Background The Dutch Working Party on Antibiotic Policy (SWAB) in collaboration with relevant professional societies, has updated their evidence-based guidelines on empiric antibacterial therapy of... Show moreBackground The Dutch Working Party on Antibiotic Policy (SWAB) in collaboration with relevant professional societies, has updated their evidence-based guidelines on empiric antibacterial therapy of sepsis in adults. Methods Our multidisciplinary guideline committee generated ten population, intervention, comparison, and outcome (PICO) questions relevant for adult patients with sepsis. For each question, a literature search was performed to obtain the best available evidence and assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The quality of evidence for clinically relevant outcomes was graded from high to very low. In structured consensus meetings, the committee formulated recommendations as strong or weak. When evidence could not be obtained, recommendations were provided based on expert opinion and experience (good practice statements). Results Fifty-five recommendations on the antibacterial therapy of sepsis were generated. Recommendations on empiric antibacterial therapy choices were differentiated for sepsis according to the source of infection, the potential causative pathogen and its resistance pattern. One important revision was the distinction between low, increased and high risk of infection with Enterobacterales resistant to third generation cephalosporins (3GRC-E) to guide the choice of empirical therapy. Other new topics included empirical antibacterial therapy in patients with a reported penicillin allergy and the role of pharmacokinetics and pharmacodynamics to guide dosing in sepsis. We also established recommendations on timing and duration of antibacterial treatment. Conclusions Our multidisciplinary committee formulated evidence-based recommendations for the empiric antibacterial therapy of adults with sepsis in The Netherlands. Show less
Grim, C.C.A.; Termorshuizen, F.; Bosman, R.J.; Cremer, O.L.; Meinders, A.J.; Nijsten, M.W.N.; ... ; Jonge, E. de 2021
OBJECTIVES: In critically ill patients, dysnatremia is common, and in these patients, in-hospital mortality is higher. It remains unknown whether changes of serum sodium after ICU admission affect... Show moreOBJECTIVES: In critically ill patients, dysnatremia is common, and in these patients, in-hospital mortality is higher. It remains unknown whether changes of serum sodium after ICU admission affect mortality, especially whether normalization of mild hyponatremia improves survival. DESIGN: Retrospective cohort study. SETTING: Ten Dutch ICUs between January 2011 and April 2017. Patients: Adult patients were included if at least one serum sodium measurement within 24 hours of ICU admission and at least one serum sodium measurement 24-48 hours after ICU admission were available. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A logistic regression model adjusted for age, sex, and Acute Physiology and Chronic Health Evaluation-IV-predicted mortality was used to assess the difference between mean of sodium measurements 24-48 hours after ICU admission and first serum sodium measurement at ICU admission (Delta 48 hr-[Na]) and in-hospital mortality. In total, 36,660 patients were included for analysis. An increase in serum sodium was independently associated with a higher risk of in-hospital mortality in patients admitted with normonatremia (Delta 48 hr-[Na] 5-10 mmol/L odds ratio: 1.61 [1.44-1.79], Delta 48 hr-[Na] > 10 mmol/L odds ratio: 4.10 [3.20-5.24]) and hypernatremia (Delta 48 hr-[Na] 5-10 mmol/L odds ratio: 1.47 [1.02-2.14], Delta 48 hr-[Na] > 10 mmol/L odds ratio: 8.46 [3.31-21.64]). In patients admitted with mild hyponatremia and Delta 48 hr-[Na] greater than 5 mmol/L, no significant difference in hospital mortality was found (odds ratio, 1.11 [0.99-1.25]). CONCLUSIONS: An increase in serum sodium in the first 48 hours of ICU admission was associated with higher in-hospital mortality in patients admitted with normonatremia and in patients admitted with hypernatremia. Show less
Bruggemann, R.J.; Moes, D.J.A.R.; Rhee, K.P. van; Veer, N. van 't; Koch, B.C.P.; Rossum, M. van; ... ; Heine, R. ter 2021
Expectancies play a major role for the treatment outcome of a broad variety of immune-mediated conditions and may strengthen or mimic the effects of regular long-term therapies. This study adds to... Show moreExpectancies play a major role for the treatment outcome of a broad variety of immune-mediated conditions and may strengthen or mimic the effects of regular long-term therapies. This study adds to a recently published study of Kox et al. (PNAS 111:7379-7384, 2014) on the ability to voluntarily influence the physiological stress response in healthy men after a training program consisting of meditation, breathing techniques, and exposure to cold, which found highly promising results on the clinical, autonomic, and immune response to experimentally induced inflammation (using the experimental human endotoxemia model). Within this project, a number of variables were included to assess the role of generalized (optimism, neuroticism) and specific outcome expectancies (related to the effects of the training on health) on the response to endotoxin administration after training. Indications were found that especially the generalized outcome expectancy optimism is a potential determinant of the autonomic (epinephrine: rho = 0.76, p Show less
Van Vliet, M.; Van den Boogaard, M.; Donnelly, J.P.; Evers, A.W.M.; Bijlevens, N.M.A.; Pickkers, P. 2014
