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

Nosocomial pneumonia (NP) is associated with a significant mortality, 66% in a previous retrospective study of NP complicating intra-abdominal sepsis (IAS). We prospectively compared the outcome of NP complicating IAS with that of recurrent IAS (R-IAS) in the absence of NP. Data were collected prospectively on 300 patients with IAS; 34 patients who presented with pneumonia were excluded from the analysis (44% mortality). One hundred seventy-one patients with no NP and no R-IAS (group 1) had a hospital mortality of 20% (34 patients); 36 without NP in whom R-IAS developed (group 2) had a 17% mortality (six patients); and 47 with NP but no R-IAS (group 3) had a 53% mortality (25 patients). Finally, 12 patients who had both NP and R-IAS suffered a 75% mortality (nine patients). We examined the relationships among the following putative risk factors and mortality: APACHE (acute physiology and chronic health evaluation) II score (at initial presentation with IAS), the need for mechanical ventilatory assistance following initial treatment for peritonitis, steroid requirement, generalized peritonitis vs abscess, and the need for surgical as opposed to percutaneous treatment. Using mortality as the dependent variable, group 2 vs 3 as the explanatory variable, and the risk factors as confounders, logistic regression analysis indicated that the group difference was significant after controlling for confounders. We conclude that NP complicating IAS is an independent risk factor associated with a significant mortality compared with R-IAS. These data challenge the notion that death in IAS is usually due to recurrent or persistent intra-abdominal infection.
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PMID:Pneumonia complicating abdominal sepsis. An independent risk factor for mortality. 199 94

The role of gastric microbial colonization in nosocomial infections and endotoxemia was investigated prospectively in 40 neurosurgical patients requiring mechanical ventilation for greater than 48 h. Each was studied up to 7 d. Swabs from the nose and oropharynx were cultured at admission, and aspirates from the stomach and trachea were cultured daily until enteral alimentation was started. Patients were evaluated every second day for endotoxemia and coagulation activation. Of 153 gastric aspirates, 66.7% contained microorganisms at a mean quantity of 10(7) cfu/ml. Nosocomial pneumonia occurred in 15 patients, septicemia in 5, and meningitis in 1. The stomach was the evident source of infection in only 1 patient with pneumonia. Of 140 plasma samples, 12 (8.6%) from 10 patients showed detectable endotoxin levels, but there was no association between endotoxemia or coagulation activation and the presence of microorganisms in the stomach. The stomach was not an important source for nosocomial infections or endotoxemia, even in patients with high gastric pH.
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PMID:Role of gastric colonization in nosocomial infections and endotoxemia: a prospective study in neurosurgical patients on mechanical ventilation. 276 Apr 97

Nosocomial pneumonia is a frequent infectious complication in ICU patients. All the patients with prolonged nasotracheal intubation presenting with nosocomial pneumonia according to Salata's criteria were examined for sinusitis in the prospective study. Diagnosis was confirmed via CT-scan views and transnasal sinus puncture. In eleven nasally intubated patients, CT-scan views showed air fluid levels and multiple sinus involvement. Bacteriological studies isolated the same gram negative bacilli in both sinus and bronchial aspirates. In four cases, a polymicrobial sinusitis was found with a single organism predominant. This predominant germ was always found in bronchial aspirate. Recovery from pneumonia was obtained only after sinus drainage. Treatment included removing the nasal tubes, or performing tracheostomy and systemic antibiotics. One patient required surgical maxillary sinus drainage after failure of medical management. The occurrence of nosocomial pneumonia in nasotracheally intubated patients should lead physicians to explore the paranasal sinuses. Sinus CT-scan views should be routinely obtained in the assessment of pulmonary sepsis in patients with prolonged nasotracheal intubation. Persistent or ignored nosocomial sinusitis in such circumstances could be a major source of treatment failure.
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PMID:[Secondary lung diseases in patients with nasotracheal intubation. Role of nosocomial sinusitis]. 334 11

During recent decades the incidence of nosocomial septicemia has considerably increased. From 1976--1980 on average 0.6% of 39, 802 prospectively analyzed hospital patients acquired septicemia. The risk of acquiring nosocomial septicemia in intensive care units is 10 times higher than in general wards. The risk is highest in medical and surgical intensive care units. Most common bacteria causing nosocomial septicemia were: Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli. Pseudomonas aeruginosa and Klebsiella pneumoniae. Nosocomial pneumonia, wound infections and venous catheter infections most often lead to septicemia. In half the patients with septicemia the infection either directly caused death or contributed to the death of the patient. The hospital costs for patients with septicemia are twice as high as for patients with the same underlying disease without septicemia.
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PMID:[Epidemiology of nosocomial septicemia (author's transl)]. 678 3

The catastrophic pulmonary failure that complicates management of patients with multiple trauma or sepsis syndrome with shock is recognizable to nearly all experienced surgeons. However, the spectrum of injury is broad, the distribution of lung injury may be heterogeneous within a single patient, and many patients will not develop acute respiratory distress syndrome (ARDS) even after a major predisposing insult. The lung responds stereotypically to many disparate insults, so a better conceptual construct of ARDS may be to consider it as one component of the multiple organ dysfunction syndrome. Support of oxygen transport with positive pressure ventilation and high levels of positive end-expiratory pressure, long the mainstay of pulmonary support, has been criticized for its predilection to cause barotrauma. Newer modes of ventilation, such as pressure-controlled, inverse-ratio ventilation and permissive hypercapnia, are under investigation but have not yet been reported with scientific rigor. However, pulmonary support extends beyond the support of gas exchange. Fluid management requires close attention so that the circulation is supported but lung water accumulation is minimized. Nosocomial pneumonia greatly increases the mortality rate in ARDS, but is difficult to diagnose and must be sought aggressively. Until recently, pharmacologic therapy has held little promise, but inhalation of very low concentrations of nitric oxide appear to decrease pulmonary vascular pressures and intrapulmonary shunt. It remains unknown whether nitric oxide is effective therapy for the underlying injury, or is simply treatment for certain manifestations.
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PMID:Organ-specific support in multiple organ failure: pulmonary support. 767 4

Nosocomial pneumonia and sepsis, as well as severe diffuse peritonitis, must be treated early in order to prevent complications such as septic shock and organ dysfunctions. With the availability of new broad-spectrum and highly bactericidal antibiotics, the need of combining beta-lactams with aminoglycosides for the treatment of severe infections should be reassessed. A prospective randomized controlled study was performed to compare imipenem monotherapy with a combination of imipenem plus netilmicin in the empiric treatment of nosocomial pneumonia, nosocomial sepsis, and severe diffuse peritonitis. A total of 313 patients were enrolled, and 280 were assessable. The antibiotic treatment was successful in 113 of 142 patients (80%) given the monotherapy and in 119 of 138 patients (86%) given the combination (P = 0.19). The failure rates for the most important type of infection, i.e., pneumonia, were similar in the two groups, as well as the number of superinfections. While creatinine increase was associated with factors not related to antibiotic therapy for all eight patients of the monotherapy group, no factor other than the antibiotics could be found for 6 of the 14 cases of nephrotoxicity observed in the combination group (P = 0.014). Finally, the emergence of Pseudomonas aeruginosa resistant to imipenem occurred in 8 monotherapy patients and in 13 combination therapy patients. In conclusion, imipenem monotherapy appeared as effective as the combination of imipenem plus netilmicin for the treatment of severe infection. The addition of netilmicin increased nephrotoxicity, and it did not prevent the emergence of P. aeruginosa resistant to imipenem.
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PMID:Prospective randomized comparison of imipenem monotherapy with imipenem plus netilmicin for treatment of severe infections in nonneutropenic patients. 809 30

An incidence study on nosocomial infections in critically ill infectious disease patients was carried out in the intensive care unit (ICU) of a university hospital for infectious diseases over a 7-year period (1 January 1990 to 31 December 1996). A total of 660 patients who stayed in the ICU for over 48 h were prospectively observed. The patients were divided into two groups: one with central nervous system infections (442 patients) and the other with other severe infections (218 patients). The risk of nosocomial sepsis and pneumonia was significantly higher in patients suffering from severe central nervous system infections. The incidence of sepsis was 24.2% vs 11.4% (relative risk 1.95; 95% confidence interval 1.32-2.89); the incidence of pneumonia was 30.5% vs 14.7% (relative risk 2.09; 95% confidence interval 1.47-2.96). The incidence of urinary tract infection was 14.3% vs 13.3% (relative risk 1.07; 95% confidence interval 0.71-1.61). Density rates of nosocomial septic episodes were 21.1 +/- 37.1 vs 11.7 +/- 32.4 episodes/100 central venous-line days (P < 0.006). Nosocomial pneumonia occurred only in mechanically ventilated patients (36.9 +/- 61.2 vs 28.5 +/- 65.8 episodes per 1000 ventilatory days, P = 0.012). Nosocomial urinary tract infection occurred only in patients with urinary catheters (11.6 +/- 60.7 episodes/1000 urinary catheter days vs 18.7 +/- 90.1, P = 0.886). Multivariate regression analysis identified age, diagnosis of CNS infection, duration of urinary tract catheterization, the use of central venous lines and mechanical ventilation as independent risk factors of nosocomial sepsis. Duration of mechanical ventilation, use of steroids and diagnosis of CNS infection were independent risk factors of nosocomial pneumonia. A subanalysis identified tetanus patients to be at particular risk of nosocomial infections.
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PMID:Nosocomial infections in critically ill infectious disease patients: results of a 7-year focal surveillance. 1002 1

Although microorganisms are the main cause of nosocomial infections, they are by no means their only determinants. Patient-associated factors play a major role (especially immune status), the therapeutic conditions (personnel behaviour, 'devices') and the patient's environment. The hospital infection control team is responsible for implementing and operating an efficient and cost-effective infection control and prevention system. Scientific data must be evaluated and every effort made to continuously improve recommendations. In order to implement an efficient and cost-effective infection control and prevention system, the infection control team must formulate sound, evidence-based recommendations and question established 'rituals'. Inappropriate measures, e. g. the routine disinfection of floors in wards and hallways place a burden on staff, patients and the environment, and distract staff from other critical measures such as proper hand hygiene. Nosocomial pneumonia, urinary tract infections, surgical wound infections and catheter-associated sepsis are the commonest hospital-acquired infections, and Intensive Care Units have become the foci of antibiotic resistance. Although the antimicrobial resistance situation is better in Germany than in other countries, e. g. Eastern and Southern European countries and the USA, substantial regional differences exist. The increase in methicillin (oxacillin) resistant S. aureus (MRSA) is particularly worrying. Building up an effective surveillance system for nosocomial infections, as demanded by the new German infection control act has far-reaching implications and entails recording risk-adjusted infection rates (KISS project = Hospital Infection Surveillance System of the National Reference Center for Hospital Hygiene in cooperation with the Robert Koch-institute). Proper collaboration between hospital staff in implementing infection control measures, and especially hand hygiene is of paramount importance.
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PMID:[Current challenges on hospital hygiene]. 1153 77

Nosocomial pneumonia is difficult to diagnose. Clinical criteria, saliva and tracheal specimen cultures can be sensitive to bacterial pathogeny, they are however nonspecific in patients with assisted mechanical ventilation; on the other hand, blood and pleural liquid cultures have very poor sensitivity. Fever and leukocytosis are not constant signs and are not compulsory for diagnosing nosocomial pneumonia (NP). Interleukine 1 (IL-1) is a proinflammatory cytokine produced by macrophages, but research studies failed to indicate some connection to the incidence or clinical outcome in nosocomial pneumonia. Tumoral necrosis factor (TNF) is considered one of the most important mediators of endotoxin induced effects: studies on acute inflammatory conditions such as severe sepsis indicated a link between the homozygosity of TNFb2 and the mortality or the incidence of nosocomial pneumonia in trauma patients. Procalcitonin (PCT) is a parameter different from other markers currently available to evaluate inflammatory response. PCT is induced by bacterial inflammation selectively and also appears in sepsis and in MODS. PCT values higher than 0.5 ng/mL always indicate acute infection or septic inflammation.
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PMID:[Diagnosis of nosocomial pneumonia: conventional and new indicators]. 1706 2