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PIRO-Based Approach for Sepsis in Immunocompromised Patients: What’s Different?

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Sepsis Management

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Abstract

The frequency of immunocompromised patients has increased dramatically over the last decades. Frequently, combined mechanisms of immunosuppression coexist, and patients are at increased risk for sepsis and for infections due to opportunistic pathogens. Despite the recent evidence demonstrating improved outcomes when they become critically ill, care for these patients remains a major challenge for intensivists and infectious diseases consultants. In this sense, immunosuppressed patients, such as those with malignancies and HIV/AIDS, provide a good opportunity to validate the PIRO concept. The predisposing factors (i.e., specific immune defects, previous antimicrobial or immunosuppressive exposure), infection (i.e., microbiologic data or clinical features related to specific pathogens), response (i.e., biomarkers, imaging findings,) and organ failure (i.e., main site of clinical expression of disease and/or associated organ dysfunction) constitute the framework to refine the information about the epidemiology, outcomes, risk stratification and response to therapeutic strategies in these patients, which are essential for future research, to assist clinicians in decision-making, therapeutic tailoring, and patient and family counseling.

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References

  • Afessa B, Green B (2000) Clinical course, prognostic factors, and outcome prediction for HIV patients in the ICU. The PIP (pulmonary complications, ICU support, and prognostic factors in hospitalized patients with HIV) study. Chest 118(1):138–145

    Article  PubMed  CAS  Google Scholar 

  • Aisenberg G, Rolston KV, Dickey BF, Kontoyiannis DP, Raad II, Safdar A (2007) Stenotrophomonas maltophilia pneumonia in cancer patients without traditional risk factors for infection, 1997–2004. Eur J Clin Microbiol Infect Dis 26(1):13–20

    Article  PubMed  CAS  Google Scholar 

  • Andreu Ballester JC, Ballester F, Gonzalez Sanchez A, Almela Quilis A, Colomer Rubio E, Penarroja Otero C (2008) Epidemiology of sepsis in the Valencian Community (Spain), 1995–2004. Infect Control Hosp Epidemiol 29(7):630–634

    Article  PubMed  Google Scholar 

  • Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29(7):1303–1310

    Article  PubMed  CAS  Google Scholar 

  • Angus DC, Burgner D, Wunderink R, Mira JP, Gerlach H, Wiedermann CJ et al (2003) The PIRO concept: P is for predisposition. Crit Care 7(3):248–251

    Article  PubMed  Google Scholar 

  • Annane D, Aegerter P, Jars-Guincestre MC, Guidet B (2003) Current epidemiology of septic shock: the CUB-Rea Network. Am J Respir Crit Care Med 168(2):165–172

    Article  PubMed  Google Scholar 

  • Arthur G, Nduba VN, Kariuki SM, Kimari J, Bhatt SM, Gilks CF (2001) Trends in bloodstream infections among human immunodeficiency virus-infected adults admitted to a hospital in Nairobi, Kenya, during the last decade. Clin Infect Dis 33(2):248–256

    Article  PubMed  CAS  Google Scholar 

  • Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C et al (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29(3):519–525

    Article  PubMed  CAS  Google Scholar 

  • Barbier F, Coquet I, Legriel S, Pavie J, Darmon M, Mayaux J, Molina JM, Schlemmer B, Azoulay E (2009) Etiologies and outcome of acute respiratory failure in HIV-infected patients. Intensive Care Med 35(10):1678–1686

    Article  PubMed  CAS  Google Scholar 

  • Beale R, Reinhart K, Brunkhorst FM, Dobb G, Levy M, Martin G et al (2009) Promoting Global Research Excellence in Severe Sepsis (PROGRESS): lessons from an international sepsis registry. Infection 37(3):222–232

    PubMed  CAS  Google Scholar 

  • Benjamim CF, Lundy SK, Lukacs NW, Hogaboam CM, Kunkel SL (2005) Reversal of long-term sepsis-induced immunosuppression by dendritic cells. Blood 105(9):3588–3595

    Article  PubMed  CAS  Google Scholar 

  • Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31(1):104–112

    Article  PubMed  Google Scholar 

  • Bianchi M, Robles AM, Vitale R, Helou S, Arechavala A, Negroni R (2000) The usefulness of blood culture in diagnosing HIV-related systemic mycoses: evaluation of a manual lysis centrifugation method. Med Mycol 38(1):77–80

    PubMed  CAS  Google Scholar 

  • Blanco J, Muriel-Bombin A, Sagredo V, Taboada F, Gandia F, Tamayo L et al (2008) Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study. Crit Care 12(6):R158

    PubMed  Google Scholar 

  • Bozza FA, Salluh JI, Japiassu AM, Soares M, Assis EF, Gomes RN et al (2007) Cytokine profiles as markers of disease severity in sepsis: a multiplex analysis. Crit Care 11(2):R49

    Article  PubMed  Google Scholar 

  • Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Chest 101(6):1644–1655

    Google Scholar 

  • Brenchley JM, Price DA, Schacker TW, Asher TE, Silvestri G, Rao S et al (2006) Microbial translocation is a cause of systemic immune activation in chronic HIV infection. Nat Med 12(12):1365–1371

    Article  PubMed  CAS  Google Scholar 

  • Brun-Buisson C, Meshaka P, Pinton P, Vallet B (2004) EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med 30(4):580–588; Epub 2004 Mar 2

    Article  PubMed  CAS  Google Scholar 

  • Casalino E, Wolff M, Ravaud P, Choquet C, Bruneel F, Regnier B (2004) Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit. AIDS 18(10):1429–1433

    Article  PubMed  Google Scholar 

  • Coquet I, Pavie J, Palmer P, Barbier F, Legriel S, Mayaux J et al (2010) Survival trends in critically ill HIV-infected patients in the highly active antiretroviral therapy era. Crit Care 14(3):R107

    Article  PubMed  Google Scholar 

  • Croda J, Croda MG, Neves A, De Sousa dos Santos S (2009) Crit Care Med 37(5):1605–1611

    Google Scholar 

  • Danai PA, Moss M, Mannino DM, Martin GS (2006) The epidemiology of sepsis in patients with malignancy. Chest 129(6):1432–1440

    Article  PubMed  Google Scholar 

  • Danel C, Moh R, Minga A, Anzian A, Ba-Gomis O, Kanga C et al (2006) CD4-guided structured antiretroviral treatment interruption strategy in HIV-infected adults in west Africa (Trivacan ANRS 1269 trial): a randomised trial. Lancet 367(9527):1981–1989

    Article  PubMed  CAS  Google Scholar 

  • Darmon M, Azoulay E (2009) Critical care management of cancer patients: cause for optimism and need for objectivity. Curr Opin Oncol 21(4):318–326

    Article  PubMed  Google Scholar 

  • Davaro RE, Thirumalai A (2007) Life-threatening complications of HIV infection. J Intensive Care Med 22(2):73–81

    Article  PubMed  Google Scholar 

  • Davis JL, Morris A, Kallet RH, Powell K, Chi AS, Bensley M et al (2008) Low tidal volume ventilation is associated with reduced mortality in HIV-infected patients with acute lung injury. Thorax 63(11):988–993

    Article  PubMed  CAS  Google Scholar 

  • Dickson SJ, Batson S, Copas AJ, Edwards SG, Singer M, Miller RF (2007) Thorax 62(11):964–968. Epub 2007 May 21

    Google Scholar 

  • Fox AC, Robertson CM, Belt B, Clark AT, Chang KC, Leathersich AM et al (2010) Cancer causes increased mortality and is associated with altered apoptosis in murine sepsis. Crit Care Med 38(3):886–893

    Article  PubMed  Google Scholar 

  • Gea-Banacloche JC, Opal SM, Jorgensen J, Carcillo JA, Sepkowitz KA, Cordonnier C (2004) Sepsis associated with immunosuppressive medications: an evidence-based review. Crit Care Med 32(11 Suppl):S578–S590

    Article  PubMed  Google Scholar 

  • Grinsztejn B, Veloso VG, Friedman RK, Moreira RI, Luz PM, Campos DP et al (2009) Early mortality and cause of deaths in patients using HAART in Brazil and the United States. AIDS 23(16):2107–2114

    Article  PubMed  Google Scholar 

  • Huang L, Quartin A, Jones D, Havlir DV (2006) Intensive care of patients with HIV infection. N Engl J Med 355(2):173–181

    Article  PubMed  CAS  Google Scholar 

  • Jacob ST, Moore CC, Banura P, Pinkerton R, Meya D, Opendi P et al (2009) Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population. PLoS One 4(11):e7782

    Article  PubMed  Google Scholar 

  • Japiassu AM, Salluh JI, Bozza PT, Bozza FA, Castro-Faria-Neto HC (2009) Revisiting steroid treatment for septic shock: molecular actions and clinical effects–a review. Mem Inst Oswaldo Cruz 104(4):531–548

    Article  PubMed  CAS  Google Scholar 

  • Japiassu AM, Amancio RT, Mesquita EC, Medeiros DM, Bernal HB, Nunes EP et al (2010) Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients. Crit Care 14(4):R152

    Article  PubMed  Google Scholar 

  • Khouli H, Afrasiabi A, Shibli M, Hajal R, Barrett CR, Homel P (2005) Outcome of critically ill human immunodeficiency virus–infected patients in the era of highly active antiretroviral therapy. J Intensive Care Med 20:279–285

    Article  PubMed  CAS  Google Scholar 

  • Khwannimit B, Bhurayanontachai R (2009) The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting. Epidemiol Infect 137(9):1333–1341

    Article  PubMed  CAS  Google Scholar 

  • Lambotte O, Lucet JC, Fleury L, Joly-Guillou ML, Bouvet E (2000) Nosocomial bacteremia in HIV patients: the role of peripheral venous catheters. Infect Control Hosp Epidemiol 21(5):330–333

    Article  PubMed  CAS  Google Scholar 

  • Larche J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G et al (2003) Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 29(10):1688–1695

    Article  PubMed  Google Scholar 

  • Levy MM, Macias WL, Vincent JL, Russell JA, Silva E, Trzaskoma B et al (2005) Early changes in organ function predict eventual survival in severe sepsis. Crit Care Med 33(10):2194–2201

    Article  PubMed  Google Scholar 

  • Lewden C, Chene G, Morlat P, Raffi F, Dupon M, Dellamonica P et al (2007) HIV-infected adults with a CD4 cell count greater than 500 cells/mm3 on long-term combination antiretroviral therapy reach same mortality rates as the general population. J Acquir Immune Defic Syndr 46(1):72–77

    PubMed  Google Scholar 

  • Lisboa T, Diaz E, Sa-Borges M, Socias A, Sole-Violan J, Rodriguez A et al (2008) The ventilator-associated pneumonia PIRO score: a tool for predicting ICU mortality and health-care resources use in ventilator-associated pneumonia. Chest 134(6):1208–1216

    Article  PubMed  Google Scholar 

  • Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348(16):1546–1554

    Article  PubMed  Google Scholar 

  • Maschmeyer G, Bertschat FL, Moesta KT, Hausler E, Held TK, Nolte M et al (2003) Outcome analysis of 189 consecutive cancer patients referred to the intensive care unit as emergencies during a 2-year period. Eur J Cancer 39(6):783–792

    Article  PubMed  CAS  Google Scholar 

  • Mendez-Tellez PA, Damluji A, Ammerman D, Colantuoni E, Fan E, Sevransky JE et al (2010) Human immunodeficiency virus infection and hospital mortality in acute lung injury patients. Crit Care Med 38(7):1530–1535

    Article  PubMed  Google Scholar 

  • Meynard JL, Guiguet M, Fonquernie L, Lefebvre B, Lalande V, Honore I et al (2003) Impact of highly active antiretroviral therapy on the occurrence of bacteraemia in HIV-infected patients and their epidemiologic characteristics. HIV Med 4(2):127–132

    Article  PubMed  CAS  Google Scholar 

  • Morris A, Creasman J, Turner J, Luce JM, Wachter RM, Huang L (2002) Intensive care of human immunodeficiency virus-infected patients during the era of highly active antiretroviral therapy. Am J Respir Crit Care Med 166(3):262–267

    Article  PubMed  Google Scholar 

  • Mrus JM, Braun L, Yi MS, Linde-Zwirble WT, Johnston JA (2005) Impact of HIV/AIDS on care and outcomes of severe sepsis. Crit Care 9(6):R623–R630

    Article  PubMed  Google Scholar 

  • Narasihman M, Posner AJ, DePalo VA, Mayo PH, Rosen MJ (2004) Intensive care in patients with HIV infection in the era of highly active antiretroviral therapy. Chest 125:1800–1804

    Article  PubMed  Google Scholar 

  • Nickas G, Wachter RM (2000) Outcomes of intensive care for patients with human immunodeficiency virus infection. Arch Intern Med 160(4):541–547

    Article  PubMed  CAS  Google Scholar 

  • Pacheco AG, Tuboi SH, May SB, Moreira LF, Ramadas L, Nunes EP et al (2009) Temporal changes in causes of death among HIV-infected patients in the HAART era in Rio de Janeiro, Brazil. J Acquir Immune Defic Syndr 51(5):624–630

    Article  PubMed  Google Scholar 

  • Palacios R, Hidalgo A, Reina C, de la Torre MV, Márquez M, Santos J (2006) Effect of antiretroviral therapy on admissions of HIV-infected patients to an intensive care unit. HIV Med 7:193–196

    Article  PubMed  Google Scholar 

  • Pene F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marque S et al (2008) Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med 36(3):690–696

    Article  PubMed  Google Scholar 

  • Povoa P (2008) Serum markers in community-acquired pneumonia and ventilator-associated pneumonia. Curr Opin Infect Dis 21(2):157–162

    Article  PubMed  CAS  Google Scholar 

  • Powell K, Davis JL, Morris AM, Chi A, Bensley MR, Huang L (2009) Survival for patients With HIV admitted to the ICU continues to improve in the current era of combination antiretroviral therapy. Chest 135(1):11–17

    Article  PubMed  Google Scholar 

  • Regazzoni CJ, Irrazabal C, Luna CM, Poderoso JJ (2004) Cancer patients with septic shock: mortality predictors and neutropenia. Support Care Cancer 12(12):833–839

    Article  PubMed  Google Scholar 

  • Rello J, Rodriguez A, Lisboa T, Gallego M, Lujan M, Wunderink R (2009) PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia. Crit Care Med 37(2):456–462

    Article  PubMed  Google Scholar 

  • Rosen MJ, Narasimhan M (2006) Critical care of immunocompromised patients: human immunodeficiency virus. Crit Care Med 34(9 Suppl):S245–S250

    Article  PubMed  Google Scholar 

  • Ross AC, Rizk N, O’Riordan MA, Dogra V, El-Bejjani D, Storer N et al (2009) Relationship between inflammatory markers, endothelial activation markers, and carotid intima-media thickness in HIV-infected patients receiving antiretroviral therapy. Clin Infect Dis 49(7):1119–1127

    Article  PubMed  CAS  Google Scholar 

  • Rubulotta F, Ramsay D, Williams MD (2010) PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia. Crit Care Med 38(4):1236; author reply −7

    Article  PubMed  CAS  Google Scholar 

  • Safdar A, Rolston KV (2007) Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clin Infect Dis 45(12):1602–1609

    Article  PubMed  Google Scholar 

  • Salluh JI, Bozza FA, Pinto TS, Toscano L, Weller PF, Soares M (2005) Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease? Braz J Infect Dis 9(5):419–424

    Article  PubMed  Google Scholar 

  • Salluh JI, Soares M, Coelho LM, Bozza FA, Verdeal JC, Castro-Faria-Neto HC et al (2011) Impact of systemic corticosteroids on the clinical course and outcomes of patients with severe community-acquired pneumonia: a cohort study. J Crit Care 26(2):193–200

    Article  PubMed  CAS  Google Scholar 

  • Schleicher GK, Herbert V, Brink A, Martin S, Maraj R, Galpin JS et al (2005) Procalcitonin and C-reactive protein levels in HIV-positive subjects with tuberculosis and pneumonia. Eur Respir J 25(4):688–692

    Article  PubMed  CAS  Google Scholar 

  • Sivasangeetha K, Harish BN, Sujatha S, Parija SC, Dutta TK (2007) Cryptococcal meningoencephalitis diagnosed by blood culture. Indian J Med Microbiol 25(3):282–284

    Article  PubMed  CAS  Google Scholar 

  • Soares M, Azoulay E (2009) Critical care management of lung cancer patients to prolong life without prolonging dying. Intensive Care Med 35(12):2012–2014

    Article  PubMed  Google Scholar 

  • Soares M, Salluh JI, Ferreira CG, Luiz RR, Spector N, Rocco JR (2005) Impact of two different comorbidity measures on the 6-month mortality of critically ill cancer patients. Intensive Care Med 31(3):408–415

    Article  PubMed  Google Scholar 

  • Soares M, Salluh JI, Carvalho MS, Darmon M, Rocco JR, Spector N (2006a) Prognosis of critically ill patients with cancer and acute renal dysfunction. J Clin Oncol 24(24):4003–4010

    Article  PubMed  Google Scholar 

  • Soares M, Carvalho MS, Salluh JI, Ferreira CG, Luiz RR, Rocco JR et al (2006b) Effect of age on survival of critically ill patients with cancer. Crit Care Med 34(3):715–721

    PubMed  Google Scholar 

  • Soares M, Darmon M, Salluh JI, Ferreira CG, Thiery G, Schlemmer B et al (2007a) Prognosis of lung cancer patients with life-threatening complications. Chest 131(3):840–846

    Article  PubMed  Google Scholar 

  • Soares M, Salluh JI, Toscano L, Dias FL (2007b) Outcomes and prognostic factors in patients with head and neck cancer and severe acute illnesses. Intensive Care Med 33(11):2009–2013, Epub 2007 Jul 10

    Article  PubMed  Google Scholar 

  • Soares M, Salluh JI, Torres VB, Leal JV, Spector N (2008) Short- and long-term outcomes of critically ill patients with cancer and prolonged ICU length of stay. Chest 134(3):520–526

    Article  PubMed  Google Scholar 

  • Soares M, Caruso P, Silva E, Teles JM, Lobo SM, Friedman G et al (2010a) Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med 38(1):9–15

    Article  PubMed  Google Scholar 

  • Soares M, Depuydt PO, Salluh JI (2010b) Mechanical ventilation in cancer patients: clinical characteristics and outcomes. Crit Care Clin 26(1):41–58

    Article  PubMed  Google Scholar 

  • Soares M, Silva UV, Teles JM, Silva E, Caruso P, Lobo SM et al (2010c) Validation of four prognostic scores in patients with cancer admitted to Brazilian intensive care units: results from a prospective multicenter study. Intensive Care Med 36(7):1188–1195

    Article  PubMed  Google Scholar 

  • Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL (2009) Characteristics and outcomes of cancer patients in European ICUs. Crit Care 13(1):R15

    Article  PubMed  Google Scholar 

  • Taniguchi T, Ogawa Y, Kasai D, Watanabe D, Yoshikawa K, Bando H et al (2010) Three cases of fungemia in HIV-infected patients diagnosed through the use of mycobacterial blood culture bottles. Intern Med 49(19):2179–2183

    Article  PubMed  Google Scholar 

  • Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V et al (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23(19):4406–4413

    Article  PubMed  Google Scholar 

  • Thirumala R, Ramaswamy M, Chawla S (2010) Diagnosis and management of infectious complications in critically ill patients with cancer. Crit Care Clin 26(1):59–91

    Article  PubMed  CAS  Google Scholar 

  • Tien PC, Choi AI, Zolopa AR, Benson C, Tracy R, Scherzer R et al (2010) Inflammation and mortality in HIV-infected adults: analysis of the FRAM study cohort. J Acquir Immune Defic Syndr 55(3):316–322

    Article  PubMed  CAS  Google Scholar 

  • Torre D, Pugliese A (2008) Platelets and HIV-1 infection: old and new aspects. Curr HIV Res 6(5):411–418

    Article  PubMed  CAS  Google Scholar 

  • Tumbarello M, Tacconelli E, Donati KG, Citton R, Leone F, Spanu T et al (2000) HIV-associated bacteremia: how it has changed in the highly active antiretroviral therapy (HAART) era. J Acquir Immune Defic Syndr 23(2):145–151

    Article  PubMed  CAS  Google Scholar 

  • Vandewoude KH, Blot SI, Depuydt P, Benoit D, Temmerman W, Colardyn F et al (2006) Clinical relevance of Aspergillus isolation from respiratory tract samples in critically ill patients. Crit Care 10(1):R31

    Article  PubMed  Google Scholar 

  • Vandijck DM, Benoit DD, Depuydt PO, Offner FC, Blot SI, Van Tilborgh AK et al (2008) Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. Intensive Care Med 34(5):847–855

    Article  PubMed  Google Scholar 

  • Velasco E, Portugal RD, Salluh JI (2009) A simple score to predict early death in adult cancer patients with bloodstream infections. J Infect 59(5):332–336

    Article  PubMed  Google Scholar 

  • Vincent B, Timsit JF, Auburtin M, Schortgen F, Bouadma L, Wolff M, Regnier B (2004) Characteristics and outcomes of HIV-infected patients in the ICU: impact of the highly active antiretroviral treatment era. Intensive Care Med. 30(5):859–866. Epub 2004 Feb 6.

    Article  PubMed  CAS  Google Scholar 

  • Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD et al (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302(21):2323–2329

    Article  PubMed  CAS  Google Scholar 

  • Vincent JL, Opal SM, Marshall JC (2010) Ten reasons why we should NOT use severity scores as entry criteria for clinical trials or in our treatment decisions. Crit Care Med 38(1):283–287

    Article  PubMed  Google Scholar 

  • Waddell RD, Lishimpi K, von Reyn CF, Chintu C, Baboo KS, Kreiswirth B et al (2001) Bacteremia due to Mycobacterium tuberculosis or M. bovis, Bacille Calmette-Guerin (BCG) among HIV-positive children and adults in Zambia. AIDS 15(1):55–60

    Article  PubMed  CAS  Google Scholar 

  • Williams MD, Braun LA, Cooper LM, Johnston J, Weiss RV, Qualy RL et al (2004) Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care 8(5):R291–R298

    Article  PubMed  Google Scholar 

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Acknowledgments

Financial support:Dr. Soares and Dr. Bozza are supported in part by individual research grants from CNPq.

Conflicts of interest:None.

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Authors and Affiliations

  1. Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil

    Jorge I. F. Salluh & Márcio Soares

  2. D’Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil

    Jorge I. F. Salluh, Fernando Augusto Bozza, André Miguel Japiassu & Márcio Soares

  3. ICU, Instituto de Pesquisa Evandro Chagas, Rio de Janeiro, RJ, Brazil

    Fernando Augusto Bozza

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  1. Jorge I. F. Salluh
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  2. Fernando Augusto Bozza
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  3. André Miguel Japiassu
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  4. Márcio Soares
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Correspondence to Jorge I. F. Salluh .

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  1. Unidad de Cuidados Críticos, Hospital Universitari Joan XXIII, Carrer Mallafré Guasch 4, Tarragona, 43007, Spain

    Jordi Rello

  2. Intensive Care Facility, Royal Brisbane Hospital, Herston Road, Herston, Brisbane, 4029, Queensland, Australia

    J. Lipman

  3. Unidad de Cuidados Críticos, Hospital Universitari Joan XXIII, Carrer Mallafré Guasch 4, Tarragona, 43007, Spain

    Thiago Lisboa

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Salluh, J.I.F., Bozza, F.A., Japiassu, A.M., Soares, M. (2012). PIRO-Based Approach for Sepsis in Immunocompromised Patients: What’s Different?. In: Rello, J., Lipman, J., Lisboa, T. (eds) Sepsis Management. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-03519-7_5

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