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Article: Empiric antibiotic therapy in early periprosthetic joint infection: a retrospective cohort study.

Scholten, Ruben / Klein Klouwenberg, Peter M C / Gisolf, Jet E H / van Susante, Job L C / Somford, Matthijs P

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

2021

Abstract: Purpose: Periprosthetic joint infection (PJI) is a devastating complication following total knee or total hip arthroplasty (TKA/THA). Appropriate empiric antibiotic treatment, initiated directly after debridement and implant retention (DAIR), is ... ...

Abstract	Purpose: Periprosthetic joint infection (PJI) is a devastating complication following total knee or total hip arthroplasty (TKA/THA). Appropriate empiric antibiotic treatment, initiated directly after debridement and implant retention (DAIR), is suggested to contribute to treatment success. The aim of this study was to describe the microbiology and the antibiotic susceptibility in early PJI to guide future empiric treatment in a region with a low incidence of methicillin-resistant Staphylococcus aureus (MRSA). Methods: Consecutive patients who underwent DAIR within 3 months after primary unilateral TKA or THA between January 2011 and December 2018 were retrospectively identified from the hospital electronic health records. Data on causative pathogens, antimicrobial susceptibility and the number of post-operative days until cultures demonstrated bacterial growth were collected. Results: One hundred and eleven early PJIs were identified of which 65 (59%) were monomicrobial and 46 (41%) polymicrobial. Among all isolated pathogens, Staphylococcus aureus (n = 53; 29%) was the most commonly identified pathogen in early PJI without any involvement of MRSA. 72% of PJIs were susceptible to vancomycin which could be increased to around 90% by adding gram-negative coverage. On the 5th postoperative day, bacterial growth was observed in 98% of cases. All gram-negative bacteria demonstrated positive tissue cultures on the 4th postoperative day. Conclusion: Vancomycin combined with ciprofloxacin or a third generation cephalosporin provided the highest antimicrobial coverage of all responsible pathogens identified in early PJI. Empiric treatment of gram-negative treatment can be safely terminated in the absence of gram-negative pathogens after 4 days of culturing in cases without preoperative antibiotic treatment.
Language	English
Publishing date	2021-10-27
Publishing country	France
Document type	Journal Article
ZDB-ID	1231084-0
ISSN	1432-1068 ; 1633-8065 ; 0948-4817 ; 0940-3264
ISSN (online)	1432-1068
ISSN	1633-8065 ; 0948-4817 ; 0940-3264
DOI	10.1007/s00590-021-03156-0
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Zs.A 3479: Show issues

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Article ; Online: Correction to: Predicting the clinical trajectory in critically ill patients with sepsis: a cohort study.

Klein Klouwenberg, Peter M C / Spitoni, Cristian / van der Poll, Tom / Bonten, Marc J / Cremer, Olaf L

Critical care (London, England)

2020 Volume 24, Issue 1, Page(s) 41

Abstract: In the publication of this article [1], there are 4 collaborating authors missing from the 'MARS consortium'. This has now been included in this correction article. ...

Abstract	In the publication of this article [1], there are 4 collaborating authors missing from the 'MARS consortium'. This has now been included in this correction article.
Language	English
Publishing date	2020-02-06
Publishing country	England
Document type	Journal Article ; Published Erratum
ZDB-ID	2051256-9
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-020-2758-1
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Article: Validation of SeptiCyte RAPID to Discriminate Sepsis from Non-Infectious Systemic Inflammation.

Balk, Robert / Esper, Annette M / Martin, Greg S / Miller, Russell R / Lopansri, Bert K / Burke, John P / Levy, Mitchell / Opal, Steven / Rothman, Richard E / D'Alessio, Franco R / Sidhaye, Venkataramana K / Aggarwal, Neil R / Greenberg, Jared A / Yoder, Mark / Patel, Gourang / Gilbert, Emily / Parada, Jorge P / Afshar, Majid / Kempker, Jordan A /

van der Poll, Tom / Schultz, Marcus J / Scicluna, Brendon P / Klein Klouwenberg, Peter M C / Liebler, Janice / Blodget, Emily / Kumar, Santhi / Navalkar, Krupa / Yager, Thomas D / Sampson, Dayle / Kirk, James T / Cermelli, Silvia / Davis, Roy F / Brandon, Richard B

Journal of clinical medicine

2024 Volume 13, Issue 5

Abstract: 1) ...

Abstract	(1)
Language	English
Publishing date	2024-02-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13051194
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Article ; Online: Predicting the clinical trajectory in critically ill patients with sepsis: a cohort study.

Klein Klouwenberg, Peter M C / Spitoni, Cristian / van der Poll, Tom / Bonten, Marc J / Cremer, Olaf L

Critical care (London, England)

2019 Volume 23, Issue 1, Page(s) 408

Abstract: Background: To develop a mathematical model to estimate daily evolution of disease severity using routinely available parameters in patients admitted to the intensive care unit (ICU).: Methods: Over a 3-year period, we prospectively enrolled ... ...

Abstract	Background: To develop a mathematical model to estimate daily evolution of disease severity using routinely available parameters in patients admitted to the intensive care unit (ICU). Methods: Over a 3-year period, we prospectively enrolled consecutive adults with sepsis and categorized patients as (1) being at risk for developing (more severe) organ dysfunction, (2) having (potentially still reversible) limited organ failure, or (3) having multiple-organ failure. Daily probabilities for transitions between these disease states, and to death or discharge, during the first 2 weeks in ICU were calculated using a multi-state model that was updated every 2 days using both baseline and time-varying information. The model was validated in independent patients. Results: We studied 1371 sepsis admissions in 1251 patients. Upon presentation, 53 (4%) were classed at risk, 1151 (84%) had limited organ failure, and 167 (12%) had multiple-organ failure. Among patients with limited organ failure, 197 (17%) evolved to multiple-organ failure or died and 809 (70%) improved or were discharged alive within 14 days. Among patients with multiple-organ failure, 67 (40%) died and 91 (54%) improved or were discharged. Treatment response could be predicted with reasonable accuracy (c-statistic ranging from 0.55 to 0.81 for individual disease states, and 0.67 overall). Model performance in the validation cohort was similar. Conclusions: This prediction model that estimates daily evolution of disease severity during sepsis may eventually support clinicians in making better informed treatment decisions and could be used to evaluate prognostic biomarkers or perform in silico modeling of novel sepsis therapies during trial design. Clinical trial registration: ClinicalTrials.gov NCT01905033.
MeSH term(s)	APACHE ; Aged ; Cohort Studies ; Critical Illness/classification ; Critical Illness/mortality ; Female ; Hospital Mortality ; Humans ; Intensive Care Units/organization & administration ; Intensive Care Units/statistics & numerical data ; Male ; Markov Chains ; Middle Aged ; Organ Dysfunction Scores ; Prognosis ; Prospective Studies ; Sepsis/classification ; Sepsis/mortality ; Severity of Illness Index ; Simplified Acute Physiology Score
Language	English
Publishing date	2019-12-12
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2051256-9
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-019-2687-z
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Article ; Online: Etiology of Myocardial Injury in Critically Ill Patients with Sepsis: A Cohort Study.

Frencken, Jos F / van Smeden, Maarten / van de Groep, Kirsten / Ong, David S Y / Klein Klouwenberg, Peter M C / Juffermans, Nicole / Bonten, Marc J M / van der Poll, Tom / Cremer, Olaf L

Annals of the American Thoracic Society

2021 Volume 19, Issue 5, Page(s) 773–780

Abstract: Rationale: ...

Abstract	Rationale:
MeSH term(s)	Biomarkers ; Cohort Studies ; Critical Illness ; Heart Injuries/etiology ; Humans ; Inflammation ; Intensive Care Units ; Sepsis/complications ; Troponin I
Chemical Substances	Biomarkers ; Troponin I
Language	English
Publishing date	2021-11-16
Publishing country	United States
Document type	Clinical Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.202106-689OC
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Article ; Online: Consumptive coagulopathy is associated with a disturbed host response in patients with sepsis.

van Vught, Lonneke A / Uhel, Fabrice / Ding, Chao / Van't Veer, Cees / Scicluna, Brendon P / Peters-Sengers, Hessel / Klein Klouwenberg, Peter M C / Nürnberg, Peter / Cremer, Olaf L / Schultz, Marcus J / van der Poll, Tom

Journal of thrombosis and haemostasis : JTH

2021 Volume 19, Issue 4, Page(s) 1049–1063

Abstract: Background: A prolonged prothrombin time (PT) is a common feature in sepsis indicating consumptive coagulopathy.: Objectives: To determine the association between a prolonged PT and aberrations in other host response mechanisms in sepsis.: Methods!# ...

Abstract	Background: A prolonged prothrombin time (PT) is a common feature in sepsis indicating consumptive coagulopathy. Objectives: To determine the association between a prolonged PT and aberrations in other host response mechanisms in sepsis. Methods: Patients admitted to the intensive care unit with sepsis were divided in quartiles according to the highest PT value measured within 24 h after admission. The host response was evaluated by measuring 19 plasma biomarkers reflecting pathways implicated in sepsis pathogenesis and by blood leukocyte gene expression profiling. Measurements and main results: Of 1524 admissions for sepsis, 386 (25.3%) involved patients with a normal PT (≤12.7 s); the remaining quartiles entailed 379 (24.9%) patients with a slightly prolonged PT (12.8 ≤ PT ≤ 15.0 s), 383 (25.1%) with an intermediately prolonged PT (15.1 ≤ PT ≤ 17.2 s), and 376 (24.7%) with an extremely prolonged PT (≥17.3 s). While patients with an extremely prolonged PT showed an increased crude mortality up to 1 year after admission, none of the prolonged PT groups was independently associated with 30-day adjusted mortality. Comparison of the host response between patients with a normal PT or an extremely prolonged PT matched for baseline characteristics including severity of disease showed that an extremely prolonged PT was associated with impaired anticoagulant mechanisms, a more disturbed endothelial barrier integrity and increased systemic inflammation, and blood leukocyte transcriptomes indicating more prominent metabolic reprogramming and protein catabolism. Conclusion: A prolonged PT is associated with stronger anomalies in pathways implicated in the pathogenesis of sepsis, suggesting that activation of coagulation impacts other host response mechanisms.
MeSH term(s)	Biomarkers ; Blood Coagulation Disorders ; Disseminated Intravascular Coagulation/diagnosis ; Humans ; Intensive Care Units ; Sepsis/diagnosis
Chemical Substances	Biomarkers
Language	English
Publishing date	2021-02-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2112661-6
ISSN	1538-7836 ; 1538-7933
ISSN (online)	1538-7836
ISSN	1538-7933
DOI	10.1111/jth.15246
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Zs.A 5805: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review.

Kuipers, Sanne / Klein Klouwenberg, Peter M C / Cremer, Olaf L

Critical care (London, England)

2014 Volume 18, Issue 6, Page(s) 688

Abstract: Introduction: Critically ill patients with sepsis are prone to develop cardiac dysrhythmias, most commonly atrial fibrillation (AF). Systemic inflammation, circulating stress hormones, autonomic dysfunction, and volume shifts are all possible triggers ... ...

Abstract	Introduction: Critically ill patients with sepsis are prone to develop cardiac dysrhythmias, most commonly atrial fibrillation (AF). Systemic inflammation, circulating stress hormones, autonomic dysfunction, and volume shifts are all possible triggers for AF in this setting. We conducted a systematic review to describe the incidence, risk factors and outcomes of new-onset AF in patients with sepsis. Methods: MEDLINE, EMBASE and Web Of Science were searched for studies reporting the incidence of new-onset AF, atrial flutter or supraventricular tachycardia in patients with sepsis admitted to an intensive care unit, excluding studies that primarily focused on postcardiotomy patients. Studies were assessed for methodological quality using the GRADE system. Risk factors were considered to have a high level of evidence if they were reported in ≥ 2 studies using multivariable analyses at a P value <0.05. Subsequently, the strength of association was classified as strong, moderate or weak, based on the reported odds ratios. Results: Eleven studies were included. Overall quality was low to moderate. The weighted mean incidence of new-onset AF was 8% (range 0 to 14%), 10% (4 to 23%) and 23% (6 to 46%) in critically ill patients with sepsis, severe sepsis and septic shock, respectively. Independent risk factors with a high level of evidence included advanced age (weak strength of association), white race (moderate association), presence of a respiratory tract infection (weak association), organ failure (moderate association), and pulmonary artery catheter use (moderate association). Protective factors were a history of diabetes mellitus (weak association) and the presence of a urinary tract infection (weak association). New-onset AF was associated with increased short-term mortality in five studies (crude relative effect estimates ranging from 1.96 to 3.32; adjusted effects 1.07 to 3.28). Three studies reported a significantly increased length of stay in the ICU (weighted mean difference 9 days, range 5 to 13 days), whereas an increased risk of ischemic stroke was reported in the single study that looked at this outcome. Conclusions: New-onset AF is a common consequence of sepsis and is independently associated with poor outcome. Early risk stratification of patients may allow for pharmacological interventions to prevent this complication.
MeSH term(s)	Atrial Fibrillation/diagnosis ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/therapy ; Humans ; Incidence ; Intensive Care Units/trends ; Risk Factors ; Sepsis/diagnosis ; Sepsis/epidemiology ; Sepsis/therapy ; Treatment Outcome
Language	English
Publishing date	2014-12-15
Publishing country	England
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2051256-9
ISSN	1466-609X ; 1466-609X
ISSN (online)	1466-609X
ISSN	1466-609X
DOI	10.1186/s13054-014-0688-5
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Article ; Online: Reply: Comprehensive Validation of the FAIM3:PLAC8 Ratio in Time-matched Public Gene Expression Data.

Scicluna, Brendon P / Klein Klouwenberg, Peter M C / van der Poll, Tom

American journal of respiratory and critical care medicine

2015 Volume 192, Issue 10, Page(s) 1261–1262

MeSH term(s)	Apoptosis Regulatory Proteins/genetics ; Biomarkers/blood ; Community-Acquired Infections/diagnosis ; Female ; Humans ; Male ; Pneumonia/diagnosis ; Proteins/genetics
Chemical Substances	Apoptosis Regulatory Proteins ; Biomarkers ; Proteins
Language	English
Publishing date	2015-11-15
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.201508-1552LE
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Article: Robustness of sepsis-3 criteria in critically ill patients.

Verboom, Diana M / Frencken, Jos F / Ong, David S Y / Horn, Janneke / van der Poll, Tom / Bonten, Marc J M / Cremer, Olaf L / Klein Klouwenberg, Peter M C

Journal of intensive care

2019 Volume 7, Page(s) 46

Abstract: Background: Early recognition of sepsis is challenging, and diagnostic criteria have changed repeatedly. We assessed the robustness of sepsis-3 criteria in intensive care unit (ICU) patients.: Methods: We studied the apparent incidence and associated ...

Abstract	Background: Early recognition of sepsis is challenging, and diagnostic criteria have changed repeatedly. We assessed the robustness of sepsis-3 criteria in intensive care unit (ICU) patients. Methods: We studied the apparent incidence and associated mortality of sepsis-3 among patients who were prospectively enrolled in the Molecular Diagnosis and Risk Stratification of Sepsis (MARS) cohort in the Netherlands, and explored the effects of minor variations in the precise definition and timing of diagnostic criteria for organ failure. Results: Among 1081 patients with suspected infection upon ICU admission, 648 (60%) were considered to have sepsis according to prospective adjudication in the MARS study, whereas 976 (90%) met sepsis-3 criteria, yielding only 64% agreement at the individual patient level. Among 501 subjects developing ICU-acquired infection, these rates were 270 (54%) and 260 (52%), respectively (yielding 58% agreement). Hospital mortality was 234 (36%) vs 277 (28%) for those meeting MARS-sepsis or sepsis-3 criteria upon presentation ( Conclusion: The sepsis-3 definition lacks robustness as well as discriminatory ability, since nearly all patients presenting to ICU with suspected infection fulfill its criteria. These should therefore be specified in greater detail, and applied more consistently, during future sepsis studies. Trial registration: The MARS study is registered at ClinicalTrials.gov (identifier NCT01905033).
Language	English
Publishing date	2019-08-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2739853-5
ISSN	2052-0492
ISSN	2052-0492
DOI	10.1186/s40560-019-0400-6
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Article ; Online: Reply: FAIM3:PLAC8 Ratio Compared with Existing Biomarkers for Diagnosis of Severe Community-acquired Pneumonia: Comparing Apples to Oranges?

Scicluna, Brendon P / van Vught, Lonneke A / van der Poll, Tom / Klein Klouwenberg, Peter M C / Cremer, Olaf L

American journal of respiratory and critical care medicine

2016 Volume 193, Issue 1, Page(s) 102–103

MeSH term(s)	Apoptosis Regulatory Proteins/genetics ; Biomarkers/blood ; Community-Acquired Infections/diagnosis ; Female ; Humans ; Male ; Pneumonia/diagnosis ; Proteins/genetics
Chemical Substances	Apoptosis Regulatory Proteins ; Biomarkers ; Proteins
Language	English
Publishing date	2016-01-01
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.201509-1752LE
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