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Intra-abdominal sepsis

Adrian Sousa, María Teresa Pérez-Rodríguez, Adriana Soto, Lorena Rodríguez, Antonio Pérez-Landeiro, Lucia Martínez-Lamas, Andrés Nodar, Manuel Crespo
Background: Experience in real clinical practice with ceftazidime/avibactam is limited, and there are even fewer data on infections due to OXA-48-producing Enterobacteriaceae. Methods: We designed an observational study of a prospectively collected cohort of adult patients receiving ceftazidime/avibactam in our centre. Only the first treatment course of each patient was analysed. Efficacy and safety were evaluated as 14 and 30 day mortality, recurrence rate at 90 days, resistance development and occurrence of adverse effects...
August 7, 2018: Journal of Antimicrobial Chemotherapy
H Ciesielczuk, M Wilks, S Castelain, M Choquet, M Morotti, E Pluquet, V Sambri, M Tassinari, S Zannoli, L Cavalié, H Dupont, H Guet-Revillet
Intra-abdominal infections (IAIs) are one of the most common type of infections in patients with sepsis and an important cause of death in intensive care units. Early detection and treatment are necessary to reduce patient complications and improve outcomes. The Unyvero IAI Application (Curetis GmbH) is the first automated assay to rapidly and simultaneously identify a large panel of bacteria, fungi, toxins, and antibiotic resistance markers directly from IAI-related samples. The assay was evaluated in four European clinical laboratories in comparison to routine microbiological practices...
August 10, 2018: European Journal of Clinical Microbiology & Infectious Diseases
Chizuru Yamashita, Kazuhiro Moriyama, Daisuke Hasegawa, Yoshitaka Hara, Naohide Kuriyama, Tomoyuki Nakamura, Junpei Shibata, Hidefumi Komura, Osamu Nishida
BACKGROUND: Sepsis frequently leads to multiple organ failure due to the uncontrolled amplification and spread of inflammation, even if the infectious source is controlled. Lipopolysaccharide (LPS), a typical pathogen-associated molecular pattern (PAMP), is adsorbed by the polymyxin B-immobilized fiber column (PMX). PMX has been used for decades in Europe. Results of a North American randomized controlled trial (RCT) on PMX have recently been announced in a press release; results of large-scale observational studies and meta-analyses have also been reported in the last several years...
2018: Contributions to Nephrology
Fekade B Sime, Janine Stuart, Jenie Butler, Therese Starr, Steven C Wallis, Saurabh Pandey, Jeffrey Lipman, Jason A Roberts
We present a pharmacokinetic case-study of intravenous posaconazole in a 49-years-old male patient with intra-abdominal sepsis and hypoalbuminemia receiving continuous venovenous hemodiafiltration. Concentration-time data following 300mg intravenous dose was analysed using a population pharmacokinetics approach. The 300mg intravenous dose appears adequate for the treatment of yeast infections; however, for treatment of invasive aspergillosis in isolated cases of critically ill patients with hypoalbuminemia, the current dosing may not achieve desired exposure although steady-state exposure data is needed...
July 18, 2018: International Journal of Antimicrobial Agents
Alexia Chauzy, Isabelle Lamarche, Christophe Adier, William Couet, Sandrine Marchand
The purpose of this study was to investigate aztreonam (ATM) and avibactam (AVI) distribution in intraperitoneal fluid and muscle interstitial fluid by microdialysis in rats, with or without peritonitis, and to compare the unbound concentrations in tissue with the unbound concentrations in blood. Microdialysis probes were inserted into the jugular vein, hind leg muscle and peritoneal cavity of control rats ( n = 5) and rats with intra-abdominal sepsis ( n = 9) induced by cecal ligation and punctures. ATM and AVI probe recoveries in each media were determined for both molecules in each rat by retrodialysis by drug...
July 16, 2018: Antimicrobial Agents and Chemotherapy
Hua Xiao, Hu Quan, Shuguang Pan, Bin Yin, Wei Luo, Ming Tang, Yongzhong Ouyang, Wei Tang
The aim of this retrospective study was to investigate the incidence of, causes and risk factors for readmission to hospital ≤30 days after discharge of patients who underwent radical gastrectomy for gastric cancer. A total of 2,023 patients underwent radical gastrectomy operations from November 2010 to July 2017 in our hospital. Of these, 60 patients (3.0%) were readmitted within 30 days after their original discharge. The median time span between the index discharge and readmission was 14 days and the median time for readmission was 8 days...
July 12, 2018: Scientific Reports
Andrew W Kirkpatrick, Federico Coccolini, Luca Ansaloni, Derek J Roberts, Matti Tolonen, Jessica L McKee, Ari Leppaniemi, Peter Faris, Christopher J Doig, Fausto Catena, Timothy Fabian, Craig N Jenne, Osvaldo Chiara, Paul Kubes, Braden Manns, Yoram Kluger, Gustavo P Fraga, Bruno M Pereira, Jose J Diaz, Michael Sugrue, Ernest E Moore, Jianan Ren, Chad G Ball, Raul Coimbra, Zsolt J Balogh, Fikri M Abu-Zidan, Elijah Dixon, Walter Biffl, Anthony MacLean, Ian Ball, John Drover, Paul B McBeth, Juan G Posadas-Calleja, Neil G Parry, Salomone Di Saverio, Carlos A Ordonez, Jimmy Xiao, Massimo Sartelli
Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. Principles of treatment include early antibiotic administration and operative source control. A further therapeutic option may be open abdomen (OA) management with active negative peritoneal pressure therapy (ANPPT) to remove inflammatory ascites and ameliorate the systemic damage from SCIAS...
2018: World Journal of Emergency Surgery: WJES
Juan G Posadas-Calleja, Henry T Stelfox, Andre Ferland, Danny J Zuege, Daniel J Niven, Luc Berthiaume, Christopher James Doig
BACKGROUND: Mortality in patients with intra-abdominal sepsis remains high. Recognition and classification of patients with sepsis are challenging; about 70% of critical care specialists find the existing definitions confusing and not clinically useful. OBJECTIVE: To assess the usefulness of the predisposition, infection/injury, response, organ dysfunction (PIRO) concept in surgical intensive care patients with severe sepsis or septic shock due to an intra-abdominal source...
July 2018: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Myeongjin Choi, Pratistha Tamrakar, Patricia F Schuck, Julie L Proctor, Ashley Moore, Katrina Asbury, Gary Fiskum, Turhan Coksaygan, Alan S Cross
BACKGROUND: Injured warfighters air evacuated to tertiary medical care facilities are subjected to many stresses that may promote the development of sepsis. In this study, we tested the hypothesis that exposure to "in-flight" hypobaria and/or hyperoxia within 24 hours after onset of intra-abdominal infection in rats accelerates the development and/or severity of sepsis and neurologic injury in survivors. METHODS: Sprague-Dawley rats underwent cecal ligation/puncture (CLP) or sham procedures...
July 2018: Journal of Trauma and Acute Care Surgery
Sherree Gray, Martin Christensen, Judy Craft
Intra-abdominal hypertension is classified as either primary or secondary - primary occurs due to intra-abdominal or retro-peritoneal pathophysiology, whereas secondary results in alterations in capillary fluid dynamics due to factors, such as massive fluid resuscitation and generalised inflammation. The renal and gastro-intestinal effects occur early in the progression of intra-abdominal hypertension, and may lead to poor patient outcomes if not identified. As a direct response to intra-abdominal hypertension, renal function is reduced with remarkable impairment from pressures of around 10 mmHg, oliguria developing at 15 mmHg and anuria developing at 30 mmHg...
June 21, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Hua Xiao, Yu Wang, Hu Quan, Yongzhong Ouyang
Background: To investigate the incidence, causes and risk factors for unplanned reoperation because of early complications within 30 days of radical gastrectomy for gastric cancer. Methods: The study cohort comprised 1,948 patients who underwent radical gastrectomy for gastric cancer between November 2010 and April 2017. The incidence, causes and outcomes of unplanned reoperation were examined and the risk factors were identified using univariate and multivariate analyses...
June 2018: Gastroenterology Research
Jinjian Huang, Jianan Ren, Luise Brakert, Jiao Jiao, Qinjie Liu, Gefei Wang, Xiuwen Wu, Steven W M Olde Damink
BACKGROUND: This purpose of this study was to investigate the effects of blood stream infections (BSIs) on the prognosis of patients with complicated intra-abdominal infections (IAIs) and to make predictions based on patients' characteristics on admission. PATIENTS AND METHODS: One hundred eighty-seven patients with complicated IAI in 2014 and 2015 were included in our retrospective analysis, except for those diagnosed with central line-associated blood stream infections (CLABSIs)...
May 2018: Surgical Infections
Ioannis Siasios, Kunal Vakharia, Asham Khan, Joshua E Meyers, Samantha Yavorek, John Pollina, Vassilios Dimopoulos
Although rarely documented in the medical literature, bowel perforation injury can be a severe complication of spine surgery. Our goal was to review current literature regarding this complication and study possible methods of avoidance. We conducted a literature search in the PubMed database between January 1960 and March 2016 using the terms abrasion, bowels, bowel, complication, injury, intestine, intra-abdominal sepsis/shock, perforation, lumbar, spine, surgery, visceral. Diagnostic criteria, outcomes, risk factors, surgical approach, and treatment strategy were the parameters extracted from the search results and used for review...
March 2018: Journal of Spine Surgery (Hong Kong)
Leo I Amodu, Jamil Alexis, Aron Soleiman, Meredith Akerman, Poppy Addison, Toni Iurcotta, Horacio L Rodriguez Rilo
BACKGROUND: Pancreatectomies have been identified as procedures with an increased risk of readmission. In surgical patients, readmissions within 30 days of discharge are usually procedure-related. We sought to determine predictors of 30-day readmission following pancreatic resections in a large healthcare system. METHODS: We retrospectively collected information from the records of 383 patients who underwent pancreatic resections from 2004-2013. To find the predictors of readmission in the 30 days after discharge, we performed a univariate screen of possible variables using the Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables...
June 2018: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Paula R Keschenau, Shirley Ketting, Barend Mees, Mohammad E Barbati, Jochen Grommes, Alexander Gombert, Geert Willem H Schurink, Drosos Kotelis, Michael J Jacobs
OBJECTIVE: The aim was to present current results of open thoracic and thoraco-abdominal aortic repair as secondary procedure after prior endovascular therapy. METHODS: This was a retrospective cross border single centre study. From 2006 to July 2017 45 open thoracic aortic (TAA) or thoraco-abdominal aortic aneurysm (TAAA) operations were performed on 44 patients (median age 58 [15-80] years) as secondary surgery after previous endovascular therapy comprising TEVAR (n = 38; 86%), EVAR (n = 3; 7%), fenestrated EVAR (n = 1; 2%) and TEVAR plus EVAR (n = 1; 2%)...
July 2018: European Journal of Vascular and Endovascular Surgery
Emily Harding-Theobald, Bharat Maraj
Lactobacillus species colonize the human gastrointestinal tract and are rarely pathogenic. We present a case involving a cirrhotic patient who presented with sepsis and was found to have peritoneal cultures demonstrating Lactobacillus as the sole pathogen concerning for spontaneous bacterial peritonitis. Treatment was achieved with high-dose penicillin and clindamycin but the patient developed hepatorenal syndrome and died from acute renal failure. Intra-abdominal Lactobacillus infections are typically seen in patients undergoing peritoneal dialysis or who have recently had bowel perforation...
2018: Case Reports in Gastrointestinal Medicine
Marion Taleb, Nicolas Nardi, Alexis Arnaud, Nathalie Costet, Pierre-Yves Donnio, Charlotte Engrand, Edouard Habonimana, Eric Wodey, Pierre Tattevin
Acute appendicitis in children requires early surgery and short-course antibiotics active against Enterobacteriaceae and anaerobes. Although an aminoglycoside-containing three-drug regimen has been used successfully for decades, simpler regimens with similar efficacy are increasingly used. This study evaluated the impact of a switch from the combination of cefotaxime, metronidazole and gentamicin (regimen 1) to piperacillin/tazobactam (regimen 2) as first-line regimen for complicated acute appendicitis in children...
April 18, 2018: International Journal of Antimicrobial Agents
Yun Ji, Baoli Cheng, Zhipeng Xu, Hui Ye, Weina Lu, Xiaoqian Luo, Shuiqiao Fu, Xiangming Fang
PURPOSE: This study aimed to investigate the association between sarcopenic obesity and 30-day mortality in critically ill patients with intra-abdominal sepsis. MATERIAL AND METHODS: We analyzed 236 surgical ICU patients with sepsis due to intra-abdominal infection who underwent urgent surgical intervention. Sarcopenia, visceral obesity and sarcopenic obesity were analyzed by computed tomography scans using the third lumbar vertebrae skeletal muscle index and visceral adipose tissue area, using previously reported cutoff values...
August 2018: Journal of Critical Care
Hui Xu, Jing Xu, Li Xu, Shuqing Jin, Heth R Turnquist, Rosemary Hoffman, Patricia Loughran, Timothy R Billiar, Meihong Deng
Sepsis is defined as infection with organ dysfunction due to a dysregulated immune response. The lung is one of the most vulnerable organs at the onset of sepsis. Interleukin (IL)-33 can be released by injured epithelial and endothelial cells in the lung and regulate immune activation and infiltration. Therefore, we postulated that IL-33 would contribute to the immune response in the lung during sepsis. Using the cecal ligation and puncture (CLP) sepsis model, we show here that IL-33 contributes significantly to both sepsis-induced inflammation in the lung and systemic inflammatory response in the early phase of sepsis...
April 19, 2018: Immunology and Cell Biology
Paula M Jaramillo, Jaime A Montoya, David A Mejia, Salin Pereira Warr
Introduction: Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years. Presentation of the Case: A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea, or abdominal pain...
2018: Case Reports in Surgery
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