The epidemiology of septic shock in French intensive care units: the prospective multicenter cohort EPISS study

Quenot, Jean‐Pierre; Binquet, Christine; Kara, F; Martinet, Olivier; Ganster, Frédérique; Navellou, Jean-Christophe; Castelain, Vincent; Barraud, Damien; Cousson, J.; Louis, Guillaume; Perez, Pierre; Kuteifan, Khaldoun; Noirot, A; Badié, Julio; Mezher, Chaouki; Lessire, H.; Pavon, Arnaud

doi:10.1186/cc12598

Cited by 169 publications

(114 citation statements)

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“…The growing interest in these new applications of PMX-DHP was firstly experienced in Japan. In this population the mortality rate was similar to that reported for septic shock in recent epidemiologic studies [9,10]. However, there were some differences in the abdominal group that may have influenced the results: the time of inclusion in 20% of nonabdominal patients exceeded 48 h, suggesting a delayed intervention in which clinical conditions deteriorated to such an extent that they could not be recovered by removing endotoxin.…”

Section: Discussionsupporting

confidence: 65%

Polymyxin B Hemoperfusion in Clinical Practice: The Picture from an Unbound Collaborative Registry

Antonelli¹

2014

Blood Purif

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After the publication of the EUPHAS trial, the clinical use of polymyxin B hemoperfusion (Toraymyxin®) increased significantly in Italy. Nevertheless, no structured data collections have been carried out to underline the characteristics of treated patients. Therefore, a collaborative registry of clinical data was promoted among users in order to better define the structure of the prospective data collection named the EUPHAS2 project. Neither inclusion criteria nor therapeutic constraints were imposed, highlighting adherence to clinical evidence provided by previous randomized controlled trials, and also unusual or borderline practice in the selection of patients for polymyxin B-based cartridges (PMX-DHP). This first retrospective phase of data collection included patients with severe sepsis and septic shock treated with Toraymyxin over the last 3 years, up to July 2013. Thirty-one hospitals participated in the EUPHAS2 study, collecting data on 306 patients. Enrolled patients were grouped according to the main source of sepsis: abdominal (41.8%) and nonabdominal (58.2%). The abdominal patients had characteristics well matching those selected for the EUPHAS randomized controlled trial in terms of time-to-enrolment, severity of the illness, 28-day mortality and in-hospital mortality. Their 28-day mortality rate was 35% with a significant reduction of the Sequential Organ Failure Assessment Score (SOFA) score after 72 h of treatment (p < 0.001). Patients with nonabdominal sepsis were heterogeneous and only a few of them had their endotoxin activity tested in a manner not allowing a reliable evaluation of the real efficacy of the treatment and organ dysfunction control. Their 28-day mortality rate was 49% and the SOFA score did not significantly change before and after treatment. In conclusion, clinical experience confirms the results of the original EUPHAS randomized trial in terms of outcome for patients with abdominal severe sepsis. Specific studies focused on a population of patients with Gram-negative infections of nonabdominal origin are needed before recommending treatment with Toraymyxin as an effective therapy.

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Section: Discussionsupporting

confidence: 65%

Polymyxin B Hemoperfusion in Clinical Practice: The Picture from an Unbound Collaborative Registry

Antonelli¹

2014

Blood Purif

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“…1 \10 € drugs, 2 10-100 € drugs, 3 100-1000 € drugs, 4 more than 1000 € drugs, 5 plasma, 6 red cells, 7 platelets, 8 blood derivatives, 9 basic radiology, 10 echo-Doppler, 11 computed tomography/magnetic resonance imaging, 12 specialized radiology, 13 hematology, 14 biochemistry, 15 toxicology, 16 microbiology The quite small differences we observed in cost estimation per patient must be read in conjunction with the number of admissions of these patients in ICUs. For example, on the basis of a recent epidemiological study of septic shock in France [33], finding more than 50 patients yearly admitted for septic shock in each center, our results would be relevant with an approximately 10,000 € annual underestimation per ICU. Concerning hemorrhagic shock, such a dramatic amount would be reached with only four underestimations of this clinical situation.…”

Section: Discussionmentioning

confidence: 99%

Cost awareness of physicians in intensive care units: a multicentric national study

et al. 2015

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“…ith mortality rates ranging from 15 to 50% (1)(2)(3)(4)(5), severe infections are among the most prevalent causes of death in intensive care unit (ICU) patients. Therefore, it is of high clinical relevance to establish proper treatment strategies leading to adequate blood concentrations of antibiotics in order to maximize the effectiveness of treatment (6), limit adverse reactions (7), and prevent the development of antimicrobial resistance.…”

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confidence: 99%

Predictors of Inadequate Linezolid Concentrations after Standard Dosing in Critically Ill Patients

Taubert

Zöller

Maier

et al. 2016

Antimicrob Agents Chemother

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Adequate linezolid blood concentrations have been shown to be associated with an improved clinical outcome. Our goal was to assess new predictors of inadequate linezolid concentrations often observed in critically ill patients. Fifty-two critically ill patients with severe infections receiving standard dosing of linezolid participated in this prospective observational study. Serum samples (median, 32 per patient) were taken on four consecutive days, and total linezolid concentrations were quantified. Covariates influencing linezolid pharmacokinetics were identified by multivariate analysis and a population pharmacokinetic model. Target attainment (area under the concentration-time curve over 12 h [AUC 12 ]/MIC ratio of >50; MIC ‫؍‬ 2 mg/liter) was calculated for both the study patients and a simulated independent patient group (n ‫؍‬ 67,000). Target attainment was observed for only 36% of the population on both days 1 and 4. Independent covariates related to significant decreases of linezolid concentrations included higher weight, creatinine clearance rates, and fibrinogen and antithrombin concentrations, lower concentrations of lactate, and the presence of acute respiratory distress syndrome (ARDS). Linezolid clearance was increased in ARDS patients (by 82%) and in patients with elevated fibrinogen or decreased lactate concentrations. In simulated patients, most covariates, including fibrinogen and lactate concentrations and weight, showed quantitatively minor effects on target attainment (difference of <9% between the first and fourth quartiles of the respective parameters). In contrast, the presence of ARDS had the strongest influence, with only <6% of simulated patients reaching this target. In conclusion, the presence of ARDS was identified as a new and strong predictor of insufficient linezolid concentrations, which might cause treatment failure. Insufficient concentrations might also be a major problem in patients with combined alterations of other covariate parameters. (This study has been registered at ClinicalTrials.gov under registration number NCT01793012.)

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The epidemiology of septic shock in French intensive care units: the prospective multicenter cohort EPISS study

Cited by 169 publications

References 50 publications

Polymyxin B Hemoperfusion in Clinical Practice: The Picture from an Unbound Collaborative Registry

Polymyxin B Hemoperfusion in Clinical Practice: The Picture from an Unbound Collaborative Registry

Cost awareness of physicians in intensive care units: a multicentric national study

Predictors of Inadequate Linezolid Concentrations after Standard Dosing in Critically Ill Patients

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