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

Parenteral nutrition via central venous catheterization is associated with serious risks, especially that of sepsis. Lipid emulsion (Intralipid[Sweden]), which may be administered peripherally, was evaluated for its potential to support microbial growth. Washed cultures of Staphylococcus aureus, Candida albicans, and three species of Gram-negative rods were all capable of multiplying in the emulsion at room temperature. Variations in inoculum size did not affect the growth rate. Studies comparing the emulsion to amino acid-glucose solutions (total parenteral nutrition [TPN])confirmed other reports that TPN inhibits the growth of certain bacteria but merely retards fungal multiplication. When human serum was added to the lipid emulsion in an attempt to simulate in vivo conditions at the catheter tip, Escherichia coli was inhibited while the growth of S aureus and C albicians was unaltered.
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PMID:Microbiol growth in lipid emulsions used in parenteral nutrition. 0 Sep 82

Methods of management of infections in total hip replacement vary from the use of antibiotics with reimplantation to a complete removal of the prosthetic unit. This is a series of 10 consecutive patients having documented sepsis following total hip replacement characterized by gram-negative organisms which was managed with the method of excision (Girdlestone) arthroplasty with delayed wound closure. Parenteral antibiotics were used while the wound remained open. Once wound healing had been accomplished, the patients were placed on appropriate oral antibiotics and continued on same for approximately 6 months. The duration of follow-up was 3-5 years. All patients have continued to remain free of clinical sepsis. One patient has chronic pain. All patients are fully ambulatory and are fully satisfied with their functional capacities. Recognizing a serious infection following total hip replacement, especially characterized by the presence of gram-negative organisms, requires drastic treatment methods. Excision arthroplasty with delayed wound closure is a reasonable alternative, especially in view of the functional results obtained.
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PMID:Excision arthroplasty with delayed wound closure for the infected total hip replacement. 74 13

Burn wound sepsis is still a common cause of death in burn injuries. Eighty percent of this infection is with colonisation from the patient and twenty percent as a result of cross infection. Most of the mortality is due to virulent cross infection. Pseudomonas has almost disappeared and multiple resistant staphylococcus aureus is the main pathogen today. It can cause loss of skin grafts and septicaemia, particularly due to colonisation of intravenous lines. The risk increases with the time since the burn injury. Early excision and grafting is important. With a large burn it is not possible to do this in one session and so the risk is increased with a compromised patient. Maintenance of a good diet and vitamin supplements is important, preferably orally or through a naso-gastric tube. Parenteral nutrition increases the risk of infection. Clinical infection is combated by good cleaning procedures, preferably with chlorhexidine solution and the application of a good topical agent such as Silvazine. The presence of bacteria in the wound must be monitored. Strict barrier nursing and personal hygiene, particularly hand washing, are the mainstay of cross infection prevention. Antibiotics may be required, monitored by blood cultures. Documenting MRSA is a good way to monitor the unit's infection prevention programme. The main preventive measures are early referral, early excision and grafting, good nutritional support, good topical agents and barrier nursing.
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PMID:Multiple resistant Staphylococcus aureus. 129 97

160 patients with a median age of 38 years (range two months to 84 years) having silicone rubber central venous access catheters for long-term parenteral nutrition or chemotherapy were studied prospectively. Two different types of catheters were used, the Broviac-type "life-cath" and the Groshong -catheter. Intraoperative complications were not noticed. Parenteral therapy was performed in 124 patients (81%) without any complications. After a mean postoperative interval of 36 weeks there were 34 catheters removed because of end of therapy. 78 patients died with the catheter in place. 40 catheters had to be removed before end of therapy due to catheter-related complications. Occlusion of the lumen occurred in nine patients after an interval from three to 20 weeks. Explantation of catheters due to a suspected catheter-related sepsis was performed in 17 patients. Both types of catheter showed a high cumulative patency rate of 90% after a twelve months period. However, there were catheters that had to be removed before planned end of therapy. Thus, the cumulative rate of functioning catheters is lower (44% of all catheters).
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PMID:[Hickman catheter for long-term parenteral therapy. A prospective interdisciplinary study]. 140 73

The introduction of Total Parenteral Nutrition (TPN) in the treatment of malnourished patients with unusable gastrointestinal tracts has become commonplace throughout the world. However there are significant metabolic (4.2 to 7.7%) and septic (7 to 27%) complications associated with this therapy. In 1984 a TPN committee was formed at Royal Newcastle Hospital and a TPN nurse was appointed. This series documents the use of TPN at Royal Newcastle Hospital from August 1984 to July 1989. There were 251 patients who received TPN, representing 3422 days of TPN. The primary catheter sepsis rate was 10.4% at the commencement of the series and decreased appreciably to 3.2%. The formation of the TPN committee and the appointment of a TPN nurse have represented a considerable cost in time and money but this action has been justified by the drop in the sepsis rate resulting in a decrease in morbidity and mortality associated with TPN.
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PMID:Reduction of complications associated with total parenteral nutrition by introduction of a clinical monitoring team. The Total Parenteral Nutrition Committee. 180 73

Thirty patients diagnosed with non-metastatic infiltrating vesical cancer (pT2-3, NoMo) due to receive radical cystectomy and transintestinal urinary by-pass, underwent Pre-operative Nutritional Assessment (PRNA), Cystectomy, post-operative Total Parenteral Nutrition (TPN), and Post-operative Nutritional Assessment (PONA) in day 7. The purposes of this prospective, uncontrolled clinical trial were: to identify, prior to surgery, undernourished patients, to assess the effectiveness of post-operative TPN with regard to a decrease in morbidity and mortality, and to evaluate the influence of a deficient nutritional condition in the occurrence of post-operative complications. It was found the 16.6% patients were undernourished prior to surgery, 80% of which showed complications, while only 28% patients considered to be in a normal state of nutrition had complications (there were no fistulae, intraabdominal abscesses, and abdominal sepsis). 6.6% complications were TPN-related. The conclusions were: the percentage of patients with malnutrition prior to surgery is large enough to justify a routine PRNA; TPN decreases morbidity and mortality in patients with previous good nutritional state but not in those with malnutrition; undernourished patients have a very high rate of complications and surgery should be delayed until a acceptable state of nutrition is achieved.
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PMID:[Usefulness++ of total parenteral nutrition in radical surgery for bladder cancer]. 180 21

The gastrointestinal tract is a major target of the human immunodeficiency virus. Many AIDS patients have weight loss and/or diarrhea. Parenteral nutrition can be used to treat malnutrition associated with malabsorption. We reviewed retrospectively the clinical course of 22 patients with AIDS and weight loss greater than 10% who received home parenteral nutrition (HPN) for 56.2 patient-months. Mean weight loss was 21.4%, mean duration of HPN 2.55 months, mean age 37.4 years. Fifteen patients gained weight, six stabilized and two continued to lose weight. Nine patients returned to previous activity. Five died. The rates of catheter-related sepsis, complications, and metabolic disturbances were 0.12, 0.25, and 0.12/100 catheter days, respectively, results identical to those reported in other patient populations where HPN is commonly applied. We found that HPN induced weight gain and clinical improvement in most patients without higher risks of sepsis than in patients with malignancies.
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PMID:Risks and benefits of home parenteral nutrition in the acquired immunodeficiency syndrome. 190 Nov 11

The author discusses the problem of chemotherapy of staphylococcal sepsis with consideration of the action mechanism of the drugs used, namely bactericidity and bacteriostatic effect, methods of administration of the drugs. Parenteral administration of chemotherapeutic agents and their combinations proved highly efficient. The value of using immune agents and unspecific drugs is emphasized.
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PMID:[The chemotherapy problems of staphylococcal sepsis]. 236 48

The efficacy of sulbactam plus ampicillin in the treatment of various gynecologic infections was evaluated in 24 women (median age, 35 years). Ten women had pelvic cellulitis plus vaginal cuff abscess; six, pyeloperitonitis; three, vaginal cuff abscess; three, surgical wound sepsis; one, tubo-ovarian abscess; and one, endometritis. Surgical procedures preceding infection included abdominal hysterectomy, ovarian cyst removal, ectopic pregnancy, correction of cystocele, and uterine dilatation and curettage. Twenty patients received 1 g of sulbactam plus 1 g of ampicillin per dose; four received 0.5 g of sulbactam plus 1 g of ampicillin per dose. The combination was given iv every 6 hr for three to four days and then im every 8 hr for three to five days (mean treatment duration, seven days). Pus cultures yielded Enterobacteriaceae (21 cases), enterococci (two), Bacteroides fragilis (12), other Bacteroides species (five), Peptococcus species (nine), Peptostreptococcus species (seven), and other anaerobes (five). Six infections were purely anaerobic; 18 were mixed. All but two infections were cured by both clinical and bacteriologic criteria, with no adverse reactions. Parenteral sulbactam/ampicillin seems safe and effective in the treatment of gynecologic infections of moderate severity.
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PMID:Efficacy of sulbactam plus ampicillin in gynecologic infections. 302 7

For a period of 32 months from the inception of the Parenteral and Enteral Nutrition (PEN) Team at the University of Michigan, the infection rate (IR) related to central venous catheters (CVCs) for total parenteral nutrition (TPN) was prospectively evaluated. Six hundred twenty-two catheters were placed in 377 patients for a total of 9,200 patient days. The length of CVC stay ranged from 2 to 108 days with a mean of 14.5. CVC longevity was longer on units where certification of nurses by the PEN team was mandatory (mean 20.4 days, IR 3.5%) vs comparable units which utilized informal instruction (mean 14.4 days, IR 3.5%). Twenty-two catheters led to patient sepsis for a rate of 3.5%, or 2.39 CVC-related infections per 1000 patient days. The preteam infection rate was 24.0%, as determined by a 6-month prospective study. Infection rates for CVCs used for TPN only and those used for parenteral nutrition (PN) plus blood products, antibiotics, and CVP measurements were identical, 3.5%. The team approach can effectively increase PN catheter longevity and reduce infection rates. Conservative cost accounting of best and worst case scenarios determined a range of $3,700 to $8,900 per episode of catheter sepsis.
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PMID:Total parenteral nutrition catheter sepsis: impact of the team approach. 309 11


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