DOCSLIB.ORG

ADULT SEPSIS SCREEN and TREATMENT ALGORITHM BAYLOR UNIVERSITY MEDICAL CENTER Publication Year: 2013

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
ADULT SEPSIS SCREEN and TREATMENT ALGORITHM BAYLOR UNIVERSITY MEDICAL CENTER Publication Year: 2013 ADULT SEPSIS SCREEN AND TREATMENT ALGORITHM BAYLOR UNIVERSITY MEDICAL CENTER Publication Year: 2013 Summary: Hospital: Baylor University Medical Center The development and implementation of a nursing driven sepsis screening protocol and Location: Dallas, Texas treatment algorithm. Contact: John S Garrett, Associate Medical Director, Department of Emergency Medicine [email protected] Category: Hospital Metrics: . A: Arrival . Annual ED Volume: 117,571 . Hospital Beds: 1,065 . B: Bed Placement . Ownership: Baylor Healthcare System, . C: Clinician Initial Evaluation & Not-For-Profit Throughput . Trauma Level: 1 . E: Exit from the ED . Teaching Status: Yes Key Words: . Sepsis . Triage Tools Provided: . BHCS Adult Sepsis Screen & Treatment Algorithm Tools Provided: . Hahnemann University Hospital Clinical Areas Affected: Staff Involved: Triage Plan . Emergency Department . ED Staff . Nurses . Pharmacists . Physicians . Technicians Copyright © 2002‐2013 Urgent Matters 1 Innovation Severe sepsis and septic shock are major drivers of in-hospital mortality, with rates that are over 8 times higher than those associated with other inpatient admissions. When coupled with an apparent rise in incidence: hospital admission rates for severe sepsis and septic shock doubled between 2000 and 2008, sepsis is projected to be a growing source of mortality, morbidity, and healthcare cost within the United States. This data is especially pertinent to Emergency Departments (ED): effective treatments for patients with severe sepsis and septic shock are time-sensitive whereby early recognition and treatment significantly impacts mortality. Based upon growing evidence that rapid recognition and aggressive treatment significantly improves outcomes, the Surviving Sepsis Campaign (SSC) recently released updated guidelines detailing a standard operating procedure for early risk stratification and management of patients with severe sepsis and septic shock. These guidelines have been endorsed by the National Quality Forum (NQF). More specifically, these guidelines describe a 3 hour and 6 hour bundles of care to be completed in patients with severe sepsis and septic shock. In patients admitted to the ED with evidence of sepsis, the 3 hour bundle includes four aspects of patient care that occur within the first 3 hours following triage in the ED. These include the institution of aggressive screening for occult severe sepsis with serum lactates, obtaining blood cultures prior to antibiotic administration, the administration of broad spectrum antibiotics, and completion of a 30ml/kg crystalloid bolus. Those patients who fail to respond to the 3 hour bundle or have serum lactate of greater than 4 mg/gL are eligible for the 6 hour bundle. Importantly, multiple studies have demonstrated that a delay in the administration of effective antibiotics is associated with increased mortality in patients with severe sepsis and septic shock. More telling perhaps is a reported 7.6% increase in mortality for every hour delay in antibiotic administration following initial hypotension in patients with septic shock. Based upon this literature, the SSC suggests that broad- spectrum antibiotic administration should occur as soon as possible following the diagnosis of severe sepsis. Rapid identification of these patients in a busy ED is very difficult. Additionally, several events must occur, often in serial order, prior to the administration of antibiotics. Sepsis has long been noted to be a major driver of inpatient mortality within our institution. As such, it has been the focus of a continual quality improvement (CQI) project for the past 3 years at Baylor University Medical Center (BUMC). These CQI projects led to several improvements. One of these was the development of a hospital wide sepsis notification aimed at expediting the septic patients from the ED to the Intensive Care Unit. Additionally, this pulled Intensive Care nursing resources to the ED to help with patient care. These interventions dramatically improved ED disposition to ICU times, reducing this timeframe by almost 60% (374 minutes to 151 minutes). Additionally a sepsis screen based upon SIRS criteria was added to the initial triage forms completed by the triage nurse. A positive screen prompted the triage nurse to contact an EM physician for further instructions. Our Emergency Department set out to develop a nursing driven sepsis screening protocol and treatment algorithm whereby patients at risk for severe sepsis and septic shock would be rapidly identified in triage. A positive screen then triggers a multidisciplinary response involving ED nursing and technicians, radiology technicians, respiratory therapy, pharmacists, and Emergency Medicine physicians. The goal of this response was to perform the necessary tasks to: . Initiate broad spectrum antibiotics within 2 hours of triage . Complete the remainder of the 3 hour bundle of care as described by the NQF and SSC. Triage was defined at the time that first vital are entered into the chart. In the Baylor University Medical Center ED this occurs within 2-3 minutes of patient arrival as pulse rate and oxygen saturation are measured and recorded at the time chief complaint is collected. Despite these improvements, no impact was made on improving processes that would impact patient morbidity and mortality. Timeframes associated with triage to lactate result, triage to administration of antibiotics, and triage to completion of initial crystalloid bolus were essentially unchanged between July of 2009 and February of 2013.We recognized several major impediments in reaching our goal of triage to antibiotics within 2 hours and successful completion of the 3 hour bundle. In 2012, the ED at BUMC had an annual census of 117,571 patients. BUMC is a level 1 Copyright © 2002‐2013 Urgent Matters 2 trauma center and flagship hospital for the Baylor Healthcare System. It also serves as a training center for multiple levels of Emergency Medicine (EM) practitioners: we host a 1 month rotation for a local EM residency, are the training campus for a midlevel practitioner EM internship, and have rotating non-EM interns from other service lines within the hospital. As such protocol education and protocol mastery in our group or transient residents and mid-level providers is difficult. Additionally the average door to bed placement time at BUMC is 46 minutes. On average this left 74 minutes for provider evaluation, order entry, IV start, blood culture collection from two sites, lactate processing and resulting, antibiotic preparation, and antibiotic administration. Oftentimes these steps occurred in the setting of ongoing patient resuscitation. Innovation Implementation The team responsible for the development and implementation of the sepsis screen and treatment algorithm was a multidisciplinary group of ED nurses, EM physicians, and ED staff. With support of ED leadership, the primary team consisted of two ED nurse champions (Scott Garvin RN & Lisa Ball RN), ED nursing informatics (Millie Early RN), and EM physician champions (John Garrett MD & Matthew Muller MD). Each team member was instrumental and cooperatively involved in each aspect of the design, implementation, and ongoing education required for successful deployment of the algorithm. Given the limitations of our ED size and patient volume, we recognized that the delays associated with waiting for a provider to trigger a sepsis screening labs prevented rapid recognition and treatment of patients with occult severe sepsis and septic shock. As such a team comprised of representatives from ED nursing, Emergency Medicine, and the BUMC pharmacy met to develop a nursing based triage sepsis screen and protocol (Appendix 1: BHCS Adult Sepsis Screen & Treatment Algorithm). It was quickly realized that the triage nurse played a critical role in the early recognition and screening of septic patients. We had seen marked success in rapid mobilization of resources when the triage nurse is empowered to start workups and initiate treatment. This had become standard care at BUMC when identifying patients with STEMI, acute stroke, and trauma. We hoped that by coupling the existing sepsis screen with a nursing protocol that facilitated rapid treatment, we would remove the delays inherent in waiting for the provider's evaluation. Throughout this process the sepsis screen itself remained essentially unchanged. A positive screen was considered when two SIRS criteria existed in the setting of suspected infection, which the triage nurse would identify through a list of potential sources. The definition of SIRS was expanded to include high risk patients such as hypotension upon arrival. (Appendix 1) After linking the positive screen to a sepsis screening protocol the nurse triggered a process to: . Page an ED technician to draw labs and a blood culture, and then transport the sample to the lab; . Order a sepsis screening bundle containing a serum lactate, complete metabolic panel, and complete blood count with differential; and . Expedited processing within the ED laboratory. In the event that a bed was immediately available, this process was completed at the bedside prior to provider evaluation. In the event that no ED bed was available, this occurred in the triage area of the ED. Results from the screen were then called to the triage nurse. As noted in the Sepsis Algorithm (Appendix 1), if the serum lactate was abnormal (>2 mg/dL) or the patient needed immediate resuscitation, the triage nurse was to immediately bed the patient,
Load more

Recommended publications
  • Prophylactic Antibiotics and Prevention of Surgical Site Infections
    Prophylactic Antibiotics and Prevention of Surgical Site Infections Peter A. Najjar, MD, Douglas S. Smink, MD, MPH* KEYWORDS Surgical site infection Prophylactic antibiotics Perioperative infection control KEY POINTS Surgical site infections (SSIs) are the most common type of healthcare-associated infection in the United States, affecting more than 500,000 patients annually. Studies suggest that 40% to 60% of these infections may be preventable. Patients diagnosed with SSI face a 2 to 11 times increase in mortality along with prolonged hospital stays, treatment-associated risks, and potential long-term sequelae. Nationwide efforts to improve SSI rates include monitoring compliance with preventive guidelines via the Surgical Care Improvement Program (SCIP) along with reporting of risk-adjusted infection rates via the National Healthcare Safety Network (NHSN) and the American College of Surgeons National Surgical Quality Improvement Program (ACS- NSQIP). Preoperative prophylaxis with appropriately selected procedure-specific antibiotics administered 1 hour before skin incision is a mainstay of SSI prevention; excess prophy- lactic antibiotic use either through poor selection or continuation postoperatively is a major driver of increased multidrug-resistant organism isolates. Adjunctive measures, such as surgical safety checklists, minimally invasive surgical techniques, and maintenance of perioperative homeostasis, can help further reduce the burden of SSI. INTRODUCTION Healthcare-associated infections (HAIs) present a significant source of preventable morbidity and mortality. More than 30% of all HAIs are represented by surgical site infections (SSIs), making them the most common subtype.1,2 Between 1.9% and Conflict of Interest: None. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA * Corresponding author.
    [Show full text]
  • Current Issues and Perspectives in Patients with Possible Sepsis at Emergency Departments
    antibiotics Review Current Issues and Perspectives in Patients with Possible Sepsis at Emergency Departments Ioannis Alexandros Charitos 1, Skender Topi 2, Francesca Castellaneta 3 and Donato D’Agostino 4,* 1 Department of Emergency/Urgency, National Poisoning Center, Riuniti University Hospital (OO.RR.) of Foggia, 71122 Foggia, Italy; [email protected] 2 School of Technical Medical Sciences, University A. Xhuvani, Elbasan 3001, Albania; [email protected] 3 School of Medicine, University of Foggia, 71122 Foggia, Italy; [email protected] 4 Department of Emergency and Organ Transplantation (DETO), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy * Correspondence: donato.d’[email protected] or [email protected]; Tel./Fax: +39-0805595076 Received: 8 April 2019; Accepted: 25 April 2019; Published: 7 May 2019 Abstract: In the area of Emergency Room (ER), many patients present criteria compatible with a SIRS, but only some of them have an associated infection. The new definition of sepsis by the European Society of Intensive Care Medicine and the Society of Critical Care Medicine (2016), revolutionizes precedent criteria, overcoming the concept of SIRS and clearly distinguishing the infection with the patient’s physiological response from the symptoms of sepsis. Another fundamental change concerns the recognition method: The use of SOFA (Sequential-Sepsis Related-Organ Failure Assessment Score) as reference score for organ damage assessment. Also, the use of the qSOFA is based on the use of three objective parameters: Altered level of consciousness (GCS <15 or AVPU), systolic blood pressure 100 mmHg, and respiratory rate 22/min. If patients have at least two of these ≤ ≥ altered parameters in association with an infection, then there is the suspicion of sepsis.
    [Show full text]
  • Antimicrobial Treatment Guidelines for Common Infections
    Antimicrobial Treatment Guidelines for Common Infections June 2016 Published by: The NB Provincial Health Authorities Anti-infective Stewardship Committee under the direction of the Drugs and Therapeutics Committee Introduction: These clinical guidelines have been developed or endorsed by the NB Provincial Health Authorities Anti-infective Stewardship Committee and its Working Group, a sub- committee of the New Brunswick Drugs and Therapeutics Committee. Local antibiotic resistance patterns and input from local infectious disease specialists, medical microbiologists, pharmacists and other physician specialists were considered in their development. These guidelines provide general recommendations for appropriate antibiotic use in specific infectious diseases and are not a substitute for clinical judgment. Website Links For Horizon Physicians and Staff: http://skyline/patientcare/antimicrobial For Vitalité Physicians and Staff: http://boulevard/FR/patientcare/antimicrobial To contact us: [email protected] When prescribing antimicrobials: Carefully consider if an antimicrobial is truly warranted in the given clinical situation Consult local antibiograms when selecting empiric therapy Include a documented indication, appropriate dose, route and the planned duration of therapy in all antimicrobial drug orders Obtain microbiological cultures before the administration of antibiotics (when possible) Reassess therapy after 24-72 hours to determine if antibiotic therapy is still warranted or effective for the given organism or
    [Show full text]
  • Antimicrobial Stewardship
    Antimicrobial Stewardship: Arizona Partnerships Working to Improve the Use of Antimicrobials in the Hospital and Community Part 1 “Antibacterials – indeed, anti-infectives as a whole – are unique in that misuse of these agents can have a negative effect on society at large. Misuse of antibacterials has led to the development of bacterial resistance, whereas misuse of a cardiovascular drug harms only the one patient, not causing a societal consequence.” - Glenn Tillotson; Clin Infect Dis. 2010;51:752 “…we hold closely the principles that antibiotics are a gift to us from prior generations and that we have a moral obligation to ensure that this global treasure is available for our children and future generations.” - David Gilbert, et al (and the Infectious Diseases Society of America). Clin Infect Dis. 2010;51:754-5 A Note To Our Readers and Slide Presenters The objectives of the Subcommittee on Antimicrobial Stewardship Programs are directed at education, presentation, and identification of resources for clinicians to create toolkits of strategies that will assist clinicians with understanding, implementing, measuring, and maintaining antimicrobial stewardship programs. The slide compendium was developed by the Subcommittee on Antimicrobial Stewardship Programs (ASP) of the Arizona Healthcare-Associated Infection (HAI) Advisory Committee in 2012-2013. ASP is a multidisciplinary committee representing various healthcare disciplines working to define and provide guidance for establishing and maintaining an antimicrobial stewardship programs within acute care and long-term care institutions and in the community. Their work was guided by the best available evidence at the time although the subject matter encompassed thousands of references. Accordingly, the Subcommittee selectively used examples from the published literature to provide guidance and evidenced-based criteria regarding antimicrobial stewardship.
    [Show full text]
  • Antimicrobials and Resistance | Microbiology and Risk Factors for Transmission | Table of Contents | APIC
    11/2/2017 26. Antimicrobials and Resistance | Microbiology and Risk Factors for Transmission | Table of Contents | APIC Antimicrobials and Resistance Author(s): Forest W. Arnold, DO, MSc, FIDSA Assistant Professor, Division of Infectious Diseases University of Louisville Hospital Epidemiologist University of Louisville Hospital Louisville, KY Published: November 1, 2017 Abstract Although infection prevention traditionally has approached the problem of resistance primarily from the aspect of preventing transmission from an infected patient to a noninfected patient, more needs to be done to improve how antimicrobials are commonly used. Antimicrobial use is the main selective pressure responsible for the increasing resistance seen in hospitals. Patients come to possess a resistant pathogen either by transmitting bacteria that already have the resistance gene in place or by having their bacteria acquire a gene that codes for resistance. The former is more common because it merely requires a handshake while the latter takes days to weeks to develop. To have an impact on antimicrobial use so as to reduce resistance, infection preventionists (IPs) need a working knowledge of available antimicrobials, principles for their appropriate use, the mechanisms by which these drugs inhibit microbial growth, and the mechanisms by which microorganisms develop resistance. In addition, IPs need to understand promising new strategies to improve antimicrobial use and how members of the infection prevention community can become more involved. Key Concepts Although infection prevention traditionally has approached the problem of resistance primarily from the aspect of preventing transmission, more needs to be done to control how antimicrobials are commonly used. Antimicrobial stewardship is the best investment for preventing the proliferation of multidrug-resistant pathogens and the adverse events associated with the drugs used to treat such pathogens.
    [Show full text]
  • IDSA/ATS Consensus Guidelines on The
    SUPPLEMENT ARTICLE Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults Lionel A. Mandell,1,a Richard G. Wunderink,2,a Antonio Anzueto,3,4 John G. Bartlett,7 G. Douglas Campbell,8 Nathan C. Dean,9,10 Scott F. Dowell,11 Thomas M. File, Jr.12,13 Daniel M. Musher,5,6 Michael S. Niederman,14,15 Antonio Torres,16 and Cynthia G. Whitney11 1McMaster University Medical School, Hamilton, Ontario, Canada; 2Northwestern University Feinberg School of Medicine, Chicago, Illinois; 3University of Texas Health Science Center and 4South Texas Veterans Health Care System, San Antonio, and 5Michael E. DeBakey Veterans Affairs Medical Center and 6Baylor College of Medicine, Houston, Texas; 7Johns Hopkins University School of Medicine, Baltimore, Maryland; 8Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi School of Medicine, Jackson; 9Division of Pulmonary and Critical Care Medicine, LDS Hospital, and 10University of Utah, Salt Lake City, Utah; 11Centers for Disease Control and Prevention, Atlanta, Georgia; 12Northeastern Ohio Universities College of Medicine, Rootstown, and 13Summa Health System, Akron, Ohio; 14State University of New York at Stony Brook, Stony Brook, and 15Department of Medicine, Winthrop University Hospital, Mineola, New York; and 16Cap de Servei de Pneumologia i Alle`rgia Respirato`ria, Institut Clı´nic del To`rax, Hospital Clı´nic de Barcelona, Facultat de Medicina, Universitat de Barcelona, Institut d’Investigacions Biome`diques August Pi i Sunyer, CIBER CB06/06/0028, Barcelona, Spain. EXECUTIVE SUMMARY priate starting point for consultation by specialists. Substantial overlap exists among the patients whom Improving the care of adult patients with community- these guidelines address and those discussed in the re- acquired pneumonia (CAP) has been the focus of many cently published guidelines for health care–associated different organizations, and several have developed pneumonia (HCAP).
    [Show full text]
  • Clinical Microbiology
    Clinical Microbiology Antibiotics are medicines used to fight bacterial infections. There are different types of antibiotics. Each type is only effective against certain bacteria. An antibiotic sensitivity test can help find out which antibiotic will be most effective in treating your infection. The test can also be helpful in finding a treatment for antibiotic-resistant infections. Antibiotic resistance happens when standard antibiotics become less effective or ineffective against certain bacteria. Antibiotic resistance can turn once easily treatable diseases into serious, even life- threatening illnesses. Antibiotic sensitivity testing or Antibiotic susceptibility testing is the measurement of the susceptibility of bacteria to antibiotics. It is used because bacteria may have resistance to some antibiotics. Sensitivity testing results can allow a clinician to change the choice of antibiotics from empiric therapy, which is when an antibiotic is selected based on clinical suspicion about the site of an infection and common causative bacteria, to directed therapy, in which the choice of antibiotic is based on knowledge of the organism and its sensitivities. Sensitivity testing usually occurs in a medical laboratory, and may be based on culture methods that expose bacteria to antibiotics, or genetic methods that test to see if bacteria have genes that confer resistance. Culture methods often involve measuring the diameter of areas without bacterial growth, called zones of inhibition, around paper discs containing antibiotics on agar culture dishes that have been evenly inoculated with bacteria. The minimum inhibitory concentration, which is the lowest concentration of the antibiotic that stops the growth of bacteria, can be estimated from the size of the zone of inhibition.
    [Show full text]
  • Review Host-Directed Therapies for Infectious Diseases
    Review Host-directed therapies for infectious diseases: current status, recent progress, and future prospects Alimuddin Zumla, Martin Rao, Robert S Wallis, Stefan H E Kaufmann, Roxana Rustomjee, Peter Mwaba, Cris Vilaplana, Dorothy Yeboah-Manu, Jeremiah Chakaya, Giuseppe Ippolito, Esam Azhar, Michael Hoelscher, Markus Maeurer, for the Host-Directed Therapies Network consortium* Despite extensive global eff orts in the fi ght against killer infectious diseases, they still cause one in four deaths Lancet Infect Dis 2016; worldwide and are important causes of long-term functional disability arising from tissue damage. The continuing 16: e47–63 epidemics of tuberculosis, HIV, malaria, and infl uenza, and the emergence of novel zoonotic pathogens represent *List of consortium partners is major clinical management challenges worldwide. Newer approaches to improving treatment outcomes are needed to available from http://www.unza- uclms.org/hdt-net-partners reduce the high morbidity and mortality caused by infectious diseases. Recent insights into pathogen–host interactions, Centre for Clinical pathogenesis, infl ammatory pathways, and the host’s innate and acquired immune responses are leading to Microbiology, Division of identifi cation and development of a wide range of host-directed therapies with diff erent mechanisms of action. Host- Infection and Immunity, directed therapeutic strategies are now becoming viable adjuncts to standard antimicrobial treatment. Host-directed University College London therapies include commonly used drugs for non-communicable diseases with good safety profi les, immunomodulatory (UCL), London, UK (Prof A Zumla FRCP); National agents, biologics (eg monoclonal antibodies), nutritional products, and cellular therapy using the patient’s own Institute for Health Research immune or bone marrow mesenchymal stromal cells.
    [Show full text]
  • AS Clinical Teaching Tool
    AS Clinical Teaching Tool Use this tool to debrief on 1. Antibiotic Stewardship. Antibiotic stewardship involves the judicious antimicrobial stewardship use of antibiotics and can be described as guardianship of a limited principles for the patients resource (antibiotics) in order to preserve their activity for the future. you are seeing in the More specifically, it can be described as prescribing the right drug for clinical area. the right patient for the right indication for the right duration at the right dose. At the level of the individual patient, What are some ways that you practice antibiotic stewardship? What are some tools you use to ensure that the antibiotics you recommend or prescribe are given for the right indication, dose, and duration? What factors should be considered when considering whether a case is appropriate for stewardship interventions vs a formal infectious diseases consultation? 2. Empiric vs directed therapy. Empiric therapy is necessary for clinical conditions that require prompt therapy to reduce morbidity and mortality, whereas directed therapy is prescribed when diagnostic information is available. Choose a patient from the consult list who was prescribed an empiric antibiotic regimen. A Discuss instances where empiric therapy is indicated. Discuss 1-2 alternative antibiotic regimens that could be considered. What are the pros and cons of various regimens? Be sure to address potential for collateral damage, adverse effects, etc. Discuss what information is needed in order to change the patient’s antibiotic regimen from empiric to directed therapy. Discuss situations in which empiric antibiotics may be withheld. For example, antibiotics may be B withheld pending information on more targeted therapy in patients with osteomyelitis without cellulitis or systemic illness.
    [Show full text]
  • Pneumonia-Antibiotic-Treatment Executive
    Comparative Effectiveness Review Number 136 Effective Health Care Program Pharmacokinetic/Pharmacodynamic Measures for Guiding Antibiotic Treatment for Hospital- Acquired Pneumonia Executive Summary Background Effective Health Care Program Hospital-Acquired Pneumonia: The Effective Health Care Program Epidemiology was initiated in 2005 to provide valid Hospital-acquired (or nosocomial) evidence about the comparative pneumonia (HAP) is the second most effectiveness of different medical common hospital-acquired infection. interventions. The object is to help It occurs especially in the elderly, consumers, health care providers, and immunocompromised patients, surgical others in making informed choices patients, and individuals receiving enteral among treatment alternatives. Through feeding through a nasogastric tube. The its Comparative Effectiveness Reviews, incidence rates for HAP, which can occur the program supports systematic in all areas of hospitals, range from 5 to appraisals of existing scientific more than 20 per 1,000 admissions.1,2 evidence regarding treatments for high-priority health conditions. It HAP is the leading cause of hospital- also promotes and generates new acquired infection in the intensive care scientific evidence by identifying gaps unit (ICU).1 Almost one-third of HAP in existing scientific evidence and episodes are acquired in ICUs;3 as many supporting new research. The program as 90 percent of ICU cases may be puts special emphasis on translating ventilator associated.3,4 In the ICU setting, findings into a variety of useful HAP accounts for up to 25 percent of all formats for different stakeholders, infections and for more than 50 percent of including consumers. the antibiotics prescribed.1 The full report and this summary are Guidelines issued in 2005 by the available at www.effectivehealthcare.
    [Show full text]
  • Diagnostic and Clinical Aspects of Invasive Fungal Disease After Allogeneic Hematopoietic Stem Cell Transplantation
    DEPARTMENT OF LABORATORY MEDICINE Karolinska Institutet, Stockholm, Sweden DIAGNOSTIC AND CLINICAL ASPECTS OF INVASIVE FUNGAL DISEASE AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION Ola Blennow Stockholm 2014 Cover picture: Thoracic CT showing a dense infiltrate with halo sign (top), and hyphae in a lung biopsy (bottom). All previously published papers were reproduced with permission from the publisher. Published by Karolinska Institutet. Printed by Åtta.45 Tryckeri AB © Ola Blennow, 2014 ISBN 978-91-7549-690-0 Institutionen för laboratoriemedicin Diagnostic and Clinical Aspects of Invasive Fungal Disease after Allogeneic Hematopoietic Stem Cell Transplantation AKADEMISK AVHANDLING som för avläggande av medicine doktorsexamen vid Karolinska Institutet offentligen försvaras i föreläsningssal R64, Karolinska Universitetsjukhuset, Huddinge Fredagen den 17 oktober 2014, kl 09.00 av Ola Blennow MD Huvudhandledare: Fakultetsopponent: Docent Jonas Mattsson Professor Kieren Marr Karolinska Institutet Johns Hopkins University School of Medicine Institutionen för onkologi och patologi Department of Infectious Diseases Centrum för allogen stamcellstransplantation (CAST) Betygsnämnd: Docent Stig Lenhoff Bihandledare: Lunds Universitet Professor Per Ljungman Avdelningen för hematologi och Karolinska Institutet transfusionsmedicin Institutionen för medicin, Huddinge Enheten för hematologi Professor Christine Wennerås Göteborgs Universitet Avdelningen för infektionssjukdomar Professor Bertil Christensson Lunds Universitet Stockholm 2014 Avdelningen
    [Show full text]
  • Comparative Effectiveness of Narrow-Spectrum Antibiotics Versus Broad-Spectrum Antibiotics in the Treatment of Community-Acquired Pneumonia in Adults
    Future Research Prioritization: Comparative effectiveness of narrow-spectrum antibiotics versus broad-spectrum antibiotics in the treatment of community-acquired pneumonia in adults Prepared for: Patient-Centered Outcomes Research Institute (PCORI) 1828 L St., NW, Suite 900 Washington, DC 20036 Phone: (202) 827-7700 Fax: (202) 355-9558 www.pcori.org Prepared by: Johns Hopkins Evidence-Based Practice Center Baltimore, Maryland Investigators: Sydney Dy, MD, MSc Susan Hutfless, PhD Catalina Suarez-Cuervo, MD Acknowledgments: John Bartlett, MD and Sara Cosgrove, MD, MS October 2015 1 INTRODUCTION Community-acquired pneumonia (CAP) is defined as an infection of the lung in persons who have not been hospitalized recently or exposed to other health care settings that markedly increase risk of contracting pneumonia. Health care-associated pneumonia is defined and treated differently than CAP. In 2012, 1.1 million persons were diagnosed with CAP in the United States, resulting in 327,840 hospital admissions.1 Characteristics of individuals at increased susceptibility to CAP include older age, comorbidities, immunosuppression, non-white race, and lower education and income. In 2013, CAP was the 9th leading cause of death in the US with a mortality rate of 16.9 per 100,000 contributing to 53,000 deaths.2 The national total cost (both direct and indirect) is estimated at $10.6 billion per year.3,4 Typical symptoms of CAP include fever, cough, sputum production, and shortness of breath, with leukocytosis on laboratory testing and lung consolidation or infiltrate on chest imaging. However, the diagnosis of CAP can be challenging, as some patients, especially those who are elderly or have comorbidities, may not present with these symptoms and signs.
    [Show full text]