The Journal of infection
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The Journal of infection · Jul 1998
ReviewStrategies to rationalize sepsis management--a review of 4 years' experience in Dundee.
Hospitals worldwide are facing an unprecedented crisis of rising cost of antibacterials due to the increasing rapid emergence and dissemination of antibiotic-resistant organisms, improper use of antibiotics and the use of broad spectrum parenteral agents. The last 25 years has seen the introduction of many measures to improve the quality of sepsis management, and specifically antimicrobial use. The present paper reviews the development, implementation and evaluation of some of the key strategies employed within the Dundee Teaching Hospitals NHS Trust (DTHT) to enhance recognition and assessment of sepsis and to rationalize the early and often empiric antibiotic treatment of patients in hospital with infection. Particular emphasis is given to optimizing the use of expensive parenteral agents in conjunction with promotion of oral switch therapy where appropriate.
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The Journal of infection · Jul 1998
Case ReportsGlycopeptide-induced vasculitis--cross-reactivity between vancomycin and teicoplanin.
Teicoplanin has been suggested for use in patients suffering complications from vancomycin. We describe two patients who developed a vasculitic rash whilst on vancomycin with recrudescence of the rash with subsequent teicoplanin therapy.
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Standard definitions of sepsis have been proposed and have been widely adopted. Recognition of the systemic inflammatory response syndrome (SIRS) and assessment of its severity can easily be achieved at the bedside using basic observations and simple laboratory tests. Fulfillment of standardized criteria defining increasing severity of sepsis or manifestation of two, three and four SIRS criteria directly correlates with risk of mortality and progression to organ failure. ⋯ Furthermore, sepsis definitions take no account of pre-existing illness, source of infection or causative agent, all of which have a significant influence on outcome. Despite these limitations, manifestation of four SIRS criteria or the persistence of markers of severe sepsis identifies individuals on general wards who are at particularly high risk of death, who should be closely monitored for deterioration and discussed with an intensive-care physician at an early stage. If the source of sepsis is not clear, empirical antibiotic therapy for such individuals should be discussed with a medical microbiologist or infectious diseases physician.