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

The complications of sepsis often make it necessary to suspend nutritional therapy. The origin of these is the nutritive mixture as well as the catheter connection and/or point where it has been inserted. The aim of this study is to show the need for bacteriological control of the whole process, in order to evaluate the effectiveness of the methods used, dilucidate the origin of the sepsis and establish an internal quality control. Study of different methods for bacteriological control of the nutritive mixtures, comparing them with the methods used in our Hospital, which is based on systematic culture of the mixtures, the collecting of samples after preparation and prior to perfusing the mixture through the patient, the performing of a further culture control and a bacteriological examination of the catheter. For this purpose, 28,501 nutritive mixtures were studied, corresponding to 1,782 patients. Of these, 185 samples were initially positive (0.65%) and only 59 samples showed positive cultures (0.21%). Of the 6 cases of sepsis discovered and confirmed by haemoculture, 5 corresponded to Enterobacter cloacae and 1 to Klebsiella pneumoniae.
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PMID:[The bacteriological control of TPN mixtures at the Hospital de Bellvitge]. 248 55

Twenty-four episodes of bacterial infections were identified over a 18 month period in 11 patients (8 with acquired immunodeficiency syndrome and 3 with AIDS related complex). Eight of the 11 infected patients were drug abusers and 3 homosexual people. Nosocomial bacterial infections were common in patients with AIDS and had high fatality rates. Gram-negative bacteria resulted the most common micro-organisms (E.coli, Proteus, Enterobacter, Serratia, Klebsiella). The Aztreonam treatment was very useful in providing bacteria eradication. Gram-positive bacteria as Staphylococcus from a sepsis and Enterococcus from a cystopyelitis were eradicated by B-lactam antibiotics. Common micro-organism are frequent in patients affected by LAS/ARC or AIDS and they negatively interfere with the disease outcome.
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PMID:[Significant bacteriological findings in HIV-positive patients]. 249 36

The in vitro opsonic activity and in vivo therapeutic effect of an intravenous immunoglobulin (IGIV) pH 4.25 against Klebsiella pneumoniae were evaluated in this study. By an opsonophagocytic assay in microtiter plates, bacteria were opsonized with IGIV pH 4.25, 10% rabbit serum, or 10% rabbit serum heated at 56 degrees C for 30 minutes. Opsonized bacteria were challenged with polymorphonuclear leukocytes (PMNs) from normal adults and bacterial killing was measured at 60 and 150 minutes. Forty-four newborn Wistar rats were infected subcutaneously with a 75% lethal dose of Klebsiella pneumoniae, and 90 minutes after, 24 rats were assigned to receive 500 mg/kg of IGIV pH 4.25 by intraperitoneal route and the remaining 20 animals received an equal volume injection of PBS. Animal survival was observed during a ten-day period. The best bacterial killing index was reached when bacteria were previously opsonized with IGIV pH 4.25 at 60 minutes (p less than 0.001), as well as at 150 minutes (p less than 0.0001) of challenge with PMNs. Newborn rat survival was better in the IGIV group (17/24), than PBS group (5/20), with significant statistical difference (p = 0.0029). These data suggest IGIV pH 4.25 can be a useful adjunct in the treatment of Klebsiella pneumoniae newborn sepsis.
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PMID:[Therapeutic effectiveness of an intravenous immunoglobulin with pH 4.25 in experimental neonatal sepsis caused by Klebsiella pneumoniae]. 249

In July 1984, two patients fed enteral nutrition solutions contaminated with Enterobacter cloacae developed nosocomial bacteremia. Despite careful review of the preparation procedures as well as repeated microbiological surveys, 83 (27%) of the 309 formula bottles tested over a 1-yr period were contaminated and the source of contamination remained unknown. E. cloacae was the most frequent organism isolated (34%). The plasmid profiles of E. cloacae recovered from enteral nutrition solutions remained identical for several months. Blood culture isolates from 10 of the 40 patients who had developed E. cloacae nosocomial sepsis over a 7-yr period (1979-1985) had plasmid profiles linking them to contaminated enteral nutrition solutions. Epidemiological data from a case control study revealed that these 10 patients were indeed more likely to be exposed to enteral nutrition than the 30 others: 9/10 vs 10/30 (odds ratio 18, p = 0.002). Similarly, two of seven nosocomial Klebsiella pneumoniae bacteremias over a 6-month period in 1986 could be ascribed to administration of contaminated enteral liquid feeds prompting a general policy for using sterile commercially prepared solutions. Our results suggest that contaminated enteral nutrition solutions represent a significant cause of nosocomial sepsis.
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PMID:Contaminated enteral nutrition solutions as a cause of nosocomial bloodstream infection: a study using plasmid fingerprinting. 250 32

Hospitalized patients with sepsis caused by ciprofloxacin-susceptible organisms were treated with intravenous ciprofloxacin 300 mg every 12 hours. Patients were followed closely for side effects and adverse reactions as well as for their response to therapy. Culture specimens and laboratory parameters including serum chemistry profile, complete blood cell count, and urinalysis were obtained before, during (every four to five days), and after ciprofloxacin therapy. Antimicrobial susceptibility of bacterial isolates was determined by the microtiter technique. Patients were considered to have had a successful outcome if satisfactory improvement in signs and symptoms of infection occurred as well as bacteriologic cure, such as eradication of organisms from the blood during and after treatment. Of 30 septic episodes in 30 patients, 27 episodes were considered evaluable. Two septic episodes occurred in patients who were neutropenic (absolute neutrophil count less than 1,000/mm3). The sources of the 27 septic episodes were intra-abdominal (12 patients), indwelling intravenous access devices (11 patients), urinary tract (three patients), and skin/soft tissue (one patient). Of the 27 evaluable episodes, 24 (88.9 percent) had a completely successful outcome; three (11.1 percent) had a partially successful outcome. Partial successes included the occurrence of a Klebsiella pneumoniae reinfection in one patient, superinfection with Listeria monocytogenes in another patient with the concurrent development of a highly ciprofloxacin-resistant K. pneumoniae, and the recovery of a ciprofloxacin-resistant Pseudomonas aeruginosa during therapy in a third patient who also had superinfection due to Candida albicans. There were minimal ciprofloxacin-related adverse reactions and side effects. Although ciprofloxacin was generally well tolerated with minimal side effects and adverse reactions and was efficacious in the treatment of serious septicemic infections caused by gram-negative aerobic bacilli, the development of a resistant K. pneumoniae and the recovery of a resistant P. aeruginosa during therapy in two cases are of concern and deserve further investigation.
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PMID:Treatment of sepsis in patients with neoplastic diseases with intravenous ciprofloxacin. 258 76

We have treated 42 episodes of pediatric infections with sulbactam/ampicillin since 1987. Included were 9 cellulitis, 9 urinary tract infections, 5 cervical lymphadenitis, 4 meningitis, 2 thoracic empyema, 2 osteomyelitis, 2 sepsis, 1 furuncle, 1 perianal abscess, 1 dental abscess, 1 peritonsillitis, 1 salmonellosis, 1 shigellosis, 1 peritonitis, 1 suppurative thyroiditis, 1 infective endocarditis. Responsible pathogens were Escherichia coli in 8, Staphylococcus aureus in 6, Hemophilus influenzae in 2, Streptococcus pneumoniae in 3, Streptococcus viridans in 2, Staphylococcus epidermidis in 1, Bacteroides fragilis in 1, Salmonella D1 in 1, Shigella sonnei in 1, Klebsiella pneumoniae in 1, Enterobacter agglomerans in 1, Acinetobacter calcoaceticus in 1, Enterobacter cloacae in 1, group A beta-hemolytic streptococcus in 1, and polymicrobial infection in 4 cases. Thirty-nine out of 41 (95%) clinically evaluable patients cured and all (34/34) bacteriologically evaluable patients eradicated their pathogens after treatment with sulbactam/ampicillin. Side reactions were seen in five patients; one maculopapular skin rash, one hemolytic anemia, two diarrhea, and one liver function impairment plus leukopenia. All these reactions were transient and did not require interruption of therapy. These results indicate that sulbactam/ampicillin is safe and effective in the treatment of common pediatric infections beyond the neonatal period.
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PMID:A clinical evaluation of sulbactam/ampicillin in the treatment of pediatric infections. 263 93

Bacterial infections are lethal complications of neutropenia, and antibiotics alone are inadequate therapy for these infections. Irradiated mice become severely neutropenic and remain susceptible to infection for 2 to 3 weeks, depending on the dose and quality of radiation. Some bacterial cell wall derivatives stimulate nonspecific host defense mechanisms against a variety of microbes which might cause postirradiation infection. In this study we determined if the cell wall glycolipid trehalose dimycolate (TDM), derived from Mycobacterium phlei, or a synthetic preparation of TDM was able to (i) enhance survival in mice when given before or after lethal doses of 60Co radiation and (ii) increase nonspecific resistance to postirradiation infection. Treatment with TDM oil-in-water emulsions and with synthetic TDM significantly enhanced survival before and after lethal doses of 60Co irradiation. This result correlated with the ability of TDM to reduce the translocation of intestinal bacteria and to stimulate hematopoiesis. With respect to nonspecific resistance to infection, TDM injected 1 h after sublethal irradiation increased resistance to a lethal Klebsiella pneumoniae challenge (10 50% lethal doses of K. pneumoniae in 30 days [LD50/30]) 4 or 14 days later. Increasing the dose of K. pneumoniae to 5,000 LD50/30 on day 4 overwhelmed the ability of TDM-treated mice to overcome infection. However, TDM treatment 1 h postirradiation combined with ceftriaxone antibiotic therapy (days 5 through 14) enhanced survival, even when the higher dose of bacteria (5,000 LD50/30) was used. These results indicate that in irradiated mice, TDM can be used to enhance survival and, as a potent stimulant of nonspecific resistance to infection in neutropenic mice, can act synergistically with antibiotic therapy to reduce sepsis and mortality.
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PMID:Trehalose dimycolate enhances resistance to infection in neutropenic animals. 266 26

Myocardial function with ultrastructure and high energy phosphate levels in dogs was correlated after 24 hours of sepsis using live Klebsiella aerogenes. All animals developed progressive hemodynamic deterioration over a 24 hour period. Mean arterial pressure decreased from 148 +/- 7 mmHg to 85 (P less than 0.01) and cardiac output decreased from 3.43 +/- .31 to 1.6 +/- 0.5 L/min. Left ventricular stroke work decreased from 48.2 +/- 5 to 18.1 +/- 6 gm-meters (P less than 0.001). Systemic and pulmonary vascular resistances were increased at 24 hours (3,538 +/- 27 to 7,404 +/- 1,400 dyne/sec/cm-5 (P less than 0.01), and 185 +/- 20 and 619 +/- 90 dyne/sec/cm-5 (P less than 0.001), respectively. Left ventricular function curves at 24 hours showed a fixed low output. However, myocardial ultrastructure was preserved and high energy phosphate levels remained normal. These observations correlate well with the changes seen clinically in early gram negative sepsis in hypovolemic patients. Thus, this appears to be a suitable model for further investigation of the effects of gram negative sepsis on myocardial performance, ultrastructure, and maintenance of energy stores.
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PMID:Preservation of myocardial ultrastructure after 24 hours of Klebsiella sepsis: histologic, functional, and biochemical correlations. 268 98

Of 243 children born after premature rupture of the membranes (PROM) 61 (26%) had the same bacteria in placental arterial blood, in ear swabs (taken deep from the external auditory canal) and in meconium. The predominant organisms were E. coli, Bacteroides fragilis, Streptococcus faecalis (enterococci) and Streptococcus agalactiae (group B streptococci). The infection rate was only 10% if the membranes had ruptured within 24 h of the onset of labour and 30% if the interval was longer than 24 h. Of 131 children born without premature rupture of the membranes but with risk factors for sepsis 9 (7%) had a positive blood culture with the same organism in the ear swabs and in meconium. The organisms were Streptococcus agalactiae (6 cases) and E. coli, Streptococcus faecalis and Klebsiella pneumoniae (one case each). Contamination of placental blood cultures was rare.
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PMID:Bacteriological findings after premature rupture of the membranes. 271 99

A 68-year-old Japanese woman with sepsis developed a gangrene on her left cheek from a small wound in contact with a gastric tube. Klebsiella pneumoniae was cultured from the sputum, wound, and the blood and was assumed to be responsible for this condition, possibly through thrombosis of an artery.
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PMID:Bacterial gangrene on the cheek of a comatose patient--necrotizing fasciitis or noma. 279 26


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