Rationale: Early detection, standardized therapy, adequate infrastructure, and strategies for quality improvement should constitute essential components of every hospital's sepsis plan. Objectives: To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute-care hospitals. Methods: A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives (QIIs) in hospitals. Measurements and Main Results: A total of 1,023 hospitals in 69 countries were included. Most of them, 835 (81.6%), were in Europe. Sepsis screening was used in 54.2% of emergency departments (EDs), 47.9% of wards, and 61.7% of ICUs. Sepsis management was standardized in 57.3% of EDs, 45.2% of wards, and 70.7% of ICUs. The implementation of comprehensive QIIs was associated with increased screening (EDs, +33.3%; wards, +44.4%; ICUs, +23.8% absolute difference) and increased standardized sepsis management (EDs, +33.6%; wards, +40.0%; ICUs, +17.7% absolute difference) compared with hospitals without QIIs. A total of 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs. Conclusions: The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regard to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.

• Klíčová slova
• quality of care, sepsis management, sepsis programs, sepsis screening, standard of care,
• MeSH
• dodržování směrnic statistika a číselné údaje   MeSH
• jednotky intenzivní péče statistika a číselné údaje   MeSH
• lidé MeSH
• nemocnice statistika a číselné údaje   MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• sepse * terapie   diagnóza   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• zlepšení kvality MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

Acute kidney injury (AKI) is a consequence of several diseases that can severely damage kidney function. It is a frequent complication of hospitalization and very common in critically ill patients because of other serious illnesses, such as septic conditions. New diagnostic options, including renal biomarkers, may help in early diagnosis. Our study included 46 patients, 31 with AKI and 15 without AKI on admission. Blood samples were collected on the first, fourth, and seventh days of treatment, and in addition to basic biochemical parameters, neutrophil gelatinase-associated lipocalin (NGAL) levels in serum were also examined. Data from the first and seventh day were used for statistical analysis. On the first follow-up day, NGAL values were categorized according to an optimal cut-off value of 290 µg/l. We demonstrated that if NGAL levels were higher, the risk of renal injury increased approximately 16 times. Other results showed that NGAL levels were moderately correlated with serum creatinine (r = 0.613, p < 0.0001), procalcitonin (PCT) (r = 0.627, p < 0.0001), and AKI stage (r = 0.589, p < 0.0001). There was also a significant positive correlation with SOFA (Sequential Organ Failure Assessment) score (r = 0.395, p = 0.007). Early diagnosis and treatment are crucial in managing AKI and preventing further kidney damage. NGAL levels can increase within a few hours after injury, making it a useful tool for early AKI detection and diagnosis. Key words: Acute kidney injury, Biomarker, NGAL, Sepsis.

• MeSH
• akutní poškození ledvin * krev   diagnóza   MeSH
• biologické markery * krev   MeSH
• dospělí MeSH
• kritický stav * MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipokalin-2 * krev   MeSH
• prediktivní hodnota testů MeSH
• senioři MeSH
• sepse * krev   diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• biologické markery * MeSH
• LCN2 protein, human MeSH Prohlížeč
• lipokalin-2 * MeSH

BACKGROUND AND AIM: Large number of studies proved undisputable role of procalcitonin (PCT) in sepsis diagnosis. Moreover, potential of procalcitonin to predict blood culture results according to Gram staining, different types of pathogens and foci of infection is discussed lately. The primary aim of our study was to compare the PCT levels in septic patients with documented Gram-positive and Gram-negative bacteraemia. We also evaluated the PCT levels according to different foci of infection and with different types of pathogens. MATERIAL AND METHODS: Procalcitonin levels measured at the time of sepsis diagnosis (PCT1) and after 24 hours (PCT2) in welldefined cohort of septic patients were statistically evaluated according to the results of blood cultures and foci of infection. RESULTS: Out of 258 patients, 180 had negative and 78 positive blood culture. The difference in PCT1 and PCT2 levels between gram-negative (GN) and gram-positive (GP) bacteraemia was not significant. The highest values of PCT1 as well as PCT2 in culturepositive cases were found in patients infected with Streptococcus spp. followed by Escherichia Coli in contrast to Staphylococcus spp. with the lowest PCT concentrations. Highest procalcitonin levels were observed in urosepsis with PCT2 concentrations significantly higher than in all other foci of infection. CONCLUSION: PCT discriminatory power to differentiate between GN and GP bacteraemia in septic patients appears to be low. PCT concentrations correlates probably more closely to different type of pathogens with highest PCT levels in Streptococci spp. and foci of infection rather than result of the Gram stain. In our study population, urosepsis showed statistically significant higher PCT concentrations 24 hours following sepsis diagnosis when compared to other site of infection.

• Klíčová slova
• bacteraemia, foci of infection, presepsin, procalcitonin, sepsis, sepsis mimics, septic shock,
• MeSH
• bakteriemie * diagnóza   krev   mikrobiologie   MeSH
• biologické markery krev   MeSH
• dospělí MeSH
• gramnegativní bakteriální infekce diagnóza   krev   MeSH
• grampozitivní bakteriální infekce * diagnóza   krev   mikrobiologie   MeSH
• kultivační vyšetření krve * MeSH
• lidé středního věku MeSH
• lidé MeSH
• prokalcitonin * krev   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sepse * diagnóza   krev   mikrobiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• biologické markery MeSH
• prokalcitonin * MeSH

The quest for a definitive diagnostic tool for sepsis has spanned decades, yet it remains elusive. The diagnostic workup of sepsis is inherently complex, involving dozens of biochemical, hematologic, and immunologic parameters, alongside complex microbiological diagnostics. Over the past decade, the integration of omics technologies has further complicated this diagnostic landscape. Despite these advancements, clinical assessment remains the gold standard for the diagnostic workup of sepsis. This work provides an overview of selected diagnostic biomarkers that are deemed readily applicable in routine clinical practice, extending applicability beyond highly specialized university hospitals. Verifying the reliability and clinical utility of diagnostic parameters generally takes several years, and often is more challenging in patients with sepsis, as compared with other cohorts, because of the complexity of this condition. Nevertheless, the integration of new technologies, the expanded use of bedside diagnostics, and advancements in omics technologies are propelling us toward the realization of personalized medicine and theranostics.

• MeSH
• biologické markery * krev   MeSH
• lidé MeSH
• sepse * diagnóza   krev   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• biologické markery * MeSH

The positive detection rate of blood metagenomic next-generation sequencing (mNGS) was still too low to meet clinical needs, while pus from the site of primary infection may be advantageous for identification of pathogens. To assess the value of mNGS using pus in patients with sepsis, thirty-five samples were collected. Pathogen identification and mixed infection diagnosis obtained by use of mNGS or cultivation methods were compared. Fifty-three aerobic or facultative anaerobes, 59 obligate anaerobes and 7 fungi were identified by the two methods. mNGS increased the accuracy rate of diagnosing aerobic or facultative anaerobic infections from 44.4% to 94.4%; mNGS also increased the sensitivity of diagnosing obligate anaerobic infections from 52.9% to 100.0%; however, mNGS did not show any advantage in terms of fungal infections. Culture and mNGS identified 1 and 24 patients with mixed infection, respectively. For obligate anaerobes, source of microorganisms was analyzed. The odontogenic bacteria all caused empyema (n = 7) or skin and soft tissue infections (n = 5), whereas the gut-derived microbes all caused intra-abdominal infections (n = 7). We also compared the clinical characteristics of non-obligate anaerobic and obligate anaerobic infection groups. The SOFA score [9.0 (7.5, 14.3) vs. 5.0 (3.0, 8.0), P = 0.005], procalcitonin value [4.7 (1.8, 39.9) vs. 2.50 (0.7, 8.0), P = 0.035], the proportion of septic shock (66.7% vs. 35.3%, P = 0.044) and acute liver injury (66.7% vs. 23.5%, P = 0.018) in the non-obligate anaerobic infection group were significantly higher than those in the obligate anaerobic infection group. In patients with sepsis caused by purulent infection, mNGS using pus from the primary lesion may yield more valuable microbiological information.

• Klíčová slova
• Metagenomic next-generation sequencing (mNGS), Obligate anaerobic infection, Pus, Sepsis, Mixed infection,
• MeSH
• Bacteria * genetika   izolace a purifikace   klasifikace   MeSH
• dospělí MeSH
• hnisání mikrobiologie   MeSH
• houby genetika   izolace a purifikace   klasifikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metagenomika * metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• sepse * mikrobiologie   diagnóza   MeSH
• vysoce účinné nukleotidové sekvenování * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The monocyte distribution width (MDW) has emerged as a promising biomarker for accurate and early identification of patients with potentially life-threatening infections. Here we tested the diagnostic performance of MDW in adult patients requiring hospital admission for community-acquired infections and sepsis, evaluated sources of heterogeneity in the estimates of diagnostic accuracy, and assessed the meaning of MDW in a patient population presenting to the emergency department (ED) for acute non-infectious conditions. 1925 consecutive patients were categorized into three groups: non-infection (n = 1507), infection (n = 316), and sepsis/septic shock (n = 102). Diagnostic performance for infection or sepsis of MDW alone or in combination with components of SOFA was tested using AUC of ROC curves, sensitivity, and specificity. The relationship between MDW and different pathogens as well as the impact of non-infectious conditions on MDW values were explored. For the prediction of infection, the AUC/ROC of MDW (0.84) was nearly overlapping that of procalcitonin (0.83), and C-reactive protein (0.89). Statistical optimal cut-off value for MDW was 21 for predicting infection (sensitivity 73%, specificity 82%) and 22 for predicting sepsis (sensitivity 79%, specificity 83%). The best threshold to rule out infection was MDW ≤ 17 (NPV 96.9, 95% CI 88.3-100.0), and ≤ 18 (NPV 99.5, 95% CI 98.3-100.0) to rule out sepsis. The combination of MDW with markers of organ dysfunction (creatinine, bilirubin, platelets) substantially improved the AUC (0.96 (95% CI 0.94-0.97); specificity and sensitivity of 88% and 94%, respectively). In conclusion, MDW has a good diagnostic performance in diagnosing infection and sepsis in patients presenting in ED. Its use as an infection marker even increases when combined with other markers of organ dysfunction. Understanding the impact of interactions of non-infectious conditions and comorbidities on MDW and its diagnostic accuracy requires further elucidation.

• Klíčová slova
• Diagnostic biomarkers, Emergency department, Infection, Monocyte distribution width, Sepsis,
• MeSH
• akutní nemoc MeSH
• biologické markery * krev   MeSH
• dospělí MeSH
• infekce získané v komunitě diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• monocyty * metabolismus   MeSH
• prospektivní studie MeSH
• ROC křivka MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• sepse * diagnóza   krev   MeSH
• urgentní služby nemocnice * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• biologické markery * MeSH

This article reports a case of systemic infection caused by Pasteurella multocida. The infection was confirmed in a 79-year-old man who was admitted to the hospital after falling from a couch. The disease was manifested by the development of fever, chills, joint pain. Laboratory tests revealed elevated C-reactive protein levels, slightly elevated nitrogen metabolites, borderline leukocytosis, and thrombocytopenia. The pathogen was identified in a blood culture and a wound swab culture. The patient was initially treated with third-generation cephalosporin (cefotaxime) and later with cefuroxime. The article is supplemented with information on the etiologic agent, its history, and a literature review of documented complicated cases of pasteurellosis.

• MeSH
• infekce bakteriemi rodu Pasteurella * diagnóza   mikrobiologie   farmakoterapie   MeSH
• kousnutí a bodnutí * komplikace   mikrobiologie   MeSH
• lidé MeSH
• Pasteurella multocida * izolace a purifikace   MeSH
• psi MeSH
• senioři MeSH
• sepse mikrobiologie   diagnóza   farmakoterapie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• psi MeSH
• senioři MeSH
• zvířata MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

The aim of this retrospective study was to evaluate the reliability of peak interleukin-6 (IL-6) level within 24 hours after delivery as a predictor for early-onset sepsis (EOS) in very preterm neonates. Interleukin-6 was assessed at 2 hours and at 12 to 24 hours after delivery. The highest level was considered a peak value. The definition of EOS was based on positive blood culture and clinical signs of infection or negative blood culture, clinical signs of infection, and C-reactive protein >10 mg/L. Among 445 enrolled infants, 53 developed EOS. A peak IL-6 level of more than 200 ng/L had a sensitivity of 89% and specificity of 77% for the presence of EOS. The negative predictive value was 98%. Receiver operating characteristics curve had area under the curve of 0.92. Peak IL-6 is a reliable marker of systemic inflammatory response and might be useful to exclude EOS within the first 24 hours.

• Klíčová slova
• interleukin-6, neonatal early-onset sepsis, systemic inflammatory response, very preterm infants,
• MeSH
• biologické markery MeSH
• C-reaktivní protein analýza   MeSH
• interleukin-6 MeSH
• lidé MeSH
• nemoci nedonošenců * MeSH
• novorozenec nedonošený MeSH
• novorozenec MeSH
• novorozenecká sepse * diagnóza   MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• sepse * diagnóza   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• biologické markery MeSH
• C-reaktivní protein MeSH
• interleukin-6 MeSH

Mortality and morbidity of newborns with sepsis can be improved by early and accurate diagnosis and targeted therapy. To evaluate the early molecular events associated with inflammation and infection, we evaluated markers of endothelial activation and injury and circulating plasma miRNAs in preterm newborns with sepsis. The study group consisted of newborns with gestational age ≤ 32 weeks, with culture-positive early-onset neonatal sepsis (sepsis group, N = 8), and as a control group, we enrolled newborns without sepsis (control group, N = 12). Soluble markers of inflammation were measured using Luminex-based multiplex assay. Platelet-free plasma RNA was used to construct the library for miRNA sequencing analysis. Normalized counts were calculated and used to measure differential expression of individual detected miRNAs. We found a significant increase of interleukin 18 (IL-18) in the cord blood of the sepsis group (mean ± SEM, 104.7 ± 30.4 pg/ml vs 52.7 ± 5.6 pg/ml, P = 0.02). In peripheral blood of sepsis group patients, we found a significant increase of VEGF-A compared to controls (196.0 ± 70.5 pg/ml vs 59.6 ± 8.5 pg/ml, P = 0.02). In the cord blood plasma, eight miRNAs had significantly differential expression (P < 0.05), four miRNAs were up-regulated and four miRNAs down-regulated. In peripheral blood plasma, all nine miRNAs with significant differential expression were up-regulated. In conclusion, in early-onset neonatal sepsis, IL-18 and VEGF-A might be considered in diagnostic workup. Early-onset sepsis in preterm newborns is associated with significant changes in the circulating miRNA pattern.

• Klíčová slova
• endothelial biomarkers, inflammation, inflammatory markers, microRNA, newborn, sepsis,
• MeSH
• biologické markery metabolismus   MeSH
• interleukin-18 MeSH
• kojenec MeSH
• lidé MeSH
• mikro RNA * genetika   MeSH
• novorozenec MeSH
• novorozenecká sepse * diagnóza   MeSH
• sepse * diagnóza   genetika   MeSH
• vaskulární endoteliální růstový faktor A MeSH
• zánět MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• biologické markery MeSH
• interleukin-18 MeSH
• mikro RNA * MeSH
• vaskulární endoteliální růstový faktor A MeSH

INTRODUCTION: Neonatal sepsis is a leading cause of infant mortality worldwide with non-specific and varied presentation. We aimed to catalogue the current definitions of neonatal sepsis in published randomised controlled trials (RCTs). METHOD: A systematic search of the Embase and Cochrane databases was performed for RCTs which explicitly stated a definition for neonatal sepsis. Definitions were sub-divided into five primary criteria for infection (culture, laboratory findings, clinical signs, radiological evidence and risk factors) and stratified by qualifiers (early/late-onset and likelihood of sepsis). RESULTS: Of 668 papers screened, 80 RCTs were included and 128 individual definitions identified. The single most common definition was neonatal sepsis defined by blood culture alone (n = 35), followed by culture and clinical signs (n = 29), and then laboratory tests/clinical signs (n = 25). Blood culture featured in 83 definitions, laboratory testing featured in 48 definitions while clinical signs and radiology featured in 80 and 8 definitions, respectively. DISCUSSION: A diverse range of definitions of neonatal sepsis are used and based on microbiological culture, laboratory tests and clinical signs in contrast to adult and paediatric sepsis which use organ dysfunction. An international consensus-based definition of neonatal sepsis could allow meta-analysis and translate results to improve outcomes.

• MeSH
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• kojenecká mortalita MeSH
• lidé MeSH
• novorozenec MeSH
• novorozenecká sepse * diagnóza   MeSH
• randomizované kontrolované studie jako téma MeSH
• sepse diagnóza   terapie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH