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

To evaluate the role of atmosphere of incubation in the detection of clinically important bacteremia and fungemia in adults, we compared the yield of microorganisms from 10,541 paired 5-ml samples of blood incubated aerobically and anaerobically. The medium, supplemented peptone broth (SPB) with 0.03% sodium polyanetholesulfonate, and the ratio of blood to broth (1:10) were the same for all cultures. Only cultures with adequate blood samples (greater than or equal to 80% of stated volume) were compared statistically. More fungi (P less than 10(-7) ) grew in continuously vented bottles of SPB. Aerobic incubation also favored (P less than 0.01) isolation of Neisseria gonorrhoeae and Eubacterium; more than 80% of these bacterial organisms were detected only in vented bottles. Anaerobic incubation (plugged venting units) did not significantly favor the isolation of any genus of microorganisms, although an estimated 11% more Bacteroidaceae grew in the unvented bottle of SPB. By comparison of our data with published results for other media, we conclude that the need for both aerobic and anaerobic incubation of blood cultures is dependent upon the medium used and the microorganisms likely to be encountered. Vented incubation of blood cultured in SPB is crucial for detection of fungi and some bacteria. Routine use of an unvented bottle of SPB may not be worthwhile for patients in whom Bacteroidaceae cause bacteremia infrequently. However, when Bacteroidaceae are suspected as the cause of sepsis, use of an unvented bottle of SPB is prudent.
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PMID:Controlled evaluation of the effect of atmosphere of incubation on detection of bacteremia and fungemia in supplemented peptone broth. 675 84

A patient receiving total parenteral alimentation through a central catheter developed fatal candida sepsis originating from suppurative phlebitis of a peripheral vein. This case underscores the importance of aggressively pursuing all potential endovascular sources of fungemia in susceptible patients: those on antibiotics, with chemical phlebitis, and hyperglycemia.
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PMID:Suppurative Candida phlebitis of a peripheral vein. 677 16

Catheter-related sepsis is one of the major complications of total parenteral nutrition (TPN) therapy. The relationship between microbial colonization of the skin at the site of catheter insertion and colonization of the central venous catheter was investigated in 74 catheters used to administer TPN therapy in 53 patients. Semiquantitative culture specimens were obtained from the insertion site and intravascular and subcutaneous catheter segments at the time of catheter removal. Bacteria and/or fungi were recovered from 19 catheters and 19 insertion sites; of the 19 colonized catheters, 6 had sterile insertion sites. Organisms isolated from the remaining 13 catheters were isolated concurrently from the insertion site. Catheter-associated bacteremia or fungemia was observed in 10 of the 19 patients with colonized catheters. The association between colonization of catheters and the presence of more than 10(3) bacterial or fungal colony-forming units at the insertion site was significant (P less than 0.005). These results demonstrated that colonization of catheters by organisms present on the skin at the site of catheter insertion occurred twice as frequently as colonization by the hematogenous route. The results also suggested that colonization of catheters by organisms present at the insertion site occurred only after a threshold number of organisms was reached.
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PMID:Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. 681 29

Among 500 patients with bacteremia and fungemia, total mortality was 42%; about half of all deaths were attributable directly to infection. Mortality increased with age, but deaths unrelated to infection itself were responsible in part for this increase. Mortality was 2.6% among obstetric-gynecologic patients, 42% among medical patients, 49% among surgical patients, and 60% among transplant patients. The risk of death was especially high with enterococcal, facultative gram-negative, fungal, polymicrobial, or hospital-acquired sepsis; in the presence of shock, leukopenia, absolute granulocytopenia, or defined predisposing conditions (neoplasia, cirrhosis, and combinations of factors such as surgery and renal failure); and with a primary infected focus in the respiratory tract, the skin, a surgical wound, an abscess, or an unknown site. Body temperature was inversely related to mortality. Survival was increased by the use of appropriate antibiotics and, where applicable, additional therapeutic maneuvers (e.g., drainage). Multivariate analysis defined seven variables that independently influenced outcome: microorganism, blood pressure, body temperature, primary focus of infection, place of acquisition of infection, age, and predisposing factors. Although some adverse prognostic factors are not amenable to intervention, prevention of nosocomial bacteremia and fungemia and early reversal of hypotension may reduce the death rate from sepsis.
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PMID:The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II. Clinical observations, with special reference to factors influencing prognosis. 682 12

Records of 65 surgical patients with positive fungal blood cultures were reviewed to address risk, overall mortality, and treatment. Negative urine cultures did not rule out sepsis. Staphylococcus epidermidis sepsis was present in 27 (42%) of the patients. In 70% of whom it occurred before or during fungemia. Increased mortality correlated with the use of multiple antibiotics, antibiotic use for prolonged periods, and with associated bacterial sepsis. Stopping antibiotic therapy did not reduce mortality. Amphotericin B reduced mortality in patients with dissemination, indicating that it is the treatment of choice for disseminated fungemia and that antibiotic therapy should not be discontinued when concomitant bacterial sepsis is present.
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PMID:Fungal sepsis in surgical patients. 684 38

Trichosporon beigelii fungemia and multiple, purpuric, papular skin lesions developed on the chest wall and extremities of a 22-year-old man with acute granulocytic leukemia. Histologically, the skin lesions demonstrated dermal budding yeasts, which were identified as T beigelii in culture. Unexplained biventricular, congestive heart failure and sepsis wit Streptococcus intermedius developed, and the patient died 28 days after his admission to the hospital.
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PMID:Trichosporon beigelii fungemia and cutaneous dissemination. 695 20

Using an indirect immunofluorescent antibody technic, the authors determined the serum microbial antibody titer (MAT) in 26 patients (five with infective endocarditis, eight with septicemia without endocarditis, and three with access device-related bacteremia, three with fungemia without endocarditis, and seven with false-positive blood cultures). The MAT in the early clinical stage of infective endocarditis (IE) exceeded 350; after appropriate antibiotic therapy, it decreased to below 50 with clinical improvement. MAT in patients with septicemia was above 20 and less than 200; in patients with bacteremia, above 10 and less than 50; and in patients with false-positive blood cultures, it was less than 10. The authors suggest that MAT against isolated bacteria may be useful in diagnosing septicemia with or without IE, in determining the appropriate length of treatment, and in differentiating bacteremia from false-positive blood cultures.
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PMID:Clinical significance of titered circulating microbial antibody in bacteremia. 704 21

To evaluate the role of the volume of blood cultured in the detection of clinically important bacteremia and fungemia in adults, we evaluated the yield and speed of detection of microorganisms from 5,317 paired 2- and 5-ml samples of blood. The same kind of medium (supplemented peptone broth with 0.03% sodium polyanetholsulfonate) and atmosphere of incubation (open venting units) were used for all blood cultures. Only adequately filled (less than or equal to 80% of stated volume) sets (20-ml tube and 50-ml bottle) were compared statistically. Significantly more bacteria (p less than 0.01), Pseudomonas spp. In particular (P less than 0.05), were isolated from the 5-ml samples of blood. We conclude that the volume of blood cultured is a critical factor in the detection of septicemia. Consequently, valid evaluation of other factors influencing the detection of septicemia must be based on comparisons in which equal volumes of blood are cultured.
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PMID:Controlled evaluation of the volume of blood cultured in detection of bacteremia and fungemia. 706 35

Rhodotorula glutinis var. glutinis was isolated from the blood of two patients who were seriously ill and required long-term intravenous therapy. Although both isolates were sensitive to amphotericin B and 5-fluorocytosine, neither patient received antifungal therapy. One of the two patients died, but Rhodotorula was not recovered at autopsy. Review of the literature shows that Rhodotorula septicemia is often associated with contamination of intravenous infusion equipment, resulting in toxemia and hypotension. Initial therapy for fungemia should consist of removal of infected cannulas and fluid replacement. If fungemia persists, antifungal drug therapy should be considered.
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PMID:Rhodotorula septicemia: two cases and a review of the literature. 718 2

Antimicrobial antibody titer (AMT) in the sera was determined in 5 patients with infective endocarditis (IE), 8 with septicemia without endocarditis, 3 with fungemia, and 4 with false-positive blood culture. AMT in cases of IE in the early stage of clinical course was over 350 and decreased to less than 50 with clinical improvement following appropriate antibiotic therapy. AMT in cases of septicemia without endocarditis was over 20 and less than 200 and the titer in patients with false-positive blood culture was less than 10. AMT in cases of fungemia without endocarditis ranged from 200-800.
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PMID:The diagnostic and therapeutic significance of antimicrobial antibody titer in the bacteremia. 732 Nov 49


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