Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004610 (bacteremia)
 13,199 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Percutaneous transhepatic cholangiography (PTC) for jaundice of undetermined etiology was performed with the Chiba needle in 30 patients. Successful visualization of the biliary ductal system was accomplished in 26 patients (86.7%); two of six patients (33.3%) with normal biliary systems had ducts visualized, and the ducts were visualized in the 24 patients (100%) with obstruction. Bile leakage of 50 to 500 ml (average, 200 ml) was observed at laparotomy or autopsy in 12 patients (40%), nine (30%) of whom had symptoms of peritonitis. Six (20%) of these were transient and three (10%) progressed to an acute abdomen. Bacteremia occurred in seven patients (23.3%), in three (10%) it progressed to septic shock, with one death (3.3%). There were no complications in patients with nonobstructed ducts. This study suggests that PTC with the Chiba needle has little advantage over the larger sheathed needles, and surgical standby is indicated in suspected cases of obstructive jaundice.
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PMID:Bile leakage following percutaneous transhepatic cholangiography with the Chiba needle. 88 44

Reticuloendothelial system dysfunction has been suggested as an explanation for the increased susceptibility to infection in patients with obstructive jaundice. In the present study, the response of cholestatic rats to a bacterial challenge was investigated and the uptake of bacteria by their Kupffer cells was examined with the electron microscope. Rats underwent bile duct ligation (BDL, n = 8) of sham celiotomy (SC, n = 8) and were allowed to recover for 10 days. They were then injected with 10(9) Staphylococcus aureus IV and killed at intervals of 15, 30, 60, and 180 minutes after injection. Two from each group were killed at each interval. Quantitative blood cultures were performed, and specimens of liver and lung were obtained for quantitative bacterial culture and processed for electron microscopy. Bacteria were rapidly cleared from the bloodstream of SC animals but persisted in BDL rats. Electron microscopy consistently demonstrated bacteria within Kupffer cell phagocytic vesicles of both SC and BDL animals at each interval selected. There was no morphologic difference in these vesicles between the two groups. Bacteremia persists in BDL rats subjected to a bacterial challenge despite rapid uptake of bacteria in apparently normal phagocytic vesicles. This study suggests a defect in intracellular killing of bacteria, an impairment of delivery of bacteria to RE cells, or a combination of these factors.
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PMID:Bacterial phagocytosis in obstructive jaundice. A microbiologic and electron microscopic analysis. 199 71

To determine the risk of operations on the biliary tract in the elderly, we retrospectively examined 56 patients 80 years of age or older undergoing choledochotomy for calculous disease and compared their outcomes with those of a contemporary group of 257 patients undergoing similar surgery. Thirty of 56 elderly patients (54%) required urgent surgery for acute cholangitis, acute cholecystitis, or obstructive jaundice (serum bilirubin greater than 5 mg/dL), compared with 97 of 257 younger patients (38%) (p = 0.029). Mortality in elderly patients was significantly higher (5 of 56) than in younger (6 of 257) patients (p = 0.015). In three of the five patients who died, urgent surgery was performed for obstructive jaundice, reflecting the higher mortality experienced by jaundiced patients in the entire series (9.4%). Biliary cultures grew organisms in 25 of 27 elderly patients (93%). This is in contrast to findings of bactibilia in 62 of 118 patients (53%) under the age of 80 (p = 0.001). Similarly, preoperative blood cultures were positive more often in elderly (63%) than in younger patients (26%) (p = 0.007). Mean postoperative hospital recovery was longer in the elderly group (16.2 +/- 8.5 days) than in the younger group (12.2 +/- 9.3 days) (p = 0.002). In conclusion, elderly patients, particularly those with obstructive jaundice, are at higher risk for complicated biliary tract disease necessitating choledochotomy. They appear to be more susceptible to bactibilia and bacteremia, and require longer hospital recovery than younger patients.
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PMID:Choledochotomy for calculous disease in the elderly. 225 22

Adult male rats underwent common bile duct ligation or sham celiotomy. At intervals of 7 and 14 days postoperatively, bacteremia was induced by intravenous injection of 10(9) Escherichia coli or intraperitoneal injection of 10(6) E. coli. Serial quantitative blood cultures and quantitative whole organ cultures were obtained. One week after surgery, clearance of bacteremia was impaired in all of the animals. Clearance of intraperitoneally injected E. coli was less efficient in the duct ligation rats. Fourteen days postoperatively, clearance of bacteremia induced by intravenous or intraperitoneal injection had improved in the sham celiotomy rats but was still significantly impaired in the duct ligation rats. An increased number of viable E. coli were recovered from the lungs of duct ligation rats after intravenous administration. We found that rats with obstructive jaundice do not respond normally to a bacteremia challenge. This impairment in reticuloendothelial function can be noted as early as 1 week after common duct ligation.
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PMID:Impaired clearance of Escherichia coli bacteremia in early biliary obstruction. 264 60

The incidence of fecal streptococci in bile is between 5 and 15 per cent of all positive culture findings. Fecal streptococci are not susceptible to the aminoglycoside or cephalosporin antibiotics, although these drugs are widely favored for prophylaxis during surgical treatment of the biliary tract. Over a three year period, 64 episodes of bacteremia have been identified in patients undergoing treatment for obstructive jaundice. Fifteen (23 per cent) of these episodes were due to fecal streptococci. The implications of this finding are discussed and the role of acylureidopenicillin antibiotics for prophylaxis considered.
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PMID:Streptococcal bacteremia in hepatobiliary operations. 391 52

In a consecutive study of 49 patients with obstructive jaundice who underwent preoperative percutaneous transhepatic drainage, the incidence of bacteria in bile at the time of insertion of the drainage catheter was 29 percent. Patients drained with a conventional open drainage system showed an increase to 100 percent positive cultures after 20 days drainage. In this group, there was also a high incidence of episodes of bacteremia preoperatively and postoperatively and a high incidence of positive wound cultures. An antiseptic barrier incorporated into the drainage system reduced the incidence of positive bile cultures during the drainage period although this did not afford a significant reduction in bacteremic episodes and positive wound cultures. Using a new closed drainage system, the acquisition of environmental organisms to the bile was eliminated which allowed a significant reduction in septic complications both preoperatively and postoperatively. This new closed drainage system increased the value of preoperative decompression of the obstructed biliary tree by preventing exogenous bacterial contamination and reducing associated septic episodes.
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PMID:Septic complications of percutaneous transhepatic biliary drainage. Evaluation of a new closed drainage system. 642 81

A 46-year-old woman was seen with biliary obstruction secondary to a pancreatic tumor. After undergoing a percutaneous liver biopsy, she became septic and went into shock. Haemophilus influenzae type be bacteremia and biliary infection were verified. With treatment, the patient recovered from the infection. Biliary infection by H influenzae is rare, and fulminant infections in adults are even more uncommon. Hazards of invasive diagnostic procedures in patients with obstructive jaundice are discussed.
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PMID:Haemophilus influenza sepsis and shock secondary to biliary infection in an adult. 697

A review of 120 consecutive percutaneous transhepatic biliary drainage (PTBD) procedures performed for high-grade obstructive jaundice identified seven patients whose bile output exceeded normal volumes. Three patients required intense fluid therapy for intravascular volume depletion. No patient exhibited fever or bacteremia. Hypovolemia due to high-volume biliary drainage was considered responsible for severe hypotension. Hypovolemia secondary to large-volume biliary secretion may complicate PTBD. The pathophysiology of high-volume biliary drainage unrelated to initial decompression is uncertain.
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PMID:Work in progress: hypotension and high-volume biliary excretion following external percutaneous transhepatic biliary drainage. 714 89

These studies have direct clinical relevance to the multisystem deficits seen in mechanical biliary obstruction (Fig. 3). Defects in two crucial elements of effective phagocytosis (chemotaxis and intracellular killing) have been demonstrated in obstructive jaundice. At the same time, complete diversion of bile (containing bile salts and s-IgA) from the gut lumen causes changes in the endogenous bacterial flora, loss of mucosal integrity, and decreased endotoxin inactivation, resulting in portal bacteremia, endotoxemia, and increased translocation to mesenteric lymph nodes. This increased load comes at a time when the liver is metabolically impaired and RES function is abnormal. Decreased hepatic clearance of intrabiliary bacteria may contribute to the development of cholangitis (by both ascending and hematogenous routes). Inadequate RES control of portal bacteremia results in "spillover" with subsequent systemic bacteremia and localization of organisms in the lungs where they may contribute to pulmonary dysfunction or pneumonia. Although reversal of jaundice is readily accomplished by either external or internal biliary drainage, chronic biliary obstruction results in functional alterations in the liver which are reversed, generally incompletely, only after weeks or months of decompression. External biliary decompression fails to restore the enterohepatic circulation, preventing bile salts, s-IgA, and other substances from entering the lumen of the gut. It is not as effective as internal biliary drainage in reversing RES dysfunction or restoring immune parameters. Even with internal drainage, restoration of normal function in these systems takes weeks or months. Muramyl dipeptide analogues show some promise. A possible unifying mechanism may provide the clues to further experiments which will suggest better ways of reducing the morbidity and mortality in these patients. All macrophages share common functions which include not only phagocytosis but also antigen processing and the production of cytokines. The immune dysfunction noted in obstructive jaundice may be due to inadequate or inappropriate antigen processing or cytokine production by macrophages or to abnormal hepatocyte-Kupffer cell interactions. Kupffer cells are the largest pool of macrophages. Most numerous in periportal areas, Kupffer cells process significant quantities of enteric-derived antigens and Kupffer cell blockade results in an exaggerated response to these antigens. Kupffer cells also act as important scavengers of endotoxin, which stimulates the release of TNF and IL-6.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The pathophysiology of biliary obstruction and its effect on phagocytic and immune function. 802 41

To evaluate the rationale of using antibiotics in acute pancreatitis and to determine whether the indication for their use depends upon the etiology of the pancreatitis, the records of 202 patients with acute pancreatitis were retrospectively reviewed. The incidence of abnormal body temperature, leukocytosis, bacteremia and the results of biochemistry tests in different etiologies of the disease were investigated. Pancreatitis was found to be alcohol-related (47 patients), gallstone-related (105 patients), idiopathic (26 patients) and miscellaneous (24 patients). On admission, 83 patients had abnormal body temperature and 146 patients showed leukocytosis. Bacteremia occurred in 20 patients. Of these, 15 had gallstone-related pancreatitis, two had pancreatic cancers and one developed bacteremia after endoscopic retrograde cholangio-pancreatography (ERCP). These 18 patients had abnormal biochemistry results (including high serum levels of direct bilirubin, alkaline phosphatase and gamma-glutamyltransferase) and dilated bile ducts on imaging studies, indicating biliary infections. The remaining two patients with bacteremia included one alcoholic patient and one patient with idiopathic pancreatitis. The most commonly involved pathogens were Escherichia coli and Klebsiella pneumoniae. In addition, eight patients (4%) developed secondary pancreatic infections during hospitalization; the blood cultures of seven of these patients were negative on admission. Although fever and leukocytosis are not good predictors of infection in acute pancreatitis our results showed that bacteremia is common in patients whose pancreatitis is related to gallstones, ERCP or pancreatic malignancy with obstructive jaundice. We recommend that antibiotics be used only in this subset of acute pancreatitis patients.
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PMID:Bacteremia in acute pancreatitis of different etiologies. 854 31


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