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

Toxic epidermal necrolysis (TEN) is a rare condition in childhood usually attributed to drugs. We describe a 4-month-old infant who developed typical clinical and histologic findings of TEN concomitantly with Klebsiella pneumoniae sepsis. We emphasize that in cases of acute, severe exfoliative disease in infants, apart from staphylococcal infection, gram-negative bacterial sepsis must also be considered.
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PMID:Toxic epidermal necrolysis associated with Klebsiella pneumoniae sepsis. 789 84

Twenty-four cases of septic arthritis in rheumatoid arthritis patients were compared with 99 cases of septic arthritis in patients without rheumatoid arthritis. In addition, 238 previously published cases of septic arthritis with rheumatoid arthritis were analyzed. Fifteen percent of our patients with septic arthritis had rheumatoid arthritis, which was typically of long duration (mean 15 years), erosive, and seropositive. Fifty-four per cent (28% in the literature) and 9% of patients with and without rheumatoid arthritis, respectively, had pyarthrosis of multiple joints. The knee represented one-third of infected joints and the elbows and wrists were more often infected in patients with than without rheumatoid arthritis. S. aureus was recovered in 80% versus only 60% of patients with and without rheumatoid arthritis, respectively. The source of sepsis was often a skin lesion, in particular at the foot, emphasizing the need for early orthopedic treatment of deformities responsible for skin lesions. Monoarticular infection was more likely to be due to an intraarticular injection. Mortality rate was 17% in patients with rheumatoid arthritis (23% in the literature) versus 7% in patients without rheumatoid arthritis. Staphylococcal infection and infection of multiple joints were associated with higher mortality rates (35% and 49%, respectively). The mortality rate in polyarticular infections has failed to decline over the last 35 years. Initial failure to distinguish septic arthritis from an exacerbation of rheumatoid arthritis contributes to the high mortality rate. The diagnosis of septic arthritis rests on a high index of suspicion. Septic arthritis cannot be ruled out based on absence of local inflammation, fever, or hyperleukocytosis or on presence of inflammation of multiple joints. Joint fluid specimens should routinely be sent to the microbiological laboratory and should be inoculated in blood culture bottles at the least suspicion.
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PMID:[Septic arthritis in rheumatoid polyarthritis. 24 cases and review of the literature]. 792 May 11

A single-institution, randomised trial was conducted to compare the clinical and microbiological efficacy of two different doses of ceftazidime in combination with a single daily dose of tobramycin for the empirical management of febrile neutropenic patients with hematologic disorders (absolute neutrophil count < 1 x 10(9)/l). Upon the development of fever or signs of sepsis, patients received either 2 g ceftazidime every 8 h plus a single daily dose tobramycin (5 mg/kg/day) (C2T, n = 73) or 1 g ceftazidime every 8 h plus a single daily dose of tobramycin (C1T, n = 77). In addition, flucloxacillin (1-2 g every 4 h) could be added if there was clinical suspicion of staphylococcal infection. Analysis was performed for the whole group and for the subset which did not receive flucloxacillin. When evaluated at 96 h, 70% (95% CI, +/- 11%) of patients randomised to C2T and 60% (95% CI, +/- 11%) randomised to C1T had responded (chi 2 = 1.27, P = 0.26). The response rates at 96 h for those who did not receive flucloxacillin were 77% (+/- 12%) and 74% (+/- 13%), respectively (chi 2 = 0.01, P = 0.92). Overall, 68 (93% +/- 6%) and 72 (94% +/- 6%) patients, respectively, eventually became afebrile (chi 2 = 0.06, P = 0.81). Renal function, as judged by serum creatinine, was unaffected by either antibiotic schedule. Within 10 days of antibiotic commencement there was one death in each arm and overall there were five deaths in each arm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A randomised dosage study of ceftazidime with single daily tobramycin for the empirical management of febrile neutropenia in patients with hematological diseases. 794 61

Coagulase-negative staphylococci are the major cause of late-onset nosocomial neonatal sepsis. We prospectively examined all infants less than 6 months of age hospitalized at Children's Hospital of Philadelphia from whom at least one of two or more blood cultures grew coagulase-negative staphylococci. We considered as infections only those episodes in which multiple blood cultures grew identical isolates. Among 59 episodes that yielded specimens meeting study criteria, 25 were considered infection and 34 contamination. Cultures from infected infants yielded significantly higher numbers of coagulase-negative staphylococci than cultures representing contamination (p = 0.001). Infected infants were more likely to have central venous lines (p = 0.009), and to have received any parenteral nutrition (p = 0.002) or lipids (0.017). Hematologic values were not helpful in distinguishing between infected and uninfected infants. Isolates representing true infection were not different from contaminants in the frequency of positivity for putative virulence phenotypes. Our data corroborate previous studies indicating risk factors and predictors of coagulase-negative staphylococcal infection.
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PMID:Prospective analysis of coagulase-negative staphylococcal infection in hospitalized infants. 796 37

A single-institution, randomised pilot trial was conducted to compare the clinical efficacy, microbiological efficacy and possible toxicity of empirical single daily antibiotic administration in febrile neutropenic patients with haematologic disorders (absolute neutrophil count < 1 x 10(9)/l). Upon the development of signs of sepsis, patients received either single daily dose tobramycin (5 mg/kg per day) plus ceftriaxone (2 g/day) (C + T, n = 47) or tobramycin (1.5 mg/kg, every 8 h) plus azlocillin (4 g, every 6 h) (A + T, n = 45). In addition, flucloxacillin (1-2 g, every 4 h) could be added if there was clinical suspicion of staphylococcal infection (17 in each arm). Analysis was performed for the whole group and for the subset which did not receive flucloxacillin. When evaluated at 96 h, 62% of patients randomised to C + T and 67% randomised to A + T had responded (95% confidence interval (CI) for the difference in rates, -25% to +15%). Ninety-six hour response rates for those who did not receive flucloxacillin were 73% and 78%, respectively (95% CI, -17% to +27%). Overall, 42 (89%) and 41 (91%) patients, respectively, eventually became afebrile (95% CI, -14 to 10%) and there was no evidence of altered renal function or electrolyte imbalance in patients randomised to single daily antibiotic therapy compared with the conventional (multi-daily dose) arm. Within 10 days of antibiotic commencement there was 1 death in the C + T arm and 4 deaths in the A + T arm, although overall there were 4 deaths in each arm. Our results suggest that single daily empirical antibiotic therapy with tobramycin and ceftriaxone is efficacious and is not associated with an increased incidence of renal dysfunction or electrolyte imbalance compared with conventional administration schedules of azlocillin plus tobramycin. Single daily therapy has the potential to lead to savings in nursing-staff time and materials and may well contribute to an improved quality of life for febrile neutropenic patients.
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PMID:Single daily ceftriaxone and tobramycin in the empirical management of febrile neutropenic patients: a randomised trial. 821 13

The concept of the systemic inflammatory response (SIRS) has recently been defined with suggested new terminology and criteria for diagnosis, and this has gained acceptance in the international literature. The importance of Gram-positive organisms as a cause of the SIRS has become increasingly recognised in recent years. This report describes a case of severe staphylococcal infection with a clinical picture similar to 'classic' endotoxic shock associated with Gram-negative organisms. We use this report to discuss the management of severe sepsis with organ dysfunction, outline the clinical complications and specific therapy of staphylococcal infections, discuss the new terminology, and compare and contrast the features of SIRS associated with varying causes.
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PMID:Systemic response to gram-positive and gram-negative infections--comparison and contrast. 860 54

Dramatic changes in the epidemiology and susceptibility patterns of Gram-positive cocci during the last decade have mandated new approaches to the management of many bacterial infections. For example, there has been a sharp increase in the incidence of infections caused by Staphylococcus aureus, particularly those resistant to methicillin (MRSA), and methicillin-resistant coagulase-negative staphylococci, particularly those associated with foreign bodies and indwelling medical devices. Additionally, the worldwide spread of Streptococcus pneumoniae strains resistant to penicillin and macrolides, and the emergence of enterococci (particularly Enterococcus faecium) resistant to vancomycin, teicoplanin and other antibiotics, present further therapeutic problems. New antibacterial agents are urgently required to meet the challenges posed by these epidemiological trends. The semisynthetic streptogramins, a unique class of antibacterials currently under development, offer promise in the treatment of such multiresistant infections. Possible future applications include treatment of infections caused by the following organisms: MRSA, enterococci resistant to vancomycin, macrolides or lincosamides; and beta-lactam-resistant streptococci. They may also prove useful as therapy for children with staphylococcal infection and patients with multiresistant infections who are unable to tolerate vancomycin, including patients with skin and soft tissue infections caused by Gram-positive pathogens, patients with osteomyelitis, foreign body associated infections, endocarditis and sepsis due to Gram-positive bacteria. Clinical trials are required to evaluate the efficacy and tolerability of streptogramins in these settings.
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PMID:Future prospects and therapeutic potential of streptogramins. 872 15

Neonatal sepsis is a life-threatening emergency and any delay in treatment may cause death. Initial signs of neonatal sepsis are slight and nonspecific. Therefore, in suspected sepsis, two or three days empirical antibiotic therapy should begin immediately after cultures have been obtained without awaiting the results. Antibiotics should be reevaluated when the results of the cultures and susceptibility tests are available. If the cultures are negative and the clinical findings are well, antibiotics should be stopped. Because of the nonspecific nature of neonatal sepsis, especially in small preterm infants, physicians continue antibiotics once started. If a baby has pneumonia or what appears to be sepsis, antibiotics should not be stopped, although cultures are negative. The duration of therapy depends on the initial response to the appropriate antibiotics but should be 10 to 14 days in most infants with sepsis and minimal or absent focal infection. In infants who developed sepsis during the first week of life, empirical therapy must cover group B streptococci, Enterobacteriaceae (especially E. coli) and Listeria monocytogenes. Penicillin or ampicillin plus an aminoglycoside is usually effective against all these organisms. Initial empirical antibiotic therapy for infants who developed sepsis beyond the first days of life must cover the organisms associated with early-onset sepsis as well as hospital-acquired pathogens such as staphylococci, enterococci and Pseudomonas aeruginosa. Penicillin or ampicillin and an aminoglycoside combination may also be used in the initial therapy of late-onset sepsis as in cases with early-onset sepsis. In nosocomial infections, netilmicin or amikacin should be preferred. In cases showing increased risk of staphylococcal infection (e.g. presence of vascular catheter) or Pseudomonas infection (e.g. presence of typical skin lesions), antistaphylococcal or anti-Pseudomonas agents may be preferred in the initial empirical therapy. In some centers, third-generation cephalosporins in combinations with penicillin or ampicillin have been used in the initial therapy of early-onset and late-onset neonatal sepsis. Third-generation cephalosporin may also be combined with an aminoglycoside in places where aminoglycoside-resistance to this antibiotic is high. However, third-generation cephalosporins should not be used in the initial therapy of suspected sepsis, because 1) extensive use of cephalosporins for initial therapy of neonatal sepsis may lead to the emergence of drug-resistant microorganisms (this has occurred more rapidly as compared with the aminoglycosides), 2) Antagonistic interactions have been demonstrated when the other beta-lactam antibiotics (e.g. penicillins) were combined with cephalosporins. Infections due to gram-negative bacilli can be treated with the combination of a penicillin-derivative (ampicillin or extended-spectrum penicillins) and an aminoglycoside. Third-generation cephalosporins in combination with an aminoglycoside or an extended-spectrum penicillin have been used in the treatment of sepsis due to these organisms. Piperacillin and azlocillin are the most active of extended-spectrum penicillins against Pseudomonas aeruginosa. Among the third-generation cephalosporins, cefoperazone and ceftazidime possess anti-Pseudomonas activity. Ceftazidime was found to be more active in vitro against Pseudomonas than cefoperazone or piperacillin. New antibiotics for gram-negative bacteria resistant to other agents are carbapenems, aztreonam, quinolones and isepamicin. Enterococci can be treated with a cell wall-active agent (e.g. penicillin, ampicillin, or vancomycin) and an aminoglycoside. Staphylococci are susceptible to penicillinase-resistant penicillins (e.g. oxacillin, nafcillin and methicillin). Resistant strains are uniformly sensitive to vancomycin. A penicillin or vancomycin and an aminoglycoside combination result in a more rapid bacteriocidal effect than is produced by either dr
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PMID:Antibiotic use in neonatal sepsis. 972 68

Between August 1996 and August 1997, 130 children were admitted to our pediatric orthopaedic unit with Staphylococcus aureus musculoskeletal infection. Twenty-six of the 130 staphylococcal isolates were resistant to methicillin, an incidence of 20%. All but one of the infections, a femoral fixator-pin infection, were community-acquired. Twenty-two of the infections were superficial; however, there were four cases of deep musculoskeletal sepsis due to methicillin-resistant S. aureus. In areas where methicillin-resistant S. aureus is prevalent in the community, methicillin resistance should be considered in any overwhelming staphylococcal infection not responding to conventional antibiotics despite adequate surgical debridement.
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PMID:Community-acquired methicillin-resistant Staphylococcus aureus: a cause of musculoskeletal sepsis in children. 1034 31

Staphylococcal infections cause a number of serious diseases, ranging from acute septicaemia to chronic problems such as osteomyelitis and septic arthritis. Resistance to antibiotics is a growing problem and has re-ignited interest in vaccines and in passive immunization with antibodies. Natural infections and vaccines based on whole bacteria lead to poor antibody responses, but recent research using animal models of several staphylococcal diseases reveals that vaccines based on recombinant staphylococcal extracellular-matrix-binding proteins are much more protective. Passive immunization with antibodies against one of these proteins (collagen-binding protein) also shows promise in a mouse model of sepsis.
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PMID:Extracellular-matrix-binding proteins as targets for the prevention of Staphylococcus aureus infections. 1056 19


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