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

From January, 1979, to December, 1984, 63 Hickman or Broviac catheters were inserted into 50 high risk pediatric oncology patients (median age, 37 months). Catheters remained in place for an average of 241 days. Possible catheter sepsis and exit site infection accounted for the majority (39 of 76) of the complications of long term central venous catheterization. Neutropenia (absolute neutrophil count under 500/mm3) was associated with 70% of the catheter-related infections and 75% of the non-catheter-related infections. Catheters inserted during neutropenic episodes (23) were associated with an increased risk of subsequent septicemia (60% vs. 25%), a finding apparently related to their exposure to further neutropenia (38% vs. 16% catheter days). Of the 32 episodes of septicemia of unknown origin, 19 involved Gram-negative bacteria, 14 involved Gram-positive bacteria and 4 were caused by fungi. Five of these episodes involved multiple organisms. Staphylococcus epidermidis was the most common Gram-positive organism isolated (7 of 14). Four episodes of septicemia resolved before therapy and are considered false positive cultures. Of the other 28 episodes of septicemia, 25 (89%) were successfully treated without catheter removal including 3 episodes of fungemia and 4 of multiple organism sepsis. These data demonstrate the efficacy of antimicrobial treatment without catheter removal in the pediatric oncology population with catheter-associated infections including those associated with neutropenia, multiple organisms and fungemia.
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PMID:Management of septic complications associated with Silastic catheters in childhood malignancy. 369 42

Ninety-one episodes of polymicrobial bacteremia and fungemia were compared with 407 unimicrobial episodes to assess differences in the microbiological, epidemiological, and clinical features of the two syndromes. Enterobacteriaceae, nongroup A streptococci, anaerobic bacteria, and pseudomonads were disproportionately common in polymicrobial bacteremia. Polymicrobial episodes were significantly more likely to be hospital-acquired, to emanate from bowel or multiple foci, and to occur in patients with nonhematologic malignancies or multiple underlying diseases. Deaths directly related to sepsis were twofold higher in polymicrobial versus unimicrobial bacteremia. Factors associated with increased mortality in polymicrobial sepsis included age greater than 40 yr; absent or diminished febrile response to sepsis; absolute granulocytopenia; inadequate antimicrobial therapy for all microorganisms isolated; and a primary focus of infection in the bowel, the respiratory tract, an abscess, or an occult site. The occurrence and type of polymicrobial bacteremia can suggest a source of sepsis as well as additional diagnostic and therapeutic maneuvers.
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PMID:Clinical importance of polymicrobial bacteremia. 375 73

This report describes the experience with disseminated histoplasmosis in seven of 15 patients with the acquired immune deficiency syndrome (AIDS) diagnosed in Indianapolis since 1981. Three were homosexual, two were intravenous drug addicts, one was the spouse of another patient with AIDS and disseminated histoplasmosis, and the seventh was a hemophiliac. Six had associated infections: candidiasis in three, Pneumocystis carinii pneumonia, recurrent mucocutaneous herpes simplex infection, and disseminated Mycobacterium avium infection in two each, and disseminated infection with an unidentified mycobacterium in one. Clinical diseases suggested sepsis in four. Histoplasma fungemia occurred in five, but the diagnosis was established first by visualization of organisms in blood or bone marrow in three. Results of Histoplasma serologic tests were positive in each. Three died before receiving 50 mg of amphotericin B, three had prompt improvement with amphotericin B, and one was treated with ketoconazole to prevent dissemination. However, two of the three patients treated with amphotericin B had relapses after a 35 mg/kg course, and the third died within a month following therapy. Disseminated histoplasmosis is a major opportunistic infection in patients with AIDS from endemic areas. AIDS should be strongly considered in otherwise healthy persons with disseminated histoplasmosis, especially if risk factors for AIDS are present. Amphotericin B is not curative in these patients.
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PMID:Histoplasmosis in the acquired immune deficiency syndrome. 387 88

Thirteen episodes of intravascular cannula-related sepsis were seen during a two year period. Staphylococcus aureus was the most common pathogen. Fungaemia occurred in four patients all receiving total parenteral nutrition. Culture of the cannula tip and swabs of the insertion site were useful in confirming the diagnosis. Three patients with infection due to S aureus died while receiving treatment for their infections. Care with insertion and maintenance of intravascular cannulae should reduce the frequency of this iatrogenic infection.
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PMID:Intravascular cannula-related sepsis: two years experience. 393 2

Consider where the patient acquired the infection--in the community or the hospital. Gram-negative sepsis that develops after admission to a hospital or extended-care facility is likely to be caused by multiply-resistant organisms. Lack of fever does not reliably exclude sepsis in elderly patients. Among 27 afebrile patients found to have bacteremia-fungemia, diagnosis was made in one-third only after blood cultures were drawn, and almost one-half were already receiving antibiotics.
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PMID:Managing sepsis--a common cause of geriatric death. 394 67

Opportunistic systemic fungal infections are more frequent than generally realized. Increased awareness and a high index of suspicion of fungal super-infection in the presence of sepsis is required to bring about recognition and therapy. The intravenous catheter is an important portal of entry or may act as a foreign body favoring localization of a septic process. In its presence, fungemia must be guarded against. Whenever an intravenous catheter is removed, its tip should be cultured. Removal alone may be a critical item in therapy. In febrile patients, in whom the course of fever is not established, frequent blood cultures with attention directed specifically at fungi should be obtained. Fungi are not easily isolated and identified and only by requesting special attention from the microbiologist can the diagnosis be established in the average institutional laboratory in time to permit appropriate therapy. Since available therapeutic measures are strikingly effective when instituted early, awareness and alertness on the part of the clinician constitute the key to cure.
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PMID:Fungal septicemia in surgical patients. 421 22

Malassezia furfur, a lipophilic fungus commonly found on the skin of healthy adult, was isolated from Broviac catheter blood cultures in five sick infants who were receiving fat emulsions intravenously. The most common manifestations of sepsis included apnea and bradycardia, low-grade fever, interstitial pneumonia, elevated neutrophil band counts, and thrombocytopenia. All infants recovered without antifungal therapy after removal of the Broviac catheters. Early onset of fungemia after catheter placement in these five infants and the recovery of M. furfur from the skin of nearly 33% of hospitalized premature neonates indicate that contamination of the Broviac catheter at time of placement may be the most likely origin of infection.
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PMID:Broviac catheter-related Malassezia furfur sepsis in five infants receiving intravenous fat emulsions. 654 35

A 33-yr-old Puerto Rican women was hospitalized for chemotherapy and multiple antibiotic treatment for relapse of acute myelomonocytic leukemia. While she was already receiving amphotericin for suspected Aspergillus infection, she developed hepatomegaly and abnormal liver enzymes with high serum bilirubin. The blood cultures were negative. Percutaneous liver biopsy revealed granulomatous fungal hepatitis identified by cultures as Trichosporon cutaneum. In spite of the continued administration of amphotericin, with the addition of 5-fluorocytosine, Trichosporon was later cultured from her blood, and she succumbed to fungemia and polymicrobial sepsis.
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PMID:Trichosporon hepatitis. 657 26

To evaluate the role of atmosphere of incubation in the detection of clinically important bacteremia and fungemia in adults, we compared the yield of microorganisms from 10,541 paired 5-ml samples of blood incubated aerobically and anaerobically. The medium, supplemented peptone broth (SPB) with 0.03% sodium polyanetholesulfonate, and the ratio of blood to broth (1:10) were the same for all cultures. Only cultures with adequate blood samples (greater than or equal to 80% of stated volume) were compared statistically. More fungi (P less than 10(-7) ) grew in continuously vented bottles of SPB. Aerobic incubation also favored (P less than 0.01) isolation of Neisseria gonorrhoeae and Eubacterium; more than 80% of these bacterial organisms were detected only in vented bottles. Anaerobic incubation (plugged venting units) did not significantly favor the isolation of any genus of microorganisms, although an estimated 11% more Bacteroidaceae grew in the unvented bottle of SPB. By comparison of our data with published results for other media, we conclude that the need for both aerobic and anaerobic incubation of blood cultures is dependent upon the medium used and the microorganisms likely to be encountered. Vented incubation of blood cultured in SPB is crucial for detection of fungi and some bacteria. Routine use of an unvented bottle of SPB may not be worthwhile for patients in whom Bacteroidaceae cause bacteremia infrequently. However, when Bacteroidaceae are suspected as the cause of sepsis, use of an unvented bottle of SPB is prudent.
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PMID:Controlled evaluation of the effect of atmosphere of incubation on detection of bacteremia and fungemia in supplemented peptone broth. 675 84

A patient receiving total parenteral alimentation through a central catheter developed fatal candida sepsis originating from suppurative phlebitis of a peripheral vein. This case underscores the importance of aggressively pursuing all potential endovascular sources of fungemia in susceptible patients: those on antibiotics, with chemical phlebitis, and hyperglycemia.
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PMID:Suppurative Candida phlebitis of a peripheral vein. 677 16


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