Articles: sepsis.
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Med. Clin. North Am. · Jul 1986
ReviewClinical indicators in sepsis and septic adult respiratory distress syndrome.
Sepsis and septic ARDS remain clinical problems of great significance because of the numbers of patients affected each year and the high mortality associated with development of the syndrome. The standard therapies for these conditions, judicious antibiotic administration and supportive care, continue to be the mainstays of treatment for these patients, but mortality even with optimal conventional therapy is between 50% and 90% for septic ARDS. ⋯ Two therapies that are used extensively in the intensive care unit today--corticosteroid administration and PEEP--have not been shown to reduce the overall mortality of sepsis or septic ARDS. Newer therapeutic modalities, designed to protect against or reverse cardiovascular consequences of sepsis, reduce the incidence of multiorgan system failure, and diminish the high incidence of uncontrolled infections in these patients, are needed; investigations of these interventions are in progress.
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The medical records of 507 patients with polymicrobial septicemia were examined to determine prognostic and descriptive factors. Over 50% of the episodes occurred in patients with solid tumors and 80% originated during hospitalization. Invasive procedures and immunosuppressive therapy frequently preceded development of polymicrobial septicemia, and infection was often accompanied by shock and pneumonia. ⋯ Overall response among these patients was 50%, with poorest response seen among patients with persistent neutropenia (25%), pneumonia (19%), and gram-negative bacillary infection (46%). Therapy with an antibiotic regimen to which all causative organisms were sensitive was of greatest prognostic significance. Response to appropriate therapy was 58%, whereas only 10% of those who received inappropriate therapy were cured (p less than .0001).
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Swiss medical weekly · Jun 1986
Case Reports[Antibiotic-resistant Corynebacteria--a new problem of infection in immunosuppressed patients].
Corynebacterium species can normally be found on the skin and mucous membranes but rarely cause infections. They are sensitive to most antibiotics. Two patients with severe aplastic anemia undergoing antilymphocyte globulin therapy developed septicemia with a highly antibiotic-resistant corynebacterium (JK-group) only sensitive to vancomycin. ⋯ One patient was even colonized with corynebacterium for several months before. If this strain is detected in the blood when new fever develops during prolonged neutropenia and broad-spectrum antibiotic therapy, it indicates serious infection in these highly compromised patients. Both cases illustrate that regular microbial surveillance can help to reveal colonization of high risk patients with multiple antibiotic-resistant corynebacterium strains and thus allow early initiation of treatment with vancomycin, which is the only effective antibiotic.