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)

A survey was done to determine how burn wound microbial monitoring is performed and how topical antimicrobial agents are employed. The survey was sent to 90 burn-care facilities, which comprised most of the major burn centers in the United States. The survey contained questions concerning frequency and techniques of wound monitoring, personnel involved in monitoring, as well as questions about how decisions were made to initiate topical antimicrobial therapy, which agents were selected, and how they were administered. Sixty of 90 facilities (66%) responded to the survey. Although there were few areas of unanimous agreement, several trends did emerge. Most facilities monitored burn wounds for microbes (92%). Wound monitoring was typically done at least twice weekly by either surface swab or quantitative biopsy. Nursing staff played a significant role in specimen collection in 69% of facilities and were solely responsible for obtaining biopsy specimens in 29% of facilities that used biopsies exclusively. All responding facilities used topical antimicrobial agents; silver sulfadiazine was the most popular (95%). Only 33% of facilities surveyed had their own laboratory for microbial monitoring. Rapid techniques for early diagnosis of wound sepsis were used in 20% of units, and topical antimicrobial testing was used in 17% of facilities surveyed.
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PMID:A survey of wound monitoring and topical antimicrobial therapy practices in the treatment of burn injury. 224 12

Three hundred and forty-two patients with 10-50 per cent body surface area burns were studied prospectively over the 5-year period from 1982 to 1986 for the effectiveness of topical 1 per cent silver sulphadiazine. Various parameters were studied including: (i) healing time of deep partial skin thickness burns, (ii) eschar separation time, (iii) conversion rate of deep dermal burns to full skin thickness burns, (iv) burn wound surface bacterial flora and their changing pattern over the years, (v) incidence of invasive sepsis and (vi) overall mortality. There was a remarkable decrease in the time taken for the healing of deep dermal burns, and the conversion rate of deep dermal burns to full skin thickness was significantly reduced. Eschar separation was delayed considerably. There was a total change in the predominent surface micro-organisms from Staph. aureus, which was predominant in 1982, to pseudomonas species and klebsiella in 1986. Moreover, there was the emergence of a new variety of micro-organism within the last 2 years. The incidence of invasive infection and overall mortality was significantly reduced.
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PMID:Long-term experience with 1 per cent topical silver sulphadiazine cream in the management of burn wounds. 251 45

Pilot in vitro studies demonstrated that nystatin combined with Silvadene (silver sulfadiazine 1% [Marion Laboratories, Inc., Kansas City Mo.]) or Furacin in a 1:1 ratio was equally effective against Candida albicans and ATCC strains of Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, but Sulfamylon (Winthrop Pharmaceuticals, Winthrop, N.Y.) combined with nystatin demonstrated an antagonistic response. Therefore we examined the susceptibility to nystatin of 165 clinical isolates, both gram-positive and gram-negative, to nystatin combined with Silvadene or Sulfamylon and 144 isolates to nystatin and Furacin. Both Silvadene and Furacin combined with nystatin were equally effective against the microorganisms as were the individual drugs. Conversely, Sulfamylon combined with nystatin lost its antimicrobial capability (93.3% resistance, p less than 0.001). On the basis of the in vitro results, 93 patients with acute burns were treated with the appropriate topical antimicrobials from April 1988 to September 1988. Of the 93 patients treated, 90 had neither a major systemic bacterial nor a Candida sepsis, and none of these patients had associated localized burn wound sepsis during their hospital stays. These 90 patients were discharged without any documented signs of infection. The average burnsize was greater than or equal to 29.44% total body surface area. These data suggest that the antimicrobial properties of nystatin, when combined with Silvadene and Furacin, remain effective. Consequently, such combinations have been effective in controlling both local and systemic Candida and bacterial burn wound sepsis.
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PMID:The efficacy of nystatin combined with topical microbial agents in the treatment of burn wound sepsis. 260 98

A comparative study of patients receiving or not receiving topical applications of 1 per cent silver sulphadiazine cream as treatment for burn wounds has shown that the drug is still effective in significantly reducing the amount of bacterial contamination of burn wounds, even after 15 years of use in our Burn Unit. Consequently the overall mortality due to burn wound sepsis has been decreased in this Burn Unit.
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PMID:Assessment of topical therapy of the burn wound with silver sulphadiazine after its use for 15 years in a burn unit. 275 70

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

The therapeutic and prophylactic effects of nylon dressings coated with metallic silver in a direct current circuit have been examined in a rat model of fatal burn wound sepsis. Male Sprague-Dawley rats weighing 325 +/- 25 grams with 20% full-thickness scald injuries were used. Therapeutic effects were examined at 4 or 24 hours after surface inoculation with a lethal dose of Pseudomonas aeruginosa (Strain 59-1244). When used as a surface anode with an implanted silver needle cathode, the silver nylon was therapeutic at currents between 0.4 and 40 microA when applied at either test time and continued for 5 days (p less than 0.001). When used as a cathode, silver nylon was not effective. Nylon cloth without a silver metal coating was not effective without applied current or when used as an anode. Silver nylon dressings placed at 4 hours after inoculation but without applied current showed significant effectiveness (p less than 0.01). This effect, however, was significantly less than that seen with silver nylon used as an anode (p less than 0.001). Barrier prophylactic effects were examined by placing silver nylon or uncoated nylon on burn wounds before inoculation with Pseudomonas aeruginosa. The uncoated nylon had no barrier effect. Silver nylon was found protective but applied current was not required for significant (p less than 0.001) barrier effect. These results indicate silver nylon dressings may be a valuable antimicrobial burn wound covering device.
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PMID:Therapeutic effects of silver nylon dressings with weak direct current on Pseudomonas aeruginosa-infected burn wounds. 317 11

I retrospectively reviewed a series of 402 patients treated for diverticulitis at Holy Cross Hospital in Silver Spring, Maryland. Patients were identified as medical or surgical, depending upon the service to which they were admitted. Patients aged 50 years or younger comprised 17.4% of the entire series and had no more severe or aggressive disease than older patients. Those in the medical series were older and had a lower operative rate, a higher rate of postoperative complications, and more bleeding. The total operative mortality was 4.7% and was essentially the same for both groups. Sepsis and immunosuppression can be particular hazards. Leukocytosis and fever were not reliable predictors of outcome.
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PMID:Diverticulitis: management patterns in a community hospital. 326 54

The increased incidence of Candida burn wound infection and septicemia in massively burned patients is well known. One thousand thirty six patients were admitted from January 1982 through December 1986. Nystatin prophylaxis, both oral and topical, was initiated in October 1984 and 472 patients were treated. The control group was comprised of the 564 patients treated January 1982 through September 1984. There was a significant difference (p less than 0.005) between the groups in the number of Candida colonized patients, the numbers of Candida burn wound infections, the incidence of multi-organ system involvement/failure, and the occurrence of Candida sepsis. There has not been a Candida burn wound infection in this institution since June 1985. Nystatin, given orally as a 'swish and swallow' or mixed 1:1 with either silver sulfadiazine or polymyxin B/bacitracin, has eradicated Candida burn wound infections and septicemia from this institution and thus obviated the need for systemic antifungals such as amphotericin B.
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PMID:Eradication of Candida burn wound septicemia in massively burned patients. 327 19

During the 10-year period July 1977 to June 1987, 23 patients were referred to one surgical department with hepatic hydatid cysts. Accurate diagnosis in all but one case was possible by hydatid serology (hydatid immunoelectrophoresis and enzyme-linked immunosorbent assay), and ultrasonography or computed tomography which showed the presence of daughter cysts. Endoscopic retrograde cholangiography demonstrated the presence of hepatic-duct hydatid cysts in one case. The probable source of the hydatid infection was identified in all 23 cases. The surgical management was standardized and included the use of a suction cone to prevent spillage; the closure of biliary communications under vision; 0.5% silver nitrate solution as the scolicidal agent; primary closure of the residual cavity without drainage; omentoplasty for infected cysts; and bile-duct exploration and operative choledochoscopy for choledochal hydatid cysts. Two hepatic wedge resections were performed for hydatid cysts in a Riedel's lobe, but formal liver resection, in which normal liver tissue was sacrificed, was not necessary. There was no mortality and there were no postsurgical hepatobiliary complications such as biliary fistulas, biliary sepsis or jaundice. Three (13%) recurrences were recognized; all three recurrences occurred about five years after the removal of hydatid cysts with numerous daughter cysts, which were located in multiple cavities in both lobes of the liver. Postsurgical surveillance for several years by annual clinical review, hydatid immunoelectrophoresis testing and ultrasonography is recommended.
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PMID:Current management of liver hydatid cysts: results of a 10-year study. 329 Jun 33

Burn wound therapy with silver-kaolin, a topical agent applied as an aerosol spray, was evaluated in male rats given a 20 per cent total body surface area, full thickness dorsal scald burn. Burn wounds treated with silver-kaolin healed at rates comparable to untreated wounds. No significant differences were noted in the numbers or types of organisms colonizing the wounds of treated and untreated rats at 5, 12 and 19 days post-burn. To evaluate the effectiveness of silver-kaolin in treating burn wound sepsis, rats were inoculated on the wound surface with 2.5 x 10(8) Pseudomonas aeruginosa. This inoculum resulted in 100 per cent mortality in untreated rats. Rats treated with silver-kaolin had a mortality rate of 71 per cent, compared to a 9 per cent mortality rate in rats treated with 1 per cent silver sulphadiazine. When silver-kaolin was applied to the wound prior to bacterial inoculation, the mortality rate was reduced to 6 per cent. When wounds were treated with kaolin alone and then inoculated with bacteria, the mortality rate was 50 per cent, indicating that part of the effectiveness of silver-kaolin appeared to be due to a barrier effect. These results indicate that silver-kaolin may be useful for preventive topical antimicrobial therapy of acute burns or after wound debridement or excision, but is not suitable for therapy of wounds previously colonized by microorganisms.
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PMID:Evaluation of topical therapy with silver-kaolin (Argostop) in an experimental model of burn wound sepsis. 366 17


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