INTRODUCTION

Despite universal agreement on the application of antimicrobial prophylaxis, the optimum administration period of antibiotics for percutaneous nephrolithotomy (PCNL) remains controversial and the risk for antimicrobial resistance due to prolonged antibiotic use as well as financial burden that may prove to be challenging for both the patient and the physician. This study therefore aims to determine the safety and effectiveness of a single dose antibiotic prophylaxis in patients undergoing PCNL.

A randomized controlled trial was conducted in PCNL patients between 2021-2023. The patients were randomly assigned to three groups: single dose prophylaxis 30 minutes before surgery arm (Group A), 30 minutes before and 12 hours after surgery arm (Group B), and continued antibiotics until removal of nephrostomy tube arm (Group C), respectively.

A total of 81 patients were included (Group A=27, Group B=28, and Group C=26). The rate of comorbidities did not differ significantly in the three groups: HTN (p=0.166), DM (p=0.121), and Others (p=0.405). The presence of hydronephrosis was seen in 70.4% of patients. About half had solitary stone type (54.3%) and had left area affected (51.8%). Also, 14.8% had history of UTI. The patient groups did not differ in clinical and operative characteristics (all p > 0.05) except in history of previous stone surgeries. Significantly more patients had previous history of stone surgeries in Group A (37.0%) than in Group B (3.6%) and Group C (15.4%) (p=0.006). The following proportion of no growth in preoperative urine culture was observed: Group A (92.6%), Group B (89.3%), and Group C (80.8%) (p=0.174). The estimated blood loss was significantly lower in Group A (130.7ml) than in Group B (235.7ml) and Group C (261.5ml) (p=0.032). Significantly less patients in Group A were free from stone (74.1%) compared to Group B (92.9%) and Group C (96.2%) (p=0.030). After surgery, only two patients (2.5%) had criteria consistent with SIRS and both belonged in Group C. No significant difference in incidence of SIRS was observed among the three groups (p=0.067).

Single dose antibiotic prophylaxis for the prevention of post-operative bacterial infection in patients undergoing PCNL is as effective as multiple dose antibiotic prophylaxis. Consistent with existing guidelines on PCNL, single dose antibiotic prophylaxis is highly recommended as it is more cost-effective and may lower the risk for antibiotic resistance in the future. More RCTs with larger sample size which can determine the effectiveness of single dose antibiotic prophylaxis in patients at high-risk for post-operative PCNL infections are recommended.

Systemic Inflammatory Response Syndrome ; virology ; Virus Diseases

Background: Sepsis is a leading cause of mortality both locally and worldwide. Despite this, early diagnosis of sepsis remains challenging, with a significant number not fulfilling SIRS (Systemic Inflammatory Response Syndrome) criteria. In 2016, the Sepsis-3 guidelines modified its definition to include the qSOFA (Quick Sequential Organ Failure Assessment) score in an attempt to include a significant number of SIRS-negative septic patients.

Methods: To compare the two, 295 adult patients in the emergency room with suspected infection were included in the study and simultaneously determined their qSOFA score and SIRS criteria. Three infection specialists adjudicated the presence of sepsis, and outcomes within the first 48 hours were acquired. Sensitivity, specificity, positive predictive and negative predictive values for qSOFA and SIRS were computed using constructed confusion matrices, and overall predictive accuracy was measured by the Area under the Receiver Operating Characteristic (AUROC) curve.

Results: Of the 295 patients included in the study, 95 (32.2%) were deemed sepsis positive via adjudication. The qSOFA score was a specific (95.5%) but a poorly sensitive (46.3%) test compared to the SIRS criteria (sensitivity 73.7% and specificity 60%). Both qSOFA and the SIRS criteria significantly correlated with sepsis positivity, but the qSOFA score had superior overall predictive accuracy at 70.9% compared to the SIRS criteria. The adjudicators had moderate strength in agreement (Fleiss' kappa = 0.39) and a percentage agreement of 60%.

Conclusion: We concluded that the qSOFA score was a more accurate predictor of sepsis and a reliable pre-dictor of in-hospital mortality, but should not be used as a sepsis screening tool due to the low sensitivity. We recommend that the SIRS criteria be maintained as a screening tool and to use the qSOFA score concurrently for time management.

Key Words: Sepsis, qSOFA, SIRS

BACKGROUND: The burden of sepsis is global despite measures to improve its prompt recognition. However, there is no single reliable parameter for its early detection. Heparin-binding protein (HBP) is a new and promising biomarker for sepsis. Presently, there are no published reports in children apart from a limited study on UTI.

OBJECTIVE: To evaluate the role of HBP as a diagnostic tool and prognostic marker of sepsis syndrome among pediatric patients.

METHODS: This prospective cohort study enrolled pediatric patients who were categorized as SIRS or sepsis syndrome. HBP assay was determined on Day1. Likewise, blood culture was taken. A 7-day observation period using PELOD scoring was done. Final category as SIRS or sepsis syndrome was done on Day7. Statistical analysis was done to know relationship of HBP level to SIRS and sepsis.

RESULTS: 106 patients were included in this study. There was statistical significance in the correlation of HBP assay with presence of growth in blood culture and toxic granulations, length of ventilator support, and development of complications including mortality. The cutoff point was >125ng/mL. Sensitivity and specificity for HBP in sepsis syndrome were 98.31% and 97.87% respectively. Positive predictive value was 98.3%. Negative predictive value was 97.9%. Positive likelihood ratio was 46.2. Negative likelihood ratio was 0.017. Risk ratio was 47.6. Subjects with HBP level of >125 ng/mL had 47.6 times the risk of having sepsis syndrome as compared to those with level

CONCLUSION & RECOMMENDATIONS: Elevated HBP level is a useful diagnostic and prognostic marker for childhood sepsis syndrome. Determination of HBP levels at different time intervals within a longer observation period may give a more accurate description of subject's clinical improvement or progression to MODS or mortality.

Child ; Humans ; Systemic Inflammatory Response Syndrome

Diagnosis and treatment criteria were recently updated based on the Sepsis-3 guidelines, which recommend the sequential organ failure assessment for accurate characterization of organ dysfunction. Large randomized controlled trials have found neutral results with early goal-directed therapy. To improve outcomes, treatment bundles incorporating standards for early sepsis treatment, including antibiotic and steroid treatment, were developed. Thus, future research should address the effects of steroids and immune-modulating agents on refractory septic shock as well as the development of new coagulopathy therapies and dynamic assessment tools.
Diagnosis ; Sepsis ; Shock, Septic ; Steroids ; Systemic Inflammatory Response Syndrome

OBJECTIVE: To compare the value of intraoperative stone culture (IOSC) and intraoperative pelvic urine culture (IOPUC) versus pre-operative urine culture (POBUC) in the early detection of systemic inflammatory response syndrome (SIRS) in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: This is a prospective clinical study which includes all adult patients undergoing PCNL. All patients who were operated on should have a negative preoperative urine culture (POBUC) results. Intraoperative pelvic urine culture (IOPUC) and stone culture (IOSC) were extracted and results were interpreted if they were contributory in acquiring SIRS post operatively. RESULTS: The demographics of each patient such as age, sex, having diabetes, laterality, location of calculi had no correlation to the development of SIRS. Patients with positive IOPUC and IOSC results yielded a significant value with odds of having SIRS 4.71 and 13.74, respectively. CONCLUSION In the study, all patients underwent PCNL with negative preoperative urine culture findings. Having intraoperative cultures, IOPUC and IOSC, can definitely help predict the occurrence of SIRS and ultimately be one step ahead in the management of these patients to decrease overall morbidity and mortality.
Nephrolithotomy, Percutaneous ; Systemic Inflammatory Response Syndrome ; Postoperative Period

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

Cholinesterases ; blood ; Female ; Humans ; Male ; Systemic Inflammatory Response Syndrome ; enzymology ; pathology

The Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3) task force assessed the latest pathophysiological parameters associated with sepsis and septic shock and defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. This SEPSIS-3 definition may be applied using relevant clinical and biological criteria including changes in the Sequential Organ Failure Assessment score and serum lactate levels. The new definition does not include criteria for systemic inflammatory response syndrome or the concept of 'severe sepsis.' The SEPSIS-3 definition aims to devise more precise descriptions of sepsis and to improve clinical care. However, there are important questions relating to the clinical application of the new definition. We review the main characteristics and limitations of previous definitions and discuss some of the potential controversies raised by the new framework.
Advisory Committees ; Consensus ; Lactic Acid ; Organ Dysfunction Scores ; Sepsis* ; Shock, Septic ; Systemic Inflammatory Response Syndrome