Background: As the incidences of preterm births and surgical cases increases, so do cases of neonatal sepsis in CMH. Furthermore, the common etiology of neonatal sepsis are multidrug-resistant bacteria which increase the risk of mortality. Cefepime is a fourth-generation cephalosporin which is increasingly being utilized in NICUs. Theoretically, continuous infusion of beta lactam antibiotics could maximize the time- dependent bactericidal activity and improve the probability of target attainment. This study aims to determine the effectiveness and safety of continuous cefepime administration in managing sepsis. Methods: This is retrospective cohort study on infants who suspected late onset sepsis from 2021 to 2023. The independent variables are continuous infusion and intermittent infusion, with outcomes including mortality rate, reduction in septic markers, use of antibiotic combinations, duration of antibiotic use, and renal function test. Result: There were 106 subjects receiving cefepime (56 continuous and 50 intermittent infusions; p>0.05). No significant differences in demographic data such as gestational age, prematurity condition, birth weight, and surgical conditions were found between the two methods. Out of 66 subjects with proven sepsis, 28% were classified as MDR, 12% as XDR, and 16% as PDR. No difference in sepsis-related mortality outcomes was observed between the two methods (64.3% vs. 70%; p=0.532). Continuous administration reduced C-reactive protein (80.52 vs. 51.69 mg/L; p=0.000) and procalcitonin (11.9 vs. 6.72 ng/mL; p=0.008) more effectively than intermittent. In surgical cases, continuous administration reduced the risk of multidrug therapy (RR 0.5 CI 95% 0.243-0.902; p=0.045). There was no difference renal function impairment between two methods. Conclusion: Cefepime continuous infusion can significantly reduce infection markers compared to intermittent administration. In surgical cases, continuous cefepime administration reduces the risk of multidrug therapy. The use of continuous cefepime can be considered as part of antibiotic stewardship in the NICU.

Case Presentation: A 68 year old man. Hospitalized with decreased consciousness. Experienced severe shortness of breath 3 days before entering the hospital. The patient also had wounds on his right and left legs since 1 month ago. But then became more widespread. The patient has kidney failure and routinely undergoes hemodialysis. The patient had diabetes since 6 years ago. Laboratory: Hemoglobin 7.5 Leukocytes 17.8 Netrophils 91.70 Lymphocytes 4.20 Albumin 2.2 Creatinine 2.5 Ureum 61 Artery 2.30, urine bacteria+++. Pus culture results: Enterobacter cloacae with the antibiotic meropenem. Sputum culture results Klebsiella pneumoniae ss. Pneumoniae with amikacin. After 1 week pus culture results: Pseudomonas aeruginosa with amikacin. Blood culture results: Staphylococcus epidermidis suggested vancomycin. The patient underwent debriment in the operating room. However, the condition did not improve. Discussion: This patient experienced sepsis with MDRO. Apart from geriatric age, the patient also has diabetes with complications of kidney failure. This worsens the patient’s immune system. So the patient’s diabetic ulcers and decubitus ulcers worsened with the results of cultures with various antibiotic-resistant multiorganisms. And also the respiratory infections increase the risk of mortality. Conclusion : MDRO is a risk factor for inappropriate antibiotic therapy, which is undoubtedly associated with increased mortality.

Figure :

Diabetic ulcers and decubitus ulcers in patient

Minimising suffering is an ethical and legal requirement in animal research. This is particularly relevant for research on animal models of sepsis and septic shock, which show rapid progression towards severe stages and death. Specific and reliable criteria signalling non-recovery points can be used as humane endpoints, beyond which a study cannot be allowed to progress, thus preventing avoidable suffering. Body temperature is a key indicator for assessing animal health and welfare and has been suggested to have potential for monitoring the status of mouse models of sepsis. In this study, we monitored temperature variations using contactless methods – thermal imaging and subcutaneously implanted PIT tags – in a surgical model of sepsis by caecal ligation and puncture (CLP). We monitored body temperature variation following mid-grade CLP, high-grade CLP and sham surgery. All mice (Mus musculus) were monitored four times per day in the high-grade CLP model and three times per day in the mid-grade CLP model by both PIT tag readout and infrared thermography for ten days post-surgery, or until animals reached a predefined humane endpoint. Thermal data were compared with the clinical score and weight loss threshold used at our facility. Mean body surface temperature (MBST) assessed by thermal imaging and subcutaneous temperature (SCT) measured by PIT tags correlated, albeit not strongly. Moreover, while MBST does not appear to be a reliable predictor of non-recovery stages, SCT showed promise in this regard, even surpassing the widely used weight loss criterion, particularly for the high-grade CLP model of induced sepsis.

Extraintestinal pathogenic Escherichia coli (ExPEC) causes invasive E. coli disease (IED), including bacteraemia and (uro)sepsis, resulting in a high disease burden, especially among older adults. This study describes the epidemiology of IED in England (2013–2017) by combining laboratory surveillance and clinical data. A total of 191 612 IED cases were identified. IED incidence increased annually by 4.4–8.2% across all ages and 2.8–7.6% among adults ≥60 years of age. When laboratory-confirmed urosepsis cases without a positive blood culture were included, IED incidence in 2017 reached 149.4/100 000 person-years among all adults and 368.4/100 000 person-years among adults ≥60 years of age. Laboratory-confirmed IED cases were identified through E. coli-positive blood samples (55.3%), other sterile site samples (26.3%), and urine samples (16.6%), with similar proportions observed among adults ≥60 years of age. IED-associated case fatality rates ranged between 11.8–13.2% among all adults and 13.1–14.7% among adults ≥60 years of age. This study reflects the findings of other published studies and demonstrates IED constitutes a major and growing global health concern disproportionately affecting the older adult population. The high case fatality rates observed despite available antibiotic treatments emphasize the growing urgency for effective intervention strategies. The burden of urosepsis due to E. coli is likely underestimated and requires additional investigation.

This study aimed to determine the impact of current hepatitis B virus (HBV) infection on patients hospitalised with sepsis. This was a retrospective cohort study. Patients from three medical centres in Suzhou from 10 January 2016 to 23 July 2022 participated in this study. Demographic characteristics and clinical characteristics were collected. A total of 945 adult patients with sepsis were included. The median age was 66.0 years, 68.6% were male, 13.1% presented with current HBV infection, and 34.9% of all patients died. In the multivariable-adjusted Cox model, patients with current HBV infection had significantly higher mortality than those without (hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.11–2.02). A subgroup analysis showed that being infected with HBV significantly increased in-hospital mortality in patients younger than 65 years old (HR 1.74, 95% CI 1.16–2.63), whereas no significant impact was observed in patients ≥65 years. The propensity score-matched case–control analysis showed that the rate of septic shock (91.4% vs. 62.1%, P < 0.001) and in-hospital mortality (48.3% vs. 35.3%, P = 0.045) were much higher in the propensity score-matched HBV infection group compared with the control group. In conclusion, current HBV infection was associated with mortality in adults with sepsis.

Sepsis is a clinical syndrome characterised by a severe disorder of pathophysiology caused by infection of pathogenic micro-organisms. The addition of antioxidant micronutrient therapies such as thiamine to sepsis treatment remains controversial. This study explored the effect of thiamine on the prognosis of patients with sepsis. This study was a retrospective study involving patients with sepsis from the Medical Information Mart for Intensive Care IV. Patients were divided into two groups, the thiamine received group (TR) and the thiamine unreceived group (TUR), according to whether they were supplemented with thiamin via intravenous while in the intensive care unit (ICU). The primary outcome was ICU mortality. The association between thiamine and outcome was analysed using the Cox proportional hazards regression model, propensity score matching (PSM), generalised boosted model-based inverse probability of treatment weighting (IPTW) and doubly robust estimation. A total of 11 553 sepsis patients were enrolled in this study. After controlling for potential confounders using Cox regression models, the TR group had a statistically significantly lower ICU mortality risk than the TUR group. The hazard ratio of ICU mortality for the TR group was 0·80 (95 % CI 0·70, 0·93). We obtained the same results after using PSM, IPTW and doubly robust estimation. Supplementation with thiamine has a beneficial effect on the prognosis of patients with sepsis. More randomised controlled trials are needed to confirm the effectiveness of thiamine supplementation in the treatment of sepsis.

Sepsis is a complex clinical syndrome triggered by an inflammatory host response to an infection. It is usually complicated to detect and diagnose, and has severe consequences in human and veterinary health, especially when treatment is not started early. Therefore, efforts to detect sepsis accurately are needed. In addition, its proper diagnosis could reduce the misuse of antibiotics, which is essential fighting against antimicrobial resistance. This case is a particular issue in farm animals, as antibiotics have been traditionally given massively, but now they are becoming increasingly restricted. When sepsis is suspected in animals, the most frequently used biomarkers are acute phase proteins such as C-reactive protein, serum amyloid A and haptoglobin, but their concentrations can increase in other inflammatory conditions. In human patients, the most promising biomarkers to detect sepsis are currently procalcitonin and presepsin, and there is a wide range of other biomarkers under study. However, there is little information on the application of these biomarkers in veterinary species. This review aims to describe the general concepts of sepsis and the current knowledge about the biomarkers of sepsis in pigs, horses, and cattle and to discuss possible advances in the field.