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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

13 episodes of bacteremia caused by Pasteurella multocida were seen in a general hospital during a 12-year period. All the patients had an underlying disease (77% had cirrhosis) and 2 were receiving chemotherapy for hematologic malignancy. There was a numerical preponderance of male patients (69%). In 5/13 cases a recent animal-derived trauma could be found. In the other cases the source of the infecting organism was thought to be endogenous (from patients' own pharyngeal commensal flora) or secondary to contact with secretions of a pet animal. The clinical presentation of sepsis caused by this organism was nonspecific. Hypotension was seen in 5 cases. Localized sites of infection were certain in 6 and only clinically suspected in 4 other cases. The overall mortality rate was 31%. The administration of ampicillin seems the appropriate therapy for Pasteurella multocida bacteremia.
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PMID:Pasteurella multocida bacteremia: report of thirteen cases over twelve years and review of the literature. 331 79

Spontaneous bacterial peritonitis (SBP) is an increasingly recognized complication of cirrhosis with ascites. However, the presence of ascites from any cause appears to be a risk factor for this infection. The etiology of SBP is multifactorial, including derangements in the reticuloendothelial system, abnormalities of both the serum and ascitic fluid humoral immune systems, and systemic bacteremia. Gram-negative enteric pathogens are the etiologic agents in 70% of the cases; anaerobes are an uncommon cause. Fever and abdominal pain are the most common presenting symptoms. However, asymptomatic patients are being increasingly recognized. When SBP is suspected, paracentesis is indicated. An absolute polymorphonuclear leukocyte count greater than 500/mm3 is highly suggestive of SBP. Ascitic fluid lactate and pH may offer additional diagnostic assistance when the PMN count is ambiguous. Appropriate antibiotic therapy should be initially based on the centrifuged Gram stain of ascites as well as the patient's renal function. Mortality is substantial and appears to be related to the severity of the underlying liver disease.
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PMID:Spontaneous bacterial peritonitis. A review of pathogenesis, diagnosis, and treatment. 331 22

To determine the efficacy of aztreonam in the treatment of spontaneous bacterial peritonitis in patients with hepatic cirrhosis, 14 patients (7 males, 7 females) with 16 Gram-negative infective episodes (12 Escherichia coli and 4 Klebsiella pneumoniae) were treated with aztreonam infusions at doses of 1 gm per 8 hr for a planned 14-day period. Ages ranged from 40 to 75 years with a mean of 57 +/- 10 years. All organisms were highly susceptible to aztreonam (minimal inhibitory concentration less than or equal to 0.06 to 0.12 micrograms per ml). Serum antibiotic levels were 61.9 +/- 25.5 micrograms per ml (peak) and 27 +/- 18.5 micrograms per ml (trough). Ascitic fluid antibiotic levels were 33.6 +/- 22.5 micrograms per ml (peak) and 32.7 +/- 16.8 micrograms per ml (trough). Although the symptoms of infection were controlled within 3 days and ascitic fluid cultures became negative after 48 hr, 10 patients (62.5%) died, with hepatorenal syndrome and digestive tract hemorrhage as the principal causes of death. Three patients developed streptococcal superinfections during treatment; Streptococcus faecalis peritonitis in one case and spontaneous bacteremia due to Streptococcus equinus and Streptococcus mutans in the other two. Aztreonam was well tolerated and clinically and bacteriologically efficacious in controlling the infection. Serum and ascitic fluid levels were considerably higher than the minimal inhibitory concentration for the causative organisms, suggesting that lower doses may achieve suitable therapeutic levels. A negative aspect of the antibiotic therapy was the superinfections. The high mortality rate was attributable to the generally poor underlying condition of the patients.
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PMID:Evaluation of aztreonam in the treatment of spontaneous bacterial peritonitis in patients with cirrhosis. 353 Sep 45

In a retrospective study the average yearly incidence of bacteremia in cirrhosis patients was found to be 4.5%. This is about 5-7 times higher than in two general materials of all bacteremic patients from the same hospital. There was no difference between the distribution of bacterial strains in the 43 bacteremic cirrhosis patients and the two general materials of all bacteremic patients.
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PMID:Bacteremia in cirrhosis of the liver. 353 5

In order to investigate whether bacteremic cirrhosis patients generally have a more serious prognosis than non-bacteremic cirrhosis patients the survival rates of 43 bacteremic and 43 matched non-bacteremic cirrhosis patients were compared. No difference in survival existed between the two groups from the time of cirrhosis diagnosis. However, the survival rate of the bacteremic patients calculated from the onset of bacteremia was significantly shorter than the survival rate of the non-bacteremic cirrhosis patients calculated from the time of random selection (p less than 0.05). Thus the bacteremic patients at the time of bacteremia were generally in a later phase of their disease than the controls at the time of selection. Therefore, bacteremia when it occurs in cirrhosis is a severe prognostic sign, not because of its influence on survival but because of its occurrence late in the course of cirrhosis.
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PMID:The prognostic significance of bacteremia in hepatic cirrhosis. 361 83

Risk factors predisposing to auditory toxicity of aminoglycosides were analyzed from records of 187 patients enrolled in three prospective randomized trials comparing the toxicity of netilmicin, tobramycin, and amikacin. Patients were eligible if they received three or more days of therapy and at least two serial audiograms were available. The overall auditory toxicity rate was 9.6% (18 of 187). Auditory toxicity was detected in 4.4, 10.8, and 23.5% of patients given netilmicin, tobramycin, and amikacin, respectively (P = 0.05). In the univariate analysis, patients who developed auditory toxicity were significantly older (P = 0.01) and had a significantly higher (P = 0.04) percentage of trough levels of netilmicin or tobramycin above 2 mg/liter or amikacin above 5 mg/liter. In the final logistic regression model, only age was retained as independently influencing the development of auditory toxicity (P less than 0.00001). Conversely, factors that did not add significantly to the prediction of auditory toxicity were aminoglycoside serum levels, total aminoglycoside dose, duration of therapy, sex, peak temperature, presence of bacteremia, shock, liver cirrhosis, dehydration, previous otic pathology or renal failure, and development of renal toxicity. At least in certain populations, age is the most important predisposing factor for the development of auditory toxicity in patients receiving aminoglycosides.
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PMID:Univariate and multivariate analyses of risk factors predisposing to auditory toxicity in patients receiving aminoglycosides. 367 49

Spontaneous bacterial peritonitis (SBP), a fascinating disease that had been reported perhaps 50 times in varying guises over the preceding century, suddenly burst forth in the 1960s and was recognized in clusters of cases almost simultaneously in Paris, London, and West Haven, Connecticut. The spectrum of the disease has broadened. Initially, it was associated almost exclusively with alcoholic cirrhosis, but it has now been found in association with posthepatitic cirrhosis, cryptogenic cirrhosis, chronic active liver disease, and, occasionally, in biliary cirrhosis and cardiac cirrhosis. Recently, it has been reported in alcoholic hepatitis and acute viral hepatitis. It occurs occasionally in malignant ascites and in pancreatitis in the absence of cirrhosis. It is surprisingly common in disseminated lupus, in which it occurs relatively more commonly than in alcoholic cirrhosis. A similar syndrome, primary peritonitis, occurs frequently in children with nephrotic ascites. The clinical pattern of SBP has broadened. Initially it consisted of abdominal pain, fever, rebound tenderness, hypoactive bowel sounds, hypotension, encephalopathy, and cloudy ascites with large numbers of polymorphonuclear leukocytes in ascitic fluid. Each and every symptom, sign, and laboratory abnormality may be absent; indeed, the syndrome can be completely silent. Initially, the causative bacteria appeared to be almost exclusively enteric, but now the list of bacteria isolated in cases of SBP looks like a bacteriology textbook. Anaerobes are rare. Multiple organisms usually suggest nonspontaneous origin such as perforation or vasopressin induction. The differentiation between spontaneous and nonspontaneous bacterial peritonitis is crucial in the differential diagnosis. The great majority of cases of SBP develop in the hospital, 80% more than one week after admission. It is therefore a nosocomial disease that may be precipitated by procedure-induced bacteremia, gastrointestinal bleeding, or diarrhea, and it tends to occur in patients with low ascitic fluid protein (complement) concentrations and severe portal-systemic shunting.
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PMID:Spontaneous bacterial peritonitis: variant syndromes. 368 33

Vibrio cholerae bacteremia occurred in a patient with cirrhosis after placement of a LeVeen shunt. At the time of bacteremia, cultures of peritoneal fluid were negative and fluid dynamics did not suggest spontaneous bacterial peritonitis. Despite apparent successful treatment of the bacteremia, relapse and death occurred with culture positivity of peritoneal fluid for V. cholerae. Simultaneously, blood cultures were positive for Klebsiella pneumoniae. Agglutination studies demonstrated the V. cholerae to be a non-01 strain. Insertion of a LeVeen shunt, which bypasses the hepatic clearance mechanisms, appeared to have allowed bacteremia to occur with this bacterium that is rarely isolated from blood. In patients with LeVeen shunts, bacteremia with noninvasive pathogens may occur, and in coastal areas, Vibrios should be considered when bacteremia occurs.
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PMID:Non-01 Vibrio cholerae bacteremia--complication of a LeVeen shunt. 370 3

In a five-year retrospective study, there were 57 episodes of bacteremia among 1623 admissions (3.5%) of patients suffering from cirrhosis. Gram-positive bacteria were found in 70% of the episodes, gram-negative bacteria in 30%. All of the gram-positive bacteria found were fully sensitive to methicillin and to gentamicin. The gram-negative bacteria found were all sensitive to gentamicin, but only 50% were sensitive to ampicillin. The distribution between gram-positive and gram-negative bacteria was the same, irrespective of whether the patients acquired the infection inside or outside the hospital. More than 50% of the patients suffered from one or more of the following complications of cirrhosis: ascites, encephalopathy and haematemesis. Twenty-one patients died within seven days after the bacteremia was diagnosed. Bacteremia is a serious complication of advanced cirrhosis, and it is recommended that adequate antibiotic treatment is started when septicemia is suspected.
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PMID:Bacteremia in patients suffering from cirrhosis. 371 May 95

It is well-known that cirrhosis is a predisposing factor to Yersinia septicemia. This study includes 73 cirrhotics and shows a high number of positive serologic tests (47/73 : 64.4%). However, there is no correlation with clinical features or bacteriological findings. The most frequent serotypes, i.e. pseudotuberculosis IV and enterocolitica 0:9, differ from those which are usually found in Yersinia septicemias. Iron overload in cirrhosis, increased intestinal load of gram-negative bacilli and possible latent bacteremia may partly explain these results. However, the role probably played by as yet poorly known cross-reactions between Yersinia and other pathogens (Shigella, E. Coli...) must be underscored. The authors conclude that slightly positive, stable, serodiagnostic tests have little meaning in cirrhotics.
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PMID:[Serodiagnosis of Yersinia infections in cirrhotic patients. Study apropos of 73 patients]. 631 24


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