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

In cirrhotic patients, the authors studied the modification of the pharmacokinetics of ampicillin in the plasma and in the ascitic fluid, as well as its concentration in the urine. The influence of the jaundice, the ascites and diuretics were studied. In cirrhosis, dilution and elimination of the antibiotic are modified, as is shown by the increase in T 1/2 alpha and T 1/2 beta. These anomalies seem to be due essentially to modifications in the distribution volume; the degree of hepatocellular insufficiency does not appear to be of importance. The ascites acts as an independent compartment, into which the antibiotic's passage in slight. The practical consequences are the following: less frequent injections, increasing of the fractionated doses, in situ injections of ampicillin in cases of infection of the ascitic liquid.
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PMID:[Metabolism and kinetics of ampicillin elimination in cirrhosis. Therapeutical consequences. (author's transl)]. 38 20

Listeria monocytogenes is a Gram-positive bacillus that is pathogenic in both the normal and compromised host. We describe Listeria peritonitis and cerebritis in a patient with cirrhosis due to non-A, non-B hepatitis, and review the 11 other cases of Listeria peritonitis reported in the English-language literature. Listeria is a rare cause of peritonitis in debilitated, older patients, with two-thirds of the cases occurring in patients with chronic liver disease. Listeria peritonitis may also occur in patients undergoing peritoneal dialysis, or in those with malignancy. Peritonitis due to Listeria is clinically similar to spontaneous bacterial peritonitis, and is associated with fever, variable abdominal pain, and neutrocytic ascites; bacteremia commonly accompanies Listeria peritonitis. This syndrome can be successfully treated with antimicrobial drugs, although the third-generation cephalosporins commonly used in the therapy of spontaneous bacterial peritonitis are not recommended. Ampicillin may be the drug of choice, with combination therapy with an aminoglycoside reserved for cases that do not respond to ampicillin alone.
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PMID:Listeria monocytogenes peritonitis: case report and literature review. 144 54

Sixteen clinical isolates of ampicillin-resistant enterococci (ARE) were recovered from the microbiology laboratory of a 450-bed rehabilitation medical center from January 1981 to September 1987. These isolates were detected when a disk diffusion test using 10 micrograms of ampicillin on a blood agar plate revealed no zones of inhibition. Tube macrodilution tests yielded an MIC of greater than or equal to 16 micrograms of ampicillin per ml. None of the isolates were penicillinase producers by the chromogenic cephalosporin disk test. Ten isolates were Enterococcus faecium, four isolates were E. raffinosus, one isolate was E. gallinarum, and one isolate was not identified (lost). There were 6 male and 10 female patients. The sources of isolates were urine (n = 7), wound (n = 5), ascitic fluid (n = 2), blood (n = 2), peritoneal catheter tip (n = 1), Bartholin's cyst abscess (n = 1), rectal swab (n = 2), and pancreatic abscess (n = 1). The organism was isolated from multiple sites in 4 patients, was a pure culture isolate in 5 patients, and was part of a polymicrobial flora in 11 patients. Six patients were diabetic, and four had liver cirrhosis. All but four patients had received at least one antibiotic within 3 weeks of ARE isolation. The MICs (micrograms per milliliter) for 50 and 90% of isolates tested, respectively, were as follows: ampicillin, 64 and 64; penicillin, 128 and greater than 128; vancomycin, 1 and 2; gentamicin, 4 and 16; ciprofloxacin, 1.6 and 3.2; imipenem, 128 and greater than 128; and daptomycin (LY146032), 1.6 and 6.4. ARE may be an emerging pathogen in the hospitalized patient population.
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PMID:Enterococci highly resistant to penicillin and ampicillin: an emerging clinical problem? 211 Jan 82

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

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

The ten published cases of septic arthritis due to Campylobacter fetus and two more recent cases, one of which was a delayed septic complication of a total hip replacement, are discussed. In 83% of cases, febrile monoarthritis occurred which in 7 out of the 12 cases involved an already diseased joint in a subject over 70 years of age (half of the patients), who was frequently alcoholic and presented either cancer or hepatic cirrhosis and/or diabetes. Hyperleukocytosis of the blood was variable (55% of cases). The joint fluid, which contained a high level of deteriorated polynuclear cells, was routinely cultured on an enriched medium in an anaerobic or microerophilic atmosphere and in 10 out of 12 cases Campylobacter fetus was isolated within 15 days, even in the absence of previous antibiotic therapy. The arthritis, which showed little sign radiographically of destructiveness, was cured, leaving no sequellae in most cases. Treatment usually involved ampicillin or the tetracyclines, either alone or in association with the aminoglycosides.
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PMID:[Septic arthritis caused by Campylobacter fetus]. 373 80

In cirrhotic patients, the authors studied the modification of the pharmacokinetics of ampicillin in the plasma and in the ascitic fluid, as well as its concentration in the urine. The influence of the jaundice, the ascites and diuretics were studied. In cirrhosis, dilution and elimination of the antibiotic are modified, as is shown by the increase in T 1/2 alpha and T 1/2 beta. These anomalies seem to be due essentially to modifications in the distribution volume; the degree of hepatocellular insufficiency does not appear to be of importance. The ascites acts as an independent compartment, into which the antibiotic's passage is slight. The practical consequences are the following: less frequent injections, increasing of the fractionated doses, in situ injections of ampicillin in cases of infection of the ascitic liquid.
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PMID:[Metabolism and kinetics of ampicillin elimination in cirrhosis. Therapeutical consequences (author's transl)]. 624 68

Among 31 patients with positive blood cultures for gram-negative bacilli seen in a department of internal medicine, 13 had at least 3 positive blood cultures from samples taken over more than 12 hours and were diagnosed as having septicemia (group I) ; 18 patients had less than three positive blood cultures over the same period or had several positive blood cultures over a shorter period and were diagnosed as having bacteremia (group II). There were no significant differences between these two groups concerning age, sex, fever, other clinical features, or biological findings. E. coli was recovered in 70 % of cases and was almost always related to urinary infection. 8 patients died (3 in group I, 5 in group II), 6 of whom had cirrhosis. The sensitivity of the pathogens to the main antibiotics is described. The most often used antibiotic combination was ampicillin-gentamycin. It is suggested that in departments receiving patients from outside the hospital rather than from intensive care units the ampicillin-gentamycin combination can be advocated as the first treatment. As there were no significant differences between patients with septicemia or bacteremia, in severe infections a single positive blood culture should be taken into account and discrimination between septicemia and bacteremia is useless.
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PMID:[Gram-negative septicemia and bacteremia in an internal medicine department]. 631 29

Dietary cholesterol absorption was studied in patients with either "mild" (n = 23) or "severe" (n = 12) liver cirrhosis in relation to both total and individual bile acid pool size. Cholesterol absorption was significantly reduced in both groups of patients, and it was inversely related (r = -0.68; p less than 0.001) to the severity of the disease. Total, cholic acid, and deoxycholic acid p ool sizes were significantly reduced in cirrhosis, and a correlation was found between cholesterol absorption and cholic acid pool size (r = 0.78; p less than 0.001). In 5 patients, cholesterol absorption and bile acid pool size were estimated both before and after treatment with cholic acid (15 mg/kg/day) plus ampicillin (2 g/day). The treatment was followed by a mean threefold increase of cholic acid pool and by a sharp enhancement of cholesterol absorption in each patient. In conclusion, cholesterol absorption is often impaired in cirrhosis and is related to the severity of the disease. The correlation between cholic acid pool and cholesterol absorption and the constant increase of the absorption values after cholic acid pool expansion suggest that the size of cholic acid pool may be considered as an important factor in the regulation of cholesterol absorption.
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PMID:Cholesterol absorption in cirrhosis: the role of total and individual bile acid pool size. 722 68

An autopsy of rupture of Mucor cerebral aneurysm, not diagnosed during the patient's life, was experienced. A 63-year-old female was admitted to our hospital with the chief complaint of disturbance of consciousness and high fever. Her past histories were diabetes mellitus, liver cirrhosis and nasal sinusitis. The remarkable findings on admission were moderate inflammatory data, high blood sugar level in serum and ascites. Brain CT film revealed a non-enhanced low-density area in the frontal region. The cerebrospinal fluid showed bloody color and white blood cell counts were 3300/microliter (mostly neutrophils). Under our suspected of bacterial encephalomeningitis, intravenous cefotaxime and ampicillin therapy was started immediately. Cultures of cerebrospinal fluid for bacteria were negative. The disturbance of her consciousness gradually improved under general treatment. However, her conscious level suddenly became a coma on the 6th hospital day and she died on the 9th hospital day. An autopsy revealed Mucor at the site of the rupture of the cerebral aneurysm.
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PMID:[An autopsy case of fungal (Mucor) cerebral aneurysm]. 775 53


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