Biomarkers for streamlining of Antibiotics in patients with severe infection.
|
|
- Jessica Phelps
- 5 years ago
- Views:
Transcription
1 Biomarkers for streamlining of Antibiotics in patients with severe infection. Philipp Schuetz, MD Feb,
2 You see this patient in your ICU -3d: Cough, Dyspnoe, Sputum T: 38.8 C, basal RG s (?) 8-9h: 9h: Culture (Sputum, blood) Legionella Ag, Serology, PCR Laboratory values 1) Antibiotic Therapy needed? 2) If yes for how long
3 Fraction of total patients Possible harm of UNDER-TREATMENT 1 Survival Fraction Cumulative Effective Antimicrobial Initiation Time from hypotension onset (hrs) Kumar A. et al., Crit Care Med 2006, 34:1286
4 Possible harm of OVER-TREATMENT r = 0.75 Albrich WC, Emerg Inf Dis 04
5 Biomarker guided therapy in the ICU Signs & Symptoms? - Temperature, BP - - SIRS criteria Imaging? Cultures? - Blood, Sputum, Tissue Laboratory? - Leukocytes / WBC - ESR, CRP, SAA - Neopterin, strem-1 Other? Condition Diabetes Hyperglycemia Hypotension Shock Infection Sepsis Biomarker Blood glucose Lactate / ScvO 2 Procalcitonin?! Treatment Insulin: Dose / type Fluid: Amount / rate Antibiotics Initiation / duration
6 Thyrocytes Thyroxine Hormokines Hormones expressed like Cytokines C-Cells Calcitonin Thyroid Leukocytes Perit. Macrophages Spleen Lung Liver Kidney Adrenals Brain Spine Stomach Pancreas Small Intestine Colon Heart Muscle Skin Adipose Tissue Testes Healthy Sepsis Inflammation Bacterial Interferons Toxins IL-1 viral Infection TNF Procalcitonin Müller B, et al. J Clin Endocrinol Metab 2001
7 Inflammatory Host Response Golgi apparatus ProCT Bacterial Infection (e.g.endotoxin) ProCT IL-1 TNF IFN "hormokine" CT-mRNA ALL Other Organs Constitutive Secretion viral Infection CT Golgi apparatus CT ProCT endocrine Linscheid P, et al Crit Care Med 04; 32: Endocrinology 03; 144: & 05; 146: CT-mRNA Regulated Secretion Thyroidal C-cells Thyroidal C-cell (camp, Mg, Gastrin)
8 Cytokines & Hormokines upon Infection TNFa IL6 PCT CRP ug/ml 5 4 Fatal Outcome h Endotoxin iv adapted from Meisner M, J Lab Med 1999 Dandona P, et al. J Clin Endocrinol Metab 1994 Harbarth S, AJRCCM 2001 Becker KL, J Clin Endocrinol Metab 2004
9 30 Studien, 3244 patients pooled sensitivity: 0.77 (95%CI ) pooled specificity 0.79 (95% CI ) Lancet Infect Dis Jan 31.
10 Medicine Murphy s Law Dynamic Continuum RTI Common Cold Bronchitis Pneumonia Sepsis Setting Primary Care Emergency Room Hospital ICU Prevalence EU 500Mio 50Mio 5Mio 0.05Mio Mortality <<1% <1-3% 5-20% 30-70% better to start antibiotic therapy & to hospitalize early!?
11 Proof-of-Concept RCTs Respiratory Tract Infection Standard Group (without PCT-result) Randomization PCT Group Treatment Based on Standard Guidelines Follow-up After Days PCT (ng/ml) < >0.5 Antimicrobial Treatment NO! No Yes YES! Clinical and PCT Control After 6-24h
12 Antibiotic prescriptions (%) The ProResp-Study Antibiotic Use in LRTI 83% 44% 100 Standard group PCT group p = 0.03 p = p < p = p < CAP Bronchitis AECB Asthma Others Christ-Crain M et al, Lancet 04
13 PCT Rules out Mortality in High Risk Patients our main finding was that in patients with CAP, patients with a PCT 0.1 ng/ml had a low 30-day mortality rate, even in patients defined as high risk by established clinical risk prediction rules. Huang, Ann Emerg Med Jul;52(1):48-58.e2.
14 The ProHOSP - Study A novel Concept to optimize Allocation of Health Care Resources
15 Differential effects of PCT - Guidance Depending on type and severity of LRTI Schuetz P, ProHOSP, n=1359, JAMA, 2009
16 Safety of PCT Guided Antibiotic Stewardship SAE n=234 (17.2%) SAE n=168 (18.1%) Schuetz P, ProHOSP, n=1359, JAMA, 2009
17 How about Safety of Control Patients? Risk of Drug related Adverse Events increases with duration of AB Therapy adjusted OR: 1.08 (95%CI ) 42% increase in AB side effects in ProHOSP control patients (28.1% vs 19.8%, p<0.001) Schuetz P, ProHOSP, n=1359, JAMA, 2009 Schuetz P, Virulence, 2009
18 PCT for Antibiotic Stewardship in the ICU?
19 Prognostic value of PCT in sepsis Survivors Deceased SIRS Harbarth et al. AJRCCM 2001
20 Similar to high risk patients for PE don t waste time! Patient Admitted to the ICU with Systemic Inflammatory Response Syndrome (SIRS) Clinical Evaluation Measurement of Procalcitonin Microbiological Workup No Life Threatening Disease, Not Immuno-Compromised Life Threatening Disease, High Suspicion of Bacterial Infection No Identification Identification of Organism Consider Initial Empiric Antibiotic Therapy Evaluation of Procalcitonin Cut off Range <0.25 > > >1.0 Exclusion of Contamination NO AB! No AB AB Yes AB YES! Reevaluation of the Clinical Course and Procalcitonin After 6-24 h, 48h, 72h No Infectious Cause of Fever Infection PCT not decreasing Patient Deteriorating Consider Surgery Drainage, Removal of Foreign Body or Obstruction Stop Antibiotics Schuetz P, Curr Opin Crit Care, 07
21 The PRORATA Study: Multicenter, ICU, Sepsis n = 621 Antibiotic Duration Outcome 23% more antibiotic free days alive Bouadma, Lancet 2010
22 The PRORATA Study Subgroups Antibiotic Duration Outcome Bouadma, Lancet 2010
23 PCT has pitfalls as a marker of infections Cut-off range depends on clinical setting PCT does not replace the doctor ( pretest-probability!) Co-Morbidities? Setting? Site & Extent of Infection? Assay? False positives & negative values occur pos: Surgery, cardiac shock, cytokine storm, neg: early, localised, subacute Single PCT measurement is of limited value Course & prognosis of disease? Withhold antibiotic therapy? Christ-Crain M, Muller B, Swiss Med Wkly 05; 135:
24 Procalcitonin to Diagnose Postoperative Infection after Cardiac Surgery 100 patients, 16 with infection postoperatively White blood count Procalcitonin AUC of procalcitonin: 0.88 [ ]) Jebali, 2007, Anesthesiology
25 PCT to guide duration of AB therapy in surgical ICU patients: a randomized controlled trial PCT concentrations during follow up Choice and Duration of Antibiotic therapy 110 Surgical ICU patients with suspicion of sepsis Stopp AB if clinical signs improved and PCT <1 ng/ml or the PCT value was >1 ng/ml, but had dropped to 25 to 35% of the initial value over three days. Similar outcomes (SOFA & mortality) Conclusion: Monitoring of PCT is a helpful tool for guiding AB treatment in surgical intensive care patients. Hochreiter et all, CC 2009
26 14 randomised-controlled Trials, 4221 Patients with acute Respiratory Infections
27 The effect of PCT guidance is dependent on acuity of patients Schuetz P, Clinical Infectious Disease, 2012
28 Safety of PCT Protocols: Results from an IPD Metaanalysis 0.76 (0.61, 0.95) Schuetz P, CID 2012
29 Recent Guidelines recommend PCT as an adjunctive tool in discriminating true infection from other inflammatory processes causing acute fever IDSA guidelines, 2008 Recently, biomarkers have been described as useful tools to safely reduce antibiotic treatment duration. Biomarkers can guide treatment duration by the application of predefined stopping rules for antibiotics. It has been shown that such rules work even in most severe cases, including pneumonia with septic shock, and even if clinicians are allowed to overrule the predefined stopping rule Woodhead, Clin Microbiol Infect 2011; 17(Suppl. 6): E1 E59 We suggest the use of low procalcitonin to assist the clinician in the discontinuation of empiric antibiotics when no evidence of infection is found (grade 2C) Surviving Sepsis Campaign Guidelines, Dellinger P, CCM, 2013
30 How about Choice of therapy?
31 Can PCT differentiate viral from bacterial CAP? n=103 with Influenza CAP, 46.6% with bacterial coinfection PCT cut-off of 0.8: Sens: 91%, Spec: 68%, NPV 91% AUC 0.90 (95% CI ) Cuquemelle et al, ICM 2011
32 How about Costs?
33 Is Procalcitonin testing Cost-effective? Cost: around 24 USD per measurement Heyland KH et al, CCM 2011
34 What doesn t work?
35 Therapy Escalation based on PCT levels? Jensen et al.; PASS Study; CCM 2011
36 but Antibiotics cause side effects! 50% surgical patients (we know that PCT increases in these patients!) Who is to blame: PCT or the intervention or the algorithm? Algorithm used very small PCT changes (variability?)
37 Crit Care Med Aug;40(8):
38 Procalcitonin: What is the Evidence?
39 How do we treat patients in clincial practice? PCT guided therapy with the new Biomarker-APP
40 Now available in the APP Stores PCT ProADM Biomarker
41 Selection
42 Enter new patient / risk score calculation CURB-65
43 Risk score calculation - PSI
44 Recommendation
45 Follow-up 48h
46 Follow-up Recommendation - History
47 References
48 Questions? (First Update is planned soon)
49 Conclusions: Biomarker guided antibiotic duration is a rational approach to prevent antibiotic overconsumption in the ICU setting Procalcitonin seems to be a reliable marker to assist clinicians in the decision to stopp antibiotics This concept has been validated in 14 RCTs including >4500 patients Antibiotic reduction of 30-70% depending on the setting Reduction in antibitoic related side effects No evidence for recurrent infection / adverse outcomes No evidence for Therapy escalation based on PCT Residual limitations include Few US data, high rate of non-compliance False positives & negative values occur ( 10%) Single PCT measurement of limited value Future RCTs need to validate this promising concept DOWNLOAD THE «BIOMARKER» APP IT`S FREE!!!
50 Thank you, that s all folks! Any Questions? Schuetzph@gmail.com
51
52 Disclosure slide Support for speaking engagements was provided by BioMerieux Inc. Brahms/Thermofisher
53 Prognostic YES! But can it change Outcomes?
54 Similar to high risk patients for PE don t waste time! Patient Admitted to the ICU with Systemic Inflammatory Response Syndrome (SIRS) Clinical Evaluation Measurement of Procalcitonin Microbiological Workup No Life Threatening Disease, Not Immuno-Compromised Life Threatening Disease, High Suspicion of Bacterial Infection No Identification Identification of Organism Consider Initial Empiric Antibiotic Therapy Evaluation of Procalcitonin Cut off Range <0.25 > > >1.0 Exclusion of Contamination NO AB! No AB AB Yes AB YES! Reevaluation of the Clinical Course and Procalcitonin After 6-24 h, 48h, 72h No Infectious Cause of Fever Infection PCT not decreasing Patient Deteriorating Consider Surgery Drainage, Removal of Foreign Body or Obstruction Stop Antibiotics Schuetz P, Curr Opin Crit Care, 07
55 PCT has pitfalls as a marker of infections Cut-off range depends on clinical setting PCT does not replace the doctor ( pretest-probability!) Co-Morbidities? Setting? Site & Extent of Infection? Assay? False positives & negative values occur pos: Surgery, cardiac shock, cytokine storm, neg: early, localised, subacute Single PCT measurement is of limited value Course & prognosis of disease? Withhold antibiotic therapy? Christ-Crain M, Muller B, Swiss Med Wkly 05; 135:
56 Biomarker guided therapy in the ICU Signs & Symptoms? - Temperature, BP - - SIRS criteria Imaging? Cultures? - Blood, Sputum, Tissue Laboratory? - Leukocytes / WBC - ESR, CRP, SAA - Neopterin, strem-1 Other? Condition Diabetes Hyperglycemia Hypotension Shock Infection Sepsis Biomarker Blood glucose Lactate / ScvO 2 Procalcitonin?! Treatment Insulin: Dose / type Fluid: Amount / rate Antibiotics Initiation / duration
57 % Survival in Hamsters Procalcitonin Hormokine -Mediator in Sepsis E.coli E.coli + hproct E.coli + ProCT-Ab ip E.coli + prophyl. ProCT-Ab %Survival in Hamsters h 12h 24h 36h 48h 60h 72h Nylen ES, et. al. Crit Care Med 1998, adapted
58 ProCT-Immunoneutralization in mammals Crit Care Med 02; 30: & J Endotox Res 03; 9: 1-8
59 What motivates YOU stopping antibiotics? We said 8 days Patient is stable Patient has no more fever Patient goes home Patient develops a rash Patient sits on toilet with diarrhea Renal function is deteriorating The fellow (attending) is changing Cultures came back negative pick your choice or add another J. Pugin
60 Antibiotic stewardship in primary Care? 1 Endpoint: Sickdays 40 P< % 30 30% 8.6 vs 8.7 d = 0.2 ( )* * Intention to treat Endpoint: Overall Antibiotic use Antibiotic Prescription (%) Sickdays Diarrhea (%) % - 77% % 10% 0% Antibiotic Exposure Control ProCT Briel M, Schuetz P et al, Arch Int Med
61 Antibiotic duration (days) The ProCAP Study Antibiotic Duration Antibiotic Prescriptoin (%) p < Standard group ProCT group Standard group ProCT group 10 0 AB started > 4d > 6d > 8d > 10d > 14d > 21d Shorter AB-Courses Fewer Resistances! But don t we have Guidelines in CAP to individually guide AB-Therapy? Christ-Crain M et al, Am J Respir Crit Care Med 2006
62 Recommendations for Future use / studies: Moderate Risk Situations (ED/CAP) Schuetz P, Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med. 2011;171:(15):
63 A Biomarker should embedded in pragmatic, setting-specific, prospectively validated safe and effective clinical algorithms Respiratory tract infections Intensive Care Unit Schuetz P et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. Jama. 2009;302:(10): Bouadma L et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375:(9713):463-74
64 Recommendations for Future use / studies: ICU / High risk Situations Schuetz P, Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med. 2011;171:(15):
65 What is Procalcitonin (PCT)?
66 Procalcitonin: Hype or Hope? Ever gave a talk on Procalcitonin?
The Usefulness of Sepsis Biomarkers. Dr Vineya Rai Department of Anesthesiology University of Malaya
The Usefulness of Sepsis Biomarkers Dr Vineya Rai Department of Anesthesiology University of Malaya 1 What is Sepsis? Whole Body Inflammatory State + Infection 2 Incidence and Burden of Sepsis in US In
More informationDisclosures. Objectives. Procalcitonin: Pearls and Pitfalls in Daily Practice
Procalcitonin: Pearls and Pitfalls in Daily Practice Sarah K Harrison, PharmD, BCCCP Clinical Pearl Disclosures The author of this presentation has no disclosures concerning possible financial or personal
More informationPCT. PCT in Bacterial Infections and Sepsis. Early Diagnosis. Assessment of Severity and Prognosis. Support for Therapeutic Decision Making
PCT PCT in Bacterial Infections and Sepsis Early Diagnosis Assessment of Severity and Prognosis Support for Therapeutic Decision Making Diagnosis and monitoring of sepsis Clinical need for earlier detection
More informationUsefulness of Procalcitonin in the management of Infections in ICU. P Damas CHU Sart Tilman Liège
Usefulness of Procalcitonin in the management of Infections in ICU P Damas CHU Sart Tilman Liège Procalcitonin Peptide 116 AA Produced by parenchymal cells during «sepsis»: IL1, TNF, IL6 : stimulators
More informationEarly infection diagnosis
Procalcitonin in the EMERGENCY DEPARTMENT Early infection diagnosis and risk assessment with Procalcitonin (PCT) Early differential diagnosis and therapy decision in the emergency department Antibiotic
More informationBIOMARKERS IN SEPSIS: DO THEY REALLY GUIDE US? Asist. Prof. M.D. Mehmet Akif KARAMERCAN Gazi University School of Medicine Depertment of Emergency
BIOMARKERS IN SEPSIS: DO THEY REALLY GUIDE US? Asist. Prof. M.D. Mehmet Akif KARAMERCAN Gazi University School of Medicine Depertment of Emergency Medicine 1 NO CONFLICT OF INTEREST 2 We do not fully understand
More informationESCMID Online Lecture Library. by author
What room for biomarkers in the management of anti-infective therapy Philippe Montravers Hôpital Bichat-Claude Bernard, Pole SUPRA APHP UFR Paris Diderot, Paris 7, Paris Cité Sorbonne Disclosures Speaker
More informationClinical Guide to Use of PROCALCITONIN. for Diagnosis and PCT-Guided Antibiotic Therapy
Clinical Guide to Use of PROCALCITONIN for Diagnosis and PCT-Guided Antibiotic Therapy The content of this booklet was kindly written by: Philipp Schuetz, MD, MPH Privat Dozent for Endocrinology and Internal
More informationAntimicrobial Stewardship in Community Acquired Pneumonia
Antimicrobial Stewardship in Community Acquired Pneumonia Medicine Review Course 2018 Dr Lee Tau Hong Consultant Department of Infectious Diseases National Centre for Infectious Diseases Scope 1. Diagnosis
More informationBiomarkers in sepsis. Dr S Omar University of Witwatersrand CHBAH Bara ICU
Biomarkers in sepsis Dr S Omar University of Witwatersrand CHBAH Bara ICU Procalcitonin PCT biomarker 1993- described as a sepsis associated protein Identical to the precursor protein of calcitonin which
More informationUse of surrogate inflammatory markers in the diagnosis & monitoring of patients with severe sepsis
Thursday 11 th June 2015 Use of surrogate inflammatory markers in the diagnosis & monitoring of patients with severe sepsis Dr Duncan Wyncoll Guy s & St Thomas NHS Trust, London Conflicts of Interest In
More informationUsing procalcitonin (PCT) to improve the odds in sepsis management
Using procalcitonin (PCT) to improve the odds in sepsis management Disclaimer This guide provides information for healthcare professionals on the optimal use of procalcitonin (PCT) testing and the subsequent
More informationClinical Guide to Use of PROCALCITONIN. for Diagnosis and Guidance of Antibiotic Therapy
Clinical Guide to Use of PROCALCITONIN for Diagnosis and Guidance of Antibiotic Therapy THE CONTENT OF THIS BOOKLET WAS KINDLY WRITTEN BY: Philipp SCHUETZ, MD, MPH Privat Dozent for Endocrinology and Internal
More informationProcalcitonin kinetics guided antibiotic management of the critically ill patient
Procalcitonin kinetics guided antibiotic management of the critically ill patient András LOVAS MD, PhD, EDIC, EDAIC University of Szeged, Hungary Department of Anaesthesiology and Intensive Therapy 19/11/2016,
More information6/29/2017. Role of Biomarkers in the Management of Heart Failure Patients. What s New in Biomarkers for HF Patients?
What s New in Biomarkers for HF Patients? Role of Biomarkers in the Management of Heart Failure Patients Lori B. Daniels, MD, MAS, FACC Professor of Medicine Director, Cardiovascular Intensive Care Unit
More informationBiomarkers in sepsis: Utility in critical care
Biomarkers in sepsis: Utility in critical care Fathima Paruk, PhD Charlotte Maxeke Johannesburg Academic Hospital and University of Witwatersrand Kumar A et al, Chest 2009; 136:1237-48. von Gunten et al
More informationUse of procalcitonin assay to streamline antibiotic usage. Dr Kristine Luk
Use of procalcitonin assay to streamline antibiotic usage Dr Kristine Luk Outline Procalcitonin physiology & kinetics Limitations Different settings - primary care & AED - critically ill patients - neutropenic
More informationADVANCES IN BIOMARKER TESTING FOR SEPSIS AND BACTERIAL INFECTIONS
ADVANCES IN BIOMARKER TESTING FOR SEPSIS AND BACTERIAL INFECTIONS ERIC H GLUCK MD JD FCCP FCCM DIRECTOR OF CRITICAL SERVICES SWEDISH COVENANT HOSPTIAL DISCLOSURES: Speaking engagements and consulting:
More informationAbstract. Introduction. that can safely discriminate between viral and bacterial infection
ORIGINAL ARTICLE 10.1111/j.1469-0691.2009.02709.x Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission a randomized
More informationBiomarcadores. orientação terapêutica
Biomarcadores estratificação do risco e orientação terapêutica Pedro Póvoa Faculdade de Ciências Médicas Universidade Nova de Lisboa Unidade de Cuidados Intensivos Médicos Hospital de São Francisco Xavier
More informationProcalcitonin as a biomarker of infectious diseases
REVIEW Korean J Intern Med 2013;28:285-291 Procalcitonin as a biomarker of infectious diseases Hyuck Lee Division of Infectious Diseases, Department of Internal Medicine, Dong-A University Hospital, Busan,
More informationPCT-assisted antibiotic therapy
PCT-assisted antibiotic therapy Prof. Zsolt Molnár zsoltmolna@gmail.com Department of Anaesthesia and Intensive Care University of Szeged Hungary Problems with the definition of sepsis Definitive diagnoses
More informationOverview of the ID PRN
Overview of the ID PRN The Infectious Diseases Practice and Research Network (ID PRN) is composed of students, residents, fellows, pharmacists, and other clinical research specialists throughout the world
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Blum CA, Nigro N, Briel M, et al. Adjunct prednisone
More informationBIOMARKERS IN SEPSIS
BIOMARKERS IN SEPSIS Dr. Syed Ghulam Mogni Mowla Assistant Professor, Medicine, DMC BSMCON 17 WHY WE NEED TO KNOW Sepsis and its complications are a common cause of infectious disease illness and mortality
More informationProcalcitonin YUKON KUSKOKWIM HEALTH CORPORATION PRESENTED BY: CURT BUCHHOLZ, MD AUGUST 2017
Procalcitonin YUKON KUSKOKWIM HEALTH CORPORATION PRESENTED BY: CURT BUCHHOLZ, MD AUGUST 2017 Procalcitonin (PCT) PCT isbeing studied as a biomarker for infection PCT consists of 116 amino
More informationL utilizzo della Procalcitonina in Medicina d Urgenza
L utilizzo della Procalcitonina in Medicina d Urgenza Stefania Battista Dirigente Medico S.C. Medicina d Urgenza Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino Savona, 15 ottobre 2009
More informationPCT-assisted antibiotic therapy
PCT-assisted antibiotic therapy Prof. Zsolt Molnár zsoltmolna@gmail.com Department of Anaesthesia and Intensive Care University of Szeged Hungary Problems with the definition of sepsis Sepsis is not a
More informationAdsorbtion of Cytokines Early in Septic Shock: the ACESS trial
Adsorbtion of Cytokines Early in Septic Shock: the ACESS trial Prof. Zsolt Molnár zsoltmolna@gmail.com Department of Anaesthesia and Intensive Care University of Szeged Hungary Pathophysiology Local insult
More informationFluorescence immunoassay Point of care test Wide range PCT. whole blood. plasma. serum
Fluorescence immunoassay Point of care test Wide range PCT whole blood serum plasma ichroma PCT Description ichroma PCT along with ichroma Reader is a fluorescence immunoassay for quantitative determination
More informationPneumonia in the Hospitalized
Pneumonia in the Hospitalized Patient: Use of Steroids Nicolette Myers, MD Pulmonary/Sleep/Critical Care November 9, 2018 Park Nicollet Clinic Facts About Pneumonia CAP is the 8 th most common cause of
More informationALSO AVAILABLE: biomérieux S.A Marcy l Etoile France Tel. : 33 (0) Fax : 33 (0)
12-13 / 9304555 010/GB/A / This document is not legally binding. biomérieux reserves the right to modify specifications without notice / BIOMERIEUX, the blue logo, and Empowering Clinical Decisions and
More information/////// Procalcitonin. Solutions for Emergency Diagnostics. A Novel Biomarker for Bacterial Infections and Sepsis. VIDAS Emergency Assays
/////// Solutions for Emergency Diagnostics 2015 BIOMÉRIEUX, INC. BIOMÉRIEUX, THE BLUE LOGO AND VIDAS ARE USED PENDING AND/OR REGISTERED TRADEMARKS BELONGING TO BIOMÉRIEUX SA OR ONE OF ITS SUBSIDIARIES
More informationDIAGNOSIS AND INVESTIGATIONS FOR SEPSIS. B. Mrara
DIAGNOSIS AND INVESTIGATIONS FOR SEPSIS B. Mrara CH C.H. Baragwanath ICU OUTLINE Introduction Diagnostic issues in sepsis Diagnosis and investigations for sepsis: clinical and laboratory lb investigations
More informationPneumonia 2017 OMAR PIRZADA
Pneumonia 2017 OMAR PIRZADA Pneumonia Pneumonia is common 0.5-1% of adults per year, 5-12% presenting to GP with LRTi 22-42% will be admitted to hospital Symptoms and signs Case 1 26 year old man Sudden
More informationSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care
More informationOHSU. Update in Sepsis
Update in Sepsis Jonathan Pak, MD June 1, 2017 Structure of Talk 1. Sepsis-3: The latest definition 2. Clinical Management - Is EGDT dead? - Surviving Sepsis Campaign Guidelines 3. A novel therapy: Vitamin
More informationCommunity Acquired & Nosocomial Pneumonias
Community Acquired & Nosocomial Pneumonias IDSA/ATS 2007 & 2016 Guidelines José Luis González, MD Clinical Assistant Professor of Medicine Outline Intro - Definitions & Diagnosing CAP treatment VAP & HAP
More informationAdvancements in Sepsis
Objectives Advancements in Sepsis Brian Gilbert, PharmD PGY-1 Pharmacy Resident Jackson Memorial Hospital 3/13/2016 www.fshp.org Pharmacist objectives Review recent updates in resuscitation strategies
More informationJohn Park, MD Assistant Professor of Medicine
John Park, MD Assistant Professor of Medicine Faculty photo will be placed here park.john@mayo.edu 2015 MFMER 3543652-1 Sepsis Out with the Old, In with the New Mayo School of Continuous Professional Development
More informationImportance of kinetics of procalcitonin in septic patients. János Fazakas MD, PhD Semmelweis University, Department of Transplantation and Surgery
Importance of kinetics of procalcitonin in septic patients János Fazakas MD, PhD Semmelweis University, Department of Transplantation and Surgery Host pathogen interactions the innate and the adaptive
More informationPROCALCITONIN. A Specific Marker for Diagnosis of Bacterial Infection and Sepsis INNOVATIONS IN CLINICAL DIAGNOSTICS
PROCALCITONIN A Specific Marker for Diagnosis of Bacterial Infection and Sepsis INNOVATIONS IN CLINICAL DIAGNOSTICS About Diazyme Diazyme Laboratories, Inc., an affiliate of General Atomics, is located
More informationCHEST Recent Advances in Chest Medicine
CHEST Recent Advances in Chest Medicine Role of Procalcitonin in Managing Adult Patients With Respiratory Tract Infections Philipp Schuetz, MD, MPH ; Devendra N. Amin, MD, FCCP ; and Jeffrey L. Greenwald,
More informationPolmoniti: Steroidi sì, no, quando. Alfredo Chetta Clinica Pneumologica Università degli Studi di Parma
Polmoniti: Steroidi sì, no, quando Alfredo Chetta Clinica Pneumologica Università degli Studi di Parma Number of patients Epidemiology and outcome of severe pneumococcal pneumonia admitted to intensive
More informationCorticosteroids in Severe CAP. Mervyn Mer Department of Medicine & ICU Johannesburg Hospital University of the Witwatersrand
Corticosteroids in Severe CAP Mervyn Mer Department of Medicine & ICU Johannesburg Hospital University of the Witwatersrand Introduction Much controversy and debate regarding the use of corticosteroids
More informationWhat is sepsis? RECOGNITION. Sepsis I Know It When I See It 9/21/2017
Sepsis I Know It When I See It September 15, 2017 Matthew Exline, MD MPH Medical Director, Medical ICU What is sepsis? I shall not today attempt further to define the kinds of material [b]ut I know it
More informationCopyright 2017 University of Wisconsin Hospitals and Clinics Authority Contact: Lee Vermeulen, Last Revised: 01/2017
Procalcitonin Monitoring Related to the Diagnosis and Treatment of Respiratory Tract Infections and Emerging Sepsis Adult Inpatient Clinical Practice Guideline Note: Active Table of Contents Click to follow
More informationEFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK. Alexandria Rydz
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK Alexandria Rydz BACKGROUND- SEPSIS Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated
More informationSepsis Management: Past, Present, and Future
Sepsis Management: Past, Present, and Future Benjamin Ferrell, MD Tennessee ACP Meeting October 28, 2017 Learning Objectives Identify the most updated definition and clinical criteria for sepsis Describe
More informationDiagnosis and Management of Sepsis and Septic Shock. Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire
Diagnosis and Management of Sepsis and Septic Shock Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire Financial: none Disclosures Objectives: Identify physiologic principles of septic
More informationUPDATE IN HOSPITAL MEDICINE
UPDATE IN HOSPITAL MEDICINE FLORIDA CHAPTER ACP MEETING 2016 Himangi Kaushal, M.D., F.A.C.P. Program Director Memorial Healthcare System Internal Medicine Residency DISCLOSURES None OBJECTIVES Review some
More informationMAKING SENSE OF IT ALL AUGUST 17
MAKING SENSE OF IT ALL AUGUST 17 @SepsisUK Dr Ron Daniels B.E.M. CEO, UK Sepsis Trust CEO, Global Sepsis Alliance Special Adviser to WHO SCALE AND BURDEN @sepsisuk Dr Ron Daniels B.E.M. CEO, UK Sepsis
More informationPrehospital recognition of sepsis Christopher W. Seymour, MD MSc
Prehospital recognition of sepsis Christopher W. Seymour, MD MSc The CRISMA Center Assistant Professor of Critical Care Medicine & Emergency Medicine University of Pittsburgh School of Medicine Disclosures
More informationInterventions To Improve Antibiotic Prescribing for Uncomplicated Acute Respiratory Tract Infections
Clinician Summary Breathing Conditions Respiratory Tract Infections Interventions To Improve Antibiotic Prescribing for Uncomplicated Acute Respiratory Tract Infections Focus of This Summary This is a
More informationEndothelium as a part of septic Multiple Organ Dysfunction Syndrome (MODS)-is endocan an answer?
Endothelium as a part of septic Multiple Organ Dysfunction Syndrome (MODS)-is endocan an answer? Małgorzata Lipinska-Gediga Department of Anaesthesiology and Intensive Therapy Medical University Wroclaw,
More informationPrognostic role of adrenomedullin in sepsis
Int. J. Adv. Res. Biol. Sci. (2016). 3(5): 136-141 International Journal of Advanced Research in Biological Sciences ISSN: 2348-8069 www.ijarbs.com Volume 3, Issue 5-2016 Research Article Prognostic role
More informationDepartment of Internal Medicine, Harbour Hospital, Institute for Tropical Diseases, Haringvliet 2, 3011 TD Rotterdam, The Netherlands 2
Hindawi Publishing Corporation Interdisciplinary Perspectives on Infectious Diseases Volume 29, Article ID 13769, 7 pages doi:1.1155/29/13769 Research Article Procalcitonin as a Biomarker for a Bacterial
More informationBack to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill
Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill Joe Palumbo PGY-2 Critical Care Pharmacy Resident Buffalo General Medical Center Disclosures
More informationBrice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine
Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Discuss advances in predicting prognosis Understand dwhat we know (and don t know) about the Microbiology Recognize important
More informationCommunity Acquired Pneumonia. Abdullah Alharbi, MD, FCCP
Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent
More information5/1/2015 SEPSIS SURVIVING SEPSIS CAMPAIGN HOW TO APPROACH THE POSSIBLE SEPTIC CHILD 2015 INFECTION CAN BE CONFIRMED BY:
SURVIVING SEPSIS CAMPAIGN HOW TO APPROACH THE POSSIBLE SEPTIC CHILD 2015 Omer Nasiroglu MD Baptist Children s Hospital Pediatric Emergency Department SEPSIS IS A SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
More informationPathology Seminar Series. 9/26/11 Steven Held, MD
Pathology Seminar Series 9/26/11 Steven Held, MD Procalcitonin: Current and Future Roles in Clinical Medicine Learning ObjecFves To discuss the biology of procalcitonin To discuss the assays for procalcitonin
More informationDisclosures. Learning Objectives: Marker for Inflammation
39 th National Conference on Pediatric Health Care March 19-22, 2018 CHICAGO Inflammatory Markers: When and What to Order and What to Do With the Number None to disclose Disclosures Cathy S. Woodward,
More informationMarkers of acute inflammation in assessing and managing lower respiratory tract infections: focus on procalcitonin
REVIEW Markers of acute inflammation in assessing and managing lower respiratory tract infections: focus on procalcitonin B. Müller 1 and C. Prat 2 1 Department of Internal Medicine, University Hospital,
More informationThe Use of Procalcitonin Monitoring in Critically Ill Adults for Early Identification and Treatment of Sepsis
St. Catherine University SOPHIA Master of Arts in Nursing Theses Nursing 4-2012 The Use of Procalcitonin Monitoring in Critically Ill Adults for Early Identification and Treatment of Sepsis Raquel DeLaMater
More informationThe syndrome formerly known as. Severe Sepsis. James Rooks MD. Coordinator of critical care education OU College of Medicine, Tulsa
The syndrome formerly known as Severe Sepsis James Rooks MD Coordinator of critical care education OU College of Medicine, Tulsa Disclosures I have no actual or practical conflicts of interest in relation
More informationPneumonia Community-Acquired Healthcare-Associated
Pneumonia Community-Acquired Healthcare-Associated Edwin Yu Clin Infect Dis 2007;44(S2):27-72 Am J Respir Crit Care Med 2005; 171:388-416 IDSA / ATS Guidelines Microbiology Principles and Practice of Infectious
More informationSepsis: What Is It Really?
Sepsis: What Is It Really? Steven D. Burdette, MD, FIDSA, FACP Professor of Medicine Wright State University Boonshoft School of Medicine Director of Antimicrobial Stewardship for Premier Health and Miami
More informationSEPSIS & SEPTIC SHOCK
SEPSIS & SEPTIC SHOCK DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and mitigate potential bias
More informationThe Ever Changing World of Sepsis Management. Laura Evans MD MSc Medical Director of Critical Care Bellevue Hospital
The Ever Changing World of Sepsis Management Laura Evans MD MSc Medical Director of Critical Care Bellevue Hospital COI Disclosures No financial interests to disclose Learning Objectives Review the evolution
More informationSepsis the clinical syndrome
Sepsis the clinical syndrome João Gonçalves Pereira ICU director Vila Franca Xira Hospital Systemic Inflamatory Response 2 Temperature 38ºC or 36ºC bacteraemia other trauma HR 90/min INFECTION RR 20/min
More informationInitial Resuscitation of Sepsis & Septic Shock
Initial Resuscitation of Sepsis & Septic Shock Dr. Fatema Ahmed MD (Critical Care Medicine) FCPS (Medicine) Associate professor Dept. of Critical Care Medicine BIRDEM General Hospital Is Sepsis a known
More informationChapter 5: Sepsis Stephen Lo
Chapter 5: Sepsis Stephen Lo Introduction Sepsis and its consequence are the bread and butter of intensive care medicine and management of it is time critical. This chapter will discuss the definitions,
More informationNo conflicts of interest to disclose
No conflicts of interest to disclose Introduction Epidemiology Surviving sepsis guidelines 2012 Updates Resuscitation protocols Map Goals Transfusion Sepsis-3 Bundle Management Questions Sepsis is a systemic,
More informationSeptic Shock. Rontgene M. Solante, MD, FPCP,FPSMID
Septic Shock Rontgene M. Solante, MD, FPCP,FPSMID Learning Objectives Identify situations wherein high or low BP are hemodynamically significant Recognize complications arising from BP emergencies Manage
More informationSepsis is an important issue. Clinician s decision-making capability. Guideline recommendations
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 Clinicians decision-making capability Guideline recommendations Sepsis is an important issue 8.7%
More informationPneumonia Severity Scores:
Pneumonia Severity Scores: Are they Accurate Predictors of Mortality? JILL McEWEN, MD FRCPC Clinical Professor Department of Emergency Medicine University of British Columbia Vancouver, BC Canada President,
More informationEARLY GOAL DIRECTED THERAPY : seminaires iris. Etat des lieux en Daniel De Backer
EARLY GOAL DIRECTED THERAPY : Etat des lieux en 2017 Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles Past-President European
More informationPlasma concentrations of copeptin, C-reactive protein and procalcitonin are positively correlated with APACHE II scores in patients with sepsis
Research Report Plasma concentrations of copeptin, C-reactive protein and procalcitonin are positively correlated with APACHE II scores in patients with sepsis Journal of International Medical Research
More informationThe Pharmaceutical and Chemical Journal, 2016, 3(1): Research Article
, 2016, 3(1):45-54 Available online www.tpcj.org Research Article ISSN: 2349-7092 CODEN(USA): PCJHBA Effectiveness of implementing a pharmacy coordinated procalcitonin level monitoring protocol to direct
More informationR2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
More informationBC Sepsis Network Emergency Department Sepsis Guidelines
The provincial Sepsis Clinical Expert Group developed the BC, taking into account the most up-to-date literature (references below) and expert opinion. For more information about the guidelines, and to
More informationHow did I decide on the topics?
Disclosures None How did I decide on the topics? Important papers within 1 year vs topics of importance or innovation/aha moments Sepsis Atrial Fibrillation Pneumonia Procalcitonin Objectives By the end
More informationTop Sepsis Studies
A75M233/A75M529 Monday 08:00-09:15 Wednesday 14:45-16:00 Maureen A Seckel APRN, ACNS-BC, CCRN, CCNS, FCCM Critical Care CNS and Sepsis Leader Christiana Care Health Services, Newark, DE Top Sepsis Studies
More informationPneumococcal pneumonia
Pneumococcal pneumonia Wei Shen Lim Consultant Respiratory Physician & Honorary Professor of Medicine Nottingham University Hospitals NHS Trust University of Nottingham Declarations of interest Unrestricted
More informationSepsis. Reliability- can we achieve Dr Ron Daniels
Sepsis. Reliability- can we achieve it? @SepsisUK Dr Ron Daniels Chief Executive, Global Sepsis Alliance Fellow: NHS Improvement Faculty Chief Executive: United Kingdom Sepsis Trust & Chair, UK SSC RRAILS
More informationSepsi: nuove definizioni, approccio diagnostico e terapia
GIORNATA MONDIALE DELLA SEPSI DIAGNOSI E GESTIONE CLINICA DELLA SEPSI Giovedì, 13 settembre 2018 Sepsi: nuove definizioni, approccio diagnostico e terapia Nicola Petrosillo Società Italiana Terapia Antiinfettiva
More informationOriginal Article Diagnostic value of dynamic serum PCT testing in patients with recurrent infections
Int J Clin Exp Med 2016;9(2):3173-3178 www.ijcem.com /ISSN:1940-5901/IJCEM0015966 Original Article Diagnostic value of dynamic serum PCT testing in patients with recurrent infections Yuejing Mu *, Weijia
More informationMDR AGENTS: RISK FACTORS AND THERAPEUTIC STRATEGIES
MDR AGENTS: RISK FACTORS AND THERAPEUTIC STRATEGIES 1 Marin H. Kollef, MD Professor of Medicine Virginia E. and Sam J. Golman Chair in Respiratory Intensive Care Medicine Washington University School of
More informationAndrea Blotsky MDCM FRCPC General Internal Medicine, McGill University Thursday, October 15, 2015
The TIMES Project: (Time to Initiation of Antibiotic Therapy in Medical Patients Presenting to the Emergency Department with Sepsis) - Preliminary Findings Andrea Blotsky MDCM FRCPC General Internal Medicine,
More informationEarly Recognition and Timely Management of Sepsis Amid Changes in Definitions
Early Recognition and Timely Management of Sepsis Amid Changes in Definitions Tze Shien Lo, MD, FACP Chief, Infectious Disease Service Fargo VA Medical Center Professor of Medicine UND School of Medicine
More informationNothing to disclose 9/25/2017
Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Nothing to disclose 1 Explain
More informationTo develop guidelines for the use of appropriate antibiotics for adult patients with CAP and guidance on IV to PO conversion.
Page 1 of 5 TITLE: COMMUNITY-ACQUIRED PNEUMONIA (CAP) EMPIRIC MANAGEMENT OF ADULT PATIENTS AND IV TO PO CONVERSION GUIDELINES: These guidelines serve to aid clinicians in the diagnostic work-up, assessment
More information9/25/2017. Nothing to disclose
Nothing to disclose Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Explain
More informationShould we go All In with Procalcitonin? Examining the Utility of the New Biomarker
Should we go All In with Procalcitonin? Examining the Utility of the New Biomarker http://www.amctv.com/shows/breaking- bad/ Residency Rounds Justin Gonzalez, PharmD PGY1 Pharmacy Resident Department of
More informationSepsis-3: clarity or confusion
Sepsis-3: clarity or confusion Christopher W. Seymour, MD MSc The CRISMA Center Assistant Professor of Critical Care Medicine & Emergency Medicine University of Pittsburgh School of Medicine Can an otherwise
More informationThe changing face of
The changing face of sepsis. @SepsisUK Dr Ron Daniels B.E.M. CEO, UK Sepsis Trust CEO, Global Sepsis Alliance Special Adviser (maternal sepsis) to WHO Breast cancer Cognitive impairment Mild 3.8 7.1
More informationKAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA
KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA Methodology: Expert opinion Issue Date: 8-97 Champion: Pulmonary Medicine Most Recent Update: 6-08, 7-10, 7-12 Key Stakeholders: Pulmonary Medicine,
More informationSepsis Update: Early Identification and Management
Sepsis Update: Early Identification and Management Q&A From the Live Webinar Presenter: Tom Ahrens, RN, PhD, FAAN Live webinar: Thursday, May 09, 2013 The AACN Critical Care Webinar Series is not only
More information