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      Hemoperfusion with Polymyxin B-Immobilized Fiber in Septic Patients with Methicillin-Resistant Staphylococcus aureus-Associated Glomerulonephritis

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          Background/Aims: We investigated whether urinary podocytes are present in septic patients with methicillin-resistant Staphylococcus aureus (MRSA)-associated glomerulonephritis and whether polymyxin B-immobilized fiber (PMX-F) treatment affects proteinuria and urinary podocyte excretion in these patients. Methods: Twenty septic patients with MRSA-associated glomerulonephritis (mean age: 63.7 years) and 80 septic patients whose MRSA infection was not followed by glomerulonephritis (mean age: 60.5 years) were included in this study. All septic patients were treated with fosfomycin sodium, β-lactams, arbekacin sulfate, and teicoplanin, or a combination of these. Twenty septic patients with MRSA-associated glomerulonephritis were randomly assigned to one of two treatments: PMX-F treatment (group A, n = 10) and conventional treatment (group B, n = 10). PMX-F treatment was repeated twice. Results: Urinary podocytes and urinary protein excretion were not detected in MRSA septic patients without glomerulonephritis. However, urinary podocytes (1.7 ± 0.6 cells/ml) and proteinuria (2.6 ± 0.6 g/d) were detected in the 20 septic patients with MRSA-associated glomerulonephritis. Plasma endotoxin levels were decreased from 13.6 ± 4.6 pg/ml to 6.6 ± 2.2 pg/ml (p < 0.05) in group A. Levels in group B, however, showed little difference after treatment. Urinary podocytes were reduced in group A (from 1.8 ± 0.6 cells/ml to 0.4 ± 0.2 cells/ml, p < 0.01) as was urinary protein excretion (from 3.0 ± 0.5 g/d to 0.8 ± 0.4 g/d, p < 0.01) but urinary podocytes and protein excretion levels showed little difference after treatment in group B. Conclusion: PMX-F treatment may be effective in reducing urinary protein and urinary podocyte excretion in septic patients with MRSA-associated glomerulonephritis.

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          Most cited references 11

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          Has the mortality of septic shock changed with time.

          To determine whether a systematic review of the literature could identify changes in the mortality of septic shock over time. A review of all relevant papers from 1958 to August 1997, identified through a MEDLINE search and from the bibliographies of articles identified. The search identified 131 studies (99 prospective and 32 retrospective) involving a total of 10,694 patients. The patients' mean age was 57 yrs with no change over time. The overall mortality rate in the 131 studies was 49.7%. There was an overall significant trend of decreased mortality over the period studied (r=.49, p < .05). The mortality rate in those patients with bacteremia as an entry criterion was greater than that rate in patients whose entry criterion was sepsis without definite bacteremia (52.1% vs. 49.1%; chi2=6.1 and p< .05). The site of infection altered noticeably over the years. Chest-related infections increased over time, with Gram-negative infections becoming proportionately less common. If all other organisms and mixed infections are included with the Gram-positives, the result is more dramatic, with these organisms being causative in just 10% of infections between 1958 and 1979 but in 31% of infections between 1980 and 1997. The present review showed a slight reduction in mortality from septic shock over the years, although this result should be approached with caution. The heterogeneity of the articles and absence of a severity score for most of the studies limited our analysis. Furthermore, there was an increasing prevalence of Gram-positive causative organisms, and a change of the predominant origin of sepsis from the abdomen to the chest.
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            Gram-positive organisms and sepsis.

             Courtney Bone (1994)
            In recent years, the importance of gram-negative organisms in the genesis of sepsis has been emphasized. However, this emphasis may no longer be correct; recent studies show an increasing incidence of gram-positive sources of sepsis, and its is possible that these cases may predominate in the coming years. This increase results from more than just a greater prevalence of infection--it appears that gram-positive organisms may also be more virulent in fomenting the disease, as can be evidenced by the emergence of streptococcal toxic shock syndrome and the resurgence of acute rheumatic fever. This may result from the ability of gram-positive organisms to produce more inflammation-causing cell wall constituents, as well as unbound exotoxins. Despite the recent emphasis on gram-negative causes, sepsis resulting from gram-positive sources is increasingly common. Research on these causes of sepsis should be encouraged.
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              Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis


                Author and article information

                Nephron Clin Pract
                Nephron Clinical Practice
                S. Karger AG
                June 2003
                17 November 2004
                : 94
                : 2
                : c33-c39
                Departments of aMedicine and bSurgery, Misato Junshin Hospital, cDepartment of Medicine, National Rehabilitation Center, and dDepartment of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama; eArtificial Organ Department, Toray Medical Co., Ltd., Tokyo; fDepartment of Pediatrics, Yoshida Hospital, Niigata; gDepartment of Medicine, Koto Hospital, Tokyo, Japan
                71279 Nephron Clin Pract 2003;94:c33–c39
                © 2003 S. Karger AG, Basel

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                Figures: 3, Tables: 3, References: 38, Pages: 1
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