Przegla̧d epidemiologiczny
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At present, the only reasonable action which reduces the case fatality rate at patients with severe sepsis and septic shock is the early diagnosis of infection which allows to introduce effective therapy. Although sepsis is a typical clinical syndrome recognized in connection with infection, it should be remembered that infection does not reveal itself in each case. ⋯ In view of few characteristic, especially in the initial phase of sepsis, clinical symptoms, laboratory investigations describing the present state of immune response of organism find a huge application. In our work we made an attempt to bring closer the latest markers of inflammatory reaction and infection such as acute phase proteins procalcytonin (PCT), proANP and lipopolisacharyde binding protein (LBP).
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The paper presents contemporary definitions and guidelines for management of severe sepsis and septic shock in neonates. We discuss main directions of hemodynamic resuscitation, antibacterial and supportive treatment. Pathophysiological differences of septic shock in this group of patients were described.
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Controlled Clinical Trial
[Procalcitonin as a diagnostic marker in systemic inflammatory response syndrome (SIRS) and sepsis].
Evaluation the value of procalcitonin as a diagnostic and prognostic marker in septic patients and patients with systemic inflammatory response syndrome (SIRS). ⋯ Measurement of PCT level on the first, second and third day of hospitalization has no prognostic value. There is no significant difference in PCT level in sepsis caused by Gram positive and Gram negative bacteria. PCT is a useful marker in diagnosis of sepsis but its role in monitoring the severity of sepsis requires more clinical studies.
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Currently, the Polish Society of Hospital Infections is coordinating a national program of active surveillance of nosocomial infections. One of its elements is the control of hospital acquired pneumonia (PNEU) on Intensive Care Units. This paper analyzes the epidemiology and etiology of hospital acquired pneumonia (PNEU) at the Intensive Care Units (ICU). ⋯ The average cumulative incidence of PNEU was 5.6% (median 4.9%), incidence density of Ventilator Associated Pneumonia (VAP) on average reached 17.9 per thousand (median 18.8 per thousand); mortality of patients with PNEU totaled 12.6% and for patients on ventilator and with coexisting infections 15.0% and 20%, respectively--it wasn't high enough to be statistically significant. Dominant etiologic factors of hospital acquired pneumonia in patients with a risk factor were Pseudomonas aeruginosa and Escherichia coli Methicillin-resistant Staphylococcus aureus(MRSA) comprised 21.1% of isolated S. aureus strains. The analyzes in this paper show that it's possible to effectively implement uniform methods of detection, qualification and analysis in relatively new settings at Polish hospitals, where tools of modern hospital epidemiology are only used since the mid 90-ties.
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Cat scratch disease is an infection which often causes regional lymphadenopathy. Bartenolloses present a growing health problem both in human and veterinary medicine. They may be etiological fevers of unknown etiology, endocarditis, pneumonia, meningitis. ⋯ Swollen lymph nodes together with patient contact with a cat or other animals established during a detailed interviewing, raise suspicion of CSD. Denial by a patient of the primary change does not rule out diagnosis. When regional lymphadenopathy of cat scratch disease is taken into consideration in differential diagnosis and serological tests are carried out, it may be possible in many cases to eliminate any further diagnostics burdening a sick person.