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

We describe a case-control study of a small outbreak of nosocomial sepsis and pneumonia with high mortality due to clonal dissemination of a multiresistant Klebsiella pneumoniae in the neonatal intensive care unit of a Mexican institution. Our study helped to change nosocomial infection control policy in this hospital.
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PMID:Outbreak of nosocomial sepsis and pneumonia in a newborn intensive care unit by multiresistant extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: high impact on mortality. 1184 97

Bacteremia continues to be one of the main causes of mortality despite the existence of numerous antimicrobial agents and an increase in means of support. A variety of factors, such as the type of microorganism, age, the underlying disease and where the bacteremia was acquired, can change the prognosis of the infection. The aim of this study was to analyze the cases of community-acquired bacteremia gathered prospectively from the Basurto hospital in Bilbao, Spain. The incidence of bacteremia was estimated using preestablished protocol (SEPSIS-DATA) from January 1994 to September 2001. Information was gathered on all the cases of bacteremia at the hospital and only those which were of non-hospital origin (2886 cases) were selected for the study. In our hospital, 67.82% of the bacteremia cases were community-acquired, a figure which remained stable throughout the 8-year study period. A total of 54.64% of the patients were male, 1603 (55.54%) of whom were over age 60 years. The most common underlying diseases were diabetes (15.75%), neoplasia (14.96%) and HIV infection (12.9%). The majority of the cases (2216, 76.8%) were admitted to the general medicine ward, 335 (11.6%) to surgery, 200 (6.9%) to pediatrics and 135 (4.67%) to ICU. The origin of the bacteremia was urinary (33%), gastrointestinal (18%) or respiratory (18.26%). The most common microorganisms were E. coli (36%), S. pneumoniae (13%), S. aureus (9.46%), S. enteritidis (2.87%), P. aeruginosa (2.71%), P. mirabilis (2.65%) and N. meningitidis (2.45%). The bacteremia was polymicrobial in 6.27% of the cases. The most used antibiotics were ceftriaxone (31%), gentamicin (7.3%) and amoxicillin-clavulanic acid (6.9%). Overall mortality was 13.82%. The relative frequency of community-acquired/nosocomial infection remained stable in two-thirds of the total cases. The incidence of bacteremia decreased in the 20-40 year age group and in those with HIV infection. E. coli and S. pneumoniae increased, while S. aureus decreased. The use of imipenem and quinolones increased. E. coli resistance to quinolones increased from 3.54% in 1995 to 14.36% in 2000. Mortality decreased slightly, with no significant differences.
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PMID:[Community-acquired bacteremia]. 1185 84

This study aims to evaluate the diagnostic utilities of four leukocyte surface antigens-two lymphocyte antigens (CD25 and CD45RO) and two neutrophil antigens (CD11b and CD64)-for identification of late-onset nosocomial bacterial infection in preterm, very low birthweight infants, and to define the optimal cutoff value for each marker so that it may act as a reference with which future studies can be compared. Very low birthweight infants in whom infection was suspected when they were >72 h of age were eligible for the study. A full sepsis screen was performed in each episode. IL-6, C-reactive protein, and leukocyte surface antigens (CD25, CD45RO, CD11b, and CD64) were measured at 0 (at the time of sepsis evaluation), 24, and 48 h by standard biochemical methods and quantitative flow cytometric analysis. The diagnostic utilities including sensitivity, specificity, and positive and negative predictive values of each marker and combination of markers for predicting late-onset neonatal infection were determined. One hundred twenty-seven episodes of suspected clinical sepsis were investigated in 80 infants. Thirty-seven episodes were proven infection. The calculated optimal cutoff values for CD25, CD45RO, CD11b, and CD64 were 3,100, 2,900, 10,450, and 4,000 phycoerythrin-molecules bound per cell, respectively. An interim analysis of data after 68 episodes suggested that CD25 and CD45RO were poor predictors of neonatal infection with sensitivity or specificity <75% during a single measurement. Thus, these two markers were excluded from further investigation. In the final analysis, CD64 has the highest sensitivity (95-97%) and negative predictive value (97-99%) at 0 and 24 h after the onset. The addition of IL-6 or C-reactive protein (0 h) to CD64 (24 h) further enhanced the sensitivity and negative predictive value to 100%, and has the specificity and positive predictive value exceeding 88% and 80%, respectively. Neutrophil CD64 expression is a very sensitive marker for diagnosing late-onset nosocomial infection in very low birthweight infants. If further validated, the use of CD64 as an infection marker should allow early discontinuation of antibiotic treatment at 24 h without waiting for the definitive microbiologic culture results. The quantitative flow cytometric analysis applied in this study could be developed into a routine clinical test with high comparability and reproducibility across different laboratories.
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PMID:Neutrophil CD64 expression: a sensitive diagnostic marker for late-onset nosocomial infection in very low birthweight infants. 1186 33

The aim of the present study was analysis of bacteremia occurring among oncological patients treated in 3 departments of Regional Center of Oncology, in period 1997-2000. A total number of 255 blood cultures from 89 patients were tested using the automatic system to early detection of positive blood-cultures Bactec 9050 (Becton Dickinson). The strains were identified in the automatic VITEK system using commercial strips with biochemical tests and in manual system API (bioMerieux). The total number of positive blood cultures was 70 (27.45%). The most frequently isolated causal agents were the Gram-positive microorganisms (65.79%). Among 28 examined patients with positive blood cultures 10 were with lymphoma and 9 with cancer of the gastrointestinal tract. 9 patients (32.14%) had sepsis, 4 patients with sepsis died. Constant monitoring of bacteremia in oncological patients should be fundamental element in control of hospital infection program.
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PMID:[Monitoring of bacteremia in oncological patients]. 1198 57

This study had the objective of to analyze the demographic and bacteriologic data of 32 hospitalized newborns in an neonatal intensive care unit of a public maternity hospital in Rio de Janeiro city, Brazil, seized by Pseudomonas aeruginosa sepsis during a period ranged from July 1997 to July 1999, and to determine the antimicrobial resistance percentage, serotypes and pulsed field gel electrophoresis (PFGE) patterns of 32 strains isolated during this period. The study group presented mean age of 12.5 days, with higher prevalence of hospital infection in males (59.4%) and vaginal delivery (81.2%), than females (40.6%) and cesarean delivery (18.8%), respectively. In this group, 20 (62.5%) patients received antimicrobials before positive blood cultures presentation. A total of 87.5% of the patients were premature, 62.5% presented very low birth weight and 40.6% had asphyxia. We detected high antimicrobial resistance percentage to b-lactams, chloramphenicol, trimethoprim/sulfamethoxazole and tetracycline among the isolated strains. All isolated strains were classified as multi-drug resistant. Most strains presented serotype O11 while PFGE analysis revealed seven distinct clones with isolation predominance of a single clone (75%) isolated from July 1997 to June 1998.
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PMID:Pseudomonas aeruginosa: study of antibiotic resistance and molecular typing in hospital infection cases in a neonatal intensive care unit from Rio de Janeiro City, Brazil. 1204 70

Infection, while a major cause of morbidity, should not be considered an inevitable consequence of injury. Good aseptic technique, compulsive attention to detail, and thorough understanding of the points addressed in the following list of critical points are the best guarantee that infection will not add avoidable morbidity to misfortune. Critical points regarding infectious problems in care of the injured child: 1. Polymicrobial infection is the rule with 50% of isolates being mixed aerobic and anaerobic bacteria. 2. It is a misnomer to consider antibiotic use in a pediatric trauma victim as prophylactic. Antimicrobials used in this setting are best considered adjunctive. 3. The major indication for anti-infective therapy in pediatric trauma is an injury with a high probability of infection. 4. Antibiotics do not sterilize the wound or body cavity; they limit bacterial proliferation, thereby supplementing effective immune control. 5. Available studies suggest that 24 hours is as efficacious as a longer treatment duration in a purely adjunctive mode. 6. In bites inflicted by dogs and cats, Pasturella species are frequent. 7. Human bites may result in infection by Eikenella corrodens. 8. Based on this bacteriology, adjunctive intravenous ampicillin sulbactam or oral amoxicillin clavulanate are recommended for human and animal bites. 9. Tetanus prophylaxis is indicated in all significant soft tissue injuries. 10. Risk of osteomyelitis correlates directly with the extent of the associated soft tissue injury and vascular compromise. 11. The majority of infectious complications in the injured child are not a consequence of the injury itself, but rather in the treatment thereof. 12. In the injured child the most common nosocomial infection is lower respiratory followed by primary blood stream and the urinary tract. 13. The management of nosocomial pneumonia in the injured child is based on the time of diagnoses. Early evidence of pulmonary infection requires treatment with a third generation cephalosporin with or without an antistaphylococcal penicillin. Late pneumonia is treated with an aminoglycoside with or without an antipseudomonal added. 14. Catheter related infection is, in the injured child, overwhelmingly gram positive with coagulase negative staphlococcal species accounting for 30-60% of isolates. Staphlococcus aureus is responsible for an additional 15-20%. 15. The role of antibiotics in the prevention of catheter related meningitis is controversial. Recent adult studies suggest no advantage to their routine use. If utilized, they should only be employed prophylactically and not continued throughout the monitoring period. 16. Lack of response to treatment of sepsis may represent an inappropriate antimicrobial agent, improper dosage, inability to achieve adequate levels at the site of infection. (eg, CSF) fungal pathogen, and/or ongoing contamination or undrained purulent focus.
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PMID:Infection control: avoiding the inevitable. 1211 72

This study determined the incidence, clinical characteristics, treatment and outcome in extremely low birth-weight (ELBW) premature infants with perforated necrotizing enterocolitis (NEC). We retrospectively reviewed the medical records of ELBW (birth weight <1000 g ) premature infants with perforated NEC diagnosed and managed at National Taiwan University Hospital (NTUH) from January 1993 through December 2000. A total of 8 ELBW premature infants with perforated NEC were collected. The incidence of perforated NEC in ELBW premature infants was 5.1% (8 out of 158). The average age at onset of perforated NEC was 26 days. The most common clinical features were abdominal distention, decreased bowel sound and poor activity level. Dilated and fixed bowel loops, bowel wall thickening and ascites with stool-like substance drainage out from penrose drain tube were the predominant signs at the time of diagnosis of perforated NEC. Thrombocytopenia, elevated C-reactive protein and anemia were the major laboratory findings. All infants received a primary penrose drain in the acute stage of disease. The overall survival rate was 37.5% (3 out of 8). Death occurred due to nosocomial infection with sepsis in 3 patients and due to perforated NEC in 2 patients. Two of the three surviving patients started enteral feeding 19 and 41 days after the diagnosis of perforated NEC and tolerated oral feedings well; the third patient still required total parenteral nutrition two years after diagnosis. Although the clinical characteristics and radiographic findings of perforated NEC in ELBW premature infants were variable, brown color ascites with stool-like substance may be considered a significant sign of perforated NEC despite the absence of free air on radiography at the early stage of disease. Close observation of clinical symptoms and signs, more aggressive surgical intervention and prevention of the following nosocomial infection may have the opportunity to reduce the mortality due to perforated NEC.
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PMID:Necrotizing enterocolitis complicated with perforation in extremely low birth-weight premature infants. 1214 61

Nosocomial infection surveillance is common in the USA and in some European countries but in Italy few hospitals use it. In order to evaluate its usefulness in clinical practice we performed a one year prospective epidemiological study that included 178 patients, admitted to an intensive care unit (ICU) for more than 48 h. Median ICU stay was 16 days. Trauma and neurological diseases accounted for 65% of admissions. The selected population had high severity scores and required a large number of invasive procedures for diagnosis and therapy. The most common infections were: pneumonia 46/1000 ventilator-days; urinary tract infections 17/1000 catheter-days; central venous catheter infections 14.5/1000 catheter-days with 1.7/1000 CVC-related sepsis; bacteraemic sepsis 12/1000 ICU-days. The most frequent pathogens were Staphylococcus aureus,Pseudomonas aeruginosa, other Gram-negative aerobes and Candida spp. Antimicrobial resistance was substantial, with 68% methicillin-resistance in S. aureus and 76% of P. aeruginosa displaying antibiotic resistance. Severe sepsis or septic shock occurred in 30 patients (8/1000 ICU-days), and three patients died from septic shock of unknown origin (10% case fatality rate). There were no case fatalities for pneumonia and bacteraemic sepsis. Overall, ICU-acquired infections were not associated with an increased risk of death.
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PMID:Surveillance of infections acquired in intensive care: usefulness in clinical practice. 1239 4

Staphylococcus aureus is one of the leading agents of nosocomial infection among adult patients. The aim of this study was to determine the predisposing factors and secondary complications of Staphylococcus aureus septicemia (SAS) in non neutropenic patients, as well as the predictors of the outcome in non neutropenic patients with SAS. We performed a retrospective study of 56 cases of SAS that occurred from January 1997 through June 2001 in patients hospitalized in medical wards at the Policlinico Umberto I, "La Sapienza" University of Rome; we excluded surgical patients and those admitted to the intensive care unit. The median age was 61.9 years (range 24-89 years), 29 (51%) patients were male, and infection was hospital-acquired in 83.5% of cases. Metastatic infections were found in 12 patients (21.4%), with 6 (10.7%) developing infectious endocarditis; the relapse rate was 8.9%; 30.3% of Staphylococcus aureus isolates were methicillin-resistant. The overall mortality was 41% and the attributable mortality 28.5%. Twenty-nine patients who developed metastatic infections or died for sepsis were compared with 27 patients who did not develop complications. At univariate analysis, the following factors were associated with a complicated course: delay to adequate antibiotic therapy (2.46 vs 1.15 days, p < 0.03), persistent Staphylococcus aureus bacteremia during antibiotic therapy (3.56 vs 1.51 days, p = 0.01), septic shock (58.6 vs 3.7%, p < 0.002), bacteremic pneumonia as the source of bacteremia (17.2 vs 0%, p = 0.02), and the increased severity of illness at the onset of SAS as evaluated using an "illness score" (4.2 vs 2.1, p < 0.002). At multivariate analysis, septic shock (p < 0.01) and delay to adequate antibiotic therapy (p = 0.05) were confirmed as associated with a complicated outcome. SAS in non neutropenic patients is associated with significant morbidity consequent to a high rate of metastatic infectious disease and with a considerable related mortality.
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PMID:[Staphylococcus aureus sepsis in hospitalized non neutropenic patients: retrospective clinical and microbiological analysis]. 1240 64

Staphylococcus aureus is an important cause of sepsis in both community and hospital settings, a major risk factor for which is nasal carriage of the bacterium. Eradication of carriage by topical antibiotics reduces sepsis rates in high-risk individuals, an important strategy for the reduction of nosocomial infection in targeted patient populations. Understanding the mechanisms by which S. aureus adheres to nasal epithelial cells in vivo may lead to alternative methods of decolonization that do not rely on sustained antimicrobial susceptibility. Here, we demonstrate for the first time that the S. aureus surface-expressed protein, clumping factor B (ClfB), promotes adherence to immobilized epidermal cytokeratins in vitro. By expressing a range of S. aureus adhesins on the surface of the heterologous host Lactococcus lactis, we demonstrated that adherence to epidermal cytokeratins was conferred by ClfB. Adherence of wild-type S. aureus was inhibited by recombinant ClfB protein or anti-ClfB antibodies, and S. aureus mutants defective in ClfB adhered poorly to epidermal cytokeratins. Expression of ClfB promoted adherence of L. lactis to human desquamated nasal epithelial cells, and a mutant of S. aureus defective in ClfB had reduced adherence compared with wild type. ClfB also promoted adherence of L. lactis cells to a human keratinocyte cell line. Cytokeratin 10 molecules were shown by flow cytometry to be exposed on the surface of both desquamated nasal epithelial cells and keratinocytes. Cytokeratin 10 was also detected on the surface of desquamated human nasal cells using immunofluorescence, and recombinant ClfB protein was shown to bind to cytokeratin K10 extracted from these cells. We also showed that ClfB is transcribed by S. aureus in the human nares. We propose that ClfB is a major determinant in S. aureus nasal colonization.
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PMID:Staphylococcus aureus clumping factor B (ClfB) promotes adherence to human type I cytokeratin 10: implications for nasal colonization. 1242 98


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