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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with central nervous system trauma frequently have fevers while in the neurosurgical intensive care unit. Temperature elevations in the neurosurgical patient often cause much diagnostic confusion, and little is written that assists the critical care team in arriving at a proper etiologic diagnosis for the fever. This article discusses the common causes of temperature elevations in neurosurgical patients, such as central fever, wound infection, nosocomial pneumonia, posterior fossa syndrome, line sepsis, urosepsis, and drug fever. The recognition of central fevers, posterior fossa syndrome, and drug fevers is particularly important in neurosurgical patients to avoid inappropriate and potentially dangerous treatment with unnecessary antimicrobial therapy. Clinical and laboratory clues provide the clinician with a diagnostic approach to fever in the neurosurgical intensive care setting.
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PMID:Fever in the neurosurgical patient. 305 81

The third-generation cephalosporins offer considerable appeal for treatment of specific life-threatening infections (nosocomial pneumonia, meningitis, urosepsis) in elderly patients when the disorders are caused by aerobic gram-negative bacilli. Despite the frequent presence of cross-reactive antibodies in the sera of recipients of cephalosporins, clinically evident serious reactions to cephalosporins occur infrequently in patients with known penicillin allergy.
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PMID:Newer antibiotics: their place in geriatric care. Part I. 346 71

The problems of selecting antibiotics for hospital use from the broad variety offered, and the problems of what is often necessarily a non-specific initial therapy, are discussed. A review is given of groups of antibiotics which are important for hospital therapy such as penicillins, aminoglycosides, metronidazole and cephalosporins. Firstly the range of effects of the individual groups of antibiotics is summarized in a simplified form from which the indications are then derived. In discussing the clinical use of antibiotics special importance is attached to initial therapy prior to or in the absence of identification of the pathogens in fatal infectious diseases. From this aspect the therapy for pneumonia, peritonitis, sepsis and urosepsis as well as meningitis is discussed. The small number of indications for the prophylactic use of antibiotics is briefly dealt with. Finally a selection of antibiotics necessary for hospital therapy is presented.
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PMID:[Antibiotic therapy in severe infections]. 666 Apr 41

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

Interstitial pneumonia caused by Herpes simplex virus type 1 (HSV-1) is a severe complication of orthotopic liver transplantation (LTX). The records of patients were reviewed who had an LTX at the age of 16 years or older between 1991 and 1994 with a mean follow-up of 21 months (range, 10 to 44 months). Six patients were included who had fever of > 38 degrees C, deterioration of arterial blood gases, radiological evidence of interstitial pneumonia and proof of HSV-1 in bronchoalveolar lavage fluid. All patients were anti-HSV-IgG positive before LTX. All patients were successfully treated with intravenous acyclovir, mechanical ventilation and reduced immunosuppression. Three patients who received cyclosporin A had a rejection which was successfully treated by switching to FK 506. Four patients were discharged in good health. One patient died 36 months after LTX of an unrelated cause. One patient died of urosepsis on postoperative day 139. Acyclovir together with mechanical ventilation and reduced immunosuppression proved to be an effective treatment for HSV-1 pneumonia following LTX.
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PMID:Management of herpes simplex virus type 1 pneumonia following liver transplantation. 874 Jan 5

Despite improvements in immunosuppression, rejection occurs in 50% of liver transplant patients and may cause significant morbidity. The most frequent cause of death after liver transplantation is severe infection. Determination of the cytokine network may lead to earlier detection of patients at risk for severe rejection and infection. For this purpose, 81 patients with 85 liver transplants were monitored for cytokines and neopterin on a daily basis. During the first postoperative month, 28 patients (34.6%) developed acute rejection; 14 patients were successfully treated with methylprednisolone (steroid-sensitive rejection), while 14 patients required additional treatment with FK506 and OKT3 (steroid-resistant rejection). Ten patients developed severe infections, and 11 patients experienced asymptomatic cholangitis. Patients with an uneventful postoperative course (n=37) were the control group. One-year patient survival was 88.9%: 1 patient died because of chronic rejection and Pseudomonas urosepsis; a further 4 patients died of aspergillus pneumonia and bacterial sepsis. Soluble TNF-RII, sIL-2R-, and IL-10 levels were significantly elevated 3 days prior to or at the onset of acute steroid-resistant rejection (P < or = 0.01 versus steroid-sensitive rejection and on uneventful postoperative course). An increase in IL-8, neopterin, and sTNF-RII was indicative of severe infection 3 days prior to onset of infection. In this group of patients, a simultaneous increase in IL-10 indicated a lethal outcome of severe infection. During the second week of acute steroid-resistant rejection and lethal infection, a significant rise in IL-1beta, IFN-gamma, and IL-6 was observed (P < or = 0.01 versus control groups). The different patterns in neopterin- and cytokine-increase could differentiate between severe rejection and severe infection. Furthermore, the increase in these parameters indicated severe rejection--i.e., steroid resistance at the onset of acute rejection--which could prompt us to initiate rescue therapy immediately. The ability to detect patients at risk for severe or lethal infection may result in intensified infectious screening and more aggressive antiinfectious treatment. Therefore, routine monitoring of these parameters may lead to changes in therapeutic management of severe acute rejection and infection after liver transplantation.
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PMID:Cytokine pattern during rejection and infection after liver transplantation--improvements in postoperative monitoring? 895 70

Three cases of infection with Streptococcus agalactiae, or Lancefield group B beta-haemolytic streptococcus (GBS), in adults are described and the literature is reviewed. During a period of 14 years the incidence of GBS-disease in adults aged above 15 years has increased in Denmark. The most common clinical presentations of GBS-disease in adults are puerpural fever, bacteraemia without evident focus, skin or soft-tissue infection, pneumonia, urosepsis and meningitis, preceded by a few days of influenza-like symptoms. The features of this fulminant disease include rapid development of multiple organ dysfunction syndrome (MODS) with renal impairment, adult respiratory distress syndrome (ARDS) and, in many patients, also cardiovascular instability. The therapy includes parenteral antibiotics, usually with high doses of benzylpenicillin, and symptomatic treatment. GBS-disease in both infants and adults may be prevented by the development of effective GBS-vaccines.
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PMID:[Group B streptococcal infection in adults]. 904 60

Nosocomial infection in the critically ill results from defects in the intrinsic barriers to microbial invasion. The diagnosis is complicated by an inability to perform an adequate physical examination in a patient with several compounding findings, usually necessitating sophisticated technologies to aid in the diagnosis. Pneumonia, line sepsis, urosepsis, sinusitis, endocarditis, peritonitis, and acalculous cholecystitis are the more common infections that challenge the care of the critically ill. Antibiotic therapy is adjunctive to efforts to preserve the barrier, but should be started early, should be targeted as specifically as possible to the offending organisms, and should be dosed adequately to ensure an effective concentration in the infected tissue.
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PMID:Contemporary issues with bacterial infection in the intensive care unit. 1089 68

Group B streptococcal (GBS) disease in nonpregnant adults is increasing, particularly in elderly persons and those with significant underlying diseases. Diabetes, neurological impairment, and cirrhosis increase risk for invasive GBS disease. Skin, soft-tissue, and osteoarticular infections, pneumonia, and urosepsis are common presentations. Meningitis and endocarditis are less common but associated with serious morbidity and mortality. Disease is frequently nosocomial and may be related to the placement of an iv catheter. Recurrent infection occurs in 4.3% of survivors. Capsular serotypes Ia, III, and V account for the majority of disease in nonpregnant adults. Although group B streptococci are susceptible to penicillin, minimum inhibitory concentrations are 4-fold to 8-fold higher than for group A streptococci. Resistance to erythromycin and clindamycin is increasing. The role of antibodies in protection against GBS disease in nonpregnant adults is unresolved. However, the immunogenicity of GBS vaccines being developed for prevention of neonatal disease should be assessed for adults who are at risk.
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PMID:Group B streptococcal disease in nonpregnant adults. 1146 95

The liver is the organ most commonly injured during blunt abdominal trauma. As our society ages, emergency surgery for active elderly patients increases, but data on aggressive emergency hepatic resection remain scarce in the literature. The purpose of this study was to determine whether the elderly (70 years of age or older) can tolerate major liver injury and subsequent hepatic resection. We investigated 100 patients who were treated by an anatomic resection for severe blunt liver trauma (29 elderly patients who were 70 years of age or older and 71 young patients who were younger than 70 years of age) in a retrospective study. The elderly patients were more severely injured as demonstrated by a higher Injury Severity Score, a lower Glascow Coma Scale, and lower survival (80.3% vs. 65.5%; p < 0.05). The total number of associated injuries was greater in elderly patients. Motor vehicle accidents were responsible for 71.8% of the injuries in the young group, and the predominant mechanism in the elderly patients was also motor vehicle accidents (51.7%). The 71 anatomic hepatic resections performed on the young patients included right hemihepatectomy (n = 45), left lateral segment resection (n = 14), bisegmentectomy (n = 5), and others. The 29 anatomic hepatic resections performed for the elderly patients were right hemihepatectomy (n = 15), left lateral segment resection (n = 5), left hemihepatectomy (n = 4), and others. Pneumonia, subphrenic abscess, and urosepsis occurred at a significantly higher frequency in elderly patients than in young patients. Our data clearly indicated that (1) the mechanism of injury, grade of associated intraabdominal injuries, distribution of surgical procedures, and complications differ significantly between young and elderly patients; and (2) the survival rate (65.5%) in elderly patients may be sufficient to consider anatomic hepatic resection to be a useful, safe procedure.
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PMID:Anatomic resection for severe blunt liver trauma in 100 patients: significant differences between young and elderly. 1220 35


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