Infectious Disease & Sepsis

Timing of Vasopressin Addition to Norepinephrine and Efficacy Outcomes in Patients With Septic Shock

1. 🏥 The trial examined the effect of the timing of vasopressin (AVP) addition to norepinephrine (NE) on septic shock patients' clinical outcomes, conducted retrospectively in a single health system over several sites from January 2018 to December 2019. 🕰️

2. 👥 The trial included 243 patients out of the initial 497, with patients being above 18, diagnosed with septic shock, and having received NE followed by AVP. Those with certain medical conditions or who were pregnant were excluded. 🚫

3. 🕑 Two groups were formed based on when AVP was added to NE treatment: an early group (within 3 hours) and a late group (after 3 hours). ⌛

4. 📊 Both groups had balanced characteristics at NE initiation. Still, differences were noticed in the SOFA score, weight, administration of hydrocortisone and vitamin C, and fluid dose prior to NE…

How Fast Should a Fluid Bolus be Given? (icureach.com)

1. 📚 A systematic review included 85 studies and 3601 patients, investigating the impact of rapid infusion rates (completed within 30 minutes) on stroke volume or cardiac output. It found a potential enhancement of these parameters due to effectively increased venous return and preload. 🔎✅🏥

2. 💧 Fluid volumes used in the review's trials varied: less than 500 mL in 12.7% of cases, 500 mL in 79.4%, and more than 500 mL in 7.9% of cases. 📏📊💧

3. 📈 Despite positive hemodynamic outcomes, the impact of rapid infusion rates on patient-centered outcomes remains uncertain, signaling a need for more research in this area. 🔄❔🚑

4. ⏱ A randomized controlled trial involving 10,520 critically ill patients compared infusion rates of 333 mL/hour (slower) vs. 999 mL/hour (faster). Mortality rates showed no significant difference between the groups, indicating that infusion rates don't dramatically impact survival. ☠️⚖️🕓

5. 💡…

Efficacy and safety of sulbactam–durlobactam versus colistin for the treatment of patients with serious infections caused by Acinetobacter baumannii–calcoaceticus complex: a multicentre, randomised, active-controlled, phase 3, non-inferiority clinical trial (ATTACK) - The Lancet Infectious Diseases

The urgent need for effective antibiotics against carbapenem-resistant Acinetobacter baumannii–calcoaceticus complex (ABC) infections led to a phase 3 randomized controlled trial comparing the efficacy and safety of sulbactam–durlobactam versus colistin. The trial involved adults with confirmed ABC-related infections, such as hospital-acquired bacterial pneumonia, ventilator-associated bacterial pneumonia, ventilated pneumonia, or bloodstream infections. Patients received either sulbactam–durlobactam or colistin, in combination with imipenem–cilastatin, as background therapy for 7-14 days.

The primary efficacy endpoint was 28-day all-cause mortality in patients with confirmed carbapenem-resistant ABC. The study concluded that sulbactam–durlobactam was non-inferior to colistin (28-day all-cause mortality of 19% versus 20%). Additionally, sulbactam–durlobactam showed a significantly lower incidence of nephrotoxicity compared to colistin. The trial demonstrated that sulbactam–durlobactam could…

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…