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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ninety-eight cases of empyema thoracis admitted to Juntendo University Hospital between 1979 and 1990 were reviewed. Males accounted for 78 cases and females 20 cases. Thirteen pediatric patients ranged in age from 17 days to 4 years, while the 85 adult cases ranged from 16 to 89 years (mean: 58.4 years). The mortality rate increased with age. Fifty-three cases of community-acquired empyema thoracis consisted of 24 with no underlying disease (including 13 pediatric cases), and 29 with diabetes mellitus, alcoholic liver damage or chronic obstructive bronchopulmonary disease. Forty-five nosocomial empyema cases occurred after chest operation or thoracocentesis, or due to a subdiaphragmatic pathogenic condition or congestive heart failure complicated with aspiration pneumonia. In this series, 63 patients (64.3%) had para- or post-pneumonic empyema. Compared with the community-acquired infection cases, the mortality rate of the nosocomial infection cases was very high. Seventy-eight cases were culture-positive, including 3 positive for Mycobacterium tuberculosis. The remaining 20 cases were culture-negative. In 75 cases of culture-positive pleural fluid, aerobic bacteria were isolated from 31 cases (mortality rate: 22.6%), anaerobes mixed with aerobes from 21 cases (mortality rate: 52.4%), and anaerobes only from 23 cases (mortality rate: 21.7%). Thus, the mortality rate of mixed infected cases was highest. Anaerobes were frequently isolated from the community-acquired empyema cases, and were often found in para- or postpneumonic lesions, including aspiration pneumonia. The most commonly encountered aerobe was Staphylococcus aureus. Among the anaerobes, Bacteroides spp., microaerophilic streptococcus, Peptostreptococcus and Fusobacterium spp. were most common. A single organism was isolated in pure culture from 39 cases. Single organisms isolated from fluids were more frequently aerobes (25) than anaerobes (14). The cases harboring Bacteroides spp. showed the worst outcome, with 11 deaths in 25 such cases.
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PMID:[Analysis of 98 cases of thoracic empyema]. 178 10

Thirty three patients, 24 male and 9 female, aged from 19 to 90 with an average of 58.8, were admitted to the medical intensive care unit (ICU) from 1988 December to 1989 December. Their host defenses were evaluated. Cell-mediated immunity (CMI) included delayed type skin test (MULTITEST CMI), total lymphocyte count and lymphocyte subpopulations (CD3, CD4 and CD8) were determined. Investigation of humoral immunity (HI) included use of serum levels of immunoglobulins (IgG, IgA and IgM) and complements (C3 and C4). Episodes of nosocomial infection were documented by patients' clinical and laboratory data, including positive culture. The CMI, especially for total lymphocyte count, T lymphocyte count and skin test, was impaired by underlying diabetes mellitus and such associated conditions as malnutrition, steroid administration and surgical procedures. The longer the admission period, the lower was the CMI including total lymphocyte count, CD3 percentage, CD4 percentage and skin test response. The HI was less impaired by underlying conditions and not influenced by admission duration. More infection episodes were found in patients with longer admission duration. In conclusion, the host defense was impaired in patients hospitalized longer in medical ICU, and the combination of compromised immunity and impaired mucocutaneous barriers made them more susceptible to infections.
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PMID:Evaluation of host defense in critically ill patients in medical intensive care unit. 209 3

One hundred and eleven patients with pyogenic infections were studied. Of these, 32 patients (28.8%) were diabetic, and 33 patients (30%) had positive cultures obtained. Fifty-eight patients (52.3%) had fever (T degrees greater than 37.2 degrees C) while 69 patients (62.2%) had leucocytosis. Forty-one patients (36.9%) had nosocomial infections. It was found that patients older than 75 years-old did not respond to infection by a febrile response as often as those younger than 75 years-old. Mortality rate was increased in those whose T degrees greater than 38.2 degrees C and in those with more than one source of infection. Age and the presence of diabetes was not found to increase the mortality rate, though diabetics tend to have more than one source of infection. A positive blood culture was also associated with a higher mortality rate. There were also more deaths among patients with nosocomial infection than the community acquired group. The three most common sources of infection were lung, urinary tract and skin respectively. The most common group of organisms cultured was gram negative bacilli, of which Klebsiella species was most frequently isolated. Of these, 57% of the Klebsiella sp cultured came from the nosocomial group. Staphylococcus aureus was the next most frequently cultured bacteria, and all these isolates (100%) came from the nosocomial group. Though antibiotics were started within 48 hours of suspicion of infection in majority of patients (101 patients or 91%), and all of these received appropriate initial antibiotics, mortality rate remained high (26 deaths or 23.4%).
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PMID:Infection in the elderly. 239 38

Thirty cases of Candida sepsis occurring at Howard University Hospital between January 1983 and December 1985 were studied. A retrospective analysis was done to determine which risk factors or methods of treatment led to higher morbidity and mortality. Nosocomial infections with fungi are becoming more widespread as patients survive illnesses once deemed terminal. Patients had positive blood cultures for Candida accompanied by signs of systemic sepsis. Risk factors included diabetes, central hyperalimentation, malignancy, intraabdominal abscesses, and fistulae. The correlation between the total dose of amphotericin administered and patient recovery was analyzed.
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PMID:Candida sepsis. 358 39

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

Out of a total of 422 patients studied, 164 (38.8%) developed nosocomial infection. The rate was higher (41.6%) in males than in females (34.7%). A rising trend of infection was observed with age, maximum (69.6%) being in the above 60 age group. Nosocomial infection rate was inversely proportional to the socio-economic status of the patient. At the same time some underlying diseases in the patients influenced the rate of infection to a great extent, eg infection rates in patients with anaemia (53.7%), diabetes mellitus (85.2%), hypertension (82.0%) and obesity (51.5%) were much more than in patients with no such underlying disease (17.5%).
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PMID:A study of nosocomial infection in relation to different host factors in an Indian teaching hospital. 756 71

Group B streptococcal infection has recently been recognised as an important and apparently increasingly common cause of invasive disease in nonpregnant adults. The annual incidence of invasive disease has been estimated at 4.4 per 100,000 nonpregnant adults and is highest among adults over 60 years of age. The most common clinical diagnoses include skin and soft-tissue infections, bacteraemia with no identified source, osteomyelitis, urosepsis and pneumonia. Other important but less common infections include peritonitis, infectious arthritis, meningitis and endocarditis. The majority of adults with group B streptococcal infections have underlying diseases including diabetes mellitus, malignant neoplasms and liver disease. Nosocomial infection and polymicrobial bacteraemia occur in a significant proportion of patients with invasive group B streptococcal disease. Mortality from invasive disease is particularly high in the elderly. For treatment of serious group B streptococcal infections, high doses of benzylpenicillin (penicillin G) are recommended because of the somewhat higher minimal inhibitory concentrations. In addition to parenteral antibiotic therapy surgical management may be required for successful treatment, particularly in the case of soft-tissue or bone infection. Invasive group B streptococcal infection is a major problem in elderly adults and those with chronic diseases, and efforts should be made to identify and treat such infections early. Future approaches may include vaccine prevention of serious group B streptococcal infection in adults at highest risk.
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PMID:Group B streptococcal infection in older patients. Spectrum of disease and management strategies. 761 18

As part of a programme for improving hospital infection control in Mauritius a nationwide survey, including a prevalence study, was carried out in order to identify characteristics of the hospitals, the population, and the infections. Community-acquired infections were three times more prevalent than nosocomial infections: 15.0% and 4.9%, respectively. Surgical wound infection was by far the most common nosocomial infection, with a prevalence rate of 8.2 per 100 operations, followed by urinary tract infection with a low rate of 0.8 per 100 admissions. The survey showed that these hospitals in Mauritius housed mainly a young population (mean of 36.8 years for females and 39.4 years for males) with few risk factors for acquiring nosocomial infection. Although diabetes mellitus is prevalent in Mauritius the diagnosis of diabetes was not associated with nosocomial infection. The spectrum of operations offered was limited, and Caesarean section was the most prevalent operation. The amount and types of antibiotics used in hospitalized patients were recorded. More than one third of the patients received antibiotic treatment at the time of the survey, which is comparable to figures reported from large teaching hospitals in Western Europe. The information gathered from the survey, the interviews and the inspection were used to establish priorities for a collaborative programme for improved infection control. It included the draft of a set of custom-made guidelines, which were eventually studied by staff members from hospitals in Mauritius during a training period in Denmark. We believe that a prevalence survey is useful for initiating infection control programmes in hospitals in developing countries.
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PMID:Prevalence of infections and use of antibiotics among hospitalized patients in Mauritius. A nationwide survey for the planning of a national infection control programme. 790 23

One hundred and one cases of Klebsiella bacteraemia from the National University Hospital, Singapore, were reviewed retrospectively. There were 54 (53.5%) males and 47 (46.5%) females. Mean (+/- SE) age was 54 (+/- 2.4) years. Overall mortality was 26%. Nosocomial infections accounted for 20%. Underlying diabetes mellitus and malignancy were present in 36 and 26% respectively. The source of the bacteraemia was not known in 33% of cases, 17% had liver abscess, 29% had urinary tract infections, 9% had pneumonia, 10% had an abscess separate from the liver, and 3% had biliary sepsis. Elevated alkaline phosphatase (> 100 U-1) was seen in all cases of liver abscess (sensitivity 100%, specificity 27%). Nonsurvivors had a significantly lower platelet count than survivors (104 +/- 25 x 10(9)/l vs. 176 +/- 15 x 10(9)/l, unpaired t-test P < 0.05), and a platelet count of less than 150 x 10(9)/l was associated with a significantly higher mortality (37% vs. 11%, chi 2 P < 0.01). Nosocomial infection was associated with 45% mortality, whereas community-acquired infection had a lower rate of 21%, this was not statistically significant. Seventy-eight per cent of these Klebsiella isolates were sensitive to gentamicin and cotrimoxazole, and 100% to imipenem.
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PMID:Klebsiella bacteraemia: a report of 101 cases from National University Hospital, Singapore. 796 72

A 12-year review identified 21 patients with nontyphoidal, nonparatyphoidal salmonella septicemia. Eight of the patients had no predisposing factors. Factors identified included malignancy in five, recent surgery in four, alcoholism with aspiration pneumonia in two, chronic lung disease in two, diabetes in two, systemic lupus erythematosus in one and burns in one. Ten patients presented with gastroenteritis, two with localized abscesses, two with aspiration pneumonia and the remainder with nonspecific septicemia. Three patients died of underlying diseases and three died shortly after the septicemia of related causes. Six cases were nosocomial infection and were not related to hospital outbreaks. Salmonella septicemia with these serotypes is uncommon (1 per 14,000 admissions, 1 per 4000 blood cultures) and can occur in patients without diminished host resistance.
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PMID:Nontyphoidal, nonparatyphoidal salmonella septicemia in adults. 850 19


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