Articles: sepsis.
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Am. J. Respir. Crit. Care Med. · Sep 1996
Multicenter Study Comparative StudyBacteremia and severe sepsis in adults: a multicenter prospective survey in ICUs and wards of 24 hospitals. French Bacteremia-Sepsis Study Group.
To examine the relationships between bacteremia and severe sepsis and assess the influence of characteristics of infection on the risk of severe sepsis and outcome of bacteremia, we analyzed all clinically significant episodes of bacteremia occurring during a 2-mo prospective survey of 85,750 admissions to adult wards and intensive care units (ICUs) of 24 hospitals in France. Incidence rates of bacteremia and of bacteremic severe sepsis were 9.8 (95% CI: 9.2 to 10.5) and 2.6 (95% CI: 2.2 to 2.9), respectively, per 1,000 adult admissions; these rates were eight and 32 times higher in ICUs than in wards, respectively. Independent risk factors for severe sepsis during bacteremia included age (p < 0.001) and an intraabdominal (p < 0.001), pulmonary (p < 0.001), neuromeningeal (p = 0.004), or multiple (p < 0.001) source of bacteremia, but not categories of organisms involved. ⋯ The risk of death after bacteremia increased with age (p < 0.001), a rapidly or ultimately fatal underlying disease (p < 0.001), and the presence of severe sepsis (p < 0.001), shock (p = 0.03), and infection caused by gram-positive organisms other than coagulase-negative staphylococci, relative to other organisms (p < 0.001). A primary urinary tract source of infection was associated with a better prognosis (p = 0.03). We conclude that whereas sources of infection influence both the risk of severe sepsis and the outcome of bacteremia, the microbiologic characteristics of infection influence only the outcome, with gram-negative organisms and coagulase-negative staphylococci posing a lesser risk than other organisms.
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The Journal of pediatrics · Jul 1996
Multicenter StudyLate-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network.
Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 7861 VLBW (401 to 1500 gm) neonates admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991 to 1993). ⋯ Late-onset sepsis is a frequent and important problem among VLBW preterm infants. Successful strategies to decrease late-onset sepsis should decrease VLBW mortality rates, shorten hospital stay, and reduce costs.
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The Journal of pediatrics · Jul 1996
Multicenter StudyEarly-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network.
Early-onset sepsis (occurring within 72 hours of birth) is included in the differential diagnosis of most very low birth weight (VLBW) neonates. To determine the current incidence of early-onset sepsis, risk factors for disease, and the impact of early-onset sepsis on subsequent hospital course, we studied a cohort of 7861 VLBW neonates (401 to 1500 gm) admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991-1993). ⋯ Early-onset sepsis remains an important but uncommon problem among VLBW preterm infants. Improved diagnostic strategies are needed to enable the clinician to distinguish between the infected and the uninfected VLBW neonate with symptoms and to target continued antibiotic therapy to those who are truly infected.
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Critical care medicine · May 1996
Randomized Controlled Trial Multicenter Study Clinical TrialAssessment of the safety and efficacy of the monoclonal anti-tumor necrosis factor antibody-fragment, MAK 195F, in patients with sepsis and septic shock: a multicenter, randomized, placebo-controlled, dose-ranging study.
To investigate the safety, biological effects, and efficacy of the anti-tumor necrosis factor (TNF) antibody fragment, MAK 195F, in a phase II trial in patient with severe sepsis. ⋯ There was no increase in survival from sepsis for the patients receiving anti-TNF treatment in the overall study population. Retrospective stratification of patients by IL-6 concentrations suggests beneficial effects of the drug for patients with baseline circulating IL-6 concentrations of > 1000 pg/mL. This hypothesis requires validation in a larger, blinded, prospective study.
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Intensive care medicine · Nov 1995
Multicenter StudyThe Italian SEPSIS study: preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock.
This prospective, multicenter, epidemiological study was carried out in 99 Italian ICUs, distributed throughout the country, from April 1993 to March 1994. In the study, we applied the new ACCP/SCCM classification system for sepsis (SIRS, sepsis, severe sepsis and septic shock) and determined the prevalence, incidence, evolution and outcome of these categories in critically ill patients. The preliminary analysis of 1101 patients showed that on admission SIRS accounted for about half of the diagnoses (52%) with sepsis, severe sepsis and septic shock accounting for 4.5%, 2.1% and 3% of patients, respectively. ⋯ With respect to evolution, the incidence of septic shock was progressively higher in patients admitted with more severe "sepsis-related" diagnoses, while only a trivial difference in rates of incidence was observed between SIRS patients and those admitted without SIRS or any septic disorder (nil). The breakdown of the various ACCP/SCCM "sepsis-related" diagnoses at any time during the study was: SIRS in 58% of the population, sepsis in 16.3%, severe sepsis in 5.5% and septic shock in 6.1%. It seems reasonable to expect from the final evaluation of our study answers to the questions raised by the ACCP/SCCM Consensus Conference about the correlations between "sepsis-related" diagnosis, severity score, organ dysfunction score and outcome.