Management Of Severe Infections Research Articles

Scedosporium prolificansOsteomyelitis in an Immunocompetent Child Treated with a Novel Agent, Hexadecylphospocholine (Miltefosine), in Combination with Terbinafine and Voriconazole: A Case Report

We describe an 8-year-old girl who sustained multiple compound fractures in an accident involving agricultural equipment. She developed Scedosporium prolificans osteomyelitis of the pelvis, septic arthritis of the hip, and myositis of adjacent muscles. The infection progressed, despite extensive surgical debridement and joint washouts with 0.2% polyhexamethylene biguanide; antifungal therapy with caspofungin, terbinafine, and voriconazole; and adjunctive therapy with interferon-gamma. Gradual resolution was achieved after the addition of a novel agent, hexadecylphospocholine (miltefosine), and the continuation of terbinafine and voriconazole. This is the first report of the use of miltefosine as an antifungal agent in the management of severe infection with S. prolificans.

Evaluation of compliance with bundle treatment in the management of severe infection

To evaluate compliance with bundle treatment in the management of severe infection in a tertiary hospital, aiming at analyzing clinical data in order to popularize guidelines for management of severe sepsis and septic shock. A 14-month (from November 1, 2006 to December 31, 2007) prospective observational study of a group of 43 patients admitted to the respiratory intensive care unit in First Affiliated Hospital (tertiary hospital) of Guangzhou Medical College meeting the criteria for severe pneumonia and septic shock was carried out. Implementation of 6-hour and 24-hour bundle treatment for severe infection was divided into three phases consisting of education, trial, and application. A cohort of 43 patients with matched disease history admitted during January 1, 2004 to October 31, 2006 were enrolled as control group. (1) In 6-hour bundle treatment for severe infection, 20.9% (9/43) had serum lactate measured, blood culture was obtained prior to antibiotic administration in 7.0% (3/43) of patients, 100% (43/43) had empirical antibiotics administration within 1 hour, an infusion of an initial minimum of 20 ml/kg of crystalloid or colloid equivalent (1.1 ml/kg of 20% albumin or 4.8 ml/kg of 6% hydroxyethyl starch) was given in 44.2% (19/43), with infused fluid (converted into 6% hydroxyethyl starch) reaching (503.95+/-176.19) ml within 6 hours, in 94.7% (18/19) of patients had received vasopressors , and inotropic dobutamine and/or transfusion of packed red blood cells were administered in 7.0% (3/43). (2) In 24-hour bundle treatment for severe infection group, 31.6% (6/19) had received low-dose steroids, 34.9% (15/43) had their blood glucose controlled<8.3 mmol/L, mechanical ventilation with inspiratory plateau pressures maintained<30 cm H(2)O (1 cm H(2)O=0.098 kPa, 6 ml/kg tidal volume) was instituted in 97.6% (40/41) of patients. (3) The percentage of compliance with 6-hour and 24-hour bundle treatment for severe infection were 0 and 21.4% respectively, total compliance was also 0. (4) As compared with control group, a 23.30% absolute mortality reduction was found in bundle group (18.6% vs. 41.9%, P=0.019). Bundle treatment for severe infection is complied with partially in our hospital, suggesting that it is still quite arduous to popularize guidelines for management of severe sepsis and septic shock in our country.

In vitro activity of MSI-78 alone and in combination with antibiotics against bacteria responsible for bloodstream infections in neutropenic patients

MSI-78 is a 22 amino acid amphipathic peptide with potent antimicrobial activity against Gram-positive and Gram-negative organisms, including antibiotic-resistant strains. In this study, we assessed the in vitro activity of MSI-78 alone and in combination with eight clinically used antimicrobial agents against several strains of Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli isolated from blood of neutropenic febrile patients. Antimicrobial activity of MSI-78 was measured by minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), time–kill studies and checkerboard titration method. The Gram-negative isolates were susceptible to the peptide at concentrations in the range 0.50–16 mg/L, while staphylococci showed lower susceptibility. MSI-78 demonstrated a higher antimicrobial activity than colistin against Gram-negative organisms. The checkerboard titration method demonstrated synergy when the peptide was combined with β-lactams. These results provide evidence for the potential use of MSI-78 in the management of severe infections in neutropenic patients.

The nexus between systemic inflammation and disordered coagulation in sepsis

The innate immune system is designed as an early defense system that recognizes and clears potential microbial invaders. The coagulation system co-evolved with the innate immune system from a common ancestral cellular origin, and these two systems continue to exhibit a remarkable degree of integration in their signaling pathways and regulatory circuits following tissue injury and microbial invasion. Inflammatory mediators generate procoagulant signals and intravascular thrombosis activates multiple components of the innate immune system. The success of recombinant human activated protein C for the treatment of human septic shock is likely attributable to its combined effects as an endogenous anticoagulant and an anti-inflammatory molecule. Further advances in the management of severe infections may accrue with a better understanding of the integral link between coagulation and innate immunity.

The nexus between systemic inflammation and disordered coagulation in sepsis.

The innate immune system is designed as an early defense system that recognizes and clears potential microbial invaders. The coagulation system co-evolved with the innate immune system from a common ancestral cellular origin, and these two systems continue to exhibit a remarkable degree of integration in their signaling pathways and regulatory circuits following tissue injury and microbial invasion. Inflammatory mediators generate procoagulant signals and intravascular thrombosis activates multiple components of the innate immune system. The success of recombinant human activated protein C for the treatment of human septic shock is likely attributable to its combined effects as an endogenous anticoagulant and an anti-inflammatory molecule. Further advances in the management of severe infections may accrue with a better understanding of the integral link between coagulation and innate immunity.

Therapeutic options for the management of influenza.

Over the past few years a novel class of antiviral agents, the neuraminidase inhibitors, has been found to be safe and effective in the prevention and treatment of influenza. Previously available agents, the M2 inhibitors amantadine and rimantadine, could only be used to treat influenza A infections and resistance develops rapidly. Zanamivir (Relenza) and oseltamivir (Tamiflu), the two clinically available neuraminidase inhibitors, are effective for treating both influenza A and B infections in adults and children and have also been shown to reduce the frequency of antibiotic-requiring complications of influenza infections. Inhaled zanamivir has shown benefit in treating acute influenza with mild to moderate underlying asthma or chronic obstructive pulmonary disease. Studies are needed to examine the use of these agents, alone or in combination with M2 inhibitors or ribavirin, in the management of severe infections in hospitalized patients and immunocompromised hosts. Studies are also needed to address other groups at increased risk for influenza complications, such as pregnant women and children below one year of age.

Beneficial Effect of Granulocyte Transfusions in Patients with Defects in Granulocyte Function and Severe Infections

A 3-year-old boy (patient A) with a congenital and a 24-year-old man (patient B) with an acquired granulocyte function defect received supportive granulocyte transfusions for the management of severe infections. The boy had suffered from recurrent infections since bith. His granulocytes showed in vitro almost no chemotactic responsiveness, an impaired phagocytosis and reduced intracellular killing of Candida albicans. Family studies suggested that it was an inherited autosomal recessive defect. The child developed a Pseudomonas pneumonia at the age of 3 years, which did not respond to antibiotic therapy. Granulocyte transfusions were then started and soon after the fever and pneumonia disappeared. Patient B showed the haematological signs of a preleukaemic state. He had 3 recurrent episodes of furunculosis which led each time to cellulitis and septic temperatures accompanied by symptoms of an enterocolitis. Tests of granulocyte function in vitro showed reduced intracellular killing of Staphylococcus aureus. Granulocyte transfusions were started, since no clinical improvement could be attained by antibiotics. With transfusion therapy, fever, cellulitis and enterocolitis disappeared each time.

The use of tombramycin in the management of severe infections. Clinical and pharmacological data.

Tobramycin was used in the treatment of 35 severe infections. Its clinical effectiveness was confirmed in broncho-pulmonary infections without septicemia and in septicemia without lung involvement. Poor results were obtained in septicemia where the initial site 9 infection was in the lungs. This antibiotic appeared as a very good antistaphylococcal agent. In vitro superiority over gentamicin against Pseudomonas was not be confirmed clinically. Tobramycin deserves to be administered initially in serious infections because of the possibility that the causative organism might be a gentamicin-resistant, tobramycin susceptible strain. Three such cases were observed in our 35 patients. This susceptibility dissociation in favor of tobramycin was demonstrated in two strains of Klebsiella and one strain of Enterobacter. A dosage regimen in patients with impaired renal function is proposed. It requires confirmation.

Gilbert B. Forbes, MD, chief editor.

With this January 1973 issue of the American Journal of Diseases of Children, Gilbert B. Forbes, MD, Professor of Pediatrics and Professor of Radiation Biology and Biophysics at the University of Rochester School of Medicine assumes the responsibilities of Chief Editor. He brings to the position talent as a writer, experience as an editor, and stature in the world of pediatrics. These are strong statements but to document is easy. At my elbow is an impressive bibliography with well over 100 entries. The titles of papers disclose a wide range of interest in the problems of pediatrics—pneumothorax, chylothorax, pyloric stenosis, salicylate intoxication, management of severe infections, glycogen storage disease, scarlet fever, and poliomyelitis. Rigidly scientific are his clear expositions of isotope methodology used to determine body composition with respect to bone, fat, lean mass, water, and electrolytes. Especially refreshing are his contributions to a series of papers published in the

Antibiotic Management of Severe Infections

Antibiotic Management of Severe Infections

Hydrocortisone for Infection

To the Editor. —The limitations in the Special Contribution, Effectiveness of Hydrocortisone in the Management of Severe Infections ( JAMA 183 :462 [Feb 9] 1963) are clearly apparent to the members of the cooperative study group, as is made evident by their remarks. The purpose of this letter is to draw specific attention to the fact that the analysis of detailed data and the section headed Conclusions deal only with adults. It is stated that a series of 16 was studied, but apart from citing their low rate of mortality in the treated and placebo groups, the report concerns adults. The age grouping of the adults is given; the children are lumped together and simply referred to as being under 16. It is not the purpose of this letter to comment about the use of hydrocortisone in the treatment of life-threatening infections but rather to call to mind

The Effectiveness of Hydrocortisone in the Management of Severe Infections

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Assay of antibacterial activity in serum. A useful guide for complex antimicrobial therapy.

Is the patient receiving the proper drugs? Is he being given sufficient amounts to eradicate the infection? Every physician asks himself these questions when faced with the antimicrobial treatment of a serious infection. In many well-defined bacterial infections, clinical experience alone can supply an adequate answer. However, with the changing behavior of microbes and the changing natural history of infectious processes, additional guidance is often welcome and sometimes essential for optimal therapy. It is the purpose of this communication to draw attention to a helpful laboratory test, the assay of antibacterial activity in serum of patients receiving antimicrobial drugs. The test is simple, inexpensive, can be learned by any laboratory in a short time and—if properly interpreted—can aid the physician in the management of severe infections. To be effective in systemic infections, orally or parenterally administered drugs must be absorbed and distributed, in active form, to tissues harboring microorganism. Blood

Adrenocorticosteroids and the management of infectious diseases.

The discovery of the effect of adrenocorticosteroids in altering the manifestations of many clinical disorders was, in common with many other important medical discoveries, a clinical observation without an adequate theoretical framework for predicting the observed effects. Much of the subsequent investigation of the action of adrenocorticosteroids has followed the same pragmatic pattern. In addition, increasing attention has been focused on mechanisms of action of these steroids, although a clear metabolic basis for understanding their action is still not available. In the study of the role of corticosteroids in the management of severe infections, pragmatic clinical observations have necessarily provided much of the available information. Unfortunately, most of these observations have not been controlled. The need for critical and carefully controlled investigation of the role of corticosteroids in the management of infectious diseases is perhaps best displayed by citing the numerous important arguments supporting the use of corticosteroids in the

Diagnosis and management of severe infections in infants and children: A review of experiences since the introduction of sulfonamide therapy: VI. Acute iliac lymphadenitis

Diagnosis and management of severe infections in infants and children: A review of experiences since the introduction of sulfonamide therapy: VI. Acute iliac lymphadenitis

Diagnosis and management of severe infections in infants and children: A review of experiences since the introduction of sulfonamide therapy: V. Staphylococcal empyema: The importance of pyopneumothorax as a complication

Diagnosis and management of severe infections in infants and children: A review of experiences since the introduction of sulfonamide therapy: V. Staphylococcal empyema: The importance of pyopneumothorax as a complication

MENINGOCOCCIC MENINGITIS TREATED WITH SULFADIAZINE AND SULFAMERAZINE: A THREE YEAR STUDY

Article1 September 1945MENINGOCOCCIC MENINGITIS TREATED WITH SULFADIAZINE AND SULFAMERAZINE: A THREE YEAR STUDYLEWIS K. SWEET, M.D., EDITH DUMOFF-STANLEY, M.D., HARRY F. DOWLING, M.D., F.A.C.P.LEWIS K. SWEET, M.D.Search for more papers by this author, EDITH DUMOFF-STANLEY, M.D.Search for more papers by this author, HARRY F. DOWLING, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-23-3-338 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptMeningococcic meningitis has been encountered with considerable frequency in the Gallinger Municipal Hospital as well as throughout the United States during the past few years. Previous reports from this clinic1, 2and from others3, 4, 5, 6have amply demonstrated the suitability of sulfadiazine and sulfamerazine for the treatment of this type of infection. The number of patients reported in each of these studies has been relatively small, however, or the period of time covered by them has been short. It still is pertinent to question the efficacy of these drugs when used in large numbers of patients treated over...Bibliography1. FELDMANSWEETDOWLING HALKHF: Sulfadiazine therapy of purulent meningitis, including its use in twenty-four consecutive patients with meningococcic meningitis, War Med., 1942, ii, 995-1007. Google Scholar2. LEPPERSWEETDOWLING MHLKHF: The treatment of meningococcic infections with sulfadiazine and sulfamerazine (sulfamethyldiazine, monomethylsulfadiazine), Jr. Am. Med. Assoc., 1943, cxxiii, 134-138. CrossrefGoogle Scholar3. DINGLETHOMASMORTON JHLAR: Treatment of meningococcic meningitis and meningococcemia with sulfadiazine, Jr. Am. Med. Assoc., 1941, cxvi, 2666-2668. CrossrefGoogle Scholar4. DANIELSSOLOMONJAQUETTE WBSWA: Meningococcic infection in soldiers, Jr. Am. Med. Assoc., 1943, cxxiii, 1-9. Google Scholar5. OLIVERANDERSON CSDG: The treatment of meningococcic meningitis with sulfamerazine, Am. Jr. Med. Sci., 1944, ccviii, 597-602. CrossrefGoogle Scholar6. GOLDRINGMAXWELLHARTMANN DRAF: Diagnosis and management of severe infections in infants and children: a review of experiences since the introduction of sulfonamide therapy. III. Meningococcal infections, Jr. Pediat., 1945, xxvi, 1-31. Google Scholar7. BENEDICT SR: The determination of blood sugar, Jr. Biol. Chem., 1925, lxiv, 207. CrossrefGoogle Scholar8. DOWLINGLEPPER HFMH: Toxic reactions following therapy with sulfapyridine, sulfathiazole and sulfadiazine, Jr. Am. Med. Assoc., 1943, cxxi, 1190-1194. CrossrefGoogle Scholar9. DOWLINGDUMOFF-STANLEYLEPPERSWEET HFEMHLK: Relative toxicity of sulfamerazine and sulfadiazine, Jr. Am. Med. Assoc., 1944, cxxv, 103-105. CrossrefGoogle Scholar10. SWEETDUMOFF-STANLEYDOWLINGLEPPER LKEHFMH: The treatment of pneumococcic meningitis with penicillin, Jr. Am. Med. Assoc., 1945, cxxvii, 263-267. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication March 26, 1945.From the Infectious Disease Service and the George Washington Medical Division, Gallinger Municipal Hospital, and the Departments of Pediatrics and Medicine, George Washington University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMeningokokkeninfektionenREFERENCESAcute meningococcemia 1 September 1945Volume 23, Issue 3Page: 338-348KeywordsDrugsHospital medicineInfectious diseasesMeningitisPediatrics ePublished: 1 December 2008 Issue Published: 1 September 1945 PDF downloadLoading ...

Diagnosis and Management of Severe infections in infants and children: A review of experiences since the introduction of sulfonamide therapy: IV. Pneumococcus meningitis

Diagnosis and Management of Severe infections in infants and children: A review of experiences since the introduction of sulfonamide therapy: IV. Pneumococcus meningitis

Diagnosis and management of severe infections in infants and children: a review of experiences since the introduction of sulfonamide therapy: III. Meningococcal infections A. Experiences at the St. Louis Children's Hospital B. Experiences at the St. Louis Isolation Hospital

Diagnosis and management of severe infections in infants and children: a review of experiences since the introduction of sulfonamide therapy: III. Meningococcal infections A. Experiences at the St. Louis Children's Hospital B. Experiences at the St. Louis Isolation Hospital

Diagnosis and management of severe infections in infants and children: A review of experiences since the introduction of sulfonamide therapy: II. Hemolytic streptococcal meningitis

Diagnosis and management of severe infections in infants and children: A review of experiences since the introduction of sulfonamide therapy: II. Hemolytic streptococcal meningitis