Introduction: Septic shock is the most common type of shock encountered by internists and is the most common cause of death in non-coronary intensive care units. In the 2012 Surviving Sepsis Campaign, one recommendation is antibiotic administration within three hours from sepsis recognition. Several large-scale studies challenged this recommendation with contrasting results. The researchers aim to determine the impact of early antibiotic therapy (EAT) on mortality and outcome of patients and to determine institutional compliance to current sepsis recommendations. Methods: This retrospective single center study included septic patients at the emergency room from February 2013 to January 2015 and were grouped into the EAT group (lesser than or equal to three hours) and control group (more than three hours) antibiotic initiation from sepsis recognition). Primary outcomes are in-hospital mortality, time-to-antibiotics and extraction of blood culture prior to antibiotics. Secondary outcomes include length of hospital stay, use of vasopressors and mechanical ventilation and development of sepsis-related complications. Results: Two-hundred sixty-one patients were included with 53.26% overall mortality rate. The overall mean timeto-antibiotics is 355.1 minutes and time-to-blood culture is 434.64 minutes. Mean time-to-antibiotics were 115 and 556 minutes in the EAT and control group respectively. Mortality was significantly higher in the control group (43.7% vs. 61.3%, p=0.006). For the sepsis related complications, development of acute kidney injury (p=0.033) was higher in the EAT group and acute respiratory failure (p=0.009) was significantly increased in the control group. Conclusion Antibiotic administration within three hours from sepsis recognition significantly reduced in-hospital mortality. Timing of antibiotics and collection of blood cultures were delayed compared to current recommendations. Among the sepsis-related complications, prolonged time-to-antibiotics (>3 hours) is associated with risk of developing acute respiratory failure and subsequent need for mechanical ventilation.
Early antibiotic therapy ; Shock, Septic ; Sepsis ; Systemic Inflammatory Response Syndrome

Nowadays, it is necessary to emphasize the three basic inseparable elements in the treatment of severe burn infection, which are systemic care, burn wound care, and rational use of antimicrobials topically or systematically. Systemic care has been shifted from simple nutritional support to maintaining the systemic homeostasis, including balancing immune-inflammatory response, and protecting organs from dysfunction. Some work focused on regulating systemic immune response in the initial phase and the balance of inflammatory response after occurrence of severe burn infection have been reported. These results at least broaden our thinking to recognize that treatment should not only destroy microbes, but also balance the response of the body. Escharectomy in earlier phase has been a consensus. Currently, we turn our vision into how to use "damage control surgery (DCS)" concept in management of severe burn. DCS in burn care includes the evaluation of perioperative situation more accurate to make a more appropriate surgical decision. Meanwhile, an overall strategy should be established to confront the rapidly increasing drug resistance of the pathogens. The release of endotoxin after use of antimicrobials, which has been studied widely, should be explored further.
Anti-Infective Agents ; therapeutic use ; Burns ; complications ; therapy ; Humans ; Infection Control ; Systemic Inflammatory Response Syndrome ; therapy

Apoptosis ; Child ; Cytokines ; immunology ; secretion ; Humans ; Systemic Inflammatory Response Syndrome ; immunology ; therapy

Multisystem inflammatory syndrome in children (MIS-C) is a complex syndrome characterized by multi-organ involvement that has emerged in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak. The clinical presentation of MIS-C is similar to Kawasaki disease but predominantly presents with fever and gastrointestinal symptoms, and severe cases can involve toxic shock and cardiac dysfunction. Epidemiological findings indicate that the majority of MIS-C patients test positive for SARS-CoV-2 antibodies. The pathogenesis and pathophysiology of MIS-C remain unclear, though immune dysregulation following SARS-CoV-2 infection is considered a major contributing factor. Current treatment approaches for MIS-C primarily involve intravenous immunoglobulin therapy and symptomatic supportive care. This review article provides a comprehensive overview of the definition, epidemiology, pathogenesis, clinical presentation, diagnosis, treatment, and prognosis of MIS-C.
Child ; Humans ; COVID-19 ; SARS-CoV-2 ; Pandemics ; Systemic Inflammatory Response Syndrome/therapy*

The aim of this study was to explore the effects of parenteral supplementation with omega-3 fish oil emulsion (Omegaven) on systemic inflammatory response syndrome (SIRS) during the initial stage of severe acute pancreatitis (SAP). In a prospective, randomized and controlled trial, 60 patients with SAP were randomized either to treat with conventional therapy (Con group, n=30) or conventional therapy plus intravenous supplementation with omega-3 fish oil emulsion 0.2 g/kg every day (FO group, n=30). The effects were analyzed by the SIRS-related indexes. The results showed that APACHE-II scores in FO group were significantly lower, and the gap increased much farther after the 4th day than those in Con group (P<0.05). Fluid equilibrium time became shorter markedly in FO group than in Con group (5.1+/-2.2 days vs 8.4+/-2.3 days). In FO group, SIRS scores were markedly decreased and the SIRS state vanished after the 4th day; Plasma level of TNF-alpha was significantly reduced, while IL-10 decreased markedly, most prominently between the 4th and 7th day, and the ratio of IL-10/TNF-alpha raised as compared with Con group (P<0.05). During the initial stage of SAP, parenteral supplementation with omega-3 fish oil emulsion could efficiently lower the magnitude and persistence time of the SIRS, markedly retrieve the unbalance of the pro-/anti-inflammatory cytokines, improve severe condition of illness and may provide a new way to regulate the SIRS.
Dietary Supplements ; Emulsions ; Fatty Acids, Omega-3/*administration & dosage ; Fish Oils/*administration & dosage ; Pancreatitis, Acute Necrotizing/complications ; Pancreatitis, Acute Necrotizing/*therapy ; Parenteral Nutrition/methods ; Prospective Studies ; Systemic Inflammatory Response Syndrome/etiology ; Systemic Inflammatory Response Syndrome/*therapy ; Young Adult

In this paper we investigated the mechanisms of Baihu Decoction ((白虎汤, BH) and Baihu with Radix Ginseng (BHG) in treating systemic inflammatory response syndrome (SIRS) and sepsis in humans and animals. By reviewing published data on the effects of BH and BHG and the control of blood glucose in treating SIRS and sepsis, we found that (1) BH and BHG were beneficial in the treatment of SIRS and sepsis in humans and animals; (2) BH and BHG also had great effect in lowering blood glucose level; and (3) the tight control of blood glucose during critical illness substantially improved the outcome. Considering these data together, we hypothesize that one of the major mechanisms of BH and BHG in treating SIRS and sepsis is to lower the blood glucose level. The findings also suggest that the application of BH and BHG can extend to many acute illnesses and injuries, which commonly cause hyperglycemia.
Animals ; Blood Glucose ; analysis ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Systemic Inflammatory Response Syndrome ; blood ; drug therapy

Adjuvants, Immunologic ; therapeutic use ; Animals ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Phytotherapy ; Systemic Inflammatory Response Syndrome ; complications ; drug therapy

To systematically review the efficacy of Xuebijing Injection combined with western medicine in the treatment of systemic inflammatory response syndrome(SIRS). In this study, CBM, CNKI, Wanfang, VIP, PubMed and EMbase databases were retrieved for clinical randomized controlled trials on the effect of Xuebijing Injection combined with western medicine in the treatment of SIRS from the establishment of the database to July 31, 2020. After screening, Meta-analysis was conducted by RevMan 5.3 software, trial sequential analysis was conducted by TSA 0.9.5.10 beta software, and the evidence quality level was evaluated by GRADEprofiler 3.6.1 software. Meta-analysis showed that Xuebijing Injection combined with western medicine could reduce white blood cell count(MD=-2.32, 95%CI[-2.44,-2.21], P<0.000 01), C-reactive protein count(MD=-22.70, 95%CI[-29.61,-15.79], P<0.000 01), APACHE Ⅱ score(MD=-2.15, 95%CI[-2.43,-1.87], P<0.000 01), tumor necrosis factor alpha count(SMD=-1.23, 95%CI[-1.48,-0.99], P<0.000 01) and interleukin-6 count(SMD=-0.92, 95%CI[-1.15,-0.69], P<0.000 01), improve treatment efficiency(RR=1.39, 95%CI[1.23, 1.56], P<0.000 01), reduce incidence of multiple organ dysfunction(RR=0.47, 95%CI[0.35, 0.64], P<0.000 01) and mortality(RR=0.22, 95%CI[0.13, 0.37], P<0.000 01), which were better than western medicine treatment alone. Trial sequential analysis showed that in terms of reducing the incidence of multiple organ dysfunction and C-reactive protein count, the cumulative Z value passed through the traditional threshold, TSA threshold and expected information value, and reached the required number of cases. GRADE evaluation showed that the level of evidence was low or very low. According to the findings, Xuebijing Injection combined with western medicine is effective in treating SIRS. However, as the low quality of the included studies may affect the reliability of the conclusion, more high-quality studies shall be included for further verification in the future, so as to provide better suggestions for clinical medication.
Drugs, Chinese Herbal ; Humans ; Injections ; Randomized Controlled Trials as Topic ; Reproducibility of Results ; Systemic Inflammatory Response Syndrome/drug therapy*

The inflammatory reaction is the important pathologic foundation of growth and development of many diseases. Previously, anti-pathogen is the chief treating principle on infectious diseases, while anti-inflammation is the supplementary one. With the deep-going investigation on the effect of inflammatory reaction in the pathological process of severe infectious diseases in recent decade, especially the advance of concept on systemic inflammatory reaction syndrome (SIRS), anti-inflammatory treatment has become the vital link for comprehensive intervention therapy of severe infectious disease. Close correlation is also presented between numerous non-infectious diseases with systemic inflammatory reaction, e.g., atherosclerosis is one kind of inflammatory reaction, there are effects of many inflammatory factors on the metabolic process in patients with obesity. The regulation of Chinese herbs on inflammatory reaction may be one of the well cut-in points of integrative Chinese and Western medical study of anti-inflammation.
Anti-Inflammatory Agents ; therapeutic use ; Diagnosis, Differential ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Phytotherapy ; Systemic Inflammatory Response Syndrome ; drug therapy

Glucocorticoids ; adverse effects ; therapeutic use ; Humans ; Respiratory Distress Syndrome, Adult ; drug therapy ; immunology ; metabolism ; Systemic Inflammatory Response Syndrome ; drug therapy ; immunology ; metabolism