Annali italiani di medicina interna : organo ufficiale della Società italiana di medicina interna
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Ann. Ital. Med. Int. · Jul 2002
Review[Staphylococcus aureus sepsis in hospitalized non neutropenic patients: retrospective clinical and microbiological analysis].
Staphylococcus aureus is one of the leading agents of nosocomial infection among adult patients. The aim of this study was to determine the predisposing factors and secondary complications of Staphylococcus aureus septicemia (SAS) in non neutropenic patients, as well as the predictors of the outcome in non neutropenic patients with SAS. We performed a retrospective study of 56 cases of SAS that occurred from January 1997 through June 2001 in patients hospitalized in medical wards at the Policlinico Umberto I, "La Sapienza" University of Rome; we excluded surgical patients and those admitted to the intensive care unit. ⋯ At univariate analysis, the following factors were associated with a complicated course: delay to adequate antibiotic therapy (2.46 vs 1.15 days, p < 0.03), persistent Staphylococcus aureus bacteremia during antibiotic therapy (3.56 vs 1.51 days, p = 0.01), septic shock (58.6 vs 3.7%, p < 0.002), bacteremic pneumonia as the source of bacteremia (17.2 vs 0%, p = 0.02), and the increased severity of illness at the onset of SAS as evaluated using an "illness score" (4.2 vs 2.1, p < 0.002). At multivariate analysis, septic shock (p < 0.01) and delay to adequate antibiotic therapy (p = 0.05) were confirmed as associated with a complicated outcome. SAS in non neutropenic patients is associated with significant morbidity consequent to a high rate of metastatic infectious disease and with a considerable related mortality.
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Ann. Ital. Med. Int. · Jul 2002
Case ReportsThree cases of severe acute hepatitis after parenteral administration of amiodarone: the active ingredient is not the only agent responsible for hepatotoxicity.
Amiodarone is one of the most effective antiarrhythmic drugs available and is widely prescribed despite several potentially life-threatening side-effects. Hepatotoxicity is the most frequent one during long-term oral therapy: occasionally acute hepatitis necessitates the suspension of treatment but monitoring of a transient increase in serum aminotransferases is usually sufficient; the clinical-morphological pictures of liver cirrhosis have also been reported. Fulminant hepatitis soon after a parenteral load of the drug is far less well described in the literature. ⋯ Because of the rarity of this diagnosis, we report 3 cases of short-term hepatotoxicity secondary to amiodarone treatment for supraventricular tachyarrhythmias: in 2 male patients with dilated cardiomyopathy and in a female with liver disease. The diagnosis was presumptive and based on a thorough drug history, the temporal relationship, the time-course of liver dysfunction, the exclusion of other causes and on the rapid improvement observed after parenteral amiodarone withdrawal in 2 cases; in no case could we find any other explanation for the liver damage. Since amiodarone is sometimes still an irreplaceable antiarrhythmic drug, we raise the question of whether careful and continuous vigilance should be mandatory in patients receiving the drug or whether it is possible to introduce a pharmaceutical preparation not containing the vehicle that induces acute liver toxicity.