Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Immunoblotting sera from 26 patients with septicemia due to an epidemic strain of methicillin-resistant Staphylococcus aureus (EMRSA-15), 6 of whom died, revealed an immunodominant EMRSA-15 antigen at 61 kDa. There was a statistically significant correlate (P < 0.001) between survival and immunoglobulin G to the 61-kDa band. The antigen was identified by sequencing positive clones obtained by screening a genomic expression library of EMRSA-15 with pooled sera from patients taken after the septicemic episode. Eluted antibody reacted with the 61-kDa antigen on immunoblots. The amino terminus was obtained by searching the S. aureus NCTC 8325 and MRSA strain COL databases, and the whole protein was expressed in Escherichia coli TOP 10F'. The derived amino acid sequence showed homology with ABC transporters, with paired Walker A and Walker B motifs and 73% homology to YkpA from Bacillus subtilis. Epitope mapping of the derived amino acid sequence with sera from patients who had recovered from EMRSA-15 septicemia delineated seven epitopes. Three of these epitopes, represented by peptides 1 (KIKVYVGNYDFWYQS), 2 (TVIVVSHDRHFLYNNV), and 3 (TETFLRGFLGRMLFS), were synthesized and used to isolate human recombinant antibodies from a phage antibody display library. Recombinant antibodies against peptides 1 and 2 gave logarithmic reductions in organ colony counts, compared with control groups, in a mouse model of the infection. This study suggests the potential role of an ABC transporter as a target for immunotherapy.
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PMID:Identification of an immunodominant ABC transporter in methicillin-resistant Staphylococcus aureus infections. 1081 64

A 50-year-old woman was admitted to our hospital because of MRSA septicemia caused by a contaminated permanent pacemaker lead. A pacemaker system was successfully removed under cardiopulmonary bypass support. Postoperative antibiotics was administered for 7 weeks. Total removal of a pacemaker system under cardiopulmonary bypass support is the treatment of choice in a case with pacemaker infection associated with MRSA septicemia.
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PMID:[MRSA septicemia caused by an infected pacemaker lead: a case report with a review of Japanese literatures]. 1089 71

Although microorganisms are the main cause of nosocomial infections, they are by no means their only determinants. Patient-associated factors play a major role (especially immune status), the therapeutic conditions (personnel behaviour, 'devices') and the patient's environment. The hospital infection control team is responsible for implementing and operating an efficient and cost-effective infection control and prevention system. Scientific data must be evaluated and every effort made to continuously improve recommendations. In order to implement an efficient and cost-effective infection control and prevention system, the infection control team must formulate sound, evidence-based recommendations and question established 'rituals'. Inappropriate measures, e. g. the routine disinfection of floors in wards and hallways place a burden on staff, patients and the environment, and distract staff from other critical measures such as proper hand hygiene. Nosocomial pneumonia, urinary tract infections, surgical wound infections and catheter-associated sepsis are the commonest hospital-acquired infections, and Intensive Care Units have become the foci of antibiotic resistance. Although the antimicrobial resistance situation is better in Germany than in other countries, e. g. Eastern and Southern European countries and the USA, substantial regional differences exist. The increase in methicillin (oxacillin) resistant S. aureus (MRSA) is particularly worrying. Building up an effective surveillance system for nosocomial infections, as demanded by the new German infection control act has far-reaching implications and entails recording risk-adjusted infection rates (KISS project = Hospital Infection Surveillance System of the National Reference Center for Hospital Hygiene in cooperation with the Robert Koch-institute). Proper collaboration between hospital staff in implementing infection control measures, and especially hand hygiene is of paramount importance.
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PMID:[Current challenges on hospital hygiene]. 1153 77

An analysis of the burned patients, admitted to our eight bed burn unit and treated between 1 January and 31 December 2000, was performed. Prevalence, etiologic agents, length of hospitalization, cost of treatment and mortality rates caused by nosocomial infections (NIs) were studied. The study included 63 patients. Eighteen of these (Group-A) had 24 NI episodes. The most common NI observed was burn-wound infection (58.3%), followed by bacteraemia-sepsis (16.7%). NIs were not detected in the rest at all (Group B). The mean length of hospitalization was 38.5+/-19.7 days in Group A, and 20.3+/-7.6 days in Group B. The mean total burned surface area (TBSA) was 43+/-21 in Group A and 29+/-18 in Group B, while the most important independent risk factor for NI was TBSA in burned patients (OR, 1.08; CI(95), 0.93-1.24). NI prolonged the mean hospital stay to 18 days and increased the cost of treatment by 502 US dollars. The most common bacteria isolated was Pseudomonas aeruginosa (41.7%) and the second was methicillin resistant Staphylococcus aureus (MRSA-25.0%). All of the NI-free patients survived, while, five (28.5%) patients with NI died (P<0.01). These findings emphasized the need for careful disinfection and conscientious contact control procedures in areas that serve immunosupressed individuals, such as burned patients.
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PMID:The evaluation of nosocomial infection during 1-year-period in the burn unit of a training hospital in Istanbul, Turkey. 1292 96

Pharmacokinetics, clinical efficacy and safety of teicoplanin (TEIC) were evaluated in pediatric and neonate patients with MRSA sepsis in the dosages approved in overseas. The administrated dose for pediatrics patients was 10 mg/kg once at hour 0, 12 and 24, followed by every 24 hours intervals. In neonates patients, first dose was 16 mg/kg, then 8 mg/kg every 24 hours intervals. 1. Pharmacokinetic results. All 17 patients (9 neonates and 8 pediatrics) who received TEIC were evaluated for pharmacokinetics. Trough concentrations were analyzed in 16 patients (9 neonates and 7 pediatrics) excluding one patient for lack of measurement of drug concentration at day 7. No patient with a concentration exceeding 60 micrograms/mL in peak or trough concentrations were reported. Mean concentrations in trough at day 3, 4 and 7 in neonates were 15.2, 14.7 and 17.8 micrograms/mL, and in pediatrics were 12.5, 12.2 and 13.1 micrograms/mL, respectively. These results were similar to those reported in foreign pediatrics and neonates patients. 2. Efficacy and safety results. Since no patient was excluded, all patients were evaluated for efficacy and safety. Microbiological efficacy as well as clinical cure were secondarily evaluated in 2 patients for whom MRSA was isolated from blood. Clinical efficacy rate was 76.5% (13/17) and number of cases in judgments of excellent, good, fairly improved and no change were 12, 1, 3 and 1 cases respectively. The patients for whom MRSA was isolated from blood were judged as MRSA eradicated case and cured without any additional anti-MRSA drugs. Adverse events were reported in 2 neonates and 3 pediatric patients. Possibly related adverse events to study drug (adverse drug reactions) were: 1 case of respiratory disorder, thrombocythemia, gamma-GTP increased, GOT increased and GPT increased in 3 pediatrics. These results suggest that an application of overseas dose regimen of TEIC for neonate and pediatrics is appropriate in Japan.
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PMID:[Pharmacokinetic and clinical studies on teicoplanin for sepsis by methicillin-cephem resistant Staphylococcus aureus in the pediatric and neonate field]. 1253 39

Infectious complications occur in 60-100% of patients following high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (HSCT), and are commonly caused by Gram-negative aerobic bacteria (such as Pseudomonas aeruginosa and enterobacteriacea e) and Gram-positive cocci (such as enterococci, streptococci and staphylococci), which should be covered by empiric first-line antibiotic therapy. Less frequently, infections are caused by fungi and anaerobic bacteria, and initial therapy does not necessarily have to cover coagulase-negative staphylococci, oxacillin-resistant S. aureus (MRSA), anaerobic bacteria and fungi. Patients who already receive antibiotics and develop pulmonary infiltrates should immediately be treated with systemic antifungals. Patients with fever and diarrhea or other signs and symptoms of gastrointestinal or perianal infection should be treated with antibiotics covering anaerobic bacteria and enterococci. Clinically stable patients with skin infections or central venous catheter-related infections can be treated with standard empiric antibiotic therapy including a beta-lactam active against Pseudomonas aeruginosa with or without an aminoglycoside, and should only receive glycopeptides if they do not respond to first-line therapy within 72 hours, become clinically unstable, have severe mucositis, or when resistance against the empiric antibiotics is demonstrated. Recombinant hematopoietic growth factors should not be added routinely but may be considered in life-threatening situations such as invasive pulmonary mycoses or sepsis.
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PMID:Antimicrobial therapy of febrile complications after high-dose chemo-/radiotherapy and autologous hematopoietic stem cell transplantation--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). 1368 Jan 66

Neonates are susceptible to nosocomial infections due to immunological immaturity, prolonged hospital stay and the use of invasive procedures. We evaluated the incidence of infections and the prevalence of colonization by MRSA (Methicillin-resistant Staphylococcus aureus) and MSSA (Methilin-susceptible Staphylococcus aureus), as well as colonization risk factors. Staphylococcal infections were observed by analyzing medical records in the HICS (Hospital Infection Control Service) and the HRN (High Risk Nursery). Additionally, four inquiries concerning colonization prevalence were made for S. aureus, from January/2000 to December/2002. Clinical specimens from the nostrils, mouth and anus were cultivated in mannitol-salt agar plates and identification was made through standard methods. The frequency of neonates colonized by S. aureus was 49%. MSSA was more prevalent (57%) than MRSA (43%). Risk factors related to the acquisition of MRSA were: low weight and antibiotic use., Hospital stay was the only variable significantly associated with colonization by S. aureus. The incidence of infections by S. aureus during the last three years was 2.18% (159 cases). Nine of them (5.5%) were associated with MRSA and 150 (94.5%) with MSSA. Staphylococcal infections were considered as invasive (sepsis) and non-invasive (conjunctivitis, cutaneous), corresponding to 31% and 69%, respectively. The MRSA phenotype in infection was rare compared with methicillin-susceptible samples, although S. aureus, MRSA and MSSA colonization rates were high.
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PMID:Infection and colonization by Staphylococcus aureus in a high risk nursery of a Brazilian teaching hospital. 1463 77

Lipopolysaccharide (LPS) is the principal initiator of septic shock and it is to a large extent responsible for post-operative mortality. The use of antibiotics is still the most successful therapy against infection that may lead to sepsis and septic shock. With the advent of antibiotic resistant strains like MRSA the usefulness of conventional antibiotics is declining and new treatment strategies for LPS-mediated septic shock are called for. In this review we discuss the molecular mechanisms that are involved in the recognition of LPS and in the initiation of an immune response. Furthermore, we also review the recent insights in the signal transduction including receptor clustering and signalosome activation. Further insight into LPS-dependent signal transduction will assist the development of novel rational therapy.
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PMID:LPS signal transduction: the picture is becoming more complex. 1527 4

DISTURBING EPIDEMIOLOGICAL DATA: Over the past decade there has been a continuous progression in the percentage of Staphylococcus aureus strains resistant to methicillin (MRSA), a slight progression in coagulase-negative staphylococci strains resistant to methicillin and a spectacular progression of enterococci resistant to glycopeptides, not only in hospitals but also in intensive care settings. The increase in nosocomial septicemia is currently a major patient safety issue. HIGHER MORTALITY IN BACTEREMIC PATIENTS: The excess mortality globally observed in cases of bacteremia (compared with patients without bacteremia) is markedly enhanced with regard to secondary bacteremia. Bacteremia is responsible for a significant increase in the overall duration of hospitalization. PROGNOSTIC FACTORS OF STAPHYLOCOCCI BACTEREMIA: The mortality rate is significantly higher in patients in whom initial therapy was inappropriate compared with those in whom it was adequate. The isolation of MRSA strains is a negative prognostic factor. PATIENTS AT RISK OF MRSA BACTEREMIA: Independent risk factors for MRSA bacteremia include prior exposure to antibiotics, a nosocomial origin, a history of hospitalization within the 6 preceding months, and the presence of a decubitus ulcer. To avoid MRSA bacteremias related to catheters, alternatives should be found to their use, all hygiene rules should be carefully respected, the insertion point should be carefully disinfected and protected, and the catheter should be removed as rapidly as possible.
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PMID:[Challenges, treatment strategies and clinical progression of MRSA bacteremia]. 1532 Apr 40

A 66-year-old man was referred to our hospital for the treatment of refractory multiple myeloma with thalidomide. He had a history of an interstitial pneumonia of unknown etiology two months before admission. Eight days after starting 200 mg/ day of thalidomide, he developed dyspnea and fever, followed by a macropapular rash in the trunk. The dyspnea got worse and a CT scan revealed interstitial pneumonia 16 days after the treatment. He required mechanical ventilatory support. Bronchoalveolar lavage fluid revealed eosinophilia, suggesting a thalidomide-induced interstitial pneumonia. Thalidomide was discontinued and methylprednisolone (1000 mg/d x 3 days) was started, and the pneumonia and rash markedly improved within six days. After that the patient contracted MRSA pneumonia and died of MRSA septicemia.
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PMID:[Interstitial pneumonia during treatment with thalidomide in a patient with multiple myeloma]. 1551 Aug 38


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