Articles: sepsis.
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Parenteral ceftriaxone was administered as a once-daily outpatient treatment to a selected low-risk population of neonates, infants, and children with moderate to severe bacterial infections. No incidences of treatment failure were seen in 200 children with uncomplicated infections responsive to ceftriaxone therapy. The mean period of outpatient treatment in initially hospitalized children with non-CNS infections, excluding endocarditis, was 1-3 days. Ceftriaxone outpatient management was successful in the control of organisms causing meningitis (n = 54), periorbital facial cellulitis (n = 16), sinusitis (n = 10), arthritis (n = 6), endocarditis (n = 4), and other infections.
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Bacteremia is a recognized complication in patients with indwelling central venous catheters. More recently pulmonary embolism in such patients has also been described. Despite abundant clinical experience with these devices, to our knowledge, septic pulmonary embolism has not been reported in adult patients. This case illustrates such a complication.
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Physicians and surgeons have long recognized that septic illness may be accompanied by abnormal brain functions; however, no systematic, comprehensive study has been done to define the clinical and laboratory features of the syndrome of sepsis-associated encephalopathy. We undertook such a prospective study in a tertiary care hospital and found that of 69 patients with fever and microbial cultures, 32 had marked brain dysfunction, 17 showed mild encephalopathy, and 20 were clinically nonencephalopathic. Severe cases showed obtundation and paratonic rigidity while milder cases showed confusion, inappropriate behavior, inattention, disorientation, and writing errors. ⋯ Pathogenetic mechanisms are discussed. The brain dysfunction should be regarded as potentially reversible, even in severely encephalopathic cases. Prompt control of the infection is the most important measure in controlling the encephalopathy and in preventing the increased mortality found with severely encephalopathic patients.
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Awareness of the role of anaerobic bacteria in neonatal bacteremia has increased in recent years. The incidence of recovery of anaerobes in neonatal bacteremia varies, according to different studies, between 1.8% and 12.5%. Of the 178 cases reported in the literature, 73 were due to Bacteroides species (69 were the Bacteroides fragilis group), 57 Clostridium species (mostly Clostridium perfringens), 35 Peptostreptococci, 5 Propionibacterium acnes, 3 Veillonella species, 3 Fusobacterium species, and 2 Eubacterium species. ⋯ Correction of underlying pathology, surgical drainage, and the use of proper antimicrobials are critical to successful resolution of the infection. Penicillin G is the drug of choice for anaerobic infection other than beta-lactamase-producing Bacteroides. Antimicrobials useful for therapy of beta-lactamase-producing Bacteroides include clindamycin, metronidazole, chloramphenicol, imipenem-cilastatin, and the combination of a penicillin plus a beta-lactamase inhibitor.
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Annales de pédiatrie · Dec 1990
Case Reports[Capnocytophaga septicemia during bone marrow transplantation. Apropos of 2 cases].
Two cases of septicemia due to Capnocytophaga in pediatric bone marrow recipients are reported. These gram negative rods, which are part of the normal buccal flora, cause periodontitis and localized or systemic infections, usually in immunocompromised hosts. Severe, prolonged neutropenia and mucitis due to chemotherapy and/or radiotherapy are risk factors for this opportunistic infection. Recovery can be achieved with most of the drug combinations including a beta-lactam used in hematology.