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Burns
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Brian Brisebois, Joyce McIntyre
Infection and sepsis are involved in 75–85% of all burn injury deaths (Liu). Defining sepsis in burn patients is problematic due to the always present concurrent hypermetabolic response. Systemic inflammatory response syndrome (SIRS), the typical hallmark of sepsis, is present in most burn patients and therefore not helpful. The 2007 American Burn Association Consensus Conference defined sepsis in burns as three or more changes in temperature, heart rate, respiration rate, platelet abnormalities, hyperglycemia, or inability to continue enteral feedings which should trigger a search for infection (Greenhalgh). Typical causes of bacteremia include Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Enterococci, Acinetobacter, and perhaps the most well know burn-associated pathogen, Pseudomonas aeruginosa. Resistant organisms are becoming more common (Lundy). It should be noted that burn patients are often excluded from major sepsis trials (Greenhalgh), greatly limiting our understanding of sepsis in burn injuries.
Septic shock
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Bryan E. Freeman, Michael R. Foley
In order to clarify other terms that are commonly used with sepsis, they proposed the following definitions. Infection is the invasion of a normally sterile host by an organism that leads to an inflammatory response. Bacteremia refers to viable bacteria in the blood. If the invading pathogen is not bacteria, the appropriate corresponding term should be employed (viremia, fungemia, etc.) (7).
The Relevance of Endotoxin Detection in Sepsis
Published in Helmut Brade, Steven M. Opal, Stefanie N. Vogel, David C. Morrison, Endotoxin in Health and Disease, 2020
Future investigations should give close attention to the types of gram-negative isolates. The frequency of endotoxemia is much greater in patients with non-Enterobacteriaceae bacteremias who had a fatal outcome; a negative LAL test in this group of patients implies survival (Table 1). Although gram-negative bacteremia is generally regarded as a weak indicator of prognosis (33–35), this is not uniformly the case for different gram-negative bacterial agents. Bacteremia with P aeruginosa is a powerful independent predictor of poor prognosis (61). Hence it is worth considering whether the detection of endotoxemia may be an indicator of the pathogenic potential of specific gram-negative bacteria found in the blood stream. For example, could the detection of endotoxin indicate other pathogenic properties of specific gram-negative bacteria in patients with sepsis (62)? Indeed, an aphorism applied in the context of a review of experimental studies, “For the proper study of sepsis, study the bacteria that cause sepsis” (36), can equally be cited in the context of clinical studies.
Bacteremia in patients with diabetic ketoacidosis: a cross-sectional study
Published in Hospital Practice, 2023
Naoto Ishimaru, Toshio Shimokawa, Takahiro Nakajima, Yohei Kanzawa, Saori Kinami
In a prospective study of patients with DKA, mortality was significantly higher in patients with sepsis compared with those without [15], but the data on bacteremia in their study population was not reported. Bacteremia was identified as an independent risk factor for incomplete recovery of renal function at discharge in a retrospective study of patients with infection-precipitated DKA [16]. Bacteremia accounted for 18.1% of the study population, although the number from whom blood culture was obtained was unclear [16]. Blood culture is important for the diagnosis of infectious diseases and is essential for the diagnosis of bacteremia. Moreover, it is recommended that blood cultures are taken for patients with DKA as a septic screening [1,17]. Owing to the differences in previous studies in populations and outcomes, the blood culture positivity ratio within patients with DKA is unclear. This study therefore aims to determine the incidence of bacteremia in patients with DKA and to investigate the factors associated with the positive blood culture.
Differences in the distribution of pathogens and antimicrobial resistance in bloodstream infections in migrants compared with non-migrants in Denmark
Published in Infectious Diseases, 2023
Rikke Thoft Nielsen, Christian Østergaard Andersen, Henrik Carl Schønheyder, Jørgen Holm Petersen, Jenny Dahl Knudsen, Jens Otto Jarløv, Marie Norredam
Bloodstream infection was defined as true bacteraemia detected in blood cultures. All departments use automated blood culture systems (Bactec™ [BD, Franklin Lakes, NJ, USA] or BacT/Alert® [bioMérieux, Marcy l’Etoil, France]). Pathogen identification was obtained by conventional methods and often aided by automated methods like Vitek®2 (bioMérieux) or MALDI-TOF (Bruker, Bremen, Germany) [26]. Susceptibility testing was performed using standard microbiological procedures initially using guidelines from the Swedish Reference Group for Antibiotics and subsequently the European Committee on Antimicrobial Testing. We included susceptibility testing for penicillin, dicloxacillin, ampicillin, piperacillin-tazobactam, cefuroxime, ciprofloxacin, and gentamicin. We divided the pathogens into 10 groups: S. aureus, S. pneumoniae, beta-haemolytic Streptococci, Enterococcus species, other Gram-positive bacteria, E. coli, other Enterobacterales, other Gram-negative bacteria, and fungi.
A case report of a fulminant Aeromonas hydrophila soft tissue infection in a patient with acute lymphoblastic leukemia harboring a rare translocation
Published in Current Medical Research and Opinion, 2022
Emmanouil Charakopoulos, Panagiotis T. Diamantopoulos, Konstantinos Zervakis, Nefeli Giannakopoulou, Mina Psichogiou, Nora-Athina Viniou
Patients with hematological malignancies are at increased risk for Aeromonas septicemia, which has an overall mortality rate ranging from 28% to 60%5–7. According to a Taiwanese study, the three most common hematologic conditions associated with Aeromonas sepsis are acute myelogenous leukemia (AML) (38%), myelodysplastic syndrome (MDS) (27%), and non-Hodgkin’s lymphoma (18%). In 90% of cases, bacteremia is manifested by fever while 40% of patients develop septic shock. The mean timeframe between blood culture drawing and death is approximately four days, while additional microbes are isolated in 25% of bacteremias. Altered mental status is present in 27% of cases and represents an independent poor prognostic factor2. Specifically for patients infected with A. veronii, additional risk factors for death are age >65 years, non-remission of primary malignancy, and septic shock8.