Assuntos
Humanos , Feminino , Idoso , Doença de Gilbert/diagnóstico , Doença de Gilbert/genética , Doença de Gilbert , Drenagem/instrumentação , Drenagem/métodos , Veias Pulmonares/anormalidades , Veias Pulmonares/fisiopatologia , Veias Pulmonares , Furosemida/uso terapêutico , Veias Pulmonares , Dispneia/complicações , Dispneia , Radiografia Torácica/instrumentação , Radiografia Torácica/métodos , Veia Ázigos/patologia , Veia Ázigos , Imageamento por Ressonância Magnética/métodosRESUMO
No disponible
Assuntos
Masculino , Pessoa de Meia-Idade , Humanos , Escleredema do Adulto/diagnóstico , Obesidade/complicações , Diabetes MellitusRESUMO
We prospectively evaluated 61 episodes of bacteremia in 54 patients with hepatic cirrhosis, representing 9% of the overall number of bacteremic episodes in adult patients seen in our center during the study period. Spontaneous bacteremia represented 46% of all episodes (virtually always in patients with ascites), followed by the urinary origin (30%). Gram negative organisms were isolated in 71% of episodes. 43% of these were hospital-acquired 25% of patients had spontaneous peritonitis. Among other complications of bacteremia there were shock (28%), renal failure (24%), and disseminated intravascular coagulation (6%). The mortality rate due to sepsis was 28%, that due to complications of cirrhosis by itself was 20%, and that of nonrelated diseases was 8%. Shock and renal failure secondary to bacteremia were independent predictors of a poor prognosis.
Assuntos
Cirrose Hepática/complicações , Sepse/epidemiologia , Injúria Renal Aguda/etiologia , Adulto , Idoso , Infecção Hospitalar/epidemiologia , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Peritonite/complicações , Peritonite/epidemiologia , Estudos Prospectivos , Fatores de Risco , Sepse/complicações , Sepse/microbiologia , Sepse/mortalidade , Choque Séptico/etiologia , Choque Séptico/mortalidadeRESUMO
We have prospectively evaluated 16 episodes of bacteremia induced by decubitus ulcers. The most commonly isolated microorganisms were Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa and Bacteroides fragilis. Bacteremia was polymicrobial in 5 cases (31%). Most ulcers were already present at the time of admission, but bacteremia developed within the hospital in 13 patients. In 3 patients, ulcers did not show local features of infection. The initial antibiotic therapy was satisfactory in 13 cases. Mortality rate directly associated with bacteremia was 18%, but the overall mortality rate was 62%. We did not identify data permitting a reliable prediction of the findings of blood culture; therefore, the initial empirical therapy should be active against Staphylococcus aureus, Pseudomonas, enteric Gram-negative bacilli and anaerobes including Bacteroides fragilis.
