cefotaxime and Shock--Septic

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

Reduced target attainment of β-lactam antibiotics is reported in critically ill patients. However, as target attainment of cefotaxime in severely ill pediatric sepsis patients may differ from adults due to age-related variation in pharmacokinetics, we aimed to assess target attainment of cefotaxime in this pilot study using meningococcal septic shock patients as a model for severe sepsis. Secondary analysis of prospectively collected data from a randomized controlled trial. Children with meningococcal septic shock (1 month to 18 years) included in this study received cefotaxime 100-150 mg/kg/day as antibiotic treatment. Left-over plasma samples were analyzed using LC-MS/MS to determine cefotaxime concentrations. MIC values from EUCAST were used to determine target attainment of cefotaxime for Neisseria meningitidis (0.125 mg/l), but also for Streptococcus pneumoniae (0.5 mg/l), Enterobacteriaceae (1 mg/l), and Staphylococcus aureus (4 mg/l). Target attainment was adequate when all samples exceeded MIC or fourfold MIC values. One thirty-six plasma samples of 37 severe septic shock patients were analyzed for cefotaxime concentrations. Median age was 2 years with a median PRISM-score of 24 and mortality of 24.8%. The median unbound cefotaxime concentration was 4.8 mg/l (range 0-48.7). Target attainment ranged from 94.6% for the MIC of N. meningitidis to 16.2% for fourfold the MIC S. aureus. Creatinine levels were significantly correlated with cefotaxime levels. Target attainment of cefotaxime with current dosing guidelines seems to be adequate for N. meningitidis but seems to fail for more frequently encountered pathogens in severely ill children.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Critical Illness; Female; Humans; Infant; Infant, Newborn; Male; Meningococcal Infections; Neisseria meningitidis; Pilot Projects; Sepsis; Shock, Septic

Topics: Anti-Bacterial Agents; Cefotaxime; Disseminated Intravascular Coagulation; Female; Fever; Humans; Middle Aged; Pneumococcal Infections; Shock, Septic; Streptococcus pneumoniae

Staphylococcus aureus has emerged as a leading cause of invasive severe diseases with a high rate of morbidity and mortality worldwide. The wide spectrum of clinical manifestations and outcome observed in staphylococcal illness may be a consequence of both microbial factors and variability of the host immune response.. A 14-years old child developed limb ischemia with gangrene following S. aureus bloodstream infection. Histopathology revealed medium-sized arterial vasculitis. The causing strain belonged to the emerging clone CC1-MSSA and numerous pathogenesis-related genes were identified. Patient's genotyping revealed functional variants associated with severe infections. A combination of virulence and host factors might explain this unique severe form of staphylococcal disease.. A combination of virulence and genetic host factors might explain this unique severe form of staphylococcal disease.

Topics: Adolescent; Amputation, Surgical; Anti-Bacterial Agents; Brain; Cefotaxime; Clindamycin; Humans; Leg; Magnetic Resonance Imaging; Male; Methicillin; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Vasculitis

Megalocytic interstitial nephritis is a rare form of kidney disease caused by chronic inflammation. We report a case of megalocytic interstitial nephritis occurring in a 45-yrold woman who presented with oliguric acute kidney injury and acute pyelonephritis accompanied by Escherichia coli bacteremia. Her renal function was not recovered despite adequate duration of susceptible antibiotic treatment, accompanied by negative conversion of bacteremia and bacteriuria. Kidney biopsy revealed an infiltration of numerous histiocytes without Michaelis-Gutmann bodies. The patient's renal function was markedly improved after short-term treatment with high-dose steroid.

Topics: Acute Disease; Acute Kidney Injury; Anti-Bacterial Agents; Azithromycin; Bacteremia; Cefotaxime; Creatinine; Escherichia coli; Escherichia coli Infections; Female; Humans; Kidney; Methylprednisolone; Middle Aged; Nephritis, Interstitial; Pyelonephritis; Renal Dialysis; Shock, Septic

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Antimalarials; Cefotaxime; Cote d'Ivoire; Drug Therapy, Combination; Female; France; HIV Seronegativity; Humans; Malaria, Falciparum; Norepinephrine; Parasitemia; Pregnancy; Pregnancy Complications, Infectious; Quinine; Shock, Septic; Travel

Group A streptococcus (GAS) is a major bacterial pathogen affecting children globally. Approximately 15% of school-age children experience a symptomatic episode of GAS culture-positive pharyngitis each year. Although the incidence of invasive GAS disease under these circumstances is low (0.5%-2%), an increasing number of invasive GAS cases have been reported over the last 2 decades. This report describes a 7-year-old boy who, after being treated for GAS pharyngitis, developed a fatal streptococcal toxic shock syndrome.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Cefotaxime; Child; Clindamycin; Drug Therapy, Combination; Emergencies; Fatal Outcome; Fluid Therapy; Hemorrhage; Humans; Hypotension; Intubation, Intratracheal; Male; Pharyngitis; Respiration, Artificial; Respiratory Distress Syndrome; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes

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: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Early Diagnosis; Escherichia coli; Escherichia coli Proteins; Humans; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Shock, Septic; Thienamycins; Time Factors

The authors report an unusual case of prosthetic vascular graft infection due to Salmonellatyphimurium. The initial treatment combined antibiotherapy and surgical replacement of the arteriovenous graft. The infection relapsed within 6 weeks and was successfully treated with antibiotics only. Five cases of vascular graft infection due to Salmonella have been reported so far, but only one occurred in a previously healthy man and was not related to local infection, but to bacteremic seeding. Specific features of vascular graft infection and importance of prevention are discussed.

Topics: Aged; Amikacin; Anti-Bacterial Agents; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Cefotaxime; Ceftriaxone; Combined Modality Therapy; Device Removal; Drug Therapy, Combination; Femoral Artery; Humans; Laparotomy; Male; Ofloxacin; Oxacillin; Popliteal Artery; Prosthesis-Related Infections; Recurrence; Salmonella Infections; Salmonella typhimurium; Shock, Septic

Since the mid-1980s, an increase in incidence of invasive disease caused by group A streptococci has been noted among adults and children. The characteristic clinical and laboratory features of the streptococcal toxic shock syndrome include deep-seated infection associated with shock, skin manifestation, and multiorgan failure. However, bullous impetigo is invariably considered to be a staphylococcal disease. Staphylococcus aureus produces an epidermolytic toxin, assumed to be the cause of bullous formation in the skin. Here, we present a case of bullous impetigo in an infant with streptococcal toxic shock syndrome. This is a rare presentation of bullous impetigo caused by group A streptococcus.

Topics: Anti-Bacterial Agents; Cardiotonic Agents; Cefotaxime; Clindamycin; Colloids; Combined Modality Therapy; Disseminated Intravascular Coagulation; Female; Humans; Impetigo; Infant; Plasma; Respiration, Artificial; Shock, Septic; Skin Diseases, Vesiculobullous; Streptococcal Infections; Streptococcus pyogenes; Vancomycin; Vitamin K

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

Occasionally, trivial odontogenic infections may develop into complex diseases. This may even result in an unrestrained phlegmonous spread causing life-threatening complications. These problems have decreased since the introduction of antibiotics and also due to improved oral hygiene and improved diagnostic measures resulting in optimized medical treatment. However, life-threatening forms are still seen, in particular if infections spread along the cervical fascial sheaths down towards to the mediastinum. Over the past decade the number of critical infections has increased in other medical specialties. This is usually explained by the development of multiresistant pathogens in the context of nosocomial infections.. We reviewed the patients' records of the past 15 years at the Department of Oral and Maxillofacial Surgery of the University Hospital Kiel to assess a possible increase of odontogenic infections with life-threatening complications. From 1990 to 2004, four patients with odontogenic infections exhibiting critical phlegmonous spread were treated in the intensive care unit. Two patients developed bacterial mediastinitis which could be controlled by intravenous antibiotics only. One patient progressed to general septic mediastinitis and eventually died of cardiorespiratory arrest. The last patient also had septic mediastinitis and developed right pleural empyema. Several operations were necessary before the disease could be controlled. This patient's case report is presented in detail.. The prognosis of patients with mediastinitis crucially depends on (a) early diagnosis including computed tomography of the neck and thorax, (b) early radical surgical intervention, and (c) optimized pathogen-oriented antibiotic treatment.

Topics: Abscess; Ampicillin; Cefotaxime; Cellulitis; Combined Modality Therapy; Critical Care; Disease Progression; Empyema, Pleural; Follow-Up Studies; Humans; Male; Mediastinitis; Middle Aged; Neck; Reoperation; Shock, Septic; Staphylococcal Infections; Staphylococcus epidermidis; Streptococcal Infections; Sulbactam; Therapeutic Irrigation; Thoracotomy; Tomography, X-Ray Computed; Vancomycin

A 30-year-old male was transferred to the intensive care unit with worsening sepsis of unknown origin and a known history of Crohn's disease. The patient presented with a five-day history of nausea, fever, and serous diarrhea. Clinical examination of the abdomen was unremarkable except for mild epigastric pain on palpation.. Computed tomography (CT) of the abdomen revealed gas within the intrahepatic branches of the portal venous system, thickening of the wall of the neoterminal ileum, and mild ascites. In addition, ultrasonography showed acute thrombosis of the portal vein and the superior mesenteric vein. No wall perfusion was seen in either the neoterminal ileum or the ascending colon on color Doppler sonography.. Based on the combination of portal vein thrombosis along with venous gas in the portal venous system and absence of intestinal perfusion, the diagnosis of pylephlebitis with septic shock was suspected and a laparotomy was performed. Intraoperative exploration revealed phlegmonous terminal ileitis, a significant amount of cloudy fluid, and thrombosis of the mesenteric vein. A right-sided hemicolectomy with ileotransversostomy was performed. Histologic examination confirmed Crohn's disease that was associated with vasculitis and, in particular, with thrombophlebitis and subsequent transmural bowel necrosis. Antibiotic and anticoagulation therapy was resumed without further complications.. In the differential diagnosis of sepsis, especially in combination with abdominal pain or gas in the portal venous system, pylephlebitis should be taken into account. Because of the high mortality, immediate further diagnostic testing and appropriate therapy of this rare diagnosis are necessary.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Anticoagulants; Cefotaxime; Crohn Disease; Diagnosis, Differential; Embolism, Air; Heparin; Humans; Male; Mesenteric Veins; Metronidazole; Phlebitis; Portal Vein; Radiography; Shock, Septic; Thrombosis; Ultrasonography

Varicella is a common viral infection which is generally benign in infancy and has a good outcome. It may sometimes be complicated by severe group A streptococcal superinfection.. Three days after the beginning of varicella, a previously healthy 2-year-old girl presented with left leg pain, lameness and edema of all four limbs. Toxic shock syndrome occurred, due to beta-hemolytic group A Streptococcus grown from blood culture. Computerized tomography (CT) scan showed a mild effusion involving both hips. Cefotaxim was administered, but the week after magnetic resonance imaging (MRI) showed a necrotizing fasciitis and a lesion of the left leg leading to a patchy femoral diaphysis consistent with osteomyelitis. Joint aspirate culture did not grow. The left leg was immobilized in plaster for 6 weeks and the child was given cefotaxim and fosfomycin parenterally during 30 days, then followed by 45 days of oral amoxicillin. She recovered without sequelae.. Group A Streptococcus infection is a dangerous complication of varicella. It must be considered in case of any joint pain occurring during or just after this disease. The choice of the best treatment needs full collaboration between surgeons, radiologists and pediatricians.

Topics: Cefotaxime; Chickenpox; Child, Preschool; Drug Therapy, Combination; Female; Fosfomycin; Humans; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes

Topics: Bacteremia; Cefotaxime; Cephalosporins; Child, Preschool; Extracorporeal Membrane Oxygenation; Female; Humans; Infant; Meningococcal Infections; Shock, Septic

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

A 60-year-old woman with rheumatoid arthritis developed acute emphysematous septic arthritis of the knee due to Klebsiella pneumoniae. She was brought to the hospital in septic shock with disseminated intravascular coagulation and had striking physical signs and roentgenograms showing distention of the knee with gas. She also had an infection of the hand with subcutaneous gas. After surgical drainage and institution of antibiotic therapy, she remained critically ill for several days but gradually improved. Two months later, she was ambulating independently. Emphysematous septic arthritis is rare. Four cases have previously been reported, but none were caused by Klebsiella.

Topics: Arthritis, Infectious; Cefotaxime; Emphysema; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Knee Joint; Middle Aged; Radiography; Shock, Septic

Topics: Adult; Cefotaxime; Cesarean Section; Chloramphenicol; Female; Humans; Penicillins; Shock, Septic; Staphylococcal Infections; Surgical Wound Infection

Mortality due to serious infections is significantly higher among elderly patients than among younger patients. This differential is particularly striking in some subsets of patients; for example, the mortality rate among older patients with afebrile bacteremia is 65 percent, compared with 25 to 35 percent in younger patients. Although serious underlying disease is an important reason for older patients' difficulties with infection, other problems of these patients include a tendency to deny the presence of disease and some obstacles to interaction with the health care system. Older patients with infection are less likely to present with typical symptoms, which makes early recognition difficult for physicians. For example, typical findings of sepsis (mental obtundation, tachycardia, and fever) may be absent in an elderly patient; the only clue may be the patient's failure to eat. Once sepsis is recognized, its source must be identified. Urinary tract infection is the most common cause of sepsis in the elderly and responds best to antibiotic therapy. Pneumonia is the next most common cause and leads to the highest mortality in this age group; rapid (sometimes invasive) methods must be utilized to identify the etiologic agent. In this life-threatening infection, initial antibiotic therapy should include an aminoglycoside, such as amikacin, to ensure the broadest coverage against the common pathogens. Supportive measures should be instituted for patients with sepsis, including careful monitoring of fluid intake and output and special attention to adequate oxygenation. Fluid volume replacement must be carried out in patients with septic shock, and hemodynamic monitoring with a Swan-Ganz catheter should be performed frequently. Careful consideration should be given to the use of corticosteroids and inotropic agents. After appropriate cultures have been obtained, antibiotics should be started; the time from initial presentation to the administration of the first dose of antibiotic should not exceed one hour. Important considerations in antibiotic selection include the patient's history and environment (community, nursing home, or hospital), anatomic location of the infection, and the pathogen. In our institution, initial empiric antibiotic therapy consists of a combination of amikacin and cefotaxime. When older patients are treated, adjustments in dosing should be based on estimates of kidney function.

Topics: Aged; Amikacin; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cross Infection; Drug Therapy, Combination; Female; Humans; Male; Pneumonia; Risk; Shock, Septic; Urinary Tract Infections