Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance - A Randomized Clinical Trial
Question Can piperacillin-tazobactam be used as carbapenem-sparing therapy in patients with bloodstream infections caused by ceftriaxone-resistant Escherichia coli or Klebsiella pneumoniae?
Findings In this noninferiority randomized clinical trial that included 391 patients with E coli or K pneumoniae bloodstream infection and ceftriaxone resistance, the 30-day mortality rate for patients treated with piperacillin-tazobactam compared with meropenem was 12.3% vs 3.7%, respectively. The difference did not meet the noninferiority margin of 5%.
Meaning These findings do not support piperacillin-tazobactam compared with meropenem for these infections.
Link
https://jamanetwork.com/journals/jama/fullarticle/2702145?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jama.2018.12163
Showing posts with label Learning Hubs. Show all posts
Showing posts with label Learning Hubs. Show all posts
Antibiogram (Medical) Universiti Kebangsaan Malaysia Medical Centre (UKMMC)
With all the effort of Antimicrobial Stewardship Committee of UKMMC, our antibiogram (medical) finally officially launch in 2017. With this protocol, it facilitate our antibiotic prescription decision and slow down the development toward antibiotic resistance. Congratulation to AMS team UKMMC.
#AMSMalaysia #MAMSIG
#AMSMalaysia #MAMSIG
Modified Sepsis Related Organ Failure Assessment Score (MSOFA)
MSOFA: An Essential Step Ahead, but Are We Spending Too Much Time on the SOFA?
SEPSIS 3 recommended the use of SOFA score to assess the organ failure status. However, the criteria are quite complex. We recommend the use of modified SOFA (MSOFA) to adapt to the local minimum setting.
The mortality rate was 9% for patients with no organ failure on admission, increasing to 82.6% for patients with four or more failing organs similar for both SOFA and MSOFA score.
When two organ systems were failing, as defined by a SOFA/MSOFA of 3 or 4, the presence of respiratory failure as one of the two failing systems was associated with a lower mortality rate than any other combination. For combinations of other organs, there was a narrow range of mortality (65% to 74%), and no identifiable pattern of increased risk with any specific organ.
SOFA score Mortality (noted: MSOFA have a similar mortality as SOFA.
Below are the link to assess MSOFA score template for easy downloading and used.
To download this file please follow this link :
powerpoint : https://drive.google.com/open?id=1j1bGoA7yAv4cshuLqR9_qcnM8VIAyx5H
png file : https://drive.google.com/open?id=19UczWkza9U6udO-oBxUn8vVjjU1qRyxN
#SOFAScore #MSOFA
SEPSIS 3 recommended the use of SOFA score to assess the organ failure status. However, the criteria are quite complex. We recommend the use of modified SOFA (MSOFA) to adapt to the local minimum setting.
The mortality rate was 9% for patients with no organ failure on admission, increasing to 82.6% for patients with four or more failing organs similar for both SOFA and MSOFA score.
When two organ systems were failing, as defined by a SOFA/MSOFA of 3 or 4, the presence of respiratory failure as one of the two failing systems was associated with a lower mortality rate than any other combination. For combinations of other organs, there was a narrow range of mortality (65% to 74%), and no identifiable pattern of increased risk with any specific organ.
SOFA score Mortality (noted: MSOFA have a similar mortality as SOFA.
SOFA Score
|
Mortality if initial score
|
Mortality if highest score
|
0-1
|
0.0%
|
0.0%
|
2-3
|
6.4%
|
1.5%
|
4-5
|
20.2%
|
6.7%
|
6-7
|
21.5%
|
18.2%
|
8-9
|
33.3%
|
26.3%
|
10-11
|
50.0%
|
45.8%
|
12-14
|
95.2%
|
80.0%
|
>14
|
95.2%
|
89.7%
|
Mean SOFA Score
|
Mortality
|
0-1.0
|
1.2%
|
1.1-2.0
|
5.4%
|
2.1-3.0
|
20.0%
|
3.1-4.0
|
36.1%
|
4.1-5.0
|
73.1%
|
>5.1
|
84.4%
|
To download this file please follow this link :
powerpoint : https://drive.google.com/open?id=1j1bGoA7yAv4cshuLqR9_qcnM8VIAyx5H
png file : https://drive.google.com/open?id=19UczWkza9U6udO-oBxUn8vVjjU1qRyxN
#SOFAScore #MSOFA
Corticosteroid Therapy for Sepsis : A Clinical Practice Guideline - The BMJ Aug 2018
15 August 2018
The BMJ
WHAT YOU NEED TO KNOW
• Sepsis is a syndrome of life threatening infection with organ dysfunction, and most guidelines do not advise use of corticosteroids to treat it in the absence of refractory shock
• Two new trials of corticosteroid treatment for sepsis came to differing conclusions
• Corticosteroids may reduce the risk of death by a small amount and increase neuromuscular weakness by a small amount, but the evidence is not definitive
• This guideline makes a weak recommendation for corticosteroids in patients with sepsis; both steroids and no steroids are reasonable management options
• Fully informed patients who value avoiding death over quality of life and function would likely choose corticosteroids
For Further Reading, please go to the follow link
https://www.bmj.com/content/362/bmj.k3284
Acknowledgement to The BMJ for permission for non profit reused.
Immune effects of corticosteroids in sepsis
2 Aug 2018
Immune effects of corticosteroids in sepsis.
In sepsis, there is sufficient evidence from animals and humans studies to support that glucocorticoids modulate innate immunity to promote the resolution of inflammation and organs failure.
Much less is known about the immune effects of mineralocorticoids though increasing evidence from laboratory investigations suggested that they might favorably impact the outcome from sepsis. So far, survival benefits in adults with septic shock have been shown only for the combination of hydrocortisone plus fludrocortisone and not from the administration of hydrocortisone alone.
by Heming et al. (2018)
Heming NM, Sivanandamoorthy SM, Meng PM, Bounab RM, Annane DM. Immune effects of corticosteroids in sepsis. Frontiers in Immunology. July 2018;9:1736.
For further reading, please click the link
Immune effects of corticosteroids in sepsis.
In sepsis, there is sufficient evidence from animals and humans studies to support that glucocorticoids modulate innate immunity to promote the resolution of inflammation and organs failure.
Much less is known about the immune effects of mineralocorticoids though increasing evidence from laboratory investigations suggested that they might favorably impact the outcome from sepsis. So far, survival benefits in adults with septic shock have been shown only for the combination of hydrocortisone plus fludrocortisone and not from the administration of hydrocortisone alone.
by Heming et al. (2018)
Heming NM, Sivanandamoorthy SM, Meng PM, Bounab RM, Annane DM. Immune effects of corticosteroids in sepsis. Frontiers in Immunology. July 2018;9:1736.
For further reading, please click the link
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