Suchergebnisse

Background. There is a clear need for a better assessment of independent risk factors for in-hospital mortality, intensive care unit admission, and bacteremia in patients presenting with suspected sepsis at the emergency department. Methods. A prospective observational cohort study including 1690 patients was performed. Two multivariable logistic regression models were used to identify independent risk factors. Results. Sequential organ failure assessment (SOFA) score of >= 2 and serum lactate of >= 2mmol/L were associated with all outcomes. Other independent risk factors were individual SOFA variables and systemic inflammatory response syndrome variables but varied per outcome. Mean arterial pressure <70 mmHg negatively impacted all outcomes. Conclusions. These readily available measurements can help with early risk stratification and prediction of prognosis. ; This work was funded by the European Union's Horizon 2020 Research and Innovation Program under Grant Agreement 634137 and is part of the Fast Assay for Pathogen Identification and Characterisation project. Acknowledgments We thank Dr. Liesbeth Bruckers (Interuniversity institute for Biostatistics and Statistical Bioinformatics, Hasselt University) for providing statistical advice and reviewing the statistical methodology of this study. This study is part of the Limburg Clinical Research Center UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Financial support. This work was funded by the European Union's Horizon 2020 Research and Innovation Program under Grant Agreement 634137 and is part of the Fast Assay for Pathogen Identification and Characterisation project ; Gyssens, IC (corresponding author), Radboud Univ Nijmegen, Dept Internal Med, Med Ctr, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands ; Radboud Univ Nijmegen, Radboud Ctr Infect Dis, Med Ctr, Nijmegen, Netherlands. inge.gyssens@radboudumc.nl

Objectives: To perform an audit of empirical antibiotic therapy (EAT) of sepsis at the emergency de-partment and to analyse the impact of an antimicrobial stewardship (AMS) programme on process and patient outcomes. Patients and Methods: A prospective, single-centre cohort study including patients with sequential or-gan failure assessment (SOFA) score >= 2 from whom blood cultures were taken was conducted between February 2019 and April 2020. EAT was assessed using eight applicable inpatient quality indicators (IQIs) for responsible antibiotic use. Patient outcomes were hospital length-of-stay (LOS), ICU admission, ICU LOS, and in-hospital mortality. Results: The audit included 900 sepsis episodes in 803 patients. Full guideline adherence regarding choice and dosing was 45.9%; adherence regarding choice alone was 68.1%. EAT was active against all likely pathogens in 665/787 (84.5%) episodes. In the guideline non-adherent group, choice of EAT was inappro-priate in 122/251 (48.6%) episodes. Changes within 3 days occurred in 335/900 (37.2%) episodes. Treating physicians changed administration route more often, whereas microbiological/infectious disease (ID)/AMS consultant advice resulted in de-escalation and discontinuation ( P = 0.0 0 0). Guideline-adherent choice was associated with significantly shorter LOS (6 (4-11) vs. 8 (5-15) days). Full adherence was associated with significantly lower mortality (23 (6.4%) vs. 48 (11.3%)) and shorter LOS (6 (4-10) vs. 8 (5-14) days). Conclusion: Five global quality indicators of EAT were measurable in routine clinical practice. Full ad-herence to guidelines was only moderate. Adherence to guidelines was associated with better patient outcomes. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ) ; European Union European Commission [GA 634137]; foundation Limburg Sterk Merk (LSM); Hasselt University; Jessa Hospital; Ziekenhuis Oost-Limburg

Background Sepsis is a life-threatening organ dysfunction. A fast diagnosis is crucial for patient management. Proteins that are synthesized during the inflammatory response can be used as biomarkers, helping in a rapid clinical assessment or an early diagnosis of infection. The aim of this study was to identify biomarkers of inflammation for the diagnosis and prognosis of infection in patients with suspected sepsis. Methods In total 406 episodes were included in a prospective cohort study. Plasma was collected from all patients with suspected sepsis, for whom blood cultures were drawn, in the emergency department (ED), the department of infectious diseases, or the haemodialysis unit on the first day of a new episode. Samples were analysed using a 92-plex proteomic panel based on a proximity extension assay with oligonucleotide-labelled antibody probe pairs (OLink, Uppsala, Sweden). Supervised and unsupervised differential expression analyses and pathway enrichment analyses were performed to search for inflammatory proteins that were different between patients with viral or bacterial sepsis and between patients with worse or less severe outcome. Results Supervised differential expression analysis revealed 21 proteins that were significantly lower in circulation of patients with viral infections compared to patients with bacterial infections. More strongly, higher expression levels were observed for 38 proteins in patients with high SOFA scores (> 4), and for 21 proteins in patients with worse outcome. These proteins are mostly involved in pathways known to be activated early in the inflammatory response. Unsupervised, hierarchical clustering confirmed that inflammatory response was more strongly related to disease severity than to aetiology. Conclusion Several differentially expressed inflammatory proteins were identified that could be used as biomarkers for sepsis. These proteins are mostly related to disease severity. Within the setting of an emergency department, they could be used for outcome prediction, patient monitoring, and directing diagnostics. Trail registration number: clinicaltrial.gov identifier NCT03841162. ; This study is part of the FAPIC project and has received funding from the European Union's Horizon 2020 research and innovation program under GA 634137. The human biological material used in this publication was stored in and released from the University Biobank Limburg (UBiLim) [16]. This study is part of the Limburg Clinical Research Center (LCRC) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk (LSM), Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. This research has been presented as an e-poster during the European Conference of Clinical Microbiology and Infectious Diseases (ECCMID), July 2021.

Trichinellosis is a rare parasitic zoonosis caused by Trichinella following ingestion of raw or undercooked meat containing Trichinella larvae. In the past five years, there has been a sharp decrease in human trichinellosis incidence rates in the European Union due to better practices in rearing domestic animals and control measures in slaughterhouses. In November 2014, a large outbreak of trichinellosis occurred in Belgium, related to the consumption of imported wild boar meat. After a swift local public health response, 16 cases were identified and diagnosed with trichinellosis. Of the 16 cases, six were female. The diagnosis was confirmed by serology or the presence of larvae in the patients' muscle biopsies by histology and/or PCR. The ensuing investigation traced the wild boar meat back to Spain. Several batches of imported wild boar meat were recalled but tested negative. The public health investigation allowed us to identify clustered undiagnosed cases. Early warning alerts and a coordinated response remain indispensable at a European level.

Trichinellosis is a rare parasitic zoonosis caused by Trichinella following ingestion of raw or undercooked meat containing Trichinella larvae. In the past five years, there has been a sharp decrease in human trichinellosis incidence rates in the European Union due to better practices in rearing domestic animals and control measures in slaughterhouses. In November 2014, a large outbreak of trichinellosis occurred in Belgium, related to the consumption of imported wild boar meat. After a swift local public health response, 16 cases were identified and diagnosed with trichinellosis. Of the 16 cases, six were female. The diagnosis was confirmed by serology or the presence of larvae in the patients' muscle biopsies by histology and/or PCR. The ensuing investigation traced the wild boar meat back to Spain. Several batches of imported wild boar meat were recalled but tested negative. The public health investigation allowed us to identify clustered undiagnosed cases. Early warning alerts and a coordinated response remain indispensable at a European level.