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- (-) Sepsis (10)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 10 of 10 Research Studies DisplayedChiotos K, Blumenthal J, Boguniewicz J
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
The purpose of this study was to describe indications and appropriateness of antibiotic orders in pediatric intensive care unit (PICU) patients. The study found that of 1462 patients admitted to participating PICUs, 58% had at least 1 antibiotic order, with 1277 antibiotic orders being reviewed. Common indications were empiric therapy for suspected bacterial infections without sepsis or septic shock, nonoperative prophylaxis, empiric therapy for sepsis or septic shock, community-acquired pneumonia, and post-operative prophylaxis. Appropriateness was evaluated for 985 orders for which an evidence-based heading for appropriateness could be created. Of these, 34% were categorized as inappropriate. Indications with the most orders classified as inappropriate were empiric therapy for suspected bacterial infection without sepsis or septic shock, sepsis or septic shock, CAP, ventilator-associated infections, and post-operative prophylaxis. The proportion of antibiotics classified as inappropriate differed across institutions.
AHRQ-funded; HS026393.
Citation: Chiotos K, Blumenthal J, Boguniewicz J .
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
Clin Infect Dis 2023 Feb 8; 76(3):e1021-e30. doi: 10.1093/cid/ciac698..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Antibiotics, Medication, Antimicrobial Stewardship, Sepsis
Anesi GL, Liu VX, Chowdhury M
Association of ICU admission and outcomes in sepsis and acute respiratory failure.
ICU capacity is strained and its capacity and effectiveness are limited because many patient admission decisions are not evidence-based regarding who benefits from admission triage. The purpose of the study was to measure the benefits of admission to the ICU in patients who were experiencing sepsis or acute respiratory failure. Researchers looked retrospectively from 2013 to 2018 at cohorts within 27 U.S. hospitals across two health systems. They compared ICU admission vs ward admission among patients with sepsis and/ or acute respiratory failure who did not require vasopressors or mechanical ventilation in the emergency department. Study results revealed in patients with sepsis that ICU admission was associated with a hospital stay of 1.32 days longer than ward admissions, with a higher in-hospital mortality ratio. In patients with respiratory failure, ICU admission was associated with a .82-day shorter length of stay and reduced in-patient mortality. Within the two groups, subgroup analysis was conducted, and results revealed that for patients with sepsis, harms were concentrated among older patients and patients with fewer comorbidities. In addition, for patients with respiratory failure, the benefits were concentrated among older patients, patients with higher lab-based acute physiology scores (“high acuity” patients), and patients with comorbidities. The study concluded that among sepsis patients with high acuity scores and not requiring life support in the emergency department, initial admission to the ward was associated with shorter length of stay and improved survival, compared to the same category of patients admitted to the ICU. This result differed from patients with acute respiratory failure, for whom triage to the ICU was associated with improved survival when compared to admission to the ward.
AHRQ-funded; HS026372.
Citation: Anesi GL, Liu VX, Chowdhury M .
Association of ICU admission and outcomes in sepsis and acute respiratory failure.
Am J Respir Crit Care Med 2022 Mar 1;205(5):520-28. doi: 10.1164/rccm.202106-1350OC..
Keywords: Intensive Care Unit (ICU), Sepsis, Respiratory Conditions, Outcomes
Savarimuthu SM, Cairns C, Allorto NL SM, Cairns C, Allorto NL
qSOFA as a predictor of ICU outcomes in a resource-limited setting in KwaZulu-Natal Province, South Africa.
This study’s goal was to determine whether the quick sequential organ failure assessment (qSOFA) score based on bedside assessment alone was a promising tool for risk prediction in low-resource settings. This retrospective cohort study included adult patients admitted to the intensive care unit (ICU) at Edendale Hospital in Pietermaritzburg, South Africa (SA), recruited into the study between 2014 and 2018. Using multivariable logistic regression, the association of qSOFA with in-ICU mortality was measured, and discrimination was assessed using the area under the receiver operating characteristic curve and the additive contribution to a baseline model using likelihood ratio testing. The qSOFA scores of 0, 1 and 2 were not associated with increased odds of in-ICU mortality in patients with infection, while the qSOFA of 3 was associated with in-ICU mortality in infected patients. Discrimination for mortality was fair to poor and adding qSOFA to a baseline model yielded a statistical improvement in both cases.
AHRQ-funded; HS026372.
Citation: Savarimuthu SM, Cairns C, Allorto NL SM, Cairns C, Allorto NL .
qSOFA as a predictor of ICU outcomes in a resource-limited setting in KwaZulu-Natal Province, South Africa.
South Afr J Crit Care 2020; 36(2). doi: 10.7196/SAJCC.2020.v36i2.433..
Keywords: Intensive Care Unit (ICU), Sepsis, Critical Care, Outcomes
Anesi GL, Chelluri J, Qasim ZA
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
The purpose of this study was to evaluate the potential impact of an emergency department-embedded critical care unit (CCU) at the Hospital of the University of Pennsylvania among patients with sepsis and acute respiratory failure (ARF) admitted from the emergency department to a medical ward or ICU from January 2016 to December 2017. Findings showed that the emergency department-embedded CCU was not associated with clinical outcomes among patients admitted with sepsis or ARF. Among less sick patients with sepsis, the emergency department-embedded CCU was initially associated with reduced rates of direct ICU admission from the emergency department. Further research was recommended to further evaluate the impact and utility of the emergency department-embedded CCU model.
AHRQ-funded; HS026372.
Citation: Anesi GL, Chelluri J, Qasim ZA .
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
Ann Am Thorac Soc 2020 Dec;17(12):1599-609. doi: 10.1513/AnnalsATS.201912-912OC..
Keywords: Emergency Department, Critical Care, Intensive Care Unit (ICU), Hospitals, Sepsis, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Healthcare Delivery
Lindell RB, Nishisaki A, Weiss SL
Risk of mortality in immunocompromised children with severe sepsis and septic shock.
This study’s objective was to assess the risk of mortality for immunocompromised children admitted to the hospital with septic shock or sepsis. This retrospective multicenter cohort study used eighty-three centers in the Virtual Pediatric systems database. The cohort included children admitted to the pediatric intensive care unit (PICU) with severe sepsis or septic shock from 2012-2016. Across 83 centers, 10,768 PICU admissions with an International Classification of Diseases, 9th Revision, Clinical Modification code for severe sepsis or septic shock were identified; with 3,021 of these patients (28%) having an immunocompromised diagnosis. PICU mortality rates varied widely by center, and those centers with a higher mean number of sepsis patients per month in a center had a lower PICU mortality rate. Multiple prior malignancies, hemophagocytic lymphohistiocytosis, congenital immunodeficiency, and hematopoietic cell transplant are conditions independently associated with an increased odds of PICU mortality in children with severe sepsis or septic shock.
AHRQ-funded; HS024511; HS026939; HS021583; HS022464.
Citation: Lindell RB, Nishisaki A, Weiss SL .
Risk of mortality in immunocompromised children with severe sepsis and septic shock.
Crit Care Med 2020 Jul;48(7):1026-33. doi: 10.1097/ccm.0000000000004329..
Keywords: Children/Adolescents, Mortality, Sepsis, Risk, Intensive Care Unit (ICU), Hospitalization, Hospitals
Lindell RB, Nishisaki A, Weiss SL
Comparison of methods for identification of pediatric severe sepsis and septic shock in the Virtual Pediatric Systems Database.
This study compared the use of Virtual Pediatric Systems with traditional use of International Classification of Diseases, 9th edition (ICD) to identify children with severe sepsis or septic shock in PICU settings. Two different systems were compared “Martin” and “Angus”. Both showed good agreement, but ICD9 identified a smaller more accurate cohort of children. Additional analysis of discrepancies between the reference standard the two virtual systems showed that prospective screening missed 66 patients who were diagnosed with severe sepsis or severe shock. Once they were included in the standard cohort, agreement improved with a positive predictive value of 70%.
AHRQ-funded; HS024511; HS022464.
Citation: Lindell RB, Nishisaki A, Weiss SL .
Comparison of methods for identification of pediatric severe sepsis and septic shock in the Virtual Pediatric Systems Database.
Crit Care Med 2019 Feb;47(2):e129-e35. doi: 10.1097/ccm.0000000000003541..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Data, Sepsis
Sudduth CL, Overton EC, Lyu PF
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
Using administrative codes and minimal physiologic and laboratory data, researchers sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay. They concluded that selected administrative codes coupled to SIRS criteria and applied to patients admitted to ICU can yield up to 94 percent authentic sepsis patients. However, only 1/3 of patients thus identified appeared to become septic during their ICU stay.
AHRQ-funded; HS000055.
Citation: Sudduth CL, Overton EC, Lyu PF .
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
J Crit Care 2017 Jun;39:220-24. doi: 10.1016/j.jcrc.2017.01.012.
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Keywords: Diagnostic Safety and Quality, Intensive Care Unit (ICU), Hospitalization, Sepsis
Wheeler DS, Wong HR
Sepsis in pediatric cardiac intensive care.
The authors reviewed risk factors for developing sepsis; the role of biomarkers; and the pathophysiology and management of severe sepsis and septic shock. They concluded that while scientific advances in the diagnosis and clinical staging of sepsis offer tremendous promise for the future, it is also evident that sepsis mortality has not improved enough, even with progress in our understanding of the molecular pathophysiology of sepsis.
AHRQ-funded; HS020455.
Citation: Wheeler DS, Wong HR .
Sepsis in pediatric cardiac intensive care.
Pediatr Crit Care Med 2016 Aug;17(8 Suppl 1):S266-71. doi: 10.1097/pcc.0000000000000796.
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Keywords: Cardiovascular Conditions, Children/Adolescents, Intensive Care Unit (ICU), Children/Adolescents, Sepsis
Harrison AM, Gajic O, Pickering BW
Development and implementation of sepsis alert systems.
Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Current evidence does not support routine use of sepsis alert systems in clinical practice. Continuous improvement in the afferent and efferent aspects will help translate theoretic advantages into measurable patient benefit.
AHRQ-funded; HS022799.
Citation: Harrison AM, Gajic O, Pickering BW .
Development and implementation of sepsis alert systems.
Clin Chest Med 2016 Jun;37(2):219-29. doi: 10.1016/j.ccm.2016.01.004..
Keywords: Intensive Care Unit (ICU), Sepsis, Outcomes, Adverse Events
Septimus EJ, Hayden MK, Kleinman K
Does chlorhexidine bathing in adult intensive care units reduce blood culture contamination? A pragmatic cluster-randomized trial.
The investigators determined rates of blood culture contamination comparing 3 strategies to prevent intensive care unit (ICU) infections: screening and isolation, targeted decolonization, and universal decolonization. They demonstrated that universal decolonization with mupirocin and chlorhexidine bathing resulted in a significant reduction in blood culture contamination.
AHRQ-funded; 290201000008I; 290032007T.
Citation: Septimus EJ, Hayden MK, Kleinman K .
Does chlorhexidine bathing in adult intensive care units reduce blood culture contamination? A pragmatic cluster-randomized trial.
Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S17-22. doi: 10.1086/677822.
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Keywords: Comparative Effectiveness, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Methicillin-Resistant Staphylococcus aureus (MRSA), Sepsis