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

The efficacy of tobramycin in doses of 2.7 to 5.6 mg/kg per day in 29 courses of therapy in 25 hospitalized patients with serious Pseudomonas aeruginosa infections was studied. Eighty-three percent of the P. aeruginosa strains showed zones of inhibition of 16 mm or more around a 10-mug tobramycin disk in the Bauer-Kirby disk method. Tobramycin minimal inhibitory concentration ranged from <0.05 to 1.5 mug/ml (microtiter twofold dilution method); for gentamicin they ranged from 0.05 to 6.2 mug/ml; corresponding geometric means were 0.19 and 0.49 mug/ml. Therapy was given for a median of 10 days (mean 19, range 1 to 83). The clinically satisfactory response rate for the 29 courses of therapy was 52%: critically ill, 44%; seriously ill, 50%; moderately ill, 80%. The response rates for various sites of infection were bone and cartilage, 100%; urinary tract infection, 56%; wound, 50%; respiratory tract, 67%; septicemia, 40%; abscess, 0%; burns, 44%. No adverse reactions were seen. Serum concentration (mug/ml +/- standard deviation) of tobramycin determined by an agar-well plate method, were 4.81 +/- 2.17 (1 h); 3.24 +/- 1.43 (2 h); 2.35 +/- 1.30 (4 h); and 1.40 +/- 1.09 (8 h). Tobramycin appears to be as effacacious as gentamicin in the treatment of serious P. aeruginosa infections and has a theoretical advantage of lower minimal inhibitory concentration for P. aeruginosa. The data suggest that, for life-threatening infections, dosages of tobramycin may need to be increased over those used in this study.
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PMID:Therapy of Pseudomonas aeruginosa infections with tobramycin. 80 2

Zinc sulfadiazine is a new compound which is effective in vitro and in vivo against Pseudomonas aeruginosa infections in burned mice and rats. It contains an important body constituent, zinc, and appears to expedite wound healing, diminish weight loss after infected burns and improve food intake. Like silver sulfadiazine, it prevents the postburn changes in plasma proteins. After topical application, the uptake of the radioactively labeled zinc is significant in the zone of injury and negligible in organs and body fluids. The binding to deoxyribonucleic acid by zinc is similar to, but less than, that by silver. The data indicate that zinc sulfadiazine may be a valuable addition to the therapeutic armamentarium for the control of burn wound sepsis.
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PMID:Zinc sulfadiazine for topical therapy of pseudomonas infection in burns. 81 19

9 cases of Pseudomonas aeruginosa endocarditis are reported and the results of this study are compared with the data of the literature. The source of infection was known in 8 patients: 7 were nosocomial infections (cardiac catheterization in 5 cases, cardiac surgery in 2 cases). The diagnosis was made in 8 patients with left-sided endocarditis. In 1 patient tricuspid endocarditis was diagnosed on postmortem examination. Carbenicillin associated with an aminoglycoside antibiotic appeared to be the most effective treatment when prescribed for several weeks. 6 of 9 patients died of uncontrolled septicemia, 3 of whom underwent surgery which was twice performed because of poor hemodynamic status. In the other 3 patients drug administration was effective at first. However, a relapse occurred in these three cases compelling another effective antibiotic therapy. Surgery was peformed in these three patients. Valve cultures were negative in two cases and positive in 1. These 3 patients survived. They are still alive after a follow-up period of 2 or 3 years.
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PMID:Pseudomonas aeruginosa endocarditis. A report of nine cases. 81 57

In order to optimize the clinical management of fever in acute myelocytic leukemia (AML), our experience with febrile patients during two therapy periods was reviewed. A structured approach to the management of fever was then devised and evaluated during a third period. Among a total of 104 patients with AML, 77 were febrile at presentation. Only agranulocytic patients (15%) had severe infection, while 43% had localized sites which responded to specific antibiotic therapy. The remainder (42%) had fever functionally attributed to leukemia. In contrast, life-threatening infection occurred in most patients (90%) after antileukemic treatment was begun. During the trial therapy period, the empiric use of carbenicillin-gentamicin for fever greater than or equal to 101 degree F during aplasia reduced the incidence of sepsis from 90 to 30% and of bacteremia from 50 to 23%. The fall in the incidence of blood and localized site cultures positive for Pseudomonas aeruginosa from 65 to 15% corresponded to a reduction in the number of distinct organisms per site from 1.6 to 1.0. These data suggest that hematogenously born invasion of infected sites by endogenous organisms has been prevented. Aplastic patients with fever responded to therapy by defervescing (54%) or improving clinically (34%). Stopping antibiotics once started while evaluating persistent fever was detrimental. Although the early empiric use of amphotericin B reduced the incidence of fungemia, its proper use in fever management is yet to be determined.
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PMID:The clinical significance and management of fever in acute myelocytic leukemia. 82 Sep 17

The susceptibilities of various clinical isolates to tobramycin were studied, and the applicability of these data to clinical situations was evaluated. The bactericidal nature of tobramycin was confirmed by killing curves, and the minimal inhibitory concentrations for 500 common pathogens were used to define its spectrum. Isolates inhibited by less than or equal to 5 mug/ml were considered to be sensitive to tobramycin. The clinical response of some patients was examined in relation to the minimal inhibitory concentration for the infecting organism and the serum and urine levels of tobramycin. The activity of tobramycin was compared with that of gentamicin against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. Tobramycin was at least twice as active as gentamicin against P. aeruginosa. The effectiveness of tobramycin against S. aureus and E. coli was compared with that of other commonly used antibiotics, and its clinical role as an alternative to gentamicin in the "best guess" treatment of septicemia was considered. Lincomycin is often added to counter the ineffectiveness of tobramycin against streptococci and anaerobes such as Bacteroides species, but this combination was antagonistic against E. coli when tested in vitro by the checkerboard technique and its graphical display, the isobologram. Tobramycin was essentially similar to gentamicin in laboratory characteristics and clinical application but was more active against P. aeruginosa in general and against gentamicin-resistant strains in particular.
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PMID:Laboratory findings of tobramycin and their relation to clinical response. 82 77

Tobramycin is a new aminoglycoside antibiotic with pharmacological similarities to gentamicin. Eleven of 15 patients with a severe or complicated gram-negative urinary tract infection were cured by treatment with a five day course of tobramycin. No side effects were noted. This drug should prove beneficial for the treatment of severe gram-negative sepsis and promises to be particularly valuable for infections due to Pseudomonas aeruginosa and organisms resistant to gentamicin.
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PMID:Tobramycin in the treatment of severe and complicated urinary tract infections. 82 77

Specific passive immunity against Pseudomonas aeruginosa sepsis was assessed in granulocytopenic dogs. Dogs were infused with either normal or antipseudomonas immune plasma 24 h before pseudomonas challenge. They were challenged intravenously with 10(7) serotype 6 P. aeruginosa during granulocytopenia. Treatment was evaluated by observation of survival periods, febrile responses, type 6 pseudomonas antibody titers, and quantitative cultures of blood and tissues. The results demonstrated that passively immunized dogs did not survive infection. Both normal-plasma and immune-plasma recipients had bacteremia at death, with median values of 980 and 470 pseudomonas per ml of blood, respectively. All dogs had marked febrile responses 24 h after pseudomonas challenge and had high concentrations of pseudomonas in their lung tissue at death, with median values of 10(8) pseudomonas per g of wet tissue weight. After plasma infusion, immune-plasma recipients had high concentrations of anti-pseudomonas antibody, with total antibody titers ranging from 256 to 1,024 and a median value of 1,024. These titers were comparable to titers attained in a previous study from our laboratory using active immunization with pseudomonas lipopolysaccharide vaccine, where the median total anti-pseudomonas antibody titer was 2,048. Actively immunized animals, however, were significantly protected against pseudomonas sepsis and had prolonged survival periods and prevention of bacteremia. The present study demonstrates that circulating type-specific antibody is not solely responsible for the protection afforded to granulocytopenic dogs actively immunized against pseudomonas.
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PMID:Passive immunity against pseudomonas sepsis during granulocytopenia. 82 5

Ticarcillin, a semisynthetic penicillin, was evaluated in the treatment of 75 serious gram-negative infections, 50 of which were caused by Pseudomonas aeruginosa. The overall rate of response was 81%. Septicemia and urinary tract infections responded more frequently (93%) than infections of the lower respiratory tract (71%). Response to therapy was comparable to results achieved previously with larger doses of carbenicillin. Response was not correlated with levels of drug in serum. Patients with nonfatal underlying disease were the most likely to respond to treatment. Ticarcillin-resistant organisms were isolated during therapy in 39% of the cases, and superinfection occurred in 12%. Colonization with resistant organisms did nto correlate with success or failure of therapy, severity of underlying disease, or levels of ticarcillin in serum. The clinical response and incidence of colonization were not altered by concurrent use of gentamicin, nor was the development of superinfection affected. Combination of ticarcillin and gentamicin in treatment of 19 patients did not produce toxicity. Eosinophilia, phlebitis, and hypokalemia occurred, as seen with carbenicillin, but major toxicity was not encountered.
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PMID:Ticarcillin for treatment of serious infections with gram-negative bacteria. 82 82

Trends in relative susceptibility of clinical isolates, mostly from newborns with nosocomial infections, to the aminoglycosides in use in a hospital for children are described and related to practical therapeutic aspects. Currently, amikacin is the most effective of the available antibiotics against many gram-negative bacterial species, and its administration appears to be as complicated as that of other aminoglycosides. With 5 mug/ml taken as the cut-off point for susceptibility in vitro, 90% of 211 clinical isolates (Pseudomonas aeruginosa, Escherichia coli, Klebsiella, Serratia, and other species) could be considered sensitive to amikacin; the respective figures for sensitivity to sisomicin, gentamicin, and tobramycin were 80.5%, 66%, and 70%. Cross-resistance of microorganisms to amikacin and gentamicin, sisomicin, or tobramycin has not been demonstrated. Treatment with amikacin was successful in 13 of 15 children (premature and normal newborns with primarily septicemia); death of two patients was attributable to the underlying disease. For neonatal infections we recommend 12 mg of amikacin/kg per day; determination of the minimal inhibitory concentration for the causative pathogen and monitoring of serum concentrations are desirable.
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PMID:Use of Amikacin in a hospital for children: microbiological and clinical studies. 82 92

Bacterial and fungal growth in 10% soybean oil emulsion (Intralipid) and 5% fibrin hydrolysate in 5% dextrose was studied at 4, 25 and 37 degrees C. Staphylococcus aureus, Streptococcus pyogenes, Str. fecalis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Candida albicans were grown in broth at 37 degrees C, diluted in saline and inoculated into each of the two preparations as well as a mixture of the two. Growth was measured at 24, 48 and 72 hours. In 10% soybean emulsion, all bacteria except S. pyogenes multiplied, but in fibrin hydrolysate-dextrose solution the only organism of those studied to grow was S. aureus. In the hydrolysate-dextrose-lipid mixture, all organisms multiplied except S. pyogenes and P. aeruginosa. C. albicans grew in all solutions tested. While at 4 degrees C, organisms did not multiply. The fibrin hydrolysate-dextrose solutions given by infusion into a central vein for hyperalimentation have been shown to support predominantly fungal growth, and contamination of the solution and ultimately of the indwelling catheter is a constant hazard. Because both bacteria and C. albicans grew equally well in 10% soybean oil emulsion, its use as a caloric source when infused into a central vein may increase the occurrence of sepsis. When this emulsion is used to provide essential fatty acids or calories, it should be given via a peripheral vein, so that a central catheter will not be contaminated.
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PMID:Growth of common bacteria and Candida albicans in 10% soybean oil emulsion. 83 63


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