Results of the severe sepsis registry in intensive care units in Poland from 2003−2009

 BACKGROUND: Severe sepsis remains the most common cause of death in intensive care units (ICUs) according to many epidemiological studies. There are no data in Poland on the extent of severe sepsis cases treated in ICUs. The aim of the study was to analyse the course and outcome of severe sepsis patients treated in Polish ICUs.METHODS: In 2003, the internet-based severe sepsis registry was created as a multicentre observational research project. An online questionnaire was made accessible to ICUs participating in the study. Questionnaires were completed after the discharge of patients and included demographic data, clinical and microbiological information about the cause, course, treatment and outcome of septic patients. All data were given voluntarily and anonymously.RESULTS: During the 7-year period (2003−2009), 4999 cases of severe sepsis were registered for analysis. The mean age of septic patients was 57 years, and the majority of the patients were men (58%). The mean length of stay in the ICU was 10 days. A significant decrease in the mortality rate was observed from 54% in 2003 and 56% in 2004 to 46% in 2009 (P < 0.05). Most of the patients were admitted to the ICU for surgical reasons (56%), and intra-abdominal infections predominated (49%). Severe sepsis patients were admitted to ICUs in critical condition, and the majority of them (89%) had 3 or more organs dysfunction. The APACHE II score on admission was 26 points. Community acquired infections were the most frequent cause of severe sepsis (53%). Most of the pathogens responsible for infection were Gram-negative bacteria (58%). Gram-positive bacteria were identified in 34% of patients and fungi in 16%. A positive blood culture was detected in 41% of patients. Vasopressors were administered to most of the patients (86%). There was a marked increase in the frequency of administering noradrenaline and a decrease in administering dopamine. Renal replacement therapy was applied in 22% of the patients, and there was a marked increase in this type of therapy in the last two years of the study period.CONCLUSIONS: Patients with severe sepsis involved in the 7-year registry were critically ill in half of the cases because of intra-abdominal infections, and the majority of them had multi-organ dysfunction. The mortality of registered patients was high, but it significantly decreased during the observation time. Based on the results obtained from this voluntary registry, the authors conclude that mandated sepsis registries should be established in Polish hospitals to improve the strategy of diagnosing and managing this syndrome. BACKGROUND: Severe sepsis remains the most common cause of death in intensive care units (ICUs) according to many epidemiological studies. There are no data in Poland on the extent of severe sepsis cases treated in ICUs. The aim of the study was to analyse the course and outcome of severe sepsis patients treated in Polish ICUs.METHODS: In 2003, the internet-based severe sepsis registry was created as a multicentre observational research project. An online questionnaire was made accessible to ICUs participating in the study. Questionnaires were completed after the discharge of patients and included demographic data, clinical and microbiological information about the cause, course, treatment and outcome of septic patients. All data were given voluntarily and anonymously.RESULTS: During the 7-year period (2003−2009), 4999 cases of severe sepsis were registered for analysis. The mean age of septic patients was 57 years, and the majority of the patients were men (58%). The mean length of stay in the ICU was 10 days. A significant decrease in the mortality rate was observed from 54% in 2003 and 56% in 2004 to 46% in 2009 (P < 0.05). Most of the patients were admitted to the ICU for surgical reasons (56%), and intra-abdominal infections predominated (49%). Severe sepsis patients were admitted to ICUs in critical condition, and the majority of them (89%) had 3 or more organs dysfunction. The APACHE II score on admission was 26 points. Community acquired infections were the most frequent cause of severe sepsis (53%). Most of the pathogens responsible for infection were Gram-negative bacteria (58%). Gram-positive bacteria were identified in 34% of patients and fungi in 16%. A positive blood culture was detected in 41% of patients. Vasopressors were administered to most of the patients (86%). There was a marked increase in the frequency of administering noradrenaline and a decrease in administering dopamine. Renal replacement therapy was applied in 22% of the patients, and there was a marked increase in this type of therapy in the last two years of the study period.CONCLUSIONS: Patients with severe sepsis involved in the 7-year registry were critically ill in half of the cases because of intra-abdominal infections, and the majority of them had multi-organ dysfunction. The mortality of registered patients was high, but it significantly decreased during the observation time. Based on the results obtained from this voluntary registry, the authors conclude that mandated sepsis registries should be established in Polish hospitals to improve the strategy of diagnosing and managing this syndrome

Wpływ polimorfizmu genu kalpastatyny na wybrane parametry użytkowości mięsnej owiec

Ze względu na fakt, iż dla gospodarki duże znaczenie zaczyna odgrywać mięsny kierunek użytkowania owiec, niezbędna jest wiedza dotycząca uwarunkowań genetycznych cech wpływających na jakość mięsa jagnięcego. Gen kodujący kalpastatynę został wytypowany jako gen kandydujący dla cech użytkowości mięsnej owiec. Badania nad polimorfizmem tego genu prowadzone były na wielu rasach owiec w Europie, Azji i Ameryce Północnej. Powiązano zaobserwowany polimorfizm z masą urodzeniową, dziennymi przyrostami masy ciała, masą jagniąt po odsadzeniu oraz masą mięśni zwierząt. Równocześnie zaobserwowano związek tego genu z takimi cechami mięsa jak: zawartość tłuszczu śródmięśniowego, kruchość oraz barwa. Świadomość i struktura związku między masą ciała oraz cechami mięsa owczego a polimorficznymi postaciami genu kalpastatyny może prowadzić do wyznaczenia markerów genetycznych, które będą mogły być wykorzystywane jako dodatkowe kryterium selekcji owiec ras mięsnych

Zakażenia dróg moczowych u chorych leczonych na oddziale intensywnej terapii — trzyletnie jednoośrodkowe badanie obserwacyjne według projektu INICC

Background: Urinary tract infections (UTI) in patients with urinary catheters could be a serious complication of hospitalisation in the intensive care unit (ICU). Methods: A prospective study (01.01.2012−31.12.2014) was conducted in the 20-bed ICU of the University Hospital in Wroclaw, Poland. The frequency (density, incidence) and aetiology of UTI as well as prophylactic method compliance were estimated in patients of the ICU according to the INICC project. Results: Among 1261 ICU patients, urinary tract infections were diagnosed in 91 (7%). The incidence index was 7.25/100 admissions to the ICU. CA-UTI constituted 36% of the device-associated, healthcare-associated infections (n = 255). A urinary catheter was used in 92.21 ± 4.51% of patients during 14,006 patient-days and 12,917 urinarycatheter- days. The density of CA-UTI/1000 catheter-days was 6.44, 6.84, 7.16 during the years 2012, 2013, and 2014, respectively. The main pathogens of CA-UTI were Enterococcus spp. (22%), Acinetobacter baumannii (20%), Klebsiella pneumoniae (18%), Pseudomonas aeruginosa (13%), and Candida spp. (13%). Only in four elements of the “Urinary Catheter Bundle” was 100% compliance noted. Conclusions: In the observed period of time, the incidence of CA-UTI was higher than in the INICC (2014) report and the NHSN/CDC (2012) report. Analysis of compliance with a “Urinary Catheter Bundle” to prevent UTI shows low implementation of preventative methods with the INICC protocol.Background: Urinary tract infections (UTI) in patients with urinary catheters could be a serious complication of hospitalisation in the intensive care unit (ICU). Methods: A prospective study (01.01.2012−31.12.2014) was conducted in the 20-bed ICU of the University Hospital in Wroclaw, Poland. The frequency (density, incidence) and aetiology of UTI as well as prophylactic method compliance were estimated in patients of the ICU according to the INICC project. Results: Among 1261 ICU patients, urinary tract infections were diagnosed in 91 (7%). The incidence index was 7.25/100 admissions to the ICU. CA-UTI constituted 36% of the device-associated, healthcare-associated infections (n = 255). A urinary catheter was used in 92.21 ± 4.51% of patients during 14,006 patient-days and 12,917 urinarycatheter- days. The density of CA-UTI/1000 catheter-days was 6.44, 6.84, 7.16 during the years 2012, 2013, and 2014, respectively. The main pathogens of CA-UTI were Enterococcus spp. (22%), Acinetobacter baumannii (20%), Klebsiella pneumoniae (18%), Pseudomonas aeruginosa (13%), and Candida spp. (13%). Only in four elements of the “Urinary Catheter Bundle” was 100% compliance noted. Conclusions: In the observed period of time, the incidence of CA-UTI was higher than in the INICC (2014) report and the NHSN/CDC (2012) report. Analysis of compliance with a “Urinary Catheter Bundle” to prevent UTI shows low implementation of preventative methods with the INICC protocol