Infection
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Aim of this study was to evaluate whether risk factors which predict the development of candidemia may also predict death in ICU patients with candidemia. During an 8-year-period all ICU patients whose blood cultures yielded Candida species (n = 40) were retrospectively evaluated in a case-control fashion. The average incidence of Candida bloodstream infections was 5.5 per 10,000 patient days, ranging from 2.4 in 1990 to 7.4 in 1994. ⋯ The overall mortality of patients with candidemia was 58%. Mortality was highest in the group of patients with multi-organ dysfunction syndrome, especially among those in need of hemodialysis. Risk factors for the development of candidemia, such as age, malignancy, steroid use, i.v. catheterization, and the use of broad-spectrum antibiotics were not correlated with mortality in the ICU patients studied.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Meropenem monotherapy versus cefotaxime plus metronidazole combination treatment for serious intra-abdominal infections.
In an open, randomised, multicentre trial, the efficacy and tolerability of empirical meropenem monotherapy (1 g intravenously every 8 hours) and cefotaxime (2 g every 8 hours) plus metronidazole (0.5 g intravenously every 8 hours) for 5 to 10 days was compared in 94 patients with serious intra-abdominal infection who required surgery. Eighty-three patients had an evaluable clinical response. ⋯ In the bacteriologically evaluable population, a satisfactory clinical response was observed in 31/33 of those who received meropenem compared to 24/32 of the cefotaxime/metronidazole recipients (p = 0.03). Empirical meropenem monotherapy should prove a useful alternative to the currently standard combination treatment for serious intraabdominal infections.
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Comparative Study
Procalcitonin in patients with and without immunosuppression and sepsis.
High serum levels of procalcitonin (PCT) are observed in patients with sepsis or severe infection. In a prospective study of 122 hospitalised adult medical patients with sepsis, serum PCT was determined on admission and for 9 days thereafter. Patients with no alteration in their immune system showed high PCT values up to day 5, decreasing to normal levels by day 9. ⋯ PCT concentrations fell to base line levels on days 6 to 9 of the sepsis episode in both groups. The observed difference was not significantly related to the kind of causative microorganism or a culture negative sepsis. Leukopenia seemed to go together with lower PCT values after day 2 of the episode, but this could not be proven statistically.
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Two different receptors exist for tumor necrosis factor-alpha (TNF-alpha), designated as p55 (TNF-RI) and p75 (TNF-RII). Soluble (= s) forms of TNF-Rs are secreted after proteolytic cleavage and block the effects of TNF-alpha. sTNF-RI, sTNF-RII and the soluble interleukin 2 receptor (sIL-2R) were determined by ELISA in serum samples of HIV-infected children and adolescents. Twelve children with vertical HIV infection (mean age +/- SD, 5.9 +/- 3.8 years) and 17 horizontally infected patients (16.1 +/- 7.3 years) were classified according to the revised CDC criteria. ⋯ There were no differences in soluble receptor levels between vertical or horizontal transmission. Surprisingly, no significant differences for sTNF-RI, sTNF-RII and sIL-2R occurred when 19 patients in stage CDC I were compared to ten patients in stages II or III. The clearly elevated sTNF-RII levels in patients with horizontal and vertical HIV infection indicate the activation of the monocyte/macrophage system in both groups.