Articles: sepsis.
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Acta Anaesthesiol Scand · Apr 1992
Case ReportsAn outbreak of Klebsiella oxytoca septicemias associated with the use of invasive blood pressure monitoring equipment.
Seven cases of septicemia with piperacillin-resistant Klebsiella oxytoca (PRKO) occurred at 2-monthly intervals in a thoracic surgery intensive care unit. All PRKO isolates were serotyped, and phenotyped with a biochemical typing system. ⋯ PRKO of the epidemic phenotype was recovered from several non-patient transducer domes. The outbreak ended when transducer heads were disinfected and the use of non-patient domes was abolished.
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Although hepatocellular dysfunction occurs early in sepsis despite fluid resuscitation, it is unknown if an increased volume of resuscitation protects hepatocellular function. To study this, rats were subjected to sepsis by cecal ligation and puncture (CLP). These and sham-treated rats then received either 3 or 6 mL/100 g BW normal saline subcutaneously. ⋯ These results confirm the notion that the depression in hepatocellular function in early sepsis is not the result of any reduction of hepatic perfusion. The dissociation of increased hepatic blood flow from depressed hepatocellular function remains despite the larger volume of resuscitation. The hepatocellular dysfunction that occurs even in early sepsis cannot be corrected simply by increasing the volume of crystalloid resuscitation.
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Infection and immunity · Mar 1992
Lipopolysaccharide-tumor necrosis factor-glucocorticoid interactions during cecal ligation and puncture-induced sepsis in mature versus senescent mice.
Previous work in our laboratory demonstrated increased sensitivity of senescent (24-month-old) mice to cecal ligation and puncture (CLP) sepsis compared with that of mature (12-month-old) mice. In this study the median lethal dose of the strain of Escherichia coli most frequently isolated during CLP sepsis was determined. No significant age-associated difference in the mean lethal dose or the mean survival time was noted; however, sham surgery before injection of E. coli decreased the mean lethal dose by at least 100-fold. ⋯ The amount of TNF produced locally in the peritoneum was also substantially higher in senescent mice than in mature animals (1,716 pg/ml versus 776 pg/ml). The increased production of TNF in senescent animals, despite elevated circulating corticosterone levels, suggested an age-related defect in glucocorticoid-directed downregulation of TNF production. This was confirmed in lipopolysaccharide-treated animals given exogenous dexamethasone.(ABSTRACT TRUNCATED AT 400 WORDS)
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Although catheter-related sepsis (CRS) is an important cause of nosocomial infection and the major complication of intravenous catheter use, there is, as yet, no consensus concerning either a useful definition of CRS or the optimal method of catheter management and prevention of infection. Semiquantitative culture of catheter tips is a useful method of diagnosis of CRS but other techniques such as quantitative catheter blood cultures and Gram staining of the catheter have roles in selected patients. The most significant impact on the prevention of CRS is made by the introduction of an intravenous therapy team. ⋯ Techniques such as guide-wire exchange and catheters such as triple lumen and total implantable venous access devices have their own infection problems. Many new and interesting approaches to the prevention of CRS are being formulated. To facilitate further progress, a standardized definition for diagnosis, and revised recommendations for prevention of CRS would be helpful.
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Comparative Study
Intratracheal suctioning, systemic infection, and the meconium aspiration syndrome.
A retrospective analysis was performed to determine: (1) the proportion of neonates with the meconium aspiration syndrome (MAS) who were not depressed at birth; (2) to evaluate the clinical course of neonates with MAS, particularly relating to whether or not delivery room intubation and intratracheal suctioning had taken place; and (3) to examine the incidence of culture-proven bacteremia among meconium-stained neonates and those with MAS. The medical records of all meconium-stained neonates and those with MAS admitted to our facility from 1985 through 1989 were reviewed. Of 5697 liveborn neonates, 741 (13%) were meconium-stained, of whom 608 (82%) were intubated and suctioned in the delivery room. ⋯ Nine (75%) of 12 nonsuctioned neonates, as well as 6 (25%) of 24 suctioned neonates, required mechanical ventilation for more than 6 hours (P = .010). Pneumothoraces occurred in 6 (50%) of 12 nonsuctioned and 5 (21%) of 24 suctioned babies (P = .125). Four of 12 nonsuctioned newborns either died (n = 1) or required extracorporeal membrane oxygenation (n = 3), while only 1 of the suctioned newborns required extracorporeal membrane oxygenation (P = .034).(ABSTRACT TRUNCATED AT 250 WORDS)