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  • 1
    ISSN: 1437-7780
    Keywords: burn ; septicemia ; infection ; pulmonary injury ; drug resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Serial microbiological tests were performed on 4 patients burned by the pyroclastic flow of Mt. Fugen in Unzen, Japan on June 3, 1991. The patients were young (average age, 30 years) and had extensive burns (average total burn surface area, 83%) and inhalation injury. All 4 patients died of multiple organ failure and septicemia. Methicillin-resistantStaphylococcus aureus (MRSA) andPseudomonas aeruginosa were persistently isolated from bronchial aspirates, burn wounds and the blood until death. There were no differences in isolates among the 3 specimen sites.S. aureus isolated from all patients became resistant to all antibiotics used, and the use of imipenem/cilastatin sodium, and ceftazidime transformedP. aeruginosa to a resistant strain within a short period of time. On the other hand, the sensitivity to gentamicin varied from one patient to another. From a study of the phenotypic character ofS. aureus strains, there was a suggestion of nosocomial infection in 2 patients. Our results demonstrate that extensive burns are usually associated with bacteremia and septicemia. In spite of prudent management with antibiotics, the control of resistant bacteria is difficult. We stress the need for the development of specific therapy for severe infections in burn patients, encompassing immunotherapy, antibiotic treatment, and wound treatment.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1437-7780
    Keywords: cellular immunity ; chronic renal failure ; hemodialysis ; infection ; neutrophil function ; nutritional index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Infection is a major complication associated with increased morbidity and mortality in patients on hemodialysis. We analyzed the incidence and type of infection occurring in 4841 patients on hemodialysis between 1986 and 1993 in our hospital and 11 other hemodialysis centers. Infection was noted in 193 patients (4.98 infections/1000 patients/year). Pneumonia (n=71) and bacteremia (n=24) were the 2 most common infections, followed by tuberculosis (n=14), herpes zoster infections (n=12) and infections at the vascular access site (n=12). The most commonly isolated organism in pneumonia, bacteremia and vascular access site infections wasStaphylococcus aureus. Analysis of the prognosis of patients with pneumonia showed a mortality rate of 50% in patients greater than 60 years old, which was significantly higher than that of younger patients (6.7%,P〈0.01), whereas the mortality rate in patients with bacteremia was not different between the 2 age groups (60.0% vs. 57.9%, respectively). We also analyzed changes in immunological function and nutritional status in 16 patients on hemodialysis and 21 healthy control subjects. Although the phagocytic and bactericidal activities of neutrophils and monocytes were not different between the groups, superoxide production, the percentage of natural killer cells and the degree of blastoid transformation with phytohemagglutinin stimulation were significantly lower in hemodialysis patients. Low levels of Niderman's index and serum albumin and transferrin indicated poor nutritional status in these patients. Furthermore, the degree of Niderman's index and serum albumin significantly correlated with impairment of immunological function, such as reduced blastoid transformation and the number of lymphocytes. Our results suggest that analysis of the patterns of infection in patients on hemodialysis should provide better management and that improvement of malnutrition may ameliorate impaired immunity in hemodialysis patients.
    Type of Medium: Electronic Resource
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