Trends in mortality in septic patients according to the different organ failure during 15 years.

BACKGROUND: The incidence of sepsis can be estimated between 250 and 500 cases/100.000 people per year and is responsible for up to 6% of total hospital admissions. Identified as one of the most relevant global health problems, sepsis is the condition that generates the highest costs in the healthcare system. Important changes in the management of septic patients have been included in recent years; however, there is no information about how changes in the management of sepsis-associated organ failure have contributed to reduce mortality. METHODS: A retrospective analysis was conducted from hospital discharge records from the Minimum Basic Data Set Acute-Care Hospitals (CMBD-HA in Catalan language) for the Catalan Health System (CatSalut). CMBD-HA is a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia. Sepsis was defined by the presence of infection and at least one organ dysfunction. Patients hospitalized with sepsis were detected, according ICD-9-CM (since 2005 to 2017) and ICD-10-CM (2018 and 2019) codes used to identify acute organ dysfunction and infectious processes. RESULTS: Of 11.916.974 discharges from all acute-care hospitals during the study period (2005-2019), 296.554 had sepsis (2.49%). The mean annual sepsis incidence in the population was 264.1 per 100.000 inhabitants/year, and it increased every year, going from 144.5 in 2005 to 410.1 in 2019. Multiorgan failure was present in 21.9% and bacteremia in 26.3% of cases. Renal was the most frequent organ failure (56.8%), followed by cardiovascular (24.2%). Hospital mortality during the study period was 19.5%, but decreases continuously from 25.7% in 2005 to 17.9% in 2019 (p < 0.0001). The most important reduction in mortality was observed in cases with cardiovascular failure (from 47.3% in 2005 to 31.2% in 2019) (p < 0.0001). In the same way, mean mortality related to renal and respiratory failure in sepsis was decreased in last years (p < 0.0001). CONCLUSIONS: The incidence of sepsis has been increasing in recent years in our country. However, hospital mortality has been significantly reduced. In septic patients, all organ failures except liver have shown a statistically significant reduction on associated mortality, with cardiovascular failure as the most relevant.

Randomized trial: inflammatory response to corticoids versus placebo in moderate and severe bronchiolitis. COTHEB study

ABSTRACT Introduction: The use of corticosteroids has been shown not to improve the prognosis of patients with bronchiolitis, but it could be assumed that steroids will reduce inflammation. Objective: This study aimed to assess whether corticoid therapy influenced the inflammatory and clinical response of critically ill infants. Methods: Prospective, randomized, double blind placebo-controlled trial of glucocorticoids (GCT) in infants of less than 12 months with severe or moderate bronchiolitis. Patients were randomized to receive systemic corticoid therapy (low dose for 7 days) or placebo. The main outcomes were: a) levels of lymphocyte subsets; b) levels of IL-2, IL-12, and IFNγ as pro-inflammatory factors, and c) levels of IL-4 and IL-10 as anti-inflammatory response. Secondary outcomes related with the clinical response were also analyzed. Results: 97 patients were randomized. Evolution of lymphocyte subsets was similar in both groups. Pro-inflammatory interleukins and interferon decreased, but without differences. Anti-inflammatory interleukins showed a significant decrease from baseline to the end of the study, and IL-10 values were significantly lower (p = 0.046) in the GCT group [1.82 pg/ml (1.2-3.5)] vs non-GCT [4 pg/ml (1.5-6.3)]. GCT group showed a lower time of mechanical ventilation and of hospitalization, but without statistically significant differences. No cases of severe adverse reaction to steroids were detected. Conclusions: Administration of systemic GCT did not modify the inflammatory nor the clinical response of patients with severe bronchiolitis, except for IL-10 levels that were significantly lower in the GCT group. This can open a line of investigation about the relation of IL-10 and response to bronchiolitis.

RESUMEN Introducción: Se ha demostrado que los glucocorticoides no mejoran el pronóstico de pacientes con bronquiolitis, pero se podría suponer que reducen la inflamación. Objetivo: Evaluar si los glucocorticoides influyen en la respuesta inflamatoria y clínica de los lactantes críticos. Métodos: Ensayo prospectivo, aleatorizado, doble ciego, controlado con placebo en lactantes < 12 meses con bronquiolitis grave y administración de glucocorticoides sistémicos (dosis bajas 7 días). Se examinaron: a) concentraciones de subconjuntos de linfocitos; b) concentraciones de IL-2, IL-12 e IFNγ como factores proinflamatorios, y c) concentraciones de IL-4 e IL-10 como respuesta antiinflamatoria. También se analizaron los resultados relacionados con la respuesta clínica. Resultados: Se aleatorizaron 97 pacientes. La evolución de los subconjuntos de linfocitos fue similar en ambos grupos. Disminuyeron las interleucinas proinflamatorias y el interferón, pero sin diferencias. Las interleucinas antiinflamatorias mostraron una disminución significativa desde el inicio hasta el final del estudio, y los valores de IL-10 fueron significativamente más bajos (p= 0,046) en el grupo de glucocorticoides [1,82 pg/ml (1,2-3,5)] frente a los no glucocorticoides [4 pg/ml (1,5 - 6,3)]. El grupo glucocorticoides mostró menor tiempo de ventilación mecánica y de hospitalización, pero sin diferencias significativas. No se detectaron reacciones adversas graves a glucocorticoides. Conclusiones: La administración de glucocorticoides sistémicos no modificó la respuesta inflamatoria ni clínica de los pacientes con bronquiolitis severa, excepto las concentraciones de IL-10 que fueron significativamente menores en el grupo de glucocorticoides. Esto puede abrir una línea de investigación sobre la relación de IL-10 y la respuesta a la bronquiolitis.

Trends in nosocomial infections and multidrug-resistant microorganisms in Spanish pediatric intensive care units / Tendencia de la infección nosocomial y microorganismos multirresistentes en unidades de cuidados intensivos pediátricas en España

INTRODUCTION: Nosocomial infections (NI) are a major healthcare problem. National surveillance systems enable data to be compared and to implement new measures to improve our practice. METHODS: A multicentre, prospective, descriptive and observational study was conducted using the data from surveillance system for nosocomial infections created in 2007 for Spanish pediatric intensive care units. Data were collected for one month, between 01 and 31 March, for every study year (2008-2012). The objective was to report 5-years of NI surveillance data, as well as trends in infections by multidrug resistant organisms in Spanish pediatric intensive care units. RESULTS: A total of 3667 patients were admitted to the units during the study period. There were 90 (2.45%) patients with nosocomial infections. The mean rates during the 5 years study were: central line-associated bloodstream infection, 3.8/1000 central venous catheter-days, Ventilator-associated pneumonia 7.5/1000 endotracheal tube-days, and catheter-associated urinary tract infections 4.1/1000 urinary catheter-days. The comparison between the 2008 and 2009 rates for nosocomial infections did not show statistically significant differences. All rates homogeneously decreased from 2009 to 2012: central line-associated bloodstream infection 5.83 (95% CI 2.67-11.07) to 0.49 (95% CI 0.0125-2.76), P = 0.0029; ventilator-associated pneumonia 10.44 (95% CI 5.21-18.67) to 4.04 (95% CI 1.48-8.80), P = 0.0525; and Catheter-associated urinary tract infections 7.10 (95% CI 3.067-13.999) to 2.56 (95% CI 0.697-6.553), P = 0.0817; respectively. The microorganism analysis: 63 of the 99 isolated bacteria (63.6%) were Gram-negative bacteria (36.5% were resistant), 19 (19.2%) Gram-positive bacteria, and 17 (17.2%) were Candida spp. infections. CONCLUSIONS: The local surveillance systems provide information for dealing with nosocomial infections rates

INTRODUCCIÓN: Las infecciones nosocomiales son un problema de salud pública. Los sistemas nacionales de vigilancia permiten comparar datos e implementar medidas para mejorar la práctica asistencial. MÉTODO: Estudio multicéntrico, prospectivo, descriptivo y observacional. En 2007 se creó un sistema de vigilancia para infección nosocomial en las Unidades de Cuidados Intensivos Pediátricas Españolas. Se recogieron datos durante un mes (Marzo) por año (2008-2012). El objetivo fue reportar las tasas de los 5 años de vigilancia de la infección nosocomial y la evolución de las infecciones por microorganismos multirresistentes. RESULTADOS: Ingresaron 3667 pacientes. Número de pacientes con infección nosocomial: 90 (2.45%). Tasas medias de los 5 años de estudio: Bacteriemia relacionada con catéter 3.8/1000 días de catéter venoso central, Neumonía asociada a la ventilación mecánica 7.5/1000 días de tubo endotraqueal e Infecciones urinarias asociadas a sonda 4.1/1000 días de sonda urinaria. La comparación de tasas entre 2008 y 2009 no mostró diferencias estadísticamente significativas. Todas las tasas se redujeron homogéneamente desde 2009 a 2012: Bacteriemia relacionada con catéter 5.83 (95% CI 2.67-11.07) a 0.49 (95% CI 0.0125-2.76), P = 0.0029; Neumonía asociada a la ventilación mecánica 10.44 (95% CI 5.21-18.67) a 4.04 (95% CI 1.48-8.80), P = 0.0525; Infecciones urinarias asociadas a sonda 7.10 (95% CI 3.067-13.999) a 2.56 (95% CI 0.697-6.553), P = 0.0817; respectivamente. Microorganismos: 63 de 99 (83.6%) microorganismos aislados fueron bacterias gram-negativas (36.5% resistentes), 19 (19.2%) bacterias gram-positivas y 17 (17.2%) infecciones por Candida spp. CONCLUSIONES: Los sistemas de vigilancia local aportan información para mejorar las tasas de infección nosocomial

Trends in nosocomial infections and multidrug-resistant microorganisms in Spanish pediatric intensive care units.

INTRODUCTION: Nosocomial infections (NI) are a major healthcare problem. National surveillance systems enable data to be compared and to implement new measures to improve our practice. METHODS: A multicentre, prospective, descriptive and observational study was conducted using the data from surveillance system for nosocomial infections created in 2007 for Spanish pediatric intensive care units. Data were collected for one month, between 01 and 31 March, for every study year (2008-2012). The objective was to report 5-years of NI surveillance data, as well as trends in infections by multidrug resistant organisms in Spanish pediatric intensive care units. RESULTS: A total of 3667 patients were admitted to the units during the study period. There were 90 (2.45%) patients with nosocomial infections. The mean rates during the 5 years study were: central line-associated bloodstream infection, 3.8/1000 central venous catheter-days, Ventilator-associated pneumonia 7.5/1000 endotracheal tube-days, and catheter-associated urinary tract infections 4.1/1000 urinary catheter-days. The comparison between the 2008 and 2009 rates for nosocomial infections did not show statistically significant differences. All rates homogeneously decreased from 2009 to 2012: central line-associated bloodstream infection 5.83 (95% CI 2.67-11.07) to 0.49 (95% CI 0.0125-2.76), P=0.0029; ventilator-associated pneumonia 10.44 (95% CI 5.21-18.67) to 4.04 (95% CI 1.48-8.80), P=0.0525; and Catheter-associated urinary tract infections 7.10 (95% CI 3.067-13.999) to 2.56 (95% CI 0.697-6.553), P=0.0817; respectively. The microorganism analysis: 63 of the 99 isolated bacteria (63.6%) were Gram-negative bacteria (36.5% were resistant), 19 (19.2%) Gram-positive bacteria, and 17 (17.2%) were Candida spp. infections. CONCLUSIONS: The local surveillance systems provide information for dealing with nosocomial infections rates.