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Intra-abdominal sepsis

Silvia Marchesi, Fracisco Ortiz Nieto, Kerstin Magdalena Ahlgren, Agneta Roneus, Ricardo Feinstein, Miklos Lipcsey, Anders Larsson, Håkan Ahlström, Goran Hedenstierna
Diffusion-weighted magnetic resonance imaging (DW-MRI) uses water as contrast and enables the study of perfusion in many organs simultaneously in situ. We used DW-MRI in a sepsis model, comparing abdominal organs perfusion with global hemodynamic measurements and inflammation. Sixteen anesthetized piglets were randomized into 3 groups: HighMAP (mean arterial pressure, MAP > 65 mmHg), LowMAP (MAP between 50 and 60 mmHg) and Healthy Controls (HC). Sepsis was obtained with endotoxin and the desired MAP maintained with noradrenaline...
October 18, 2018: American Journal of Physiology. Gastrointestinal and Liver Physiology
Saleh Abdel-Kader, Massimo Sartelli, Fikri M Abu-Zidan
INTRODUCTION: The World Society of Emergency Surgery (WSES) has recently developed and validated a sepsis severity score for complicated intra-abdominal infections (cIAIs). We aimed to prospectively study the validity of this score in our local setting and compare it with global findings. METHODS: In a prospective study of 100 consecutive adult patients with cIAIs treated at Al-Ain Hospital, United Arab Emirates, from October 2014 to January 2016, we studied the demography of patients, disease, risk factors, WSES Sepsis Severity Score, management, hospital stay and mortality...
October 10, 2018: Singapore Medical Journal
Nicholas P McKenna, Elizabeth B Habermann, Amy E Glasgow, Eric J Dozois, Amy L Lightner
BACKGROUND: Intra-abdominal sepsis complicates <10% of ileocolic resections for Crohn's disease, but the impact of combination immunosuppression and repeat resection on its development remains unknown. OBJECTIVE: The purpose of this study was to determine risk factors for intra-abdominal sepsis after ileocolic resection, specifically examining the role of combination immunosuppression and repeat intestinal resection. DESIGN: This was a retrospective review of patient records from 2007 to 2017...
October 9, 2018: Diseases of the Colon and Rectum
Jia Rui Kwan, Keith Sheng Hng Low, Rahul Lohan, Vishal G Shelat
Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report on a 76-year-old lady with recurrent pyogenic cholangitis and PTBD catheter fracture. She had hepatitis B virus-related Child-Pugh class A liver cirrhosis, hypothyroidism, hyperlipidaemia, and previous atrial fibrillation with a background of mild mitral, tricuspid and aortic valvular regurgitation. She had history of laparoscopic cholecystectomy in the past...
August 2018: Annals of Hepato-Biliary-Pancreatic Surgery
Xibing Ding, Shuqing Jin, Zhenzhen Shao, Li Xu, Zhuang Yu, Yao Tong, Zhixia Chen, Heth Turnquist, Bruce R Pitt, Timothy R Billiar, Li-Ming Zhang, Quan Li
Mechanical ventilation (MV) is frequently employed to manage respiratory failure in sepsis patients and is required for the surgical management of intra-abdominal sepsis. The impact of MV varies dramatically depending on tidal volume, with even moderate tidal volume (MTV) ventilation leading to ventilator-induced lung injury, whereas low tidal volume (LTV) ventilation protects against sepsis-induced ARDS. IL-33 is known to contribute to lung injury in sepsis and its release can be induced by mechanical stress...
September 5, 2018: Shock
Ling-Ling Zhu, Quan Zhou
Background: Sporadic studies in antimicrobial therapy have evaluated the effects of infusion rates on therapeutic and economic outcomes, and new findings may challenge the regular infusion regimen. Methods: Focusing on studies comparing the outcomes of different infusion regimens, the relevant literature was identified by searching PubMed, Web of Science, and Scopus from January 1, 2013 to March 1, 2018. Papers were finally chosen using a PRISMA flowchart. Results: Antimicrobials with the superiority of prolonged infusion to standard infusion in terms of efficacy and safety include meropenem, doripenem, imipenem, cefepime, ceftazidime, piperacillin/tazobactam, linezolid, and vancomycin...
2018: Infection and Drug Resistance
Harry Wang, Vivek Batra
Pneumoperitoneum is often associated with surgical complications or intra-abdominal sepsis. While commonly deemed a surgical emergency, pneumoperitoneum in a minority of cases does not involve a viscus perforation or require urgent surgical management; these cases of "spontaneous pneumoperitoneum" can stem from a variety of etiologies. We report a case of a 72-year-old African American male with a history of metastatic pancreatic adenocarcinoma who presented with new-onset abdominal distention and an incidentally discovered massive pneumoperitoneum with no clear source of perforation on surveillance imaging...
June 11, 2018: Curēus
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
This article reports a pharmacokinetic case study of intravenous posaconazole in a 49-year-old male patient with intra-abdominal sepsis and hypoalbuminaemia receiving continuous venovenous haemodiafiltration. Concentration-time data following 300 mg intravenous posaconazole was analysed using a population pharmacokinetics approach. The 300-mg intravenous dose appears to be adequate for the treatment of yeast infections; however, for the treatment of invasive aspergillosis in isolated cases of critically ill patients with hypoalbuminaemia, the current dosing may not achieve desired exposure, although steady state exposure data are needed...
July 19, 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 veins, hind leg muscles, and peritoneal cavities 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 medium were determined for both molecules in each rat by retrodialysis by drug...
October 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...
October 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)
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