pituitrin and Gram-Negative-Bacterial-Infections

Septic shock is associated with vasopressin deficiency and hypersensitivity to its exogenous administration. The aim of this study is to review the 28-day survival rate, hemodynamic and renal effects of vasopressin therapy in refractory septic shock Japanese patients.. 55 Japanese patients experiencing catecholamine-resistant septic shock were treated with vasopressin. Hemodynamic alterations and the serum concentrations of aspartate aminotransferase, total bilirubin and creatinine clearance were evaluated following vasopressin treatment.. In both, survivors and non-surviving patients, treatment with vasopressin resulted in a significantly increase in mean arterial pressure, hourly urine output, and a significant decrease in heart rate and total pressor dosage requirements. Creatinine clearance was significantly increased only in survivors. There were no significant changes in the serum concentrations of aspartate aminotransferase and total bilirubin. The 28-day survival rate was 45% (25 patients).. In Japanese septic shock patients, vasopressin infusion improved hemodynamic status and reduced catecholamine requirement, and 28-day survival rate was 45%.

Topics: Blood Pressure; Cardiotonic Agents; Dopamine; Dose-Response Relationship, Drug; Drug Resistance; Drug Therapy, Combination; Follow-Up Studies; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Infusions, Intravenous; Japan; Middle Aged; Norepinephrine; Prospective Studies; Shock, Septic; Survival Rate; Time Factors; Treatment Outcome; Vasoconstrictor Agents; Vasopressins

Vasopressin and direct hemoperfusion with an immobilized polymyxin B column (PMX) have emerged recently as treatments for septic shock. This study assessed the impact of these two treatments on the survival of patients with septic shock.. A retrospective, matched cohort study was performed to compare patients who had septic shock and were treated with PMX or vasopressin. The primary endpoint was the 90-day mortality rate. 30 patients receiving PMX were matched to 30 treated with vasopressin.. The 90-day survival rate was significantly higher in the vasopressin group than the PMX group (83% vs. 53%; p = 0.008). In the PMX group, the subgroup with gastrointestinal surgery had a significantly higher survival rate than the subgroup without surgery (76.9% vs. 52.9%; p = 0.01). Cox multivariate analysis showed that vasopressin therapy (versus PMX; HR = 0.27; p < 0.01). The estimated hazard ratio for the SOFA score was 1.44 (p < 0.01), and total pressor dosage an baseline was 1.26 (p = 0.01).. We found a significant reduction of the mortality rate in septic shock patients who received vasopressin compared with PMX. In the PMX group, the subgroup with gastrointestinal surgery had a significantly higher survival rate than the subgroup without such surgery.

Topics: Aged; Anti-Bacterial Agents; Case-Control Studies; Cohort Studies; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Hemoperfusion; Humans; Male; Middle Aged; Polymyxin B; Retrospective Studies; Shock, Septic; Survival Analysis; Treatment Outcome; Vasoconstrictor Agents; Vasopressins

Capnocytophaga canimorsus is a gram-negative rod that is a normal inhabitant of the oral flora of most dogs, cats and other animals. Clinically significant infections of humans by this common organism are extremely rare. We present a case of an 87-year-old woman who presented with septic shock and multiorgan system failure. Blood cultures were positive for a gram-negative rod that five days after admission was identified as C. canimorsus. She was treated aggressively with intravenous fluid resuscitation, vasopressors and parenteral antibiotics and recovered. The epidemiology, virulence factors, and treatment options for C. canimorsus are discussed.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Antidiuretic Agents; Capnocytophaga; Female; Fluid Therapy; Gram-Negative Bacterial Infections; Humans; Multiple Organ Failure; Penicillanic Acid; Piperacillin; Risk Factors; Shock, Septic; Tazobactam; Vancomycin; Vasopressins