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

Catheter-related sepsis is one of the major complications of total parenteral nutrition (TPN) therapy. The relationship between microbial colonization of the skin at the site of catheter insertion and colonization of the central venous catheter was investigated in 74 catheters used to administer TPN therapy in 53 patients. Semiquantitative culture specimens were obtained from the insertion site and intravascular and subcutaneous catheter segments at the time of catheter removal. Bacteria and/or fungi were recovered from 19 catheters and 19 insertion sites; of the 19 colonized catheters, 6 had sterile insertion sites. Organisms isolated from the remaining 13 catheters were isolated concurrently from the insertion site. Catheter-associated bacteremia or fungemia was observed in 10 of the 19 patients with colonized catheters. The association between colonization of catheters and the presence of more than 10(3) bacterial or fungal colony-forming units at the insertion site was significant (P less than 0.005). These results demonstrated that colonization of catheters by organisms present on the skin at the site of catheter insertion occurred twice as frequently as colonization by the hematogenous route. The results also suggested that colonization of catheters by organisms present at the insertion site occurred only after a threshold number of organisms was reached.
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PMID:Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. 681 29

Among 500 patients with bacteremia and fungemia, total mortality was 42%; about half of all deaths were attributable directly to infection. Mortality increased with age, but deaths unrelated to infection itself were responsible in part for this increase. Mortality was 2.6% among obstetric-gynecologic patients, 42% among medical patients, 49% among surgical patients, and 60% among transplant patients. The risk of death was especially high with enterococcal, facultative gram-negative, fungal, polymicrobial, or hospital-acquired sepsis; in the presence of shock, leukopenia, absolute granulocytopenia, or defined predisposing conditions (neoplasia, cirrhosis, and combinations of factors such as surgery and renal failure); and with a primary infected focus in the respiratory tract, the skin, a surgical wound, an abscess, or an unknown site. Body temperature was inversely related to mortality. Survival was increased by the use of appropriate antibiotics and, where applicable, additional therapeutic maneuvers (e.g., drainage). Multivariate analysis defined seven variables that independently influenced outcome: microorganism, blood pressure, body temperature, primary focus of infection, place of acquisition of infection, age, and predisposing factors. Although some adverse prognostic factors are not amenable to intervention, prevention of nosocomial bacteremia and fungemia and early reversal of hypotension may reduce the death rate from sepsis.
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PMID:The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II. Clinical observations, with special reference to factors influencing prognosis. 682 12

Records of 65 surgical patients with positive fungal blood cultures were reviewed to address risk, overall mortality, and treatment. Negative urine cultures did not rule out sepsis. Staphylococcus epidermidis sepsis was present in 27 (42%) of the patients. In 70% of whom it occurred before or during fungemia. Increased mortality correlated with the use of multiple antibiotics, antibiotic use for prolonged periods, and with associated bacterial sepsis. Stopping antibiotic therapy did not reduce mortality. Amphotericin B reduced mortality in patients with dissemination, indicating that it is the treatment of choice for disseminated fungemia and that antibiotic therapy should not be discontinued when concomitant bacterial sepsis is present.
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PMID:Fungal sepsis in surgical patients. 684 38

Trichosporon beigelii fungemia and multiple, purpuric, papular skin lesions developed on the chest wall and extremities of a 22-year-old man with acute granulocytic leukemia. Histologically, the skin lesions demonstrated dermal budding yeasts, which were identified as T beigelii in culture. Unexplained biventricular, congestive heart failure and sepsis wit Streptococcus intermedius developed, and the patient died 28 days after his admission to the hospital.
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PMID:Trichosporon beigelii fungemia and cutaneous dissemination. 695 20

Tobramycin in combination with clindamycin or lincomycin were used as systemic antibiotics in the treatment of 20 consecutive patients with septic peritonitis or intraabdominal sepsis, 10 of which were in septic shock. Doses were: tobramycin 1.5 mg/kg body weight every 8 hours, with prolonged dosage interval in patients with reduced renal function, clindamycin 0.9 g every 8 hours and lincomycin 1.2 g every 8 hours. Therapy was monitored by means of tobramycin serum concentration determinations and renal function tests. Eventual cure of the infection was obtained in 19 patients. In 2 of these, the effects of the antibiotics were doubtful. Side effects were observed on 8 occasions: One patient had a slight and temporary subjective hearing loss, coinciding with raised trough levels of tobramycin. Diarrhoea occurred in 3 cases and skin reactions in 3 cases. Superinfection with Candida albicans fungemia occurred in one patient. From the overall results it is concluded that the antibiotic regimen is of value in serious life-threatening infections. Although the tobramycin dose was higher than customarily used in Scandinavia at the time, 0 hour and 1 hour serum concentrations remained stable during therapy in patients whose renal function was normal at onset of therapy. Serum creatinine (S-Cr) levels in these patients were also essentially unchanged. Temporary reductions in osmolality (Osm) ratio Osm-urine/Osm-serum occurred in 11 patients despite normal S-Cr, but it was hard to attribute these impairments of renal function to tobramycin specifically. It was also doubtful whether tobramycin further aggravated renal function in those patients where it was impaired at onset of therapy. Thus, no conclusive evidence of clinically important tobramycin-induced nephrotoxicity were found. We suggest that the dosage schedule of tobramycin used in this study is applied when treating serious intraabdominal infections.
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PMID:High-dose tobramycin combined with clindamycin or lincomycin in the treatment of septic peritonitis and intraabdominal sepsis. 732 60

The syndrome of sepsis-associated severe acute renal failure is a frequent component of sepsis-induced multiorgan failure. Continuous hemofiltration techniques are often used in its dialytic management but little is known about their impact. The aim of this study is to define the biochemical and clinical impact of continuous hemodiafiltration (CHD) in the management of this syndrome and to retrospectively compare it to that of conventional dialysis. A prospective, cohort study and retrospective comparison with historical controls was conducted at an intensive care unit (ICU) of a tertiary institution. Eighty-seven consecutive septic patients with acute renal failure were treated by continuous hemodiafiltration and 40 consecutive similar patients by conventional dialysis. All new cases of severe acute renal failure with sepsis were treated by means of continuous hemodiafiltration. Historical controls were treated by means of conventional dialysis. Illness and sepsis severity were assessed on admission and prior to initiation of treatment. Biochemical variables were assessed daily. Outcome was measured as discharge from the ICU, duration of oliguria and discharge from hospital. Of the 87 patients treated by hemodiafiltration, 86 had multiorgan failure, 71 (81.6%) septic shock and 52 (59.8%) bacteremia/fungemia. Their APACHE II score on admission was 29.9 and their mean organ failure score prior to treatment was 4.3. Hemodiafiltration resulted in a significant fall in mean urea and creatinine levels within 24 h and in the correction of acidosis. The mean alveolar-arterial gradient fell from 276 to 211 mm Hg (p < 0.02) within 24 h of therapy. Complications were few and mostly related to vascular access.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of sepsis-associated severe acute renal failure with continuous hemodiafiltration: clinical experience and comparison with conventional dialysis. 754 27

Catheter-related infections with both local inflammation and bacteremia or fungemia are common in hospitalized patients. The diagnosis of these infections is not, however, straightforward. Evidence of local inflammation is helpful, if present, but is not always found with site infections, and blood cultures are not positive. Systemic infection is associated with positive blood cultures, but the finding of a positive blood culture does not identify the catheter as the source. With central catheters, making a diagnosis without having to remove the catheter would be useful, because many of these patients could be treated with antibiotics without catheter removal. Multiple methods have been described for identification of these infections. Semiquantitative cultures of the catheter tip performed by rolling the catheter on the surface of an agar plate are the most popular. For central catheters, many advocate obtaining blood cultures through the catheter and comparing the results by quantitative methods with peripherally obtained blood cultures. No method has clearly demonstrated a clinical benefit in large numbers of patients. Because the most serious manifestation of catheter-related infection is bacteremia or fungemia, ordinary blood cultures are of the most practical importance in the identification of patients requiring therapy. Whether any of the additional studies described can be justified in everyday laboratory practice or simply represent considerable wasted effort is not known. Better methods for identifying infections and for managing such infections in patients with long-term indwelling central catheters are needed.
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PMID:Catheter-related infections and blood cultures. 818 Dec 33

The autopsy is receiving renewed emphasis as a tool for quality assurance in clinical medicine. Postmortem blood cultures frequently are taken during the autopsy but are costly and of unclear diagnostic utility. To assess whether postmortem blood cultures contribute any useful information not already known from antemortem blood cultures, we compared positive postmortem blood cultures taken in 111 autopsies with the results of antemortem blood cultures. Of these, 60 (54%) of 111 had positive postmortem blood cultures despite a cause of death not related to an infectious cause. Of the 111 patients, 54 (49%) had antemortem blood cultures drawn in the 7 days before death, of which 34 (63%) of 54 were negative and 20 (37%) of 54 were positive. Of the 20 patients with true antemortem bacteremia/fungemia, seven (35%) had postmortem blood cultures that yielded the same organism, 10 (50%) yielded multiple organisms that were considered to be contaminants, and three (15%) yielded different organisms. These latter three cultures yielded microorganisms that were related to the patients' illness but did not provide additional information not already known from antemortem blood cultures or the patients' clinical or autopsy findings. Of the 91 patients who had no, negative, or contaminated antemortem blood cultures, 69 (76%) had postmortem blood cultures that yielded contaminants and 22 (24%) yielded microorganisms that were indeterminate as a cause of sepsis and, therefore, did not yield new or useful information. In summary, results of postmortem blood cultures rarely, if ever, provide information that is not already known, can be interpreted, provide new insights into pathophysiology, or detect errors in therapy.
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PMID:Diagnostic utility of postmortem blood cultures. 820 1

A laboratory-confirmed case of Malassezia furfur fungemia in a 71-year-old chronic total parenteral nutrition patient is described. The patient had extensive bowel necrosis secondary to vascular necrosis, and the infection appeared to be related to the use of Hickman catheter. A brief review of the literature about catheter-related malassezia sepsis, as well as salient aspects of laboratory diagnosis and identification of the fungus, are presented.
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PMID:Malassezia furfur fungemia: a case report. 825 55

Candidemia in critically ill patients is a significant source of mortality. To identify perioperative risk factors accounting for patient death, we performed a retrospective study of 46 surgical patients with fungemia during the period from 1981 to 1990. Twenty patients survived (43%), and 26 died (57%). Mortality was associated with age older than 46 (p < 0.02, unpaired Student's t-test) and concomitant renal failure, hepatic failure, postoperative shock, or adult respiratory distress syndrome (p < 0.0001, p < 0.0001, and p < 0.05, respectively, chi 2 test). Survival was not influenced by the presence of diabetes, chronic obstructive pulmonary disease, gastrointestinal hemorrhage, pneumonia, alcohol consumption, steroid use, or enteral/parental nutrition. Bacterial speticemia developed in 26 patients (11 lived, 15 died) and typically preceded or was concomitant with the onset of fungal sepsis (88%). Candida albicans was the fungal species most commonly isolated from blood cultures (30 of 46). Its was cultured from other sites in addition to blood in 30 patients. Candidemia carries a higher risk of mortality in older patients and in those with multiple organ dysfunction. Other immunocompromised conditions such as diabetes and steroid use did not increase mortality. These findings suggest that the pathogenicity of Candida sepsis is not solely related to opportunistic superinfections but may reflect failure of other host defense mechanisms. Moreover, the frequent occurrence of bacterial septicemia prior to the development of Candida sepsis further emphasizes the importance of fungal surveillance cultures to detect early fungal colonization in the critically ill.
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PMID:Candida sepsis in surgical patients. 784 Mar 97


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