amoxicillin-potassium-clavulanate-combination and Shock--Septic

Variability in the management of patients hospitalized with community-acquired pneumonia (CAP) is attributable to many factors. The objective of this study was to determine whether such variability is influenced by the medical specialty area where the patient is treated.. The treatment and outcomes for a random sample of patients with CAP admitted to 4 hospitals over 2 periods (1 year starting March 1, 1998, and 1.5 years starting March 1, 2000) were compared by medical specialty department. Multiple linear and logistic regression models were used to analyze differences.. Differences were found between departments in the coverage of atypical pathogens (P<.001). The adjusted mean length of stay in hospital varied between 6.8 and 9.1 days (P<.01), and the duration of intravenous treatment varied between 4.6 and 7.3 days (P<.05). Adjusted models showed that mortality in hospital and at 30 days was significantly higher for patients treated in internal medicine departments (odds ratios, 2.1 and 2, respectively) than for those treated in pulmonology departments.. Interdepartmental differences were observed in how patients hospitalized with CAP were treated and in the outcomes achieved. This variation is probably influenced by the differences that were found in the use of antibiotics.

Topics: Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Case Management; Community-Acquired Infections; Comorbidity; Drug Therapy, Combination; Drug Utilization; Female; Hospital Departments; Hospital Mortality; Hospitalization; Hospitals, Teaching; Humans; Incidence; Male; Medicine; Middle Aged; Patient Care Team; Pneumonia; Practice Patterns, Physicians'; Retrospective Studies; Shock, Septic; Spain; Specialization; Treatment Outcome

Topics: Africa; Albendazole; Amoxicillin-Potassium Clavulanate Combination; Animals; Anthelmintics; Ascaris lumbricoides; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Common Bile Duct; Decompression, Surgical; Drainage; Female; Humans; Klebsiella pneumoniae; Liver; Liver Abscess; Liver Diseases, Parasitic; Middle Aged; Shock, Septic; Travel-Related Illness; Treatment Outcome

Toxic shock syndrome (TSS) was first described by Todd in 1978. The relevant Lancet publication reported 7 cases of children with fever, exanthema, hypotension and diarrhoea associated with multiple organ failure. An association between TSS and use of hyper-absorbent tampons in menstruating women was discovered in the 1980s. Following the market withdrawal of such tampons, TSS virtually disappeared. Herein we report a new case of TSS in a 15-year-old girl.. A 15-year-old patient was admitted to intensive care for severe sepsis and impaired consciousness associated with diffuse abdominal pain. Dermatological examination revealed diffuse macular exanthema. Laboratory tests showed hepatic cytolysis (ASAT 101 U/L, ALAT 167 U/L, total bilirubin 68μmol/L) and an inflammatory syndrome. Lumbar puncture and blood cultures were sterile while thoraco-abdomino-pelvic and brain scans were normal. The patient was menstruating and had been using a tampon over the previous 24hours. Vaginal sampling and tampon culture revealed TSST-1 toxin-producing S. aureus. Management consisted of intensive care measures and treatment with amoxicillin-clavulanic acid and clindamycin for 10 days.. In case of septic shock associated with diffuse macular exanthema a diagnosis of TSS must be envisaged, particularly in menstruating women.

Topics: Abdominal Pain; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Bacterial Toxins; Clindamycin; Critical Care; Diagnosis, Differential; Drug Therapy, Combination; Enterotoxins; Erythema; Female; Fever of Unknown Origin; Humans; Menstrual Hygiene Products; Shock; Shock, Septic; Staphylococcus aureus; Superantigens

Human-to-human transmission of Fusobacterium necrophorum has not been described before.. We present the case of a 15-year-old girl with Lemierre Syndrome and possible nosocomial transmission of F. necrophorum to her treating physician in hospital.. Early diagnosis and treatment of anaerobic pharyngitis is critical to prevent Lemierre Syndrome. Respiratory precautions should be recommended to medical staff caring for patients with suspected Lemierre Syndrome to prevent nosocomial transmission.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cross Infection; Drug Therapy, Combination; Early Diagnosis; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Image Processing, Computer-Assisted; Infectious Disease Transmission, Patient-to-Professional; Internship and Residency; Jugular Veins; Lemierre Syndrome; Pediatrics; Pneumonia, Bacterial; Pulmonary Embolism; Shock, Septic; Tomography, X-Ray Computed; Tonsillitis

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Toxins; Enterotoxins; Female; Humans; Receptors, Antigen, T-Cell, alpha-beta; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Superantigens; T-Lymphocytes; Tampons, Surgical