Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

Reinhart, Konrad; Brunkhorst, Frank M.; Bone, Hans-Georg; Bardutzky, Juergen; Dempfle, Carl-Erik; Forst, H.; Gastmeier, Petra; Gerlach, Herwig; Gründling, Matthias; John, Siji; Kern, Winfried V.; Kreymann, G.; Krüger, Wolfgang; Kujath, P.; Marggraf, G.; Martin, Janet; Mayer, Konstantin; Meier‐Hellmann, Andreas; Oppert, Michael; Putensen, Christian; Quintel, Michael; Ragaller, M.; Rossaint, Rolf; Seifert, Harald; Spies, Christian; Stüber, Frank; Weiler, Norbert; Weimann, Andreas; Werdan, Karl; Welte, Tobias

doi:10.3205/000103

Cited by 54 publications

(9 citation statements)

References 375 publications

(523 reference statements)

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“…Patients were eligible for study enrollment if sepsis onset and start of piperacillin/tazobactam therapy occurred no more than 24 h prior to randomization. Sepsis was defined according to the criteria valid at the time of initiation of the study (Sepsis-2 criteria) [ 19 ]. The trial protocol has been published previously [ 20 ], and the trial is registered at the German Clinical Trials Register (DRKS00011159; 10th October 2016).…”

Section: Methodsmentioning

confidence: 99%

Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial

et al. 2022

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Purpose: Insufficient antimicrobial exposure is associated with worse outcomes in sepsis. We evaluated whether therapeutic drug monitoring (TDM)-guided antibiotic therapy improves outcomes.Methods: Randomized, multicenter, controlled trial from January 2017 to December 2019. Adult patients (n = 254) with sepsis or septic shock were randomly assigned 1:1 to receive continuous infusion of piperacillin/tazobactam with dosing guided by daily TDM of piperacillin or continuous infusion with a fixed dose (13.5 g/24 h if eGFR ≥ 20 mL/min). Target plasma concentration was four times the minimal inhibitory concentration (range ± 20%) of the underlying pathogen, respectively, of Pseudomonas aeruginosa in empiric situation. Primary outcome was the mean of daily total Sequential Organ Failure Assessment (SOFA) score up to day 10.Results: Among 249 evaluable patients (66.3 ± 13.7 years; female, 30.9%), there was no significant difference in mean SOFA score between patients with TDM (7.9 points; 95% CI 7.1-8.7) and without TDM (8.2 points; 95% CI 7.5-9.0) (p = 0.39). Patients with TDM-guided therapy showed a lower 28-day mortality (21.6% vs. 25.8%, RR 0.8, 95% CI 0.5-1.3, p = 0.44) and a higher rate of clinical (OR 1.9; 95% CI 0.5-6.2, p = 0.30) and microbiological cure (OR 2.4; 95% CI 0.7-7.4, p = 0.12), but these differences did not reach statistical significance. Attainment of target concentration was more common in patients with TDM (37.3% vs. 14.6%, OR 4.5, CI 95%, 2.9-6.9, p < 0.001).

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Section: Methodsmentioning

confidence: 99%

Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial

et al. 2022

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“…A longer duration of treatment has shown worsened outcomes. 15 The timely administration of antibiotics has been one of the main cornerstones of sepsis treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, Paramedics received additional training to recognize sepsis using screening tools and blood cultures and provide IV antibiotics at the most needed time, as the primary focus of sepsis treatment is to emphasize the immediate delivery of IV antibiotics and oxygen therapy. 15 , 17 …”

Section: Discussionmentioning

confidence: 99%

Prehospital administration of broad‐spectrum antibiotics for sepsis patients: A systematic review and meta‐analysis

Varney

Motawea

Kandil

et al. 2022

Health Science Reports

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Background and Aims Some studies have suggested that earlier initiation of antibiotics has shown positive outcomes in sepsis patients. We aimed to do a systematic review and meta‐analysis to evaluate the effect of prehospital administration of antibiotics on 28 days mortality and length of stay in hospital and intensive care unit for sepsis patients. Methods We formulated a search strategy and used it on search databases PubMed, Scopus, Web of Science, and Embase. We then screened the records for eligibility and included controlled studies, either clinical trials or cohort studies reporting prehospital antibiotic administration for sepsis patients. We excluded duplicates, books, conferences' abstracts, case reports, editorials, letters, author responses, not English studies, and studies with nonavailable full text. Animal and lab studies were also excluded. Results The total number of studies identified is 1811, 19 were eligible for systematic review and 4 for meta‐analysis (three cohort and one clinical trial). The total number of sepsis patients in the four included studies in the 28 days mortality outcome was 3523 (1779 took prehospital antibiotics and 1744 did not take prehospital antibiotics). Of 1779 who took the antibiotics, 190 died, and of 1744 who did not take antibiotics, 292 died (95% confidence interval 0.68–0.97, p = 0.02). Conclusion This meta‐analysis reveals that receiving prehospital antibiotics can significantly lower mortality in sepsis patients compared to patients who do not receive prehospital antibiotics. However, more clinical trials and multicenter prospective studies with high sample sizes are needed to get strong evidence supporting our findings.

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“…The full version of inclusion and exclusion criteria is given in the Supporting Information. Postoperative sepsis was diagnosed according to the European diagnostic criteria of sepsis . Finally, 41 patients were qualified, including 20 postoperative sepsis patients (sepsis group, S ) and 21 patients without clinical signs of postoperative infections (nonsepsis group, C ).…”

Section: Experimental Methodsmentioning

confidence: 99%

“…Briefly, the ProteoMiner column was prewashed with 200 μL of phosphate-buffered saline (PBS) (10 mM NaH 2 PO 4 , 150 mM NaCl, pH = 7.4), loaded with 200 μL of the plasma sample and vortexed for 2 h. After washing the column twice using 200 μL of PBS and 200 μL of ddH 2 O, the protein was eluted with 180 μL of 8 M urea with 2% CHAPS. The eluted proteins were quantified by the bicinchoninic acid protein assay (Pierce) and processed using a modified in-solution digestion protocol . Briefly, 200 μg of the protein was reduced using 5 mM dithiothreitol (DTT) for 30 min at room temperature and alkylated using 15 mM iodoacetamide (IAA) in the dark for the same time.…”

Section: Experimental Methodsmentioning

confidence: 99%

Proteomic Signature of Urosepsis: From Discovery in a Rabbit Model to Validation in Humans

Zheng

Sun

et al. 2021

J. Proteome Res.

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Urosepsis after upper urinary tract endoscopic lithotripsy (UUTEL) may cause uroseptic shock with high mortality, which can be prevented if early diagnosis and timely intervention are implemented with help of a diagnostic protein panel. The plasma of five rabbits of uroseptic shock and five controls was subjected to exploratory proteomics to search biomarker candidates from proteomic profiles related to uroseptic shock. Then, plasma from 21 nonsepsis and 20 urosepsis patients according to European diagnostic criteria of sepsis was enrolled in the validation study via targeted proteomics. Changes in a massive number of plasma proteins, mainly enriched in immune regulation, coagulation, structural repair, and transport activity, were observed in the rabbit model of septic shock. Fifteen proteins were identified as differential expression proteins between sepsis and nonsepsis patients. A diagnostic model composed of three proteins lipopolysaccharide-binding protein (LBP), clusterin (CLU), and vascular cell adhesion protein 1 (VCAM1) was developed for the early detection (2 hours postoperatively) of urosepsis after UUTEL, with a high area under the receiver operating characteristic (ROC) curve of 0.921. In conclusion, changes in the proteomic profile may reflect the underlying biological mechanisms during the development of urosepsis and produce diagnostic biomarkers for the early detection of urosepsis after UUTEL.

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Cited by 54 publications

References 375 publications

Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial

Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial

Prehospital administration of broad‐spectrum antibiotics for sepsis patients: A systematic review and meta‐analysis

Proteomic Signature of Urosepsis: From Discovery in a Rabbit Model to Validation in Humans

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