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

The purposes of this study were to analyze the causes and routes of infection of indwelling central venous catheters and to improve the diagnosis of catheter sepsis before the removal of the cannula. One hundred forty catheter tips were prospectively studies; also, cultures of 52 proximal segments of catheters, 44 swabs of the subcutaneous segment, 195 skin entry sites, 181 infusional fluids, 208 blood samples, and 106 infected distant sites were examined. The catheter sepsis rate was 7.6%, but this sepsis was primary in only 3.4%, because in 4.2% prior isolation of organisms from the wound, urine, throat, or sputum was possible, indicating that the catheter was not primarily responsible for the infection. Primary infection always disappears with removal of the cannula (with or without antibiotics), whereas the course of the secondary infection is related to the gravity of the infected foci and the involved microorganisms. Contamination of the infusional fluid, the skin entry site, and some distant foci carry a real risk of seeding the catheter (from 5.8% to 19.5%). The cultures of the skin entry sites, infusional fluids, distant foci, and the subcutaneous segment of the catheter did not prove useful in predicting the infection. Only the blood cultures were a reliable diagnostic tool: a positive blood culture meant colonization of the catheter tip in 44% of cases and sepsis in 36%. Although the potential colonization varied greatly for different microorganisms, the growth of microorganisms in the blood was a strong indication for removing the cannula.
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PMID:Pathogenesis and predictability of central venous catheter sepsis. 680 97

Septic thromboembolism resulting from the placement of infected autologous thrombi was studied in three groups of ten dogs each following vena caval ligation (VCL) or Greenfield filter (GF) placement with or without antibiotic treatment. All the dogs that did not receive antibiotic therapy died, and the shortest survival time was after acute VCL. Dogs with GF and with delayed embolism after VCL survived significantly longer than did the control animals. Antibiotic therapy consisting of ampicillin and clindamycin resulted in survival except for one control dog with lung abscess. Cultures of the GF and contained thrombus were negative after 2 weeks. However, after VCL, two died of sepsis and two survivors had caval abscess. In a group of six dogs with VCL and delayed embolism, there were four deaths from sepsis and one survivor found to have a caval abscess. To test secondary infection of a trapped thrombus, in 12 dogs with GF and a sterile thrombus we created an extremity abscess with a fecally contaminated sponge, which resulted in death from sepsis in six animals within 3 days. Surgical drainage and antibiotic treatment of the remaining six resulted in survival in five dogs. Cultures of filters and emboli showed heavy contamination in the untreated animals and in one treated dog that died within 24 hours. The remainder had sterile filters and emboli. The presence of sepsis does not preclude use of the Greenfield filter, which is well tolerated in the face of septic embolism and allows sterilization with antibiotic treatment. Prophylactic antibiotic therapy seems advisable for any patient with a filter during a procedure that may produce bacteremia.
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PMID:Comparison of Greenfield filter and vena caval ligation for experimental septic thromboembolism. 683 8

An extremely rare observation of gangrenizing granuloma of the nose in a woman of 29 with a fatal outcome is presented. The disease is characterized by rapidly developing changes in the nasal mucosa and sinuses, skin, soft tissues of the face, destruction of cartilage and bone tissues of the nose, upper jaw with perforation of the hard palate and loss of teeth. Wegener's granulomatosis was diagnosed in the hospital. The disease was complicated by multiple errosive bleedings and sepsis. The lack of involvement of the internal organs and granulomatous reaction distinguished the present observation from the classic Wegener's granulomatosis. The presence of marked vascular changes with fibrinoid necrosis of vessel walls and thrombosis, large necrotic areas and accumulation of plasma cells should be regarded as manifestations of hyperergic reaction of the immediate type. The abundance of microbes and polymorphonuclear leukocytes indicates the occurrence of a secondary infection and purulent inflammation.
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PMID:[Granuloma gangraenescens of the nose]. 711 35

The diabetic neurogenic paralytic bladder is characterized by marked residual urine, secondary infection, pyelonephritis, sepsis, and azotemia. Initial manifestations were studied in diabetic patients with and without neuropathy and in nondiabetic controls, all without symptoms referable to the urinary tract. The nondiabetic controls and the diabetics without neuropathy were urologically normal. Eighty-three percent of the diabetic patients with neuropathy had objective evidence of neurogenic bladder involvement; however, there was no residual urine, infection, pyelonephritis, sepsis or azotemia. The disparity between early and late bladder involvement is determined by the factor of residual urine, which is the measure of advancing bladder neuropathy leading to decompensation. Progressive decompensation of the asymptomatic diabetic bladder may be a cause of the increased frequency of renal infection in diabetic patients.
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PMID:Development of urinary bladder dysfunction in diabetes mellitus. 735 22

This paper describes the course of a patient who had delayed breakdown of the implantation site of a permanently placed pacemaker electrode. Transvenously placed endocardial electrodes have a lower incidence of morbidity and mortality, but skin erosions and secondary infection of the electrode tracts occur in both types. Once skin erosion is suspected, it is better to resituate the pacemaker as early as possible, since any delay may invite septicemia.
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PMID:Erosion of pacemaker lead. 736 51

Infection is one of the major complications of severe head trauma in children. To assess whether intravenous immunoglobulin (IVIg) decreases the incidence of secondary infection after head injury in children, a randomized, double-blind trial was performed. Thirty-three children (mean age, 6.67 years; mean injury severity score, 32.8; mean Glasgow coma score, 6.1) with severe head injuries were enrolled; 1 child was excluded, 18 received IVIg, and 14 received the placebo preparation. Four hundred milligrams per kilogram of IVIg or albumin placebo was administered within 48 hours of admission. IgG levels were obtained before the infusion and then 1 week later. Patients were monitored for evidence of infection for the next 21 days. There was a 66% increase in mean IgG levels in the treatment group compared with 45% in the control group (P = .057). One death occurred in the IVIg group and two in the placebo group. No significant differences in the incidence of pneumonia, sepsis, presumed sepsis, or any other type of infection was noted. There was no difference in the number of days on mechanical ventilation or in number of hospital days. There were no side effects. It is concluded that prophylactic administration of commercial IVIg at a dose of 400 mg/kg, although safe, had no effect on the incidence of secondary infections in children with severe head injuries.
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PMID:Safety and efficacy of intravenous immunoglobulin prophylaxis in pediatric head trauma patients: a double-blind controlled trial. 830 58

Staphylococcus aureus is the causative organism for many skin and soft tissue (SST) infections. Some SST infections have severe systemic complications, such as bacteraemia and sepsis. S. aureus is the cause of 75% of primary pyodermas. Pre-existing conditions, like tissue injury (ulcers, wounds) or tissue inflammation (exudative dermatitis), and also underlying disorders (such as poorly controlled insulin-dependent diabetes mellitus or cancer) are some of the risk factors for secondary infection with S. aureus. In S. aureus-infected primary skin disorders (impetigo, recurrent eczema), 2% mupirocin ointment has proved effective in several clinical trials. S. aureus is responsible for 25% of all burn-wound infections, and burn units could be the point of entry and source of spread of methicillin-resistant S. aureus infection outbreaks. Mupirocin (2% ointment) has also proven effective for topical treatment of these infections. Pressure sores develop in 6% of all patients admitted to acute and chronic health care institutions. An average of three aerobic species (including S. aureus) plus one anaerobic species are isolated when infected. Infectious complications are responsible for 60-80% of all intravenous drug user (IVDU) hospital admissions, 5-20% being due to S. aureus infective endocarditis (IE). The origin of IE in IVDUs is probably the skin. Data from a Collaborative Spanish Study of IVDU infectious complications (including more than 10,000 episodes) are discussed.
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PMID:Identifying high risk patients for Staphylococcus aureus infections: skin and soft tissue infections. 860 37

Calciphylaxis is a rare and life-threatening complication that is estimated to occur in 1% of patients with ESRD each year. Typically, extensive microvascular calcification and occlusion/thrombosis leads to violaceous skin lesions, which progress to nonhealing ulcers and sepsis. Secondary infection of skin lesions is common, often leading to sepsis and death. The lower extremities are predominantly involved (roughly 90% of patients). Patients with skin involvement over the trunk or proximal extremities have a poorer prognosis. Although most calciphylaxis patients have abnormalities of the calcium:phosphate axis or elevated levels of parathyroid hormone, these abnormalities do not appear to be fundamental to the pathophysiology of the disorder, and the etiology of calciphylaxis remains unclear. Recently, functional protein C deficiency has been hypothesized to cause a hypercoagulable state that could induce thrombosis in small vessels, with resulting skin ischemia, necrosis, and gangrene. The lack of understanding of the pathophysiology of the disease results in treatments that are equally unsatisfactory. Patients who undergo parathyroidectomy have a tendency to improve, but the prognosis for the disease is poor and mortality remains high.
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PMID:Calciphylaxis in chronic renal failure. 882 11

We report a case of an infected renal cystic mass associated with bacterial meningitis in a 70-year-old woman who had had poorly-controlled diabetes mellitus for approximately 30 years. She suffered from bacterial meningitis due to Klebsiella pneumoniae, which was successfully treated with antimicrobial chemotherapy for 1 month. Approximately 2 weeks later she developed left flank pain and a high fever. A CT scan and an ultrasonogram revealed a left renal cystic mass, which was considered to be an infected renal cyst. Turbid and thick fluid was obtained by percutaneous aspiration which contained numerous white blood cells. Culture of this fluid yielded K. pneumoniae. The bacterial meningitis was considered to be a secondary infection of the septicemia which resulted from the infected renal cystic mass.
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PMID:Infected renal cystic mass associated with bacterial meningitis: a case report. 884 88

Procalcitonin (ProCT) is a recently described marker of severe sepsis. It was decided to assess the value of proCT as a marker of secondary infection in patients infected with HIV-1. ProCT plasma levels were measured by immunoluminometric assay in a prospective study in 155 HIV-infected individuals: 102 asymptomatic and 53 with lever or suspected secondary infections. The baseline plasma level of ProCT was low (0.5 ng/ml +/- 0.37), even in the latest stages of the disease, and did not differ from the values of healthy subjects (0.54 ng/ml +/- 0.08). EDTA-treated whole blood was collected from patients before starting specific antimicrobial therapy. No elevation of ProCT level was detected in HIV-infected patients with evolving secondary infections including PCP (n = 4), cerebral toxoplasmosis (n = 4), viral infections (n = 9), mycobacterial infections (n = 5), localized bacterial (n = 12) and fungal infections (n = 4), malignancies (n = 3), and in various associated infectious and non-infectious febrile events (n = 13). All these plasma values were lower than 2.1 ng/ml. In contrast, high ProCT plasma levels were detected in one HIV-infected patient with a septicaemic Haemophilus influenzae infection (16.5 ng/ml) and another one with a septicaemic Pseudomonas aeruginosa infection (44.1 ng/ ml), ProCT values decreased rapidly under appropriate therapy. ProCT seems to be a specific marker of bacterial sepsis in HIV-infected patients, as no increase in other secondary infections could be detected in those patients. A rapid determination of ProCT level could be useful to confirm or refute bacterial sepsis for a better management of febrile HIV-infected patients.
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PMID:Procalcitonin as a marker of bacterial sepsis in patients infected with HIV-1. 927 23


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