Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0040586 (tracheobronchitis)
 449 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aminoglycoside antibiotic tobramycin was given intramuscularly to 15 patients with infected body fluids (empyema in five patients, peritonitis in five, peritonitis and empyema in one, tracheobronchitis in three, and infection of the pacemaker pocket in one). The infecting bacteria included Pseudomonas aeruginosa, Klebsiella, Enterobacter, Serratia, Escherichia coli, Proteus species, and Staphylococcus aureus. The mean dose of tobramycin was 1.7 mg/kg given intramuscularly every 8 hr for nine to 10 days. Levels of tobramycin in specimens of serum and infected body fluid obtained simultaneously were measured at various intervals after a dose of the antibiotic. Comparison was made between levels of tobramycin and minimal inhibitory concentrations (MICs) of the infecting bacteria. Bacteriological and clinical failures were common if the level in body fluid did not exceed the MIC. In patients with levels of tobramycin in body fluid that were higher than the MIC, cures were frequent. Drainage of infected body fluids is a necessary part of successful therapy of these infections.
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PMID:Penetration of tobramycin into infected extravascular fluids and its therapeutic effectiveness. 86 91

Pulmonary infections are the most life-threatening infections in mechanically ventilated patients. Methods to avoid these infections by prophylactic systemic or local administration of antibiotics may promote resistance and selection of distinct groups of pathogens. In mechanically ventilated patients we studied the impact of early diagnosis and specific therapy on the prevention of pulmonary infections. Due to the very short interval between colonization and infection, daily microscopic and microbiologic examinations of tracheobronchial secretions proved to be essential for early and successful therapy and even prevention of pulmonary infections. PATIENTS AND METHODS. The present study comprised a total of 190 patients admitted to the surgical intensive care unit who required mechanical ventilation for a period of at least 48 h: 56 were admitted for multiple trauma; 38 had peritonitis; and the remainder had postoperative complications such as renal failure, cardiac problems, septicemia or pneumonia. Multitraumatized patients (16.5 days) and those with peritonitis (13.8 days) needed the most extensive ventilatory support. After admission antibiotic therapy was started with a second-generation cephalosporin or amoxicillin/clavulanic acid. Further antibiotic treatment was directed strictly against the isolated pathogens. Tracheobronchial secretions were monitored daily by microscopy and cultures. Microscopic evaluation was essential to discriminate between colonization and inflammation, and often indicated the infective agent. If infections were suspected provisional antibiograms were performed on the material. This procedure allowed a specific antibiotic treatment to be initiated 8-12 h later. In patients with pulmonary infections, additional bronchoscopic material was taken in order to correlate these findings with those gained from the tracheobronchial secretions. RESULTS. In 85% of cases massive colonization of the trachea with Pseudomonas aeruginosa, enterobacteria, Staphylococcus aureus or Streptococcus pneumoniae resulted in pulmonary infections 24-48 h later. The reduced virulence of Pseudomonas species (non-aeruginosa) and Acinetobacter species is reflected by an infection rate of 50% and an extended period of time to establish an infection (2-4 days). Only 30% of patients highly contaminated with Candida developed pulmonary infections after 3-6 days. A fair correlation (86%) was found between pathogens isolated in tracheobronchial secretions and bronchoscopic material. In the population studied, 68 patients (35.7%) developed pulmonary infections, 32 of them pneumonia (16.8%), and the others purulent tracheobronchitis with fever. Both groups were treated with antibiotics. Patients with multiple trauma, often accompanied by lung contusion, were most frequently affected. In 59 patients (87%) pulmonary infections were treated successfully by specific antibiotic therapy; 9 patients died so rapidly, that the pulmonary complication could not account for the fatal outcome. In 38 patients with massive contamination of the tracheobronchial system by enterobacteria, Pseudomonas aeruginosa or Staph. aureus, progression from colonization to infection was prevented by early administration of specific therapy. CONCLUSIONS. Because pulmonary infections in most cases arise very soon after pathogens have gained access to the tracheobronchial system daily monitoring of tracheobronchial secretions is required for early initiation of specific therapy.
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PMID:[Microbiological care of ventilated intensive care patients. Feasibility of diagnosis and therapy of pulmonary infection]. 195 44

Ether link cleavage (ELC) of T4 yielding diiodotyrosine (DIT) has recently been shown in vitro to be the major pathway of T4 metabolism in phagocytosing leukocytes. To evaluate this pathway in vivo and the possible clinical relevance of DIT measurements in diseases with increased leukocyte activity, radioimmunological studies on serum levels of DIT and other thyroid parameters were performed in 125 critically ill patients classified into 3 groups with bacterial infections according to the severity of infection and 1 group without infections. While the pattern of iodothyronine and TSH levels typical for severe nonthyroidal disorders, i.e. decreased total T3 and elevated rT3, normal or decreased total T4 and TSH, and normal free T4, was found in all four groups of intensive care patients studied, elevated serum DIT was observed only in those patients whose clinical course was complicated by severe bacterial infections. Serial measurements revealed a close temporal connection between the infection phase and increased DIT levels. Median values and 16th to 84th percentile ranges (in parentheses) of serum DIT (normal range, 0.02-0.55 nmol/L) were as follows: sepsis, 1.38 (0.32-5.14); severe nonsystemic infections such as peritonitis and abscesses, 3.84 (0.24-17.2); moderate infections such as pneumonia and tracheobronchitis, 0.44 (0.18-1.16); and critical illness without infections, 0.14 (0.08-0.30) nmol/L. These elevations of circulating DIT could neither be correlated with changes in renal function nor attributed to drug effects. The results of the present study do not allow any definitive conclusions to be made about the mechanisms underlying the phenomenon of increased serum DIT levels in infections. Apart from this open question, DIT appears to be a relatively specific serum parameter for the presence and course of severe bacterial inflammations. Its measurement could provide useful clinical information, particularly for monitoring the time course of deep-seated infections.
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PMID:Elevated serum diiodotyrosine (DIT) in severe infections and sepsis: DIT, a possible new marker of leukocyte activity. 200 22