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

Peripherally inserted central venous silicone elastomer catheters were studied in 81 patients who had malignancy requiring prolonged intravenous therapy. The catheters remained in place from 5 to 171 days, with a median of 30 days. Ninety-one percent of the catheters were unassociated with clinical complications. Six percent of 87 inserted catheters were removed due to peripheral thrombophlebitis. Two patients developed subclavian thrombosis, requiring catheter removal. One patient had catheter-related sepsis with Staphylococcus aureus. Bacteria grew from eleven percent of the cultured catheter tips. Indwelling catheters presence did not appear to influence response to antibiotic therapy. We conclude from this pilot study that long-term central venous access with peripherally inserted silicone elastomer catheters has an acceptably low complication rate in a high-risk patient population.
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PMID:Long-term intravenous therapy with peripherally inserted silicone elastomer central venous catheters in patients with malignant diseases. 10 82

Eighty four cases of meningococcal infections are reviewed. Fifty seven cases presented themselfs as meningococcal meningitis, twelve cases as sepsis with moderate hypotension and 15 cases were sepsis with septic shock. A brief course of the disease, shock, echymosis, absence of meningeal signs, leucopenia and intravascular coagulation were findings more frequent in the group of patients with hiperacute sepsis, whereas other signs as fever, headaches, vomiting and petechiae were present with equal frequency in the three groups. N. meningitis was isolated in 73% of the cases. Shock (18.85%) and intravascular coagulation (12%) were the complications more frequently found, followed by convulsions (4.81%), arthritis (4.81%), skin necrosis (4.81%), subdural efusion (3.57%), cerebral palsy (3.40%), thrombophlebitis (1.20%), recurrence (1.20%), inapropiate antidiuretic hormone secretion (1.20%) and subaracnoideal hemorrage (1.20%). The overall mortality was 10.70% and 60% of the patients which initially presented with shock and intravascular coagulation died. Autopsy findings included wide spred hemorragic lesions and intravascular thrombi in skin, mucous membranes and viscera. Adrenal hemorrhage was present in five of the six cases studied.
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PMID:[Incidence, clinical, forms and complications of meningococcal infections (author's transl)]. 41 52

Ceforanide, a new cephalosporin antibiotic with a long half-life (3 h), can be administered twice daily. We evaluated its antimicrobial activity, pharmacology, and clinical efficacy. Twenty-seven patients with infections due to susceptible organisms received ceforanide, 0.5, 1, or 2 g, intramuscularly or intravenously every 12 h for 6 to 28 days. In vitro studies with the clinical isolates from 27 patients treated plus 263 additional isolates showed that ceforanide was active against cephalothin-susceptible gram-positive and gram-negative microorganisms. In addition, ceforanide inhibited 65% of cephalothin-resistant Escherichia coli and 65% of Enterobacter spp. at </=12.5 mug/ml. After a single 1-g intramuscular dose, the mean peak plasma concentration at 1 h was 48.9 mug/ml and that at 12 h was 4.7 mug/ml. Plasma accumulation occurred in some patients. The infections included 10 pneumonias, 3 with bacteremia and 1 with empyema; 11 soft tissue infections, 4 with abscesses and 3 with sepsis; and 3 urinary tract infections. One case each of endocarditis, osteomyelitis, and septic thrombophlebitis, all due to Staphylococcus aureus, were treated. Clinical response was satisfactory in all patients; bacteriological response was satisfactory in 26 of 27 patients. Ceforanide was well tolerated. Three patients developed mild increases in liver enzymes, and one developed slight eosinophilia. In another case, the antibiotic was discontinued because of a fivefold rise in serum glutamic-oxalacetic transaminase (aspartate aminotransferase) and serum glutamic-pyruvic transaminase (alanine aminotransferase) and a twofold rise in lactic acid dehydrogenase and alkaline phosphatase.
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PMID:Ceforanide: in vitro and clinical evaluation. 50 95

Particulate and bacterial contamination of IV fluids and drugs have been implicated in venous thrombosis, infusion phlebitis, suppurative thrombophlebitis, pyrogenic reactions, and systemic sepsis. In a study of the inflammatory potential of the filterable residue of sodium cephalothin, we have found a tissue-specific reaction with venous endothelium but not with cutaneous or subcutaneous tissues. In a controlled animal model, removal of particulates from an infusion by use of a 0.45 micron in-line membrane filter reduces the incidence and severity of infusion phlebitis.
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PMID:Inflammatory potential of foreign particulates in parenteral drugs. 55 45

Intravenously administered rehydration therapy was compared with orally administered rehydration therapy for treating children with diarrhea in a clinical study of 3000 children admitted to the Medical College Hospital, Kottayam, India. Oral rehydration was more effective and safer than intravenously administered fluid therapy. The 3000 children were divided into 2 treatment groups. The 1st group consisted of 1800 patients admitted between January 1970 and August 1972. The 2nd group consisted of 1200 patients admitted after September 1972. In the 1st group 72.3% of the cases were mild, 22.1% were moderate, and 5.7% were severe. Respective proportions for the 2nd group were 78.0%, 17.3%, and 4.7%. In the 1st group fluid was administered intravenously to the patients whenever it was needed. None were treated with orally administered fluids. In the 2nd group all the patients received oral rehydration therapy. In addition 1.3% of the mild cases, 10% of the moderate cases, and most of the severe cases received intravenously administered fluids. Abdominal distension occurred in 7% of the patients in the 1st group and in none of the patients in the 2nd group. Treatment duration was shorter for the second group. Venesection was necessary for 61 of the moderately dehydrated patients and 50 of the severely dehydrated patients in the 1st group but only for 5 severely dehydrated patients in the 2nd group. In the 1st group 4.5% of the moderately dehydrated patients and 34% of the severely dehydrated patients died. In the 2nd group none of the moderately dehydrated patients and only 18% of the severely dehydrated patients died. The occurrence of thrombophlebitis and septicemia were markedly reduced for the 2nd group compared to the 1st group.
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PMID:Oral rehydration therapy in childhood diarrhoea: a comparative study. 73 Mar

The patterns of endogenous bacterial participation, particularly of Bacteroides fragilis, in the condition called progressive anaerobic syndrome and their clinical consequences are discussed. B. fragilis is an anaerobe recently resistant to tetracycline, which before 1970, was the drug of choice. Presently, clindamycin is the drug of choice for severe Bacteroides infections, though diarrheal side effects often interfere with administration; if contraindicated or side effects occur which are intolerable, doxycycline is indicated, for this -OH-substituted form rarely shares cross-resistances with other tetracyclines. A Bacteroides infection almost invariably involves organisms that have been present within the patient's own microbiologic environment, especially mucosal areas such as the female genital tract and the gastrointestinal tract. In the course of disease, whether spontaneous or due to iatrogenic factors, certain conditions are created that may select for the Bacteriodaceae by virtue of creating a low oxidation-reduction potential: 1) creation of new tissue spaces, i.e., hematomas; 2) necrotic tissues that might be present with incomplete abortion or retained products of conception, criminal abortion, degenerating tumor masses, crush injury, or devitalization of previously healthy tissue; 3) penetration of the gastrointestinal tract with spillage of fecal material; and 4) alteration of the microbiologic environment by Neisseria gonorrhoeae. Clinical consequences include the continuum of endometritis--septic thrombophlebitis--septicemia and puerperal septic abortion.
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PMID:Infectious morbidity due to Bacteroides fragilis in obstetric patients. 76 27

A discussion of postoperative infections in obstetrics and gynecology has been presented with particular emphasis on soft tissue infections involving the operative site. It has been emphasized that the offending organisms are those normally found in the vagina and cervix and that mixed infections are common. The immediate life threats to the patient are endotoxin shock and clostridial sepsis; therefore, initial therapy should include coverage for those organisms. Because of the potential toxicity of clindamycin and chloramphenicol, as well as the usual protracted course of Bacteroides infections, the addition of one of these drugs can generally be deferred until its use is dictated by microbiologic data or a failure of clinical response. Persistent fever generally indicates a lack of the appropriate antibiotic, an undrained collection of pus, or concomitant pelvic thrombophlebitis, the latter being a special concern with anaerobic infections. Specific infections and their management have also been discussed as have urinary tract and pulmonary infections and drug fever.
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PMID:Management of postoperative infections in obstetrics and gynecology. 76 29

Detailed analysis of the clinical data and autopsy material of 100 consecutive renal transplant recipients revealed significant thromboembolic disease in 25 patients and a total of 41 complications. In six of them, thromboembolism was associated with sepsis. Nine patients died (20% of total number of deaths) due to a primary thromboembolic event. The incidence of pulmonary embolism was 14%; myocardial infarction, 3%; cerebrovascular disease, 4%; renal artery thrombosis, 2%; renal vein thrombosis, 3%; thrombophlebitis/deep vein thrombosis, 13%; and miscellaneous, 2%. The incidence of thromboembolism was higher in patients older than 40 years of age (P = .02) and during the earlier months after transplantation. We summarize the general incidence and mortality related to thromboembolism and discuss the factors predisposing the graft recipient to thromboembolic disease. Prevention and therapy of this complication should decrease the morbidity and mortality in graft recipients and enhance the success of renal transplantation.
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PMID:Thromboembolic disease in renal allograft recipients. What is its clinical significance? 78 76

In a retrospective review of 53 patients, 58 episodes of infection due to Acinetobacter calcoaceticus var. anitratus (Herellea vaginicola) were studied. Although the organism is widely distributed in nature, it is of relatively low virulence since colonization is more frequently noted than infection and since most infections occur in patients subjected to the epidemiologic pressures common to nosocomial, gram-negative bacillary infection: prior antibiotic therapy; instrumentation and manipulation (e.g., endotracheal intubation, urinary bladder catheterization, arterial and venous cannulation); surgery; hospitalization, especially with residence in an intensive care unit; severe underlying disease, either systemic (e.g., chronic obstructive pulmonary disease, malignancy) or localized to the infected area (e.g., prior bacterial or aspirational pneumonia, trauma). Pneumonia was the most common infection due to A. calcoaceticus, and occurred only in patients with a tracheostomy or endotracheal tube in place. In over half the 25 patients, more than one lobe was involved and bronchopneumonia was the usual roentgenographic appearance. Cavitation (2 patients) and empyema formation (3 patients) were uncommon. The severity of acinetobacter pneumonia is reflected in the high mortality rate (44% overall, with a 36% mortality rate due primarily to infection). Tracheobronchitis due to A. calcoaceticus was less severe than pneumonia since no patients died primarily as a result of the infection. Urinary tract infections occurred in five patients, none of whom were ill and none of whom died. Urinary bladder catheterization was thought to be responsible for infection in three patients, and in at least four of the five patients infection was restricted to the lower tract. Wound infections were noted in six patients who had undergone surgery and were related to the presence of foreign bodies in the operative site in five of the patients. Surgical debridement and/or drainage of the infected area was the primary therapeutic measure employed in most cases. Only one patient died and this was a result of noninfectious causes. Skin infection due to A. calcoaceticus was seen in two patients, one of whom exhibited fulminant, fatal cellulitis and septicemia in the setting of pancytopenia. All nine patients with acinetobacter septicemia had received antecedent antibiotic therapy, and in all cases intravenous catheters were in place at the time bacteremia occurred. Clinically, seven of the nine patients were in shock. The mortality rate was 44% overall, with a 22% mortality rate due to infection. Although septicemia was thought to be "line-related" in five of the nine patients, serious post-bacteremic complications developed in three patients: prosthetic valve endocarditis, suppurative thrombophlebitis and subhepatic abscess.
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PMID:Infections with Acinetobacter calcoaceticus (Herellea vaginicola): clinical and laboratory studies. 84 90

Fifty patients with anaerobic sepsis were treated with intravenous and oral metronidazole. In 26 cases this was combined with other antimicrobial agents. Highly satisfactory clinical results were obtained in most patients, though in many surgical drainage was also essential. No side effects or thrombophlebitis were seen. Mixed growths of anaerobic and aerobic bacteria were isolated from all except five patients, who produced only anaerobes. Metronidazole is the only available antimicrobial agent providing selective activity against anaerobic organisms. It is effective and safe and is usually the drug of choice for treating severe anaerobic sepsis.
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PMID:Metronidazole and anaerobic sepsis. 100 57


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