Point of care technologies for sepsis diagnosis and treatment

Oeschger, Taylor; McCloskey, Duncan; Kopparthy, Varun; Singh, Ankur; Erickson, David

doi:10.1039/c8lc01102h

Cited by 56 publications

(45 citation statements)

References 106 publications

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“…Hence, establishing a consistent definition of sepsis risk may be of some importance for effective antimicrobial stewardship. Assisting practitioner identification of patients at risk of sepsis remains a challenge across veterinary and medical care (35). In the absence of a specific diagnosis, clinical scoring has previously been successfully utilised to uniformly measure clinical severity and response to therapy (9, 10, 22).…”

Section: Discussionmentioning

confidence: 99%

Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices

et al. 2019

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Canine acute diarrhoea is frequently observed in first opinion practice, though little is known about commonly used diagnostic or therapeutic management plans, including use of antimicrobials. This retrospective observational study utilised electronic health records augmented with practitioner-completed questionnaires from 3,189 cases (3,159 dogs) collected from 179 volunteer veterinary practices between April 2014 and January 2017. We used multivariable analysis to explore factors potentially associated with pharmaceutical agent prescription, and resolution of clinical signs by 10 days post-initial presentation. Use of bacteriological and/or parasitological diagnostic tests were uncommon (3.2% of cases, 95% confidence interval, CI, 2.4–4.0), though systemic antimicrobials were the most commonly prescribed pharmaceutical agents (49.7% of cases, 95% CI 46.1–53.2). Such prescription was associated with haemorrhagic diarrhoea (odds ratio, OR, 4.1; 95% CI 3.4–5.0), body temperature in excess of 39.0°C, or moderate/severe cases (OR 1.3, 95% CI 1.1–1.7). Gastrointestinal agents (e.g., antacids) were prescribed to 37.7% of cases (95% CI 35.4–39.9), and were most frequently prescribed to vomiting dogs regardless of presence (OR 46.4, 95% CI 19.4–110.8) or absence of blood (OR 17.1, 95% CI 13.4–21.9). Endoparasiticides/endectocides were prescribed to 7.8% of cases (95% CI 6.8–9.0), such prescription being less frequent for moderate/severe cases (OR 0.5, 95% CI 0.4–0.7), though more frequent when weight loss was recorded (OR 3.4, 95% CI 1.3–9.0). Gastrointestinal nutraceuticals (e.g., probiotics) were dispensed to 60.8% of cases (95% CI 57.1–64.6), these cases less frequently presenting with moderate/severe clinical signs (OR 0.6, 95% CI 0.5–0.8). Nearly a quarter of cases were judged lost to follow-up ( n =754). Insured (OR 0.7, 95% CI 0.5–0.9); neutered (OR 0.4, 95% CI 0.3–0.5), or vaccinated dogs (OR 0.3, 95% CI 0.3–0.4) were less commonly lost to follow-up. Of remaining dogs, clinical signs were deemed resolved in 95.4% of cases (95% CI 94.6–96.2). Provision of dietary modification advice and gastrointestinal nutraceuticals alone were positively associated with resolution (OR 2.8, 95% CI 1.3–6.1); no such associations were found for pharmaceutical agents, including antimicrobials. Hence, this study supports the view that antimicrobials are largely unnecessary for acute diarrhoea cases; this being of particular importance when considering the global threat posed by antimicrobial resistance.

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Section: Discussionmentioning

confidence: 99%

Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices

et al. 2019

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“…Furthermore, the use of point-of-care testing for sepsis was not limited to pathogen detection, but was also used for blood plasma protein quantification (e.g. C-reactive protein and procalcitonin) and leukocyte monitoring (through antibody capture or intrinsic property characterisation) [111]. Clinical characteristics, blood biomarkers including C-reactive protein and procalcitonin, were not fully demonstrated to clearly discern viral and bacterial infection among patients with pneumonia, while the discrimination ability among patients with sepsis needs to be further demonstrated [112].…”

Section: Diagnosis Of Respiratory Viral Sepsismentioning

confidence: 99%

Respiratory viral sepsis: epidemiology, pathophysiology, diagnosis and treatment

Zhou

Wang

et al. 2020

Eur Respir Rev

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According to the Third International Consensus Definition for Sepsis and Septic Shock, sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Epidemiological data about sepsis from the 2017 Global Burden of Diseases, Injuries and Risk Factor Study showed that the global burden of sepsis was greater than previously estimated. Bacteria have been shown to be the predominant pathogen of sepsis among patients with pathogens detected, while sepsis caused by viruses is underdiagnosed worldwide. The coronavirus disease that emerged in 2019 in China and now in many other countries has brought viral sepsis back into the vision of physicians and researchers worldwide. Although the current understanding of the pathophysiology of sepsis has improved, the differences between viral and bacterial sepsis at the level of pathophysiology are not well understood. Diagnosis methods that can broadly differentiate between bacterial and viral sepsis at the initial stage after the development of sepsis are limited. New treatments that can be applied at clinics for sepsis are scarce and this situation is not consistent with the growing understanding of pathophysiology. This review aims to give a brief summary of current knowledge of the epidemiology, pathophysiology, diagnosis and treatment of viral sepsis.

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“…Even nowadays, clear diagnosis of sepsis is complicated by highly variable symptoms and non-specific criteria, and it is still difficult to be formulated [4]. For this purpose, a specific algorithm-Sequential (sepsis-related) Organ Failure Assessment (SOFA)-has been defined, with the aim of providing a score capable of identifying sepsis among patients who are critically ill with suspected infection [4,6,7]. Notwithstanding this, sepsis is still often diagnosed and treated too late, and an early diagnosis is necessary for the selection of the optimal treatment for this highly heterogeneous group of sepsis patients.…”

Section: Introductionmentioning

confidence: 99%

“…In the framework of this complicated clinical picture, the on-time and simultaneous measurement of those compounds circulating in blood that are overproduced in sepsis-the so-called sepsis biomarkers-can be of extreme help to physicians. Even if single-analyte systems, which have the advantage of simpler procedure and easier measurement setup, have been developed, their application remains challenging due to the lack of specificity of a single biomarker for sepsis [7]. Therefore, the diagnostic can potentiality be increased by the identification of a suitable panel of different biomarkers.…”

Section: Introductionmentioning

confidence: 99%

Towards an Integrated System as Point-of-Care Device for the Optical Detection of Sepsis Biomarkers

et al. 2020

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Severe infection and sepsis are a common, expensive, and frequently fatal conditions in critically ill patients. The sepsis diagnosis is not trivial, since it is an extremely complex chain of events involving inflammatory and anti-inflammatory processes, cellular reactions, and circulatory disorders. For these reasons, delay in diagnosis and initiation of drug treatments have shown to be crucial for this pathology. Moreover, a multitude of biomarkers has been proposed, many more than for other pathologies. In order to select optimal treatments for the highly heterogeneous group of sepsis patients and to reduce costs, novel multiplexed tools that better characterize the patient and his or her specific immune response are highly desired. In order to achieve the fundament of drastically improved multi-analyte detection and to attain low limits of detection in diagnostics, the area of point-of-care testing (POCT) technology is developing quickly, leading to the production of instruments, the reliability of which is continuously increasing. For this purpose, a selection of two biomarkers—C-reactive protein (CRP) and neopterin (NP)—was studied in this paper and a fluorescence-based integrated optical system, suitable for future POCT applications, was implemented that is capable of performing the simultaneous measurement of the two different biomarkers in replicate. A limit of detection of 10 and 2.1 µg L−1 was achieved for CRP and NP spiked in commercially available human serum, respectively. Moreover, measurements on both biomarkers were also performed on serum samples collected from septic patients.

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Point of care technologies for sepsis diagnosis and treatment

Abstract: Development of new point of care tools for sepsis has the potential to improve diagnostic speed and accuracy, leading to prompt administration of appropriate therapeutics, thereby reducing healthcare costs and improving patient outcomes.

Cited by 56 publications

References 106 publications

Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices

Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices

Respiratory viral sepsis: epidemiology, pathophysiology, diagnosis and treatment

Towards an Integrated System as Point-of-Care Device for the Optical Detection of Sepsis Biomarkers

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