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

Catheter-related infections (CRI) are frequent and manifest in a wide range of clinical situations. A rational approach is necessary for the adequate management of these infections. Whenever a CRI is suspected, two main questions have to be addressed: whether to remove the catheter and whether to initiate empiric antimicrobial treatment. As the clinical diagnosis of CRI has a low specificity, the catheter should be removed only in circumstances such as severe or ongoing sepsis, persistent bacteremia, pulmonary or peripheral embolization, endocarditis, signs of tunnel infection, when the catheters or when the CRI is caused by fungi, Staphylococcus aureus or Pseudomonas aeruginosa are easy to replace among others. Exchanging the catheter through a guidewire is a frequent practice but is not recommended by some authors. Empiric antimicrobial treatment should be administered in any of the following situations: when the catheter is not removed, in the case of central venous or surgically implanted catheters and prosthetic implants, in the presence of severe sepsis, neutropenia or other immunodepressed status, suppurative phlebitis, embolization and acute endocarditis. Empriic antimicrobial treatment should include a glycopeptide (vancomycin or teicoplanin) as staphylococci are the most frequent cause of CRI. Adding an antipseudomonal agent, such as amikacin, aztreonam, ceftazidime, cefepime, piperacillin/tazobactam, or a carbapenem (depending on the local antimicrobial susceptibility data or antibiotic policy) is necessary in cases of neutropenia, burn patients, severe sepsis, or suspicion of contaminated infusate. Empiric treatment against Candida is not initially necessary in most cases. Empiric treatment should be replaced by specific therapy whenever possible.
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PMID:Selection of empiric therapy in patients with catheter-related infections. 1204 4

A 7-year-old castrated male German Shepherd Dog was evaluated for lethargy, icterus, and sepsis. Porcupine quills had been removed from the dog's face 1 month prior to examination; progressive right forelimb lameness had developed soon after removal of the quills. Septic arthritis of the right elbow joint was diagnosed and was unresponsive to antimicrobial and anti-inflammatory treatments. At the time of referral, the dog had developed endocarditis, septicemia, and disseminated intravascular coagulation. Via ultrasonography, a foreign body consistent with a porcupine quill was detected in the medial portion of the right humeroradial joint. The dog did not respond to initial supportive treatment and died as a result of cardiac arrest. Postmortem examination confirmed the presence of a quill in the medial compartment of the right elbow joint and severe acute endocarditis with septic emboli to the kidneys and spleen. Ultrasonographic examination should be considered as a diagnostic tool when septic arthritis secondary to a foreign body is suspected in dogs.
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PMID:Ultrasonographic diagnosis of septic arthritis secondary to porcupine quill migration in a dog. 1512 88


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