Severe influenza infection has no effective treatment available. One of the key barriers to developing host-directed therapy is a lack of reliable prognostic factors needed to guide such therapy. Here, we use a network analysis approach to identify host factors associated with severe influenza and fatal outcome. In influenza patients with moderate-to-severe diseases, we uncover a complex landscape of immunological pathways, with the main changes occurring in pathways related to circulating neutrophils. Patients with severe disease display excessive neutrophil extracellular traps formation, neutrophil-inflammation and delayed apoptosis, all of which have been associated with fatal outcome in animal models. Excessive neutrophil activation correlates with worsening oxygenation impairment and predicted fatal outcome (AUROC 0.817-0.898). These findings provide new evidence that neutrophil-dominated host response is associated with poor outcomes. Measuring neutrophil-related changes may improve risk stratification and patient selection, a critical first step in developing host-directed immune therapy.

• MeSH
• aktivace neutrofilů imunologie   MeSH
• buněčný cyklus imunologie   MeSH
• chřipka lidská imunologie   mortalita   patologie   MeSH
• exprese genu genetika   MeSH
• extracelulární pasti imunologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neutrofily imunologie   MeSH
• plíce imunologie   MeSH
• prospektivní studie MeSH
• respirační insuficience mortalita   patologie   virologie   MeSH
• umělé dýchání MeSH
• virus chřipky A, podtyp H1N1 imunologie   izolace a purifikace   MeSH
• virus chřipky A, podtyp H3N2 imunologie   izolace a purifikace   MeSH
• virus chřipky B imunologie   izolace a purifikace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.

• MeSH
• antibiotická politika metody   MeSH
• antiinfekční látky terapeutické užití   MeSH
• celosvětové zdraví trendy   MeSH
• lidé MeSH
• nitrobřišní infekce farmakoterapie   MeSH
• pooperační komplikace farmakoterapie   MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

The early recognition and treatment of sepsis is paramount to reducing the mortality of this disease. However, unlike trauma, stroke or acute myocardial infarction, the initial signs of sepsis are subtle and easily missed by clinicians. Thus, hospital-based systems are needed to identify and triage patients who might be septic. This review focuses on the early diagnosis of sepsis and the implementation of a systems-based approach to help coordinate the identification and treatment of patients with this disease. RECENT FINDINGS: Alterations in traditional hemodynamic parameters, such as blood pressure and heart rate, are poor predictors of the presence of septic shock. Other more subtle findings (such as the 10 signs of vitality) are stronger determinants of poor tissue perfusion in a patient who may be septic. Early detection of a patient who is 'in trouble' on the ward by bedside nurses or physicians and activation of a medical emergency team has been shown to improve outcome. By coupling the medical emergency team with early goal-directed therapy, patients with sepsis can be discovered earlier and have therapy instituted within the so-called 'golden hour', first appreciated with trauma care. SUMMARY: The institution of a rapid response system for the detection and treatment of septic shock requires a multidisciplinary approach. The infrastructure to create such a system must be facilitated by administrators and implemented by front-line healthcare providers. Continuous assessment of the outcome benefit of such a system by a quality assurance team is the final part of a truly integrated approach to sepsis treatment.

• MeSH
• časná diagnóza MeSH
• časové faktory MeSH
• klinické protokoly normy   MeSH
• lidé MeSH
• mezioborová komunikace MeSH
• septický šok diagnóza   farmakoterapie   MeSH
• týmová péče o pacienty MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH