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

A frequently overlooked source of sepsis in the critical care patient is the paranasal sinuses. These patients are typically unable to communicate and, therefore, the usual findings of sinus infection, such as facial pain and complaints of purulent drainage, will be absent. Sepsis may be the first manifestation of such infection. Nasotracheal intubation is the most important predisposing factor to developing sinusitis in these patients. The clinician, therefore, must maintain a high index of suspicion in any patient with fever of unknown origin. Radiologic studies, including plain sinus radiographs, or preferably, a computed tomography scan, will usually show the presence of fluid or inflammation. Lavage of the maxillary sinus is helpful both to verify the presence of infection and to obtain culture material. These infections tend to be polymicrobial, and often display a predominance of Gram-negative organisms, particularly Pseudomonas aeruginosa. Treatment includes removal of all nasal tubes and institution of appropriate antibiotics, along with decongestant therapy. In some cases, surgical drainage will be necessary. For patients who are immunocompromised, or requiring intubation for > 7 days, the nasotracheal route is best avoided.
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PMID:Sinusitis in the critical care patient. 752 19

Twenty-four isolated double lung transplants (LTXs) have been performed in 22 patients with cystic fibrosis, with a follow-up of 4 to 47 months. Prior to LTX, all patients were colonized with Pseudomonas aeruginosa, and ten patients were also colonized with Pseudomonas cepacia. Both organisms were specifically sought before LTX. All patients who grew P cepacia before LTX did so after LTX. Five additional patients only grew this bacterium after LTX. There was no difference between those who grew P cepacia and those who did not in terms of data before LTX for age, weight, pulmonary function, and 6-min walk. After LTX, 7 of the 15 patients who had ever grown P cepacia died. No patient who grew only P aeruginosa died. The median survival in the subgroup with P cepacia was 28 days. Five of the seven died as a direct result of P cepacia pneumonia and sepsis. One died of cyclosporin A (cyclosporine) neurotoxicity with concurrent P cepacia pneumonia, and one died at the time of a retransplant for graft failure (associated with three bouts of P cepacia pneumonia and cytomegalovirus). Four of seven had not grown this bacterium before LTX. There were no perioperative factors, including antibiotic choices, that distinguished survivors and nonsurvivors. Overall 1-year survival is about 70 percent (15/22). Fourteen bouts of P cepacia pneumonia occurred in 12 patients. Four empyemas, one lung abscess, one suppurative pericarditis, and five cases of sinusitis were also due to this bacterium. In conclusion, P cepacia is responsible for excess morbidity and mortality after LTX. This organism is particularly lethal if isolated for the first time after LTX. Factors predicting its acquisition in this setting are unknown. While it is possible that the facial sinuses may act as an unrecognized reservoir or that patients or equipment provide a source, further study into the epidemiology of this organism is necessary to improve the survival of colonized patients undergoing LTX.
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PMID:Pseudomonas cepacia in lung transplant recipients with cystic fibrosis. 751 20

Branhamella catarrhalis, previously regarded as a harmless member of the normal nasopharyngeal flora, has periodically been implicated as the major pathogen in representative cases of a variety of infections such as sinusitis, pneumonia, septicemia and meningitis. In addition, beta-lactamase production of these microorganisms, first described in 1977, has been reported with increasing frequency, up to 80%. The first-choice drug for the therapy of the infections caused by beta-lactamase producing strains of B. catarrhalis is amoxicillin combined with clavulanic acid. The aim of our work was to determine the influence of amoxicillin and clavulanic acid on the biosynthesis of beta-lactamase of B. catarrhalis. Our results point out that the combination of amoxicillin and clavulanic acid produces only a slight increase in enzyme activity in 5003 and 462 strains. Clavulanic acid alone caused no increase in enzyme production. Ravasio strain showed no increase in enzyme formation after exposure to antibiotics.
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PMID:Increased beta-lactamase activity in Branhamella catarrhalis after exposure to amoxicillin and clavulanic acid. 769 24

The occurrence of sinusitis and middle ear effusions has frequently been attributed to the obstruction of the sinus ostia and/or eustachian tube. In the intensive care unit setting, edema caused by the irritation from nasogastric, nasotracheal and orotracheal tubes has been associated with this pathology and has been responsible for occult sepsis in this population. Our investigation was performed to determine the risk of chronic otitis media with effusion necessitating myringotomy with tympanostomy tubes among tracheotomized, ventilator dependent children in a consecutive series of children admitted to our recently created stable ventilator unit. We retrospectively reviewed the medical records of all tracheotomized, chronically ventilator dependent children < 48 months of age who had been hospitalized in this unit from the initial opening in September 1990 to January 1993. Data collected consisted of patient demographics, gestational age, cognitive abilities, age at onset of mechanical ventilation, age at tracheostomy, age at myringotomy, presence of nasogastric and gastroenterostomy tubes and evidence of gastric-esophageal reflux. All children underwent a tracheostomy procedure subsequent to the onset of mechanical ventilation. Of these patients, 9/12 (75%) later required myringotomy with tympanostomy tube placement following the occurrence of chronic otitis media with effusion. Ventilation tubes for chronic otitis media with effusion were not required in 3 patients. Using a case control study design, we examined the need of myringotomy tubes for children requiring continuous mechanical ventilation versus those requiring night-time only ventilation. The risk of myringotomy tubes in the continuously ventilated group (9/9) was significantly greater than the risk in the intermittently ventilated group (0/3) P < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic otitis media requiring ventilation tubes in tracheotomized ventilator dependent children. 783 30

Acute sinusitis is a frequent complication in ventilated intensive care patients and may be a possible source of pneumonia or septicemia. A study of 49 ventilated intensive care neurosurgical patients without previously known disease of the paranasal sinuses or midface fractures was conducted retrospectively from 1989-1990. The kind of intubation used (naso- or orotracheal) was taken into account and the period of ventilation examined in order to determine the genesis of inflammatory changes in the paranasal sinuses (as defined by computed tomography). Intensive care patients suffering from sinusitis showed a characteristic early opacity of the sphenoid sinuses, with lesser involvements in the ethmoid and maxillary sinuses. Only in rare cases and after very long periods of ventilation were the frontal sinuses found to be opaque. Nasotracheal ventilation was observed to produce an earlier attack on the intubated ipsilateral sinuses. These findings indicate that nasotracheal intubation should be avoided if possible or the method of intubation changed as early as feasible. If conservative measures fail sinusitis should best be treated by means of endonasal microsurgical open sinostomy.
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PMID:[The pathogenesis of sinusitis in intensive care patients]. 822 16

Sinus-induced intracranial sepsis can represent a genuine medical and surgical emergency. We review 12 cases presenting to our hospitals over a five-year period. Nine were male and three were female with an age range of 16 to 74 years (mean 35.5 years). Four patients had their sinusitis diagnosed prior to admission and eight did not. Nine patients had bilateral sinus disease, the most common sinus involved was the frontal followed by the ethmoid, maxillary and sphenoid. Neurosurgical drainage was via a craniotomy in seven cases and burr hole in three. Nine patients underwent sinus surgery and three did not. Of the nine who had sinus surgery three had frontal drainage, four fronto-ethmoidal and two trans-sphenoidal drainage. The most common organism was Streptococcus milleri. Our series confirms that sinus-induced intracranial sepsis is a serious problem needing early diagnosis and aggressive treatment. We would recommend a high index of suspicion of sinusitis in patients with intracranial infection.
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PMID:Intracranial complications of sinusitis: the need for aggressive management. 855 Nov 20

The CT imaging and clinical presentation in 14 children with coexistent intracranial sepsis and sinusitis were reviewed. A routine CT head scan (10-mm thick semi-axial slices through the cranium done before and after intravenous contrast medium administration) was found to be an inadequate initial investigation as the intracranial collection was missed in four patients and the abnormal sinuses not shown in six. In half the children the diagnosis of sinusitis was unsuspected at the time of admission. The dominant clinical features were fever, intense headache and facial swelling in early adolescent males. In this clinical setting we recommend: (1) the routine scan is extended through the frontal and ethmoidal sinuses and photographed at a window level and width showing both bone detail and air/soft tissue interfaces; (2) direct coronal projections are performed through the anterior cranial fossa if no collection is seen on the routine study; (3) an early repeat scan within 48 h if the initial study shows no intracranial pathology but the fronto-ethmoidal sinuses are abnormal and there is a high clinical suspicion of intracranial sepsis; and (4) in the presence of intracranial sepsis the vault is viewed at bone window settings to exclude cranial osteomyelitis.
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PMID:Sinusitis and intracranial sepsis: the CT imaging and clinical presentation. 857 33

Sinusitis is a complication known to accompany nasotracheal intubation, but its frequency has not been well established. During a two-year-period, 1,126 patients in an intensive care unit have been studied. Twenty-seven of them (2%) developed a bacterial sinusitis. The diagnosis is established on the basis of an unexplained clinical sepsis, imaging evidence of fluid in the maxillary sinus, and antral puncture. Microbiological samples showed Gram-negative micro-organisms, in particular Pseudomonas aeruginosa, and an elevated percentage of Staphylococcus aureus and Escherichia coli. The likely predisposing factors (nasogastric and/or nasotracheal tubes) are discussed. Aetiology, diagnosis and management of the disease are discussed in detail. The importance of prompt removal of nasal instrumentation and of early sinus drainage, in addition to broad-spectrum antibiotic therapy, is emphasized.
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PMID:Sinus infection in intensive care patients. 905 Jan 3

Chryseobacterium meningosepticum is a ubiquitous Gram-negative bacillus historically associated with meningitis in premature neonates. We report 15 positive cultures and 6 cases of infection among immunocompromised adults at our institution over a 10-year period and review the English-language literature on C. meningosepticum. Excluding the present series, there are 308 reports of positive cultures in the literature, of which 59% were determined to represent true infections. Sixty-five percent of those infected were younger than 3 months of age. Meningitis was the most common infectious syndrome among neonates, seen in 84% of cases and associated with a 57% mortality rate. Less commonly reported infections among infants included sepsis (13%) and pneumonia (3%). Pneumonia was the most frequent infection among the postneonatal group, accounting for 40% of cases, followed by sepsis (24%), meningitis (18%), endocarditis (3%), cellulitis (3%), abdominal infections (3%), eye infections (3%), and single case reports of sinusitis, bronchitis, and epididymitis. The 6 cases in our series were all adults, with a mean age of 58.7 years. Sites of C. meningosepticum infection were limited to the lungs, bloodstream, and biliary tree. Infection in our series was associated with prolonged hospitalization, prior exposure to multiple antibiotics, and host immunocompromise, particularly neutropenia. C. meningosepticum is resistant to multiple antibiotics, and disk dilution is notoriously unreliable for antibiotic sensitivity testing. Sensitivity testing on the 15 isolates from our institution revealed the most efficacious antibiotics to be minocycline (100% sensitive), rifampin (93%), trimethoprim-sulfamethoxazole (67%), and ciprofloxacin (53%). In contrast to reports in the literature, the isolates in our series displayed widespread resistance to vancomycin (100% resistant or intermediately sensitive), erythromycin (100%), and clindamycin (86%). These findings have important implications for the clinician when choosing empiric antibiotic regimens for patients with risk factors for C. meningosepticum infection.
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PMID:Chryseobacterium meningosepticum: an emerging pathogen among immunocompromised adults. Report of 6 cases and literature review. 906 86

We report an 18-year-old man with a posterior fossa tumor who had to undergo a partial resection of the tumor and supportive radiation therapy. Functional deficits of the lower cranial nerves, particularly the glossopharyngeal and vagal nerves, associated with severe swallowing disorders and refractory aspiration pneumonia were seen postoperatively. The admission to the intensive care unit (ICU) resulted from increasing respiratory failure accompanied by recurrent septic episodes. Nutritional support via nasogastric tube and later percutaneous endoscopic gastrostomy (PEG) were hampered by complications such as persistent sinusitis, local dermatitis surrounding the entrance of the PEG tube, and the development of duodenal ulcers. Furthermore, the use of continuous subglottic aspiration failed to prevent pulmonary infections. After a 9-week stay in the ICU due to inadequate antimicrobial therapy of aspiration pneumonia and the patient's persistent sepsis, a temporary surgical separation of airway and food passages was performed by glottic closure. Subsequently chronic aspiration stopped, and 3 months after admission to the ICU, the patient had stable vital organ function and was transferred to a surgical ward free of infections. Glottic closure was reversed successfully 7 months later. When compared with laryngeal function on admission, there was no more impairment. Thus, temporary glottic closure seems to be an efficacious treatment to prevent life-threatening septic complications in patients with refractory aspiration pneumonia.
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PMID:Management of swallowing disorders and chronic aspiration by glottic closure procedure. 923 92


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