cefotaxime and Multiple-Organ-Failure

Patients with established cirrhosis are at increased risk of sepsis. Bacterial infections are a frequent cause of morbidity and mortality in patients with advanced liver disease. Mortality for patients admitted to hospital with bacterial infection is approximately 30%, whereas the development of septic shock and multiorgan failure is associated with a mortality of 70-100%. Activation of the hypothalamic-pituitary-adrenal axis is an important feature of a patient's response to severe sepsis and major trauma. An inadequate adrenal response with suboptimal cortisol production has been recognized in patients with septic shock. Patients with septic shock and adrenal insufficiency have reduced response to vasoconstrictor agents, higher rates of refractory shock and high mortality rates. An improvement in survival with administration of hydrocortisone in patients with septic shock and an inadequate adrenal response has been demonstrated. In a more recent study, however, there was no survival benefit in septic shock though reversal of shock was faster with hydrocortisone administration. Recently, adrenal insufficiency has been demonstrated in patients with severe liver disease such as acute liver failure, acute on chronic liver failure, recent liver transplantation and cirrhosis irrespective of the presence of sepsis. Nevertheless survival benefit with administration of hydrocortisone has only been demonstrated in patients with cirrhosis and septic shock. A case report of a patient with cirrhosis and adrenal insufficiency is presented with a review of the literature.

Topics: Adrenal Insufficiency; Cefotaxime; Female; Humans; Hydrocortisone; Liver Cirrhosis, Alcoholic; Lypressin; Middle Aged; Multiple Organ Failure; Norepinephrine; Severity of Illness Index; Shock, Septic; Terlipressin; Vasoconstrictor Agents

Scarlet fever is a rare disease in adult patients. We report a patient in whom scarlet fever was associated with hypertrophic gastritis and multiple organ failure. A 62-year-old woman presented with septic shock and multiple organ failure. Bacteriological survey was negative. Abdominal tomodensitometry showed an hypertrophic gastritis. Histological analysis demonstrated a non specific gastritis without any tumoral sign. Cefotaxime and amoxicillin led to improvement and hypertrophic gastritis progressively resolved. A sandpaper rash over the body with finger desquamation, elevation of antistreptolysin O and a recent contact with an infected grandson led to the diagnosis of scarlet fever. Due to antibiotic prescription, scarlet fever is now uncommon. Although classical, ENT or gastroenteritis presentations may be puzzling for the diagnosis of scarlet fever. As 150 years ago, diagnosis of scarlet fever is still a clinical challenge.

Topics: Amoxicillin; Anti-Bacterial Agents; Antistreptolysin; Biomarkers; Cefotaxime; Diagnosis, Differential; Drug Therapy, Combination; Exanthema; Female; Gastritis, Hypertrophic; Humans; Immunologic Factors; Middle Aged; Multiple Organ Failure; Scarlet Fever; Shock, Septic; Streptococcus pyogenes; Treatment Outcome

Topics: Acute Kidney Injury; Adult; Bacteremia; Cefotaxime; Cellulitis; Clindamycin; Combined Modality Therapy; Cyanosis; Debridement; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Erythema; Fatal Outcome; Female; Gentamicins; Hemofiltration; Humans; Multiple Organ Failure; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Teicoplanin; Vulvitis

This report describes a case of life-threatening acute respiratory distress syndrome with multiple organ failure complicating probable scrub typhus. Favorable outcome was associated with fluoroquinolone therapy. Scrub typhus should be suspected in travelers returning from Southeast Asia presenting with unexplained respiratory manifestations.

Topics: Adult; Anti-Infective Agents; Cefotaxime; Cephalosporins; Female; Humans; Infant, Newborn; Multiple Organ Failure; Ofloxacin; Orientia tsutsugamushi; Scrub Typhus; Treatment Outcome

Necrotizing fasciitis is a potentially fatal, acute bacterial infection characterized by extensive fascial and subcutaneous tissue necrosis. Four factors that contribute significantly to the morbidity and mortality of necrotizing fasciitis are: 1) delayed treatment, due to difficulty in recognizing the condition; 2) inappropriate treatment; 3) host debilitation; and 4) a polymicrobial infection.

Topics: Adult; Bacteroides Infections; Candidiasis; Cefotaxime; Clindamycin; Cloxacillin; Fasciitis; Female; Focal Infection, Dental; Gentamicins; Humans; Metronidazole; Multiple Organ Failure; Neck Muscles; Necrosis; Penicillin G; Periapical Abscess; Shock, Septic; Staphylococcal Infections; Streptococcal Infections; Superinfection

The pharmacokinetics of cefotaxime were investigated in 14 patients suffering from multiple-organ failure requiring pump-assisted, continuous volume-constant hemofiltration (CVHF) for blood purification, whereby the filtration rate was 20 ml/min. Samples of blood and ultrafiltrate were evaluated by high-pressure liquid chromatography. For dose adjustment, three different algorithms of Dettli and Kroh were used. As compared with values obtained for anuric patients during the dialysis-free period, the mean serum half-life was nearly doubled (2.75 vs 4.48 h). This reduced elimination depended mainly on a diminished non-renal elimination ratio ranging from 0.085 to 0.366. The volume of distribution remained unchanged within a wide interindividual range (Vz, 0.35 l/kg, from 0.22 to 0.56 l/kg); the sieving coefficient increased to 0.89 as compared with 0.62 in healthy volunteers. Dose adjustment by algorithms showed varied degrees of over-dosage. The estimate closest to an optimal dose was reached by the application of a new algorithm of Kroh (mean dose deviation +19%; SD, +/- 27%) using an individual non-renal elimination ratio (QIND). QIND correlated significantly with the severity of disease according to the sepsis score of Elebute and Stoner (r = 0.763, P less than 0.005). Thus, it is possible to adjust reliably individual dosage in multiple-organ failure and to reduce the frequency of drug monitoring required.

Topics: Adult; Aged; Algorithms; Cefotaxime; Critical Care; Dose-Response Relationship, Drug; Female; Hemofiltration; Humans; Male; Metabolic Clearance Rate; Middle Aged; Multiple Organ Failure; Severity of Illness Index; Shock, Septic