Rationale: The Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are unknown.
Objectives: To perform a clinical decision-making analysis of Sepsis-3 in patients with community-acquired pneumonia.
Methods: This was a cohort study including adult patients with community-acquired pneumonia from two Spanish university hospitals. SIRS, qSOFA, the Confusion, Respiratory Rate and Blood Pressure (CRB) score, modified SOFA (mSOFA), the Confusion, Urea, Respiratory Rate, Blood Pressure and Age (CURB-65) score, and Pneumonia Severity Index (PSI) were calculated with data from the emergency department. We used decision-curve analysis to evaluate the clinical usefulness of each score and the primary outcome was in-hospital mortality.
Measurements And Main Results: Of 6,874 patients, 442 (6.4%) died in-hospital. SIRS presented the worst discrimination, followed by qSOFA, CRB, mSOFA, CURB-65, and PSI. Overall, overestimation of in-hospital mortality and miscalibration was more evident for qSOFA and mSOFA. SIRS had lower net benefit than qSOFA and CRB, significantly increasing the risk of over-treatment and being comparable with the "treat-all" strategy. PSI had higher net benefit than mSOFA and CURB-65 for mortality, whereas mSOFA seemed more applicable when considering mortality/intensive care unit admission. Sepsis-3 flowchart resulted in better identification of patients at high risk of mortality.
Conclusions: qSOFA and CRB outperformed SIRS and presented better clinical usefulness as prompt tools for patients with community-acquired pneumonia in the emergency department. Among the tools for a comprehensive patient assessment, PSI had the best decision-aid tool profile.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1164/rccm.201611-2262OC | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Current role of ceftobiprole in the treatment of hospital-acquired and community-acquired pneumonia: Expert opinion based on literature and real-life experiences.
Expert Rev Anti Infect Ther
January 2025
Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Introduction: Community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) are major global health challenges, with high morbidity and mortality rates. The increasing prevalence of multidrug-resistant (MDR) bacteria may diminish the effectiveness of standard empirical antibiotics, highlighting the need for broader-spectrum agents that target also MDR organisms.
Areas Covered: This review summarizes findings from a PubMed search on the use of ceftobiprole in CAP and HAP.
Impact of antimicrobial resistance on infections in children in Africa.
Curr Opin Pediatr
January 2025
Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Purpose Of Review: Antimicrobial resistance is an escalating public health threat in Africa, and an awareness of the devastating impact on children is growing. This review highlights the prevalence and patterns of antimicrobial resistance among children in Africa, focusing on pathogens responsible for bloodstream infections, community-acquired pneumonia, bacterial meningitis, neonatal infections, diarrhea and malaria. Current strategies to tackle antimicrobial resistance in pediatric populations are discussed.
View Article and Find Full Text PDFAntibiotic duration for common bacterial infections-a systematic review.
JAC Antimicrob Resist
February 2025
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Background: Reducing antibiotic duration is a key stewardship intervention to mitigate antimicrobial resistance (AMR). We examined current evidence informing antibiotic duration for common bacterial infections to identify any gaps in terms of settings, patient populations and infectious conditions. Trial methodologies were assessed to identify areas for improvement.
View Article and Find Full Text PDFGastrointestinal infections are widespread and a major cause of global mortality, mainly affecting young children and the elderly. In Germany, each resident typically experiences one episode yearly. After COVID-19 pandemic, gastrointestinal infection rates have significantly increased again.
View Article and Find Full Text PDFBackground: Chronic obstructive pulmonary disease (COPD) patients commonly exhibit significant morbidity and experience a diminished quality of life. Since there has been no prior research on pneumonia in our study population, we carried out this study to learn more about the situation.
Methods: A retrospective analysis of 912 COPD patients with CAP who were receiving ICS treatment at the DHQ Hospital in Muzaffargarh, Punjab, Pakistan was conducted.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!