Diagnostic Stewardship for Sepsis: The Need for Risk Stratification to Triage Patients for Fast Microbiology Workflows

Mangioni, Davide; Viaggi, Bruno; Giani, Tommaso; Arena, Fabio; D’Arienzo, Sara; Forni, Silvia; Tulli, G; Rossolini, Gian María

doi:10.2217/fmb-2018-0329

Cited by 25 publications

(16 citation statements)

References 22 publications

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“…Regarding multidrug-resistant organisms, Mangioni and others [25] stressed the importance of triage in sepsis patients. Capsoni et al [26] described that ESBLs were life-threatening in sepsis patients.…”

Section: Discussionmentioning

confidence: 99%

Mortality related to drug-resistant organisms in surgical sepsis-3: an 8-year time trend study using sequential organ failure assessment scores

Yoshida

Tamura

Otani

et al. 2020

Eur J Clin Microbiol Infect Dis

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The difference in sequential organ failure assessment (SOFA) scores from the baseline to sepsis is a known predictor of sepsis-3 outcome, but the prognostic value of drug-resistant organisms for mortality is unexplained. We employed sepsis stewardship and herein report an observational study. Study subjects were patients admitted to the Departments of Surgery/Chest Surgery from 2011 through 2018 with a diagnosis of sepsis and a SOFA score of 2 or more. Our sepsis stewardship methods included antimicrobial and diagnostic stewardship and infection control. We determined the primary endpoint as in-hospital death and the secondary endpoint as the annual trend of the risk-adjusted mortality ratio (RAMR). For mortality, we performed logistic regression analysis based on SOFA score, age, sex, comorbid disease, and the presence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase inhibitor–producing bacteria. In a total of 457 patients, two factors were significant predictors for fatality, i.e., SOFA score of 9 or more with an odds ratio (OR) 4.921 and 95% confidence interval [95% CI] 1.968–12.302 (P = 0.001) and presence of MRSA with an OR 1.83 and 95% CI 1.003–3.338 (P = 0.049). RAMR showed a decrease during the study years (P < 0.05). Early detection of MRSA may help patients survive surgical sepsis-3. Thus, MRSA-oriented diagnosis may play a role in expediting treatment with anti-MRSA antimicrobials.

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Section: Discussionmentioning

confidence: 99%

Mortality related to drug-resistant organisms in surgical sepsis-3: an 8-year time trend study using sequential organ failure assessment scores

Yoshida

Tamura

Otani

et al. 2020

Eur J Clin Microbiol Infect Dis

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“…These techniques may effectively improve treatment optimization in the ICU, reducing the percentage of empirically treated infections [ 36 ], anticipating the timing of de-escalation treatment, and improving critically ills patients’ outcomes [ 41 ].…”

Section: Early Microbiological Diagnosis In Bsimentioning

confidence: 99%

Blood Stream Infections from MDR Bacteria

Franco

Alfieri

Pace

et al. 2021

Life

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Background: Bloodstream infections (BSIs) constitute a growing public health concern, are among the most severe nosocomial pathologies, and are considered a worldwide cause of unfaithful outcomes, increasing treatment costs and diagnostic uncertainties. BSIs are one of the most frequent lethal conditions that are managed in intensive care units (ICUs). In the case of septic shock, immune deficiency, and delayed treatment, even with adequate antimicrobial therapy and/or source control, the outcomes are often unfavorable. Methods: this review article summarizes the epidemiological and microbiological characteristics of BSIs with a particular focus on ICU acquired BSIs (ICU-BSIs), which are usually caused by multidrug-resistant (MDR) pathogens. For this reason, their antimicrobial resistance patterns and therapeutic options have also been compiled. Results: ICU-acquired BSIs prevail in 5–7% of ICU patients. Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosae are the pathogens most often responsible for MDR infections. MDR Enterobacteriaceae have seen their prevalence increase from 6.2% (1997–2000) to 15.8% (2013–2016) in recent years. Conclusions: Considering that prevention and treatment of sepsis is nowadays considered a global health priority by the World Health Organization, it is our obligation to invest more resources into solving or reducing the spread of these unfaithful infections. It is relevant to identify patients with risk factors that make them more susceptible to BSIs, to guarantee earlier molecular or microbiological diagnoses, and more rapidly appropriate treatment by using de-escalation strategies where possible.

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“…It is necessary for cross-disciplinary borders and approach infection management in an integrated, multidisciplinary manner. Microbiology laboratories and clinical microbiologists can provide significant contributions to ASPs, including the dissemination of antimicrobial susceptibility reports and enhanced culture by means of fast microbiology [49] and diagnostic stewardship [50]. Participating in ASPs is mainly seen as a task for clinical microbiologists and/or infectious disease specialists, together with (hospital) pharmacists.…”

Section: Antimicrobial Stewardshipmentioning

confidence: 99%

Infection Prevention and Control

Costa

Privitera

Tulli³

et al. 2020

Textbook of Patient Safety and Clinical Risk Management

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Healthcare-associated infections (HAI) are adverse events exposing patients to a potentially avoidable risk of morbidity and mortality. Antimicrobial resistance (AMR) is increasingly contributing to the burden of HAIs and emerging as of the most alarming challenges for public health worldwide. Practically, harm mitigation and risk containment demand cross-sectional initiatives incorporate both approaches to infection prevention and control and methodologies from clinical risk management.

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Diagnostic Stewardship for Sepsis: The Need for Risk Stratification to Triage Patients for Fast Microbiology Workflows

Cited by 25 publications

References 22 publications

Mortality related to drug-resistant organisms in surgical sepsis-3: an 8-year time trend study using sequential organ failure assessment scores

Mortality related to drug-resistant organisms in surgical sepsis-3: an 8-year time trend study using sequential organ failure assessment scores

Blood Stream Infections from MDR Bacteria

Infection Prevention and Control

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