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Sepsis review

David Sweet, Julian Marsden, Kendall Ho, Christina Krause, James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: BC medical journal: BCMJ
Winnie Huiyan Sim, Edward Araujo Júnior, Fabricio Da Silva Costa, Penelope Marie Sheehan
AIM: To assess the contemporary maternal and neonatal outcomes following expectant management of preterm premature rupture of membranes (PPROM) prior to 24 weeks' gestation and to identify prognostic indicators of this morbid presentation. METHODS: We performed a systematic review in the Pubmed and EMBASE databases to identify the primary (perinatal mortality, severe neonatal morbidity and serious maternal morbidity) and secondary (neonatal survival and morbidity) outcomes following expectant management of previable PPROM...
October 25, 2016: Journal of Perinatal Medicine
Kareem Bedeir, Raghu Seethala, Edward Kelly
BACKGROUND: Extracorporeal life support (ECLS) is a potentially life-saving procedure for trauma patients with severe respiratory failure. Despite this, only a limited number of publications report series of trauma patients who underwent ECLS. The performance and safety of this technology in trauma patients is not fully understood. We described the efficacy and complications of ECLS in trauma patients with respiratory failure. METHODS: A systematic review of published reports was performed utilizing the Medical Literature Analysis and Retrieval System Online (MEDLINE)...
October 25, 2016: Journal of Trauma and Acute Care Surgery
Katinka Karenberg, Hannes Hudalla, David Frommhold
Impaired cellular innate immune defense accounts for susceptibility to sepsis and its high morbidity and mortality in preterm infants. Leukocyte recruitment is an integral part of the cellular immune response and follows a well-defined cascade of events from rolling of leukocytes along the endothelium to firm adhesion and finally transmigration which is concerted by a variety of adhesion molecules. Recent analytical advances such as fetal intravital microscopy have granted new insights into ontogenetic regulation and maturation of fetal immune cell recruitment...
December 2016: Molecular and Cellular Pediatrics
Lemuel R Non, Carlos A Q Santos
BACKGROUND: Staphylococcus lugdunensis is a coagulase-negative staphylococcus with similar virulence characteristics as S. aureus. Whether S. lugdunensis causes infective endocarditis (IE) in a similar proportion of cases as S. aureus (reported to be 12.6% in a definitive multicenter prospective study) is unclear. METHODS: We conducted a retrospective cohort study of adult patients with at least one blood culture positive for S. lugdunensis at our institution from January 2006 to December 2014...
October 21, 2016: Journal of Infection
J Chong, P Jones, D Spelman, K Leder, A C Cheng
Overwhelming post-splenectomy infection (OPSI) is a serious complication of asplenia and is associated with encapsulated organisms, most commonly Streptococcus pneumoniae, but also Haemophilus influenzae and Neisseria meningitidis. We aimed to estimate the risk of infection in this patient group. We reviewed data collected by the Victorian Spleen Registry in Australia. On registration, all patients are asked about significant infections requiring admission to hospital for intravenous antibiotics; those requiring admission to ICU were defined as OPSI...
October 25, 2016: Epidemiology and Infection
Appiah-Korang Labi, Noah Obeng-Nkrumah, Stephanie Bjerrum, Christabel Enweronu-Laryea, Mercy Jemima Newman
BACKGROUND: Diagnosis of bloodstream infections (BSI) in neonates is usually difficult due to minimal symptoms at presentation; thus early empirical therapy guided by local antibiotic susceptibility profile is necessary to improve therapeutic outcomes. METHODS: A review of neonatal blood cultures submitted to the microbiology department of the Korle-Bu Teaching Hospital was conducted from January 2010 through December 2013. We assessed the prevalence of bacteria and fungi involved in BSI and the susceptibility coverage of recommended empiric antibiotics by Ghana Standard Treatment guidelines and the WHO recommendations for managing neonatal sepsis...
October 24, 2016: BMC Infectious Diseases
Aravind T Reddy, Sowmya P Lakshmi, Raju C Reddy
Peroxisome proliferator-activated receptor γ (PPARγ) is now recognized as an important modulator of leukocyte inflammatory responses and function. Its immunoregulatory function has been studied in a variety of contexts, including bacterial infections of the lungs and central nervous system, sepsis, and conditions such as chronic granulomatous disease. Although it is generally believed that PPARγ activation is beneficial for the host during bacterial infections via its anti-inflammatory and antibacterial properties, PPARγ agonists have also been shown to dampen the host immune response and in some cases exacerbate infection by promoting leukocyte apoptosis and interfering with leukocyte migration and infiltration...
2016: PPAR Research
Ankana Daga, Fredrick Dapaah-Siakwan, Sharina Rajbhandari, Cassandra Arevalo, Agnes Salvador
BACKGROUND: Acute kidney injury (AKI) is common in critically ill premature infants. There is a lack of consensus on the diagnostic definition of AKI in very low birth weight (VLBW) infants. The primary aim of this study was to determine the incidence and risk factors for AKI in VLBW infants using the AKI network (AKIN) and pRIFLE (pediatric Risk, Injury, Failure, Loss, End-Stage) criteria and to evaluate whether Clinical Risk Index for Babies (CRIB II) score is a predictor of AKI. The secondary objective was to determine the extent of agreement between the AKIN and pRIFLE criteria in the diagnosis of AKI in VLBW infants...
September 28, 2016: Pediatrics and Neonatology
Ankur Jindal, Archana Rastogi, Shiv Kumar Sarin
For over 20 years, acute-on-chronic liver failure (ACLF) has taken multiple definitions and/or classifications. The definition outlines the acute and chronic insults to include a homogenous patient group with liver failure and an expected outcome in a specific time frame. Early and accurate diagnosis is essential as this inflammation of the liver may tilt the balance of liver destruction and regeneration adversely. Various factors such as superadded systemic sepsis, liver reserve, cause of primary chronic liver disease, state of immune system or the state of gut microbial flora might determine the ultimate prognosis...
October 24, 2016: Expert Review of Gastroenterology & Hepatology
Ricardo Ferrer, Rafael Zaragoza, Alejandro H Rodríguez, Emilio Maseda, Pedro Llinares, Santiago Grau, Francisco Álvarez-Lerma, Guillermo Quindós, Miguel Salavert, Rafael Huarte
BACKGROUND: Although the management of invasive fungal infection (IFI) has improved, a number of controversies persist regarding the approach to invasive fungal infection in non-neutropenic medical ward patients. AIMS: To identify the essential clinical knowledge to elaborate a set of recommendations with a high level of consensus necessary for the management of IFI in non-neutropenic medical ward patients. METHODS: A prospective, Spanish questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists (intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases) in IFI and belonging to six scientific national societies...
October 18, 2016: Revista Iberoamericana de Micología
Carsten Deppermann, Paul Kubes
The primary function of platelets is to patrol the vasculature and seal vessel breaches to limit blood loss. However, it is becoming increasingly clear that they also contribute to pathophysiological conditions like thrombosis, atherosclerosis, stroke and infection. Severe sepsis is a devastating disease that claims hundreds of thousands of lives every year in North America and is a major burden to the public health system. Platelet surface receptors like GPIb, αIIbβ3, TLR2 and TLR4 are involved in direct platelet-bacteria interactions...
October 18, 2016: Seminars in Immunology
U M Stamer, U Gundert-Remy, E Biermann, J Erlenwein, W Meiβner, S Wirz, T Stammschulte
BACKGROUND: Dipyrone (metamizole) is a non-opioid analgesic commonly used in Germany, which can, in very rare cases, cause life-threatening agranulocytosis. The prescribing information calls for regular monitoring of the differential blood count in cases of long-term treatment. However, there is uncertainty about how this testing should be handled in practice. OBJECTIVES: Which recommendations can be derived from the published literature for evaluating blood cell counts during treatment with metamizole and which other options for monitoring exist? METHODS: Data from recent epidemiological studies, reviews, and spontaneously reported cases were evaluated...
October 20, 2016: Der Schmerz
Alexandre Boulos, Katherine Rand, Josh A Johnson, Jacqueline Gautier, Michael Koster
Infections (including sepsis, meningitis, pneumonia and tetanus) stand as a major contributor to neonatal mortality in Haiti (22%). Infants acquire bacteria that cause neonatal sepsis directly from the mother's blood, skin or vaginal tract either before or during delivery. Nosocomial and environmental pathogens introduce further risk after delivery. The absence of cohesive medical systems and methods for collecting information limits the available data in countries such as Haiti. This study seeks to add more information on the burden of severe bacterial infections and their etiology in neonates of Haiti...
October 19, 2016: Journal of Tropical Pediatrics
Li Liu, Wanjun Chen, Xiaoye Lu, Keji Zhang, Changqing Zhu
BACKGROUND: Pyogenic liver abscesses have become common in emergency departments (EDs) in recent years in Shanghai, China due to a variety of risk factors contributory to the disease. OBJECTIVE: To review our experience in managing pyogenic liver abscesses to aid in the current management of this complex condition. METHODS: This retrospective study was conducted to collect and analyze information from adult patients diagnosed with liver hepatic abscesses who were admitted to Ren Ji Hospital during the period from January 1, 2010 to December 31, 2015...
October 17, 2016: Journal of Emergency Medicine
David R Stather, Alain Tremblay, Elaine Dumoulin, Paul MacEachern, Alex Chee, Christopher Hergott, Jacob Gelberg, Gary A Gelfand, Paul Burrowes, John H MacGregor, Christopher H Mody
BACKGROUND: Intracavitary pulmonary aspergilloma is a chronic, debilitating fungal infection. Without definitive therapy, death can occur from massive hemoptysis, cachexia, or secondary infection. Although surgical resection is the standard therapy, it is not possible for many patients owing to poor pulmonary function or medical comorbidities. Aspergilloma removal through bronchoscopy is an important alternative therapy that may be available in select cases. METHODS: We retrospectively reviewed all cases referred to the University of Calgary Interventional Pulmonary Service for transbronchial removal of intracavitary aspergilloma from January 1, 2009, to January 1, 2014...
October 17, 2016: Annals of Thoracic Surgery
Philippe Willems, Jan Muller, Jan Verhaegen, Veroniek Saegeman, Stefanie Desmet
We report a case of a 77-year old male who developed a fulminant erysipelas and sepsis, caused by Myroides odoratimimus. Selecting the optimal antibiotic therapy for the treatment of infections with M. odoratimimus is challenging due to limited clinical experience with this micro-organism and its reported multidrug-resistance. Review of previous studies concerning in vitro antibacterial susceptibility and clinical experience with M. odoratimimus resulted in six case reports describing bacteremia, soft tissue and bone infections, pneumonia and urinary tract infections...
October 20, 2016: Acta Clinica Belgica
Phillip M Mitchell, Benjamin M Weisenthal, Cory A Collinge
OBJECTIVE: To evaluate the incidence of knee sepsis following suprapatellar nailing of open tibia fractures. DESIGN: Retrospective SETTING:: ACS Level 1 trauma centerPatients/Participants: We reviewed 139 open tibia fractures that underwent suprapatellar nailing as definitive treatment over a five-year period (January 1, 2011 to January 1, 2016). The majority of patients (90%, n=126) underwent intramedullary nailing at the time of their initial surgery. We defined knee sepsis as intra-articular infection requiring operative debridement, either open or arthroscopically, within one month's time...
October 1, 2016: Journal of Orthopaedic Trauma
John A Kellum
PURPOSE OF REVIEW: Acute kidney injury is common and is associated with increased morbidity and mortality. Rates of acute kidney injury in most settings remain high and in some settings are increasing. Moreover, outcomes associated with acute kidney injury remain relatively poor. This review focuses on recent advances in understanding of acute kidney injury and discusses possible interventions based on these advances. RECENT FINDINGS: Acute kidney injury is not a disease with a single etiology and clinical course but rather a loose collection of syndromes whose unifying phenotype is an acute loss of glomerular filtration...
October 18, 2016: Current Opinion in Critical Care
Joshua Bloom, Shan Sun, Yousef Al-Abed
Macrophage migration inhibitory factor (MIF) has emerged as a promising drug target in diseases including sepsis, rheumatoid arthritis, and cancer. MIF has multiple properties that favor development of specific, targeted therapies: it is expressed broadly among human cells, has noted roles in diverse inflammatory and oncological processes, and has intrinsic enzymatic activity amenable to high-throughput screening. Despite these advantages, anti-MIF therapy remains well behind other cytokine-targeted therapeutics, with no small molecules in the pipeline for clinical development and anti-MIF antibodies only recently beginning clinical trials...
October 20, 2016: Expert Opinion on Therapeutic Targets
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