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

The role of ICU support in BMT patients is controversial. In an era of constrained resources, the use of prognostic factors predicting outcome may be helpful in identifying patients who are most likely (or unlikely) to benefit from this intervention. We attempted to define the survival of patients admitted to ICU following autologous or allogeneic BMT and to identify those factors important in determining patient outcome. A retrospective study of all adult BMT recipients admitted to intensive care over a 6 year study period was performed to determine overall and prognostic indicators of poor outcome. Pre-treatment, pre-ICU admission and ICU admission data were analyzed to identify factors predicting long-term survival. 116 patients were admitted to ICU on 135 separate occasions with the primary reasons for admission being respiratory failure (66%), sepsis associated with hypotension (10%), and cardiorespiratory failure (8%). No pre-ICU characteristics were predictive of survival. Univariate analysis identified the number of support measures required, the need for ventilation or hemodynamic support, the APACHE II score, the year of ICU admission and the serum bilirubin as significant predictors of post-discharge survival. On multivariate analysis the year of ICU admission, the need for hemodynamic support and the serum bilirubin remained significant. The APACHE II score significantly underestimated survival in the 46% of patients with scores less than 35, and could only be used to predict 100% mortality when it exceeded 45. Twenty-three percent of all BMT patients admitted to the ICU and 17% of ventilated patients survived to hospital discharge. Of the 27 patients surviving to leave hospital, 16 remain alive with a median follow-up of 4.2 years and a mean Karnofsky performance status of 90. Although mortality in BMT recipients admitted to ICU is high our results indicate that intensive care support can be lifesaving and that the outcome in patients requiring ventilation and ICU support may not be as poor as has been previously reported. No single variable was identified which could be used to predict futility but patients requiring both hemodynamic support and mechanical ventilation, and those with an APACHE II score greater than 45 have a very poor prognosis and are unlikely to benefit from lengthy ICU support.
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PMID:Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors. 957 10

A radiation-free, non-myeloablative, myelosuppressive protocol, containing dibromomannitol and cytosine arabinoside, that remarkably reduced the frequency of transplant-related complications, such as veno-occlusive liver disease (VOLD), severe mucositis, bacterial sepsis, hemorrhagic cystitis, interstitial pneumonitis, has been applied in 19 CML patients, allotransplanted from identical siblings. Five patients were in accelerated phase. Acute GVHD developed in two patients and chronic GVHD occurred in 66% of patients. Follow-up was 3 to 7 1/2 years. Although only eight patients were under 30 years of age, and only two patients had a history of less than 1 year, the leukemia-free survival was 82%. There were four hematological relapses. The reduction in post-BMT complications has greatly enhanced quality of life. The nurses reported significant reduction of work-load. Savings in eliminating the need for irradiation, parenteral nutrition, and several antibiotics are also remarkable. The remarkable reduction of certain transplant-related complications shows some advantage against busulphan-preconditioning.
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PMID:Reduction in the frequency of transplant-related complications in patients with chronic myeloid leukemia undergoing BMT preconditioned with a new, non-myeloablative drug combination. 960 96

Bacterial and fungal infections in pediatric BMT recipients are major causes of morbidity and mortality, although less than those in the adult BMT population. Early in the post-BMT period, when patients are neutropenic, the predominant pathogens are Gram-negative bacteria, mainly E. coli, K. pneumoniae and P. aeruginosa; Gram-positive bacteria, mainly coagulase-negative staphylococcus, S. viridans and E. faecalis; and fungi, mainly Candida spp. and Aspergillus spp. The emerging resistance of a variety of pathogens is of major concern and limits the use of prophylactic antibiotics. Mortality from invasive fungal infections is much greater than that caused by bacterial pathogens. Many centers are currently using prophylactic fluconazole, which may lead to emergence of infections with C. krusei and T. glabrata. Patients with GvHD are at continuous risk from bacterial and fungal pathogens. Late in the post-BMT period, S. pneumoniae may cause septicemia, meningitis, pneumonia and other respiratory infections. This may occur months or years following transplantation, with a significant mortality rate in patients with chronic GvHD. Development of rapid and reliable diagnostic methods for identifying fungal pathogens and of new therapeutic approaches for treating invasive fungal infections are now our greatest future challenges.
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PMID:Bacterial and fungal infections in children undergoing bone marrow transplantation. 963 Mar 34

Long term effects of BMT in thalassemia were monitored in 33 patients transplanted between 1987 and 1995 and compared with 155 patients matched for age and treated during the same period with conventional therapy (CT). The incidence of fulminant sepsis and growth impairment was significantly higher in transplanted patients, whereas the occurrence of hypothyroidism, hypogonadism, and cardiopathy was higher in CT patients. For diabetes, liver disease, and severe infections, the differences were not statistically significant. After BMT we performed monthly erythrocytaferesis for iron removal in 23 (70%) patients, obtaining a complete normalization of iron stores in 91% of cases; among untreated patients, 60% had evidence of iron up to 8.3 years after BMT. Protection against poliovirus, tetanus, diphtheria, and hepatitis B has been lost in 74%, 47%, 78%, and 44%, respectively. After BMT a careful follow-up is needed to monitor and treat late transplant-related and thalassemia-related complications.
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PMID:Late effects of bone marrow transplantation for thalassemia. 966 51

A 52-year-old female underwent autologous BMT because of acute myeloid leukaemia FAB M4 in second remission. Since the patient had no HLA-identical sibling she received a purged autologous BM transplant. On day +5 she developed signs of a sepsis syndrome with fluid retention and was treated with broad-spectrum antibiotic therapy. However, her body weight remained high, ascites and an increase of total serum bilirubin and alkaline phosphatase developed. The icterus worsened to a total bilirubin level of 25 mg/100 ml. Sonographic and endoscopic imaging showed a dilated gall bladder but disclosed a post-hepatic cause for the icterus. A transjugular liver biopsy on day +71 revealed severe cholestasis and siderosis. The patient remained aplastic with constantly increased bilirubin levels. On day +73 septic shock syndrome occurred and the patient died of multiorgan failure 3 days later. At autopsy, a highly differentiated bile duct adenocarcinoma at the porta hepatis, so-called Klatskin tumour, was found, explaining the fatal course with intractable cholestasis.
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PMID:Bile duct adenocarcinoma mimicking veno-occlusive disease after autologous bone marrow transplantation for acute leukaemia. 967 64

Episodes of bacteraemia during the aplastic phase were studied in 500 allogeneic bone marrow (BMT) recipients, regarding incidence, microbial aetiology, risk factors, mortality and causes of death. One hundred and sixty-four patients (33%) had at least one positive blood culture. Gram-positive cocci (alpha-streptococci and coagulase-negative staphylococci) were found in 146/164 cases (89%). Gram-negative bacteria were present in only seven cases. Receiving marrow from an unrelated donor was the only significant risk factor for bacteraemia in univariate regression analysis. Within 60 days after BMT, 69/500 patients died. The mortality rate was significantly higher among those with positive blood cultures during the aplastic phase, 44/164 (27%) than in those without bacteraemia, 25/336 (7%). Death directly caused by sepsis was unusual in patients with alpha-streptococci or CNS-bacteraemia (8/146, 5%). In contrast, three of seven patients with gram-negative bacteraemia died of the infection. However, in patients with bacteraemia, 21 of 44 deaths were attributable to invasive fungal infections (18 candida, three aspergillus; autopsy findings). Among patients with negative blood cultures during the aplastic phase, 6/25 died of invasive fungal infection (three candida, one saccharomyces and two aspergillus). This indicates that early bacteraemia is associated with death from invasive fungal infection. Therefore, efforts to shorten the neutropenic period after BMT, prevention, early detection of invasive fungal infections and adjustments of immunosuppressive regimens when marrow from an unrelated donor is used, may improve the outcome after BMT.
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PMID:Bacteraemia during the aplastic phase after allogeneic bone marrow transplantation is associated with early death from invasive fungal infection. 982 78

Three patients with ANLL developed Fournier's gangrene as an early complication after allo-BMT (two cases) and auto-BMT (one case); two patients were in first CR, the third had resistant disease. Patients developed fever, perineal pain, swelling and blistering of the genital area. Pseudomonas aeruginosa was isolated from the lesions and patients received systemic antibiotic therapy, surgical debridement and medication with potassium permanganate solution. Two patients made a complete recovery although one died of sepsis. The third had progressive involvement of the abdominal wall and later died of leukemia. Early diagnosis of this disorder and prompt initiation of appropriate therapy can prevent progression of this acute necrotizing infection.
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PMID:Fournier's gangrene: a clinical presentation of necrotizing fasciitis after bone marrow transplantation. 984 2

The objective of this study was to define the type, the incidence and the outcome of early infectious complications (mean interval between day 1 post-BMT and the onset of fever was 9+/-3 days) occurring in granulocytopenic bone marrow transplant recipients, requiring medical intensive care unit admission. Over a five-years period, forty-one patients with microbiologically confirmed infection were enrolled, with a statistically significant higher frequency of allogeneic marrow transplant recipients (51%, p < 0.02). Infectious pneumonia occurred in 24 patients (59%), septicemia with septic shock in ten patients (24%), catheter-related infection in 5 patients (12%) and meningitis in 2 patients (5%) (p < 0.001). Twenty-six patients died (63%). Among the patients with confirmed infectious pneumonitis, which occurred most frequently in allogeneic marrow recipients (p < 0.02), 16 died (67%). This poor outcome was related to the requirement of mechanical ventilation. Eight patients (80%) with septicemia and septic shock and the two patients with meningitis died. Bacteria (Pseudomonas aeruginosa and Staphylococcal species) were the most common isolated in bronchoalveolar lavage fluid and blood cultures. We found a lower incidence of fungal or viral infections compared to previous studies. Empiric antimicrobial therapy in the cases of patients admitted in ICU may be included antibiotics anti-Pseudomonas and anti-Staphylococcus, as the ecology of hematology unit. The requirement of mechanical ventilation is the main adverse prognostic factor in transplanted patients. At ICU admission, patients with hepatic failure combined with respiratory failure represented a subgroup with a dismal prognosis.
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PMID:Early infectious complications after bone marrow transplantation requiring medical ICU admission. 992 26

Current guidelines for the treatment of catheter-related bacteraemia (CRB) advise against central venous catheter (CVC) exchange because of the potential risk of prolonging infection. However, there are no consistent data proving this recommendation. We evaluated prospectively the usefulness of CVC exchange by guidewire for the treatment of CRB in patients undergoing BMT or intensive chemotherapy. CVC exchange was considered when fever and positive blood cultures persisted after 2 days of adequate antimicrobial therapy and no potential source of bacteraemia other than CVC could be identified. The guidewire exchange was preceded and followed by a slow infusion of adequate antimicrobial therapy. Bacteraemia was confirmed as catheter-related by demonstrating concordance between isolates from the tip and blood cultures by pulsed-field electrophoresis of genomic DNA. This procedure was performed in 19 episodes of bacteraemia during a 1-year period. Fourteen episodes (74%) were catheter-related and 71% of these were due to coagulase-negative staphylococci. Guidewire replacement was accomplished uneventfully 4 days after development of sepsis (range 3-6). In all cases, clinical signs of sepsis disappeared in less than 24 h after replacement. Definitive catheter withdrawal was carried out a median of 16 days (range 3-42) after guidewire exchange; in all cases, the tip culture was negative. We conclude that CVC replacement by guidewire under adequate antimicrobial therapy may be a reasonable option for the treatment of CRB when antimicrobial therapy alone has been unsuccessful.
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PMID:Central venous catheter exchange by guidewire for treatment of catheter-related bacteraemia in patients undergoing BMT or intensive chemotherapy. 1003 49

Encapsulated bacteria infections (EBI) can cause severe complications after BMT, usually occurring in patients with chronic GVHD (cGVHD) and attributed to functional hyposplenism. Using ultrasound (US) scan, we measured spleen size in 22 patients transplanted from HLA identical siblings, with or without cGVHD. No patient had received TBI, spleen irradiation or penicillin prophylaxis. Results were correlated with occurrence of EBI during a mean follow-up of 55 months (range 7-93). In the group without cGVHD, the difference between pre- and post-BMT spleen longitudinal diameters was not significant, and no patient developed EBI. In the cGVHD group, post-BMT spleen longitudinal diameters were significantly smaller than those pre-BMT (9.1+/-1.6 vs. 12.3+/-2.2; P = 0.0005). Out of four patients with cGVHD who showed a major spleen size reduction, two developed a severe infection (an overwhelming sepsis and a pneumococcal meningitis). In our small series, we found a borderline relationship between spleen size reduction and duration of cGVHD (P = 0.06), as well as an increased risk of life-threatening infection in patients with extensive cGVHD and hyposplenism as detected by US scan. We conclude that US scan may be useful to detect spleen size reduction following allogeneic BMT and that penicillin prophylaxis is to be strongly recommended in patients with extensive cGVHD and spleen size reduction, even in those who have not received total body or spleen irradiation.
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PMID:Spleen sizing by ultrasound scan and risk of pneumococcal infection in patients with chronic GVHD: preliminary observations. 1045 46


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