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Patients with infection can develop sepsis, and their mortality can be high. An important aspect in the treatment of sepsis is adequate management of the infection.Data sourcesUsing a modified Delphi approach, the Surviving Sepsis Campaign research committee recently published a series of 26 priorities for sepsis and septic shock.Study selectionTask force members with specific expertise were tasked with generating expanded reviews for all infection questions and a subset of adjunctive therapy questions from the larger list of sepsis priorities. Each question was addressed by one of the six task force members.Data extractionIn-depth reviews were then edited by the group as a whole, with added input from the committee cochairs.Data synthesisSix questions were addressed: 1) should empiric antibiotic combination therapy be used in sepsis or septic shock? 2) does optimization of antimicrobial pharmacokinetics and pharmacodynamics impact patient outcomes in sepsis? 3) should viral reactivation resulting from sepsis-induced immunosuppression be treated with antiviral therapy in critically ill septic patients? 4) should rapid diagnostic tests be implemented in clinical practice? 5) what is the role of lung-protective ventilation in sepsis patients without acute respiratory distress syndrome? and 6) how do we determine the efficacy of "blood purification" therapies such as endotoxin absorbers, cytokine absorbers, and plasmapheresis.ConclusionsThe research committee members for the Surviving Sepsis Campaign aimed to explore research questions in order to provide existing evidence and highlight areas of uncertainty and future directions.

ObjectiveTo identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.DesignA consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.MethodsEach committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 - supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science.ResultsThe Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?ConclusionsWhile the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

Objective: To identify priorities for administrative, epidemiologic and diagnostic research in sepsis. Design: As a follow-up to a previous consensus statement about sepsis research, members of the Surviving Sepsis Campaign Research Committee, representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine addressed six questions regarding care delivery, epidemiology, organ dysfunction, screening, identification of septic shock, and information that can predict outcomes in sepsis. Methods: Six questions from the Scoring/Identification and Administration sections of the original Research Priorities publication were explored in greater detail to better examine the knowledge gaps and rationales for questions that were previously identified through a consensus process. Results: The document provides a framework for priorities in research to address the following questions: (1) What is the optimal model of delivering sepsis care?; (2) What is the epidemiology of sepsis susceptibility and response to treatment?; (3) What information identifies organ dysfunction?; (4) How can we screen for sepsis in various settings?; (5) How do we identify septic shock?; and (6) What in-hospital clinical information is associated with important outcomes in patients with sepsis? Conclusions: There is substantial knowledge of sepsis epidemiology and ways to identify and treat sepsis patients, but many gaps remain. Areas of uncertainty identified in this manuscript can help prioritize initiatives to improve an understanding of individual patient and demographic heterogeneity with sepsis and septic shock, biomarkers and accurate patient identification, organ dysfunction, and ways to improve sepsis care. [ABSTRACT FROM AUTHOR]

Introduction: Hemophilia is a rare, inherited, coagulation disorder that impairs the body's ability to cease bleeding, making hemophiliacs susceptible to bleeding episodes. These patients often require multiple doses of clotting factor concentrates to help maintain hemostasis. In fiscal year (FY) 2016, Rush University Medical Center's drug expense for clotting factor concentrates totaled $4.6 million, which accounted for approximately 15% of the total drug budget. The Department of Pharmacy developed a Hemophilia Management Program (HMP) to improve care, reduce spending, and expand clinical pharmacy services. Prior to the HMP, the Department of Pharmacy completed drug acquisition and dispensing and no role existed for pharmacists as part of the comprehensive care team for the hemophilia population. The primary objective of this study was to evaluate clinical outcomes after implementation of clinical pharmacy services into the management of hemophilia patients in an interdisciplinary HMP. Methods: Several areas for improved care and efficiency were identified prior to the implementation of the HMP: interdisciplinary education, clinical management and continuity of care, and formulary management. Results: In total, implementation of the HMP resulted in a net savings of $2.7 million for clotting factor expenses for FY 2017. The cost savings based on clotting factor expenses resulted in a return on investment (ROI) of 20:1, exceeding the initial projections of a modest ROI of 3:1. In addition, these costs savings were realized with the average length of stay per patient staying within the previous margins. Finally, the HMP effectively reduced the need for blood transfusions per patient. Discussion Design and implementation of the HMP resulted in significant cost savings, improved efficiency, and enhanced clinical services for patients with hemophilia. This expansion of pharmacy services has become the first pharmacy‐led program in the country to not only reduce costs, but also improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to describe the prevalence, epidemiology, and clinical outcomes of multidrug‐resistant (MDR) organism (MDRO) pneumonia in critically ill patients. Methods: A multicenter, prospective, observational study of patients admitted to 60 intensive care units (ICUs), from 34 hospitals, in the United States from November to December 2016. Adults (> 18 yrs) receiving antimicrobial therapy at least 5 days for pneumonia were included. Patients were classified into two categories, with or without MDRO, and subcategorized by pneumonia type. Measurements and main results: Demographics, medication histories, and health care exposure were collected during ICU admission and compared using t test and chi‐square tests. Multivariate logistic regression was used to determine predictive factors for MDRO pneumonia and hospital mortality. Of 652 patients, 92 patients (14.1%) developed MDR pneumonia. Predictors of MDRO pneumonia were acid suppression therapy within the previous 90 days (odds ratio [OR] 1.88 [1.14–3.09]; p=0.013), mechanical ventilation (OR 1.96 [1.14–3.35]; p<0.001), and history of MDRO infection (OR 4.74 [2.21–10.18]; p<0.001). Appropriate initial antimicrobial selection occurred in 58 patients (63%) with MDRO pneumonia compared to 464 patients (82.7%) in patients without MDRO pneumonia (p<0.001). MDRO pneumonia was not associated with hospital mortality (18.5% vs 17.6%, p=0.087). Conclusions: In a broad cohort of critically ill patients, MDRO pneumonia is infrequent, and associated with factors describing the intensity of health care provided. Presence of MDRO pneumonia is not associated with hospital mortality. Further study is needed to clarify risk factors for multidrug‐resistant pneumonia in critically ill patients. [ABSTRACT FROM AUTHOR]