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)

In a prospective, randomized, comparative study, patients undergoing elective major colorectal surgery received four six-hour doses of either sulbactam (a beta-lactamase inhibitor) with ampicillin (1 gm with 1 gm), or cefoxitin (2 gm) commencing at induction of anesthesia. The groups were well matched for age, sex, diagnosis, and surgical procedures. Three patients in the sulbactam group (N = 44), and four in the cefoxitin group (N = 48) developed significant wound sepsis. Minor wound sepsis occurred in an additional four sulbactam patients, and in five cefoxitin patients. There was no difference between the groups in deep sepsis or anastomotic leak rates (sulbactam, four patients; cefoxitin, seven patients). No serious side effects were recorded in either group. These results suggest that sulbactam combined with ampicillin provides a safe, effective alternative to cefoxitin for prophylaxis in colorectal surgery.
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PMID:Sulbactam/ampicillin compared with cefoxitin for chemoprophylaxis in elective colorectal surgery. 300 35

During the first 6 years after appearing in one hospital, a 92-kilobase conjugative plasmid, pBWH1, which encoded resistance to chloramphenicol and sulfonamides and determined TEM-1 beta-lactamase and 2''-aminoglycoside nucleotidyltransferase, underwent a variety of molecular changes. It was most prevalent initially in isolates of Klebsiella pneumoniae, then in isolates of Serratia marcescens, and finally, after nearly disappearing, in isolates of Enterobacter cloacae. Evolutionary changes in the plasmid did not account for its shifts in species distribution, since the original molecule was found in isolates of each species. The late resurgence of pBWH1 occurred after a copy of its original molecule entered a distinctive ornithine decarboxylase-negative strain of E. cloacae, new to the hospital. The resulting transconjugant strain, chromosomally resistant to topical silver salts and to cephalosporins, and with the addition of pBWH1-encoded aminoglycoside resistance, spread in the hospital by causing an outbreak of sepsis in the burn unit, where these were commonly used antibacterial agents. Thus, an endemic plasmid became prevalent in a new host species because one of its genes supplemented the fitness of an uncommon strain of the species for a particular clinical niche.
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PMID:Molecular evolution, species distribution, and clinical consequences of an endemic aminoglycoside resistance plasmid. 301 Aug 49

Sulbactam is a beta-lactamase inhibitor that, when combined with ampicillin, gives the latter antibiotic a broad spectrum of activity, making it suitable for use as a prophylactic agent in acute appendicitis. In a single-blind, randomized trial, the efficacy of sulbactam plus ampicillin was compared with that of metronidazole plus cefotaxime. Thirty-five children undergoing appendectomy received intravenous sulbactam and ampicillin, while 38 children received metronidazole and cefotaxime. Single doses were given unless the appendix was considered gangrenous or perforated, in which case the drugs were administered for 72 hr. There were three wound infections in the group given sulbactam and ampicillin and five in the group given metronidazole and cefotaxime. The combination of sulbactam and ampicillin was well tolerated and appeared to be at least as effective as that of metronidazole and cefotaxime in the prevention of sepsis following appendectomy.
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PMID:A randomized comparative study of sulbactam plus ampicillin vs. metronidazole plus cefotaxime in the management of acute appendicitis in children. 302 17

During a 10-year period, four patients with leukemia were identified who had Branhamella catarrhalis septicemia. Two patients had acute leukemia and the remaining two had chronic myelogenous leukemia with blastic transformation. All patients were febrile and neutropenic at the onset of the septicemia. After appropriate antibiotic therapy, they recovered from their infection despite persistence of neutropenia. Because beta-lactamase-producing bacteria are an increasing cause of nosocomial infections, treatment should be selected to cover them.
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PMID:Branhamella catarrhalis septicemia in patients with leukemia. 313 Jan 77

(ABSTRACTOne hundred and fifty five strains of Neisseria gonorrhoeae were regrown from 216 freeze dried cultures originally isolated in Zimbabwe. The gonococci were from men (61 strains) and women (39 strains) attending a referral sexually transmitted diseases (STD) clinic, from women presenting for delivery at hospital with signs of sepsis (22 strains) or with an asymptomatic infection (16 strains), and from babies with ophthalmia neonatorum (17 strains). Seventy five of the 100 isolates from STD clinic patients and 29 of the 55 isolates from hospital patients were penicillinase producing N gonorrhoeae (PPNG). Two thirds of all PPNG strains contained the 24.5 megadalton conjugative plasmid. The 3.2 megadalton resistance plasmid, usually associated with PPNG strains originating in Africa, was present in only one third of the PPNG strains. The 2.6 megadalton cryptic plasmid was present in all strains. Prototrophic and proline requiring auxotypes predominated in both PPNG and non-PPNG strains. Arginine requiring auxotypes were found in four of the 16 isolates from asymptomatic women, whereas three of the 22 strains from women with puerperal sepsis and four of the 61 strains from men with urethritis required both proline and arginine. Fifty eight out of 66 PPNG strains with the 4.4 megadalton plasmid required proline compared with 22/38 PPNG strains with the 3.2 megadalton plasmid and 20 of the 51 non-PPNG strains. Three quarters (38/51) of non-PPNG strains belonged to serogroup WII/III as did 42/66 PPNG strains with the 4.4 megadalton plasmid but only 10/38 PPNG strains with the 3.2 megadalton plasmid. In all, 23 different strain types could be recognized on the basis of plasmid content, auxotype, and serogroup. There was, however, a high degree of homogeneity between PPNG and non-PPNG isolates.
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PMID:Characterisation by plasmid profiles, serogroups, and auxotypes of Neisseria gonorrhoeae from Harare, Zimbabwe. 314 9

Gonorrhea prevalence in pregnant women in the United States is generally low (less than 1%), although the prevalence in certain subsets of the population remains a matter of concern. Rates of 10% have been found in some central city adolescent prenatal clinics. Rates as high as this are quite often found in developing countries. The risks of transmission to the newborn are well studied for ophthalmia neonatorum and are 30%-40%. The risks of disseminated gonococcal infection of the newborn (sepsis or arthritis) are unmeasured, but are clearly rare events. In developing countries, maternal gonorrheal infection has been linked to premature delivery, which had been previously suggested in earlier studies in the United States. There is no evidence that the increasing occurrence of penicillinase-producing Neisseria gonorrheae (PPNG) affects maternal-neonatal transmission other than to require alternative therapy.
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PMID:Gonorrhea in the newborn. 314 11

The choice of treatment, the importance of chemoprophylaxis in household contacts and the potential impact of immunization with vaccines against Haemophilus influenzae type b (Hib) currently under investigation are discussed on the basis of the patients hospitalized for invasive Hib infections at the University Children's Hospital Geneva from 1976 to 1985. Among 122 culture-proven infections due to Hib, there were 41% of cases of meningitis, 37.7% of epiglottitis, 9.8% of pneumonia, 5.7% of septicemia, 3.3% of cellulitis and 2.4% of septic arthritis. From 1981 to 1983, one strain of Hib produced beta-lactamase, but between 1984 and 1985, 5 strains (19.2%) produced beta-lactamase. Only one case of possible horizontal transmission of the infection was found in this 10-year period. We conclude that 1. the appearance of beta-lactamase producing strains of Hib requires that treatment be initiated with an antimicrobial agent resistant to beta-lactamase when a Hib infection is suspected; 2. in our region, only one case of an invasive Hib infection could theoretically have been prevented by chemoprophylaxis; and 3. the calculated theoretical impact of vaccination with the new types of vaccines against Hib could have prevented 106 of 122 cases of invasive Hib infections.
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PMID:[Systemic infections due to type b Haemophilus influenzae. A retrospective study of 114 cases]. 326 4

Ticarcillin disodium/clavulanate potassium and other beta-lactamase inhibitor/penicillin combinations have been recognized recently as broad-spectrum drugs that have a major role in chemotherapy for serious surgical sepsis. Their spectrum of activity allows the economical substitution of ticarcillin disodium/clavulanate potassium for anaerobe-active cephalosporins and for the traditionally used combination of clindamycin and an aminoglycoside. Indeed, the ticarcillin disodium/clavulanate potassium spectrum was judged to be broader than that of the other agents while maintaining comparable or superior clinical efficacy and safety. The beta-lactamase inhibitor combinations have also proven their economical application to the prevention of infections after trauma and elective surgery, although those indications have not been well accepted. The timing seems to be right for the expanded use of these combinations in order to lower therapeutic and prophylactic costs. This concept is concurrent with the critical assessment of the cost effectiveness, safety and usable spectrum of older therapeutic regimens. However, some of the traditional nonpenicillin treatment modalities must be maintained for those patients with a penicillin allergy.
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PMID:Implications of beta-lactamase-inhibitor combinations. 329 2

Because of the high incidence of beta-lactamase production among bacteria that are found commonly in pelvic infections in women, beta-lactamase-inhibiting antibiotics should prove effective in treating those infections. In a randomized, comparative study of 47 women with intraabdominal infections, 23 received ticarcillin disodium/clavulanate potassium, and 24 received cefoxitin. Among the infections treated were endometritis, pelvic inflammatory disease, amnionitis, salpingitis, septicemia, intraabdominal abscess and pelvic abscess. The bacteriologic response to ticarcillin disodium/clavulanate potassium was 88.8% success as compared with 87.5% for cefoxitin. Clinical cures were achieved in 98.8% of patients treated with ticarcillin disodium/clavulanate potassium and 90.9% of patients treated with cefoxitin. The adverse reactions were diarrhea, transient eosinophilia and transient thrombocytosis.
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PMID:Infection in women. Clinical experience with beta-lactamase inhibitors. 329 5

Infections of the respiratory tract are among the most common causes for antibiotic prescribing. Their diagnosis within the community is generally limited to clinical criteria, and microbiological information is frequently lacking. Hospitalised patients with respiratory tract infections are more likely to undergo diagnostic sampling, but difficulties remain in reliably defining a microbial aetiology, thereby providing a confident basis for antibiotic selection. In considering the role of the cephalosporins in the treatment of respiratory tract infections, over 500 published articles have been reviewed. The pharmacokinetic considerations are discussed and the limitations of existing methodology are emphasised. Individual agents are reviewed by site of sepsis and conclusions are drawn from both comparative and non-comparative studies and in relation to currently recommended regimens. Although oral cephalosporins are widely used to treat upper respiratory tract infections, none is considered ideal, especially where Haemophilus influenzae is pathogenic. In the case of lower respiratory tract infections the beta-lactamase stable parenteral cephalosporins have become widely used to treat pneumonia in hospitalised patients, especially where Gram-negative enteric bacilli are of aetiological importance. However, the lack of activity of these drugs against Legionella spp., Mycoplasma pneumoniae and Coxiella burnetii must be emphasised. Another area of increasing use is in the treatment of infective exacerbations in patients suffering from cystic fibrosis of the lungs where Pseudomonas aeruginosa is pathogenic; ceftazidime in particular has proved a useful alternative to earlier antipseudomonal penicillin antibiotics.
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PMID:Treatment of respiratory tract infections with cephalosporin antibiotics. 331 1


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