Infectious Disease & Sepsis

HEMOPERFUSION USING THE LPS-SELECTIVE MESOPOROUS POLYMERIC ADSORBENT IN SEPTIC SHOCK: A MULTICENTER RANDOMIZED CLINICAL TRIAL

This multicenter randomized controlled trial evaluated the efficacy and safety of Efferon LPS hemoperfusion cartridges in patients with intra-abdominal sepsis (IAS) and septic shock. The study included a group undergoing EHP procedures (n = 38) and a control group receiving conventional protocols (n = 20). EHP resulted in significant improvements, including increased mean arterial pressure (MAP) and partial pressure arterial oxygen/fraction of inspired oxygen ratio (PaO2/FiO2), decreased norepinephrine doses, and improved multiorgan function based on Sequential Organ Failure Assessment (SOFA) scores. Notably, EHP facilitated faster weaning from mechanical ventilation. Early 3-day mortality was reduced in the Efferon LPS group, and laboratory tests showed rapid normalization of biomarkers. These findings demonstrate that EHP with Efferon LPS is a safe procedure for resolving septic shock and restoring clinical biomarkers in IAS patients.

Rey S, Kulabukhov VM, Popov…

A Prospective phase IIA Multicenter Double-Blinded Randomized Placebo-Controlled Clinical Trial Evaluating the Efficacy and Safety of Inhaled Tobramycin in Patients with Ventilator-Associated Pneumonia (iToVAP)

A prospective, multicenter, double-blinded, randomized, and placebo-controlled clinical trial was conducted to investigate the efficacy of inhaled Tobramycin as an adjunctive treatment for ventilator-associated pneumonia caused by Gram-negative pathogens. The study involved 26 patients in medical and surgical ICUs, with 14 patients assigned to receive Tobramycin Inhal and 12 patients forming the control group. The results demonstrated a significantly higher rate of microbiological eradication of Gram-negative pathogens in the intervention group compared to the control group (p < 0.001). In fact, the probability of eradication was 100% in the intervention group, indicating promising efficacy. However, despite successful eradication, no notable benefits were observed in terms of reduced systemic anti-infective therapy, shorter ICU stay, or improved patient survival.

https://www.sciencedirect.com/science/article/pii/S2352556823000577

Another new retrospective cohort study that compares the effectiveness of adding fludrocortisone to hydrocortisone vs hydrocortisone alone among patients with septic shock using target trial emulation.

The study found that among 88,275 patients with septic shock receiving norepinephrine who initiated hydrocortisone treatment, the addition of fludrocortisone to hydrocortisone was associated with a 3.7% lower adjusted absolute risk difference in the primary composite outcome of mortality or discharge to hospice compared with initiation of hydrocortisone alone.

The study concludes that among patients with septic shock receiving norepinephrine who initiated hydrocortisone treatment, the addition of fludrocortisone was associated with lower rates of the composite of death or discharge to hospice compared with hydrocortisone alone.

Bosch NA, Teja B, Law AC, Pang B, Jafarzadeh SR, Walkey AJ. Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock. JAMA Intern Med. 2023;183(5):451–459. doi:10.1001/jamainternmed.2023.0258