The objective of this study is to evaluate the impact of carbapenem-resistant Enterobacteriaceae (CRE) infection on sepsis 30-day mortality. A retrospective cohort of patients >18 years old with sepsis and organ dysfunction or septic shock was conducted. Univariate analysis was done for variables potentially related to 30-day mortality, and the ones with P values of <0.05 were included in a backward stepwise hierarchic Cox regression model. Variables that remained with P values of <0.05 were retained in the model. A total of 1,190 sepsis episodes were analyzed. Gram-negative bacterial infections occurred in 391 (68.5%) of 571 patients with positive cultures, of which 69 (17.7%) were caused by a CRE organism. Patients with CRE infections had significantly higher 30-day mortality: 63.8% versus 33.4% (P < 0.01). CRE infection was also associated with a lower rate of appropriate empirical therapy (P < 0.01) and with the presence of septic shock (P < 0.01). In the hierarchic multivariate model, CRE remained significant when controlling for demographic variables, comorbidities, and infection site but lost significance when controlling for septic shock and appropriate empirical therapy. Older age (P < 0.01), HIV-positive status (P < 0.01), cirrhosis (P < 0.01), septic shock (P < 0.01), higher quick sepsis-related organ failure assessment (quick-SOFA) (P < 0.01), and appropriate empirical therapy (P = 0.01) remained in the final model. CRE infections were associated with higher crude mortality rates. A lower rate of appropriate empirical therapy and late diagnosis were more frequent in this group, and improvement of stewardship programs is needed. IMPORTANCE The importance of this work relies on exploring the impact of multidrug-resistant bacterial infections such as those with carbapenem-resistant Enterobacteriaceae (CRE) on sepsis mortality. These infections are growing at alarming rates worldwide and are now among the most frequent and difficult-to-treat bacteria due to the very few options for susceptible antimicrobials available. This study examined 1,190 sepsis episodes, and the main findings were as follows: (i) the prevalence of CRE infections significantly increased over time, (ii) CRE infection was associated with higher 30-day mortality than that of patients with other infections (63.8% versus 33.4%), and (iii) the effect of CRE on mortality was probably influenced by the fact that those patients received lower rates of empirical therapy with active antibiotics and were also diagnosed in more advanced stages of sepsis (septic shock). Those findings point to the need for rapid diagnostic methods to identify these bacteria and the need to adjust therapeutic guidelines to this worrisome epidemiological scenario.

A relatively high value for Safety Climate was evaluated within the FME network of Italian dialysis clinics. Management showed higher Safety Climate scores than frontline staff. Fostering communication and implementation of training programs are considered valid tools to improve safety.

Objective To assess the relationship between time to focus clearance and hospital mortality in patients with sepsis and septic shock. Methods This was an observational, single-center study with a retrospective analysis of the time to clearance of abdominal septic focus. Patients were classified according to the time to focus clearance into an early (≤ 12 hours) or delayed (> 12 hours) group. Results A total of 135 patients were evaluated. There was no association between time to focus clearance and hospital mortality (≤ 12 hours versus > 12 hours): 52.3% versus 52.9%, with p = 0.137. Conclusion There was no difference in hospital mortality among patients with sepsis or septic shock who had an infectious focus evacuated before or after 12 hours after the diagnosis of sepsis.

Aims and Objective To identify clinical indicators of septic shock in critical care patients. Background The identification of clinical indicators of septic shock is relevant to avoid clinical deterioration of patients with sepsis. However, the recognition of these factors, especially by the nursing team, is still deficient and reinforces the need for studies that investigate the subject in different realities such as that of Brazil. Design The study had a cross‐sectional design based on STROBE guidelines (see Appendix S1). Methods A sample of 392 patients with sepsis or septic shock was admitted to the Intensive Care Unit of a Brazilian university hospital. Data were collected from medical records of the Intrahospital Sepsis Combat Program referring to patients admitted between January 2018–January 2019. Sociodemographic and clinical data were collected, as well as information on the time from diagnosis of sepsis or septic shock to initiation of antibiotic therapy, length of stay, and discharge or death outcomes. Data were statically analysed. Results Out of the total sample, 190 (49%) patients were admitted with septic shock. Clinical indicators of septic shock were hypotension, mechanical ventilation, lactate levels between 2.0–3.9 or >4, hypothermia <36°C, radiotherapy‐associated chemotherapy, Sequential Organ Failure Assessment score >3 and admittance through the emergency unit. Among patients with septic shock, 85 (44.7%) were discharged and 105 (55.2%) died in the intensive care unit. Conclusions Patients with septic shock presented hyperlactataemia and greater organic dysfunction as clinical indicators when compared to patients with sepsis. Mechanical ventilation, chemotherapy and radiotherapy increased the risk of developing septic shock. Relevance to clinical practice Our results can support the nursing team by providing the main clinical indicators of septic shock and contributing to the interprofessional team in the prevention of septic shock.

Introdução: Este arquivo busca verificar a incidência de lesões por pressão (LP) e eventos adversos graves em pacientes submetidos à posição prona.

Resumo OBJETIVO Identificar o conhecimento da população referente aos termos “sepse” e “infarto agudo do miocárdio” (IAM). MÉTODO Estudo transversal, quantitativo. Coleta de dados realizada com aplicação de um questionário, para dois grupamentos de participantes distintos: frequentadores de parques selecionados de Porto Alegre/RS e acompanhantes de pacientes internados em um hospital universitário de Porto Alegre/RS. A análise dos resultados foi realizada pela estatística descritiva e inferencial. RESULTADOS A amostra constitui-se de 1986 entrevistados, 1455 de parques e 531 acompanhantes de pacientes internados no hospital. Em relação ao conhecimento de sepse, apenas 19,1% dos entrevistados já tinham ouvido falar sobre o tema, já, em comparação ao conhecimento do IAM, 98,7% souberam responder sobre o termo. CONCLUSÕES Evidenciou-se que o déficit de conhecimento da população sobre o termo “sepse” está diretamente relacionado com o nível social dos entrevistados, demonstrando um déficit no acesso à informação no cuidado em saúde.

Objetivo: identificar a associação dos aspectos demográficos, clínicos e do manejo terapêutico no desfecho dos pacientes diagnosticados com sepse em uma emergência hospitalar. Método: documental retrospectivo, 312 prontuários de pacientes sépticos, realizado análise descritiva, comparações de dados categóricos utilizaram-se os Testes de Qui quadrado ou Exato de Fisher, com correção de Monte Carlo. Resultados: idade média 65 (±17,66) anos, 51,3% eram mulheres, 52,6% hipertensos, 28,5% diabéticos, 27,2% cardiopatas, 74% diagnosticados com sepse 52,3% foco infeccioso pulmonar. Existe associação entre as variáveis demográficas e os desfechos (p0,05). Histórico de acidente vascular encefálico, cirrose, cardiopatia e choque séptico associam-se ao óbito (p0,05). Sinais de alerta e disfunções orgânicas avaliadas associam-se ao desfecho. Foco infeccioso (p=1) e taquicardia (p=0,823) não tem associação com desfecho nem com gravidade da sepse (p=0,120). Conclusão: há associação entre o perfil demográfico do paciente, comorbidades, disfunções orgânicas e manejo terapêutico, com a gravidade da sepse e o desfecho.

Permanent Health Education (EPS) is based on the assumption of meaningful learning, by bringing the world of work closer to the world of education, where the learning environment is the very space of health services. Objective: The present study reports the experience of an interventionist action through the construction of an assistance protocol based on the assumptions of EPS mediated by conversation wheels, in a highly complex university hospital service in the state of Rio Grande do Sul. Results: During the interventions, the conversation wheels allowed horizontal conversation. The assistance protocol was produced collectively, alliances were made, discoveries of the weaknesses and potential of the service, we managed to create some ways in a collective way to facilitate assistance. Conclusion: We understand that EPS and its proposal for conversation circles allows the elaboration of many work actions, processes, flows and protocols and mainly, it allows us to discuss scientific evidence in an informal and collective way.