#Risk of #Infection and #Sepsis in #Pediatric Patients with Traumatic #Brain #Injury Admitted to Hospital Following Major Trauma (Sci Rep., abstract)

[Source: Scientific Reports, fu ll page: (LINK). Abstract, edited.]

Risk of Infection and Sepsis in Pediatric Patients with Traumatic Brain Injury Admitted to Hospital Following Major Trauma

Anjli Pandya, Kathleen Helen Chaput, Andrea Schertzer, Diane Moser, Jonathan Guilfoyle, Sherry MacGillivray, Jaime Blackwood, Ari R. Joffe & Graham C. Thompson

Scientific Reports, volume 8, Article number: 9798 (2018)

 

Abstract

Head injury accounts for 29% of all traumatic deaths in children. Sepsis is significantly associated with an increased risk of mortality in adult traumatic brain injury patients. In the pediatric population, this relationship is not well understood. The objective of this study was to compare the proportion of pediatric traumatic brain injury (TBI) patients and trauma patients without brain injury (NTBI) who developed sepsis or any infection during their index hospital admission. We performed a retrospective study of all trauma patients <18 years of age, admitted to trauma centres in Alberta, Canada from January 1, 2003 to December 31, 2012. Patients who died within 24 hrs of trauma (n = 147) and those with burns as the primary mechanism of injury (n = 53) were excluded. Hospital admission data for the remaining 2556 patients was analyzed. 1727 TBI patients and 829 NTBI patients were included. TBI was associated with lower odds of developing sepsis (OR 0.32 95% CI 0.14–0.77 p = 0.011). TBI was not found to be independently associated with developing any infectious complication after adjusting for confounding by Injury Severity Score (OR 1.25 95% CI 0.90–1.74 p = 0.180). These relationships warrant further study.

Keywords: Sepsis; Neurology.

——

#HPeV-3 predominated among #Parechovirus A positive #infants during an #outbreak in 2013-2014 in #Queensland, #Australia (J Clin Virol., abstract)

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

HPeV-3 predominated among Parechovirus A positive infants during an outbreak in 2013-2014 in Queensland, Australia

Donna McNeale, Claire Y.T. Wang, Katherine E. Arden, Ian M. Mackay

DOI: http://dx.doi.org/10.1016/j.jcv.2017.12.003

Published online: December 05, 2017 – Accepted: December 4, 2017 – Received in revised form: November 22, 2017 – Received: September 1, 2017

 

Highlights

  • HPeV-3 was the only Parechovirus A genotype found in CNS of ill Queensland infants.
  • HPeV testing requests peaked between spring 2013 to autumn 2014.
  • HPeV testing should be routine for CSF from infants with acute CNS-related symptoms.
  • VP3/VP1 HPeV sequence analysis is rapid and can robustly identify most genotypes.

 

Abstract

Background

Parechoviruses (HPeV) are endemic seasonal pathogens detected from the respiratory tract, gut, blood and central nervous system (CNS) of children and adults, sometimes in conjunction with a range of acute illnesses. HPeV CNS infection may lead to neurodevelopmental sequelae, especially following infection by HPeV-3, hence screening and genotyping are important to inform epidemiology, aetiology and prognosis.

Objectives

To identify and characterise HPeVs circulating during an outbreak between November 2013 and April 2014 in Queensland, Australia.

Study design

To perform PCR-based screening and comparative nucleotide sequence analysis on samples from children with clinically suspected infections submitted to a research laboratory for HPeV investigations.

Results

HPeVs were detected among 25/62 samples, identified as HPeV-3 from 23 that could be genotyped. These variants closely matched those which have occurred worldwide and in other States of Australia.

Conclusions

The inclusion of PCR-based HPeV testing is not systematically applied but should be considered essential for children under 3 months of age with CNS symptoms as should long-term follow-up of severe sepsis-like cases.

Keywords: Human parechovirus, genotyping, central nervous system, infants, sepsis, Australia

© 2017 Elsevier B.V. All rights reserved.

Keywords: Parechovirus; Sepsis; Australia; Queensland.

——-

Prehospital #antibiotics in the #ambulance for #sepsis: a multicentre, open label, randomised trial (Lancet Resp Med., abstract)

[Source: The Lancet Respiratory Medicine, full page: (LINK). Abstract, edited.]

Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial

Nadia Alam, MD, Erick Oskam, MD, Patricia M Stassen, PhD, Pieternel van Exter, MD, Peter M van de Ven, PhD, Prof Harm R Haak, PhD, Frits Holleman, PhD, Arthur van Zanten, PhD, Hien van Leeuwen-Nguyen, MD, Victor Bon, MSc, Bart A M Duineveld, MD, Rishi S Nannan Panday, MD, Prof Mark H H Kramer, FRCP, Prabath W B Nanayakkara, FRCP on behalf of the PHANTASi Trial Investigators and the ORCA (Onderzoeks Consortium Acute Geneeskunde) Research Consortium the Netherlands†

†Investigators are listed in the appendix

Published: 28 November 2017 /  DOI: http://dx.doi.org/10.1016/S2213-2600(17)30469-1

© 2017 Elsevier Ltd. All rights reserved.

 

Summary

Background

Emergency medical services (EMS) personnel have already made substantial contributions to improving care for patients with time-dependent illnesses, such as trauma and myocardial infarction. Patients with sepsis could also benefit from timely prehospital care.

Methods

After training EMS personnel in recognising sepsis, we did a randomised controlled open-label trial in ten large regional ambulance services serving 34 secondary and tertiary care hospitals in the Netherlands. We compared the effects of early administration of antibiotics in the ambulance with usual care. Eligible patients were randomly assigned (1:1) using block-randomisation with blocks of size 4 to the intervention (open-label intravenous ceftriaxone 2000 mg in addition to usual care) or usual care (fluid resuscitation and supplementary oxygen). Randomisation was stratified per region. The primary outcome was all-cause mortality at 28 days and analysis was by intention to treat. To assess the effect of training, we determined the average time to antibiotics (TTA) in the emergency department and recognition of sepsis by EMS personnel before and after training. The trial is registered at ClinicalTrials.gov, number NCT01988428.

Findings

2698 patients were enrolled between June 30, 2014, and June 26, 2016. 2672 patients were included in the intention-to-treat analysis: 1535 in the intervention group and 1137 in the usual care group. The intervention group received antibiotics a median of 26 min (IQR 19–34) before arriving at the emergency department. In the usual care group, median TTA after arriving at the emergency department was 70 min (IQR 36–128), compared with 93 min (IQR 39–140) before EMS personnel training (p=0·142). At day 28, 120 (8%) patients had died in the intervention group and 93 (8%) had died in the usual care group (relative risk 0·95, 95% CI 0·74–1·24). 102 (7%) patients in the intervention group and 119 (10%) in the usual care group were re-admitted to hospital within 28 days (p=0·0004). Seven mild allergic reactions occurred, none of which could be attributed to ceftriaxone.

Interpretation

In patients with varying severity of sepsis, EMS personnel training improved early recognition and care in the whole acute care chain. However, giving antibiotics in the ambulance did not lead to improved survival, regardless of illness severity.

Funding

The NutsOhra Foundation, Netherlands Society of Internal Medicine (NIV).

Keywords: Sepsis; Antibiotics.

——

Prolonged versus short-term intravenous #infusion of #antipseudomonal β-lactams for patients with #sepsis: a systematic review and meta-analysis of randomised trials (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Prolonged versus short-term intravenous infusion of antipseudomonal β-lactams for patients with sepsis: a systematic review and meta-analysis of randomised trials

Dr Konstantinos Z Vardakas, MD, Georgios L Voulgaris, PharmD, Athanasios Maliaros, BSc, Prof George Samonis, MD, Prof Matthew E Falagas, MD

Published: 25 October 2017 / DOI: http://dx.doi.org/10.1016/S1473-3099(17)30615-1

© 2017 Elsevier Ltd. All rights reserved.

 

Summary

Background

The findings of randomised controlled trials (RCT), observational studies, and meta-analyses vary regarding the effectiveness of prolonged β-lactam infusion. We aimed to identify the effectiveness of prolonged versus short-term infusion of antipseudomonal β-lactams in patients with sepsis.

Methods

We did a systematic review and meta-analysis to compare prolonged versus short-term intravenous infusion of antipseudomonal β-lactams in patients with sepsis. Two authors independently searched PubMed, Scopus, and the Cochrane Library of clinical trials until November, 2016, without date or language restrictions. Any RCT comparing mortality or clinical efficacy of prolonged (continuous or ≥3 h) versus short-term (≤60 min) infusion of antipseudomonal β-lactams for the treatment of patients with sepsis was eligible. Studies were excluded if they were not RCTs, the antibiotics in the two arms were not the same, neither mortality nor clinical efficacy was reported, only pharmacokinetic or pharmacodynamic outcomes were reported, or if ten or fewer patients were enrolled or randomised. Data were extracted in prespecified forms and we then did a meta-analysis using a Mantel-Haenszel random-effects model. The primary outcome was all-cause mortality at any timepoint. This meta-analysis is registered with the PROSPERO database, number CRD42016051678, and is reported according to PRISMA guidelines.

Findings

2196 articles were identified and screened, and 22 studies (1876 patients) were included in the meta-analysis. According to the Grading of Recommendations Assessment, Development, and Evaluation tool, the quality of evidence for mortality was high. Carbapenems, penicillins, and cephalosporins were studied. Patients with variable age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, severity of sepsis and renal function were enrolled. Prolonged infusion was associated with lower all-cause mortality than short-term infusion (risk ratio [RR] 0·70, 95% CI 0·56–0·87). Heterogeneity was not observed (p=0·93, I2=0%). The funnel plot and the Egger’s test (p=0·44) showed no evidence of publication bias.

Interpretation

Prolonged infusion of antipseudomonal β-lactams for the treatment of patients with sepsis was associated with significantly lower mortality than short-term infusion. Further studies in specific subgroups of patients according to age, sepsis severity, degree of renal dysfunction, and immunocompetence are warranted.

Funding

None.

Keywords: Pseudomonas spp.; Antibiotics; Sepsis.

——-

Beneficial effects of Red #LED #treatment in experimental #model of acute #lung injury induced by #sepsis (Sci Rep., abstract)

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

Beneficial effects of Red Light-Emitting Diode treatment in experimental model of acute lung injury induced by sepsis

Silvia Goes Costa,  Éric Diego Barioni,  Aline Ignácio,  Juliana Albuquerque,  Niels Olsen Saraiva Câmara,  Christiane Pavani,  Luana Beatriz Vitoretti,  Amílcar Sabino Damazo,  Sandra Helena Poliselli Farsky &  Adriana Lino-dos-Santos-Franco

Scientific Reports 7, Article number: 12670(2017) / doi:10.1038/s41598-017-13117-5

Respiration – Respiratory distress syndrome

Received: 14 February 2017 – Accepted: 19 September 2017 – Published online: 04 October 2017

 

Abstract

Sepsis is a severe disease with a high mortality index and it is responsible for the development of acute lung injury (ALI). We evaluated the effects of light-emitting diode (LED) on ALI induced by sepsis. Balb-c mice were injected with lipopolysaccharide or saline and then irradiated or not with red LED on their tracheas and lungs for 150 s, 2 and 6 h after LPS injections. The parameters were investigated 24 h after the LPS injections. Red LED treatment reduced neutrophil influx and the levels of interleukins 1β, 17 A and, tumor necrosis factor-α; in addition to enhanced levels of interferon γ in the bronchoalveolar fluid. Moreover, red LED treatment enhanced the RNAm levels of IL-10 and IFN-γ. It also partially reduced the elevated oxidative burst and enhanced apoptosis, but it did not alter the translocation of nuclear factor κB, the expression of toll-like receptor 4 (TLR4), as well as, oedema or mucus production in their lung tissues. Together, our data has shown the beneficial effects of short treatment with LED on ALI that are caused by gram negative bacterial infections. It is suggested that LED applications are an inexpensive and non-invasive additional treatment for sepsis.

Keywords: Sepsis; Acute Lung Injury; Animal Models.

——-

#Incidence and #Trends of #Sepsis in #US #Hospitals Using Clinical vs Claims Data, 2009-2014 (JAMA, abstract)

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

Original Investigation  / Caring for the Critically Ill Patient / October 3, 2017

Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014

Chanu Rhee, MD, MPH1,2; Raymund Dantes, MD, MPH3,4; Lauren Epstein, MD, MS3; et alDavid J. Murphy, MD, PhD5; Christopher W. Seymour, MD, MSc6; Theodore J. Iwashyna, MD, PhD7,8; Sameer S. Kadri, MD, MS9; Derek C. Angus, MD, MPH6,10; Robert L. Danner, MD9; Anthony E. Fiore, MD, MPH3; John A. Jernigan, MD, MS3; Greg S. Martin, MD, MSc5; Edward Septimus, MD11,12; David K. Warren, MD, MPH13; Anita Karcz, MD, MBA14; Christina Chan, MPH1; John T. Menchaca, BA1; Rui Wang, PhD1; Susan Gruber, PhD1; Michael Klompas, MD, MPH1,2; for the CDC Prevention Epicenter Program

Author Affiliations: 1 Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts; 2 Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts; 3 Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; 4 Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; 5 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, and Emory Critical Care Center, Atlanta, Georgia; 6 Clinical Research, Investigation and Systems Modeling of Acute illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 7 Department of Internal Medicine, University of Michigan, Ann Arbor; 8 VA Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan; 9 Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; 10 Associate Editor, JAMA; 11 Hospital Corporation of America, Nashville, Tennessee; 12 Texas A&M Health Science Center College of Medicine, Houston; 13 Department of Medicine, Washington University School of Medicine, St Louis, Missouri; 14 Institute for Health Metrics, Burlington, Massachusetts

JAMA. 2017;318(13):1241-1249. doi:10.1001/jama.2017.13836

 

Key Points

  • Question  – Is the incidence of sepsis in the United States increasing and mortality decreasing, as suggested by estimates from claims-based analyses?
  • Findings  – In this retrospective cohort study that included detailed clinical data from 7 801 624 adult hospitalizations, sepsis incidence did not change significantly between 2009 and 2014 (+0.6%/y). While in-hospital mortality decreased during the study period, the combined outcome of death or discharge to hospice did not change significantly (−1.3%/y).
  • Meaning  – Based on clinical data, the incidence of sepsis, and related mortality or discharge to hospice, has remained stable between 2009-2014. The findings also suggest that clinical data provide more objective estimates than claims-based data for sepsis surveillance.

 

Abstract

Importance  

Estimates from claims-based analyses suggest that the incidence of sepsis is increasing and mortality rates from sepsis are decreasing. However, estimates from claims data may lack clinical fidelity and can be affected by changing diagnosis and coding practices over time.

Objective  

To estimate the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals.

Design, Setting, and Population  

Retrospective cohort study of adult patients admitted to 409 academic, community, and federal hospitals from 2009-2014.

Exposures  

Sepsis was identified using clinical indicators of presumed infection and concurrent acute organ dysfunction, adapting Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria for objective and consistent EHR-based surveillance.

Main Outcomes and Measures  

Sepsis incidence, outcomes, and trends from 2009-2014 were calculated using regression models and compared with claims-based estimates using International Classification of Diseases, Ninth Revision, Clinical Modification codes for severe sepsis or septic shock. Case-finding criteria were validated against Sepsis-3 criteria using medical record reviews.

Results  

A total of 173 690 sepsis cases (mean age, 66.5 [SD, 15.5] y; 77 660 [42.4%] women) were identified using clinical criteria among 2 901 019 adults admitted to study hospitals in 2014 (6.0% incidence). Of these, 26 061 (15.0%) died in the hospital and 10 731 (6.2%) were discharged to hospice. From 2009-2014, sepsis incidence using clinical criteria was stable (+0.6% relative change/y [95% CI, −2.3% to 3.5%], P = .67) whereas incidence per claims increased (+10.3%/y [95% CI, 7.2% to 13.3%], P < .001). In-hospital mortality using clinical criteria declined (−3.3%/y [95% CI, −5.6% to −1.0%], P = .004), but there was no significant change in the combined outcome of death or discharge to hospice (−1.3%/y [95% CI, −3.2% to 0.6%], P = .19). In contrast, mortality using claims declined significantly (−7.0%/y [95% CI, −8.8% to −5.2%], P < .001), as did death or discharge to hospice (−4.5%/y [95% CI, −6.1% to −2.8%], P < .001). Clinical criteria were more sensitive in identifying sepsis than claims (69.7% [95% CI, 52.9% to 92.0%] vs 32.3% [95% CI, 24.4% to 43.0%], P < .001), with comparable positive predictive value (70.4% [95% CI, 64.0% to 76.8%] vs 75.2% [95% CI, 69.8% to 80.6%], P = .23).

Conclusions and Relevance  

In clinical data from 409 hospitals, sepsis was present in 6% of adult hospitalizations, and in contrast to claims-based analyses, neither the incidence of sepsis nor the combined outcome of death or discharge to hospice changed significantly between 2009-2014. The findings also suggest that EHR-based clinical data provide more objective estimates than claims-based data for sepsis surveillance.

Keywords: Sepsis; USA.

——

#Classification of #patients with #sepsis according to blood genomic endotype: a prospective cohort study (Lancet Resp Med., abstract)

[Source: The Lancet Respiratory Medicine, full page: (LINK). Abstract, edited.]

Classification of patients with sepsis according to blood genomic endotype: a prospective cohort study

Dr Brendon P Scicluna, PhD, Lonneke A van Vught, MD, Prof Aeilko H Zwinderman, PhD, Maryse A Wiewel, MD, Emma E Davenport, DPhil, Katie L Burnham, MGen, Prof Peter Nürnberg, PhD, Prof Marcus J Schultz, MD, Janneke Horn, MD, Olaf L Cremer, MD, Prof Marc J Bonten, MD, Prof Charles J Hinds, MD, Prof Hector R Wong, MD, Prof Julian C Knight, DPhil, Prof Tom van der Poll, MD on behalf of the   MARS consortium†

†Members listed in the appendix

Published: 29 August 2017 / DOI: http://dx.doi.org/10.1016/S2213-2600(17)30294-1

© 2017 Elsevier Ltd. All rights reserved.

 

Summary

Background

Host responses during sepsis are highly heterogeneous, which hampers the identification of patients at high risk of mortality and their selection for targeted therapies. In this study, we aimed to identify biologically relevant molecular endotypes in patients with sepsis.

Methods

This was a prospective observational cohort study that included consecutive patients admitted for sepsis to two intensive care units (ICUs) in the Netherlands between Jan 1, 2011, and July 20, 2012 (discovery and first validation cohorts) and patients admitted with sepsis due to community-acquired pneumonia to 29 ICUs in the UK (second validation cohort). We generated genome-wide blood gene expression profiles from admission samples and analysed them by unsupervised consensus clustering and machine learning. The primary objective of this study was to establish endotypes for patients with sepsis, and assess the association of these endotypes with clinical traits and survival outcomes. We also established candidate biomarkers for the endotypes to allow identification of patient endotypes in clinical practice.

Findings

The discovery cohort had 306 patients, the first validation cohort had 216, and the second validation cohort had 265 patients. Four molecular endotypes for sepsis, designated Mars1–4, were identified in the discovery cohort, and were associated with 28-day mortality (log-rank p=0·022). In the discovery cohort, the worst outcome was found for patients classified as having a Mars1 endotype, and at 28 days, 35 (39%) of 90 people with a Mars1 endotype had died (hazard ratio [HR] vs all other endotypes 1·86 [95% CI 1·21–2·86]; p=0·0045), compared with 23 (22%) of 105 people with a Mars2 endotype (HR 0·64 [0·40–1·04]; p=0·061), 16 (23%) of 71 people with a Mars3 endotype (HR 0·71 [0·41–1·22]; p=0·19), and 13 (33%) of 40 patients with a Mars4 endotype (HR 1·13 [0·63–2·04]; p=0·69). Analysis of the net reclassification improvement using a combined clinical and endotype model significantly improved risk prediction to 0·33 (0·09–0·58; p=0·008). A 140-gene expression signature reliably stratified patients with sepsis to the four endotypes in both the first and second validation cohorts. Only Mars1 was consistently significantly associated with 28-day mortality across the cohorts. To facilitate possible clinical use, a biomarker was derived for each endotype; BPGM and TAP2 reliably identified patients with a Mars1 endotype.

Interpretation

This study provides a method for the molecular classification of patients with sepsis to four different endotypes upon ICU admission. Detection of sepsis endotypes might assist in providing personalised patient management and in selection for trials.

Funding

Center for Translational Molecular Medicine, Netherlands.

Keywords: Sepsis.

——-

#Healthcare #infrastructure #capacity to respond to #SARI and #sepsis in #Vietnam: A low-middle income country (J Crit Care, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Crit Care. 2017 Jul 10;42:109-115. doi: 10.1016/j.jcrc.2017.07.020. [Epub ahead of print]

Healthcare infrastructure capacity to respond to severe acute respiratory infection (SARI) and sepsis in Vietnam: A low-middle income country.

Dat VQ1, Long NT2, Giang KB3, Diep PB3, Giang TH3, Diaz JV4.

Author information: 1 Department of Infectious Diseases, Hanoi Medical University, No 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam; Intensive Care Unit, National Hospital for Tropical Diseases, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam. Electronic address: datvq@hmu.edu.vn. 2 Department of Infectious Diseases, Hanoi Medical University, No 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam. 3 Institute of Preventive Medicine and Public Health, Hanoi Medical University, No 1 Ton That Tung street, Dong Da District, Hanoi, Vietnam. 4 California Pacific Medical Center, Castro St & Duboce Ave, San Francisco, CA 94114, USA.

 

Abstract

PURPOSE:

This study investigated the availability of relevant structural and human resources needed for the clinical management of patients with severe acute respiratory infections and sepsis in critical care units in Vietnam.

MATERIAL AND METHODS:

A questionnaire survey was conducted by purposive sampling of 128 hospitals (36% of total hospitals in surveyed provinces), including 25 provincial and 103 district level hospitals, from 20 provinces in Vietnam. Data on availability of hospital characteristics, structural resources and health care workers was then analyzed.

RESULTS:

Most hospitals (>80%) reported having 60% of the relevant structural resources. Significant differences were observed between provincial hospitals when compared to district hospitals in regards to availability of central oxygen piping system (78.3% vs 38.7%, p=0.001) mechanical ventilation (100.0% vs 73.6%, p=0.003), mobile x-rays (80.0% vs 29.8%, p<0.001), carbapenem antibiotic (73.9% vs 17.4%, p<0.001) and norepinephrine (95.8% vs 56.3%, p<0.001). There was a limited availability of arterial blood gas analyzers (13.7%), oseltamivir (42.2%) and N95 respirators (54.6%) across all hospitals surveyed.

CONCLUSIONS:

The limited availability of relevant structural and human resources in critical care units around Vietnam makes the implementation of quality critical care to patients with SARI and sepsis, according international guidelines, not universally possible.

Copyright © 2017 Elsevier Inc. All rights reserved.

KEYWORDS: Healthcare infrastructure; ICU capacity; Low-middle income country; Sepsis; Severe respiratory infection

PMID: 28711861 DOI: 10.1016/j.jcrc.2017.07.020

Keywords: SARI; Vietnam.

——-

#Healthcare #infrastructure #capacity to respond to severe acute respiratory infection (#SARI) and #sepsis in #Vietnam: A low-middle income country (J Crit Care., abstract)

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

Journal of Critical Care / Available online 10 July 2017 / In Press, Accepted Manuscript

Healthcare infrastructure capacity to respond to severe acute respiratory infection (SARI) and sepsis in Vietnam: A low-middle income country

Dat Vu Quoc a, b, Long Nguyen Thanh a, Kim Bao Giang c, Pham Bich Diep c, Ta Hoang Giang c, Janet V. Diaz d

a Department of Infectious Diseases, Hanoi Medical University, No 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam; b Intensive Care Unit, National Hospital for Tropical Diseases, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam; c Institute of Preventive Medicine and Public Health, Hanoi Medical University, No 1 Ton That Tung street, Dong Da District, Hanoi, Vietnam; d California Pacific Medical Center, Castro St & Duboce Ave, San Francisco, CA 94114, USA.

Available online 10 July 2017 / https://doi.org/10.1016/j.jcrc.2017.07.020

 

Highlights

  • Most hospitals have basic staffing, equipment and supplies to provide critical care services but that international standards cannot be met consistently due to lack of some key resources.
  • A major limitation in critical care units was the lack of particulate respirators (N95) necessary to implement airborne precautions.
  • There is a need to establish an essential list of equipment and supplies to better prepare ICUs for future pandemics or outbreaks of infectious threats.

 

Abstract

Purpose

This study investigated the availability of relevant structural and human resources needed for the clinical management of patients with severe acute respiratory infections and sepsis in critical care units in Vietnam.

Material and methods

A questionnaire survey was conducted by purposive sampling of 128 hospitals (36% of total hospitals in surveyed provinces), including 25 provincial and 103 district level hospitals, from 20 provinces in Vietnam. Data on availability of hospital characteristics, structural resources and health care workers was then analyzed.

Results

Most hospitals (> 80%) reported having 60% of the relevant structural resources. Significant differences were observed between provincial hospitals when compared to district hospitals in regards to availability of central oxygen piping system (78.3% vs 38.7%, p = 0.001) mechanical ventilation (100.0% vs 73.6%, p = 0.003), mobile x-rays (80.0% vs 29.8%, p < 0.001), carbapenem antibiotic (73.9% vs 17.4%, p < 0.001) and norepinephrine (95.8% vs 56.3%, p < 0.001). There was a limited availability of arterial blood gas analyzers (13.7%), oseltamivir (42.2%) and N95 respirators (54.6%) across all hospitals surveyed.

Conclusions

The limited availability of relevant structural and human resources in critical care units around Vietnam makes the implementation of quality critical care to patients with SARI and sepsis, according international guidelines, not universally possible.

Abbreviations: CCU, critical care unit; RLS, resource-limited setting; SARI, severe acute respiratory infection; WHO, World Health Organization

Keywords: Severe respiratory infection; Sepsis; ICU capacity; Healthcare infrastructure; Low-middle income country

Keywords: SARI; Sepsis; Vietnam.

——

#Knowledge, attitudes, and practice on the #prevention of central line-associated #bloodstream #infections among #nurses in #oncological care… (PLoS One, abstract)

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

OPEN ACCESS / PEER-REVIEWED / RESEARCH ARTICLE

Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy

Maria Rosaria Esposito, Assunta Guillari, Italo Francesco Angelillo

Published: June 30, 2017 / https://doi.org/10.1371/journal.pone.0180473

 

Abstract

The objectives of the cross-sectional study were to delineate the knowledge, attitudes, and behavior among nurses regarding the prevention of central line-associated bloodstream infections (CLABSIs) and to identify their predisposing factors. A questionnaire was self-administered from September to November 2011 to nurses in oncology and outpatient chemotherapy units in 16 teaching and non-teaching public and private hospitals in the Campania region (Italy). The questionnaire gathered information on demographic and occupational characteristics; knowledge about evidence-based practices for the prevention of CLABSIs; attitudes towards guidelines, the risk of transmitting infections, and hand-washing when using central venous catheter (CVC); practices about catheter site care; and sources of information. The vast majority of the 335 nurses answered questions correctly about the main recommendations to prevent CLABSIs (use sterile gauze or sterile transparent semipermeable dressing to cover the catheter site, disinfect the needleless connectors before administer medication or fluid, disinfect with hydrogen peroxide the catheter insertion site, and use routinely anticoagulants solutions). Nurses aged 36 to 50 years were less likely to know these main recommendations to prevent CLABSIs, whereas this knowledge was higher in those who have received information about the prevention of these infections from courses. Nurses with lower education and those who do not know two of the main recommendations on the site’s care to prevent the CLABSIs, were more likely to perceive the risk of transmitting an infection. Higher education, attitude toward the utility allow to dry antiseptic, and the need of washing hands before wearing gloves for access to port infusion were predictors of performing skin antiseptic and aseptic technique for dressing the catheter insertion site. Educational interventions should be implemented to address the gaps regarding knowledge and practice regarding the prevention of CLABSIs and to ensure that nurses use evidence-based prevention interventions.

_____

Citation: Esposito MR, Guillari A, Angelillo IF (2017) Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLoS ONE 12(6): e0180473. https://doi.org/10.1371/journal.pone.0180473

Editor: Lamberto Manzoli, Universita degli Studi di Ferrara, ITALY

Received: March 4, 2017; Accepted: June 15, 2017; Published: June 30, 2017

Copyright: © 2017 Esposito 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 as Supporting Information files.

Funding: The authors received no specific funding for this work.

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

Keywords: Sepsis; Bloodstream infection; Italy.

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