| 1. |
- Ljungström, Lars R., et al.
(författare)
-
Respiratory viral infections are underdiagnosed in patients with suspected sepsis
- 2017
-
Ingår i: European Journal of Clinical Microbiology & Infectious Diseases. - : Springer Science and Business Media LLC. - 0934-9723 .- 1435-4373. ; 36:10, s. 1767-1776
-
Tidskriftsartikel (refereegranskat)abstract
- The study aim was to investigate the prevalence and clinical relevance of viral findings by multiplex PCR from the nasopharynx of clinically septic patients during a winter season. During 11 weeks of the influenza epidemic period in January-March 2012, consecutive adult patients suspected to be septic (n = 432) were analyzed with cultures from blood and nasopharynx plus multiplex PCR for respiratory viruses on the nasopharyngeal specimen. The results were compared with those from microbiology analyses ordered as part of standard care. During the winter season, viral respiratory pathogens, mainly influenza A virus, human metapneumovirus, coronavirus, and respiratory syncytial virus were clinically underdiagnosed in 70% of patients positive by the multiplex PCR assay. During the first four weeks of the influenza epidemic, few tests for influenza were ordered by clinicians, indicating low awareness that the epidemic had started. Nasopharyngeal findings of Streptococcus pneumoniae and Haemophilus influenzae by culture correlated to pneumonia diagnosis, and in those patients laboratory signs of viral co-infections were common but rarely suspected by clinicians. The role of respiratory viral infections in patients presenting with a clinical picture of sepsis is underestimated. Specific antiviral treatment might be beneficial in some cases and may reduce spread in a hospital setting. Diagnosing viral infections may promote reduction of unnecessary antibiotic use. It can also be a tool for decisions concerning patient logistics, in order to minimize exposure of susceptible patients and personnel.
|
|
| 2. |
- Pepic, I., et al.
(författare)
-
Early detection of sepsis using artificial intelligence : a scoping review protocol
- 2021
-
Ingår i: Systematic Reviews. - : Springer Nature. - 2046-4053. ; 10:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. To decrease the high case fatality rates and morbidity for sepsis and septic shock, there is a need to increase the accuracy of early detection of suspected sepsis in prehospital and emergency department settings. This may be achieved by developing risk prediction decision support systems based on artificial intelligence.Methods: The overall aim of this scoping review is to summarize the literature on existing methods for early detection of sepsis using artificial intelligence. The review will be performed using the framework formulated by Arksey and O’Malley and further developed by Levac and colleagues. To identify primary studies and reviews that are suitable to answer our research questions, a comprehensive literature collection will be compiled by searching several sources. Constrictions regarding time and language will have to be implemented. Therefore, only studies published between 1 January 1990 and 31 December 2020 will be taken into consideration, and foreign language publications will not be considered, i.e., only papers with full text in English will be included. Databases/web search engines that will be used are PubMed, Web of Science Platform, Scopus, IEEE Xplore, Google Scholar, Cochrane Library, and ACM Digital Library. Furthermore, clinical studies that have completed patient recruitment and reported results found in the database ClinicalTrials.gov will be considered. The term artificial intelligence is viewed broadly, and a wide range of machine learning and mathematical models suitable as base for decision support will be evaluated. Two members of the team will test the framework on a sample of included studies to ensure that the coding framework is suitable and can be consistently applied. Analysis of collected data will provide a descriptive summary and thematic analysis. The reported results will convey knowledge about the state of current research and innovation for using artificial intelligence to detect sepsis in early phases of the medical care chain.Ethics and dissemination: The methodology used here is based on the use of publicly available information and does not need ethical approval. It aims at aiding further research towards digital solutions for disease detection and health innovation. Results will be extracted into a review report for submission to a peer-reviewed scientific journal. Results will be shared with relevant local and national authorities and disseminated in additional appropriate formats such as conferences, lectures, and press releases.
|
|
| 3. |
- Alsiö, Åsa, 1965, et al.
(författare)
-
Impact of obesity on outcome of severe bacterial infections
- 2021
-
Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 16:5
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction Obesity is a rapidly growing global health concern with considerable negative impact on life-time expectancy. It has yet not been clarified if and how obesity impacts outcomes of severe bacterial infections. The aim of this study was to determine how body mass index impacts outcome of severe bacterial infections in a well-defined population-based cohort. Methods This study is based on a cohort of 2196 patients included in a Swedish prospective, population-based, consecutive observational study of the incidence of community-onset severe sepsis and septic shock in adults. All patients with weight and height documented in the medical records on admission were included. Results The case fatality rate (CFR) was negatively correlating with increasing BMI. Outcomes included 28-day CFR (p-value = 0.002), hospital CFR (p-value = 0.039) and 1-year CFR (p-value<0.001). When BMI was applied as continuous variable in a multiple logistic regression together with other possible covariates, we still could discern that BMI was associated with decreasing 28-day CFR (OR = 0.93, 95% CI 0.88-0.98, p-value = 0.009) and 1-year CFR (OR = 0.94, 95% CI 0.91-0.97, p-value<0.001). Conclusion The hypothesis and paradox of obesity being associated with higher survival rates in severe bacterial infections was confirmed in this prospective, population-based observational study.
|
|
| 4. |
|
|
| 5. |
- Ljungström, Lars R.
(författare)
-
Community onset sepsis in Sweden - a population based study
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sepsis and previously “severe sepsis” are concepts used for denoting organ dysfunction caused by acute infection. Organ dysfunction correlates to increased case fatality rates. Sepsis is a common cause of hospitalization. Currently, sepsis is estimated to annually cause 30 million cases and 6 million deaths worldwide. The aims of this study were to explore the epidemiology, characteristics, and outcome of commu-nity onset severe sepsis in the adult population in Skaraborg, western Sweden. During a 9-month period, Sept. 2011 – June 2012, 2,462 consecutive episodes in 2,196 patients admitted to Ska-raborg Hospital and treated with intravenous antibiotics, were evaluated per protocol. The incidence of severe sepsis was 276/100,000. Age >85 years, cardiovascular disease, and diabetes mellitus were risk factors for acquiring severe sepsis. In 429 patients with severe sepsis, the 28-day case fatality rate was 25%, versus 4% in 1,767 with non-severe sepsis or no sepsis. Risk factors for 28-day case fatality were age >85 years, renal-, respiratory-, and cerebral dysfunc-tion. The respiratory tract was the most common focus of infection, seen in 41%. Applying the new sepsis definition launched in 2016 to this study population, the incidence of sepsis was 876/100,000 and the 28-day case fatality rate was 12%. During six weeks of the study, samples from 383 consecutive episodes of suspected sepsis in the emergency department were analyzed by multiplex polymerase chain reaction (PCR) for rapid detection of pathogenic bacteria in blood. We found that the multiplex PCR added some diagnostic value by detecting clinically relevant bacteria not identified by blood culture. During winter 2012, 432 nasopharyngeal samples were examined for respiratory viruses using multiplex PCR. We noted that viral infections or co-infections with bacteria were underestimated in patients with suspected sepsis, especially Influenza A virus, human metapneumovirus and respira-tory syncytial virus. Commonly used biomarkers for sepsis identification, lactate, C-reactive protein, procalcitonin and the neutrophil to lymphocyte count ratio (NLCR), were evaluated in 1,572 episodes of suspected sepsis. The combination of three or four biomarkers could improve the diagnosis of severe sepsis, having a sensitivity of 85%. In patients with proven bacterial infection of any severity, the neutro-phil to lymphocyte count ratio or procalcitonin exhibited equivalent performance. Six defined symptoms of sepsis; fever, dyspnea, acute change of mental status, severe pain, vomit-ing/diarrhea and muscle weakness were evaluated for early detection sepsis patients. Occurrence of >3 of these symptoms significantly predicted the presence or development of severe sepsis or septic shock, especially acute change of mental status and dyspnea.
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
- Ljungström, Lars R., et al.
(författare)
-
Incidences of community onset severe sepsis, Sepsis-3 sepsis, and bacteremia in Sweden - A prospective population-based study.
- 2019
-
Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 14:12
-
Tidskriftsartikel (refereegranskat)abstract
- Sepsis is a major healthcare challenge globally. However, epidemiologic data based on population studies are scarce.During a 9-month prospective, population-based study, the Swedish Sepsis-2 criteria were used to investigate the incidence of community onset severe sepsis in adults aged ≥18 years (N = 2,196; mean age, 69; range, 18-102 years). All the patients who were admitted to the hospital and started on intravenous antibiotic treatment within 48 hours were evaluated. Retrospectively the incidence of sepsis according to Sepsis-3 criteria was calculated on this cohort.The annual incidence of community onset severe sepsis in adults at first admission was 276/100,000 (95% CI, 254-300). The incidence increased more than 40-fold between the youngest and the oldest age group, and was higher for men than for women. The respiratory tract was the most common site of infection (41% of cases). Using the Sepsis-3 criteria, the annual incidence of sepsis was 838/100,000 (95% CI, 798-877), which is 3-fold higher than that of severe sepsis. The main reason for the discrepancy in incidences is the more generous criteria for respiratory dysfunction used in Sepsis-3. Bacteremia was seen in 13% of all the admitted patients, giving an incidence of 203/100,000/year (95%, CI 184-223), which is among the highest incidences reported.We found a high incidence of community onset severe sepsis, albeit lower than that seen in previous Scandinavian studies. The incidence increased markedly with age of the patient. The incidence of community onset sepsis according to the Sepsis-3 definition is the highest reported to date. It is 3-fold higher than that for severe sepsis, due to more generous criteria for respiratory dysfunction. A very high incidence of bacteremia was noted, partly explained by the high frequency of blood cultures.
|
|
| 9. |
- Olander, Agnes, et al.
(författare)
-
Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome
- 2019
-
Ingår i: Bmc Emergency Medicine. - : Springer Science and Business Media LLC. - 1471-227X. ; 19:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients with sepsis are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays. Methods This was a retrospective observational study. The patients' electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed. Results In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care were found to be associated with an adverse outcome. Conclusions The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.
|
|
