#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



  • 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.




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.


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.


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.]


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



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.


A case of the severe #human #infection by #avian #influenza #H7N9 was rescued successfully by the #sepsis bundle (Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, abstract)

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

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 May;29(5):473-476. doi: 10.3760/cma.j.issn.2095-4352.2017.05.017.

[A case of the severe human infection by avian influenza H7N9 was rescued successfully by the sepsis bundle].

[Article in Chinese]

Wang S1, Liu J, Luo H, Pan X, Yuan T, Long X.

Author information: 1 Department of Critical Care Medicine, the Second Affiliated Hospital of Guizhou Medical University, Kaili 556000, Guizhou, China. Corresponding author: Wang Shaohong, Email: 1098025735@qq.com.




One confirmed diagnosis case of severe human infection by avian influenza H7N9 admitted to intensive care unit (ICU) of the Second Affiliated Hospital of Guizhou Medical University on January 12th, 2017 was reported. The patient was treated with the sepsis bundle, and recovered finally, including a series of comprehensive treatments, such as respiratory support, circulation support, antiviral, anti-inflammation, immunization enhancement, critical nursing, fluid management, nutritional support and treatment of complications. The critical patient was admitted on January 27th, and the treatment was successful. It has important significance to rescue the severe human infection from avian influenza H7N9 by the sepsis bundle.

PMID: 28524040 DOI: 10.3760/cma.j.issn.2095-4352.2017.05.017

Keywords: Avian Influenza; H7N9; Human; China; Sepsis; Guangdong.


#Management and #outcomes of severe #dengue #patients presenting with #sepsis in a #tropical country (PLoS One, abstract)

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


Management and outcomes of severe dengue patients presenting with sepsis in a tropical country

Prapit Teparrukkul, Viriya Hantrakun, Nicholas P. J. Day, T. Eoin West, Direk Limmathurotsakul

Published: April 24, 2017 / https://doi.org/10.1371/journal.pone.0176233




Dengue is a common cause of infection in adults in tropical countries. Sepsis is a syndrome of systemic manifestations induced by infection of any organisms; including bacterial, fungal and viral agents. Here, we investigated the diagnosis, management and outcomes of dengue patients presenting with sepsis in a prospective study of community-acquired sepsis in Thailand.


From June to December 2015, 874 adult patients (age≥18 years) with suspected or documented community-acquired infection, with ≥3 diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 hours of admission were evaluated. Serum was stored and later tested for dengue PCR assays.


A total of 126 patients had dengue PCR assays positive (2 DENV-1, 12 DENV-2, 24 DENV-3 and 88 DENV-4), and 5 of them (4%) died. We found that attending physicians suspected dengue infection on admission in 84 patients (67%), and recorded dengue infection as the final diagnosis in 96 patients (76%). Four of five fatal cases were diagnosed and treated as septic shock not due to dengue. In multivariable analysis, there was a trend showing that age≥60 years, hypoxemia and misdiagnosis of dengue by attending physicians were associated with 28-day mortality.


A number of adult patients who died of dengue are misdiagnosed as severe sepsis and septic shock. Diagnosis of dengue based on clinical features alone is difficult. Rapid diagnostic tests for dengue may need to be routinely used in adult patients presenting with sepsis and septic shock in tropical countries. This approach could improve diagnosis and management of those patients.


Citation: Teparrukkul P, Hantrakun V, Day NPJ, West TE, Limmathurotsakul D (2017) Management and outcomes of severe dengue patients presenting with sepsis in a tropical country. PLoS ONE 12(4): e0176233. https://doi.org/10.1371/journal.pone.0176233

Editor: Nguyen Tien Huy, Institute of Tropical Medicine (NEKKEN), Nagasaki University, JAPAN

Received: January 9, 2017; Accepted: April 8, 2017; Published: April 24, 2017

Copyright: © 2017 Teparrukkul 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 available from figshare at: https://figshare.com/s/a31da6384a6a50c99464.

Funding: The prospective sepsis study was funded by the Wellcome Trust (106698/B/14/Z) and National Heart, Lung and Blood Institute, National Institutes of Health (R01HL113382). The dengue PCR assays were funded by Defense Threat Reduction Agency, USA (W911QY-16-C-0017). DL is supported by an intermediate fellowship from the Wellcome Trust (101103/Z/13/Z).

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

Keywords: Dengue Fever; Sepsis.


Intertypic #recombination of #human #parechovirus 4 isolated from #infants with #sepsis-like disease (J Clin Virol., abstract)

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

Intertypic recombination of human parechovirus 4 isolated from infants with sepsis-like disease

Pekka Kolehmainen, Anu Siponen, Teemu Smura, Hannimari Kallio-Kokkoemail, Olli Vapalahti, Anne Jääskeläinen1, Sisko Tauriainen1

1These authors contributed equally.

DOI: http://dx.doi.org/10.1016/j.jcv.2017.01.001

Publication History: Published online: January 03, 2017 – Accepted: January 2, 2017 – Received in revised form: December 30, 2016 – Received: October 13, 2016



  • Three HPeV-4 complete coding sequences were determined.
  • The P1 and P2 regions were highly similar to an HPeV-4 from the Netherlands, 2002.
  • Sequence similarity with HPeV-4 was lost in the 3D region indicating recombination.
  • The 2 B to 3A region clustered together with several HPeV-3 strains.
  • A three nucleotide deletion, compared to other HPeV-4s, was found in the 1C region.




Human parechoviruses (HPeVs) (family Picornaviridae), are common pathogens in young children. Despite their high prevalence, research on their genetic identity, diversity and evolution have remained scarce.


Complete coding regions of three previously reported HPeV-4 isolates from Finnish children with sepsis-like disease were sequenced in order to elucidate the phylogenetic relationships and potential recombination events during the evolution of these isolates.

Study design

The isolated viruses were sequenced and aligned with all HPeV complete genome sequences available in GenBank. Phylogenetic trees were constructed and similarity plot and bootscanning methods were used for recombination analysis.


The three HPeV-4 isolates had 99.8% nucleotide sequence similarity. The phylogenetic analysis indicated that capsid-encoding sequences of these HPeV-4 isolates were closely related to other HPeV-4 strains (80.7-94.7% nucleotide similarity), whereas their non-structural region genes 2A to 3C clustered together with several HPeV-1 and HPeV-3 strains, in addition to the HPeV-4 strain K251176-02 (isolated 2002 in the Netherlands), but not with other HPeV-4 strains. However, in 3D-encoding sequence the Finnish HPeV-4 isolates did not cluster with the strain HPeV-4/K251176-02, but instead, formed a distinct group together with several HPeV-1 and HPeV-3 strains. Similarity plot and Bootscan analyses further confirmed intertypic recombination events in the evolution of the Finnish HPeV-4 isolates.


Intertypic recombination event(s) have occurred during the evolution of HPeV-4 isolates from children with sepsis-like disease. However, due to the low number of parechovirus complete genomes available, the precise recombination partners could not be detected. The results suggest frequent intratypic recombination among parechoviruses.

Abbreviations: CDS (coding sequences), HPeV (human parechovirus), NGS (next generation sequencing), nt (nucleotide(s)), UTR (untranslated region)

Keywords: Human parechovirus, HPeV-4, Complete coding sequence, Sepsis-like disease, Recombination, Phylogenetic analysis

Keywords: Parechovirus; Picornavirus; Sepsis.


#Effect of #Hydrocortisone on Development of #Shock Among Patients With Severe #Sepsis – The #HYPRESS Randomized Clinical Trial (JAMA, abstract)

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

Original Investigation / Caring for the Critically Ill Patient / November 1, 2016

Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis
The HYPRESS Randomized Clinical Trial

Didier Keh, MD1; Evelyn Trips2; Gernot Marx, MD3; et al Stefan P. Wirtz, MD4; Emad Abduljawwad, MD4; Sven Bercker, MD5; Holger Bogatsch, MD2; Josef Briegel, MD6; Christoph Engel, MD7; Herwig Gerlach, MD, PhD, MBA8; Anton Goldmann, MD1; Sven-Olaf Kuhn, MD9; Lars Hüter, MD10; Andreas Meier-Hellmann, MD11; Axel Nierhaus, MD12; Stefan Kluge, MD12; Josefa Lehmke, MD13; Markus Loeffler, MD7; Michael Oppert, MD14; Kerstin Resener, MD15; Dirk Schädler, MD16; Tobias Schuerholz, MD3; Philipp Simon, MD5; Norbert Weiler, MD16; Andreas Weyland, MD17; Konrad Reinhart, MD18; Frank M. Brunkhorst, MD19; for the SepNet–Critical Care Trials Group

Author Affiliations: 1Department of Anesthesiology and Intensive Care Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany; 2Clinical Trial Centre Leipzig, Leipzig, Germany; 3Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany; 4Department of Intensive Care Medicine, HELIOS Hospital Bad Saarow, Bad Saarow, Germany; 5Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany; 6Department of Anesthesiology, Klinikum der Ludwig-Maximilians-Universität, München, Germany; 7Institute for Medical Informatics, Statistics and Epidemiology, Leipzig, Germany; 8Department of Anesthesia, Intensive Care Medicine and Pain Management, Vivantes-Klinikum Neukölln, Berlin, Germany; 9Department of Anesthesiology and Intensive Care Medicine, Ernst Moritz Arndt University, Greifswald, Germany; 10Department of Anesthesia and Intensive Care, Zentralklinik Bad Berka, Bad Berka, Germany; 11Department of Anesthesia, Intensive Care Medicine and Pain Management, HELIOS Hospital Erfurt, Erfurt, Germany; 12Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 13Department of Cardiology and Intensive Care Medicine, Vivantes Humboldt Klinikum, Berlin, Germany; 14Department of Emergency and Intensive Care Medicine, Klinikum Ernst von Bergmann, Potsdam, Germany; 15Department of Intensive Care Medicine, HELIOS Hospital Berlin-Buch, Berlin, Germany; 16Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig Holstein, Campus Kiel, Kiel, Germany; 17Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Management, Klinikum Oldenburg Medical Campus Carl von Ossietzky Universität, Oldenburg, Germany; 18Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany; 19Center for Clinical Studies, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany

Copyright 2016 American Medical Association. All Rights Reserved. Applicable ARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;316(17):1775-1785. doi:10.1001/jama.2016.14799


Key Points

  • Question – Does adjunctive early hydrocortisone therapy prevent the development of septic shock in patients with severe sepsis who are not in shock?
  • Findings – In this randomized clinical trial that included 380 adults, occurrence of septic shock was not significantly different between patients who received hydrocortisone or placebo (21.2% vs 22.9%, respectively).
  • Meaning – Administration of hydrocortisone did not prevent the development of shock in patients with severe sepsis.




Adjunctive hydrocortisone therapy is suggested by the Surviving Sepsis Campaign in refractory septic shock only. The efficacy of hydrocortisone in patients with severe sepsis without shock remains controversial.


To determine whether hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock.

Design, Setting, and Participants

Double-blind, randomized clinical trial conducted from January 13, 2009, to August 27, 2013, with a follow-up of 180 days until February 23, 2014. The trial was performed in 34 intermediate or intensive care units of university and community hospitals in Germany, and it included 380 adult patients with severe sepsis who were not in septic shock.


Patients were randomly allocated 1:1 either to receive a continuous infusion of 200 mg of hydrocortisone for 5 days followed by dose tapering until day 11 (n = 190) or to receive placebo (n = 190).

Main Outcomes and Measures

The primary outcome was development of septic shock within 14 days. Secondary outcomes were time until septic shock, mortality in the intensive care unit or hospital, survival up to 180 days, and assessment of secondary infections, weaning failure, muscle weakness, and hyperglycemia (blood glucose level >150 mg/dL [to convert to millimoles per liter, multiply by 0.0555]).


The intention-to-treat population consisted of 353 patients (64.9% male; mean [SD] age, 65.0 [14.4] years). Septic shock occurred in 36 of 170 patients (21.2%) in the hydrocortisone group and 39 of 170 patients (22.9%) in the placebo group (difference, −1.8%; 95% CI, −10.7% to 7.2%; P = .70). No significant differences were observed between the hydrocortisone and placebo groups for time until septic shock; mortality in the intensive care unit or in the hospital; or mortality at 28 days (15 of 171 patients [8.8%] vs 14 of 170 patients [8.2%], respectively; difference, 0.5%; 95% CI, −5.6% to 6.7%; P = .86), 90 days (34 of 171 patients [19.9%] vs 28 of 168 patients [16.7%]; difference, 3.2%; 95% CI, −5.1% to 11.4%; P = .44), and 180 days (45 of 168 patients [26.8%] vs 37 of 167 patients [22.2%], respectively; difference, 4.6%; 95% CI, −4.6% to 13.7%; P = .32). In the hydrocortisone vs placebo groups, 21.5% vs 16.9% had secondary infections, 8.6% vs 8.5% had weaning failure, 30.7% vs 23.8% had muscle weakness, and 90.9% vs 81.5% had hyperglycemia.

Conclusions and Relevance

Among adults with severe sepsis not in septic shock, use of hydrocortisone compared with placebo did not reduce the risk of septic shock within 14 days. These findings do not support the use of hydrocortisone in these patients.

Trial Registration clinicaltrials.gov Identifier: NCT00670254

Keywords: Sepsis; Corticosteroids.


#Levosimendan for the #Prevention of Acute #Organ #Dysfunction in #Sepsis (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Original Article

Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis

Anthony C. Gordon, M.D., Gavin D. Perkins, M.D., Mervyn Singer, M.D., Daniel F. McAuley, M.D., Robert M.L. Orme, M.B., Ch.B., Shalini Santhakumaran, M.Sc., Alexina J. Mason, Ph.D., Mary Cross, B.A., Farah Al-Beidh, Ph.D., Janis Best-Lane, M.Sc., David Brealey, M.D., Christopher L. Nutt, M.B., B.Ch., James J. McNamee, M.B., Henrik Reschreiter, M.D., Andrew Breen, M.B., Ch.B., Kathleen D. Liu, M.D., Ph.D., and Deborah Ashby, Ph.D.

October 5, 2016 / DOI: 10.1056/NEJMoa1609409




Levosimendan is a calcium-sensitizing drug with inotropic and other properties that may improve outcomes in patients with sepsis.


We conducted a double-blind, randomized clinical trial to investigate whether levosimendan reduces the severity of organ dysfunction in adults with sepsis. Patients were randomly assigned to receive a blinded infusion of levosimendan (at a dose of 0.05 to 0.2 μg per kilogram of body weight per minute) for 24 hours or placebo in addition to standard care. The primary outcome was the mean daily Sequential Organ Failure Assessment (SOFA) score in the intensive care unit up to day 28 (scores for each of five systems range from 0 to 4, with higher scores indicating more severe dysfunction; maximum score, 20). Secondary outcomes included 28-day mortality, time to weaning from mechanical ventilation, and adverse events.


The trial recruited 516 patients; 259 were assigned to receive levosimendan and 257 to receive placebo. There was no significant difference in the mean (±SD) SOFA score between the levosimendan group and the placebo group (6.68±3.96 vs. 6.06±3.89; mean difference, 0.61; 95% confidence interval [CI], −0.07 to 1.29; P=0.053). Mortality at 28 days was 34.5% in the levosimendan group and 30.9% in the placebo group (absolute difference, 3.6 percentage points; 95% CI, −4.5 to 11.7; P=0.43). Among patients requiring ventilation at baseline, those in the levosimendan group were less likely than those in the placebo group to be successfully weaned from mechanical ventilation over the period of 28 days (hazard ratio, 0.77; 95% CI, 0.60 to 0.97; P=0.03). More patients in the levosimendan group than in the placebo group had supraventricular tachyarrhythmia (3.1% vs. 0.4%; absolute difference, 2.7 percentage points; 95% CI, 0.1 to 5.3; P=0.04).


The addition of levosimendan to standard treatment in adults with sepsis was not associated with less severe organ dysfunction or lower mortality. Levosimendan was associated with a lower likelihood of successful weaning from mechanical ventilation and a higher risk of supraventricular tachyarrhythmia.

(Funded by the NIHR Efficacy and Mechanism Evaluation Programme and others; LeoPARDS Current Controlled Trials number, ISRCTN12776039.)

Keywords: Research; Abstracts; Sepsis.