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

Laboratory records were reviewed to assess the clinical relevance of isolating viridans (VS) and nonhemolytic (NHS) streptococci from blood and cerebrospinal fluid (CSF) specimens in a pediatric setting. During a nine-month period, 722 of 6,569 blood cultures and 113 of 2,023 CSF cultures were positive for one or more organisms. There were 26 VS and 10 NHS blood isolates from 30 patients and five NHS isolates from the CSF of five additional patients. The patients ranged in age from five weeks to 16 years. The charts of 34 patients were reviewed for evidence of sepsis or meningitis and the physician's response to the positive cultures. Three patients had subacute bacterial endocarditis (SBE) with multiple positive blood cultures. All other patients, including six oncology patients, failed to show a positive correlation between the isolation of VS or NHS and the disease process. Speciation and MIC testing were performed on 13 isolates, including those from all SBE and four oncology patients. Because of the lack of significance of VS and NHS from blood and CSF specimens in patients other than those with SBE, the authors conclude that extensive microbiologic workup of VS and NHS is not necessary without appropriate clinical indications such as SBE or immunosuppression.
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PMID:Clinical relevance of viridans and nonhemolytic streptococci isolated from blood and cerebrospinal fluid in a pediatric population. 230 Dec 89

Late-onset septicemia due to Enterococcus faecalis is common among very low-birth weight neonates. These infants have low concentrations of placentally derived IgG and developmentally low levels of complement. The aim of the present study was to determine the contribution of antibody to in vitro neutrophil-mediated phagocytosis of E. faecalis. Antibody alone, as contained in an adult serum pool heated to inactivate complement, promoted only a modest reduction in the initial bacterial inoculum (50 +/- 12%) for 6 of 10 E. faecalis bacterial strains tested and allowed growth of the other four strains. In the presence of complement, NHS promoted > or = 90% reduction in the initial bacterial inoculum of two representative strains at serum concentrations as low as 0.5%. Hypogammaglobulinemic serum supported similar activity only at concentrations above 5%. Purification of IgG and IgM fractions from NHS revealed that IgM had the higher specific activity to promote phagocytic activity. Absorption to remove specific antibody significantly reduced bactericidal activity by normal human serum, complement-deficient sera, and hypogammaglobulinemic serum. Reconstitution of hypogammaglobulinemic serum with antibody as contained in 1% heated normal human serum or in immune globulin for intravenous use (1200 mg/dl) restored phagocytic activity. Thus, E. faecalis-specific antibody enhances PMN-mediated killing of this organism. Adjunctive therapy with intravenous immunoglobulin could augment the host response to enterococcal infections in infancy.
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PMID:Contribution of antibody to neutrophil-mediated killing of Enterococcus faecalis. 941 88

Hospitals worldwide are facing an unprecedented crisis of rising cost of antibacterials due to the increasing rapid emergence and dissemination of antibiotic-resistant organisms, improper use of antibiotics and the use of broad spectrum parenteral agents. The last 25 years has seen the introduction of many measures to improve the quality of sepsis management, and specifically antimicrobial use. The present paper reviews the development, implementation and evaluation of some of the key strategies employed within the Dundee Teaching Hospitals NHS Trust (DTHT) to enhance recognition and assessment of sepsis and to rationalize the early and often empiric antibiotic treatment of patients in hospital with infection. Particular emphasis is given to optimizing the use of expensive parenteral agents in conjunction with promotion of oral switch therapy where appropriate.
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PMID:Strategies to rationalize sepsis management--a review of 4 years' experience in Dundee. 975 64

Macrorestriction fragment profile analysis by pulsed field gel electrophoresis was used to type strains of coagulase-negative staphylococci (CNS) isolated from 30 patients with catheter-related sepsis at the University Hospital Birmingham NHS Trust, UK. Twenty-three infections were hospital-acquired. A total of 56 CNS were isolated from the patients and identified by API as Staphylococcus epidermidis (54), Staphylococcus lugdunensis (1) and Staphylococcus hominis (1). The micro-organisms were further characterized by antibiograms and restriction digestion using SmaI. Analysis of the macrorestriction fragment profiles demonstrated that the isolates from 24 patients were distinct, whereas a common genotype of S. epidermidis was isolated from the blood cultures of six patients, all of whom had acquired this infection in hospital. Three of these patients were located in a haematology ward, two on an intensive care unit and one on a dialysis unit. The data from this current study suggests that specific strains of S. epidermidis may be an important cause of nosocomial catheter-related sepsis resulting from cross-infection, and that this association would not be detected by conventional typing methods including biotyping and antibiograms.
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PMID:Is hospital-acquired intravascular catheter-related sepsis associated with outbreak strains of coagulase-negative staphylococci? 1104 6

Among the range of increasingly complex care demands made of community nurses in the UK is the support of patients undergoing cytotoxic chemotherapy at home. The NHS Cancer Plan and associated standards (Department of Health, 2000a,b) have identified that community nurses need an increased awareness and knowledge of the procedures and drugs involved to ensure a quality service provision. This article, based on a validated education course commissioned for community nurses in East Berkshire, explores key areas that enable community staff to care for and support patients through the course of their treatment and allows them to begin identifying an operational structure that promotes a quality service. Health and safety (as part of risk management) routes of administration, recognizing neutropenic sepsis associated with chemotherapy, and communication and collaboration are presented as key points identified from the course.
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PMID:Cytotoxic chemotherapy: what do community nurses need to know? 1496 59

Neisseria meningitidis, an important cause of bacterial meningitis and septicemia worldwide, is associated with high mortality and serious sequelae. Natural immunity against meningococcal disease develops with age, but the specificity and functional activity of natural antibodies associated with protection are poorly understood. We addressed this question by using a selected subset of prevaccination sera (n = 26) with convergent or discrepant serum bactericidal activity (SBA) and infant rat protective activity (IRPA) against the serogroup B meningococcal strain 44/76-SL (B:15:P1.7,16) from Icelandic teenagers. The sera were analyzed by opsonophagocytic activity (OPA) assay, immunoblotting, immunoglobulin G (IgG) quantitation against live meningococcal cells by flow cytometry, and enzyme immunosorbent assay (EIA). High levels of SBA and OPA were reflected in distinct IgG binding to major outer membrane proteins and/or lipopolysaccharide in immunoblots. However, we could not detect any specific antibody patterns on blots that could explain IRPA. Only IgM antibody to group B capsular polysaccharide (B-PS), measured by EIA, correlated positively (r = 0.76, P < 0.001) with IRPA. Normal human sera (NHS; n = 20) from healthy Finnish children of different ages (7, 14, and 24 months and 10 years) supported this finding and showed an age-related increase in IRPA that coincided with the acquisition of B-PS specific IgM antibody. The protection was independent of complement-mediated bacterial lysis, as detected by the inability of NHS to augment SBA in the presence of human or infant rat complement and the equal protective activity of NHS in rat strains with fully functional or C6-deficient complement.
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PMID:Protection by natural human immunoglobulin M antibody to meningococcal serogroup B capsular polysaccharide in the infant rat protection assay is independent of complement-mediated bacterial lysis. 1604 Sep 82

Sepsis kills more people than lung cancer, and more people than bowel and breast cancer put together. The costs to the NHS are significant; it is estimated that in Europe, patients with severe sepsis cost healthcare funders around 7.6 billion euros per year (Daniels et al, 2007). Costs in the United States are estimated at $16 billion annually (Angus et al, 2001), and in the United Kingdom up to 46% of intensive care unit (ICU) bed days are used by patients with severe sepsis (Padkin et al, 2003), with each ICU bed costing around pounds sterling1700 per day. In 2002 an international campaign was launched: the Surviving Sepsis Campaign. The main aim of this campaign is to reduce mortality from sepsis by 25% by 2009. A lot of the early work has concentrated on improving sepsis care in intensive care units, but many patients on general wards develop sepsis, and the need to educate nurses throughout all areas of the hospital has been recognized. In September 2007 a new part of the campaign was launched called Survive Sepsis, which aims to deliver sepsis education to ward nurses and junior doctors. This article discusses how to recognize severe sepsis and explains how nurses can dramatically improve a patient's chance of survival by ensuring that six simple things (Sepsis Six) are done in the first hour.
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PMID:The Sepsis Six: helping patients to survive sepsis. 1839 92

Chemotherapy, the most commonly used treatment for childhood cancer, can have a devastating effect on the immune system, reducing defences against infection, particularly bacterial infection, a common cause of life-threatening sepsis. Before they leave hospital for the first time after diagnosis, patients and carers need to understand what neutropenia is and how to monitor for and recognise signs and symptoms of infection. This article describes the approach to the nursing aspects of managing febrile neutropenia at Birmingham Children's Hospital NHS Foundation Trust. Approaches to avoiding infection at home include good hand hygiene and careful management of food, drink and the child's environment. There needs to be a balance between avoiding infection risks and allowing the child to maintain a normal social life, including attending school. Preventing infection in hospital requires similar measures to those required to prevent infection in any patient. Careful monitoring of the neutropenic child is necessary so that infection is recognised early and treatment initiated rapidly. National, evidence-based guidelines for the prevention and management of febrile neutropenia should be followed, particularly the open access policy enabling patients/carers to call for advice 24 hours a day.
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PMID:Supportive care: managing febrile neutropenia. 1950 63

NHS Education for Scotland has, in collaboration with the Scottish Patient Safety Programme, made the national early warning score (NEWS) and sepsis screening tool available as a smartphone app. The app provides: a NEWS calculator to alert clinicians to deteriorating patients and acute illness; a sepsis screening tool for the prompt recognition and initiation of treatment of patients with sepsis; an outline of the Sepsis 6 care bundle; and an algorithm to help identify organ dysfunction, severe sepsis, septic shock and when to escalate care. Go to tinyurl.com/sepsis-screening to download the app.
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PMID:Sepsis screening. 2535 21

The aminoglycoside gentamicin is commonly used in many NHS trusts to cover gram negative organisms in intra-abdominal sepsis and sepsis of unknown origin. As a result it often forms an important part of thew "Sepsis 6" protocol on surgical wards. Despite it's effectiveness, the antibiotic is well known to have nephrotoxic and ototoxic side effects, making monitoring of serum levels vital. In Hairmyres Hospital, a busy district general hospital in Lanarkshire, levels are typically taken at six to 14 hour post-dose intervals, with the result guiding further gentamicin dosing. A baseline measurement was performed highlighting that 42.2% of these levels were taken after the 14 hour limit. This was thought to have serious implications for patient's, as levels designed to protect them from side effects whilst maintain g an effective antimicrobial action were not being performed properly. As a result, a "gentamicin handover" was introduced to the wards in order to ease the workload on junior staff and improve handover between teams. During our short project the number of late levels initially dropped to 33.3% after one week, falling further to 28.6% following the second week of intervention. From our results it is clear that while more intervention is required gentamicin prescription, this project highlights how a simple intervention to improve ward handover can create a very noticeable improvement in the quality of patient care within a small time period.
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PMID:Using a simple handover to improve the timing of gentamicin levels. 2673


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