血液から分離された菌における汚染菌の頻度

SOFA　score

呼吸器、凝固系、肝機能、心血管系、中枢神経系、腎機能の6項目について、臓器障害の程度を0から4点の5段階で評価する重症度評価方法である。
スコアが5を超えると死亡率は20％である。
出典
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1: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine.
著者: J L Vincent, A de Mendonça, F Cantraine, R Moreno, J Takala, P M Suter, C L Sprung, F Colardyn, S Blecher
雑誌名: Crit Care Med. 1998 Nov;26(11):1793-800.
Abstract/Text: OBJECTIVE: To evaluate the use of the Sequential Organ Failure Assessment (SOFA) score in assessing the incidence and severity of organ dysfunction in critically ill patients.
DESIGN: Prospective, multicenter study.
SETTING: Forty intensive care units (ICUs) in 16 countries.
PATIENTS: Patients admitted to the ICU in May 1995 (n = 1,449), excluding patients who underwent uncomplicated elective surgery with an ICU length of stay <48 hrs.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The main outcome measures included incidence of dysfunction/failure of different organs and the relationship of this dysfunction with outcome. In this cohort of patients, the median length of ICU stay was 5 days, and the ICU mortality rate was 22%. Multiple organ dysfunction and high SOFA scores for any individual organ were associated with increased mortality. The presence of infection on admission (28.7% of patients) was associated with higher SOFA scores for each organ. The evaluation of a subgroup of 544 patients who stayed in the ICU for at least 1 wk showed that survivors and nonsurvivors followed a different course. This subgroup had greater respiratory, cardiovascular, and neurologic scores than the other patients. In this subgroup, the total SOFA score increased in 44% of the nonsurvivors but in only 20% of the survivors (p < .001). Conversely, the total SOFA score decreased in 33% of the survivors compared with 21% of the nonsurvivors (p < .001).
CONCLUSIONS: The SOFA score is a simple, but effective method to describe organ dysfunction/failure in critically ill patients. Regular, repeated scoring enables patient condition and disease development to be monitored and better understood. The SOFA score may enable comparison between patients that would benefit clinical trials.
Crit Care Med. 1998 Nov;26(11):1793-800.

血液培養予測ルール

血液培養予測ルールにて、大項目1つ、あるいは小項目2つ以上該当すれば血液培養採取を行う。
出典
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1: Who needs a blood culture? A prospectively derived and validated prediction rule.
著者: Nathan I Shapiro, Richard E Wolfe, Sharon B Wright, Richard Moore, David W Bates
雑誌名: J Emerg Med. 2008 Oct;35(3):255-64. doi: 10.1016/j.jemermed.2008.04.001. Epub 2008 May 16.
Abstract/Text: The study objective was to derive and validate a clinical decision rule for obtaining blood cultures in Emergency Department (ED) patients with suspected infection. This was a prospective, observational cohort study of consecutive adult ED patients with blood cultures obtained. The study ran from February 1, 2000 through February 1, 2001. Patients were randomly assigned to derivation (2/3) or validation (1/3) sets. The outcome was "true bacteremia." Features of the history, co-morbid illness, physical examination, and laboratory testing were used to create a clinical decision rule. Among 3901 patients, 3730 (96%) were enrolled with 305 (8.2%) episodes of true bacteremia. A decision rule was created with "major criteria" defined as: temperature > 39.5 degrees C (103.0 degrees F), indwelling vascular catheter, or clinical suspicion of endocarditis. "Minor criteria" were: temperature 38.3-39.4 degrees C (101-102.9 degrees F), age > 65 years, chills, vomiting, hypotension (systolic blood pressure < 90 mm Hg), neutrophil% > 80, white blood cell count > 18 k, bands > 5%, platelets < 150 k, and creatinine > 2.0. A blood culture is indicated by the rule if at least one major criterion or two minor criteria are present. Otherwise, patients are classified as "low risk" and cultures may be omitted. Only 4 (0.6%) low-risk patients in the derivation set and 3 (0.9%) low-risk patients in the validation set had positive cultures. The sensitivity was 98% (95% confidence interval [CI] 96-100%) (derivation) and 97% (95% CI 94-100%) (validation). We developed and validated a promising clinical decision rule for predicting bacteremia in patients with suspected infection.
J Emerg Med. 2008 Oct;35(3):255-64. doi: 10.1016/j.jemermed.2008.04.00...

コンタミネーションの判断ツリー

[ID0702]：血液から分離された菌における汚染菌の頻度
 
参考文献：
  1. Hall KK, Lyman JA：Updated review of blood culture contamination. Clin Microbiol Rev. 2006 Oct;19(4):788-802. Review.
  1. Ji Yeon Kim, MD, MPH; Eric S. Rosenberg, MD：The Sum of the Parts Is Greater Than the Whole: Reducing Blood Culture Contamination, Ann Intern Med. 2011;154:145-51.

血液から分離された菌における汚染菌の頻度

SOFA　score

呼吸器、凝固系、肝機能、心血管系、中枢神経系、腎機能の6項目について、臓器障害の程度を0から4点の5段階で評価する重症度評価方法である。
スコアが5を超えると死亡率は20％である。
出典
imgimg
1: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine.
著者: J L Vincent, A de Mendonça, F Cantraine, R Moreno, J Takala, P M Suter, C L Sprung, F Colardyn, S Blecher
雑誌名: Crit Care Med. 1998 Nov;26(11):1793-800.
Abstract/Text: OBJECTIVE: To evaluate the use of the Sequential Organ Failure Assessment (SOFA) score in assessing the incidence and severity of organ dysfunction in critically ill patients.
DESIGN: Prospective, multicenter study.
SETTING: Forty intensive care units (ICUs) in 16 countries.
PATIENTS: Patients admitted to the ICU in May 1995 (n = 1,449), excluding patients who underwent uncomplicated elective surgery with an ICU length of stay <48 hrs.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The main outcome measures included incidence of dysfunction/failure of different organs and the relationship of this dysfunction with outcome. In this cohort of patients, the median length of ICU stay was 5 days, and the ICU mortality rate was 22%. Multiple organ dysfunction and high SOFA scores for any individual organ were associated with increased mortality. The presence of infection on admission (28.7% of patients) was associated with higher SOFA scores for each organ. The evaluation of a subgroup of 544 patients who stayed in the ICU for at least 1 wk showed that survivors and nonsurvivors followed a different course. This subgroup had greater respiratory, cardiovascular, and neurologic scores than the other patients. In this subgroup, the total SOFA score increased in 44% of the nonsurvivors but in only 20% of the survivors (p < .001). Conversely, the total SOFA score decreased in 33% of the survivors compared with 21% of the nonsurvivors (p < .001).
CONCLUSIONS: The SOFA score is a simple, but effective method to describe organ dysfunction/failure in critically ill patients. Regular, repeated scoring enables patient condition and disease development to be monitored and better understood. The SOFA score may enable comparison between patients that would benefit clinical trials.
Crit Care Med. 1998 Nov;26(11):1793-800.