Surgical infections
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Surgical infections · Apr 2007
Review Case ReportsKlebsiella pneumoniae necrotizing fasciitis and septic arthritis: an appearance in the Western hemisphere.
Necrotizing fasciitis caused by Klebsiella pneumoniae is rare, with 11 documented cases in the literature, all occurring in Asia and the Middle East. These reports have become more frequent in recent years in association with the emergence of the highly virulent K1 capsular serotype of Klebsiella. We report a case of Klebsiella necrotizing fasciitis and con-current septic arthritis in the Western hemisphere. ⋯ Although K. pneumoniae is common, monomicrobial necrotizing fasciitis and septic arthritis caused by this pathogen has not been reported previously outside Asia, where it is rare. The appearance of this infection in the Western hemisphere may reflect geographic spread of the aggressive K1 phenotype. Physicians treating patients with symptoms and signs of necrotizing fasciitis or septic arthritis, particularly in the setting of underlying chronic illness or recent travel to Asia, should consider K. pneumoniae as a potential cause and treat accordingly.
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Surgical infections · Apr 2007
Clinical TrialAddition of vasopressin to norepinephrine as independent predictor of mortality in patients with refractory septic shock: an observational study.
To identify predictors of 28-day mortality among patients with refractory septic shock treated with norepinephrine with or without vasopressin. ⋯ Our study found an association between the use of norepinephrine plus vasopressin and 28-day mortality in refractory septic shock. In view of its known mechanism of action, vasopressin contributed to this excess mortality. Further recommendations regarding the use of vasopressin await the results of large randomized trials evaluating its efficacy and safety for septic shock.