Articles: sepsis.
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We have prospectively evaluated 16 episodes of bacteremia induced by decubitus ulcers. The most commonly isolated microorganisms were Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa and Bacteroides fragilis. Bacteremia was polymicrobial in 5 cases (31%). ⋯ The initial antibiotic therapy was satisfactory in 13 cases. Mortality rate directly associated with bacteremia was 18%, but the overall mortality rate was 62%. We did not identify data permitting a reliable prediction of the findings of blood culture; therefore, the initial empirical therapy should be active against Staphylococcus aureus, Pseudomonas, enteric Gram-negative bacilli and anaerobes including Bacteroides fragilis.
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We studied hemorheological variables in ten consecutive patients with sepsis or septic shock. One patient with sepsis, eight with septic shock, and one with the toxic shock syndrome were included. The patients were studied during the first 3 days and the eighth day of their illness. ⋯ A decrease in RBC deformability was observed, due to changes in the RBC membrane. After 1 week, these changes had disappeared. The change in RBC deformability during the study period was significantly related to changes in the amount of dopamine administered.
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Severe septicemia is commonly a catabolic disease process with increased energy demands and enhanced protein degradation. Septic ICU-patients are on the one hand dependent on a sufficient substrate application; on the other hand, however, the organism's tolerance against exogenous substrate application is very often diminished in these patients because of varying organ insufficiencies. Because septicemia is not a uniform type of illness with predictable organ dysfunctions, it is not possible to give recommendations for a specific nutritional diet in septic patients. Nutritional management must be adapted individually according to the type and the degree of organ dysfunctions associated with septicemia.
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A previously fit 56 year old female presented with a rapidly progressive and fatal pneumococcal septicaemia with disseminated intravascular coagulation. Post-mortem studies confirmed a Waterhouse-Friderichsen syndrome and revealed an anatomically normal spleen; intracellular diplococci were seen within splenic macrophages providing evidence of normal splenic function. This appears to be only the second case of Waterhouse-Friderichsen syndrome due to pneumococcal septicaemia in a patient with a normal spleen.