During an episode of sepsis, the systemic inflammatory response phenomenon triggers a deficit in the action and/or secretion of cortisol. It has been suggested that the use of corticosteroids may have a role in the management of sepsis, but there is no consensus. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 16 systematic reviews including 66 randomized controlled trials addressing the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded the use of corticosteroids during a sepsis episode probably favors reversal of shock, briefly shortens the stay in intensive care unit and might reduce mortality, with few clinically relevant adverse effects.
INTRODUCTION: Severe malaria mainly affects children aged under 5 years, non-immune travellers, migrants to malarial areas, and people living in areas with unstable or seasonal malaria. Cerebral malaria, causing encephalopathy and coma, is fatal in around 20% of children and adults, and may lead to neurological sequelae in survivors. Severe malarial anaemia may have a mortality rate of over 13%. The role of fluid resuscitation in severe malaria is complex and controversial. Volume expansion could help to improve impaired organ perfusion and correct metabolic acidosis. However, rapid volume expansion could aggravate intracranial hypertension associated with cerebral malaria, leading to an increased risk of cerebral herniation.
METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What is the optimal method of fluid resuscitation in patients with severe malaria? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS: At this update, searching of electronic databases retrieved 187 studies. After deduplication and removal of conference abstracts, 93 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 82 studies and the further review of 11 full publications. Of the 11 full articles evaluated, two systematic reviews and three RCTs were added at this update. We performed a GRADE evaluation for seven PICO combinations.
CONCLUSIONS: In this systematic overview, we categorised the efficacy for three interventions based on information about the effectiveness and safety of human albumin, intravenous fluids, and whole blood or plasma.
Bacterial meningitis and meningococcal sepsis are rare conditions with high case fatality rates. Early recognition and prompt treatment saves lives. In 1999 the British Infection Society produced a consensus statement for the management of immunocompetent adults with meningitis and meningococcal sepsis. Since 1999 there have been many changes. We therefore set out to produce revised guidelines which provide a standardised evidence-based approach to the management of acute community acquired meningitis and meningococcal sepsis in adults. A working party consisting of infectious diseases physicians, neurologists, acute physicians, intensivists, microbiologists, public health experts and patient group representatives was formed. Key questions were identified and the literature reviewed. All recommendations were graded and agreed upon by the working party. The guidelines, which for the first time include viral meningitis, are written in accordance with the AGREE 2 tool and recommendations graded according to the GRADE system. Main changes from the original statement include the indications for pre-hospital antibiotics, timing of the lumbar puncture and the indications for neuroimaging. The list of investigations has been updated and more emphasis is placed on molecular diagnosis. Approaches to both antibiotic and steroid therapy have been revised. Several recommendations have been given regarding the follow-up of patients.
During an episode of sepsis, systemic inflammatory response phenomenon triggers a series of procoagulant mechanisms. It has been suggested that the use of activated protein C could play a role in the management of this pathology, but there is no consensus. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified seven systematic reviews covering 35 primary studies addressing the question of this article, including six randomized trials. We extracted data, combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded activated protein C in sepsis probably does not decrease the mortality rate and increases the rate of hemorrhagic events.
Neisseria meningitidis is a common commensal bacterium of the human pharyngeal mucosa. This organism can cause severe invasive meningococcal disease (IMD) usually presenting as meningitis, septicaemia or both. Unfortunately, public health management of sporadic IMD varies widely in Europe and this can be partly attributed to uncertainty surrounding the effectiveness of preventive measures. The purpose of this document is to provide evidence-based guidance for good practice in public health management of sporadic cases of meningococcal disease and their contacts. It has the additional aim of assisting countries across Europe in making decisions about appropriate measures to control and prevent meningococcal disease at national and sub-national levels. This guidance document should assist European countries in reviewing their own policies on public health management and microbiological diagnosis of meningococcal disease. While the results presented here do not include guidance for management of exposed healthcare workers nor of community outbreaks, it will cover the following relevant areas:
• Laboratory tests to confirm the diagnosis of IMD.
• Use of antibiotics at discharge from hospital.
• Chemoprophylaxis for close contacts considering different settings.
• Choice of antibiotic for chemoprophylaxis for different groups (adults, children, pregnant women).
• Use of meningococcal vaccine in addition to chemoprophylaxis.
In addition to the quality of scientific evidence, the conclusions take into account potential benefit and harm, values, burdens and costs.
Questa review riassume meta-analisi che valutano l'accuratezza dei test diagnostici per le malattie infettive. Ricerche sistematiche identificate 55 meta-analisi che i criteri di inclusione molto soddisfatti delle relazioni accuratezza diagnostica di un test indice rispetto a un test di riferimento. Tutte le recensioni sono stati valutati per i metodi e il reporting. La valutazione globale ha sottolineato i problemi in diversi passaggi chiave: la comunicazione delle informazioni dettagliate da studi primari sul disegno dello studio e le caratteristiche del paziente, le caratteristiche di riferimento e prove di indice, e metodi d'esame. L'esecuzione e la comunicazione delle revisioni sistematiche di test diagnostici devono essere migliorati.
During an episode of sepsis, the systemic inflammatory response phenomenon triggers a deficit in the action and/or secretion of cortisol. It has been suggested that the use of corticosteroids may have a role in the management of sepsis, but there is no consensus. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 16 systematic reviews including 66 randomized controlled trials addressing the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded the use of corticosteroids during a sepsis episode probably favors reversal of shock, briefly shortens the stay in intensive care unit and might reduce mortality, with few clinically relevant adverse effects.
