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

Twenty-eight (53%) of 53 hospital-acquired staphylococcal bacteraemias which occurred at The Royal Melbourne Hospital over a two-year period were due to methicillin-resistant Staphylococcus aureus (MRSA). Every patient with MRSA bacteraemia had a significant underlying condition predisposing to nosocomial sepsis, and each had an intravascular foreign body in situ at the time. Most were being nursed in special care areas of the hospital and had been exposed to multiple or broad-spectrum antibiotics during the month before development of bacteraemia. Patients acquiring MRSA infection should be isolated and, when the diagnosis of bacteraemia is considered, any potential primary focus should be removed. Vancomycin is the drug of choice in life-threatening MRSA infections.
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PMID:Methicillin-resistant Staphylococcus aureus bacteraemia. 702 25

Vancomycin is effective against most multiply resistant staphylococci, organisms that are becoming increasingly important in clinical medicine. Reported experience with vancomycin therapy in pediatric patients is limited. In this study vancomycin was administered intravenously to 33 patients whose ages ranged from one week to 16 years and who had suspected or proved infections caused by either Staphylococcus aureus or Staphylococcus epidermidis. The spectrum of staphylococcal infections included skin and soft-tissue infections and abscesses, osteomyelitis, pneumonia, shunt infections, endocarditis, and septicemia. All 29 patients with bacteriologically proved staphylococcal infections responded to vancomycin therapy. Peak and trough concentrations of vancomycin in serum produced satisfactory bacteriostatic and bactericidal titers against the infecting pathogens. In an anephric patient hemodialysis removed only negligible amounts of vancomycin. The amount of vancomycin that penetrated into ventricular fluid of 10 patients with shunt infections ranged from 7% to 37% (mean, 18%) of serum concentrations. One case of phlebitis and one case of transient elevation of serum levels of aspartate amino transferase were observed. No renal or otologic damage was detected in any patient. Adequate dilution of the drug, intravenous administration during 1 hr, and monitoring of the concentration in serum of patients undergoing long-term treatment and/or with impaired renal function minimize the likelihood of side effects. Vancomycin is an effective and safe agent for treatment of staphylococcal infections in pediatric patients.
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PMID:Pharmacology and efficacy of vancomycin for staphylococcal infections in children. 734 92

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

Vancomycin-resistant enterococci have emerged as important nosocomial pathogens and represent a serious threat to patients with impaired host defenses. We describe a patient with leukemia who developed prolonged colonization with vancomycin-resistant Enterococcus faecium and ultimately died of sepsis due to this multidrug-resistant organism. This case report confirms that colonization with vancomycin-resistant enterococci may last indefinitely and that asymptomatic carriage can lead to invasive infection.
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PMID:Vancomycin-resistant Enterococcus faecium sepsis following persistent colonization. 779 95

A sixteen year old female was feverish from June 12, 1993. Methicillin-resistant Staphylococcus aureus was isolated from the blood, the diagnosis of MRSA sepsis was established. Vancomycin (2 g/day) was administered for eighteen days, but MRSA was not eradicated in the blood culture. Then she was administered a combination therapy of arbekacin (200 mg/day) and imipenem/cilastain (1 g/day) for seven days, but MRSA in the blood was cultured continuously. The sequential combination therapy of netilmycin (200 mg/day) and minocycline (200 mg/day) was started, MRSA was eradicated from the blood culture after four days. The sequential combination therapy netilmycin and minocycline was seemed to be effective for MRSA infection.
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PMID:[A case of MRSA sepsis treated by the sequential combination therapy netilmycin and minocycline]. 787 75

We developed a continuous, volumetrically controlled veno-venous renal replacement system that can be operated in filtration or dialysis modes. We compared the clearances of substances with a range of molecular weights (MW) in each mode. Ten patients with acute renal failure underwent serial postdilutional hemofiltration and hemodialysis, for 30 min each, in sequence and in randomized order. All were receiving vancomycin for concurrent sepsis. The system incorporated a Filtral 10 AN69 artificial kidney; blood flow rate was 200 ml/min, and dialysate/filtrate flow rate was 25 ml/min. Sieving (SC) and diffusion (DC) co-efficients, for hemofiltration and hemodialysis, respectively, were identical for urea (MW 60; 1.01 +/- 0.05 vs 1.01 +/- 0.07) and creatinine (MW 113; 1.00 +/- 0.09 vs 1.01 +/- 0.06), and clearance equated with dialysate/filtrate flow. There was a modest difference in uric acid clearance (MW 168; SC 1.01 +/- 0.04 vs DC 0.97 +/- 0.04; p < 0.05). Vancomycin (MW 1,800) removal was 19% greater during filtration compared with dialysis (SC 0.87 +/- 0.10 vs DC 0.74 +/- 0.06; p < 0.01). For small solutes, the two modalities were equivalent. Vancomycin clearance was appreciably greater with hemofiltration, which is consistent with a greater potential for convection-based therapy in the removal of uremic and other middle molecules.
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PMID:A comparison of molecular clearance rates during continuous hemofiltration and hemodialysis with a novel volumetric continuous renal replacement system. 806 Feb 51

During the past decade, an increasing incidence of staphylococcus organisms resistant to penicillinase-resistant penicillins has necessitated the use of vancomycin. This increased utilization has revitalized research concerning efficacious vancomycin dosing regimens for premature neonates, infants, and children. Vancomycin dosing in neonates is variable because this patient population has decreased renal clearance and a larger volume of distribution than infants, children, or adults. The observation of the variability in vancomycin clearance and volume of distribution in infants with the same postconceptional age (PCA) but different gestational age (GA) suggests that the rates of maturation both extrauterine and intrauterine for disposition mechanisms of vancomycin are similar when PCAs are equal. Conditions such as patent ductus arteriosus, respiratory distress syndrome, sepsis, and asphyxia may further complicate the renal maturation process. Few investigations suggest vancomycin dosing regimens. Most of these studies propose dosing regimens based on retrospective analysis of vancomycin pharmacokinetics obtained from regimens based on physician discretion. To ensure efficacious and rational vancomycin dosing for premature neonates and infants, regimens should consider PCA as well as body weight.
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PMID:Vancomycin dosing in neonatal patients: the controversy continues. 815 9

An epidemic outbreak of Methicillin-resistant Staphylococcus Aureus (MRSA) infections affecting liver transplantation patients was detected in our hospital. In this study we describe the special characteristics of the infections and the results of prophylactic treatment with Vancomycin. Between april 1990 and december 1991, 47 patients with mean age of 54.4 +/- 10 years underwent liver transplantation. The patients were included in two chronological groups: 1) Group I: 20 patients not treated prophylactically with Vancomycin; 2) Group II: 27 consecutive patients treated with Vancomycin. Systematical cultures of body fluids for bacteria and fungi were done in every patient, and were repeated after 24 hours. The cultures were repeated again in case of sepsis. Group I patients had a significantly higher frequency of MRSA infections than group II patients. Furthermore, in patients with MRSA infection, independently of the group, duration of transplantation (p < 0.01), reoperations (p < 0.001) and prophylactic treatment with Vancomycin (p < 0.001) were significative factors. In conclusion, Vancomycin appears to be an elective prophylactic antibiotic in case of high risk of MRSA sepsis after liver transplantation.
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PMID:[Effect of antibiotic prophylaxis with vancomycin on methicillin-resistant Staphylococcus aureus infection following liver transplantation]. 835 41

We compared the in vitro activity of daptomycin, a new lipopeptide antibiotic, with that of vancomycin and other selected agents against 95 coagulase negative staphylococci (CNS) isolates causing septicemia or foreign-body infections in immunocompromised patients. These strains were classified as follows: 51 methicillin-susceptible CNS (23 slime producers); 44 methicillin-resistant CNS (23 slime producers). We also investigated the activity of daptomycin against 50 Enterococcus faecalis isolates. Minimal inhibitory concentrations (MICs) were determined by the broth microdilution method. Daptomycin at a concentration of 2 mg/L was inhibitory for all the evaluated strains. Vancomycin and ciprofloxacin showed good activity: 90% of the strains were inhibited by these agents at 8 mg/L. The activity of netilmicin, rifampin and trimethoprim-sulfamethoxazole was instead limited. Resistance to the antimicrobial agents tested was seen with increased frequency among slime producing strains. Daptomycin and teicoplanin were the most active agents tested against E. faecalis (MIC90 0.25 mg/L and 0.12 mg/L).
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PMID:Activity of daptomycin against enterococci and coagulase-negative staphylococci (CNS): relationship between CNS susceptibility and slime production. 839 25

We report a case in conjunction with MRSA sepsis, who needed re-mitral valve replacement (re-MVR) and re-tricuspid valve imposition (re-TVI), and who was successfully treated with a number of antibiotics in conjunction with hyperthermal extracorporeal circulation. Initially, we performed MVR and tricuspid valve superimposition on a 62-year-old woman lationing under the MRSA sepsis condition to control against heart failure. However, she developed a fever following the first operation, and MRSA was detected from her blood cultivation. She thus underwent treatment employing many kinds of antibiotics. A thickened C.E. valve at the tricuspid valve cardiac echogram suggested PVE, we performed a second operation of re-MVR and re-TVI about a year after the first operation. We used a tangl of antibiotics during the operation, adding Vancomycin into the extracorporeal circulation, and utilized hyperthermal extracorporeal circulation. This patient's postoperative course was uneventful, with no recurrence arising at 23 months after the second operation.
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PMID:[Case report of MRSA sepsis required two valve replacement twice a year--trying case with hyperthermal extracorporeal circulation]. 840 17


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