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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Four cases of overwhelming bacteremia were observed in asplenic renal transplant patients 12 to 20 months after transplantation. The bacteriologic findings and presentation of these infections are characteristic of post-splenectomy sepsis reported in nontransplant patients. It is suggested that the absence of the spleen, more than immunosuppression with azathioprine and prednisone, predisposes to these late, uncommon infections after transplantation.
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PMID:Acute bacteremia in asplenic renal transplant patients. 1 44

Postsplenectomy, 41 patients previously treated for Hodgkin's disease were given pneumococcal vaccine, and type-specific antibody levels were measured before and after immunization. Postimmunization antibody levels in patients with Hodgkin's disease were significantly lower than those in normal control subjects for 10 of the 12 serotypes measured. Mean postimmunization antibody level for patients (587 +/- 427 ng of antibody nitrogen/mL) was much lower than that for control subjects (1787 +/- 694). Antibody levels tended to increase with time from therapy for Hodgkin's disease, and several patients who had not received therapy for more than 3 years had normal responses to immunization. Despite vaccination, one patient developed pneumococcal meningitis and another, pneumococcal bacteremia. Both infected patients had low postimmunization mean antibody levels (282 and 137 ng/mL, respectively). Postsplenectomy sepsis in patients with Hodgkin's disease is related to a humoral immune deficiency probably induced by radiation and chemotherapy, and this immune deficiency persists for several years.
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PMID:Response of patients with Hodgkin's disease to pneumococcal vaccine. 3 21

DIC is a hemorrhagic syndrome frequently encountered as a complication in severe gram-negative bacterial sepsis. An animal model for sepsis-associated DIC was developed in order to permit study of the appearance and development of this syndrome in relation to the entire disease process. Rhesus monkeys (4 to 6 kg) were infected by intravenous injection of 10(9) Salmonella typhimurium organisms and studied for a period of 7 to 10 days following infection. Ten of 23 infected monkeys developed petechial rash characteristic of DIC, which appeared on days 1 to 2 infection and lasted 4 to 5 days. In the group of monkeys developing rash, activation of coagulation was suggested by an 80% decrease in platelet count and 20% to 30% increases in PT and APTT. Fibrinolytic system activation was indicated by the appearance of FDP. Kinin system activation was evidenced by decreases in both prekallikrein nad kininogen. Changes in laboratory tests suggestive of subclinical DIC were also noted in infected monkeys which did not develop a rash. Pathologic evidence of DIC was obtained through observation of numerous fibrin thrombi in the kidneys of the only monkey which died in the course of infection. Occurrence of DIC in association with this experimental infection in rhesus monkeys was established on the basis of clinical, laboratory, and pathologic criteria. Expression of the syndrome on days 1 to 2 following infection correlated with the period of increasing bacteremia.
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PMID:Model for disseminated intravascular coagulation: bacterial sepsis in rhesus monkeys. 9 3

A polytetrafluoroethylene (PTFE) graft from the brachial artery to the axillary vein may provide a safe and trouble-free means of vascular access in selected patients requiring long-term intravenous feeding in the hospital setting. This route for the administration of solutions supplying total parenteral nutrition (TPN) should be considered in persons whose requirement for parenteral feeding is likely to extend over many months and in whom there are other sources of bacteremia which can imitate or be confused with infection of a conventional central venous feeding line. In a 52-year-old man an 8-mm PTFE graft was anastomosed end-to-side to the brachial artery and the axillary vein and brought through a subcutaneous tunnel on the medial aspect of the upper arm. Access to it was obtained by intermittent puncture with a no. 21 butterfly needle. Hyperosmolar TPN solutions flowed easily by gravity drip into the shunt. The graft seemed resistant to infection. This form of vascular access appears to exclude parenteral feeding lines, solutions and catheters as sources of sepsis.
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PMID:Polytetrafluoroethylene grafts for vascular access for hyperalimentation. 10 78

An oral prophylactic antibiotic regimen (neomycin-erythromycin-nystatin) aimed at suppression of the bowel flora was utilized in 20 patients with thermal injury treated in a laminar flow burn unit with strict sterile technique and reverse isolation. The regimen was utilized for an average of 24 days. Surface cultures were obtained twice weekly from multiple areas of the burn wound, and burn wound biopsies were performed one to two times weekly. These patients were compared prospectively with a group of 10 patients treated in otherwise identical fashion, save for the omission of the antibiotic suppressive regimen. Bacterial colonization of the burn wound occurred an average of 19 days after admission in the group receiving antibiotics compared to 4 days after admission in the control group (p less than 0.01). Positive burn biopsies (more than 10(5) bacteria per gm of tissue) were observed twice as often in the group not receiving antibiotics (p less than 0.16) as were infectious complications of several types: bacteremia, burn wound sepsis, urinary tract infections, pneumonitis, cellulitis (0.10 less than p less than 0.20). Staphylococcal or fungal overgrowth were not encountered in the patients receiving prophylactic antibiotics, nor was there an adverse effect on serum creatinine levels with the prolonged use of neomycin.
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PMID:Clinical experience with prophylactic antibiotic bowel suppression in burn patients. 34 12

Newborn infants with "early-onset" disease due to group B beta hemolytic streptococcus were studied over a 40-month period. Clinical presentations included asymptomatic bacteremia, mild transient illness, respiratory distress, meningitis, and overwhelming sepsis. Chronologically, 18 were ill at birth; 10 became ill after a symptom-free period; and four were asymptomatic. Sixty-six percent of the cases weighted less than 2500 grams, and 56% were born to mothers whose amniotic membranes were ruptured for over 20 hours. All 15 of the deaths occurred in low birth weight infants who were criticially ill from birth. A review of 128 consecutive deliveries of infants weighing under 2000 grams revealed 28 cases with prolonged ruptured membranes, and three of these 28 infants developed group B streptococcal infection. The infant of the colonized gravid woman in premature labor or with prolonged ruptured membranes is clearly at risk, and these results suggest that the management of "early-onset" disease should begin prior to delivery.
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PMID:Risk factors in early-onset neonatal group b streptococcal infections. 34 7

Cefamandole nafate was effective in the treatment of a variety of infections caused by Staphylococcus aureus, Streptococcus pyogenes group A, Streptococcus pneumoniae, and Haemophilus influenzae in infants and children. The infections included periorbital cellulitis and ethmoiditis, bacteremia, cellulitis, pneumonia, and lymphadenitis. In vitro, cefamandole was effective in inhibiting the growth of H. influenzae isolated from blood or cerebrospinal fluid of patients with meningitis or sepsis. In two patients rash developed and cefamandole was discontinued. Other significant adverse effects were not noted.
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PMID:Clinical and laboratory investigation of cefamandole therapy of infections in infants and children. 34 94

Intra-abdominal sepsis that involves multiple aerobic and anaerobic bacteria derived from the colonic flora was studied in Wistar rats to determine the relative roles of various microbial species. The rats challenged with pooled colonic contents showed a biphasic disease. Initially, there was acute peritonitis, Escherichia coli bacteremia, and high mortality. In rats that survived this acute peritonitis stage, intra-abdominal abscesses developed, and anaerobic bacteria were the preponderant organisms. Subsequent experiments showed that antibiotics directed against coliforms prevented mortality, whereas agents active against anaerobes reduced the incidence of abscesses. Challenges with Escherichia coli alone produced bacteremia and death, whereas pure cultures of Bacteroides fragilis caused intra-abdominal abscesses. These observations suggest that both coliforms and anaerobes are important pathogens in intra-abdominal sepsis, although the different types of microbes appear to play distinctive roles in the sequence of pathological events.
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PMID:A review. Lessons from an animal model of intra-abdominal sepsis. 35 91

In the modern hospital gram negative bacteremia and the associated condition of septic shock are common occurrences. In the United States the estimated incidence of gram negative bacteremia ranges from 71,000 to 330,000 cases annually. Fatalities attributed to this disease are between 18,000 and 132,000 each year. Sepsis is defined as a systemic disease caused by microorganisms or their products in the blood. Bacteremia is the presence of viable organisms in the circulation. Gram negative bacteremia in the critically ill patient is synonymous with gram negative sepsis. Septic shock is a clinical syndrome characterized by circulatory insufficiency and inadequate tissue perfusion. Septic shock is associated primarily although not exclusively with gram negative bacilli. Focus is on predisposing factors, microbiology, pathophysiology, and the 4 components of therapy -- antibiotics, volume replacement, steroids, and surgical drainage. The underlying illness of the patient is the primary factor determining the outcome of an episode of gram negative bacteremia. Patients with a life threatening disorder have a very poor prognosis, while sepsis in a previously healthy person carries a good prognosis. The overall mortality in gram negative bacteremia is 25%. When septic shock develops, the mortality increases to 50-60%. Appropriate antibiotics that are synergistic against the infecting organism can decrease the mortality, but the overwhelming infleunce of host factors in predicting the outcome suggests that prevention and early treatment are the best means of decreasing mortality.
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PMID:Gram negative sepsis and shock. 35 39

The medical records of 293 patients who underwent renal transplantation were analyzed for the occurrence of Streptococcus pneumoniae and Haemophilus influenzae infections in relation to splenectomy. Splenectomy was done in 236 (81%) graft recipients before or concomitant with transplantation. Bacteremia developed in five and fulminant sepsis in two from 3 to 32 months after splenectomy. No serious infections with these organisms occurred in the nonsplenectomy group. These results suggest that asplenia may be an additional factor predisposing transplant patients to serious infection. Prevention of these serious pneumococcal infections may be possible with polyvalent pneumococcal vaccine.
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PMID:Severe infection due to Streptococcus pneumoniae in asplenic renal transplant patients. 36 40


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