Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The etiology of purulent meningitis was investigated in 109 newborn infants admitted in a neonatal intensive care unit throughout a ten year period. Bacterial pathogens were isolated from the CSF in 57 (52.2%) neonates. There was a predominance of Gram-negative bacilli isolated in 38 (34.9%) neonates. Gram-positive cocci were isolated from CSF in only 12 (11.0%) neonates. Microorganisms associated with nosocomial septicemia and meningitis in neonates--Klebsiella sp, Salmonella sp. Enterobacter sp, Pseudomonas sp, Flavobacterium meningosepticum and Serratia marcescens--were responsible for presumptive etiology in 38 (49.3%) among 77 patients with positive cultures in "closed sites". They were isolated from 22 (57.0%) neonates with prior hospitalization but only from 12 (34.3%) neonates coming directly from their households (chi 2 = 4.08; p < 0.05). The mortality rate was significantly higher in patients with positive CSF cultures (47.4%) in comparison to patients with negative cultures (18.4%) (X2 = 5.01; p < 0.05). It is possible to conclude that Gram-negative bacilli, many of them of hospital origin, are the major pathogens in this study. An improvement on neonatal health care and a scrupulous control of neonatal nosocomial infections are recommended.
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PMID:[Neonatal bacterial meningitis: etiological agents in 109 cases during a 10 year period]. 130 5

The authors report a nosocomial infection outbreak by Klebsiella pneumoniae, observed in neonates at a gyneco-obstetrical hospital from Mexico City. Forty six newborns presented one or more infections due to K. pneumoniae during their stay in neonatal care units, between October 3 and November 12, 1988. Sepsis was documented in 41 cases by clinical picture and routine laboratory exams, including one positive, blood culture at least. The most frequent invasive procedures practiced in these patients were catheterization and ventilatory support. K. pneumoniae was isolated as well from several environmental sources that could have led to infection of patients. Treatment of cases was initiated with ampicillin-amikacin, however, therapeutic failure with a lethality rate of 50% (14/28) and results of antimicrobial susceptibility conducted to treatment with cefotaxime. Fifteen out of 19 patients receiving the cephalosporin survived. To prevent outbreaks like the one presented here, we concluded that appropriate measures dealing with hygiene and education of personnel plus monitoring of bacterial susceptibility to antimicrobials, should prove successful in our environment.
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PMID:Neonatal septicaemia due to K. pneumoniae. Septicaemia due to Klebsiella pneumoniae in newborn infants. Nosocomial outbreak in an intensive care unit. 134 98

Klebsiella pneumoniae strains involved in hospital outbreaks of nosocomial infections, such as suppurative lesions, bacteremia, and septicemia, were resistant to multiple antibiotics including broad-spectrum cephalosporins. Epidemiologic investigations revealed that the reservoir for these K. pneumoniae strains was the gastrointestinal tracts of the patients. The study of the adherence ability of the strains reported here showed that these bacteria adhered to the microvilli of the Caco-2 cell line. This adhesion was mediated by a nonfimbrial protein with a molecular mass of 29,000 Da designated CF29K. Pretreatment of bacteria with antibodies raised against CF29K or Caco-2 cells with purified CF29K prevented the adhesion of K. pneumoniae strains to Caco-2 cells. CF29K immunologically cross-reacted with the CS31A surface protein of Escherichia coli strains involved in septicemia in calves. Genes encoding CF29K were located on a high-molecular-weight conjugative R plasmid, which transferred to E. coli K-12. Transconjugants expressed a large amount of CF29K protein and adhered to the brush border of Caco-2 cells. These findings show that K. pneumoniae strains were able to colonize the human intestinal tract through a plasmid-encoded 29,000-Da surface protein. Hybridization experiments indicated that the gene encoding resistance to broad-spectrum cephalosporins by the production of CAZ-1 enzyme and the gene encoding the adhesive property to intestinal cells were both located on a 20- to 22-kb EcoRI restriction DNA fragment. Genes encoding aerobactin and the ferric aerobactin receptor were also found on this R plasmid.
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PMID:R-plasmid-encoded adhesive factor in Klebsiella pneumoniae strains responsible for human nosocomial infections. 134 9

The murine monoclonal IgM antibody E5 has been shown to significantly reduce the mortality and morbidity of patients with Gram-negative sepsis in a multicenter randomized placebo-controlled clinical trial. The in vitro binding characteristics of monoclonal antibody (mAb) E5 were studied using highly purified smooth lipopolysaccharide (LPS) isolated from a variety of clinically relevant, wild-type Gram-negative bacteria. Using a sensitive antibody-capture assay which involves immobilized mAb E5 and a chromogenic Limulus amebocyte lysate (LAL) LPS-detection system, mAb E5 was shown to bind to all 15 smooth LPS preparations tested, including LPS isolated from Escherichia, Klebsiella, Proteus, Pseudomonas, Salmonella, Serratia and Yersinia species. When LPS was fractionated according to size by size-exclusion chromatography, mAb E5 was shown to bind to smooth LPS molecules that have long as well as short O-polysaccharide chains. These results confirm and extend those reported previously and demonstrate that the anti-lipid A mAb E5 binds specifically to a diverse spectrum of smooth LPS isolated from wild-type Gram-negative bacteria.
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PMID:Reactivity of monoclonal antibody E5 with endotoxin. II. Binding to short- and long-chain smooth lipopolysaccharides. 138 82

A study of blood cultures from 320 cases of neonatal sepsis showed 136 (42.5%) to be positive for bacterial growth; of these 82 (60.29%) isolates being gram negative bacilli. Citrobacter was the commonest gram negative bacilli isolated. Other commonly isolated gram negative organisms were Pseudomonas, Klebsiella, Salmonella typhimurium, Acinetobacter and Escherichia coli. Antibiotics susceptibility pattern revealed the isolates to be resistant to commonly used antibiotics.
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PMID:Citrobacter sepsis in infants. 139 63

Administration of free muramyl tripeptide phosphatidylethanolamide (MTPPE) or liposome-encapsulated MTPPE (LE-MTPPE) in a twofold-lower dose at 24 h before bacterial inoculation resulted in clearance of intravenously inoculated Klebsiella pneumoniae by tissue macrophages, whereas in control mice, bacteria were not effectively cleared from the blood. In addition, MTPPE and LE-MTPPE led to increased numbers of leukocytes in the blood, which could compensate for the leukopenia in mice resulting from infection with K. pneumoniae. In an attempt to elucidate the relative contributions of the activation of tissue macrophages and the recruitment of leukocytes to the antibacterial resistance induced by MTPPE and LE-MTPPE, mice were infected intraperitoneally with K. pneumoniae. In these MTPPE- and LE-MTPPE treated mice, intraperitoneal influx of leukocytes and the phagocytic capacity of leukocytes were not higher than in untreated control mice. However, MTPPE- and LE-MTPPE-treated mice survived much longer; eventually 33% of the LE-MTPPE-treated mice survived, whereas all untreated control mice died as a result of bacterial septicemia. This prevention of early death appeared to be the result of an increased clearance of bacteria from the blood by activated tissue macrophages. It was observed that depletion of these tissue macrophages in liver and spleen abrogates the effect of LE-MTPPE treatment, indicating that tissue macrophages are of major importance in the LE-MTPPE-induced resistance against K. pneumoniae infection.
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PMID:Roles of peripheral leukocytes and tissue macrophages in antibacterial resistance induced by free or liposome-encapsulated muramyl tripeptide phosphatidylethanolamide. 139

Endoscopic retrograde cholangiopancreatography (ERCP) may be complicated by bacteremia, cholangitis, or biliary sepsis. Bacteremia during ERCP implies a potential risk of endocarditis in patients with valvular prostheses or a previous history of infectious endocarditis. For these patients antibiotic prophylaxis prior to ERCP is recommended. Cholangitis or biliary sepsis may develop after ERCP in patients with obstructed bile ducts. In these patients antibiotics should be administered until adequate drainage of biliary obstructions is achieved. Antibiotic prophylaxis and antibiotic therapy must consider the spectrum of micro-organisms which is normally found in each of these situations. Regarding bacteremias associated with ERCP gram-positive cocci predominate, whereas cholangitis and biliary sepsis are caused mainly by gram-negative rods like Escherichia coli, Pseudomonas aeruginosa, or Klebsiella spp.
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PMID:[Antibiotic prevention and therapy of infectious complications in ERCP]. 140 12

A total of 980 episodes of clinically and bacteriologically proven septicemia were included in four prospective 1-year studies at a 1,300-bed university hospital in Berlin between 1979 and 1989. The incidence was 8.1 per 1,000 admissions. The percentage of patients with severe underlying diseases increased significantly from 67% to 95% over the decade. Septicemia due to gram-positive bacteria decreased from 47.3% in 1979 to 43.7% in 1986 and increased again to 51.2% in 1989. Septicemia due to gram-negative organisms decreased constantly from 45.0% in 1979 to 39.8% in 1989. The most frequently isolated species were Escherichia coli (26.4%), Staphylococcus aureus (18.9%), coagulase-negative staphylococci (10.2%), enterococci (7.7%), viridans streptococci (6.4%), Klebsiella species (5.5%), and pneumococci (5.0%). The overall mortality rate decreased significantly from 33.6% in 1979 to 20.8% in 1989. Mortality for episodes of septicemia due to gram-positive bacteria (25.5%) was higher than that for septicemia due to gram-negative bacteria (18.3%). Mortality rates associated with polymicrobic and fungal septicemia were higher than the overall mortality rate.
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PMID:Septicemia in 980 patients at a university hospital in Berlin: prospective studies during 4 selected years between 1979 and 1989. 145 72

New developments in case management presently afford cures to more than 60% of children with acute lymphoblastic leukemia (ALL). 287 children diagnosed with ALL were admitted to the All India Institute of Medical Sciences over the period January, 1982 - September, 1989, where they began chemotherapy. 50 died during initial or subsequent induction therapy and 5 died during the maintenance phase. All deaths were subsequently reviewed to identify the causes of mortality. Infection alone caused death in 47.3% of cases, hemorrhage was observed among 12.7%, and infection together with hemorrhage killed another 13 children. Septicemia, gastrointestinal, and pulmonary infections in 11, 15, and 10 cases, respectively, and meningitis in 2 cases were major sites or infection. Pseudomonas and Klebsiella in 6 cases each accounted for 54.5% of isolates. The gastrointestinal tract and pulmonary system were major sites of bleeding. While no definite cause of death was found for 5 cases, infections nonetheless either alone or combined with other factors caused 76.5% of deaths. To improve the long-term event free survival of children with ALL, practitioners must be knowledgeable about the potential spectrum of infections, begin treatment early with appropriate antibiotics, and seek to improve the availability of supportive facilities and modern antibiotics.
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PMID:Causes of mortality in children with acute lymphocytic leukemia. 150 Jan 28

Pharmacokinetic and clinical evaluations in pediatrics were made on meropenem (SM-7338, MEPM), a new parenteral dehydropeptidase-1 stable carbapenem used without any inhibitors, at 33 medical institutions. The results are summarized as follows. 1. Pharmacokinetic studies. MEPM at a dose of 10, 20, or 40 mg/kg was administered to 53 children by 30-minute drip infusion. Peak plasma concentrations (Cmax's) and plasma half-lives (T1/2's) of these doses were 28.5, 47.2 and 130.0 micrograms/ml, and 0.80, 0.93 and 0.94 hours, respectively. A clear dose response was observed in Cmax's and T1/2 values were quite similar to those observed in adults. In the first 6 hours after administration, 54.4 to 68.1% of the administered drug was recovered in urine. The cerebrospinal fluid (CSF) levels of MEPM in patients with purulent meningitis were 0.13 microgram/ml at a dose of 6 mg/kg, and 0.64 to 4.22 micrograms/ml at a dose of 29 to 44 mg/kg within day 4 of onset. The penetration rate of MEPM showed an intermediate value among those for other cephalosporin antibiotics. 2. Clinical study. Clinical efficacies of MEPM were evaluated in 389 cases. The most common doses used were 10 to 20 mg/kg/once, 2 to 3 times a day. The maximum dose was 173 mg/kg/day q.i.d. MEPM gave "excellent" or "good" responses in 242 (97.6%) out of 248 cases in which causative organisms were documented and in 134 (95.0%) out of 141 cases in which causative organisms were not identified. Clinical efficacy rates were 100% in 11 patients with purulent meningitis, 85.7% in 7 with septicemia, 98.8% in 173 with pneumonia, and 100% in 65 with UTI. Bacteriologically, 260 strains (96.7%) out of 269 strains were eradicated by MEPM treatment. Eradication rates were 89.2% for Staphylococcus aureus (37 strains) and 100% for Streptococcus pneumoniae (35 strains). The overall eradication rate for Gram-positive bacteria was 94.6%. Among Gram-negative bacteria, 98.3% out of 172 strains were eradicated. The eradication rate of Haemophilus influenzae (73 strains) was 98.6% and Pseudomonas aeruginosa (11 strains) was 90.9%, and all of Branhamella catarrhalis (15 strains), Escherichia coli (42 strains), and Klebsiella pneumoniae (6 strains) were eradicated. Out of 84 cases for which previous antibiotic therapies of 3 days or longer were not successful, MEPM gave "excellent" or "good" responses in 77 cases (91.7%) and excellent bacteriological responses (95.7%).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Pharmacokinetic and clinical studies with meropenem in the pediatric field. Pediatric Study Group of Meropenem]. 150 1


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