Daily Sepsis Research Analysis

Beta-lactam antibiotics (beta-lactams) are first-line treatments for most major infectious syndromes in acutely ill patients, with in vitro activity against common pathogens, demonstrated efficacy in trials, and a perceived low risk of adverse effects. The current dosing approach, informed by population-level data, tends to be simplistically reduced to a "one size fits all" dosing method which only accounts for body weight (i.e., in pediatrics) and end organ function to estimate drug clearance (e.g., estimated glomerular filtration rate); this approach results in substantial variability in observed serum concentrations in acutely ill patients, which can compromise real-world effectiveness and safety. Beta-lactam dose individualization, therefore, defined as a dosing regimen for one patient informed by measured concentrations from that patient, has been recommended in international clinical guidelines. Comprehensive guidance on best practices for beta-lactam dose individualization is lacking. To address this knowledge gap and develop guidance, a multidisciplinary panel of international experts was assembled from the disciplines of infectious diseases, critical care, pharmacometrics, and laboratory medicine, representing both adults and pediatrics. The panel systematically evaluated the literature, using the GRADE approach where feasible, to address broad thematic questions pertaining to whether beta-lactam dose individualization should be pursued, for what indications beta-lactam dose individualization is warranted, and the most critical considerations and best practices for implementation of beta-lactam individualization. The resultant consensus recommendations will equip healthcare professionals caring for acutely ill patients treated with beta-lactam therapy with the evidence and tools necessary to guide optimal use of beta-lactam dose individualization.

Neonatal sepsis is a predominant cause of neonatal mortality and long-term morbidity which severely effects preterm and low birth weight newborns. Antibiotic resistance and long-term developmental issues associated with neonatal sepsis necessitates finding new and improved treatment options. Interleukin-27 (IL-27) has diverse influences on the immune response, is elevated during the neonatal period compared to adulthood, and continues to rise further during infection. Elevated levels of IL-27 early in life predispose the host to impaired control of the pathogen burden and increased mortality. This study explored the therapeutic potential of IL-27p28 antibody administration to improve treatment outcomes during murine neonatal sepsis. Sepsis was induced by subcutaneous inoculation of K1-encapsulated Escherichia coli and the neonatal pups were rescued with IL-27p28 monoclonal antibody. Pups that received prophylactic antibody prior to the infection demonstrated superior bacterial clearance and significant weight gain compared to controls during infection. The combination of subclinical dose of gentamicin and IL-27p28 antibody administered 2h post-infection, significantly improved bacterial clearance, glucose homeostasis, with reduced serum levels of IL-6 and TNF-α, vital organ damage and significantly improved the survival rate of infected pups compared to gentamicin alone. These findings suggest that IL-27p28 antagonization represents a promising therapeutic tool for treatment of neonatal sepsis.

INTRODUCTION: Sepsis remains a leading cause of mortality in critical care, with dysregulated inflammatory responses driving disease progression. However, the role of necroptosis in sepsis pathogenesis remains incompletely understood. METHODS: Here, through integration of multi-center cohort data (n = 1,265) and weighted gene co-expression network analysis (WGCNA), we constructed a six-gene necroptosis signature (CEBPD, CEBPB, MARCKS, SOCS3, PIM3, and JUNB) that correlated with sepsis severity and outcomes. Subsequently, we detected the expression of these genes in whole blood using qPCR. Furthermore, machine learning models incorporating this signature were evaluated across independent cohorts. Single-cell data analysis and flow cytometric analysis were further performed to characterize CD177 RESULTS: All six Model-score genes were upregulated in sepsis patients, with four of them showing significant differences. Machine learning models incorporating this signature achieved robust diagnostic performance across independent cohorts. At the transcriptomic level, necroptosis activation showed a strong correlation with both the IL-6/STAT3 and TNF-α/NF-κB inflammatory pathways and distinct myeloid subsets. Single-cell data analysis further revealed that CD177 DISCUSSION: Collectively, our findings suggest that CD177+ neutrophils may be involved in necroptosis-related inflammation in sepsis and provide a clinically relevant gene signature for patient stratification, offering new perspectives for potential therapeutic exploration in sepsis management.