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Published year: 20143
Sepsis survivors monitoring and coordination in outpatient health care (SMOOTH): study protocol for a randomized controlled trial
SepNet - German Competence Network Sepsis

Abstract (Expand)

BACKGROUND Sepsis sequelae include critical illness polyneuropathy, myopathy, wasting, neurocognitive deficits, post-traumatic stress disorder, depression and chronic pain. Little is known howlong-term …m sequelae following hospital discharge are treated. The aim of our study is to determine the effect of a primary care-based, long-term program on health-related quality of life in sepsis survivors. METHODS/DESIGN In a two-armed randomized multicenter interventional study, patients after sepsis (n = 290) will be assessed at 6, 12 and 24 months. Patients are eligible if severe sepsis or septic shock (ICD-10), at least two criteria of systemic inflammatory response syndrome (SIRS), at least one organ dysfunction and sufficient cognitive capacity are present. The intervention comprises 1) discharge management, 2) training of general practitioners and patients in evidence-based care for sepsis sequelae and 3) telephone monitoring of patients. At six months, we expect an improved primary outcome (health-related quality of life/SF-36) and improved secondary outcomes such as costs, mortality, clinical-, psycho-social- and process-of-care measures in the intervention group compared to the control group. DISCUSSION This study evaluates a primary care-based, long-term program for patients after severe sepsis. Study results may add evidence for improved sepsis care management. General practitioners may contribute efficiently to sepsis aftercare. TRIAL REGISTRATION U1111-1119-6345. DRKS00000741, CCT-NAPN-20875 (25 February 2011).

Authors: Konrad Schmidt, Paul Thiel, Friederike Mueller, Katja Schmuecker, Susanne Worrack, Juliane Mehlhorn, Christoph Engel, Katja Brenk-Franz, Stephan Kausche, Ursula Jakobi, Anne Bindara-Klippel, Nico Schneider, Antje Freytag, Dimitry Davydow, Michel Wensing, Frank Martin Brunkhorst, Jochen Gensichen

Date Published: 1st Dec 2014

Publication Type: Journal article

Human Diseases: disease by infectious agent

Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study.
SepNet - German Competence Network Sepsis

Abstract (Expand)

INTRODUCTION: Current sepsis guidelines recommend antimicrobial treatment (AT) within one hour after onset of sepsis-related organ dysfunction (OD) and surgical source control within 12 hours. The … objective of this study was to explore the association between initial infection management according to sepsis treatment recommendations and patient outcome. METHODS: In a prospective observational multi-center cohort study in 44 German ICUs, we studied 1,011 patients with severe sepsis or septic shock regarding times to AT, source control, and adequacy of AT. Primary outcome was 28-day mortality. RESULTS: Median time to AT was 2.1 (IQR 0.8 - 6.0) hours and 3 hours (-0.1 - 13.7) to surgical source control. Only 370 (36.6%) patients received AT within one hour after OD in compliance with recommendation. Among 422 patients receiving surgical or interventional source control, those who received source control later than 6 hours after onset of OD had a significantly higher 28-day mortality than patients with earlier source control (42.9% versus 26.7%, P <0.001). Time to AT was significantly longer in ICU and hospital non-survivors; no linear relationship was found between time to AT and 28-day mortality. Regardless of timing, 28-day mortality rate was lower in patients with adequate than non-adequate AT (30.3% versus 40.9%, P < 0.001). CONCLUSIONS: A delay in source control beyond 6 hours may have a major impact on patient mortality. Adequate AT is associated with improved patient outcome but compliance with guideline recommendation requires improvement. There was only indirect evidence about the impact of timing of AT on sepsis mortality.

Authors: F. Bloos, D. Thomas-Ruddel, H. Ruddel, C. Engel, D. Schwarzkopf, J. C. Marshall, S. Harbarth, P. Simon, R. Riessen, D. Keh, K. Dey, M. Weiss, S. Toussaint, D. Schadler, A. Weyland, M. Ragaller, K. Schwarzkopf, J. Eiche, G. Kuhnle, H. Hoyer, C. Hartog, U. Kaisers, K. Reinhart

Date Published: 3rd Mar 2014

Publication Type: Not specified

Human Diseases: bacterial infectious disease

External ventricular drain infections: risk factors and outcome
SepNet - German Competence Network Sepsis

Abstract (Expand)

External ventricular drainage (EVD) is frequently used in neurosurgery to drain cerebrospinal fluid in patients with raised intracranial pressure. We performed a retrospective single center study in … order to evaluate the incidence of EVD-related infections and to identify underlying risk factors. 246 EVDs were placed in 218 patients over a 30-month period. EVD was continued in median for 7 days (range 1-44). The cumulative incidence of EVD-related infections was 8.3% (95% CI, 5.3-12.7) with a device-associated infection rate of 10.4 per 1000 drainage days (95% CI, 6.2-16.5). The pathogens most commonly identified were coagulase-negative Staphylococcus (62%) followed by Enterococcus spp. (19%). Patients with an EVD-related infection had a significantly longer ICU (11 versus 21 days, P \textless 0.01) and hospital stay (20 versus 28.5 days, P \textless 0.01) than patients without. Median total duration of external drainage was twice as long in patients with EVD-related infection (6 versus 12 days, P \textless 0.01). However, there was no significant difference in the duration between first EVD placement and the occurrence of EVD-related infection and EVD removal in patients without EVD-related infection (6 versus 7 days, P = 0.87), respectively. Interestingly no risk factor for EVD-related infection could be identified in our cohort of patients.

Authors: S. Hagel, T. Bruns, M. W. Pletz, C. Engel, R. Kalff, C. Ewald

Date Published: 2014

Publication Type: Journal article

Human Diseases: disease by infectious agent

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