edoardo Carretto, Matilde Ciccia, Marcello Lanari, Maria Federica Pedna, Vittoria Rizzo,  [ … ], Maria Letizia Bacchi Reggiani


Published: November 22, 2019 / DOI: https://doi.org/10.1371/journal.pone.0225407




Most studies regarding late-onset sepsis (LOS) address selected populations (i.e., neonates with low birth weight or extremely preterm neonates). Studying all age groups is more suitable to assess the burden of single pathogens and their clinical relevance.


This is a retrospective regional study involving paediatric departments and NICUs in Emilia-Romagna (Italy). Regional laboratory databases were searched from 2009 to 2012. Records of infants (aged 4 to 90 days) with a positive blood or cerebrospinal fluid (CSF) culture were retrospectively reviewed and analysed according to acquisition mode (whether hospital- or community-acquired).


During the study period, there were 146,682 live births (LBs), with 296 patients experiencing 331 episodes of LOS (incidence rate: 2.3/1000 LBs). Brain lesions upon discharge from the hospital were found in 12.3% (40/296) of cases, with death occurring in 7.1% (23/296; 0.14/1000 LBs). With respect to full-term neonates, extremely preterm or extremely low birth weight neonates had very high risk of LOS and related mortality (> 100- and > 800-fold higher respectively). Hospital-acquired LOS (n = 209) was significantly associated with very low birth weight, extremely preterm birth, pneumonia, mechanical ventilation, and death (p< 0.01). At multivariate logistic regression analysis, catecholamine support (OR = 3.2), central venous line before LOS (OR = 14.9), and meningitis (OR = 44.7) were associated with brain lesions or death in hospital-acquired LOS (area under the ROC curve 0.81, H-L p = 0.41). Commonly identified pathogens included coagulase-negative staphylococci (CoNS n = 71, 21.4%), Escherichia coli (n = 50, 15.1%), Staphylococcus aureus (n = 41, 12.4%) and Enterobacteriaceae (n = 41, 12.4%). Group B streptococcus was the predominant cause of meningitis (16 of 38 cases, 42%). Most pathogens were sensitive to first line antibiotics.


This study provides the first Italian data regarding late-onset sepsis (LOS) in all gestational age groups. Compared to full-term neonates, very high rates of LOS and mortality occurred in neonates with a lower birth weight and gestational age. Group B streptococcus was the leading cause of meningitis. Excluding CoNS, the predominant pathogens were Escherichia coli and Staphylococcus aureus. Neonates with hospital-acquired LOS had a worse outcome. Antibiotic associations, recommended for empirical treatment of hospital- or community-acquired LOS, were adequate.


Citation: Berardi A, Sforza F, Baroni L, Spada C, Ambretti S, Biasucci G, et al. (2019) Epidemiology and complications of late-onset sepsis: an Italian area-based study. PLoS ONE 14(11): e0225407. https://doi.org/10.1371/journal.pone.0225407

Editor: Umberto Simeoni, Centre Hospitalier Universitaire Vaudois, FRANCE

Received: May 16, 2019; Accepted: November 3, 2019; Published: November 22, 2019

Copyright: © 2019 Berardi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files

Funding: AB Part of the research leading to these results has received funding from the European Community’s Seventh Framework Programme [FP7/2007-2013] under grant agreement n° HEALTH-F7-2007-200481 DEVANI. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: This is my amended Competing Interests Statement: Professor Alberto Berardi has received fees (in 2018) from a commercial funder (GSK) for a phone interview. This does not alter adherence to PLOS ONE policies on sharing data and materials. I declare that there are no competing interest concerning the content of this manuscript. I have no further relevant declarations relating to employment, consultancy, patents, products in development, marketed products.

Keywords: Sepsis; Meningitis; Pneumonia; Intensive Care; Pediatrics; Italy.


Effect of #VitaminC Infusion on Organ Failure and #Biomarkers of #Inflammation and #Vascular Injury in Patients With #Sepsis and #ARDS – The CITRIS-ALI #RCT (JAMA, Abstract)

[Source: Journal of American Medical Association, full page: (LINK). Abstract, edited.]

Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure – The CITRIS-ALI Randomized Clinical Trial

Alpha A. Fowler III, MD 1; Jonathon D. Truwit, MD 2; R. Duncan Hite, MD 3; Peter E. Morris, MD 4; Christine DeWilde, RN, PhD 1; Anna Priday, BS, MS 1; Bernard Fisher, BS, MS 1; Leroy R. Thacker II, PhD 1; Ramesh Natarajan, PhD 1; Donald F. Brophy, PharmD  1; Robin Sculthorpe, RPh 1; Rahul Nanchal, MD 2; Aamer Syed, MD 1; Jamie Sturgill, PhD 4; Greg S. Martin, MD, MSc 5; Jonathan Sevransky, MD, MHS 5; Markos Kashiouris, MD, MPH 1; Stella Hamman, RN, MSN 1; Katherine F. Egan, BSN, RN, CCRC 5; Andrei Hastings, MD 3; Wendy Spencer, RN, CPN 6; Shawnda Tench, BBA, CCRP 3; Omar Mehkri, MD 3; James Bindas, MBA 3; Abhijit Duggal, MD 3; Jeanette Graf, BS, CCRP 2; Stephanie Zellner, MS, CCRC 2; Lynda Yanny, RN, BSN, CCRC 2; Catherine McPolin, RN, BSN, CCRP 2; Tonya Hollrith, RT, MR 2; David Kramer, MD 2; Charles Ojielo, MD 2; Tessa Damm, DO 7; Evan Cassity, MS 4; Aleksandra Wieliczko, RN 4; Matthew Halquist, PhD 1

Author Affiliations: 1 Virginia Commonwealth University, Richmond; 2 Froedtert Hospital and the Medical College of Wisconsin, Milwaukee; 3 Cleveland Clinic, Cleveland, Ohio; 4 University of Kentucky, Lexington; 5 Emory University, Atlanta, Georgia; 6 Fairview Hospital, Cleveland, Ohio; 7 Aurora St. Luke’s Medical Center, Milwaukee, Wisconsin

JAMA. 2019;322(13):1261-1270. doi:10.1001/jama.2019.11825
Key Points

  • Question  – Can intravenous administration of high-dose vitamin C reduce organ failure scores and biomarkers of inflammation and vascular injury among patients with sepsis and acute respiratory distress syndrome (ARDS)?
  • Findings  – In this randomized clinical trial that included 167 patients in the intensive care unit, intravenous infusion of high-dose vitamin C vs placebo for 96 hours resulted in no significant differences in the modified Sequential Organ Failure Assessment score at 96 hours, or in levels of C-reactive protein and thrombomodulin at 168 hours.
  • Meaning  – Among patients with sepsis and ARDS, high-dose vitamin C infusion compared with placebo did not significantly reduce organ failure scores at 96 hours or improve biomarker levels at 168 hours.




Experimental data suggest that intravenous vitamin C may attenuate inflammation and vascular injury associated with sepsis and acute respiratory distress syndrome (ARDS).


To determine the effect of intravenous vitamin C infusion on organ failure scores and biological markers of inflammation and vascular injury in patients with sepsis and ARDS.

Design, Setting, and Participants  

The CITRIS-ALI trial was a randomized, double-blind, placebo-controlled, multicenter trial conducted in 7 medical intensive care units in the United States, enrolling patients (N = 167) with sepsis and ARDS present for less than 24 hours. The study was conducted from September 2014 to November 2017, and final follow-up was January 2018.


Patients were randomly assigned to receive intravenous infusion of vitamin C (50 mg/kg in dextrose 5% in water, n = 84) or placebo (dextrose 5% in water only, n = 83) every 6 hours for 96 hours.

Main Outcomes and Measures  

The primary outcomes were change in organ failure as assessed by a modified Sequential Organ Failure Assessment score (range, 0-20, with higher scores indicating more dysfunction) from baseline to 96 hours, and plasma biomarkers of inflammation (C-reactive protein levels) and vascular injury (thrombomodulin levels) measured at 0, 48, 96, and 168 hours.


Among 167 randomized patients (mean [SD] age, 54.8 years [16.7]; 90 men [54%]), 103 (62%) completed the study to day 60. There were no significant differences between the vitamin C and placebo groups in the primary end points of change in mean modified Sequential Organ Failure Assessment score from baseline to 96 hours (from 9.8 to 6.8 in the vitamin C group [3 points] and from 10.3 to 6.8 in the placebo group [3.5 points]; difference, −0.10; 95% CI, −1.23 to 1.03; P = .86) or in C-reactive protein levels (54.1 vs 46.1 μg/mL; difference, 7.94 μg/mL; 95% CI, −8.2 to 24.11; P = .33) and thrombomodulin levels (14.5 vs 13.8 ng/mL; difference, 0.69 ng/mL; 95% CI, −2.8 to 4.2; P = .70) at 168 hours.

Conclusions and Relevance  

In this preliminary study of patients with sepsis and ARDS, a 96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury. Further research is needed to evaluate the potential role of vitamin C for other outcomes in sepsis and ARDS.

Trial Registration  ClinicalTrials.gov Identifier: NCT02106975

Keywords: Sepsis; ARDS; Vitamin C; Intensive Care.


Incidence of #Maternal #Sepsis and Sepsis-Related Maternal #Deaths in the #USA (JAMA, abstract)

[Source: JAMA, full page: (LINK). Abstract, edited.]

Research Letter / September 3, 2019

Incidence of Maternal Sepsis and Sepsis-Related Maternal Deaths in the United States

Matthew K. Hensley, MD, MPH1; Melissa E. Bauer, DO2; Lindsay K. Admon, MD, MSc3; et al Hallie C. Prescott, MD, MSc4

Author Affiliations: 1 Department of Internal Medicine, University of Michigan, Ann Arbor; 2 Department of Anesthesiology, University of Michigan, Ann Arbor; 3 Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor; 4 VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, Michigan

JAMA. 2019;322(9):890-892. doi:10.1001/jama.2019.9818



Maternal sepsis is a leading cause of maternal morbidity and mortality. However, population-based estimates of maternal sepsis occurring after delivery hospitalization have been limited because previous studies have focused on select populations or have not followed up patients longitudinally.1,2 Thus, the burden of maternal sepsis and sepsis-related deaths may be underestimated. We assessed the nationwide incidence and outcomes of maternal sepsis within 42 days of delivery hospitalization discharge using all-payer data.

Keywords: Sepsis; Pregnancy; USA.


Prospective Research of #Human #Parechovirus and #Cytokines in #CSF of Young #Children Less than One Year with #Sepsis-like Illness: Comparison with #Enterovirus (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 15 August 2019 / In Press, Journal Pre-proof

Prospective Research of Human Parechovirus and Cytokines in Cerebrospinal Fluid of Young Children Less than One Year with Sepsis-like Illness: Comparison with Enterovirus

Su Eun Park ab1, Duyeal Song c1, Kyunghwa Shin c, Sang Ook Nam ab, Ara Ko ab, Ju Hyun Kong ab, Young Mi Kim d, Gyu Min Yeon e, Yun-Jin Lee ab

{a} Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of Medicine – 20 Geumoro, Mulgeumeup, 50612, Yangsan, South Korea; {b} Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital – 20 Geumoro, Mulgeumeup, 50612, Yangsan, South Korea; {c} Department of Laboratory Medicine, Pusan National University Yangsan Hospital – 20 Geumoro, Mulgeumeup, 50612, Yangsan, South Korea; {d} Department of Pediatrics, Pusan National University Hospital – 179, Gudeok-ro, 49241, Busan, South Korea; {e} Department of Pediatrics, Kosin University Gospel Hospital, Kosin University – 262, Gamcheon-ro, 49267, Busan, South Korea

Received 26 December 2018, Revised 12 March 2019, Accepted 14 August 2019, Available online 15 August 2019. DOI: https://doi.org/10.1016/j.jcv.2019.08.006



  • HPeV meningitis was found in 11.1% of sepsis-like children less than 12 months.
  • CSF findings were significantly different between HPeV and enteroviral meningitis.
  • CSF cytokine profiles noticeably differed between HPeV and enteroviral meningitis.


{1} Su Eun Park and Duyeal Song were equally responsible for the work described in this paper.

© 2019 Elsevier B.V. All rights reserved.

Keywords: Parechovirus; Enterovirus; Sepsis; Pediatrics.