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

We correlated the height of fever with underlying infectious etiology in 683 consecutive febrile infants aged four to eight weeks who received outpatient evaluation for sepsis during a five-year period. The relative number of infants with fever was inversely proportional to fever height, as 51% had a temperature 38.1-38.9 degrees C, 45% had a temperature 39-39.9 degrees C, and 4% had a temperature greater than or equal to 40 degrees C [hyperpyrexia]. There were 34 cases of serious bacterial infections [SBI], including 16 cases of urinary tract infection, 8 cases of bacteremia, 6 cases of bacterial meningitis, and 4 cases of Salmonella enteritis. The rate of SBI increased in direct proportion to fever height, being 3.2% in those with a temperature 38.1-38.9 degrees C, 5.2% in those with a temperature 39-39.9 degrees C, and 26% in those with a temperature greater than or equal to 40 degrees C. The 6.8% rate of SBI in those with fever greater than or equal to 39 degrees C was significantly greater than the 3.2% rate in those with fever less than 39 degrees C [p less than 0.035]; and the 26% rate of SBI in those with hyperpyrexia was significantly greater than the 4.1% rate in those with fever less than 40 degrees C [p less than 0.000004]. In identifying those with SBI, the presence of hyperpyrexia had a sensitivity of 21%, specificity of 97%, positive-predictive value of 25%, and negative-predictive value of 96%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Relationship of fever magnitude to rate of serious bacterial infections in infants aged 4-8 weeks. 191 47

Fifty-two patients with moderate or severe infections associated with internal medicine were treated with imipenem/cilastatin sodium (IPM/CS) and the efficacy and the safety of this drug were evaluated. There were 20 patients with pneumonia, 10 with acute exacerbation of chronic respiratory tract infections, 9 with sepsis, 2 with pyothorax, 3 with intraabdominal infection, 2 with urinary tract infection, 1 with pulmonary abscess, 1 with infective endocarditis, 4 with fever of unknown origin. Forty-four patients were evaluable for the efficacy. Clinical efficacies were excellent in 12 patients, good in 26, fair in 3 and poor in 3. The overall clinical efficacy was 86.4%. The efficacy rate was 63.6% in patients previously treated and 93.9% in patients previously untreated with other antibiotics. Bacteriologically, Staphylococcus aureus (8 strains), Streptococcus pneumoniae (5), Streptococcus pyogenes (1), other Gram-positive coccus (1), Klebsiella pneumoniae (8), Haemophilus influenzae (4), Pseudomonas aeruginosa (3), Serratia marcescens (3), Escherichia coli (3), Branhamella catarrhalis (1), Citrobacter freundii (1), Klebsiella oxytoca (1), Enterobacter sp. (1), and Peptostreptococcus sp. (1) were eradicated. P. aeruginosa (3) and Acinetobacter sp. (1) decreased. S. aureus (1), S. epidermidis (1), P. aeruginosa (5), and S. marcescens (1) persisted or appeared. The eradication rate was 83.7%. Six patients showed adverse reactions including general fatigue 1, epigastralgia 1, eruption 1, eosinophilia 1 and elevation of S-GOT 2. But all of the adverse reactions were mild or slight, and transient. These findings indicate that IPM/CS is a useful and safe drug against bacterial infections in internal medicine.
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PMID:[Clinical evaluation of imipenem/cilastatin sodium in the internal medicine]. 192 Aug 13

The effectiveness of sulbactam/cefoperazone (SBT/CPZ) on severe infections associated with hematological diseases was evaluated in a nation-wide multicenter clinical study. SBT/CPZ (4-6 g/day), a 1:1 combination of SBT and CPZ, was given intravenously to 437 patients with hematological disorders. The underlying diseases included acute nonlymphocytic leukemia, acute lymphocytic leukemia, malignant lymphoma, multiple myeloma, myelodysplastic syndrome and others. Thus, 94.3% of the patients had hematological malignancies. The complicating infections included sepsis in 41 cases; sepsis suspected in 205; pneumonia in 47; urinary tract infection in 15; fever of unknown origin in 59; and others in 70. Clinical efficacies of SBT/CPZ were as follows; markedly effective, 83 cases; effective, 170; fairly effective, 59; and ineffective, 110. The efficacy rate (markedly effective plus effective) was 60.0% as a whole. The efficacy rate of SBT/CPZ in sepsis and suspected cases, which accounted for 56.3% of the infections, was 59%. Mild side effects such as skin rash were observed in 15 patients (3.1%). As for abnormal laboratory test results, transient increases in GOT, GPT, A1-P, LDH, etc. were observed in 42 patients (8.6%). Therefore, SBT/CPZ is considered to be a useful drug in empiric therapy for severe infections associated with hematological diseases.
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PMID:[Clinical evaluation of sulbactam/cefoperazone for severe infections associated with hematological disorders]. 196 Aug 59

A retrospective review covering a 9-year period revealed 113 patients who underwent 157 major bowel procedures during 130 operations performed solely by gynecologic oncology surgeons. Forty-eight percent of the operations were done for tumor cytoreduction, and 33% were performed for a bowel obstruction. Other indications included colostomy closure, fistula repair, resection for multiple enterotomies, temporary diversions, repair of perforated bowel, treatment for severe proctosigmoiditis, management of ureteral stricture, treatment for vulvar necrosis, and resection of an incidental small bowel tumor. Of the 157 procedures, 44% were colostomies, 32% were bowel resections with reanastomosis, 9% were urinary conduits, 6% were intestinal bypass procedures, 5% were colostomy closures, and 4% were ileostomies. Postoperative complications occurred in 32% of the 130 operations. These included wound infection, death, sepsis, fistula formation, urinary tract infection, unexplained febrile morbidity, anastomotic leakage, stomal infarction, adult respiratory distress syndrome, bowel obstruction, deep venous thrombosis, and wound hematoma. Four of the eight deaths were due to tumor progression, three were from sepsis, and one was from adult respiratory distress syndrome. Of the 130 operations, 89 (68%) were associated with no complications. These data support the concept that gynecologic oncology surgeons are able to perform intestinal operations as therapy for gynecologic malignancies with acceptable complication rates. Since a thorough understanding of the natural history of the cancer, familiarity with alternative therapeutic options, and knowledge of the prognosis are important in making operative decisions, and since gynecologic oncologists are technically capable of performing operations on the small bowel and colon, referral of patients with a primary or recurrent gynecologic malignancy or with a subsequent intestinal complication after initial therapy should be directed to the gynecologic oncologist whenever possible.
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PMID:Intestinal surgery performed on gynecologic cancer patients. 198 13

Staphylococcus epidermidis is becoming increasingly important as a cause of clinical illness. In the past, its presence in the wound, blood and urine culture was generally dismissed as contamination and went undocumented. However, more recently its pathogenic role is being recognized notably in bacterial endocarditis, postcardiotomy endocarditis, bacteraemia secondary to colonised prosthetic heart valves, postsurgical wound infection and urinary tract infection. The ability of the organism to cause local sepsis in superficial tissues is a matter of debate. A case of pyogenic infection due to multidrug resistant coagulase negative staphylococci is reported here.
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PMID:Pathogenic infection caused by coagulase negative multiple drug resistant Staphylococcus. 205 Oct 34

Pharmacokinetics and clinical study of aztreonam (AZT) in neonates and premature infants were conducted with the following results: 1. Pharmacokinetics (1) Serum concentrations of AZT at 30 minutes after one-shot intravenous injection of 10 mg/kg and 20 mg/kg to neonates including premature infants were 20.6-26.6 micrograms/ml and 38.5-46.4 micrograms/ml, respectively, and decreased thereafter. A dose response was observed in the serum concentrations with administration of AZT 10 mg/kg and 20 mg/kg. (2) Serum half-lives (T1/2) tended to be shorter in both mature and premature infants as their day-ages increased and T1/2 tended to be prolonged in premature infants compared with mature infants. (3) Changes in serum concentration upon one-hour intravenous drip infusion of AZT 20 mg/kg were very similar to those upon one-shot intravenous injection. (4) Urinary excretions in the first 6 hours after one-shot intravenous injection of AZT 10 mg/kg or 20 mg/kg tended to increase in mature infants as they grew and showed excretion rate of 26.2-54.3% but those in premature infants did not show any specific tendency with rate of 17.5-45.1%. Urinary excretions upon intravenous drip-infusion showed a tendency very similar to those upon intravenous injection. 2. Clinical studies (1) Clinically evaluable cases of AZT treatment were 88 cases (91 diseases), in which pathogenic organisms were identified in 56 cases (Group A), i.e., sepsis 9, purulent meningitis 2, pneumonia 8, urinary tract infection (UTI) 33 and others. Total efficacy rate was 98.2% including "excellent" (39), "good" (16) and "fair" (1). Number of cases in which pathogenic organisms were unknown (Group B) was 11, i.e., suspected sepsis (4), pneumonia (3) and intrauterine infection (4) and the efficacy rate was 100% with "excellent" (4) and "good" (7). Thus, both group A and B showed excellent results. AZT was also given to 24 cases for prophylaxis and all the cases showed prophylactic effect of AZT.4+ Bacteriologically AZT was deemed effective in 53 cases out of 56 (Group A) with identified pathogens "eradicated" and "unchanged" (2), thus the bacterial eradication rate was 96.2%. (3) A minor degree of loose feces was observed in 1 (1.3%) of 80 cases as a side effect. Abnormal laboratory test values found were eosinophilia (3 cases), elevation of GOT and GPT (2), platelet-increase (1), elevation of GOT (1), and thrombocytopenia.elevation of GOT.GPT.LDH (1). Every one of these was of a minor degree and transient. From the above pharmacokinetics and clinical results, standard dosage of AZT to neonates and premature infants should be in a unit dose of 20 mg/kg, twice daily to those with ages between 0 and 3 days, and 2 to 3 times daily to those with ages 4 days and above, by intravenous injection or intravenous drip infusion.
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PMID:[Pharmacokinetics and clinical studies on aztreonam in neonates and premature infants (the first report). Study on effectiveness and safety in mono-therapy with aztreonam. A study of aztreonam in the Perinatal Co-research Group]. 219 68

Patients under immunosuppressive therapy with malignant diseases, malformations, premature infants or children after major surgical interventions and trauma are particularly susceptible to infections. In these patients nosocomial infections with multiply resistant organisms may occur despite broad spectrum antibiotic prophylaxis or antimicrobial chemotherapy of existing infections. In an open clinical study 31 infants and children with an overall 45 episodes of life-threatening hospital-acquired infections occurring under broad spectrum antimicrobial coverage were treated with imipenem/cilastatin alone or in various combinations. All the patients were immunocompromised. The most frequent single diagnosis was sepsis--documented by a positive blood culture--followed by nosocomial pneumonia, urinary tract infection and peritonitis. In seven patients an infection of implanted biomaterial was present which could not be controlled by the previously administered antimicrobial therapy. Imipenem/cilastatin was given in a dose of 50 mg/kg BW. Therapy was well tolerated, no side effects were observed. A total of 34 of 45 episodes could be successfully treated with imipenem/cilastatin alone or in various combinations. One child died from refractory candida sepsis; five further children died from the underlying disorder, the respective infectious complications having been controlled adequately. Treatment failures were due to infection with Candida albicans, Pseudomonas cepacia and resistant Streptococcus faecium. Imipenem/cilastatin proved to be a suitable antibiotic for the treatment of life-threatening nosocomial infections and reinfections in children.
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PMID:Treatment of nosocomial infections in children undergoing antimicrobial chemotherapy. 227 26

We randomized 400 patients who were scheduled for an elective cardiovascular operation involving median sternotomy to receive cefamandole nafate or cefonicid in a prospective double-blind study. Three hundred fifty-seven patients were evaluable for prophylactic efficacy. Chest wound and donor site infections and early prosthetic valve endocarditis occurred more frequently with cefonicid (11 patients, 6.3%) than with cefamandole (4 patients, 2.2%) (p = 0.05). Three patients, all in the cefonicid group, required sternal debridement to control postoperative deep wound infections. Twenty-five miscellaneous postoperative infections (urinary tract infection, pneumonia, intravenous site infection, bacteremia, sepsis, Clostridium difficile diarrhea) occurred in 16 patients (9.19%) in the cefonicid group and four in 4 patients (2.19%) in the cefamandole group (p = 0.003). These data indicate that cefamandole is superior to cefonicid in preventing both surgical wound infections and miscellaneous nonsurgical infections after cardiovascular operations.
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PMID:Cefamandole versus cefonicid prophylaxis in cardiovascular surgery: a prospective study. 231 Feb 50

A 77-year-old male, who had been treated with carboquone and busulfan for polycythemia vera (PV), developed myelodysplastic syndrome (MDS) 8 years later. On admission the peripheral blood revealed pancytopenia, but blastoid cells were not noted. The bone marrow showed hypercellularity, and functional and morphological abnormalities in trilineages of hemocytes. Cytogenetic study showed complex abnormalities involving chromosomes 5 and 7. We diagnosed this case as secondary MDS to alkylating agents. He was treated with 1, 25 (OH)2 vitamin D3. However, it was not effective and the percentage of myeloblasts increased to 14.4%. In spite of supportive therapy, he died of sepsis due to urinary tract infection.
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PMID:[Polycythemia vera terminating in myelodysplastic syndrome]. 231

A retrospective study was performed of 292 infants younger than 2 months of age with a history of fever who received a standardized evaluation and were admitted to the hospital for possible sepsis. The purpose was to correlate the presence of this symptom with subsequent temperature patterns and the rate of serious bacterial infections (SBI). Caretakers reported fever per rectum via thermometer in 244 infants and tactile fever in 48 infants. Of 244 infants with reported fever per rectum, 224 (92%) had fever on presentation or during the subsequent 48 hours of hospitalization; by contrast, only 22 of 48 infants (46%) with reported tactile fever had fever on presentation or during the subsequent 48 hours of hospitalization (P less than 0.0001). Of 26 infants with tactile fever who were afebrile on presentation, none had subsequent fever during hospitalization and only 1 (3.8%) had SBI (urinary tract infection); of 40 infants with reported fever per rectum who were afebrile on presentation, 8 (20%) had subsequent fever during hospitalization and 4 (10%) had SBI (meningitis, bacteremia, osteomyelitis and urinary tract infection). There were a total of 19 infants (6.5%) with SBI; although 5 (27%) were afebrile on presentation (4 with reported fever per rectum, 1 with tactile fever), all 19 exhibited abnormal clinical and/or laboratory features on evaluation which were suggestive of underlying serious infection. Management decisions for young infants with reported fever should be based on both clinical findings and temperature-pattern profiles.
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PMID:Correlating reported fever in young infants with subsequent temperature patterns and rate of serious bacterial infections. 233 95


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