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

In a multicenter observational study of 163 medical and surgical patients with a total of 173 episodes of sepsis or septic shock (Elebute sepsis score: 19.0 +/- 0.5), the effects of supplemental i.v. immunoglobulin (i.v. IG) treatment (unmodified polyvalent IgG pH 4.25, n = 123; for Pseudomonas sepsis, n = 50, Pseudomonas IgG) on multiple organ failure (MOF) were investigated by means of APACHE II score changes (pretreatment: 23.7 +/- 0.6). In 44% of the cases ("responders"), a prompt improvement in APACHE II score (defined as decrease greater than or equal to 4) was evident from day 0 to day 4 after onset of therapy, thus being in close time relationship to the i.v. IG administration. This improvement, associated with a better prognosis (mortality 24% vs. 55%), was found in all subgroups, most importantly the following: polyvalent IgG vs. Pseudomonas IgG treatment; medical vs. surgical patients; moderate vs. severe MOF; and gram-positive vs. gram-negative septicemia. In a small-sized second comparative nonrandomized control group (n = 27, antibiotic treatment alone) of septic patients (Elebute: 14.7 +/- 1.0) with similar MOF severity (APACHE II: 23.6 +/- 1.4), the response rate (30%) was, though not statistically significant, lower by one-third. The optimal baseline score ranges for patient inclusion into future placebo-controlled randomized i.v. IG trials were found to be 20-35 for the APACHE II score and 12-27 for the Elebute score.
Infection
PMID:Supplemental immunoglobulin (ivIgG) treatment in 163 patients with sepsis and septic shock--an observational study as a prerequisite for placebo-controlled clinical trials. 191 32

Twenty-five pediatric orthotopic liver transplantations (OLTs) performed in 22 patients at Sainte-Justine Hospital were reviewed for infections complications. One patient died within 12 hours posttransplantation and is excluded. The patients had an average age of 6.1 years (range, 1.25 to 19 years) and an average weight of 20.4 kg (range, 11 to 55 kg). Two patients (9%) were cytomegalovirus (CMV) seropositive and 9 of 19 patients (48%) were Epstein-Barr virus (EBV) seropositive preoperatively. Five of the donors (20%) were CMV seropositive. The most common indications for OLT were biliary atresia (8) and tyrosinemia (7). There were 4 deaths, for an overall mortality rate of 19%. In 3 patients, deaths were related to infection (CMV hepatitis and duodenitis with aortoduodenal fistula, adult respiratory distress syndrome [ARDS] with Streptococcus viridans pneumonia, Escherichia coli cholangitis with progressive hepatic failure). Fifteen patients (72%) had 41 major infections, most of them bacterial, during the first month posttransplantation. These include pneumonia (25%), line sepsis (17%), cholangitis (14%), and tracheitis (14%). There was only one major viral infection, a CMV hepatitis that occurred in the first month posttransplantation. Three patients had fungal infections (8%) associated with hepatic artery thrombosis and recurrent cholangitis. All three patients required retransplantation. There was only one protozoal infection (Pneumocystis carinii pneumonia) causing life-threatening respiratory failure, from which patient recovered without sequelae. Infection still remains a serious complication of OLT. Bacterial infection is common and is usually associated with technical complications. The low rate of CMV infection is related to low incidence of CMV in the donor pool and the minimal use of strong immunosuppressants.
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PMID:Infectious complications of pediatric liver transplantation. 191 82

Infection and sepsis are generally considered as causally related to death in intensive care unit (ICU) patients, but in several studies a decrease in infection rates was not associated with lower mortality. We therefore investigated the causes of death in surgical ICU patients, with special regard to the relationship between infection and mortality. MATERIAL AND METHODS. During the investigation period of 6 months, 502 patients were treated in the ICU (cardiac surgery: 222, thoracoabdominal surgery: 125, vascular surgery: 84, others: 14). In all patients each antibiotic therapy and infection was documented, as was the sepsis score. Definitions of infection and bacteriological monitoring were described in detail previously. In all deaths, attention was paid to an infection that was causally related to or contributed to death. In unclear cases a postmortem examination was performed. RESULTS. Forty-two patients died (8.4%). During the first 4 days 23 patients died, 11 within 24 h, because of severe trauma with severe underlying disease (main reason for death: cardiac 30%, cerebral 32%). Infections were not significant in these patients. Nineteen patients suffered from 1 or more infections (total 30). They died after a median of 16 days. The leading cause of death was multiple organ failure. In 7 of these patients a life-threatening infection was the reason for admission and, later, death. In 8 patients a nosocomial infection was causally related to or contributed to death. In the 4 other patients a postmortem examination excluded an infection as being responsible for death. DISCUSSION. More than one-half of the deaths were caused by severe trauma or severe underlying disease. Nosocomial infections could only be related to death in 1.6% of the 502 treated ICU patients. The influence of new therapeutic regimens on infection and mortality can therefore only be investigated in multicenter trials.
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PMID:[Causes of death in intensive care surgical patients. A prospective study]. 192 18

Despite the advances in medical technologies, ARDS is highly lethal. In the management of patients with ARDS, certain clinical conditions are common predisposing factors to the development of the syndrome. Infection, sepsis syndrome, and conditions requiring massive transfusion are the most common causes in patients initially managed by obstetricians and gynecologist. Early recognition of ARDS with timely consultation is of paramount importance in these patients. Early in the course of the illness, the patient should be placed in an intensive care unit. Physicians with experience in the altered pulmonary physiology should be included in the team, as well as infectious disease and renal consultants, as the situation demands. Due to the overall relative youth of our obstetric and gynecologic patients and their lack of other underlying diseases, they should do better than most patients with ARDS. However, at least 50% of all patients succumb to the disease itself or to complications inherent in the care needed. Families and treating physicians should be apprised of this early in the course.
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PMID:Adult respiratory distress syndrome in obstetrics. 194 55

We conducted a 1-year longitudinal prospective study of infants born in a traditional rural indigenous community of Guatemala. Three hundred twenty-nine infants surviving birth and the first day of life were followed during the first 3 months of life. Surveillance included routine household and well baby clinic visits and clinic visits for minor illnesses. Detection of potentially lethal illnesses depended on orientation of families and midwives to important symptoms and to the need for immediate medical evaluation if such symptoms were identified. We identified 38 episodes of lethal and potentially lethal illness. Thirty-five (92%) of these episodes were infectious diseases, principally sepsis during the neonatal period and acute lower respiratory infection in Months 2 and 3. Of all study infants, low birth weight (less than 2500 g) infants comprised 14% and premature (less than 37 weeks gestation) infants comprised 1%. Premature infants had a relative risk of lethal and potentially lethal illnesses of 11.1 (95% confidence interval, 3.6 to 34.4) compared with normal term infants, and no premature infant survived the first 3 months of life despite medical intervention. Low birth weight infants had a relative risk of 3.2 (95% confidence interval, 1.5 to 6.6), but with medical intervention all but 2 survived. Despite their lower risk, because of their much greater number normal term infants experienced 60% of lethal and potentially lethal illnesses. Among all study infants medical intervention was associated with survival of 86% of lethal and potentially lethal infectious illnesses and with a rate of neonatal mortality among study children significantly lower than rates documented in previous years in the same community.
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PMID:Neonatal and early postneonatal morbidity and mortality in a rural Guatemalan community: the importance of infectious diseases and their management. 194 77

This prospective study was designed to determine the value of a daily modified biophysical profile in detecting infection in patients with preterm premature rupture of the membranes who were managed expectantly. Ninety-nine patients received daily nonstress tests and biophysical profile scores. Results of the last predelivery study were related to subsequent development of amnionitis or fetal sepsis. Infection was present in 16 patients. When the biophysical profile score was 0/8, infection was uniformly present. When fetal breathing was absent (biophysical profile score, less than or equal to 4/8) and nonstress test was nonreactive, infection was present in 75% of cases (sensitivity, 75%; specificity, 95%). Because a nonreactive nonstress test could be secondary to prematurity instead of infection, these results were analyzed over time. Those who initially had a reactive nonstress test that subsequently became nonreactive were more likely to be infected. We conclude that a daily biophysical profile score and nonstress test can detect infection and propose delivery of patients with a biophysical profile score of 0/8 and nonreactive nonstress test. Patients with absent fetal breathing and a nonstress test that changes from reactive to nonreactive also should be considered for delivery. Absent fetal breathing with a reactive nonstress test or a consistently nonreactive nonstress test should have further testing to rule out infection.
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PMID:Preterm premature rupture of membranes: detection of infection. 195 22

Patients with the acquired immune deficiency syndrome (AIDS) frequently develop hepatic dysfunction. Although hepatic injury may indirectly result from malnutrition, hypotension, administered medications, sepsis, or other conditions, the hepatic injury is frequently due to opportunistic hepatic infection, directly related to AIDS. Infection with Mycobacterium avium intracellulare typically occurs in patients with advanced immunocompromise and with systemic symptoms due to widely disseminated infection. In contrast, hepatic tuberculosis often occurs with less advanced immunocompromise. Cytomegaloviral infection may produce a hepatitis. Cytomegaloviral and cryptosporidial infections have been implicated as causes of acalculous cholecystitis and of a secondary sclerosing cholangitis. About 10-20% of patients with AIDS have chronic hepatitis B infection. These patients tend to develop minimal hepatic inflammation and necrosis. The clinical findings in patients with hepatic cryptococcal infection are usually due to concomitant extrahepatic infection. Hepatic histoplasmosis usually develops as part of a widely disseminated infection with systemic symptoms. Hepatic involvement by Kaposi's sarcoma is rarely documented ante mortem because an unguided liver biopsy is an insensitive diagnostic procedure. Patients with non-Hodgkin's lymphoma of the liver typically have lymphadenopathy, hepatomegaly, and systemic symptoms. As a pragmatic approach, patients with liver dysfunction and HIV-related disease should have a sonographic or computerized tomographic examination of the liver. Patients with dilated bile ducts should undergo endoscopic retrograde cholangiopancreatography because opportunistic infection may produce biliary obstruction. Patients with a focal hepatic lesion should be considered for a guided liver biopsy. Patients with a significantly elevated serum alkaline phosphatase level should be considered for a percutaneous liver biopsy. When performed for these indications, liver biopsy will demonstrate a significant disease involving the liver in about 50% of patients with AIDS and in about 25% of patients who are HIV seropositive but who are not known to have AIDS. The clinical impact of a diagnostic biopsy is blunted by a lack of efficacious therapy for many opportunistic infections.
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PMID:Hepatobiliary manifestations of the acquired immune deficiency syndrome. 198 33

The banking of femoral heads from patients who undergo total hip arthroplasty provides a valuable resource for orthopedic surgery. Quality assurance of the banked bone used in clinical procedures requires documented policies for screening, procuring, storing and distributing. Potential donors are screened at the time of donation for malignant disease, possible communicable disease, sepsis and high-risk life-styles. After negative culture results are confirmed and appropriate documentation has been completed, the bone is frozen at -70 degrees C. A quarantine period of 90 days follows. The donor is followed up 90 days or more postoperatively. At that time written consent is obtained for donation of the recovered tissue to the bone bank and for serology testing for human immunodeficiency virus (HIV-1) antibody, hepatitis B surface antigen (HBsAG), hepatitis B core antibody (HBcAb) and syphilis, and the donor is rescreened for contraindications. This protocol meets or exceeds all existing standards. The combination of obtaining consent and serology testing at 90 days streamlines the logistics of banking bone from surgical donors.
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PMID:A simplified protocol for banking bone from surgical donors requiring a 90-day quarantine and an HIV-1 antibody test. 186 83

The real breakthrough to successful antibacterial chemotherapy was caused by the development of sulfonamides and penicillin. Subsequently numerous other antibiotics were developed and successfully applied. Whilst both the percentage share as well as the resistance pattern with different bacterial strains has remained more or less stable in Europe as well as in the US over the past ten years, staphylococci, especially Staphylococcus epidermidis, appear to increase consistently. This fact can above all be seen with blood cultures. Within the Viennese clinical material, the staphylococcal share increased between 1984 and 1989 from 40 to 48%, with material from intensive care units from 42 to 60% and at the burn care unit up to almost 90% with S. epidermidis counting for the largest share. The resistance pattern has hardly changed. The lethality of patients with staphylococcal sepsis only depended on the timing of treatment: even with targeted treatment starting within two days from onset of clinical symptoms we lost 29%, when therapy was started later, lethality increased to 50%, and without treatment to 90%. Only fast diagnosis can help to fully utilize the benefits offered by antibacterial chemotherapy.
Infection 1991
PMID:[Use of antibacterial chemotherapy. A historical comparison]. 200 16

The advances in the antibiotic therapy of acute bacterial infections can be shown by the decreasing frequency of complications and fatalities in children. The annual death-rate from pneumonia in children aged one month to 15 years has fallen in Schleswig-Holstein from 1.8 (1954-1958) to 0.6 per 10,000 (1969-1973). At the same time the total death-rate in the same age group has fallen from 14.5 to 9.3 per 10,000 children. The percentage of pneumonia in the total death-rate was 5.3% in 1971-1973: 1.6% in the first month of life and after the sixteenth year 2.3%. Pneumonia was in fourth place (after accident, malformation and neoplasm) as a cause of death in children more than one month old. Of 245 children operated on for congenital heart disease in 1983-1984, bacterial and fungal infections occurred in 3.6% compared to 17.8% of 469 in 1968-1972. Staphylococcal infections decreased from 3.4% to 0.8% and those caused by gram-negative bacteria from 6.9% to 0. Perioperative prophylaxis was performed with cefotaxime plus piperacillin in 1983-1984 versus oxacillin plus ampicillin in 1968-1972. Between 1984 and 1989, 944 children (premature babies and term babies) were treated in the intensive care unit of the University Children's Hospital of Kiel. The incidence of sepsis was 5% (congenital sepsis 4%, sepsis acquired after birth 1%). Early diagnosis and treatment of severe bacterial infections with cefotaxime plus piperacillin reduced the mortality rate of sepsis to 2%. Sepsis never developed under treatment with cefotaxime plus piperacillin.(ABSTRACT TRUNCATED AT 250 WORDS)
Infection 1991
PMID:[Progress of antibiotic therapy in pediatrics]. 200 18


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