Daily Sepsis Research Analysis

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are preventable health-care-associated infections (HAIs) that cause considerable morbidity and mortality. Understanding the epidemiology of CLABSIs through large, quality-assured, hospital-based datasets could help to enable development of preventive protocols suited to specific health-care systems. We aimed to describe the profile of CLABSIs in intensive care units (ICUs) at tertiary care centres in India. METHODS: We obtained data from around 200 adult, paediatric, and neonatal ICUs at 54 hospitals reporting to the Indian HAI surveillance network over a period of 7 years. All hospitals conducted bloodstream infection surveillance using standardised protocols. Cases of CLABSI were recorded on standard case report forms and were submitted to the HAI surveillance database. Denominator data (patient-days and central line-days) were entered monthly. Data quality was evaluated by a central team at the All-India Institute of Medical Sciences (New Delhi, India). We calculated CLABSI rates per 1000 central line-days and central-line utilisation ratio (CLUR) by year and ICU type (adult, paediatric, or neonatal). Commonly reported pathogens were ranked and the proportions of priority pathogens showing antimicrobial resistance were also estimated for each 1-year period and each ICU type. FINDINGS: During the surveillance period from May 1, 2017 to April 30, 2024, 8629 laboratory-confirmed CLABSI events, 3 054 124 patient-days, and 977 052 central line-days were recorded. The overall pooled CLABSI rate was 8·83 per 1000 central line-days and the pooled CLUR was 0·32. CLABSI rates were 8·68 per 1000 central line-days in adult ICUs (CLUR 0·38), 6·71 per 1000 central line-days in paediatric ICUs (0·27), and 13·86 per 1000 central line-days in neonatal ICUs (0·11). Among the total 10 042 pathogens reported, 8981 (89·4%) were bacterial and 1061 (10·6%) were fungal; Klebsiella pneumoniae (2294 [22·8%] isolates) and Acinetobacter baumannii (2047 [20·4%] isolates) were the most frequently reported for each ICU type. Among isolates tested, resistance to carbapenem was found to be highest in A baumannii (1607 [87·1%] resistant isolates of 1846 tested) and K pneumoniae (1589 [77·7%] of 2046). INTERPRETATION: This is the first large-scale observational study and standardised surveillance report of CLABSI in India. The data generated from this network provide a valuable opportunity for a quality improvement-based approach for the reduction of CLABSI. FUNDING: US Centers for Disease Control and Prevention cooperative agreement with the All-India Institute of Medical Sciences (New Delhi, India). TRANSLATION: For the Hindi translation of the abstract see Supplementary Materials section.

OBJECTIVES: Accurate diagnosis of sepsis is needed to initiate life-saving treatment decisions. Biomarkers capable of identifying both acute infection and sepsis are required to assist clinicians. METHODS: A real-life heterogeneous cohort of 388 patients with suspected acute infections was recruited at presentation to the ED. Nine emerging host-response biomarkers (MyD88, MMP-8, leptin, ENA-78, fractalkine, PD- L1, pentraxin-3, TRAIL, and GLP-1) were quantified using a multiparameter assay. We performed AUROC analysis for the endpoints bacterial infection, sepsis, and 30-day mortality. We further assessed diagnostic performance when combining these biomarkers using a machine learning algorithm. RESULTS: Particularly, MyD88, PD-L1, and pentraxin-3 presented high AUROCs for the endpoints bacterial infection (≥0.87), sepsis (≥0.81), and 30-day mortality (≥0.71). Seven out of the nine investigated biomarkers showed statistically significant discrimination for all three endpoints. A combined algorithm via the XGBoost model using pentraxin-3, MyD88, and GLP-1 was used for sepsis prediction, with an AUROC of 0.89, higher than clinical assessment via NEWS-2 (0.83) or procalcitonin (0.81). CONCLUSION: Pentraxin-3, MyD88, GLP-1, and PD-L1 are a promising complementary set of biomarkers for risk assessment and stratification. When a trained multiparameter classifier is used, the combination of biomarkers results in a valid tool for sepsis diagnosis. TRIAL REGISTRATION: DRKS00020521, DRKS00017395.

BACKGROUND: Most sepsis patients develop sepsis-associated acute kidney injury (SA-AKI), which poses a significant threat to survival and lacks specific treatment. To date, there are no published randomized controlled trials that have established a link between albumin use and SA-AKI development in sepsis. Therefore, it is unclear whether albumin use may influence the risk of SA-AKI. METHODS: The present study employed a target trial emulation using observational data to track adult sepsis patients initially admitted to the intensive care unit at Beth Israel Deaconess Medical Center, Boston, Massachusetts, for a period of 7 d from 2008 to 2022. Immortal time bias was controlled using the clone-censor-weight (CCW) method, along with a new-user design to address current user bias. The exposure variable was the early administration of albumin following the onset of sepsis. Based on albumin use, patients were classified into two groups: the albumin group (n = 27,088) and the no albumin group (n = 27,088). The primary outcome was the development of SA-AKI, and the secondary outcome was 7-day all-cause mortality. The primary outcome was analyzed using competing risk analyses. Furthermore, sensitivity and subgroup analyses were also performed. RESULTS: Among the 27,088 patients analyzed, albumin administration was associated with a significantly higher SA-AKI risk (relative difference = 3.47%, 95% CI 1.76-5.23) compared to non-administration. There was no clinically meaningful difference in 7-day survival (relative difference = 0.05%, 95% CI -2.30 to 2.45). Sensitivity analyses consistently supported these results. All these analyses were conducted on data that were collected after CCW. CONCLUSIONS: Early albumin administration may increase the risk of SA-AKI in sepsis patients without conferring a short-term survival benefit. These results underscore the need for a rigorous risk-benefit assessment when incorporating albumin into sepsis resuscitation protocols and highlight the need for further clinical validation. However, it is important to exercise caution when interpreting the conclusions of this study, given its exploratory and preliminary nature.