Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pathogenicity of the enterococcus remains controversial despite recognition of this organism in inflammatory exudates. A review of 114 patients with 123 bacteremic events with enterococcus from all hospital services was undertaken. A total of 46% were in the perioperative period. The clinical indications for blood culture varied, but only 19 patients had septic shock at the time. Employing three or more associated diseases as a definition, 71 patients were considered chronically ill. The primary sources of bacteremia were commonly urinary tract (22), soft tissue (17), and intra-abdominal (12). An impressive total of 48 patients had no discernible primary focus of infection. Except for the urinary tract, infections tended to be polymicrobial; 51 patients had associated synchronous or metachronous polymicrobial bacteremias. Antibiotic therapy appropriate for enterococcus did not favorably influence outcome. By chi-square analysis, patients with urinary tract and soft tissue infections had significantly better survival rates than the group as a whole, while patients with intra-abdominal sepsis, polymicrobial bacteremia, or an unknown focus of infection did statistically worse. Enterococcal bacteremia results in a high mortality (54%); its frequent identification with other facultative and anaerobic organisms may indicate that it has a synergistic role; the frequency of unexplained bacteremias stimulates speculation that primary bacteremia from the gastrointestinal tract may be a plausible explanation.
 ...
PMID:Enterococcal bacteremia: clinical implications and determinants of death. 680 23

Background: Vegetative transjugular intrahepatic portosystemic shunt (TIPS) infections are a rare complication of TIPS placement. Cases have been reported in the literature and one study estimated incidence to be 1%.1 The vast majority of cases were reported in the setting of cirrhosis. Here, we report a case of vegetative polymicrobial TIPS infection refractory to broad spectrum antibiotics in a patient with a prior hepaticojejunostomy anastomosis as part of a Whipple procedure for a pancreatic neuroendocrine tumor. Case Presentation: A 40-year-old gentleman with pancreatic neuroendocrine tumor underwent neoadjuvant chemoradiation therapy and became eligible for tumor resection. A pancreaticoduodenectomy (Whipple resection) with en bloc superior mesenteric vein (SMV) and portal vein-splenic vein confluence resection was performed. The patient developed SMV stenosis, and a TIPS was placed to access the SMV for stent placement. The patient eventually developed recurrent fevers because of Escherichia coli and Enterococcal bacteremia that did not resolve with extended courses of various antibiotics, including meropenem, vancomycin, daptomycin, ertapenem, caspofungin, and piperacillin-tazobactam. The TIPS was eventually removed with an interventional radiology procedure; however, the patient ultimately succumbed to sepsis from antibiotic-resistant bacteria. Conclusion: Here we present a case of endotipsitis in a patient with a biliary enteric anastomosis who did not respond to antibiotic therapy. We caution the use of TIPS in patients with this anatomy, as the biliary tree is inevitably colonized with enteric bacteria and in contact with the intraparenchymal hardware of the TIPS.
 ...
PMID:Polymicrobial Transjugular Intrahepatic Portosystemic Shunt Infection in the Setting of a Prior Hepaticojejunostomy Anastomosis: A Case Report. 3063 19