Articles: sepsis.
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Randomized Controlled Trial Clinical Trial
Steroids in the treatment of clinical septic shock.
A prospective (Part I) and a retrospective (Part II) study were used to determine the safety and efficacy of corticosteroids in the treatment of septic shock. In Part I, 172 consecutive patients in septic shock admitted over an 8-year period were treated with either steroid or saline: 43 received dexamethasone (DMP), 43 received methylprednisolone (MPS), and 86 received saline. The study was double-blind and randomized, and the three groups were compared for age, severity of shock, presence of underlying disease, and year of study. ⋯ Again, the two groups of patients were compared for severity of shock, underlying disease, age, and year of study. Mortality among patients treated without steroid was 42.5% (68/160) and among patients treated with steroid was 14% (24/168); there was no significant difference in mortality rate between DMP- and MPS-treated patients. In Parts I and II combined, complications occurred in 6% of steroid-treated patients with no significant difference between DMP- and MPS-treated groups.
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Among 21 patients with sepsis attributed solely to decubitus ulcers, bacteremia was documented in 16 (76 per cent)9 Bacteremia involved obligate anaerobes in eight patients (50 per cent) and was polymicrobial in eight patients (50 per cent). Twelve of 17 patients who received antibiotics had persistent bacteremia; in five patients, bacteremia was terminated only after surgical debridement. ⋯ Among 14 patients who underwent surgical debridement, only four patients died. Surgical debridement and antibiotics effective against aerobic as well as anaerobic bacteria are both important in the treatment of this serious complication.
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The safety and efficacy of tobramycin and cephalothin in treatment of suspected sepsis were studied in neutropenic children with various malignancies. Twenty episodes of suspected sepsis in 19 febrile children with cancer were treated with parenteral tobramycin and cephalothin; the duration of therapy ranged from one to 80 days. In 14 of the 20 episodes of suspected sepsis, a favorable clinical response was achieved within five days after initiation of antibiotic therapy. ⋯ In four of the additional six episodes, clinical deterioration was though to be caused by the underlying malignancies. Two episodes included a case of E. coli spesis that ended fatally and a nosocomial infection with Eikenella corrodens. Results of this study suggest that combination therapy with tobramycin and cephalothin is safe and efficacious in treatment of suspected sepsis in febrile children with malignancies and neutropenia.
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Zh. Mikrobiol. Epidemiol. Immunobiol. · Aug 1976
[Several indices of non-specific immunity in staphylococcal sepsis and staphylococcal gastroenterocolitis in children of different ages].
A study was made of some nonspecific immunity indices in staphylococcus sepsis and gastroenterocolitis during the infectious process in young children. Results of these investigations pointed to the depression of bactericidal and lysozyme activity of the blood serum and of the immunoadherence reaction at the acute period of the disease, and to some increase at the phase of recovery. There was also found an elevation of the phagocytic activity (of the phagocytolysis percentage) at the acute phase of the staphylococcus sepsis and gastroenterocolitis Antistaphylococcus gamma-globulin produced a positive effect on the lysozyme and bactericidal activity of the blood sera and promoted an increase of the blood phagocytic activity in the sick children.