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

We have followed 46 children with acquired immunodeficiency syndrome and acquired immunodeficiency syndrome-related complex. Twenty-six patients had at least one episode of serious bacterial infection. Twenty-seven episodes of sepsis were documented in 21 patients. Soft tissue infection was common in both the presence and the absence of documented bacteremia. Urinary tract infection commonly presented as worsening diarrhea in the absence of sepsis. Organisms commonly isolated included Streptococcus pneumoniae, Haemophilus influenzae and Salmonella sp. Staphylococcal infection accompanied episodes of cellulitis/abscess. Escherichia coli commonly caused urinary tract infection in the absence of sepsis. Enteric and nosocomial sepsis was limited to hospitalized, instrumented patients or to individuals who had received prior antibiotic therapy as outpatients. We conclude that bacterial infection causes serious morbidity in acquired immunodeficiency syndrome and acquired immunodeficiency syndrome-related complex and may be further evidence for altered humoral immunity in the disorder.
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PMID:Bacterial infection in the acquired immunodeficiency syndrome of children. 390 Sep 44

Thirty-one immunocompromised patients (22 renal allograft recipients, 5 patients receiving chronic corticosteroid therapy, and 4 patients undergoing chemotherapy for acute leukemia) with significant dermatologic infection, excluding typical cellulitis and herpesvirus infections, were retrospectively identified over a 12-year period. Of these 31 patients, 15 (48%) had infection restricted to their skin, 6 (19%) appeared to have primary cutaneous infection that spread hematogenously to other parts of the body, 2 (6%) had infections of adjoining nasal tissue that spread to contiguous skin, and 8 (26%) appeared to have disseminated systemic infection that spread to the skin. In six of the eight patients with apparent secondary skin involvement, the development of the cutaneous lesion was the first clinical indication of disseminated infection. Eleven immunocompromised patients (35%) with bacterial infection of the skin or subcutaneous tissue were identified. These patients could be divided into three categories: leukemic patients with bacteremic gram-negative infection metastasizing to the skin (3 cases), renal transplant recipients with recurrent staphylococcal infection on and around the elbow ("transplant elbow") or streptococcal sepsis from a site of cellulitis (5 cases), and immunocompromised patients with opportunistic bacterial infection due to Nocardia asteroides or atypical mycobacteria (3 cases). Seventeen immunocompromised patients (55%) with fungal infection of the skin or subcutaneous tissue were identified. These included 12 patients with opportunistic fungal infection (Cryptococcus neoformans, 4 cases; Aspergillus species, 3 cases; Paecilomyces, 2 cases; Rhizopus species, 2 cases; and Candida tropicalis, 1 case) and 5 patients with extensive, confluent cutaneous dermatophyte infections. One patient with protothecosis and two patients with extensive papillomavirus infection were identified. Of these latter two cases, one had his immunosuppression discontinued, with clearing of his extensive warts; the other had confluent warts of the face and neck that subsequently underwent malignant degeneration to squamous cell carcinoma while chronic immunosuppressive therapy was continued.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Dermatologic manifestations of infections in immunocompromised patients. 397 41

Using a semiquantitative technique for culturing material from vascular catheters, we studied by random allocation the efficacy of three regimens for site care of 827 catheters used in adult patients: an iodophor ointment (PI2), ointment containing polymyxin, neomycin and bacitracin (PNB), and use of no topical agent whatsoever (control). Even though this is the largest study of this subject, there was not a sufficient number of catheter-related septicemias to permit valid comparisons (two in each group, 0.7 percent). However, the rate of local catheter-related infection (greater than or equal to 15 CFU on semiquantitative culture), the prelude to related septicemia, was significantly lower in the PNB group (2.2 percent, P = 0.02) as compared with controls (6.5 percent). Use of PI2-treated catheters resulted in one-half fewer infections (3.6 percent) than use of control catheters (P = NS). Staphylococcal infections occurred with 15 control catheters, eight treated with PI2 and two with PNB (P = 0.002). Infections by gram-negative bacilli occurred less frequently in both treatment groups than in controls, but three of four Candida infections, including one septicemia, occurred in the PNB group. Topical antimicrobial agents confer modest benefit in protection against catheter-related infection, primarily for peripheral venous catheters that must remain in place for more than four days. If an ointment is to be used, topical PNB may be preferable for peripheral venous catheters and PI2 ointment for central venous catheters used for parenteral nutrition and for arterial catheters.
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PMID:A comparative study of polyantibiotic and iodophor ointments in prevention of vascular catheter-related infection. 625 41

At the UCLA Medical Center in three patients treated for hematogenous infection after total joint arthroplasty, the source was apparently an infection in the extremities at a site distal to the joint arthroplasty. In a 72-year-old woman with rheumatoid arthritis infection developed in the right hip after total hip arthroplasty following a Staphylococcus aureus infection at the site of a left metatarsophalangeal arthroplasty. In a 64-year-old man with osteoarthritis the staphylococcal infection that developed after right total hip arthroplasty was seeded from a pyarthrosis of the right knee. In a 61-year-old woman with rheumatoid arthritis the sites of bilateral knee arthroplasties were seeded from a soft tissue infection of the left foot. These cases illustrate the potential for infection from local wound sepsis distal to joint arthroplasty. Such infections, particularly in patients with rheumatoid arthritis, should be treated aggressively to avoid seeding of the more proximal total joint arthroplasty site.
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PMID:Infection after total joint arthroplasty from distal extremity sepsis. 664 Oct 44

In cases of staphylococcal infection in children (osteomyelitis, purulent destructive pneumonia, phlegmons, abscesses) the use of counter immunoelectrophoresis (CIE) allowed one to detect antistaphylococcal antibodies (anti-poly-A beta) in 12.5-69.1% of cases and staphylococcal antigen in the blood serum in 6.1-25.0% of cases, the antigen titer reaching 1 : 1-1 :8. In staphylococcal sepsis with faintly pronounced local pyo-inflammatory processes, as well as in diseases of nonstaphylococcal etiology and in healthy children, no clear reactions indicating the presence of antistaphylococcal antibodies and staphylococcal antigen were registered. CIE may be used as a specific serological diagnostic test in the severe forms of staphylococcal infection in children.
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PMID:[Use of a countercurrent immunoelectrophoretic method for isolating antistaphylococcal antibodies and staphylococcal antigen in the blood serum of children with staphylococcal infections]. 708 38

We have previously demonstrated that staphylococcal enterotoxins contribute to arthritis and mortality during staphylococcal infection. To further explore the mechanism by which bacterial superantigens contribute to the pathogenesis of Staphylococcus aureus septicemia, T-cell receptor V beta 3 transgenic (TGV beta 3) mice and nontransgenic (non-TG) littermates were inoculated intravenously with S. aureus AB-1, which produces large amounts of staphylococcal enterotoxin A, which specifically reacts with T-cell receptor V beta 3. Within 9 days after inoculation, 85% of the TGV beta mice died, compared with 31% of their non-TG littermates (P < 0.01). The high mortality of TGV beta 3 mice was accompanied by elevated bacterial burdens in the blood, spleen, and kidneys. The in vivo kinetics of cytokine mRNA expression was studied by an in situ hybridization technique. Staphylococcal infection gave rise to increased expression of interleukin 1 beta (IL-1 beta) mRNA and sparsely expressed tumor necrosis factor alpha (TNF-alpha), IL-4, and IL-10 mRNAs in both groups. Gamma interferon mRNA expression increased on day 3 and was maintained at a detectable level in the late phase of infection in TGV beta 3 mice, in contrast to non-TG mice. Impressively, significantly higher expression of TNF-beta mRNA in TGV beta 3 mice was noted throughout the course of infection than in non-TG littermates. These findings suggest that overproduction of TNF-beta and gamma interferon, the Th1 cytokines, may play a crucial role in the pathogenesis of septicemia caused by enterotoxin-secreting staphylococci.
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PMID:Overexpression of the T-cell receptor V beta 3 in transgenic mice increases mortality during infection by enterotoxin A-producing Staphylococcus aureus. 759 Oct 86

Analysis of 5304 episodes of septicaemia at St Thomas' Hospital showed that both the elderly (> 65 years) and neonates accounted for increasing proportions between 1969 and 1992. In particular the increase was greatest for patients aged over 84 years who accounted for 3% of episodes in adults with community-acquired septicaemia in the 1970s compared with 13% in the 1990s. The change may be explained partly by demographic factors. The majority (85-90%) of elderly patients presented with fever, or leucocytosis or both. The urinary and gastrointestinal tracts were the most common foci for the elderly and they were less likely than other adults to have iv access associated sepsis. Among neonates Escherichia coli septicaemia became less common whereas there was little changes in the incidence of group B streptococcal septicaemia; coagulase-negative staphylococcal infection became more common. Overall mortality declined for both neonates and elderly patients. Poor outcome appeared related to the focus of infection, febrile response and age in the elderly and to the time of onset and organism in neonates.
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PMID:Septicaemia in the newborn and elderly. 784 66

Toxic epidermal necrolysis (TEN) is a rare condition in childhood usually attributed to drugs. We describe a 4-month-old infant who developed typical clinical and histologic findings of TEN concomitantly with Klebsiella pneumoniae sepsis. We emphasize that in cases of acute, severe exfoliative disease in infants, apart from staphylococcal infection, gram-negative bacterial sepsis must also be considered.
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PMID:Toxic epidermal necrolysis associated with Klebsiella pneumoniae sepsis. 789 84

Twenty-four cases of septic arthritis in rheumatoid arthritis patients were compared with 99 cases of septic arthritis in patients without rheumatoid arthritis. In addition, 238 previously published cases of septic arthritis with rheumatoid arthritis were analyzed. Fifteen percent of our patients with septic arthritis had rheumatoid arthritis, which was typically of long duration (mean 15 years), erosive, and seropositive. Fifty-four per cent (28% in the literature) and 9% of patients with and without rheumatoid arthritis, respectively, had pyarthrosis of multiple joints. The knee represented one-third of infected joints and the elbows and wrists were more often infected in patients with than without rheumatoid arthritis. S. aureus was recovered in 80% versus only 60% of patients with and without rheumatoid arthritis, respectively. The source of sepsis was often a skin lesion, in particular at the foot, emphasizing the need for early orthopedic treatment of deformities responsible for skin lesions. Monoarticular infection was more likely to be due to an intraarticular injection. Mortality rate was 17% in patients with rheumatoid arthritis (23% in the literature) versus 7% in patients without rheumatoid arthritis. Staphylococcal infection and infection of multiple joints were associated with higher mortality rates (35% and 49%, respectively). The mortality rate in polyarticular infections has failed to decline over the last 35 years. Initial failure to distinguish septic arthritis from an exacerbation of rheumatoid arthritis contributes to the high mortality rate. The diagnosis of septic arthritis rests on a high index of suspicion. Septic arthritis cannot be ruled out based on absence of local inflammation, fever, or hyperleukocytosis or on presence of inflammation of multiple joints. Joint fluid specimens should routinely be sent to the microbiological laboratory and should be inoculated in blood culture bottles at the least suspicion.
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PMID:[Septic arthritis in rheumatoid polyarthritis. 24 cases and review of the literature]. 792 May 11

A single-institution, randomised trial was conducted to compare the clinical and microbiological efficacy of two different doses of ceftazidime in combination with a single daily dose of tobramycin for the empirical management of febrile neutropenic patients with hematologic disorders (absolute neutrophil count < 1 x 10(9)/l). Upon the development of fever or signs of sepsis, patients received either 2 g ceftazidime every 8 h plus a single daily dose tobramycin (5 mg/kg/day) (C2T, n = 73) or 1 g ceftazidime every 8 h plus a single daily dose of tobramycin (C1T, n = 77). In addition, flucloxacillin (1-2 g every 4 h) could be added if there was clinical suspicion of staphylococcal infection. Analysis was performed for the whole group and for the subset which did not receive flucloxacillin. When evaluated at 96 h, 70% (95% CI, +/- 11%) of patients randomised to C2T and 60% (95% CI, +/- 11%) randomised to C1T had responded (chi 2 = 1.27, P = 0.26). The response rates at 96 h for those who did not receive flucloxacillin were 77% (+/- 12%) and 74% (+/- 13%), respectively (chi 2 = 0.01, P = 0.92). Overall, 68 (93% +/- 6%) and 72 (94% +/- 6%) patients, respectively, eventually became afebrile (chi 2 = 0.06, P = 0.81). Renal function, as judged by serum creatinine, was unaffected by either antibiotic schedule. Within 10 days of antibiotic commencement there was one death in each arm and overall there were five deaths in each arm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A randomised dosage study of ceftazidime with single daily tobramycin for the empirical management of febrile neutropenia in patients with hematological diseases. 794 61


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