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

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

Between January 1970 and June 1988, a total of 45 patients with aortic prosthetic graft infection underwent removal of the infected aortic prosthesis. In addition, 36 of these patients also underwent revascularization via an extra-anatomic bypass. We analyzed the early and long-term results with respect to survival, limb salvage, freedom from infection, and extra-anatomic graft patency. The 30-day mortality was 24% (11/45), and the amputation rate was 11% (8/73). During a mean follow-up of 36 months (range, 2 to 144 months), 80% (24/30) of the patients remained free of infection and are considered cured. Infection in the extra-anatomic bypass graft was the most common cause of recurrent sepsis and the leading cause of late amputations (four of seven). By life-table methods, 1-year survival was 63% and 5-year survival was 49%. Limb salvage rates at 1 and 5 years were 79% and 66%, respectively. The primary patency rate of extra-anatomic bypass was 43% at 3 years, with the secondary patency rate improved to 65%. These early and late results are in marked contrast to the natural history of untreated aortic graft infection. Nonetheless, a perioperative mortality rate of 24%, a 5-year limb loss rate of 33%, and 3-year graft thrombosis rate of 35% are testimony to the serious nature of aortic graft infection and the need to develop better methods to prevent this complication.
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PMID:Long-term results following surgical management of aortic graft infection. 200 68

A significant increase in the use of vascular access devices has changed the spectrum of organisms causing bacteremia and fungemia at Memorial Sloan-Kettering Cancer Center. This paper documents the 1988 laboratory experience with bacteremia and fungemia and contrasts some of that data with information obtained in 1984. In 1988, 439 tunnelled-catheters and 355 ports were inserted in patients; 2,778 organisms were subsequently recovered from 933 episodes of bacteremia and fungemia. Fifty-percent of the episodes of bacteremia and fungemia were vascular access device-related. Compared to 1984, the relative incidence of bacteremia due to gram-positive organisms increased from 33 to 43%, polymicrobic cultures increased from 24 to 27%, and the number of organisms with colony counts greater than 100 cfu/ml increased from 24 to 44%. In 1988, device-related sepsis was often caused by Acinetobacter spp., Bacillus spp., Corynebacterium spp., pseudomonads other than Pseudomonas aeruginosa, and coagulase-negative staphylococci. Infection was also caused by species of flavobacteria, Micrococcus, and Rhodotorula. Efforts required for identification of many of the newer pathogens have escalated material and personnel costs.
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PMID:Changes in the spectrum of organisms causing bacteremia and fungemia in immunocompromised patients due to venous access devices. 207 97

Relative risk of catheter-related sepsis varies according to the site and the catheter type chosen. Subclavian vein route is usually safer than internal jugular vein route. However internal jugular catheter can be tunnelled on the thorax which may decrease infections risk. Infection rate is very low during arterial cannulation whatever the site used, including femoral artery. The use of Swan-Ganz catheter is accompanied by a very low infection rate, despite repeated interventions on the catheter line. Prevention of infection is a major goal during vascular catheterization. A strict aseptic procedure must be used during placement of the line. Same aseptic precautions must be taken during every manipulation of the line. The best results are obtained when the management of the intravascular line is under the responsibility of a specialized "Catheter Team".
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PMID:[Influence of catheter type and site on infection incidence. Prevention techniques]. 208 74

Although major advances in the treatment of cancer have resulted in improved survival rates, serious infections continue to be a major source of morbidity and mortality in the immunocompromised patient. Patients may experience prolonged periods of bone marrow suppression accompanied by neutropenia as a result of the underlying disease, and as a result of treatment with myelosuppressive chemotherapy, intensive radiotherapy, or both. Neutropenia is the single most important factor predisposing patients with cancer to infection. The risk of developing infection increases as neutropenia persists, and this risk is consistently greater at lower neutrophil levels. Infection in a patient with neutropenia is regarded as an emergency situation requiring immediate action; progression of localized to disseminated infection leading to sepsis may be so rapid that, if not detected early, mortality is high. In the presence of neutropenia, the manifestation of infection leading to life-threatening septicemia is altered. The usual signs and symptoms of infection may be minimal or absent, hindering early and accurate diagnosis of infection. To provide a means of early and more accurate diagnosis of infection in the patient with neutropenia, a nursing protocol has been developed that incorporates preventive interventions, guidelines for early detection of impending infection, and measures to control infection.
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PMID:Nursing protocol for the patient with neutropenia. 210 83

To study the influence of a gram-positive sepsis on the metabolism of circulating lipids, fasted rats were injected with saline (control group) or with a suspension of heat-killed or live Staphylococcus aureus. 18 h later, body temperature was increased, while albuminemia and ketonemia were decreased in the group injected with heat-killed bacteria, as opposed to the control group. Passing from these groups to the group injected with live bacteria, more differences appeared: increase of triglyceridemia and free cholesterolemia; decrease of esterified cholesterol levels and especially of the in vitro activity of diaphragm, heart and adipose tissue lipoprotein lipase and of hepatic lipase. The decrease of lipolytic activities occurred whether they were measured on a fat emulsion containing long-chain or medium- and long-chain triglycerides. The fact that for the latter the activity was always higher than for the former suggests that the host infected with gram-positive bacteria would clear exogenous fat more easily in the case of medium-chain triglycerides.
Infection
PMID:Gram-positive bacterial sepsis in rat and tissue lipolytic activity on commercial parenteral fat emulsions. 211 Jan 16

Despite significant advances in intensive care unit technology and mechanical ventilatory support, mortality due to adult respiratory distress syndrome (ARDS) or multiorgan failure (MOF) has not changed significantly within the past two decades. The key to improving survival requires understanding and modifying (or eliminating) factors that may initiate (or modulate) these syndromes. Infection, and the host responses to infection, are major etiological factors responsible for the induction and perpetuation of the injury to the lung and microvasculature in ARDS and MOF, and contribute to late mortality. While the pathogenesis of ARDS and MOF-complicating sepsis remains to be elucidated, bacterially derived (eg, endotoxin or lipopolysaccharides [LPS]) and host-derived humoral and cellular mediators are of importance in both disease states. In fact, the host response to infection (or injurious stimuli) may be a more critical determinant of the outcome of sepsis and ARDS than the original inciting stimulus. The pleiotropic effects of LPS are largely indirect, and are orchestrated via its ability to trigger the release of an array of host-derived mediators of inflammation. Several potential mechanisms of injury in ARDS, sepsis, and MOF have been suggested and include a variety of inflammatory cells (neutrophils, mononuclear phagocytes, platelets), activated complement and coagulation components, vasoactive mediators (kinins, arachidonic acid metabolites, lipids, peptides), reactive oxygen radicals, and diverse cytokines. Interactions between these humoral and cellular mediators appear to set in motion an amplified cascade of events culminating in cellular and tissue injury. In this article, several of these putative inflammatory mediators are discussed in detail, and the importance of cytokine networking and the possible role of nonimmune cells in the orchestration of the inflammatory response associated with ARDS and MOF are explained. Finally, future therapeutic strategies aimed at blocking or suppressing the release or effects of endogenous mediators may be the key to improving the outcome of these disorders.
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PMID:Host responses in mediating sepsis and adult respiratory distress syndrome. 212 91

Infection is a common problem for bone marrow transplant (BMT) recipients during the period of neutropenia that immediately follows the procedure. Gram-negative infections present a particular hazard in these immunocompromised hosts. To augment host defenses against one such pathogen, Pseudomonas aeruginosa, we immunized bone marrow transplant donors and/or recipients with a polyvalent O-polysaccharide-toxin A conjugate vaccine. When either donor or recipient alone was vaccinated before transplant, no increase in specific antibody titers to any of the vaccine components was observed in the recipient. However, when both donor and recipient were vaccinated before transplant, increases in antibody titers to all polysaccharide components occurred to levels shown to be protective in animal models of gram-negative sepsis. Specific antibodies were primarily of the IgG1 and IgG2 subclass even though IgG2 subclass deficiency is common after BMT. The requirement for both donor and recipient immunization reflects the need for primed donor B lymphocytes in the marrow inoculum to be transferred into an antigen-containing environment so that maximum B-cell proliferation and antibody secretion can occur. Adoptive transfer of antibody responses to Pseudomonas aeruginosa and other common bacterial pathogens has the potential to reduce infection-related morbidity and mortality after allogeneic bone marrow transplantation.
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PMID:Immunity against Pseudomonas aeruginosa adoptively transferred to bone marrow transplant recipients. 212 33

After a follow up of 22 months we report results of treatment on 44 patients (22 males), aged 16 to 63 years, with acute non lymphoblastic leukemia. Complete remission was obtained in 22 patients. This was significantly more frequent in patients under 40 years of age with white cell counts under 35,000 and without metabolic complications nor disseminated intravascular coagulation before treatment. Delaying chemotherapy for 5 days after diagnosis was also associated to a better prognosis. Overall actuarial survival rate was 37% at 15 months, 55% for those experiencing a first remission. A total of 25 patients [corrected] have died, 15 during induction of therapy, 7 after complete remission and 3 after failure of induction. Infections are the main cause of death during induction, with a high lethality for sepsis (33%) and pneumonia (40%).
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PMID:[Treatment of acute non-lymphoblastic leukemia in adults. Preliminary report from the national protocol on antineoplastic drugs]. 213 62


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