Infectious Disease & Sepsis

A two-day course of antibiotics for complicated appendicitis Appendicitis

This open-label, non-inferiority trial conducted across 15 Dutch hospitals assessed the efficacy and safety of reducing postoperative intravenous antibiotic duration from 5 days to 2 days in patients aged ≥8 years with complex appendicitis, amidst rising concerns regarding antimicrobial resistance. The primary endpoint was a composite of infectious complications and mortality within a 90-day post-appendicectomy period. The trial showed no significant difference in the primary endpoint between the two groups, suggesting that a shorter antibiotic course is non-inferior to a longer one, with additional benefits of lowered adverse effects, and potentially reduced hospital stay and costs.

The IMMUNOCITRE Trial

Enteral citrulline supplementation does not improve SOFA score on day 7 in mechanically ventilated critically ill patients!

The authors conducted a multicenter, randomized, double-blind trial in four French ICUs from September 2016 to February 2019. They evaluated the effect of enteral L-citrulline on organ dysfunction and selected immune parameters in mechanically ventilated ICU patients who did not have sepsis or septic shock. The main outcome was the Sequential Organ Failure Assessment (SOFA) score on day 7. The results showed no significant difference in the SOFA score on day 7 between the L-citrulline and placebo groups (4 [IQR, 2-6] vs. 4 [IQR, 2-7]; p = 0.9). However, the L-citrulline group had significantly higher plasma arginine levels on day 3, without any observed effect on immune parameters.

Enteral citrulline supplementation versus placebo on SOFA score on day 7 in mechanically ventilated critically ill patients: the IMMUNOCITRE randomized clinical trial…

Lower vs Higher Fluid Volumes in Adult Patients With Sepsis

In a systematic review updating the optimal IV fluid volume strategy for adult sepsis patients, the study compared lower vs. higher fluid volumes. The results, based on trials with low risk of bias, indicated that lower IV fluid volumes have minimal to no impact on all-cause mortality (Relative Risk: 0.99, 97% CI, 0.89-1.10) or serious adverse events (Relative Risk: 0.95, 97% CI, 0.83-1.07) compared to higher volumes. However, these conclusions come with some imprecision, not ruling out potential benefits or risks. Notably, the trials did not report on health-related quality of life.

Lower vs Higher Fluid Volumes in Adult Patients With Sepsis - CHEST (chestnet.org)

Activities of the newer antibiotics against gram-negative resistant organisms.