| 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. |
- 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.
|
|
