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

The known patterns and functions of gastrointestinal flora and antimicrobial effects on flora are described, and the clinical implications of altered bowel flora are described. A major role of the normal endogenous intestinal flora is to inhibit gastrointestinal colonization and overgrowth by potentially pathogenic bacteria. Serious disruption of this protective mechanism may occur after the administration of various antimicrobial agents. Alteration of bacterial flora by antimicrobials is often the result of incomplete absorption after oral administration or of high concentrations in saliva, bile, or secretions from the intestinal flora. Suppression of endogeneous microflora after antimicrobial administration may permit overgrowth of pathogenic strains in the gastrointestinal tract, development or selection of antimicrobial-agent-resistant strains, and disruption of colonization resistance. The disruption of normal bowel flora can result in diarrhea, pseudomembranous colitis, and systemic infections or sepsis in immunocompromised patients. Agents that are well absorbed and have minimal biliary excretion should minimize the detrimental effects from altered flora. The choice of an antimicrobial agent that has a narrow spectrum, is specific for the infection, is not appreciably excreted in the bile, and is completely absorbed if given orally appears to be the most appropriate practice for preventing or minimizing alteration of bowel flora.
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PMID:Effect of antimicrobial therapy on bowel flora. 306 21

Almost all cases of Clostridium difficile-related pseudomembranous colitis are related to antimicrobial therapy. Virtually all antibacterial agents have been implicated, notable exceptions being vancomycin and parenterally administered aminoglycosides. The most prominent causes of colitis are ampicillin, clindamycin and various cephalosporins. In general, this complication is related to suppression of indigenous flora and overgrowth of C. difficile. In the case of ampicillin, however, C. difficile is always susceptible. Beta-lactamase production by elements of the bowel flora leads to destruction of ampicillin and subsequently to increased counts of C. difficile and colitis. Much less well-appreciated, and much less studied, is overgrowth and subsequent infection by other types of anaerobic bacteria. Superinfection by anaerobes may follow the use of "intestinal antiseptics" such as oral neomycin; indeed, that is the rationale for the current practice in the U.S. of combining erythromycin or tetracycline with the oral aminoglycoside. Superinfection with anaerobes may also follow systemic administration of various antimicrobial compounds. Such superinfections may involve any site in the body, although sepsis and intraabdominal infection have been noted most commonly; all major types of anaerobes have been involved. A wide variety of antimicrobial compounds has been implicated in predisposing to anaerobic infection.
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PMID:Anaerobic infections and Clostridium difficile colitis emerging during antibacterial therapy. 354 21

Aztreonam was used in the initial treatment of infection of the urinary tract (23 cases), respiratory tract (17 cases), skin and soft tissue (12 cases), abdominal cavity (three cases), endocarditis (two cases), septicemia (eight cases), and osteomyelitis (two cases). In 26 of 60 evaluable infectious episodes, aztreonam was used alone. Clinical cure was observed in 35 of 60, improvement in 24 of 60, and failure in one of 60 cases. Ten patients developed subsequent superinfection. Aztreonam was well tolerated, although one case of exfoliative dermatitis and one of pseudomembranous colitis occurred. However, these cases were complicated by proximal administration of other antibiotics.
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PMID:Efficacy and safety of aztreonam in the treatment of serious gram-negative bacterial infections. 381 51

A prospective randomized control trial was made in 78 patients undergoing elective operations on the stomach where the viscus was opened at operation, and the efficacy of single dose intravenous prophylaxis with cefuroxime 1.5 g or mezlocillin 2 g was compared. The overall rate of sepsis was 10.2 per cent. Infection in the cefuroxime group was significantly lower (2.5 per cent) than in the mezlocillin group (18 per cent) (P less than 0.05). Four of the seven patients with infections in the mezlocillin group were due to antibiotic resistant staphylococci. The only infections in the cefuroxime group were due to an antibiotic resistant strain of Pseudomonas aeruginosa. One case of pseudomembranous colitis occurred in the cefuroxime group. In view of the high rate of resistant organisms in patients receiving mezlocillin we believe that cefuroxime remains the antibiotic of choice for patients undergoing elective gastric operations.
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PMID:Prospective randomized trial of single dose cefuroxime against mezlocillin in elective gastric surgery. 620 60

The human normal intestinal flora prevents the colonization of exogenous bacteria, maintaining a constant microecology: this property is called "colonization resistance". In leukemia patients antibiotics used for prevention and/or therapy of infectious episodes can alter the intestinal microecology, so that the gut can represent the trigger zone for generalized septicemia. Moreover cytotoxic drugs used in these patients can favour intestinal disturbances. In our study we evaluated the in vitro activity of three commonly used antineoplastic drugs (Daunorubicin, Cytosine arabinoside, Methotrexate) against aerobic and anaerobic intestinal bacteria and Clostridium difficile that is the aetiological agent of pseudomembranous colitis. Daunorubicin proved to be the most active inhibiting, in concentration ranging from 16 to 128 micrograms/ml, 50% of Bacteroides strains and 90% of Clostridium difficile and Enterococci strains tested. Methotrexate showed activity only against some Bacteroides strains, while Cytosine arabinoside had no activity at all. We conclude that in these patients the use of these drugs may represent another factor of risk altering the intestinal flora and so lowering the colonization resistance.
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PMID:[In vitro activity of several cytostatic drugs against aerobic and anaerobic intestinal bacteria]. 653 96

We report here our first experience with the use of a total artificial heart in a human being. The heart was developed at the University of Utah, and the patient was a 61-year-old man with chronic congestive heart failure due to primary cardiomyopathy, who also had chronic obstructive pulmonary disease. Except for dysfunction of the prosthetic mitral valve, which required replacement of the left-heart prosthesis on the 13th postoperative day, the artificial heart functioned well for the entire postoperative course of 112 days. The mean blood pressure was 84 +/- 8 mm Hg, and cardiac output was generally maintained at 6.7 +/- 0.8 liters per minute for the right heart and 7.5 +/- 0.8 for the left, resulting in postoperative diuresis and relief of congestive failure. The postoperative course was complicated by recurrent pulmonary insufficiency, several episodes of acute renal failure, episodes of fever of unidentified cause (necessitating multiple courses of antibiotics), hemorrhagic complications of anticoagulation, and one generalized seizure of uncertain cause. On the 92nd postoperative day, the patient had diarrhea and vomiting, leading to aspiration pneumonia and sepsis. Death occurred on the 112th day, preceded by progressive renal failure and refractory hypotension, despite maintenance of cardiac output. Autopsy revealed extensive pseudomembranous colitis, acute tubular necrosis, peritoneal and pleural effusion, centrilobular emphysema, and chronic bronchitis with fibrosis and bronchiectasis. The artificial heart system was intact and uninvolved by thrombosis or infectious processes. This experience should encourage further clinical trials with the artificial heart, but we emphasize that the procedure is still highly experimental. Further experience, development, and discussion will be required before more general application of the device can be recommended.
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PMID:Clinical use of the total artificial heart. 1476 80

Bacteria recently recognized as nosocomial pathogens generally fall into three categories: those that grow slowly, those that are fastidious in their nutritional or atmospheric requirements and those that resemble commensals. Each characteristic has contributed to the delay in perceiving their importance. Mycobacterium chelonei and Myco. fortuitum--which grow slowly, although characterized as "rapid-growing" mycobacteria--cause sternal osteomyelitis, pericarditis and endocarditis after cardiac surgery as well as other wound infections after many types of surgery. Myco. chelonei-like organisms have been found to cause "sterile" peritonitis in patients receiving long-term peritoneal dialysis. Legionella pneumophila and L. micdadei are fastidious bacteria that were more difficult to detect because they stain poorly with the Gram method. They cause pneumonia and lung abscess, especially in immunocompromised people. Clostridium difficile is an anaerobe that causes toxin-mediated pseudomembranous colitis in persons given antibiotics that inhibit competing gut bacteria. Chylamydia trachomatis, an intracellular organism that has not been grown in vitro, causes pneumonia and conjunctivitis in young infants who acquire the organism from their mothers at birth. Group JK bacteria cause septicemia in patients whose immune responses have been suppressed and must be distinguished from "diphtheroid" contaminants in blood cultures. Clinicians, microbiologists and epidemiologists must be alert to the characteristics of these organisms that make them easily overlooked and should also anticipate the existence of other bacteria not yet identified.
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PMID:Bacteria newly recognized as nosocomial pathogens. 700 90

Examination of this series of 19 patients with antibiotic-associated pseudomembranous colitis revealed that most of the patients were given the antibiotics for trivial reasons. Many different antibiotics were identified as being related to the development of colitis. There were three deaths in this series; two of the 15 patients treated medically and one of the four treated surgically. The efficacy of all diagnostic procedures and medical therapies are discussed, and the role of surgery in treating patients with toxic state, sepsis, or perforation is presented.
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PMID:Antibiotic-associated colitis: a persistent clinical problem. 736 34

The author summarizes experience with the treatment of five patients with pseudomembranous colitis. The diagnosis of this disease was outdated and only in the last two cases it was possible to use the latex agglutination test to assess the presence of Clostridium difficile toxins. The patients were admitted to the clinic in a serious septic toxic condition and thus it proved possible to cure conservatively (using Vancomycin) only one female patient. Four patients were operated in a critical condition (subtotal colectomy with ileostomy and a mucous fistula of the rectosigmoid), two died from progressing sepsis (shock lung). The authors emphasize the necessity of early and accurate diagnosis, incl. assessment of the toxin titre. With regard to the fact that the method is demanding from the economic aspect, the authors propose an economical algorithm of examination and treatment of patients who suffer during prolonged hospitalization from repeated diarrhoea, and the use of broad spectrum antibiotics.
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PMID:[Pseudomembranous colitis. Personal experience]. 748 57

We report the case of an elderly patient who had ascites due to pseudomembranous colitis and associated hypoalbuminemia. Computed tomography showed diffuse colonic wall thickening. An indium-111 scan to localize the site of infection showed abnormal localization of 111In throughout the colon. Despite treatment, the patient died. Autopsy disclosed no other cause for the ascites, except for possible sepsis. To study the cause of ascites in patients with pseudomembranous colitis, we reviewed our institutions' experience with ascites in association with Clostridium difficile colitis, identifying 16 cases over a 1-year period (which included our case). In most of the other cases, the ascites could be attributed primarily to another mechanism, including portal hypertension, congestive heart failure, and sepsis (intra-abdominal and systemic). We also reviewed the literature regarding the association of ascites with C difficile colitis.
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PMID:Ascites associated with antibiotic-associated pseudomembranous colitis. 911 46


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