Database : MEDLINE
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[PMID]: 27177946
[Au] Autor:Gala RP; D'Souza M; Zughaier SM
[Ad] Address:Vaccine Nanotechnology Laboratory, Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University, Atlanta, GA, USA.
[Ti] Title:Evaluation of various adjuvant nanoparticulate formulations for meningococcal capsular polysaccharide-based vaccine.
[So] Source:Vaccine;34(28):3260-7, 2016 Jun 14.
[Is] ISSN:1873-2518
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Neisseria meningitidis is a leading cause of bacterial meningitis and sepsis and its capsular polysaccharides (CPS) are a major virulence factor in meningococcal infections and form the basis for serogroup designation and preventive vaccines. We have formulated a novel meningococcal nanoparticulate vaccine formulation that does not require chemical conjugation, but encapsulates meningococcal CPS polymers in a biodegradable material that slowly release antigens, thereby has antigen depot effect to enhance antigenicity. The novel vaccine formulation is inexpensive and can be stored as a dry powder with extended shelf life that does not require the cold-chain which facilitates storage and distribution. In order to enhance the antigenicity of meningococcal nanoparticulate vaccine, we screened various adjuvants formulated in nanoparticles, for their ability to potentiate antigen presentation by dendritic cells. Here, we report that MF59 and Alum are superior to TLR-based adjuvants in enhancing dendritic cell maturation and antigen presentation markers MHC I, MHC II, CD40, CD80 and CD86 in dendritic cells pulsed with meningococcal CPS nanoparticulate vaccine.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1606
[Js] Journal subset:IM
[St] Status:In-Data-Review

  2 / 97601 MEDLINE  
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[PMID]: 27132208
[Au] Autor:Alfandari S; Cabaret P; Nguyen S; Descamps D; Vachée A; Cattoen C; Van Grunderbeeck N; ARMEDA bacteremia groups
[Ad] Address:Service de réanimation et maladies infectieuses, centre hospitalier Dron, 155, rue du Président-Coty, 59200 Tourcoing, France. Electronic address: alfandari.s@gmail.com....
[Ti] Title:Evaluating the management of 493 patients presenting with bacteremia in 23 northern French hospitals.
[So] Source:Med Mal Infect;46(4):194-9, 2016 Jun.
[Is] ISSN:1769-6690
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:OBJECTIVES: We aimed to update the epidemiology of bacteremia and evaluate their management and short-term outcome. METHODS: We conducted a prospective multicenter survey from October to November 2011. Consecutive patients with at least one positive blood culture (BC) were included in the study. We evaluated the type and adequacy of empirical and documented antibiotic therapy, time to active antibiotic therapy, compliance with guidelines, and 10-day outcome. RESULTS: A total of 23 public and private hospitals and 633 patients (493 true pathogens and 140 contaminants) were included in the study. Patients' wards were medicine (57%), surgery (19%), intensive care (14%), onco/hematology (3.7%), pediatrics (3.4%), infectious diseases (1.8%), and obstetrics (1.2%). Main pathogens were Escherichia coli (36%), Staphylococcus aureus (16%), coagulase-negative staphylococci, and Klebsiella sp. (8% each). A total of 43 (8.7%) multidrug-resistant strains were observed, including 26 extended-spectrum beta-lactamase strains and 15 methicillin-resistant S. aureus strains. An antibiotic active against the isolated pathogen was used in 74% of empirical and 96% of documented therapies. Median time between BC and administration of an active drug was 0.61 day. Empirical antibiotic therapies were protocol-compliant in 77% of cases. Few (4%) patients with contaminated BC received an antibiotic therapy (all inappropriate). Day-10 mortality was 12.1%, higher in patients presenting with severe sepsis or septic shock (22.5%) than in patients presenting with non-severe bacteremia (7.1%; P<0.0001). CONCLUSION: The management of bacteremia seems satisfactory in these volunteer hospitals but bacteremia remains a severe infection.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1606
[Js] Journal subset:IM
[St] Status:In-Data-Review

  3 / 97601 MEDLINE  
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[PMID]: 27132207
[Au] Autor:Finsterer J; Dumser M
[Ad] Address:Krankenanstalt Rudolfstiftung, Vienna, Austria. Electronic address: fifigs1@yahoo.de.
[Ti] Title:Allergy to transdermal fentanyl resulting in Staphylococcus aureus sepsis and fatal endocarditis with myocardial rupture.
[So] Source:Med Mal Infect;46(4):239-40, 2016 Jun.
[Is] ISSN:1769-6690
[Cp] Country of publication:France
[La] Language:eng
[Pt] Publication type:LETTER
[Em] Entry month:1606
[Js] Journal subset:IM
[St] Status:In-Data-Review

  4 / 97601 MEDLINE  
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[PMID]: 27288619
[Au] Autor:Lorente L; Martín MM; Ferreres J; Solé-Violán J; Labarta L; Díaz C; Jiménez A; Borreguero-León JM
[Ad] Address:Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320, Tenerife, Spain. Electronic address: lorentemartin@msn.com....
[Ti] Title:Serum caspase 3 levels are associated with early mortality in severe septic patients.
[So] Source:J Crit Care;34:103-6, 2016 Aug.
[Is] ISSN:1557-8615
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Higher caspase 3 activity has been found in lymphocytes of septic patients than of healthy controls. However, an association between serum caspase 3 levels at moment of severe sepsis diagnosis and mortality in septic patients has not been previously demonstrated, and this was the main objective of the present study. METHODS: This is an observational study of 216 patients with severe sepsis in 6 Spanish intensive care units. We collected serum samples at moment of severe sepsis diagnosis to determine levels of caspase 3 and caspase-cleaved cytokeratin (CCCK) 18. End point was 30-day mortality. RESULTS: We found higher serum caspase 3 levels (P<.001) and caspase-cleaved cytokeratin 18 (P=.001) in nonsurvivors (n=76) than in survivors (n=140). Multiple binary logistic regression analysis showed that serum caspase 3 levels greater than 0.25 ng/mL were associated with 30-day mortality (odds ratio, 6.51; 95% confidence interval, 3.32-12.77; P<.001). Receiver operating characteristic analysis showed that the area under the curve to predict 30-day mortality for serum caspase 3 levels was 0.73 (95% confidence interval, 0.67-0.79; P<.001). CONCLUSIONS: The major novel findings of our study were that there is an association between serum caspase 3 levels at moment of severe sepsis diagnosis and mortality in septic patients and that serum caspase 3 levels could be used as prognostic biomarker, and further studies are needed to corroborate these findings.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1606
[Js] Journal subset:IM
[St] Status:In-Data-Review

  5 / 97601 MEDLINE  
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[PMID]: 27288613
[Au] Autor:Chan MC; Tseng JS; Hsu KH; Shih SJ; Yi CY; Wu CL; Kou YR
[Ad] Address:Institute of Physiology, National Yang-Ming University, Taipei, Taiwan; Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan....
[Ti] Title:A minimum blood glucose value less than or equal to 120 mg/dL under glycemic control is associated with increased 14-day mortality in nondiabetic intensive care unit patients with sepsis and stress hyperglycemia.
[So] Source:J Crit Care;34:69-73, 2016 Aug.
[Is] ISSN:1557-8615
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: Hyperglycemia is common in critically ill patients, but results of previous trials on glycemic control have been controversial. This study aimed to investigate whether the minimum blood glucose value during the first 72 hours after admission (72-min-BGV) was associated with mortality in patients with severe sepsis. MATERIALS AND METHODS: This is a retrospective analysis of prospectively acquired clinical data from an intensive care unit of a tertiary referral hospital in central Taiwan. Patients were included if they were admitted due to severe sepsis from July 2010 to June 2011. RESULTS: A total of 127 patients (100 males and 27 females) were included for analysis. A 72-min-BGV less than or equal to 120 mg/dL was associated with increased 14-day mortality. Further subgroup analysis revealed that this association existed only in the patients without diabetes. In multivariate logistic regression analysis, a 72-min-BGV less than or equal to 120 mg/dL was an independent risk factor for 14-day mortality (adjusted odds ratio, 5.09; 95% confidence interval, 1.26-23.33; P= .024) in the patients without diabetes. CONCLUSIONS: A 72-min-BGV less than or equal to 120 mg/dL was an independent risk factor for 14-day mortality in nondiabetic patients with hyperglycemia admitted to our intensive care unit due to severe sepsis, but not in diabetic patients under the same setting.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1606
[Js] Journal subset:IM
[St] Status:In-Data-Review

  6 / 97601 MEDLINE  
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[PMID]: 27288610
[Au] Autor:Trásy D; Tánczos K; Németh M; Hankovszky P; Lovas A; Mikor A; László I; Hajdú E; Osztroluczki A; Fazakas J; Molnár Z; EProK study group
[Ad] Address:University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: trasydom@gmail.com....
[Ti] Title:Early procalcitonin kinetics and appropriateness of empirical antimicrobial therapy in critically ill patients: A prospective observational study.
[So] Source:J Crit Care;34:50-5, 2016 Aug.
[Is] ISSN:1557-8615
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically ill patients. MATERIALS AND METHODS: This prospective observational study recruited patients in whom empirical antimicrobial therapy was started for suspected infection. Biochemical and physiological parameters were measured before initiating antimicrobials (t0), 8 hourly (t8, t16, t24), and then daily (day2-6). Patients were grouped post hoc into appropriate (A) and inappropriate (IA) groups. RESULTS: Of 209 patients, infection was confirmed in 67%. Procalcitonin kinetics were different between the IA (n = 33) and A groups (n = 108). In the IA group, PCT levels (median [interquartile range]) increased: t0= 2.8 (1.2-7.4), t16= 8.6 (4.8-22.1), t24= 14.5 (4.9-36.1), P< .05. In the A group, PCT peaked at t16 and started to decrease by t24: t0= 4.2 (1.9-12.8), t16= 6.99 (3.4-29.1), t24= 5.2 (2.0-16.7), P< .05. Receiver operating characteristic analysis revealed that a PCT elevation greater than or equal to 69% from t0 to t16 had an area under the curve for predicting inappropriate antimicrobial treatment of 0.73 (95% confidence interval, 0.63-0.83), P< .001; from t0 to t24, a greater than or equal to 74% increase had an area under the curve of 0.86 (0.77-0.94), P< .001. Hospital mortality was 37% in the A group and 61% in the IA group (P= .017). CONCLUSIONS: Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically ill patients may help the clinician to evaluate the appropriateness of therapy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1606
[Js] Journal subset:IM
[St] Status:In-Data-Review

  7 / 97601 MEDLINE  
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[PMID]: 26818706
[Au] Autor:Carrara FS; Zanei SS; Cremasco MF; Whitaker IY
[Ad] Address:São Paulo Hospital - University Hospital at Federal University of São Paulo - UNIFESP, Rua Doutor Diogo de Faria, 816, 04037-002 São Paulo, Brazil. Electronic address: fercarrara@hotmail.com....
[Ti] Title:Outcomes and nursing workload related to obese patients in the intensive care unit.
[So] Source:Intensive Crit Care Nurs;35:45-51, 2016 Aug.
[Is] ISSN:1532-4036
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:OBJECTIVES: To compare the morbidity and mortality of patients with a body mass index (BMI) < and ≥30kg/m(2) and to identify risk factors related to death and length of stay of obese patients in the intensive care unit (ICU). METHODS: Prospective and cross-sectional study. SETTING: A 35-bed mixed ICU in São Paulo, Brazil. RESULTS: The sample consisted of 530 patients, of which 105 (19.8%) had a BMI ≥30kg/m(2). A significantly higher number of obese patients were female (p=0.025). The mortality, morbidity and nursing workload were not different between the obese and nonobese groups. However, the morbidly obese patients were younger (p<0.001), had a lower Charlson Comorbidity Index (CI; p=0.002), lower Simplified Acute Physiology Score 3 (SAPS 3; p=0.047), lower Sepsis-related Organ Failure Assessment (SOFA) score (p=0.019), shorter ICU length of stay (LOS; p=0.015) and hospital LOS (p=0.039), and an increased mean nursing workload (Nursing Activities Score (NAS; p=0.004)). The SOFA score and nursing workload were identified as risk factors associated with death in the ICU. These two variables, in addition to the admission category and duration of mechanical ventilation (MV), were also related to the ICU LOS, which demonstrates an inverse relationship between the NAS and LOS. CONCLUSION: Although the morbidity, mortality and nursing workload were not significantly different between the obese and nonobese groups, our results contribute additional information to the relationship between obesity and clinical discharge and inform future research.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1606
[Js] Journal subset:N
[St] Status:In-Data-Review

  8 / 97601 MEDLINE  
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[PMID]: 26837616
[Au] Autor:Karlsson I; Hagman R; Johannisson A; Wang L; Södersten F; Wernersson S
[Ad] Address:Dept of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Box 7011, SE-75007 Uppsala, Sweden....
[Ti] Title:Multiplex cytokine analyses in dogs with pyometra suggest involvement of KC-like chemokine in canine bacterial sepsis.
[So] Source:Vet Immunol Immunopathol;170:41-6, 2016 Feb.
[Is] ISSN:1873-2534
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Clinical diagnostic criteria for sepsis (systemic inflammatory response syndrome caused by infection) are unspecific and, therefore, biomarkers for sepsis diagnosis are needed for appropriate treatment and patient survival. Pyometra, a common disease caused by bacterial infection of the uterus, results in sepsis in nearly 60% of cases in dogs. We used dogs with pyometra as a natural model for sepsis and collected serum samples from 39 dogs, of which 22 with pyometra and 17 healthy controls. Dogs with pyometra were further grouped into dogs with sepsis (n=18) and without sepsis (n=4). Serum concentrations of a panel of cytokines, including keratinocyte-derived chemokine (KC)-like, granulocyte-macrophages colony stimulating factor (GM-CSF), interleukin (IL)-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-15, IL-18, chemokine C-X-C motif ligand (CXCL)10 and tumor necrosis factor (TNF)-α, were measured using multiplex analyses. Serum C-reactive protein (CRP) levels were determined using an automated immunoturbidimetric assay. In addition to physical examination hematological and serum biochemical analyses were performed to evaluate the overall status of the dogs. Significantly higher concentrations of KC-like (757 vs 304 pg/ml) were detected in dogs with pyometra as compared to healthy dogs. Within the pyometra group, dogs with sepsis compared to dogs without sepsis had a higher KC-like concentration (873 vs 300 pg/ml). Hemoglobin levels were significantly lower in dogs with pyometra compared to healthy dogs, regardless of the presence or absence of sepsis, and correlated negatively with KC-like. KC-like concentrations correlated positively with CRP, number of hospitalization days, number of monocytes, concentrations of IL-8, and percentage band neutrophils. Our data suggest that bacterial infection triggers the expression of KC-like and further studies are warranted of KC-like as a possible biomarker for diagnosing sepsis and uterine bacterial infection in dogs.
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1602
[Js] Journal subset:IM
[St] Status:In-Process

  9 / 97601 MEDLINE  
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[PMID]: 26759980
[Au] Autor:Jones SL; Ashton CM; Kiehne LB; Nicolas JC; Rose AL; Shirkey BA; Masud F; Wray NP
[Ad] Address:Departments of *Surgery, Center for Outcomes Research †Anesthesia-Critical Care, Houston, Methodist Research Institute, Houston Methodist Hospital, Houston, TX.
[Ti] Title:Outcomes and Resource Use of Sepsis-associated Stays by Presence on Admission, Severity, and Hospital Type.
[So] Source:Med Care;54(3):303-10, 2016 Mar.
[Is] ISSN:1537-1948
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To establish a baseline for the incidence of sepsis by severity and presence on admission in acute care hospital settings before implementation of a broad sepsis screening and response initiative. METHODS: A retrospective cohort study using hospital discharge abstracts of 5672 patients, aged 18 years and above, with sepsis-associated stays between February 2012 and January 2013 at an academic medical center and 5 community hospitals in Texas. RESULTS: Sepsis was present on admission in almost 85% of cases and acquired in-hospital in the remainder. The overall inpatient death rate was 17.2%, but was higher in hospital-acquired sepsis (38.6%, medical; 29.2%, surgical) and Stages 2 (17.6%) and 3 (36.4%) compared with Stage 1 (5.9%). Patients treated at the academic medical center had a higher death rate (22.5% vs. 15.1%, P<0.001) and were more costly ($68,050±184,541 vs. $19,498±31,506, P<0.001) versus community hospitals. CONCLUSIONS: Greater emphasis is needed on public awareness of sepsis and the detection of sepsis in the prehospitalization and early hospitalization period. Hospital characteristics and case mix should be accounted for in cross-hospital comparisons of sepsis outcomes and costs.
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, U.S. GOV'T, P.H.S.
[Em] Entry month:1602
[Cu] Class update date: 160301
[Lr] Last revision date:160301
[Js] Journal subset:IM
[St] Status:In-Process
[do] DOI:10.1097/MLR.0000000000000481

  10 / 97601 MEDLINE  
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[PMID]: 26679873
[Au] Autor:Bohl DD; Mayo BC; Massel DH; Iantorno SE; Ahn J; Basques BA; Grauer JN; Singh K
[Ad] Address:*Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL †Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
[Ti] Title:Incidence and Risk Factors for Pneumonia After Posterior Lumbar Fusion Procedures: An ACS-NSQIP Study.
[So] Source:Spine (Phila Pa 1976);41(12):1058-63, 2016 Jun.
[Is] ISSN:1528-1159
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:STUDY DESIGN: Retrospective study of data collected prospectively by the American College of Surgeons National Surgical Quality Improvement Program. OBJECTIVE: To determine the incidence and risk factors for development of pneumonia after posterior lumbar fusion (PLF). SUMMARY OF BACKGROUND DATA: Postoperative pneumonia has important clinical consequences for patients and the health care system. Few studies have examined pneumonia after spinal fusion procedures. METHODS: Patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent PLF during 2005 to 2013 were included. The primary outcome was a diagnosis of pneumonia within the first 30 postoperative days. Independent risk factors for the development of postoperative pneumonia were identified using multivariate regression. Rates of sepsis and mortality were compared between patients who did and did not develop pneumonia using multivariate regression that adjusted for all demographic, comorbidity, and procedural characteristics. RESULTS: A total of 12,428 patients undergoing PLF were identified. The incidence of pneumonia was 0.59%. Independent risk factors for the development of pneumonia were chronic obstructive pulmonary disease (relative risk [RR] = 2.7, P = 0.006), steroid use (RR = 2.6, P = 0.017), non-insulin-dependent diabetes mellitus (DM) (RR = 2.4, P = 0.003), insulin-dependent DM (RR = 2.9, P = 0.005), and greater number of operative levels (two level: RR = 1.7, P = 0.033; three level: RR = 2.7, P = 0.007). Patients who developed pneumonia had a higher rate of sepsis (15.1% vs. 0.8%, adjusted RR = 14.5, P < 0.001) and mortality (2.7% versus 0.1%, adjusted RR = 27.0, P < 0.001) than other patients. Of all sepsis cases and postoperative mortalities, 10.5% and 18.2% occurred in patients who had developed pneumonia, respectively. CONCLUSION: Pneumonia occurs in approximately 1 in 200 patients after PLF. Pneumonia plays a significant role in the development of sepsis and mortality, with 10% of sepsis and 20% of mortality cases occurring in patients who had developed pneumonia. Patients with chronic obstructive pulmonary disease, steroid use, DM, and a greater number of operative levels are at greater risk. These patients should be counseled, monitored, and targeted with preventative interventions accordingly. LEVEL OF EVIDENCE: 3.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1606
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1097/BRS.0000000000001389


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