Scandinavian journal of infectious diseases
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Scand. J. Infect. Dis. · Jan 1991
Effects of different types and combinations of antimicrobial agents on endotoxin release from gram-negative bacteria: an in-vitro and in-vivo study.
Total and free endotoxin release in time from cultures of Escherichia coli by different antibiotics was studied in vitro for 4 h in relation to the antibiotic effect on viable counts and morphological features of the test cultures. The most rapid fall in viable counts was seen after treatment with imipenem or the combination of imipenem with tobramycin, accompanied by an early, but minimal increase (1.8-fold) of the total (free plus cell-bound) endotoxin level at 1 h. Total endotoxin levels increased approximately 5-fold upon incubation with ceftazidime, tobramycin or the combination of tobramycin with cefuroxime, whereas incubation with cefuroxime or aztreonam alone caused a late 22-and 49-fold increase in total endotoxin, respectively, at 4 h. ⋯ We describe the patterns of plasma endotoxin in these patients during the first 24 h of antibiotic treatment. We conclude that, in the in-vitro study, values of total endotoxin, free endotoxin, and the rate of release of endotoxin varies with the antibiotic used. We also demonstrate that in patients under treatment for septic shock endotoxin release can be related to the administration of antibiotics.
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Scand. J. Infect. Dis. · Jan 1991
Klebsiella bacteremia: a review of 196 episodes during a decade (1980-1989).
This report reviews 196 episodes of klebsiella bacteremia in 194 patients during a 10-year period (1980-1989) in a community teaching hospital in the USA. The median age of patients was 70 years with a mode of 84 years. The prevalence was 0.76 episodes/1000 admissions. ⋯ The majority of patients had major underlying conditions. The overall mortality was 37%. Factors that adversely influenced the mortality rate were nosocomial bacteremia, polymicrobial bacteremia, respiratory tract as the portal of entry, rapidly fatal and ultimately fatal underlying conditions, septic shock, severe leukopenia, increases in total serum bilirubin level or serum creatinine level and inappropriate antimicrobial therapy.