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

During the last years the cases of severe group A streptococcus infection have increased. The clinical manifestation of this streptococcal toxic shock syndrome is similar to the better known toxic shock syndrome (TSS) provocated by staphylococcus. Shock, bacteremia and acute respiratory distress syndrome are common features, and death has been associated with this infection in 30% of patients. We present the case of a 46-year-old man who fell gravely ill with sepsis, diarrhoe, scarlatina rash, desquamation of hands and feet and acute abdomen caused by group A streptococcus infection. Finally we discussed the possible port of entry of this infection, the different clinical manifestation and the concepts of treatment.
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PMID:[Diarrhea and peritonitis in infection caused by type A beta hemolytic streptococcus]. 787 13

The incidence, etiology and timing of neonatal infection were assessed in a regional neonatal intensive care unit from 1983 through 1992. Infection onset was considered as very early (< 24 hours), early (1 to 7 days) or late (8 to 60 days). Case-fatality rates were determined for different weight groups and time periods (1983 to 1987 vs. 1988 to 1992). Overall neonatal sepsis incidence changed very little, but there was a marked decrease in very early onset sepsis in 1988 to 1992 especially in very low birth weight (< 1500 g) infants, possibly attributable to increased use of prenatal antibiotics. There was an accompanying increase in late onset sepsis, primarily nosocomial infection associated with improved survival of tiny infants, most striking after exogenous surfactant became readily available. During 1988 to 1992, because of very few very early-onset cases, very low birth weight infants had overall case fatality rates of about 10%, which were the same as for larger infants. The predominant organism in very early onset infection was Group B Streptococcus (GBS) (27 of 58) and in late onset infection was coagulase-negative staphylococcus (57 of 103). More cases of early onset GBS pneumonia were seen in the last 5 years. Neonatal meningitis was seen rarely during this decade, with only one case documented in the first 24 hours of life.
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PMID:The changing face of neonatal infection: experience at a regional medical center. 789 77

Although endogenous fistulae and grafts are preferred for permanent hemodialysis access, central venous catheters are often required for varying intervals when creating permanent access is not feasible. The prospective experience with 118 catheters in over a 3.5-yr period is reported; 93 (79%) were placed by percutaneous techniques, and 25 (21%) were placed by operative techniques. Seventy seven catheters (65%) were placed in the subclavian vein, 36 (31%) were placed in the internal jugular vein (usually right side), and 5 (4%) were placed in the femoral vein. Early postplacement complications were infrequent. Catheter function at last local follow-up ranged from several days to nearly 2 yr, averaging approximately 3 mo, even though many patients returned to their referring centers with a functioning catheter after only a short follow-up. Actuarial survival for percutaneously placed catheters was approximately 60% at 6 mo and 30% at 12 mo. Catheter failure occurred in 36% of cases, equally divided between malfunction (thrombosis refractory to fibrinolysis, extrusion, kinking, or related event) and infection with septicemia requiring removal. Such failure was not more frequent after percutaneous placement than after operative placement. Failure due to mechanical malfunction, but not that due to infection, tended to be less frequent among catheters placed in the internal jugular vein than among catheters placed in the subclavian vein. Finally, infection with septicemia involved 22% of all catheters and occurred at an average cumulated rate of approximately one infection per patient-year. Coagulase-positive staphylococcus was the most common organism isolated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Successful use of cuffed central venous hemodialysis catheters inserted percutaneously. 801 82

In 1993, infectious endocarditis (IE) remains a common and serious condition. Surgery has become an essential feature of treatment in many cases. The choice and optimal timing depend on many factors: the tolerance of the underlying cardiac disease is an important feature, surgery being indicated not only in cases of necessity (refractory cardiac failure) but also as treatment of choice in cases of episodic decompensation even if temporary when related to valvular dysfunction. In these conditions, if the lesion is severe aortic incompetence, surgery can be programmed in two or three weeks after initiating antibiotic therapy; the bacteriological indications are less common: fungal endocarditis, prosthetic valve endocarditis due to gram-negative bacilli or staphylococcus aureus endocarditis, or IE on native valves with persistent signs of sepsis after one week of antibiotic therapy; the occurrence of some complications may require urgent surgery: high degree atrioventricular block, septal perforation, ring or perivalvular abscess detected at echocardiography, single or multiple systemic embolism with persistence of large, mobile vegetations at echocardiography. Conversely, tricuspid valve endocarditis usually respond well to medical treatment alone: surgery (valvuloplasty with excision of vegetations, valvulectomy or, preferably, bioprosthetic valve replacement) is sometimes indicated in septic states related to certain pathogenic organisms. The operative indications in 1993 have become more extensive and earlier: analysis of surgical results shows that operative mortality depends mainly on the haemodynamic status at the time of operation, but also on the severity of the anatomical lesions, the nature of surgery, the type of endocarditis, native or prosthetic valve, and the causal organism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Surgery for bacterial endocarditis. When?]. 802 92

Osteomyelitis of the vertebral column (VC) was considered in the past as a form of sepsis. The disease developed after purulent infection provoked by staphylococcus, enterobacteria and other infectious agents, rapidly progressed and terminated not infrequently, by a patient death. Wide spread destructive process due to the purulent lysis of the bone and cartilage was observed in VC. This disease acquired some new features at present. Although its etiology remained the same, osteomyelitis of VC is now chronic inflammatory process with recurrences and formation of purulent foci in VC with the spread to the paravertebral tissues and adjacent organs. The number of grave complications is reduced and lethal cases are practically absent.
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PMID:[Pathologic changes in vertebral osteomyelitis]. 812 67

From January 1, 1986 to December 31, 1991, data were collected on neonatal septicemia at the Maternity Hospital, Kuala Lumpur, Malaysia, to monitor the trend of the infection and to determine whether any remedial steps reduced the infection rate. Of the 155,935 live births during this period, 8.8% were admitted to the special care nursery (SCN). Septicemia accounted for 5.2-10.2/100 admissions. 392 neonates (2.5/1000 live births) died from bacteriologically proven septicemia during this period, accounting for 11% (1991) to 30.4% (1989) of all neonatal deaths. Case rates of septicemia were highest in the very low birth weight babies who constituted 28.2% of the septicemia cases (low birth weight babies constituted 55.5%). During 1986 and the early part of 1987, disposable endotracheal tubes and mucus extraction suction catheters were reused in the labor rooms and the SCN after being soaked in Hibitane, and there were only 3 mucus suction systems available in the SCN. Septicemia outbreaks reduced in late 1987 after 4 new mucus suction systems were acquired, and the practice of reusing disposables was abandoned. During 1989, constant use of the mucus suction apparatus caused frequent breakdowns, and the water supply for hand washing was interrupted frequently; therefore, septicemia increased again. A reduction was accomplished in 1991 with the establishment of a regular water supply, disposable hand towels, and the purchase of new suction systems. Thus, the varying annual septicemia rates in the SCN ran parallel to the availability of infection control facilities. Staphylococcus epidermidis and staphylococcus aureus were the most common causative organisms in 1986 and 1987, and the Klebsiella series became the most common after 1988. More than half of the neonatal septicemia occurred after the age of 2 days; the low birth weight babies who remained in the SCN the longest were the most susceptible. This study shows that simple control measures can be very effective in reducing the incidence of septicemia.
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PMID:Six year trend of neonatal septicaemia in a large Malaysian maternity hospital. 814 83

During the past decade, an increasing incidence of staphylococcus organisms resistant to penicillinase-resistant penicillins has necessitated the use of vancomycin. This increased utilization has revitalized research concerning efficacious vancomycin dosing regimens for premature neonates, infants, and children. Vancomycin dosing in neonates is variable because this patient population has decreased renal clearance and a larger volume of distribution than infants, children, or adults. The observation of the variability in vancomycin clearance and volume of distribution in infants with the same postconceptional age (PCA) but different gestational age (GA) suggests that the rates of maturation both extrauterine and intrauterine for disposition mechanisms of vancomycin are similar when PCAs are equal. Conditions such as patent ductus arteriosus, respiratory distress syndrome, sepsis, and asphyxia may further complicate the renal maturation process. Few investigations suggest vancomycin dosing regimens. Most of these studies propose dosing regimens based on retrospective analysis of vancomycin pharmacokinetics obtained from regimens based on physician discretion. To ensure efficacious and rational vancomycin dosing for premature neonates and infants, regimens should consider PCA as well as body weight.
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PMID:Vancomycin dosing in neonatal patients: the controversy continues. 815 9

The purpose of this study was to determine the clinical predictors of active infective endocarditis in 45 cases we treated between January 1971 and August 1991 (30 native valve endocarditis (NVE) and 15 prosthetic valve endocarditis (PVE). The indication of surgery in 45 patients was progressive congestive heart failure (CHF), septicemia and systemic embolization. The aortic valve was involved in 24 (53%) of 45 patients (13 of 30 NVE and 11 of 15 PVE) and there was significantly higher early mortality in aortic PVE (36%) than in aortic NVE (8%). The 9 patients with severe cardiac failure (NYHA Class V) before surgery were associated with a significantly higher incidence of early mortality (5/9 = 56%) than those in Class III (2/14 = 14%) and Class IV (3/18 = 17%). We concluded that aortic valve infection is more prevalent than mitral valve infection and is more often associated with staphylococcus infection, including abscess formation. Early surgical intervention should be performed despite the risk of cardiac failure and extensive infection.
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PMID:Surgical treatment of active infective endocarditis--early and late results of active native and prosthetic valve endocarditis. 823 Jun 84

We report on a 45-year-old man with bacterial mitral valve endocarditis and valve-ring abscess following a staphylococcus aureus sepsis with septic shock and respiratory insufficiency. A thrombosis of the marginal branch of the left circumflex coronary artery with a myocardial infarction occurred as a consequence of the unusual location of the abscess which spread to the left ventricular lateral wall with an encasement of this blood vessel, and with destruction of the arterial wall. The patient died of biventricular heart failure because of septic shock and myocardial infarction. We discuss entrance spots of infection, predisposing diseases, and complications of valve-ring and myocardial abscesses.
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PMID:[An unusual cause of myocardial infarct. Bacterial mitral valve endocarditis, valve ring and myocardial abscess with direct coronary lesion]. 832 78

The use of catheters for total parenteral nutrition frequently leads to infectious complications which are more common and virulent in patients with marrow aplasia. The main purpose of this paper was to evaluate the influence in the development of catheter-induced sepsis of the place where it was introduced (in the theatre or hospitalization unit), the type of isolation (laminar flux unit or conventional room), and its relation to the period of isolation and of the total parenteral nutrition. Forty-one bone-marrow transplant patients were studied, 18 of them autologous and 23 allogenic, who were administered total parenteral nutrition with a two-way central venous polyurethane catheter. Of the 41 catheters applied, 16 were introduced in the operating theater and 25 in the hospitalization unit: of these, 7 and 11 respectively were infected. Isolation was as follows: 21 in standard rooms and 20 in a laminar flux unit, with 11 and 7 infections respectively. We believe that the lower level of infections in laminar flux isolation was not significant, this being a reduced number of case studies. The duration of the catheter and total parenteral nutrition for the 18 patients with sepsis was 36.5 +/- 15.1 and 23.7 +/- 8.4 days respectively: this was greater--albeit possibly not significantly so because of the special characteristics of these patients--than the 29.1 +/- 12.9 and 19.5 +/- 10.9 days for non-septic cases. This reveals a catheter sepsis rate of 43.9%, in 88% of cases caused by skin flora micro-organisms (66.6% coagulase-negative staphylococcus).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Sepsis due to multiple-lumen catheters in bone marrow transplantation with total parenteral nutrition. The effect of the type of isolation]. 844 72


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