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126 cases of sepsis were retrospectively studied in an Internal Medicine Department, giving special attention to the clinical evolution. 67 males and 59 females with a median age of 65 years old were discovered. 92% had one or more diseases, mainly COLD (30%) and diabetes mellitus (28%). The septic sources were urinary (37%) and respiratory (31%). 84% of the germs were gram (-), mainly E. Coli and Proteus sp. A mortality rate of 36% was found, the primary rates being: eighth decade (52%), patients with neoplastic disease (46%), biliary tract diseases (64%), endocarditis (66%), infection by Serratia (60%), Pseudomonas (50%), shock (55%) and DIC (50%). These last two complications were analysed and found to be the more frequent (35% and 6.3% respectively), also being those with higher mortality rate. Finally, the prognostic factors are established based on the results obtained.
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PMID:[Sepsis: clinical course study of 126 patients in an internal medicine department]. 249 19

Proteus mirabilis was the predominant cause of acute diabetes-associated pyelonephritis occurring spontaneously in male MM mice until they were segregated in a new environment. Thereafter Pasteurella pneumotropica and Streptococcus faecalis emerged collectively as the most common causal organisms, the pyelonephritis became more chronic and Proteus mirabilis isolates from faeces and urine produced atypical non-swarming colonies on blood agar plates. This did not account for the reduced pathogenicity of Proteus mirabilis; when MM males were returned to the original environment the pyelonephritis again became acute but was associated with the atypical type of Proteus mirabilis although the normal type was abundant in the environment. The MM mice were Caesarean-derived and cross-fostered shortly before their transfer to the second environment, which probably accounts for their changed microbial status, but the reason for the emergence of the atypical type of Proteus mirabilis is not understood. The acute nature of the male MM pyelonephritis when caused by Proteus mirabilis parallels the situation described in other animals and humans.
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PMID:A shift from acute to chronic spontaneous pyelonephritis in male MM mice associated with a change in the causal micro-organisms. 312 33

Nosocomial urinary tract infections represent approximately 40 per cent of all nosocomial infections, thereby contributing considerably to secondary bacteremia and sepsis and possibly increased mortality. Urethral catheterization is the single most important predisposing factor in the development of urinary tract infection. Patients at increased risk of nosocomial infectious complications are the elderly, malnourished and debilitated, those with diabetes or prosthetic devices, and those on immunosuppressive therapy. About 75 per cent of nosocomial urinary tract infections are attributable to gram-negative bacteria, a disproportionate number of which when compared with community-acquired infections are caused by Proteus, Klebsiella, and Pseudomonas. There is enough evidence in the literature to support the use of prophylaxis in urologic surgery. Antimicrobial prophylaxis reduces the incidence of postoperative urinary tract infection. It does not seem to reduce the incidence of transient perioperative bacteremia but probably prevents the development of sepsis, thereby reducing the number of serious infective complications, the average hospital stay, and the associated total cost of treatment. To achieve adequate urine, blood, and tissue levels of the antimicrobial agent at the time of surgery, the drug should be given preoperatively. A short perioperative course represents sufficient prophylaxis. Regimens with combinations of beta-lactam and aminoglycoside antibiotics or single use of an extended spectrum beta-lactam antibiotic are acceptable for this purpose.
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PMID:Antimicrobial prophylaxis in urologic surgery. 353 3

There are fewer studies on bacteremia coming from the community hospital, where the practicing family physician is likely to see this problem, than from the university hospital. The hypothesis of this study was that patterns of bacteremia would be different between the two types of hospitals. Two hundred four patient episodes of culture-proven bacteremia from two analogous community hospitals were reviewed. Bacteremia was discovered in 2.6 of 1,000 patients, which is lower than reports from university hospitals. Of the 213 organisms isolated, slightly more were gram-negative than gram-positive, whereas many tertiary care centers report a preponderance of gram-negative organisms. About 20 percent of the episodes of bacteremia ended in death, a rate lower than in many tertiary care centers, and slightly more patients died of gram-negative than gram-positive bacteremia. The most common organisms in descending order were the streptococci and Escherichia coli followed by Staphylococcus aureus, Klebsiella pneumoniae, Proteus species, and Streptococcus pneumoniae. The most common sources of bacteremia were, in decreasing order, urinary tract, source unknown, heart valve, and lung. The most common underlying disorders were, in decreasing order, malignancy, diabetes mellitus, complicated urinary tract infection, valvular heart disease, and postoperative infection. Correctness of treatment of bacteremia appeared to increase survival.
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PMID:A two-center review of bacteremia in the community hospital. 354 87

From 1980 to 1983, 69 patients (36 male) with end-stage renal disease underwent kidney transplantation (11 from cadaveric donors). Twenty-six out of 69 (17 male) with a mean age of 37 years (range 16-50 years) developed 69 UTI episodes. The standard immunosuppressive regimen consisted of prednisolone and azathioprine and, in selected cases, antilymphocyte globulin or cyclosporin A were given for a short period of time. Thirty-five episodes (50%) occurred within two months of the operation. The most commonly isolated bacteria were E. coli (28 cases), Ps. aeruginosa (16) and Proteus mirabilis (9). Kidney graft dysfunction, diabetes mellitus, urological complications and antirejection treatment were the main predisposal factors. Recurrence or reinfections were finally diagnosed in 19/26 patients (73%). Thirteen patients presented with asymptomatic bacteriuria (55% of episodes). Aminoglycosides, ureidopenicillins and third-generation cephalosporins were found to be very effective for treating severely ill, febrile patients. In addition, trimethoprim/sulphamethoxazole and mecillinam were useful for patients on long-term chemotherapy. There were no deaths or impairment of the renal graft function directly attributable to the urinary infection. In conclusion, UTIs are a very common cause of morbidity in kidney graft recipients, with the highest incidence in the early post-transplant period. Recurrences or reinfections occur often and asymptomatic bacteriuria is a common finding which needs not be treated aggressively in the absence of symptoms or obstructive uropathy. Patient and graft survival in the long term remain unaffected by the presence of the urinary infection.
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PMID:Urinary tract infections after renal transplantation. 391 78

Risk factors for the development of nosocomial infection, i.e., diabetes, immunosuppressive therapy, etc., are reviewed. In most cases, the patient's own fecal flora is the primary reservoir for potentially infecting pathogens, such as Escherichia coli, Pseudomonas, Klebsiella, Enterobacter, Proteus, Serratia, and enterococcus. Hospitalized patients are likely to have antibiotic-related changes in fecal flora. Abnormal urethral flora in men, as well as high rates of vaginal and urethral colonization in women, increase the risk of infection associated with urinary catheterization or instrumentation. The costs of nosocomial urinary tract infections, both in economic and health terms, are briefly discussed. After a review of the causes and consequences of bacterial resistance to antibiotics, the issue of perioperative prophylaxis is addressed. It is concluded that the most important aspects of effective perioperative prophylaxis are achievement of suitable drug-tissue levels at the time of surgery and a limited period of postoperative antibiotic administration. The problem and probable causes of cross contamination are described. Recommendations for reducing nosocomial infections are offered.
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PMID:Nosocomial infection of urinary tract: changing pathogens, changing patterns. 401 97

The aetiology, pathogenesis, diagnosis and therapy of sepsis are dealt with in this paper. These problems are discussed on the basis of 151 patients treated for sepsis. The cases with monoinfection are 73.6% and those with polyinfection are 24.4%. Monoinfection is caused mainly by Staphylococci -65,3%, followed by E. coli - 15.2%, Proteus - 13% and Klebsiella - 3.3%. For the cases of polyinfection the gram-negative bacteria are 3:1 in respect to the gram-positive bacteria. The bacteriological finding from the haemoculture (92.8% mono- and 7.2% polyinfection) is not equal to this from the input source. Here also the cases of monoinfection are mainly caused by Staphylococci - 70.9%, followed by Proteus - 7.7%, E. coli - 6%, Klebsiella aerogenes - 5.1% and Streptococcus 2.6%. The gram-negative bacteria prevail in the cases of polyinfection. The virulent aggressive infection, bacteria resistant to antibiotics, the aggressive local infection, hypoproteinemia, anaemia, diabetes, a prolonged corticosteroid treatment and unsuitable antibiotic treatment are discussed as main factors predisposing to sepsis. All the 151 patients were treated with the complex therapy, recommended in this paper. It includes a surgical cleaning-up of the initial nidus, intensive reasonable antibiotic treatment against the gram-positive and gram-negative aerobes and anaerobes. Additionally, substitution of infusion therapy, parenteral nutrition, regulation of the pathophysiological deviations and stimulating therapy are carried out. 74.2% from the patients were cured, 25.8% died. 16.6% of the patients who died had sepsis caused by gram-positive bacteria, and 46.1% had sepsis caused by gram-negative bacteria. 17% of the patients who died had septicaemia and 22% had septicopyaemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical problems of surgical infection. The Pirogov Institute for Emergency Medicine, Sofia]. 615 Jun 8

The in vitro effect of pH and glucose concentration on the antibacterial activity of norfloxacin in urine was studied. Norfloxacin effectively inhibited the growth of four gram-negative pathogens in urine in vitro at pH values of 6.0, 7.0, and 8.0. The antibacterial activity of norfloxacin in urine was reduced severalfold at pH 6, but minimum inhibitory concentrations (MICs) at this pH remained clinically significant. Glucose at concentrations of 200 mg/dl and 400 mg/dl (simulating glucosuria of diabetes) did not significantly affect the antibacterial activity of norfloxacin when tested against clinical isolates of Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, or Pseudomonas aeruginosa. Norfloxacin appears to be a highly effective antibiotic in vitro under conditions which simulate normal and diabetic states.
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PMID:In vitro effect of pH and glucose concentration on the antibacterial activity of norfloxacin in urine. 624 49

The quantitative deep-tissue microbiology of the infected feet of 32 patients with diabetes mellitus was studied, and the clinical features of the patients were analyzed. Techniques of specimen collection designed to avoid contamination from surface flora were used to study amputated lower limbs. Cultures of deep tissue from six patients yielded only aerobes, and for one patient, only anaerobes. Cultures for 25 patients yielded a mixture of aerobes and anaerobes. A mean of 4.81 species (2.84 aerobes and 1.97 anaerobes) were isolated from each patient. The density of growth of anaerobes, however, was significantly higher than that of aerobes. Culture specimens obtained by curettage of the base of the ulcer correlated better with results of deep-tissue culture than did those obtained by needle aspiration or swab of the ulcers. The most frequently isolated organisms were Bacteroides species, anaerobic streptococci, group D streptococci, Clostridium species, and Proteus species. The presence of anaerobes was associated with a higher frequency of fever and foul-smelling lesions and with the presence of a foot ulcer. Prior antibiotic therapy did not appear to influence the nature of the microorganisms isolated. The polymicrobial nature of this disease should be considered when antimicrobial therapy is indicated.
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PMID:The infected foot of the diabetic patient: quantitative microbiology and analysis of clinical features. 671 34

The number of patients admitted to hospital who harbour Pseudomonas aeruginosa, Proteus and Klebsiella, keeps rising. Of the factors predisposing to colonization, only diabetes and antibiotic therapy exert their effect equally in extrahospital and intrahospital environment. Malignant diseases, immune suppressive therapy and instrumental interventions play a predominant role in the hospital. In extrahospital environment, infancy and old age, poor general condition as well as in almost half of the cases, an inflammatory process caused by viruses or bacteria was found to create favourable conditions for the colonization of facultative pathogens. One of the main sources of the Gram-negative facultative pathogens studied was the faeces of enteric patients in the hospital. The frequency of P. aeruginosa, Klebsiella and Proteus positive cultures rose parallel in the faecal and non-faecal bacteriological samples in the period 1958 to 1977. The seasonal changes observed in the frequency of positive cultures revealed that the Gram-negative facultative pathogens had increased in number first in the enteral wards, spreading subsequently to the medical and paediatric wards, and finally they appeared in a high number in the surgical wards, originating from patients transferred there from the medical or paediatric wards.
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PMID:Extrahospital and intrahospital factors predisposing to the spread and colonization in patients of Pseudomonas aeruginosa, Proteus and Klebsiella in an infectious hospital. 679 65


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