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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surgery for perforated appendicitis was used to estimate the infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis. The wound sepsis rates were 22.6% (7/31) after treatment with intravenous ampicillin sodium and metronidazole and 23.5% (8/34) after penicillin G sodium, streptomycin, and metronidazole, a nonsignificant difference. Intraoperative sampling by velvet pads demonstrated that the density of aerobes did not differ significantly from that of anaerobes, either on the surface of the appendix, in peritoneal exudate (aspirated), or in the wound before closure. The predominant pathogens were Escherichia coli and Bacteroides fragilis. In 15 patients who developed wound sepsis, the density of aerobes and anaerobes was significantly higher at all sampling sites than in 50 noninfected patients. The median infective dose of aerobes and anaerobes together was 4.6 X 10(5) colony forming units.cm-2 in the operative wound. There was a significantly high correlation between the densities of bacteria during operation and subsequent wound sepsis.
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PMID:The infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis. 372 11

Three hundred and fifteen patients with appendicitis were randomized into two groups. One group received pre-operative systemic gentamicin and metronidazole while the other group received 1 per cent topical povidone-iodine solution in addition to the antibiotics. For early appendicitis including normal and acutely inflamed appendices, only one dose of antibiotics was used. The postoperative wound sepsis was very low in both groups of patients and there was no statistical difference between them. For late appendicitis including gangrenous and perforated appendices, the antibiotics were continued for 7 days. Eight out of 51 patients who had the topical agent developed wound sepsis compared with one out of 52 patients who received no topical agent. This difference is statistically significant (P = 0.03). All wound infections presented within 2 weeks of operation and were deep. Povidone-iodine, 1 per cent, adversely affects the wound infection rate in late appendicitis and should not be used.
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PMID:Combined topical povidone-iodine and systemic antibiotics in postappendicectomy wound sepsis. 379 Sep 57

Mixed anaerobic-aerobic infections may occur in a variety of anatomical locations and are usually related to the spread of bacteria from a proximal mucosal surface. Much has been learned about the pathophysiology and treatment of mixed anaerobic-aerobic infections from the study of intra-abdominal sepsis related to spillage of colonic contents. There is an average of five microorganisms at the infected site: three anaerobic and two aerobic pathogens. Appendicitis and diverticulosis are the most common conditions which predispose to fecal contamination of the intra-abdominal cavity. Initially, peritonitis develops which, if untreated, progresses to an abscess. The abscess is a unique pathologic entity which may form a protective environment for the microorganisms and present a barrier to the action of certain antimicrobial agents. Treatment usually involves two modalities: surgical drainage or debridement and appropriate antimicrobial agents to cover both components of the mixed infection. On the basis of in vitro susceptibility there are six groups of antimicrobial agents that are useful in treating intra-abdominal infections: clindamycin; metronidazole; chloramphenicol; broad-spectrum penicillins (carbenicillin/ticarcillin/piperacillin); cephalosporins (cefoxitin/moxalactam); and imipenem. Randomized prospective studies have shown that the first five of these groups are effective in the therapy of intra-abdominal mixed infections. Preliminary data indicate that imipenem/cilastatin is very effective in the therapy of this serious infection; however its place in the therapeutic armamentarium awaits the completion of randomized prospective studies against established drugs.
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PMID:Therapy of mixed anaerobic-aerobic infections. Lessons from studies of intra-abdominal sepsis. 389 May 35

In a retrospective study of 300 children who underwent placement or revision of cerebrospinal fluid (CSF)-peritoneal shunts during a 10-year period, 15 (5%) developed shunt-related abdominal complications with ventricular sepsis and two developed acute perforated appendicitis. Abdominal complications and associated shunt infections suggested two potential modes of development: (1) descent of contaminated CSF from an infected shunt into the abdomen (CSF ascites--four patients, CSF pseudocysts--four patients, and shunt-induced abscess/peritonitis--five patients); and (2) ascent of bacteria into the shunt from an abdominal source (visceral perforation by the shunt catheter--two patients and acute perforated appendicitis--two patients). Three types of shunt systems were placed during the study period; five of the seven (71%) most serious septic complications were associated with the use of Raimondi spring-reinforced catheters. Bacteria isolated in this series were associated with differing modes of sepsis: those involving descent of bacteria into the abdomen from an infected shunt were predominantly gram-positive, cutaneous microorganisms, whereas those associated with ascent of bacteria from the abdomen into the shunt were mixed, gram-negative intestinal microorganisms. Appendicitis did not result in shunt infections. Aggressive treatment resulted in no operative or complication-related deaths. Removal of the shunt catheter from the abdomen and intravenous antibiotics were essential for eradication of sepsis; laparatomy was required only for cases with suspected peritonitis. In eight of the 17 (47%) patients, reestablishment of CSF-peritoneal shunts was performed after resolution of shunt-related complications. In recent years improved shunting materials and supportive care have reduced the incidence of the most serious of these complications.
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PMID:Ventricular sepsis and abdominally related complications in children with cerebrospinal fluid shunts. 398 17

All patients greater than 50 years of age (N = 96) admitted with a pre- or postoperative diagnosis of acute appendicitis from 1971 to 1980 were reviewed. A comparative series of 91 patients aged 25 to 50 years was similarly reviewed. Noninflammatory diseases of the appendix and incidental appendectomies were excluded. Detailed study of symptoms, clinical presentation, laboratory evaluation, radiographic evaluation, concomitant diseases, hospital course, surgical findings, complications, and mortality were completed. Comparison of patients aged 25 to 50 to patients older than 50 years revealed a statistically significant increased incidence of perforation in the older group (p less than 0.0001). Sixty-five per cent of the older group showed greater incidence of perforation. Further analysis of this series yields the hypothesis that the increased incidence of perforation is related to a significant decrease in the frequency of classic presentation in the greater-than-50 age group, a significant decrease in frequency of correct admission diagnosis and a significant delay between admission and surgical procedure in the older group. A more rapid pathophysiologic progression of appendicitis with increasing age was noted. A much higher percentage of older patients was undiagnosed until the surgical procedure. In this group, there was a longer duration of symptoms, less frequent classic presentation, and decreased frequency of right lower quadrant guarding and tenderness as compared to patients with correct diagnosis prior to surgery. Complications were much more frequent in older patients and higher still in those with perforation. Analysis of findings by decade of life revealed an anticipated high incidence of perforated appendicitis in patients greater than 50, but also showed a continuation of the high incidence of perforation into the decade 40 to 50. There were three deaths in the entire study group (1.6%) all occurring in the older age group with postoperative sepsis.
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PMID:Appendicitis in mature patients. 400 82

We report a four-year-old girl, previously splenectomized because of thalassemia major, who was admitted with gastroenteritis, abdominal pain and high grade fever. At laparotomy she was found to have appendicitis and mesenteric adenitis. Blood and stool cultures grew yersinia enterocolitica. Clinical course was favourable under Ampicillin-Gentamycin treatment. The importance of iron metabolism in the pathogenesis of yersinia sepsis is stressed, being this topic reviewed.
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PMID:[Yersinia enterocolitica septicemia in a thalassemic girl]. 406 76

Appendicitis remains one of the commonest paediatric surgical emergencies in a busy paediatric surgical practice. In spite of improved diagnostic skills and surgical care, the incidence of severe appendicitis has remained unaltered in children over the past few decades and therefore remains a therapeutic challenge. A protocol for the treatment of severe appendicitis was instituted in the Division of Paediatric Surgery at the Royal Canberra Hospital by the author from 1981 to 1984 inclusive, and the results of treatment according to the protocol are presented. The results suggest that an aggressive approach to gangrenous and perforated appendicitis can result in very low morbidity from sepsis. The protocol is discussed.
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PMID:The management of severe appendicitis in children. 408 3

The relationships between resistant pathogens, serum levels of gentamicin, and the outcomes of gangrenous or perforated appendicitis were analyzed in 147 patients. Failure to cure the infection occurred significantly more frequently among patients treated with cefoperazone or cefamandole than among those treated with clindamycin and gentamicin in combination. The failures were associated with recovery of resistant Bacteroides fragilis from intraoperative cultures. Pseudomonas species were also associated with failures, their in vitro susceptibility not correlating with clinical cure. Patients with gentamicin peak serum levels of less than 6 micrograms/ml in the first three days were not more likely to be associated with failure than were patients with higher levels. These clinical observations indicate that antibiotic therapy of intra-abdominal sepsis should include antibiotics with in vitro activity against B fragilis and that precise adjustments of gentamicin levels may not improve outcome. In addition, Pseudomonas species may play a significant role in some of these infections.
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PMID:Perforated and gangrenous appendicitis: an analysis of antibiotic failures. 622 64

A study of antibiotic treatment of intra-abdominal sepsis was conducted between May 1978 and May 1981. In the first phase, clindamycin (C) was compared with metronidazole (M), each combined with tobramycin (T), in a prospective, double-blind, randomized study. Twenty-three patients received C + T and 34 patients received M + T. The two groups were similar with respect to age, gender, underlying disease, presence of abscess, clinical condition, severity of illness, duration of illness before treatment and bacteriology. Anaerobic organisms outnumbered facultative and aerobic organisms. Bacteroides fragilis and Escherichia coli predominated. In the C + T group of patients, 74% had a good response. In the M + T group, 83% had good results. Adverse effects were few and minor in the two treatment groups. Three patients on C + T and one who received M + T followed by C + T died of infections; two patients died of underlying disease. In the second, open phase of the study, M + T was used to treat 45 patients with 46 courses. Twenty patients had intra-abdominal abscesses, which represented all grades of severity of illness. Five patients received long-term corticosteroid therapy. Almost half the patients had peritonitis complicating appendicitis. Good results were obtained in 81%. One patient died of the underlying disease and one died of infection complicating severe trauma and hypovolemic shock.
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PMID:Metronidazole in the treatment of intra-abdominal sepsis. 633 65

Intraabdominal sepsis most frequently follows penetrating or blunt abdominal trauma or perforated appendicitis or diverticulitis. The initial escape of the endogenous gastrointestinal microflora into the peritoneal cavity results in peritonitis and secondary septicemia, which is frequently followed by localized intraabdominal abscesses. These infections are most frequently polymicrobial and relate directly to the unique endogenous microflora at the various levels of the gastrointestinal tract. The treatment of intraabdominal sepsis is primarily centered around prompt, appropriate surgical intervention. parenterally administered antibiotics are also required to decrease the chance of local bacterial invasion or septicemia. The choice of the appropriate agent(s) to be used initially, before culture and sensitivity reports are available, depends primarily on the clinical presentation. Clinical and experimental studies of intraabdominal sepsis have largely stressed the use of antibiotic agents that have a spectrum of activity effective against both the aerobic coliforms and anaerobic Bacteroides fragilis.
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PMID:Empiric antibiotic therapy for intraabdominal infections. 634 4


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