Abstract:
OBJECTIVE:To assess the impact of sepsis classification and multidrug-resistance status on outcome in patients receiving appropriate initial antibiotic therapy. DESIGN:A retrospective cohort study. SETTING:Barnes-Jewish Hospital, a 1,250-bed teaching hospital. PATIENTS:Individuals with Enterobacteriaceae sepsis, severe sepsis, and septic shock who received appropriate initial antimicrobial therapy between June 2009 and December 2013. INTERVENTIONS:Clinical outcomes were compared according to multidrug-resistance status, sepsis classification, demographics, severity of illness, comorbidities, and antimicrobial treatment. MEASUREMENTS AND MAIN RESULTS:We identified 510 patients with Enterobacteriaceae bacteremia and sepsis, severe sepsis, or septic shock. Sixty-seven patients (13.1%) were nonsurvivors. Mortality increased significantly with increasing severity of sepsis (3.5%, 9.9%, and 28.6%, for sepsis, severe sepsis, and septic shock, respectively; p < 0.05). Time to antimicrobial therapy was not significantly associated with outcome. Acute Physiology and Chronic Health Evaluation II was more predictive of mortality than age-adjusted Charlson comorbidity index. Multidrug-resistance status did not result in excess mortality. Length of ICU and hospital stay increased with more severe sepsis. In multivariate logistic regression analysis, African-American race, sepsis severity, Acute Physiology and Chronic Health Evaluation II score, solid-organ cancer, cirrhosis, and transfer from an outside hospital were all predictors of mortality. CONCLUSIONS:Our results support sepsis severity, but not multidrug-resistance status as being an important predictor of death when all patients receive appropriate initial antibiotic therapy. Future sepsis trials should attempt to provide appropriate antimicrobial therapy and take sepsis severity into careful account when determining outcomes.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Burnham JP,Lane MA,Kollef MHdoi
10.1097/CCM.0000000000001013subject
Has Abstractpub_date
2015-08-01 00:00:00pages
1580-6issue
8eissn
0090-3493issn
1530-0293journal_volume
43pub_type
杂志文章abstract:OBJECTIVES:Muscle weakness associated with critical illness can be due to the illness itself, immobilization associated with it, and/or to concomitant use of drugs that affect neuromuscular transmission. This study investigated the contribution of immobilization per se to the muscle dysfunction, as well as the associat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199902000-00031
更新日期:1999-02-01 00:00:00
abstract:OBJECTIVE:The genetic background of hypertensive crisis is unknown. We examined the association of polymorphisms in genes involved in the renin-angiotensin-aldosterone-system with hypertensive crisis. DESIGN:Population-based case-control study. SETTING:Emergency department at a tertiary care university hospital. PAT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200210000-00010
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVE:To compare intraosseous with central venous blood samples for biochemical analyses and hemoglobin levels during cardiopulmonary resuscitation (CPR) and during cardiopulmonary resuscitation with infusion of sodium bicarbonate, epinephrine, and saline boluses through the intraosseous site. DESIGN:Prospective, ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199906000-00039
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVES:To describe the impact of choice of therapy on renal recovery. DESIGN:Literature review. MAIN RESULTS:Randomized controlled trials conducted have not shown a benefit of continuous renal replacement therapy in mortality over intermittent renal replacement therapy. However, renal recovery is another importan...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318168e4a8
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVES:This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subar...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00003246-199506000-00004
更新日期:1995-06-01 00:00:00
abstract::The metabolic support of critically ill patients is a relatively new topic of active research and discussion, and surprisingly little is known about the effects of critical illness on metabolic physiology and activity. The metabolic changes seen in critical illness are highly complex, and how and when to treat them ar...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000278601.93369.72
更新日期:2007-09-01 00:00:00
abstract:OBJECTIVES:To describe the timing of onset of organ system failure, multiple organ system failure diagnosis, and the subsequent death in children admitted to a pediatric intensive care unit (ICU). Second, to identify independent risk markers of death in pediatric patients with multiple organ system failure. DESIGN:Rev...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199406000-00023
更新日期:1994-06-01 00:00:00
abstract::Instantaneous heart rate, indices of long-term and short-term heart-rate variability (HRV), and transcutaneous O2 (PtcO2) and CO2 (PtcCO2) tensions were recorded simultaneously on 164 occasions in 16 neonates. There was significant inverse correlation between PtcCO2 and both HRV indices, while no linear correlation wa...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198501000-00003
更新日期:1985-01-01 00:00:00
abstract:OBJECTIVE:To determine whether treatment with patient-controlled analgesia (PCA) alone or in combination with nonsteroidal anti-inflammatory drugs can prevent postoperative pulmonary complications after cardiac surgery, when compared with conventional nurse-controlled analgesia. DESIGN:Randomized controlled trial. SE...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199910000-00025
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVE:To comparatively evaluate cerebral metabolic rate of oxygen consumption and a modification of it, cerebral consumption of oxygen, in patients with acute brain injury with acute anemia. DESIGN:Prospective, observational study. SETTING:Neuroscience intensive care unit (ICU) of a university hospital. PATIENTS...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199308000-00024
更新日期:1993-08-01 00:00:00
abstract:OBJECTIVE:Currently 162-325 mg aspirin is recommended for the treatment of acute coronary syndrome. We tested the effect of an additional loading dose of 250 mg aspirin at the onset of acute coronary syndrome in patients who were already on chronic therapy with 100 mg aspirin. DESIGN:This was a prospective trial in pa...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e3181de8b1e
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:Life-threatening conditions cause severe changes in the organization and conformation of macromolecules, creating urgent requirements for protein repair to ensure survival. As molecular chaperones, heat shock proteins (HSP) that have specialized functions in protein folding are now well established to restore...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:
更新日期:2002-01-01 00:00:00
abstract:OBJECTIVE:To determine the association of pulmonary artery catheter (PAC) use with in-hospital mortality. DESIGN:Prospective, observational study. SETTING:The medical intensive care units (MICU) of two teaching hospitals. METHODS:The study included 751 adults who were admitted to the MICU, excluding those who stayed...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200106000-00010
更新日期:2001-06-01 00:00:00
abstract:OBJECTIVE:To derive a target range of optimal sedation for the COMFORT Scale and to prospectively test that target range against intensivist assessment of adequacy of sedation. DESIGN:Serial prospective agreement cohort studies. SETTING:Twelve-bed pediatric intensive care unit in an urban academic teaching hospital. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199401000-00029
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:Severe thermal injury causes immune dysfunctions involving both pro- and anti-inflammatory mechanisms. It subsequently leads to a state of immune deficiency that shares some similarities with sepsis-induced immunosuppression. A hallmark of the latter is established by decreased monocyte human leukocyte antige...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000275271.77350.B6
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVES:Hyperammonemia is a key contributing factor for cerebral edema in acute liver failure. Continuous renal replacement therapy may help reduce ammonia levels. However, the optimal timing, mode, intensity, and duration of continuous renal replacement therapy in this setting are unknown. We aimed to study continu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004153
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVE:Sepsis-induced multi-organ failure continues to have a high mortality. The liver is an organ central to the disease pathogenesis. The objective of this study was to identify the liver proteins that change in abundance with sepsis and subsequently identify new drug targets. DESIGN:Proteomic discovery study an...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000281858.44387.a2
更新日期:2007-10-01 00:00:00
abstract::The effects of hypertonic mannitol on postischemic cerebral circulation were studied in 20 dogs. Mannitol, 2 g/kg iv, was infused into ten dogs during a 2-h period starting 1.5 h after 6 min of complete cerebral ischemia. One hour postischemia, regional cerebral blood flow (rCBF) was 36% in the control group (ten dogs...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198607000-00010
更新日期:1986-07-01 00:00:00
abstract:OBJECTIVES:: To characterize the epidemiology and burden of early-onset, nonnosocomial candidemia. DESIGN:: Retrospective review of Cardinal Health Outcomes Research Database, which comprises all acute care admissions at participating hospitals. SETTING:: A total of 176 acute care hospitals. PATIENTS:: All patients ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a0f95d
更新日期:2009-09-01 00:00:00
abstract:OBJECTIVE:To evaluate the action of high-dose epinephrine by measuring simultaneously its vasopressor and norepinephrine releasing effects in humans during cardiac arrest. DESIGN:A prospective study on consecutive patients admitted with cardiac arrest. SETTING:Emergency Department in a large, urban hospital. PATIENT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199305000-00012
更新日期:1993-05-01 00:00:00
abstract:OBJECTIVES:To describe the incident fracture rate in survivors of critical illness and to compare fracture risk with population-matched control subjects. DESIGN:Retrospective longitudinal case-cohort study. SETTING:A tertiary adult intensive care unit in Australia. PATIENTS:All patients ventilated admitted to intens...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318211ff3d
更新日期:2011-06-01 00:00:00
abstract::A new quantitative method for measuring the prognosis and severity of illness in terms of probability of survival was developed from 224 studies in an index population of 220 critically ill surgical patients. Patients were selected preoperatively to eliminate pre-existing cardiac disease, cirrhosis, nutritional debili...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198502000-00007
更新日期:1985-02-01 00:00:00
abstract:OBJECTIVE:Inotropic and vasopressor drugs are routinely used in critically ill patients to maintain adequate blood pressure and cardiac output in patients with cardiogenic shock although potentially at the expense of increasing myocardial oxygen demand. Pacing optimization has been demonstrated as effective in reducing...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001655
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVES:Cardiovascular dysfunction occurs in the majority of asphyxiated neonates and has been suggested to be a major cause of neonatal morbidity and mortality. We previously demonstrated that cyclosporine A treatment during resuscitation can significantly improve cardiovascular performance in asphyxiated newborn p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182746704
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVES:To determine the effects of sustained, 3-day endotoxin infusion on early steps of the insulin-signaling pathway in rat liver and skeletal muscle in vivo; to examine insulin signaling in well-established acute endotoxin models of insulin resistance. DESIGN:Prospective, controlled animal study. SETTING:Unive...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00032
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:Liquid lung ventilation has been demonstrated to improve cardiorespiratory function after cardiopulmonary bypass. We hypothesized that liquid lung ventilation (LLV) would decrease the pulmonary inflammatory response after cardiopulmonary bypass (CPB). DESIGN:Prospective, randomized, experimental, controlled,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00021
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVES:Intensive insulin therapy with tight glucose control is known to result in reduced morbidity and mortality in inflammation-related critical illness. Tumor necrosis factor (TNF)-alpha induction in myocardial infarction may trigger inflammation and have detrimental effects on cardiomyocytes. This study was des...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181782335
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVE:To examine the isolated and combined effects of positive end-expiratory pressure (PEEP) and partial liquid ventilation (PLV) on the development of ventilator-induced lung injury in an ovine model. DESIGN:Prospective controlled animal study. SETTING:University-based cardiovascular animal physiology laborator...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200201000-00026
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Overdoses of calcium channel blocker agents result in hyperglycemia, primarily due to the blockade of pancreatic L-type calcium channels and insulin resistance on the cellular level. The clinical significance of the hyperglycemia in this setting has not previously been described. METHODS:This study is a ret...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000278916.04569.23
更新日期:2007-09-01 00:00:00
abstract:OBJECTIVES:To investigate aortic functional alterations in the acute phase of aneurysmal subarachnoid hemorrhage and to evaluate the relationship between potential cardiovascular alterations and delayed cerebral infarctions or poor Glasgow Outcome Scale score at discharge from critical care unit. DESIGN:Prospective ob...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31822e9fab
更新日期:2012-01-01 00:00:00