Sepsis is a clinical syndrome that complicates severe infection. .... Waterhouse-Friderichsen syndrome ... disease, 2 patients had autoimmunological diseases,.
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Piotr Czupryna1, Adam Garkowski1, Anna Moniuszko16áDZRPLU3DQFHZLF]1, Aleksandra Ciemerych2, Joanna Zajkowska1
3$7,(176:,7+6(36,6,1,1)(&7,286',6($6(6'(3$570(17 ,160 years old. 7KHDYHUDJHDJHRIRXUSDWLHQWV \HDUV was lower than in the study from United States (1). The majority of patients in our study were males. This is in accordance with other studies (6, 13, 14). Martin et al. reported that the risk of sepsis development is ca 30% higher in men than in women (1). Almost 90% of examined patients had a communityacquired infection. This is in accordance with results DFTXLUHGE\Esteban et al. As far as source of sepsis is concerned pneumonia dominated in the group with severe sepsis while in the group with sepsis odontogenic and urinary tract infections were the most common sources. Pneumonia was also reported as the most common source of infection E\Esteban et al. (56% of community-acquired infecWLRQVYVLQRXUVWXG\ IROORZHGE\XULQDU\WUDFW LQIHFWLRQV YV According to Padkin et al. respiratory infections as a FDXVHRIVHYHUHVHSVLVDSSHDUWREHLQFUHDVLQJRYHUWLPH whereas urinary sources are decreasing (14). Kübler et al. reported than in polish ICU the most common VRXUFHRILQIHFWLRQLVDEGRPLQDOFDYLW\ IROORZHG E\UHVSLUDWRU\WUDFWLQIHFWLRQV Odontogenic infections are interesting as they are only rarely considered as a potential source of sepsis. Some authors state that there is no scientific evidence RI UHODWLRQVKLS EHWZHHQ LQIODPPDWLRQ LQ RUDO FDYLW\ (e.g. periapical) and internal organ infections (15).
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No 3 7DEOH,,,3RWHQWLDOVRXUFHVRILQIHFWLRQ Q 3RWHQWLDOVRXUFHVRIVHSVLV Pneumonia Urinary tract infection Odontogenic infection ,QWHUQDODEVFHVVHV $EGRPLQDO Skin infection i.v. catheters/injections Infectious endocarditis 9HUWHEUDORVWHRP\HOLWLV Other/Unknown
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% 15.9 15.0 6.5 6.5 19.6
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+RZHYHULWZDVSURYHQWKDWLQWHQVLYHWRRWEUXVKLQJDQG GHQWDOH[WUDFWLRQVFDXVHEDFWHULHPLDDVEDFWHULDHQWHU the circulation through gingival tissue the surrounds the teeth (16). 7KH PHGLDQ QXPEHU RI WHHWK ZLWK FDULHV LQ RXU patients in which odontogenic infection was suspected ZDV UDQJH DQGDPHGLDQRIWHHWKH[WUDFWHGGXULQJKRVSLWDOL]DWLRQLQWKLVJURXSZDV UDQJH ,Q most cases the teeth that were the source of infection had received a root canal therapy in the past. There was no other potential source of infection and extraction of decayed teeth resulted in rapid improvement of these patients’ clinical status. High percentage of meningitis in our patients may EHH[SODLQHGE\WKHVSHFLILFLW\RIWKH'HSDUWPHQWZKLFK is a regional reference center for neuroinfections. Comparison of group of patients with severe sepsis DQGPHQLQJLWLVDQGJURXSZLWKVHYHUHVHSVLVEXWZLWKRXW meningitis showed that deaths were more frequent in WKH ILUVW JURXS WKDQ LQ WKH ODWWHU S 7KHUHIRUH GHYHORSPHQWRIPHQLQJLWLVPD\EHFRQVLGHUHGDQHJDtive prognostic factor. In other studies patients suffering from CNS dysfunction in the course of sepsis are also reported to have VLJQLILFDQWO\KLJKHUULVNRIGHDWK 7KHPRVWFRPPRQFKURQLFFRPRUELGLWLHVZHUHK\pertension, autoimmune diseases, heart diseases, alcoKROLVPGLDEHWHVFDQFHUDQGWK\URLGGLVHDVHV 7DEOH, Among these, heart diseases and alcoholism were more frequent in the non-survivors group in comparison to other patients with severe sepsis, although it was on the HGJHRIVWDWLVWLFDOVLJQLILFDQFH S IRUDOFRKROLVP DQGS IRUKHDUWGLVHDVHV 2WKHU FRPRUELGLWLHV KDG OLWWOH HIIHFW RQ SDWLHQWV mortality. Forsblom et al. and Laupland et al. reported chronic alcoholism as one of the factors influencing IDWDORXWFRPHRIVHYHUHEDFWHUDHPLD $FFRUGLQJ to Schuetz et alGLDEHWHVLVQRWDQHJDWLYHSURJQRVWLF IDFWRUIRUPRUWDOLW\LQVHSVLV ,QRIH[DPLQHGSDWLHQWVEORRGFXOWXUHVZHUH SRVLWLYH,QERWKDQDO\]HGJURXSV*UDPSRVLWLYHEDFWHULD dominated with S.aureus as the most common pathogen.
% 13.5 1.9 11.5
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7KLVLVLQFRQWUDVWWRUHVXOWVUHSRUWHGE\Esteban et al. ZKLFKVKRZHGGRPLQDQFHRI*UDPQHJDWLYHEDFWHULD (FROLZDVWKHGRPLQDQWSDWKRJHQUHVSRQVLEOHIRUFD RILQIHFWLRQV $QRWKHUQRQ,&8EDVHGVWXG\ SHUIRUPHG E\ Sundararajan showed dominance of *UDP SRVLWLYH EDFWHULD ,Q ODUJHVW SROLVK HSLGHPLRORJLF VWXG\ EORRG FXOWXUHV *UDP SRVLWLYH EDFWHULDGRPLQDWHG YV ,QPDQ\,&8EDVHGVWXGLHV*UDPSRVLWLYHEDFWHULD ZHUHPRUHFRPPRQ DOWKRXJKSROLVKVWXG\RI Kübler et al. showed slight dominance of Gram negative EDFWHULD 7KHFRPSDULVRQEHWZHHQVHSVLVDQGVHYHUHVHSVLV group showed that patients with severe sepsis had statistically significantly higher CRP concentration. It is in accordance with a study of Suprin et al. who showed that &53FRQFHQWUDWLRQGHSHQGVRQVHYHULW\RIVHSVLV 7KHKHPRJORELQFRQFHQWUDWLRQLQSDWLHQWVZLWKVHvere sepsis was significantly lower. Anemia in patients ZLWKVHYHUHVHSVLVPD\EHFDXVHGHLWKHUE\KHPRO\VLV RU E\ LQIODPPDWRU\ SURFHVV 7KH SDWKRSK\VLRORJ\ of anemia of inflammation is complex and includes UHGXFHG SURGXFWLRQ RI HU\WKURSRLHWLQ LPSDLUHG ERQH marrow response to erythropoietin and decreased red EORRGFHOOVXUYLYDO $OVR WKH DOEXPLQ FRQFHQWUDWLRQ ZDV ORZHU LQ VHvere sepsis. Li et al.UHSRUWHGWKDWK\SRDOEXPLQHPLDLQ SDWLHQWVZLWKVHYHUHVHSVLVLVFDXVHGE\WKHLQFUHDVHG GLVWULEXWLRQUDWHIURPYHVVHOWRWLVVXHDQGWKHLPSURYHG GHFRPSRVLWLRQUDWH
CONCLUSIONS - Despite advances in diagnostics and treatment sepsis LVVWLOODPDMRUPHGLFDOSUREOHPZLWKKLJKPRUWDOLW\ - Because of high mortality, patients with severe sepsis DQGPHQLQJLWLVVKRXOGEHWUHDWHGLQ,&8VHWWLQJHYHQ if no circulatory or respiratory failure is present. 'HFD\HGWHHWKVKRXOGEHFRQVLGHUHGDVDSRWHQWLDO source of sepsis of unknown origin.
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Piotr Czupryna, Adam Garkowski et al.
REFERENCES 1. Martin GS, Mannino DM, Eaton S, et al. The epidemiRORJ\RIVHSVLVLQWKH8QLWHG6WDWHVIURP WKURXJK 1(-0 .EOHU$'XUHN*=DPLURZVND$HWDO6HYHUHVHSVLV in Poland-results of internet surveillance of 1043 cases. 0HG6FL0RQLWRU :LQWHUV%'(EHUOHLQ0/HXQJ-HWDO/RQJWHUPPRUtality and quality of life in sepsis: a systematic review. &ULW&DUH0HG 4. Hodgin KE, Moss M. The epidemiology of sepsis. Curr 3KDUP'HVLJQ 5. Levy MM, Fink MP, Marshall JC, et al. SCCM/ESICM/ ACCP/ATS/SIS International Sepsis Definitions ConferHQFH&ULW&DUH0HG 6. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/ 6RFLHW\RI&ULWLFDO&DUH0HGLFLQH&KHVW 1655. 6DQGV.(%DWHV':/DQNHQ31HWDO(SLGHPLRORJ\RI VHSVLVV\QGURPHLQDFDGHPLFPHGLFDOFHQWHUV-$0$ 'DQDL 3 0DUWLQ *6 (SLGHPLRORJ\ RI 6HSVLV 5HFHQW $GYDQFHV&XUU,QI'LV5HSRUWV ± (VWHEDQ$)UXWRV9LYDU))HUJXVRQ1'HWDO6HSVLV incidence and outcome: contrasting the intensive care XQLW ZLWK WKH KRVSLWDO ZDUG &ULW &DUH 0HG 10. Sundararajan V, Macisaac CM, Presneill JJ, et al. Epidemiology of sepsis in Victoria, Australia. Crit Care Med 11. Rangel-Frausto MS, Pittet D, Costigan M, et al. The natural history of the systemic inflammatory response synGURPH 6,56 $SURVSHFWLYHVWXG\-$0$ :DQJ=6FKRUU&+XQWHU.HWDO&RQWUDVWLQJWUHDWPHQW and outcomes of septic shock: presentation on hospital floors versus emergency department. Chinese Med J3HNLQJ 13. Martin GS, Mannino DM, Moss M. Effect of age on the development and outcome with sepsis. Crit Care Med 14. Padkin A, Goldfrad C, Brady A, et al. Epidemiology of VHYHUHVHSVLVRFFXUULQJLQWKHILUVWKLQLQWHQVLYHFDUH units in England, Wales, and Northern Ireland. Crit Care 0HG ±
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15. Murray CA, Saunders WP. Root canal treatment and general health: a review of the literature. Inter Endodotic - 16. Lockhart PB, Brennan MT, Sasser HC, et al. Bacteremia Associated with Tooth Brushing and Dental Extraction. &LUFXODWLRQ ± )LQIHU6%HOORPR5/LSPDQ-HWDO$GXOWSRSXODWLRQ incidence of severe sepsis in Australian and New Zealand LQWHQVLYHFDUHXQLWV,QWHQV&DUH0HG 6KDSLUR1+RZHOO0'%DWHV':HWDO7KHDVVRFLDWLRQ of sepsis syndrome and organ dysfunction with mortality in emergency department patients with suspected infecWLRQ$QQ(PHUJ0HG )RUVEORP ( 5XRWVDODLQHQ ( 0|ONlQHQ 7 HW DO 3UHdisposing factors, disease progression and outcome in 430 prospectively followed patients of healthcare- and FRPPXQLW\DVVRFLDWHG6WDSK\ORFRFFXVDXUHXVEDFWHUDHPLD-+RVS,QIHFW /DXSODQG.%6YHQVRQ/:*UHJVRQ'%HWDO/RQJ WHUPPRUWDOLW\DVVRFLDWHGZLWKFRPPXQLW\RQVHWEORRGVWUHDPLQIHFWLRQ,QIHFWLRQ 6FKXHW]3-RQHV$(+RZHOO0'HWDO'LDEHWHVLVQRW associated with increased mortality in emergency departPHQW SDWLHQWV ZLWK VHSVLV$QQ (PHUJ 0HG -XV]F]\N - %DNWHULHPLH SRVRF]QLFD ZVWU]ąV VHSW\F]Q\ ,Q &LDQFLDUD - -XV]F]\N - &KRURE\ ]DNDĨQH LSDVRĪ\WQLF]H/XEOLQ S 6XSULQ(&DPXV&*DFRXLQ$HWDO3URFDOFLWRQLQ D YDOXDEOHLQGLFDWRURILQIHFWLRQLQDPHGLFDO,&8",QWHQV &DUH0HG 6RQQHQEOLFN0&DUPRQ05XGHQVN\%6HSVLVLQHOGHUO\SDWLHQWV KDHPDWRORJLFDODQGELRFKHPLFDOG\QDPLFV LQKRVSLWDODFTXLUHGVHSVLV-+.*HULDWU6RF /L :4 :DQJ ;
