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

During a 21-month period, 50 consecutive pediatric oncology patients undergoing bone marrow transplantation and/or cytoreductive chemotherapy had 61 silastic central venous catheters placed to facilitate their therapy. All catheters were used for medications, routine blood sampling, and transfusions, with 45% also used for hyperalimentation and 57% used for bone marrow transplantation. Catheters were utilized during both inpatient and outpatient therapy periods. Total catheter days numbered 8455, an average of 139 days per catheter. Forty-seven catheters (77%) were removed electively or were in place at time of patient death. Seven were removed for mechanical complications (1/1409 catheter days). Four additional episodes of presumed catheter sepsis were managed with antibiotics and did not require catheter removal (40% of septic episodes). One catheter is still in place after 585 days. Complication rates were not influenced by this multiple use protocol. With standardized catheter care and surveillance, multipurpose, long-term central venous access can be safely utilized in the immunosuppressed pediatric patient.
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PMID:Multipurpose central venous access in the immunocompromised pediatric patient. 391

The techniques of antibiotic bonding were applied to the problem of hyperalimentation catheter sepsis. Pretreatment with tridodecylmethylammonium chloride (TDMAC) increased the bonding of 14C-penicillin to polyethylene catheter segments from 3.1 to 212 micrograms/cm and to silicone elastomer catheter segments from 0.09 to 181 micrograms/cm. The elution of the bound ligands from silicone elastomer catheter segments in the presence of plasma was studied. At 2 weeks more than 60% of the bound TDMAC remained adherent to the catheter. The elution of the bonded penicillin from the silicone elastomer catheters was biphasic, initially 95% dissociated after 48 hours of incubation. A bioassay revealed that the dissociated penicillin was bacteriocidal. Polyethylene catheters were placed in the jugular vein of rats and positioned in the right atrium. The catheters were tunneled posteriorly, exited between the forelimb shoulder girdles, and connected to a swivel mechanism. The exit site was inoculated before closure with 1 X 10(8) Staphylococcus aureus. Five days after insertion the catheters were removed via sterile thoracotomy and the tips cultured. Untreated control catheters, catheters treated by antibiotic soaking, and catheters pretreated with TDMAC all had high rates of catheter colonization (60% to 80)%. TDMAC-penicillin-bonded catheters did not become colonized. This difference was significant (p less than 0.005). Antibiotic bonding may prove effective in preventing hyperalimentation catheter sepsis.
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PMID:Prevention of catheter sepsis by antibiotic bonding. 392 72

When scleroderma involves the small intestines, malnutrition with resulting immune incompetence and sepsis can occur. Two cases are presented in which patients with scleroderma involving the gastrointestinal tract were treated with cyclic home hyperalimentation, restoring their nutritional status and improving their quality of life.
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PMID:The use of cyclic home hyperalimentation for malabsorption in patients with scleroderma involving the small intestines. 393 Jul 71

Patients who have cystic fibrosis (CF) are frequently hospitalized for long-term intravenous (IV) treatment. We evaluated clinical effectiveness of the Drum-Cartridge Catheter (Abbott Laboratories) for such patients. The catheter is placed peripherally under local anesthesia via an antecubital vein into the superior vena cava or right atrium. Patients who were more than 10 years of age and who were hospitalized for IV antibiotic therapy and/or IV hyperalimentation were studied. All but 2 patients had CF. Using an aseptic technique the catheters were inserted into the basilic or cephalic vein. Chest radiographs were used to confirm the final location of the catheter. Catheters were used to administer IV antibiotics, hyperalimentation, and lipids. There were 38 catheterizations in 23 patients; several patients had repeated insertions at later admissions. The success rate of insertion was 86% with 31 of the 38 insertions initially located either in the superior vena cava or right atrium. Mean duration of catheterization was 15.4 days (range 5-49 days). No major complications such as sepsis, catheter or clot embolism, pneumothorax, vascular perforation, or hemorrhage occurred in the patients who had DF. Complications that required displacement of catheter into the axillary vein (1 patient), and cracked catheter hub (1 patient). This study shows that the Drum-Cartridge Catheter can be used easily for IV therapy of patients who have CF for a long duration, repeatedly, and with no major complications.
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PMID:Peripherally inserted central venous catheters for treatment of cystic fibrosis. 393 8

Based on a three year surveillance in the neonatal intensive and transitional care nurseries (NICU) at the Hospital of the University of Pennsylvania (HUP), an analysis of all cases of nosocomial bacteremia was made. From January 1982 to September 1984, a total of 57 nosocomial bacteremic episodes were identified. This gave a rate of 3.6 episodes per 100 NICU admissions or 6.5 per 1000 live hospital births. While coagulase-negative staphylococci (CNS) accounted for approximately 40 percent of all positive blood cultures, it was responsible for 73 and 66 percent of the nosocomial bacteremias in 1982 and 1983, respectively. In 1984, coagulase-negative staphylococcus was the responsible pathogen for 92 percent of all nosocomial bacteremic episodes. Of 139 infants weighing less than or equal to 1250 g at birth, 30 (22 percent) developed CNS bacteremia. The risk of coagulase-negative staphylococcus bacteremia was associated with low birth weight, respiratory distress, prolonged hyperalimentation, and multiple supportive measures. Infants were treated with vancomycin hydrochloride, as most of the CNS were resistant to methicillin and/or gentamicin. There were no deaths related to coagulase-negative staphylococcal septicemia.
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PMID:Coagulase-negative Staphylococcus bacteremia--a rising threat in the newborn infant. 399 94

An elemental diet was used to prepare 11 severely debilitated malnourished patients for operation. Indications included: 1) as a substitute for parenteral hyperalimentation when catheter sepsis occurred with the latter; 2) high small fistulae; 3) short bowel syndrome; 4) radiation enteritis; and 5) partial obstruction of the gastrointestinal tract. All patients were converted to a positive nitrogen balance as evidenced by a substantial gain in weight and in serum albumin levels. All tolerated corrective operations without difficulty and their wounds healed per primum.
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PMID:Use of elemental diets to correct catabolic states prior to surgery. 420 17

Nine patients with severe sepsis were studied to determine causes for any alterations in oxygen dissociation. Seven of the patients had oxyhemoglobin curves shifted to the left of expected and diminished DPG levels. These deficiences were not corrected in one case. The other eight patients survived or expired with normal to elevated P(50T) and DPG levels. In this study, three factors occurring either individually, in concordance, or in sequence were present when P(50T) was decreased. Correction of these deficiencies lead to normalization and, in one case, exceedingly high P(50T) and DPG levels. Where hypophosphatemia, acidosis, and transfusion of DPG deficient blood were avoided, no such change occurred. Hypophosphatemia is a common occurrence in the seriously ill patient whether or not hyperalimentation is used and may occur in spite of phosphate supplementation. Blood transfusions with CPD as the preservative are effective in reducing the severity of this disorder by the addition of an inorganic phosphate load. Septic shock itself had no untoward effect on oxygen dissociation. This held true even in the terminal stages of the disease process.
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PMID:The left shifted oxyhemoglobin curve in sepsis: a preventable defect. 484 83

A review of the clinical course of gastroenteritis in 274 hospitalized children revealed a severe form of the disease. Eight-eight per cent were aged 12 months or under and 20% had severe associated malnutrition. The commonest clinical manifestations were diarrhoea (100%), dehydration (98.9%), vomiting (81.4%) and fever (77.7%). Pathogens were isolated from 75.2% of cases (rotavirus 24.5%, Escherichia coli 20.8%, salmonellae 20%, shigellae 6.2%, campylobacter 2.2% and Yersinia enterocolitica in 1.5%). Septicaemia was confirmed in 12 patients (4.4%) and strong clinical evidence of septicaemia was present in 36 more cases (13%). Dehydration was isonatraemic in 68%, hyponatraemic in 21% and hypernatraemic in 11% of cases. There was a clear association between septicaemia and hyponatraemia. The overall mortality rate was 1.8%. Data from our study show that the use of intravenous hyperalimentation, and/or antibiotics in the management of gastroenteritis in selected patients, can significantly reduce morbidity and mortality.
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PMID:Gastroenteritis in a regional hospital in Kuwait: some aspects of the disease. 619 27

10 patients with serious infections caused by Staphylococcus epidermidis (8 cases of endocarditis in non-prosthetic valves, 1 was complicated by osteomyelitis, 1 case of osteomyelitis, and 1 case of septicemia) are described. Clinical and microbiologic features were evaluated including antibiotic sensitivity and synergy studies, phage typing and biotyping. Endocarditis tended to affect the elderly population and the clinical manifestations were quite similar to those caused by Streptococcus viridans. Both patients with osteomyelitis had involvement of the cervical spine with excellent response to antibiotic therapy. The only patient with septicemia acquired via hyperalimentation had delayed clearance of the bacteremia but ultimately responded to intravenous antibiotics. Rifampicin was the most effective of all antibiotics tested. All isolates were sensitive to penicillinase-resistant penicillins and cephalosporins and over half were sensitive to penicillin. Full synergistic activity was demonstrated with cephalothin and nafcillin in combination with rifampicin, and rifampicin-vancomycin was partially synergistic against the majority of the strains. Five of 8 available isolates were non-phage typeable and no definite pattern was established for various types of infections. Four of the 8 isolates were classified as biotype SIIa, 2 biotype SIIc and 2 biotype SVh.
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PMID:Clinical and microbiologic aspects of serious infections caused by Staphylococcus epidermidis. 636 77

Rectal abscess may result in necrotizing soft-tissue infection including fasciitis, myositis, and extraperitoneal dissection of pus without muscle necrosis. The presentation and therapy of ten patients treated over the past six years are reviewed. Early recognition of rapidly spreading infection was imperative. The mortality rate of 40 per cent correlated with the degree of sepsis present at admission. The high mortality attendant with the complications of rectal abscess emphasizes the need for aggressive therapy, including frequent examinations under anesthesia, wide debridement, systemic triple antibiotic therapy, diverting colostomy, aggressive wound care, and hyperalimentation.
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PMID:Necrotizing soft-tissue infection from rectal abscess. 640 68


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