Browsing by Autor "Matthew Lanza"

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    OP021 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: VALIDATION AND APPLICABILITY OF THE PHOENIX SEPSIS SCORE IN LOW-RESOURCE SETTINGS
    (Lippincott Williams & Wilkins, 2024) Raúl Olmos; Nicola Casson; Willmer E. Diaz Villalobos; V.H. Urquieta Clavel; Mercedes Ortiz; I. Ribera Murguia; C. Mendoza Montoya; Carolina Auza; Matthew Lanza; J. Barral
    Aims & Objectives: Sepsis and Septic Shock are leading death causes, sepsis diagnosis criteria evolved since 2005 and recently the Phoenix Sepsis Score (PSS) was proposed. Our study pretends to validate and evaluate the applicability of the score in a resource-limited setting. Methods: An observational, multicentric, and retrospective study was performed in 14 hospitals in Bolivia, enrolling septic children added in 2023 and a statistical analysis was carried out to describe its application and validate the new sepsis criteria. Results: 274 patients were enrolled, with an admission diagnosis of sepsis (22,6%), septic shock (63,5%), and 13,9% cases later ruled out; a mortality rate of 29% for sepsis and 36,8% for septic shock was observed. PSS show increased sensitivity (91,1%), specificity (83.7%), and an AUROC of 0.537; better than SIRS (AUROC 0.486; sensitivity 71.1% and specificity 73.9%) and SOFA (AUROC 0.460; sensitivity 58.9% and specificity 66.8%). All the PSS criteria are routinely performed (>83,2% of patients), except Fibrinogen (19,8%) and D-Dimer; the coefficient of Cronbach’s alpha of 0,715 showed acceptable reliability, but some variations in oxygen levels due to the high-altitude geography of hospitals modified the reliability test, reducing to 0.589 the coefficient of Cronbach’s alpha in hospitals above 4000 m.a.s.l.Conclusions: The PSS is applicable in low resource settings, the limited availability of fibrinogen and D-dimer tests does not change the overall reliability of the score, which is acceptable. The high altitude of some hospitals reduces the reliability of PSS, therefore further studies are required to evaluate the correct adaptation of the PSS to high-altitude environments. Keywords: septic shock, Bolivia, Critical care, Children, Sepsis
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    PP329 Topic: AS09–Global Health/Resource Limited Setting/Health Inequalities/Impact of Global Warming/Other: ADHERENCE TO PEDIATRIC SEPSIS TREATMENT RECOMMENDATIONS IN A LOW-INCOME COUNTRY
    (Lippincott Williams & Wilkins, 2024) Raúl Olmos; Nils Cassón; Willmer E. Diaz Villalobos; V.H. Urquieta Clavel; Mercedes Ortiz; I. Rivera Murguia; C. Mendoza Montoya; Carolina Auza; Matthew Lanza; J. Barral
    Aims & Objectives: Sepsis in low-income countries is one of the most important morbidity and mortality issues in hospitals with limited resources. Our objective was to obtain data on the epidemiology and mortality of sepsis and septic shock (SS), and to assess adherence to practice guidelines (CPGs) for the management in the first hour Methods: A multicenter, retrospective, descriptive cohort study was carried out that included 14 PICU patients in Bolivia between January and December 2023. The diagnosis of sepsis and SSc shock was made based on Sepsis–3 criteria, assessing time (minutes) of the start of the following items: 1) Placement of the first vascular access within the first 5 minutes, 2) Infusion of liquids within 30 minutes, 3) Start of antibiotics within 60 minutes, and 4) Start of Vasoactives within 60 minutes, finally overall adherence and/or compliance with the recommendations of the Surviving Sepsis campaign (SSC) was evaluated in addition to overall mortality. Results: 268 patients with sepsis and SS were included, 63% of patients obtained vascular access in the first 5 minutes but only 49% started fluid infusion within the first 30 minutes, 66% started antibiotics and vasoactive drugs in the first 60 minutes, 34.8% mortality was obtained in SS and 33% overall mortality in sepsis, Adherence to all treatment goals was achieved in 18%, associated with lower mortality rates (26% vs 38%; p =0.004)Conclusions: Low adherence to the guidelines and high mortality rates were found in the PICUs of a low-income country; prospective further studies are needed to evaluate improvement interventions. Keywords: Critical care, Children, septic shock, Bolivia, Sepsis