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

Among the main aspects to be considered when treating burns, the problem of infection control remains unsolved. Considerable financial resources are needed to prevent the transmission of organisms. To justify such investments in buildings and antiseptic measures, an extensive epidemiological hospital study was carried out from 1970 to 1974, involving 930 patients, and more than 25,000 wound biopsies as well as 10,000 contact cultures and environmental swabs. Bacteria from the environment of severly burned patients were counted every week. Serotyping was used for a specialized study of Pseudomonas aeruginosa. In 200 patients wound organisms were counted. The most important organisms were: Streptococcaceae (pyogenic streptococci, less frequently faecal and salivary streptococci). Pseudomonadaceae, Enterobacteriaceae, and Micrococcaceae (especially Micrococcus aureus). Povidon iodine, gentamicin and silver sulfadiazine were used for local disinfection. Antibiotics used were gentamicin, carbenicillin and polymyxin. Whereas from 1970 to 1972 P. aeruginosa was the predominant organism found in wounds, other gram-positive organisms increased from 1972 on. Wounds were colonized mainly in the course of the first two weeks of treatment. Special studies regarding P. aeruginosa revealed a predominance of serotypes 5 and 13 between 1970 and 1973, whereas types brought into the hospital were dominant from 1973 on. An analysis of furniture and equipment, water faucets and drains showed that Pseudomonas strains found in the water did not coincide with those found in wounds. Therefore, a contamination from this source seems unlikely. Strains found on furniture and equipment, however, also appeared in the wound flora. When the therapeutic routine was changed (to prevent patients passing through common treatment areas such as bathrooms and dressing areas) hospital organisms 5 and 13 could be eliminated almost completely. Thus, it is possible to achieve a considerable reduction in the rate of cross-infection among patients by, for instance, excluding common treatment areas from the therapy programme. Nevertheless, in the majority of cases wounds will still be colonized, in particular by bacteria that were already in the anal region or on the skin before the patient was injured. For this reason, the elimination of such organisms by topical bactericidal agents constitutes an an important factor in efforts to reduce the rate of septicaemic complications. In view of the persisting high mortality due to generalized infections this therapeutic aspect must also be exploited thoroughly in the future. Although in comparative studies of topical therapy using povidon iodine, silver sulfadiazine and gentamicin, organisms did appear in the course of the first two weeks; in the case of the PVP-I the colonization never reached 10(5) organisms per cm2, i.e. the danger threshold for generalized sepsis. There was no evidence of a correlation between number of organisms and depth of burns.
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PMID:[Asepsis and antisepsis in the treatment of burn patients (author's transl)]. 85 28

We describe our experimental studies of a powder formulated to treat serious burn wounds on-the-scene. The wound powder comprises two parts silver-citro-allantoinate, two parts zinc allantoinate and 96 parts pure allantoin. The back skin of 62 rats was shaved and exposed to actively boiling water for ten seconds, resulting in third degree burns of 20% of the total body surface. Immediately, 1 ml of a culture containing 2 X 10(8) Pseudomonas aeruginosa was applied to the burn. The animals were isolated. Of the 30 control rats, six were powdered with allantoin only. Thirty-two rats were dusted with the silver-zinc-allantoin powder within 15 minutes of burning. Cultures were taken at 48 hour intervals. Eighty-seven percent of the control animals died an average of six days postburn. In the treated animals, the mortality was 15%. A mean of 27% of the applied silver (0.35 gm) became incorporated in the eschar. In all control rats, sepsis was detected under the eschar. In treated animals, bacterial concentration fell from an initial average of 5 X 10(4) at 4 hours postburn to 6 X 10(2) at 96 hours.
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PMID:The use of silver-zinc-allantoin powder for the prehospital treatment of burns. 87 Jul 34

During a 14 month period there were 364 episodes of bacteremia and fungemia at Memorial Sloan-Kettering Cancer Center. The first nine months of the study were retrospective, and the next five prospective. In patients with leukemia or lymphoma (group 1), Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus were the most frequently isolated organisms. The mortality in this group was 40.5 per cent. In the patients with solid tumor (group 2), Esch. coli, Staph. aureus, Bacteroides sp. and Candida sp. were most frequent. Mortality was 27.8 per cent. The source of infection in both groups was often indeterminate. High mortality was associated with pulmonary and intraabdominal infection and with Ps. aeruginosa, K. pneumoniae or polymicrobic sepsis. Factors of prognostic significance were the causative microorganism, source of infection and shock. Although mortality was higher in patients with leukopenia than in those with normal leukocyte counts, the differences were not significant. The mortality in this series was low considering the severity of the underlying diseases and the immunosuppressed state of many of the patients. In a prospective, randomly controlled study, mortality was further diminished by infectious disease consultation at the time the positive blood culture was reported. Severe fungal superinfection, predominantly aspergillosis and candidiasis, was found in 52 per cent of the autopsy patients with leukemia or lymphoma (group 1), but in only 8 per cent of those with solid tumors (group 2).
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PMID:Bacteremia and fungemia complicating neoplastic disease. A study of 364 cases. 87 Nov 28

The hematologic and histologic features of two, nontwin, male siblings with severe combined immunodeficiency and variable granulocytopenia are compared to the four previously reported cases of reticular dysgenesis. These sibs died at 50 and 3 days of age, respectively, with Pseudomonas sepsis and congenital cytomegalovirus infection, respectively. A maternal uncle has selective IgA deficiency. Cord blood from the second sib contained a normal percentage of E-rosetting lymphocytes; however, these lymphocytes failed to respond to mitogenic stimulation in vitro. Erythrocyte and lymphocyte levels of adenosine deaminase were elevated in the father and the second sib. Serum immunoglobulin concentrations were low in both siblings.
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PMID:Severe combined immunodeficiency with leukopenia (reticular dysgenesis) in siblings: immunologic and histopathologic findings. 95 62

The minimal inhibitory concentrations of gentamicin and minocycline alone and in combination were determined by a broth microdilution method for 100 aerobic, facultative, and anaerobic isolates representative of pathogens recovered from patients with intra-abdominal sepsis. Gentamicin inhibited all strains of Klebsiella, Enterobacter, and Pseudomonas aeruginosa in concentrations of 0.4 to 3.1 mug/ml and all strains of Escherichia coli and Proteus mirabilis in concentrations of 0.8 to 12.5 mug/ml. Whereas minocycline did not consistently inhibit these organisms in concentrations of 1.6 mug or less/ml, it did act synergistically with gentamicin against 43% of the Enterobacteriaceae tested in clinically achievable concentrations; significant synergy was most common with E. coli (60%). Minocycline inhibited 62% of Bacteroides fragilis, 71% of Clostridium, 40% of anaerobic cocci, and 40% of enterococci tested in concentrations of 1.6 mug or less/ml. Whereas gentamicin rarely inhibited these organisms in concentrations of 6.2 mug or less/ml, it did act synergistically with minocycline against 20% of B. fragilis, 67% of Clostridium, 22% of anaerobic cocci, and 22% of enterococci (which had minimal inhibitory concentrations of minocycline within the range tested) at clinically achievable concentrations. Although only four (13%) of the 30 isolates resistant to both gentamicin and minocycline alone were inhibited by clinically achievable concentrations of the combination, the observed synergy, particularly against strains of E. coli, was considered to be of potential clinical usefulness. Antagonism between gentamicin and minocycline was not observed at the concentrations tested.
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PMID:In vitro activity of gentamicin and minocycline alone and in combination against bacteria associated with intra-abdominal sepsis. 98 55

During January and February 1975, nine patients on a single ward of a rural Tennessee hospital unexpectedly developed sepsis. The aseptic technique employed in the management of intravenous infusions was implicated. Pseudomonas cepacia was recovered from the following: bloodstream, inuse intravenous infusions and the antiseptic, aqueous benzalkonium chloride. The outbreak again calls attention to the infection risk associated with the use of this product. Selection of less hazardous antiseptics and disinfectants is strongly recommended.
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PMID:Contaminated aqueous benzalkonium chloride. An unnecessary hospital infection hazard. 98 60

Thirty (86%) of 35 infants and older children with proven gram-negative sepsis had a complete clinical remission after treatment with amikacin. In 27 (82%) of 33 infectious episodes for which bacteriologic results were available before and after treatment, the organism was eradicated. The dosage of amikacin was either 7.5 mg/kg or 15 mg/kg given intramuscularly at 12-hr intervals. No adverse clinical effects or laboratory abnormalities were observed during treatment, which lasted from five to 14 days. All bacteria were sensitive to amikacin when tested by the disk diffusion method, and all but a single strain of Pseudomonas were sensitive when tested by the agar dilution method. Assays of serum and urine demonstrated adequate levels of amikacin after single intramuscular injections of 3.75 or 7.5 mg/kg; simultaneous assays of serum and cerebrospinal fluid in two cases demonstrated comparable concentrations of drug suggestive of a high degree of penetration into the cerebrospinal fluid in two cases demonstrated comparable concentrations of drug suggestive of a high degree of penetration into the cerebrospinal fluid during infection. Serial measurements of amikacin in serum from 0.5 to 12 hr after administration of single doses of 7.5 mg of drug/kg to six newborns revealed no significant differences in the concentrations achieved with intramuscular or intravenous administration of the drug.
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PMID:Clinical and laboratory studies with amikacin in newborns, infants, and children. 99 32

Thirty children over the age of one month were treated with amikacin (BBK8), a new aminoglycoside derived from kanamycin A, with three intramuscular dosage schedules. Each group consisted of ten patients. The first received 7-5 mg/kg/12 hours, the second 7-5 mg/kg/24 hours and the third, 3-75 mg/kg/12 hours. The infections and the bacteria were similar in all three groups: pyelonephritis, abscesses of soft tissues, infected wounds, septicaemia, superinfected empyema, gastro-enteritis, chronic otitis media; the bacteria were E. coli, Klebsiella, Pseudomonas and Salmonella. A were sensitive by the Kirby-Bauer method, although two were resistant by dilution in Petri dish. Of the thirty patients, twenty four (80%) were cured. The schedule of 3-75 mg/kg/12 hours was as effective as the schedule of 7-5 mg/kg/12 hours for infections such as pyelonephritis, superficial abscesses, contaminated wounds, gastro-enteritis and sepsis. The cases with infections localized in rather unaccessible sites required double the dose and strict drainage and cleanliness. Plasma levels with the administration of 3-75 mg/kg fluctuated between 8-3 and 12-6 mcg/ml; with 7-5 mg/kg they fluctuated between 8-6 and 13-1. The minimum inhibitory level (MIL) for the majority of the bacteria was 1-25 mcg/ml. No toxic reactions were observed.
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PMID:Amikacin (BBK8) in infections due to gram-negative organisms in children over the age of one month. 102 22

During the treatment of two patients with acute renal insufficiency with carbenicillin for Pseudomonas aeruginosa sepsis haematemesis, melaena and omnipresent petechiae were observed. Suspension was followed by rapid regression and the normalisation of clotting. Attention is drawn to haemorrhage as clotting. Attention is drawn to haemorrhage as a possible complication of carbenicillin management in patients with acute renal insufficiency.
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PMID:[Hemorrhagic complications during therapy with carbenicillin in 2 cases of acute renal insufficiency]. 111 40

An experimental model was designed to evaluate a combined protocol of active immunization and granulocyte transfusions for treatment of Pseudomonas aeruginosa sepsis in the neutropenic host. One member of a pair of dogs was immunized with P. aeruginosa vaccine. Both dogs were then rendered transiently neutropenic with a single intravenous dose of cyclophosphamide (40 mg. per kilogram) and challenged with an intravenous inoculum of P. aeruginosa. Twenty-four and 48 hours after pseudomonas challenge each animal received granulocyte transfusions. Effectiveness of therapy was evaluated by observation of survival time, febrile response, and quantitative blood cultures. Results showed a significant increase in the survival period (P is less than 0.05), a lower febrile response (P is less than 0.025), negative blood cultures, and a greater recovery rate in the immune group. Immune dogs that died had negative blood cultures or less than or equal to 10 pseudomonas per milliliter of blood despite the presence of P. aeruginosa in tissues. In contrast, control dogs had septic deaths within 67 hours of pseudomonas challenge, marked febrile responses with 24 hours of infection, and positive blood cultures with 4,000 to 25,800 pseudomonas per milliliter of blood. These data show that combined therapy with immunization and granulocyte transfusions is effective in reducing the severity of P. aeruginosa infection and in preventing bacteremia during periods of leukopenia.
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PMID:Combined pre-immunization and granulocyte transfusion therapy for treatment of pseudomonas septicemia in neutropenic dogs. 127 Aug 91


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