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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The causative organisms, clinical manifestations, factors influencing prognosis, and other epidemiological characteristics of 81 episodes of bacteremia due to gram-negative organisms, in non-neutropenic patients, were studied retrospectively during a 3-year period (1992-1994) at the Department of Internal Medicine of the University Hospital of Heraklion, Crete, Greece. The gram-negative bacteremia incidence was 2% and the overall mortality 12%. All 81 patients had fever; Escherichia coli was the most frequent organism isolated (from 47 patients--58%) and was associated with shock (9/47), disseminated intravascular coagulation (DIC) (8/47), anuria (5/47), adult respiratory distress syndrome (ARDS) (3/47), and pneumonia (1/47). Other less frequent gram-negative microorganisms were Klebsiella spp. (ten patients; 12%), Pseudomonas spp. (7; 7%), Salmonella spp. (5; 6%), Enterobacter spp. (5; 6%), Proteus spp. (3; 3.4%), Stenotrophomonas spp. (3; 3.4%), and Acinetobacter spp. (1; 1.2%). ARDS. shock, DIC, anuria, presence of central venous catheter, urinary catheter, unknown origin of infection and inappropriate treatment were significantly associated with a higher death rate. Early initiation of appropriate therapy was the most important intervention that favorably affected the outcome of gram-negative bacteremias in this patient population.
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PMID:Gram-negative bacteremia in non-neutropenic patients: a 3-year review. 964 6

Seventy-seven patients with Gram-negative bacillary meningitis (GNBM), 57 males and 20 females, aged 17-86 years, were identified at Kaohsiung Chang Gung Memorial Hospital, over an 11-year period. Fifty-four infections were community-acquired, and 23 were nosocomial; 49 were spontaneous and 28 occurred after head surgery or neurosurgery. The organisms most frequently involved were Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter. Rarer pathogens included Citrobacter species, Serratia marcescens, Enterobacter cloacae, and Proteus mirabilis. All patients who did not receive appropriate antibiotic therapy died. The mortality in those treated with appropriate antibiotics was 28%. Other statistically significant prognostic factors included septic shock, initial level of consciousness, hyperosmolar hyperglycemic nonketotic coma, disseminated intravascular coagulation, high cerebrospinal fluid lactate levels and leucocytosis. In the multiple logistic regression analysis, only appropriate antimicrobial therapy and septic shock were strongly associated with mortality even after adjusting for other potentially confounding factors. Despite the high mortality, management can be improved by early diagnosis, early use of appropriate antibiotics, and correction of underlying and associated medical derangement.
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PMID:The prognostic factors of adult gram-negative bacillary meningitis. 977 18

Septic adrenal hemorrhage is classically caused by meningococcemia. An autopsied case is presented of a 45-year-old man with adrenal hemorrhage due to Klebsiella oxytoca bacteremia following placement of a central venous catheter. He died 5 hours after developing disseminated intravascular coagulation (DIC). The bacterial entry site may have been the catheter. The cause of death was considered to be pulmonary edema due to bacteremia rather than adrenal insufficiency due to hemorrhage. Septic adrenal hemorrhage should be recognized as a subtype of sepsis rather than adrenal insufficiency, and may be caused in conditions of severe sepsis with DIC, independent of the microorganic variety.
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PMID:Adrenal hemorrhage associated with Klebsiella oxytoca bacteremia. 986 68

Currently, pyogenic liver abscess is not frequent, but it is a severe infectious disease. However a strategy for the effective treatment of liver abscess is not established. We analyzed 75 cases of liver abscess over an eight year period and evaluated their prognosis, any associated underlying disease, or the effect of percutaneous transhepatic abscess drainage (PTAD). For all 75 cases, laboratory data were analyzed and imaging studies were performed. Next, PTAD and antibiotic administration were started on these cases as first choice treatments. These treatments were continued until the laboratory data of the patient were restored to within the normal range. Those cases that were PTAD non-effective or required operation for underlying diseases, underwent operations. Of the total 75 cases, 63 survived after treatment and 12 cases died. Bacteria were detected in 50 cases and Klebsiella pneumoniae was detected in 31 of these 50 cases, but 25 out of 75 cases were negative. The biliary system was the main route of infection. PTAD was effective, especially in cases that were complicated with disseminated intravascular coagulation (DIC) or acute renal failure (ARF). PTAD is an effective treatment for liver abscess, it is especially useful in the restoration of severe general conditions as indicated by this study.
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PMID:Clinicopathological analysis of liver abscess in Japan. 1237 5

Endogenous endophthalmitis is a rare, but devastating complication of septicemia. The prognosis of maintaining visual acuity in patients with septic endophthalmitis is poor in spite of an early diagnosis and the timely start of conventional therapeutic procedures because the intravitreous drug concentration remains low after the systemic administration of antibiotics due to the blood-ocular barrier. We treated an elderly female patient with endogenous endophthalmitis complicated with disseminated intravascular coagulation associated with a Klebsiella pneumoniae liver abscess. Endophthalmitis developed rapidly and we thus had to perform an enucleation of both eyeballs even though we made an early diagnosis and performed liver abscess drainage as well as the prompt systemic and subconjunctival administration of antibiotics. Our experience in treating this case emphasizes the need to perform the timely intravitreous infusion of antibiotics with a support therapy consisting of the systemic and subconjunctival administration of antibiotics for endogenous endophthalmitis associated with a Klebsiella pneumoniae liver abscess.
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PMID:Endophthalmitis with Klebsiella pneumoniae liver abscess. 1272 45

We assessed the frequency and clinical significance of polymicrobial infections in 31 patients with sporadic community-acquired Legionella pneumonia. Twenty-six patients were men, 5 were women and mean age was 61 years. Eighteen patients were smokers, 6 patients were chronic alcoholics and 23 had underlying diseases. Regarding severity, the illnesses were mild (two patients), moderate (seven patients) and severe (twenty-two patients). In 9 (29%) of the patients, one other etiologic agent for community-acquired pneumonia was identified in addition to the Legionella species. The distribution of one other causal agent was as follows: Mycoplasma pneumoniae, 2 patients; Chlamydia pneumoniae, 2; Chlamydia psittaci, 1; Influenza virus, 1; Streptococcus pneumoniae, 1; Klebsiella pneumoniae, 1; Pseudomonas aeruginosa, 1 patient. Because an antimicrobial agent with activity against Legionella species can also provide coverage for Mycoplasma pneumoniae. Chlamydia pneumoniae, and Chlamydia psittaci, the patients with these coinfections improved without any complications. The patient with influenzavirus coinfection became seriously ill, and the condition was complicated by disseminated intravascular coagulation, renal failure and aspergillus bronchitis. The case of Pseudomonas aeruginosa coinfection was accompanied with a lung abscess and empyema. Our experience illustrates the importance of considering polymicrobial infections in patients with sporadic community-acquired Legionella pneumonia.
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PMID:[Polymicrobial infections in patients with Legionella pneumonia]. 1476 66

A 5-day-old newborn presented with neonatal enteroviral infection. The patient's hospital course was complicated by acute liver dysfunction, renal insufficiency, fluid overload, respiratory failure, hypertension, catheter related thrombosis, Klebsiella pneumoniae sepsis, intracerebral and intraventricular hemorrhage, and disseminated intravascular coagulation (DIC). Administration of fresh frozen plasma (FFP) and cryoprecipitate failed to control the patient's hemostasis and led to significant fluid overload. Recombinant activated factor VII (rFVIIa, Novoseven NovoNordisk, Bagsvaerd, Denmark) was given to the neonate as a bolus (rFVIIa at 60-80 microg/kg body weight), followed by a continuous infusion (2.5-16 microg/kg/hr). Recombinant activated factor VII controlled hemostasis, until the patient's liver function recovered. The patient's blood product requirement significantly decreased and his fluid overload resolved. Administration of rFVIIa appears to have stabilized the coagulation process. The patient appears to have fully recovered from the infection's complications.
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PMID:Management of coagulopathy with recombinant factor VIIa in a neonate with echovirus type 7. 1523 86

We describe a 56-year-old woman with type 2 diabetes complicated by a Klebsiella pneumoniae perirenal abscess. The patient further developed incipient diabetic ketoacidosis, disseminated intravascular coagulation, and endogenous endophthalmitis. Occurrence of the latter as a metastatic infection from perirenal abscess caused by this organism is very rare, and we know of no previously reported patient with the additional occurrence of disseminated intravascular coagulation. Since prompt intravitreal antibiotic administration is needed, physicians should be aware of these rare but severe complications of K pneumoniae infection, especially in patients with poorly controlled diabetes.
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PMID:Endogenous endophthalmitis and disseminated intravascular coagulation complicating a Klebsiella pneumoniae perirenal abscess in a patient with type 2 diabetes. 1576 24

We studied 13 emergency cases of liver abscess. Five cases of septic shock or clouding of consciousness were identified on admission. Six patients had diabetes mellitus. Twelve patients met the diagnostic criteria for systemic inflammatory response syndrome, and nine met the criteria for disseminated intravascular coagulation. Plasma endotoxin levels improved rapidly after drainage. Causative organisms were isolated in all patients, and the most common organism was Klebsiella pneumoniae (seven cases). Percutaneous transhepatic abscess drainage (PTAD) was performed not only in single cases but also in multiple cases with main huge abscesses. Surgical treatment was performed in the following three cases: a ruptured abscess, an ineffective PTAD, and a case of peritonitis after PTAD. Irrigation of abscesses with strong acidic electrolyzed water revealed a significant decrease in treatment duration. In the majority of our cases, severe conditions were identified on admission. Strong acidic electrolyzed water was useful for management of PTAD.
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PMID:[A clinical study of liver abscesses at the Critical Care and Emergency Center of Iwate Medical University]. 1618 Jun 73

Bacterial meningitis remains a major cause of death and long-term neurologic sequelae worldwide. We present a case of fatal Klebsiella pneumoniae meningitis and concomitant disseminated intravascular coagulation (DIC) in a 72-year-old woman with diabetes mellitus (DM). Both blood and cerebrospinal fluid cultures grew Klebsiella pneumoniae. Due to advanced age, newly recognized DM, K. pneumoniae bacteremia, and DIC, the prognosis of our patient was poor. Eight hours after arrival to the emergency department, cardiopulmonary resuscitation was necessary in this patient, but she died despite an early diagnosis and appropriate antibiotic therapy.
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PMID:Fatal Klebsiella pneumoniae meningitis and concomitant disseminated intravascular coagulation in a patient with diabetes mellitus. 1956 76


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