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  1 / 197 MEDLINE  
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[PMID]:29458686
[Au] Autor:Anson LW; Chau K; Sanderson N; Hoosdally S; Bradley P; Iqbal Z; Phan H; Foster D; Oakley S; Morgan M; Peto TEA; Modernizing Medical Microbiology Informatics Group Mmmig; Crook DW; Pankhurst LJ
[Ad] Endereço:1​Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
[Ti] Título:DNA extraction from primary liquid blood cultures for bloodstream infection diagnosis using whole genome sequencing.
[So] Source:J Med Microbiol;67(3):347-357, 2018 Mar.
[Is] ISSN:1473-5644
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Speed of bloodstream infection diagnosis is vital to reduce morbidity and mortality. Whole genome sequencing (WGS) performed directly from liquid blood culture could provide single-assay species and antibiotic susceptibility prediction; however, high inhibitor and human cell/DNA concentrations limit pathogen recovery. We develop a method for the preparation of bacterial DNA for WGS-based diagnostics direct from liquid blood culture. METHODOLOGY: We evaluate three commercial DNA extraction kits: BiOstic Bacteraemia, Amplex Hyplex and MolYsis Plus. Differential centrifugation, filtration, selective lysis and solid-phase reversible immobilization bead clean-up are tested to improve human cells/DNA and inhibitor removal. Using WGS (Illumina/MinION), we assess human DNA removal, pathogen recovery, and predict species and antibiotic susceptibility inpositive blood cultures of 44 Gram-negative and 54 Staphylococcus species.Results/Key findings. BiOstic kit extractions yield the greatest mean DNA concentration, 94-301 ng µl , versus 0-2.5 ng µl using Amplex and MolYsis kits. However, we note higher levels of inhibition (260/280 ratio 0.9-2.1) and human DNA (0.0-4.4×10 copies) in BiOstic extracts. Differential centrifugation (2000 g, 1 min) prior to BiOstic extraction reduces human DNA by 63-89 % with selective lysis minimizing by a further 62 %. Post-extraction bead clean-up lowers inhibition. Overall, 67 % of sequenced samples (Illumina MiSeq) contain <10 % human DNA, with >93 % concordance between WGS-based species and susceptibility predictions and clinical diagnosis. If >60 % of sequencing reads are human (7/98 samples) susceptibility prediction becomes compromised. Novel MinION-based WGS (n=9) currently gives rapid species identification but not susceptibility prediction. CONCLUSION: Our method for DNA preparation allows WGS-based diagnosis direct from blood culture bottles, providing species and antibiotic susceptibility prediction in a single assay.
[Mh] Termos MeSH primário: Bacteriemia/diagnóstico
Hemocultura
DNA Bacteriano/isolamento & purificação
Genoma Bacteriano
Sequenciamento Completo do Genoma
[Mh] Termos MeSH secundário: Bacteriemia/microbiologia
Infecções Relacionadas a Cateter/diagnóstico
Infecções Relacionadas a Cateter/microbiologia
DNA Bacteriano/análise
DNA Bacteriano/genética
Escherichia coli/genética
Seres Humanos
Testes de Sensibilidade Microbiana
Técnicas de Diagnóstico Molecular/métodos
Kit de Reagentes para Diagnóstico
Análise de Sequência de DNA/métodos
Staphylococcus aureus/genética
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (DNA, Bacterial); 0 (Reagent Kits, Diagnostic)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1099/jmm.0.000664


  2 / 197 MEDLINE  
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[PMID]:29458541
[Au] Autor:Kim JH; Kim TS; Song SH; Choi J; Han S; Kim DY; Kwon S; Lee E; Song KH; Choe PG; Bang JH; Kim ES; Park SW; Kim HB; Kim NJ; Park WB; Oh MD
[Ad] Endereço:1​Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
[Ti] Título:Direct rapid antibiotic susceptibility test (dRAST) for blood culture and its potential usefulness in clinical practice.
[So] Source:J Med Microbiol;67(3):325-331, 2018 Mar.
[Is] ISSN:1473-5644
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The direct rapid antibiotic susceptibility test (dRAST), based on analysing changes in bacterial micro-colonies under antibiotic conditions, detects antibiotic resistance within 6 h of direct smear examination results. This study aimed to assess the accuracy of dRAST and evaluate its potential usefulness for improving selection of appropriate antibiotic in real clinical practice settings. METHODOLOGY: We evaluated the accuracy of dRAST by comparing the antibiotic treatments that should have been administered based on dRAST results and the broth microdilution (BMD) test and its potential usefulness via simulation. RESULT: For 49/52 (94.2 %) patients with Gram-positive bacteraemia and 66/67 (98.5 %) patients with Gram-negative bacteraemia, antibiotics indicated by dRAST results were the same as those indicated by the BMD test. Among 34 patients with ineffective and suboptimal treatment, 19 (55.9 %) of patients could have received optimal treatment 1 to 2 days earlier with dRAST results. Among 33 patients given unnecessary broad-spectrum antibiotics, 1 to 2 days earlier de-escalation could have been possible for 27 (81.8 %) patients based on dRAST results. CONCLUSION: The introduction of dRAST could increase the use of optimal antibiotics and reduce unnecessary broad-spectrum antibiotic use in the early period of bacteraemia.
[Mh] Termos MeSH primário: Antibacterianos/farmacologia
Hemocultura
Bactérias Gram-Negativas/efeitos dos fármacos
Bactérias Gram-Positivas/efeitos dos fármacos
Testes de Sensibilidade Microbiana/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Bacteriemia/tratamento farmacológico
Bacteriemia/microbiologia
Acurácia dos Dados
Feminino
Bactérias Gram-Negativas/isolamento & purificação
Bactérias Gram-Positivas/isolamento & purificação
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1099/jmm.0.000678


  3 / 197 MEDLINE  
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[PMID]:29381916
[Au] Autor:Fournier PE; Gouriet F; Casalta JP; Lepidi H; Chaudet H; Thuny F; Collart F; Habib G; Raoult D
[Ad] Endereço:Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection.
[Ti] Título:Blood culture-negative endocarditis: Improving the diagnostic yield using new diagnostic tools.
[So] Source:Medicine (Baltimore);96(47):e8392, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Blood culture-negative endocarditis (BCNE) may represent up to 70% of all endocarditis cases, depending on series. From 2001 to 2009, we implemented in our laboratory a multimodal diagnostic strategy for BCNE that included systematized testing of blood, and when available, valvular biopsy specimens using serological, broad range molecular, and histopathological assays. A causative microorganism was identified in 62.7% of patients.In this study from January 2010 to December 2015, in an effort to increase the number of identified causative microorganisms, we prospectively added to our diagnostic protocol specific real-time (RT) polymerase chain reaction (PCR) assays targeting various endocarditis agents, and applied them to all patients with BCNE admitted to the 4 public hospitals in Marseille, France.A total of 283 patients with BCNE were included in the study. Of these, 177 were classified as having definite endocarditis. Using our new multimodal diagnostic strategy, we identified an etiology in 138 patients (78.0% of cases). Of these, 3 were not infective (2.2%) and 1 was diagnosed as having Mycobacterium bovis BCG endocarditis. By adding specific PCR assays from blood and valvular biopsies, which exhibited a significantly greater sensitivity (P < 10) than other methods, causative agents, mostly enterococci, streptococci, and zoonotic microorganisms, were identified in an additional 27 patients (14 from valves only, 11 from blood only, and 2 from both). Finally, in another 107 patients, a pathogen was detected using serology in 37, valve culture in 8, broad spectrum PCR from valvular biopsies and blood in 19 and 2, respectively, immunohistochemistry from valves in 3, and a combination of several assays in 38.By adding specific RT-PCR assays to our systematic PCR testing of patients with BCNE, we increased the diagnostic efficiency by 24.3%, mostly by detecting enterococci and streptococci that had not been detected by other diagnostic methods, but also agents requiring specific management such as Mycoplasma hominis and Tropheryma whipplei.
[Mh] Termos MeSH primário: Endocardite/diagnóstico
Endocardite/microbiologia
Reação em Cadeia da Polimerase em Tempo Real/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Biópsia
Hemocultura
Criança
Pré-Escolar
Feminino
Imunofluorescência
França
Seres Humanos
Lactente
Masculino
Meia-Idade
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008392


  4 / 197 MEDLINE  
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[PMID]:28461023
[Au] Autor:Ashizawa K; Murata S; Terada T; Ito D; Bunya M; Watanabe K; Teruuchi Y; Tsuchida S; Satoh M; Nishimura M; Matsushita K; Sugama Y; Nomura F
[Ad] Endereço:R&D Department, Nittobo Medical Co., Ltd., 1 Shiojima, Fukuhara, Fukuyama, Koriyama, Fukushima 963-8061, Japan.
[Ti] Título:Applications of copolymer for rapid identification of bacteria in blood culture broths using matrix-assisted laser desorption ionization time-of-flight mass spectrometry.
[So] Source:J Microbiol Methods;139:54-60, 2017 08.
[Is] ISSN:1872-8359
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) can be used to identify pathogens in blood culture samples. However, sample pretreatment is needed for direct identification of microbes in blood culture bottles. Conventional protocols are complex and time-consuming. Therefore, in this study, we developed a method for collecting bacteria using polyallylamine-polystyrene copolymer for application in wastewater treatment technology. Using representative bacterial species Escherichia coli and Staphylococcus capitis, we found that polyallylamine-polystyrene can form visible aggregates with bacteria, which can be identified using MALDI-TOF MS. The processing time of our protocol was as short as 15min. Hemoglobin interference in MALDI spectra analysis was significantly decreased in our method compared with the conventional method. In a preliminary experiment, we evaluated the use of our protocol to identify clinical isolates from blood culture bottles. MALDI-TOF MS-based identification of 17 strains from five bacterial species (E. coli, Klebsiella pneumoniae, Enterococcus faecalis, S. aureus, and S. capitis) collected by our protocol was satisfactory. Prospective large-scale studies are needed to further evaluate the clinical application of this novel and simple method of collecting bacteria in blood culture bottles.
[Mh] Termos MeSH primário: Bactérias/classificação
Bactérias/isolamento & purificação
Hemocultura
Polímeros/química
Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos
[Mh] Termos MeSH secundário: Infecções Bacterianas/microbiologia
Escherichia coli/isolamento & purificação
Infecções por Escherichia coli/microbiologia
Hemoglobinas/química
Seres Humanos
Poliaminas/química
Poliestirenos/química
Infecções Estafilocócicas/microbiologia
Staphylococcus/classificação
Staphylococcus/isolamento & purificação
Staphylococcus aureus/isolamento & purificação
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hemoglobins); 0 (Polyamines); 0 (Polymers); 0 (Polystyrenes); 30551-89-4 (polyallylamine)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


  5 / 197 MEDLINE  
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[PMID]:28953442
[Au] Autor:Bhattacharyya RP; Flores EJ; Azar MM
[Ad] Endereço:From the Department of Medicine, Division of Infectious Disease (R.P.B.), and the Departments of Radiology (E.J.F.) and Pathology (M.M.A.), Massachusetts General Hospital, and the Departments of Medicine (R.P.B.), Radiology (E.J.F.), and Pathology (M.M.A.), Harvard Medical School - both in Boston.
[Ti] Título:Case 30-2017. A 65-Year-Old Woman with Altered Mental Status, Bacteremia, and Acute Liver Failure.
[So] Source:N Engl J Med;377(13):1274-1282, 2017 Sep 28.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Bacteriemia/diagnóstico
Infecções por Campylobacter/diagnóstico
Campylobacter jejuni/isolamento & purificação
Hepatite Autoimune/complicações
Falência Hepática Aguda/etiologia
[Mh] Termos MeSH secundário: Idoso
Bacteriemia/complicações
Hemocultura
Infecções por Campylobacter/complicações
Delírio/etiologia
Diagnóstico Diferencial
Evolução Fatal
Feminino
Insuficiência Cardíaca/etiologia
Hepatite Autoimune/tratamento farmacológico
Seres Humanos
Hospedeiro Imunocomprometido
Icterícia/etiologia
Testes de Função Hepática
Pulmão/diagnóstico por imagem
Radiografia
[Pt] Tipo de publicação:CASE REPORTS; CLINICAL CONFERENCE; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMcpc1706100


  6 / 197 MEDLINE  
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[PMID]:28835382
[Au] Autor:Neuman MI; Hall M; Lipsett SC; Hersh AL; Williams DJ; Gerber JS; Brogan TV; Blaschke AJ; Grijalva CG; Parikh K; Ambroggio L; Shah SS; Pediatric Research in Inpatient Settings Network
[Ad] Endereço:Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; mark.neuman@childrens.harvard.edu.
[Ti] Título:Utility of Blood Culture Among Children Hospitalized With Community-Acquired Pneumonia.
[So] Source:Pediatrics;140(3), 2017 Sep.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: National guidelines recommend blood cultures for children hospitalized with presumed bacterial community-acquired pneumonia (CAP) that is moderate or severe. We sought to determine the prevalence of bacteremia and characterize the microbiology and penicillin-susceptibility patterns of positive blood culture results among children hospitalized with CAP. METHODS: We conducted a cross-sectional study of children hospitalized with CAP in 6 children's hospitals from 2007 to 2011. We included children 3 months to 18 years of age with discharge diagnosis codes for CAP using a previously validated algorithm. We excluded children with complex chronic conditions. We reviewed microbiologic data and classified positive blood culture detections as pathogens or contaminants. Antibiotic-susceptibility patterns were assessed for all pathogens. RESULTS: A total of 7509 children hospitalized with CAP were included over the 5-year study period. Overall, 34% of the children hospitalized with CAP had a blood culture performed; 65 (2.5% of patients with blood cultures; 95% confidence interval [CI]: 2.0%-3.2%) grew a pathogen. accounted for 78% of all detected pathogens. Among detected pathogens, 50 (82%) were susceptible to penicillin. Eleven children demonstrated growth of an organism nonsusceptible to penicillin, representing 0.43% (95% CI: 0.23%-0.77%) of children with blood cultures obtained and 0.15% (95% CI: 0.08%-0.26%) of all children hospitalized with CAP. CONCLUSIONS: Among children without comorbidities hospitalized with CAP in a non-ICU setting, the rate of bacteremia was low, and isolated pathogens were usually susceptible to penicillin. Blood cultures may not be needed for most children hospitalized with CAP.
[Mh] Termos MeSH primário: Bacteriemia/diagnóstico
Hemocultura/utilização
Infecções Comunitárias Adquiridas/diagnóstico
Pneumonia Bacteriana/diagnóstico
[Mh] Termos MeSH secundário: Adolescente
Antibacterianos/uso terapêutico
Bacteriemia/tratamento farmacológico
Bacteriemia/microbiologia
Bactérias/efeitos dos fármacos
Criança
Pré-Escolar
Infecções Comunitárias Adquiridas/tratamento farmacológico
Infecções Comunitárias Adquiridas/microbiologia
Estudos Transversais
Feminino
Hospitalização
Seres Humanos
Lactente
Masculino
Testes de Sensibilidade Microbiana
Penicilinas/uso terapêutico
Pneumonia Bacteriana/tratamento farmacológico
Pneumonia Bacteriana/microbiologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Penicillins)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171015
[Lr] Data última revisão:
171015
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170825
[St] Status:MEDLINE


  7 / 197 MEDLINE  
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[PMID]:28822610
[Au] Autor:DeWitt S; Chavez SA; Perkins J; Long B; Koyfman A
[Ad] Endereço:Virginia Tech-Carilion School of Medicine and Research Institute, Department of Emergency Medicine, 1 Riverside Circle, Roanoke, VA 24014, United States. Electronic address: sadewitt@carilionclinic.org.
[Ti] Título:Evaluation of fever in the emergency department.
[So] Source:Am J Emerg Med;35(11):1755-1758, 2017 Nov.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Fever is one of the most common complaints in the emergency department (ED) and is more complex than generally appreciated. The broad differential diagnosis of fever includes numerous infectious and non-infectious etiologies. An essential skill in emergency medicine is recognizing the pitfalls in fever evaluation. OBJECTIVE OF REVIEW: This review provides an overview of the complaint of fever in the ED to assist the emergency physician with a structured approach to evaluation. DISCUSSION: Fever can be due to infectious or non-infectious etiology and results from the body's natural response to a pyrogen. Adjunctive testing including C-reactive protein, erythrocyte sedimentation rate, and procalcitonin has been evaluated in the literature, but these tests do not have the needed sensitivity and specificity to definitively rule in a bacterial cause of fever. Blood cultures should be obtained in septic shock or if the results will change clinical management. Fever may not be always present in true infection, especially in elderly and immunocompromised patients. Oral temperatures suffer from poor sensitivity to diagnose fever, and core temperatures should be utilized if concern for fever is present. Consideration of non-infectious causes of elevated temperature is needed based on the clinical situation. CONCLUSION: Any fever evaluation must rigorously maintain a broad differential to avoid pitfalls that can have patient care consequences. Fever is complex and due to a variety of etiologies. An understanding of the pathophysiology, causes, and assessment is important for emergency physicians.
[Mh] Termos MeSH primário: Diagnóstico Diferencial
Febre/diagnóstico
Infecção/diagnóstico
[Mh] Termos MeSH secundário: Hemocultura
Sedimentação Sanguínea
Proteína C-Reativa/metabolismo
Calcitonina/metabolismo
Serviço Hospitalar de Emergência
Febre/etiologia
Seres Humanos
Hospedeiro Imunocomprometido
Infecção/complicações
Infecção/metabolismo
Choque Séptico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
9007-12-9 (Calcitonin); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170821
[St] Status:MEDLINE


  8 / 197 MEDLINE  
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[PMID]:28787020
[Au] Autor:Cillóniz C; Ceccato A; de la Calle C; Gabarrús A; Garcia-Vidal C; Almela M; Soriano A; Martinez JA; Marco F; Vila J; Torres A
[Ad] Endereço:Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
[Ti] Título:Time to blood culture positivity as a predictor of clinical outcomes and severity in adults with bacteremic pneumococcal pneumonia.
[So] Source:PLoS One;12(8):e0182436, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: We aimed to investigate the association between the time to positivity of blood culture (TTP) with clinical outcome and severity of pneumococcal bacteremic pneumonia. METHODS: Prospective observational study carried out in 278 hospitalized adult CAP patients with positive blood culture for Streptococcus pneumonia (2003-2015). RESULTS: A total of 278 cases of bacteremic pneumococcal pneumonia were analyzed, median age 62 (46; 79) years. Fifty-one percent of the cases had PSI IV-V. Twenty-one (8%) died within 30-days after admission. The analysis of the TTP showed that the first quartile of the TTP (9.2h) was the best cut-off for differentiating 2 groups of patients at risk, early (TTP <9.2 h) and late (TTP ≥9.2 h) detection groups (AUC 0.66 [95% CI 0.53 to 0.79]). Early TTP was associated with a statistically significant risk of invasive mechanical ventilation (18% vs. 6%, p = 0.007), longer length of hospital stay (12 days vs. 8 days, p<0.001), higher in-hospital mortality (15% vs. 4%, p = 0.010), and 30-day mortality (15% vs. 5%, p = 0.018). After adjustment for potential confounders, regression analyses revealed early TTP as independently associated with high risk of invasive mechanical ventilation (OR 4.60, 95% CI 1.63 to 13.03), longer length of hospital stay (ß 5.20, 95% CI 1.81 to 8.52), higher in-hospital mortality (OR 5.35, 95% CI 1.55 to 18.53), and a trend to higher 30-day mortality (OR 2.47, 95% CI 0.85 to 7.21) to be a contributing factor. CONCLUSION: Our results demonstrate that TTP is an easy to obtain surrogate marker of the severity of pneumococcal pneumonia and a good predictor of its outcome.
[Mh] Termos MeSH primário: Bacteriemia/complicações
Hemocultura
Pneumonia Pneumocócica/sangue
Pneumonia Pneumocócica/diagnóstico
[Mh] Termos MeSH secundário: Idoso
Infecções Comunitárias Adquiridas/sangue
Infecções Comunitárias Adquiridas/complicações
Infecções Comunitárias Adquiridas/diagnóstico
Infecções Comunitárias Adquiridas/mortalidade
Feminino
Mortalidade Hospitalar
Seres Humanos
Unidades de Terapia Intensiva/estatística & dados numéricos
Tempo de Internação
Masculino
Meia-Idade
Admissão do Paciente/estatística & dados numéricos
Pneumonia Pneumocócica/complicações
Pneumonia Pneumocócica/mortalidade
Prognóstico
Respiração Artificial
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170809
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0182436


  9 / 197 MEDLINE  
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[PMID]:28737573
[Au] Autor:Churpek MM; Snyder A; Sokol S; Pettit NN; Edelson DP
[Ad] Endereço:1Department of Medicine, University of Chicago, Chicago, IL. 2Department of Pharmacy, University of Chicago, Chicago, IL.
[Ti] Título:Investigating the Impact of Different Suspicion of Infection Criteria on the Accuracy of Quick Sepsis-Related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores.
[So] Source:Crit Care Med;45(11):1805-1812, 2017 Nov.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Studies in sepsis are limited by heterogeneity regarding what constitutes suspicion of infection. We sought to compare potential suspicion criteria using antibiotic and culture order combinations in terms of patient characteristics and outcomes. We further sought to determine the impact of differing criteria on the accuracy of sepsis screening tools and early warning scores. DESIGN: Observational cohort study. SETTING: Academic center from November 2008 to January 2016. PATIENTS: Hospitalized patients outside the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Six criteria were investigated: 1) any culture, 2) blood culture, 3) any culture plus IV antibiotics, 4) blood culture plus IV antibiotics, 5) any culture plus IV antibiotics for at least 4 of 7 days, and 6) blood culture plus IV antibiotics for at least 4 of 7 days. Accuracy of the quick Sepsis-related Organ Failure Assessment score, Sepsis-related Organ Failure Assessment score, systemic inflammatory response syndrome criteria, the National and Modified Early Warning Score, and the electronic Cardiac Arrest Risk Triage score were calculated for predicting ICU transfer or death within 48 hours of meeting suspicion criteria. A total of 53,849 patients met at least one infection criteria. Mortality increased from 3% for group 1 to 9% for group 6 and percentage meeting Angus sepsis criteria increased from 20% to 40%. Across all criteria, score discrimination was lowest for systemic inflammatory response syndrome (median area under the receiver operating characteristic curve, 0.60) and Sepsis-related Organ Failure Assessment score (median area under the receiver operating characteristic curve, 0.62), intermediate for quick Sepsis-related Organ Failure Assessment (median area under the receiver operating characteristic curve, 0.65) and Modified Early Warning Score (median area under the receiver operating characteristic curve 0.67), and highest for National Early Warning Score (median area under the receiver operating characteristic curve 0.71) and electronic Cardiac Arrest Risk Triage (median area under the receiver operating characteristic curve 0.73). CONCLUSIONS: The choice of criteria to define a potentially infected population significantly impacts prevalence of mortality but has little impact on accuracy. Systemic inflammatory response syndrome was the least predictive and electronic Cardiac Arrest Risk Triage the most predictive regardless of how infection was defined.
[Mh] Termos MeSH primário: Unidades de Terapia Intensiva/estatística & dados numéricos
Escores de Disfunção Orgânica
Sepse/mortalidade
Síndrome de Resposta Inflamatória Sistêmica/mortalidade
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Adulto
Idoso
Antibacterianos/administração & dosagem
Técnicas Bacteriológicas
Hemocultura
Estudos de Coortes
Diagnóstico Precoce
Feminino
Parada Cardíaca/mortalidade
Seres Humanos
Masculino
Meia-Idade
Valor Preditivo dos Testes
Prognóstico
Curva ROC
Estudos Retrospectivos
Sepse/diagnóstico
Sepse/tratamento farmacológico
Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170725
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002648


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[PMID]:28731901
[Au] Autor:Seale AC; Obiero CW; Jones KD; Barsosio HC; Thitiri J; Ngari M; Morpeth S; Mohammed S; Fegan G; Mturi N; Berkley JA
[Ad] Endereço:From the *Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Institution, Kilifi, Kenya; †University of Oxford, Oxford, United Kingdom; and ‡London School of Hygiene and Tropical Medicine, and §Imperial College London, London, United Kingdom.
[Ti] Título:Should First-line Empiric Treatment Strategies for Neonates Cover Coagulase-negative Staphylococcal Infections in Kenya?
[So] Source:Pediatr Infect Dis J;36(11):1073-1078, 2017 Nov.
[Is] ISSN:1532-0987
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Neonatal mortality remains high in sub-Saharan Africa, and a third of deaths are estimated to result from infection. While coagulase-negative staphylococci (CoNS) are leading neonatal pathogens in resource-rich settings, their role, and the need for early anti-Staphylococcal treatment in empiric antibiotic guidelines, is unknown in sub-Saharan Africa. METHODS: We examined systematic clinical and microbiologic surveillance data from all neonatal admissions to Kilifi County Hospital (1998-2013) to determine associated case fatality and/or prolonged duration of admission associated with CoNS in neonates treated according to standard World Health Organization guidelines. RESULTS: CoNS was isolated from blood culture in 995 of 9552 (10%) neonates. Case fatality among neonates with CoNS isolated from blood did not differ from other neonatal admissions (P = 0.2), and duration of admission was not prolonged [odds ratio (OR) = 0.9 (0.7-1.0), P = 0.040]. Neonates with CoNS were more likely to have convulsions [OR = 1.4 (1.0-1.8), P = 0.031] but less likely to have impaired consciousness or severe indrawing [OR = 0.8 (0.7-0.9), P = 0.025; OR = 0.9 (0.7-1.0), P = 0.065]. CONCLUSIONS: CoNS isolation in blood cultures at admission was not associated with adverse clinical outcomes in neonates treated according to standard World Health Organization guidelines for hospital care in this setting. There is no evidence that first-line antimicrobial treatment guidelines should be altered to increase cover for CoNS infections in neonates in this setting.
[Mh] Termos MeSH primário: Bacteriemia/tratamento farmacológico
Bacteriemia/microbiologia
Doenças do Recém-Nascido/tratamento farmacológico
Doenças do Recém-Nascido/microbiologia
Infecções Estafilocócicas/tratamento farmacológico
Infecções Estafilocócicas/microbiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Antibacterianos/farmacologia
Antibacterianos/uso terapêutico
Bacteriemia/epidemiologia
Bacteriemia/mortalidade
Hemocultura/estatística & dados numéricos
Criança
Pré-Escolar
Coagulase
Pesquisa Empírica
Feminino
Seres Humanos
Lactente
Recém-Nascido
Doenças do Recém-Nascido/epidemiologia
Doenças do Recém-Nascido/mortalidade
Quênia
Masculino
Estudos Retrospectivos
Infecções Estafilocócicas/epidemiologia
Staphylococcus/efeitos dos fármacos
Staphylococcus/enzimologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Coagulase)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170722
[St] Status:MEDLINE
[do] DOI:10.1097/INF.0000000000001699



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