Bacterial sepsis and septic shock:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
1999
|
| Series: | Infectious disease clinics of North America
13,2 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XIV S., S. 285 -. 514 Ill., graph. Darst. |
Staff View
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| 245 | 1 | 0 | |a Bacterial sepsis and septic shock |c Steven M. Opal, ... guest ed. |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 1999 | |
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| 490 | 1 | |a Infectious disease clinics of North America |v 13,2 | |
| 650 | 2 | |a Infections bactériennes | |
| 650 | 2 | |a Sepsie | |
| 650 | 4 | |a Bacterial Sepsis | |
| 650 | 4 | |a Bacterial diseases | |
| 650 | 4 | |a Septic shock | |
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CONTENTS
¦:t ¦
Preface xiii
Steven M. Opal and Alan S. Cross
Clinical Trials for Severe Sepsis: Past Failures and
Future Hopes 285
Steven M. Opal and Alan S. Cross
Recent clinical trials with experimental immunotherapeutic
agents for severe sepsis and septic shock have been largely unsuc¬
cessful despite seemingly convincing preclinical evidence of sig¬
nificant benefit of these antisepsis therapies. This article reviews
basic therapeutic rationale, preclinical evaluation, and clinical trial
design of past clinical trials of innovative sepsis treatments. Les¬
sons learned from past failures should provide insights into the
design and implementation of successful clinical trials for new
anti sepsis agents in the future.
The Epidemiology of Bacterial Sepsis 299
M. Sigfrido Rangel Frausto
As a result of better understanding of pathogenesis, new defini¬
tions of sepsis have been proposed, and the complexity of this
syndrome is clearer. Population based studies of bloodstream
infections—what now is called sepsis—have helped us to under¬
stand the natural history of this very frequent problem. The
mortality and morbidity of each of the systemic inflammatory
response syndrome stages have been described; our ability to
better understand and predict these stages will help us to make
better therapeutic decisions.
1 JT.( TKH.S I )M ; SE CLINICS OF NORTH AMERICA
VOLUME 13 • NUMBER 2 • JUNE 1999 vii
Structure Function Relationships of Bacterial
Endotoxins: Contribution to Microbial Sepsis 313
David C. Morrison, Richard Silverstein, Michael Luchi,
and Alexander Shnyra
A substantial body of knowledge has emerged over the past
several decades concerning the primary, tertiary, and quaternary
structures of endotoxic lipopolysaccharides and their contribution
to the pathogenesis of Gram negative sepsis. Important questions
however, remain. Among them are the precise three dimensional
configuration of the LPS macromolecule and the contribution of
the quaternary structure to the ability of these potent microbial
factors to interact with the host humoral and cellular inflamma¬
tory mediator systems. Also remaining to be sufficiently ad¬
dressed is the relative contribution of endotoxin interactions with
the host to the overall manifestation of disease; and under what
conditions do such contributions serve as the pivotal event in
determining outcome? The answers to these questions can be
expected to provide valuable insights into potential, novel thera¬
peutic intervention strategies and approaches that will ultimately
serve to reduce both infection morbidity and mortality from
Gram negative microbes.
Lipopolysaccharide Recognition, CD14, and
Lipopolysaccharide Receptors 341
Robin R. Ingalls, Holger Heine, Egil Lien,
Atsutoshi Yoshimura, and
Douglas Golenbock
The ability of a host to sense invasion by a pathogenic organism,
and to respond appropriately to control infection, is paramount
to survival. To that end, an array of receptors and binding pro¬
teins has evolved as part of the innate immune system to detect
Gram negative bacteria. This article reviews the role of CD14,
other LPS binding proteins, and the Toll family of receptors in
the innate recognition of bacterial lipopolysaccharide.
Vaccines and Antibodies in the Prevention and
Treatment of Sepsis 355
Apurba K. Bhattacharjee and Alan S. Cross
Antibodies to various core glycolipid antigens have been shown
to correlate with survival from Gram negative sepsis. Recent pre
clinical data also support efficacy of the anti core glycolipid anti¬
bodies in the treatment of sepsis. Failure of some of the previous
clinical trials with anti core glycolipid antibody was probably due
to inadequate levels of antibody in those preparations. Future
clinical trials must ensure that sufficient amounts of anti core
glycolipid antibodies are present in the circulation of patients
with sepsis.
viii contents
Antiendotoxin Strategies 371
Judith Hellman and H. Shaw Warren
Endotoxin is a potent stimulator of the inflammatory response
and is believed to initiate the pathology in Gram negative sepsis.
Agents are being developed that bind and neutralize or block the
effects of endotoxin, with the goal of improving outcome in the
treatment of sepsis. Strategies discussed in this article include
anti LPS antibodies, LPS binding proteins and lipoproteins, poly
myxin B conjugates, lipid A analogues, and extracorporeal tech¬
niques for endotoxin removal.
Structure and Function of Streptococcal and
Staphylococcal Superantigens in Septic Shock 387
Jason Bannan, Kumar Visvanathan, and John B. Zabriskie
The pyrogenic exotoxins of Group A Streptococci and enterotox
ins of Staphylococcus aureus constitute a family of related toxins
that acts as superantigens because of their ability to stimulate
large numbers of T cell subsets. These toxins have been impli¬
cated in gastrointestinal food poisoning, toxic shock syndromes,
Gram positive sepsis, and, possibly, septic shock. There is increas¬
ing evidence that Gram positive infections frequently coexist in
septic shock and that bacterial superantigens play a major role.
Gram positive Sepsis: Mechanisms and Differences
from Gram negative Sepsis 397
Shiranee Sriskandan and Jonathan Cohen
This article reviews the pathogenesis of septic shock caused by
important Gram positive pathogens, describing similarities with
and contrasts to Gram negative sepsis. Gram positive bacterial
structure and secreted proteins and toxins are reviewed, with an
emphasis on molecular interactions with the host leading to ad¬
verse inflammatory sequelae. Adverse proinflammatory host re¬
sponses to Gram positive infection are examined in established
animal models of septic shock and in the clinical setting. Im¬
portant considerations for anti inflammatory therapy are high¬
lighted.
Cytokines and Anticytokines in the Pathogenesis
of Sepsis 413
Tom van der Poll and Sander J. H. van Deventer
Clinical trials with anti inflammatory agents in patients with sep¬
sis are based on the assumption that excessive proinflammatory
activity of the cytokine network negatively influences the out¬
come of severe bacterial infections. The failure of these trials to
show clinical benefit, in conjunction with recent experimental
contents ix
data, raises doubt about the validity of this assumption. This
article reevaluates the role of cytokines in the pathogenesis of
sepsis and severe bacterial infections. The cytokine network is
discussed as consisting of proinflammatory cytokines, antiin
flammatory cytokines, and soluble inhibitors of proinflammatory
cytokines.
Neutrophil and Endothelial Cell Interactions in Sepsis:
The Role of Adhesion Molecules 427
Chantal Parent and Peter Q. Eichacker
Although adhesion molecules present on circulating neutrophils
and endothelial cells are essential for normal host defense, gener¬
alized activation of these molecules has been implicated in the
inflammatory tissue injury occurring during sepsis and septic
shock. A review of both preclinical and clinical studies suggests,
however, that although these molecules mediate tissue injury
related to a variety of microbial and host inflammatory mediators,
their predominant role during sepsis with infection is a protec¬
tive one.
Nitric Oxide in the Pathogenesis of Sepsis 449
Simon Symeonides and Robert A. Balk
In sepsis and septic shock, inflammatory mediators result in the
production of increased concentrations of nitric oxide (NO) from
the enzymatic breakdown of the amino acid L arginine. The in¬
creased amounts of NO are responsible for changes in vasomotor
tone, decreased vasopressor responsiveness, and decreased myo
cardial function, characteristic of septic insult. Therapeutic strate¬
gies designed to reduce the concentration of NO by inhibiting the
action of the nitric oxide synthase enzyme, or by scavenging the
excess NO, offer the potential to treat directly the vasomotor
abnormalities and myocardial depression seen in sepsis and other
inflammatory states. This article reviews the biology of NO in
sepsis and discusses strategies for neutralization of the increased
NO production, in the setting of severe sepsis and septic shock.
The Gut s Role in Metabolism, Mucosal Barrier
Function, and Gut Immunology 465
R. Chance DeWitt and Kenneth A. Kudsk
The gastrointestinal tract functions not only to absorb nutrients,
it also plays an important immunologic role during health and
critical illness. Under experimental and certain clinical conditions,
stimulating the gut attentuates the stress response and avoids
mucosal atrophy and increases permeability. Gut stimulation pre¬
vents atrophy of the gut associated lymphoid tissue, the body s
major defender of moist mucosal surfaces. A better understand
X CONTENTS
ing of gut function and improved nutrient delivery has clinical
implications in the treatment of critically ill patients.
Rapid Diagnostic Methods in the Detection of Sepsis 483
Jean Carlet
Any delay in the management of infection is deleterious, espe¬
cially in patients whose illness is severe. It is of paramount
importance to shorten this delay. This article emphasizes the
different ways to reach this goal, including the use of new bio¬
logic markers, such as cytokines or procalcitonin.
Current Therapy for Sepsis 495
R. Phillip Dellinger
This article addresses general management principles in patients
with severe sepsis and septic shock. Included are identification
and control of infection nidus, typical choices for antibiotic ther¬
apy based on empiric coverage, and specific locations of infec¬
tions and specific organisms. Initial attention to airway, breathing,
and circulation is addressed. Considerable attention is directed to
the use of monitoring to guide definitive therapy of hemody
namic derangements and organ hypoperfusion. Monitoring tools
and physical examination guide choices of volume resuscitation
and vasopressor therapy. Supportive therapy, such as transfu
i sions, nutrition, and preventive measures are discussed in the
management of the septic patient.
Index 511
Subscription Information Inside back cover
i
CONTENTS xi
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| spelling | Bacterial sepsis and septic shock Steven M. Opal, ... guest ed. Philadelphia [u.a.] Saunders 1999 XIV S., S. 285 -. 514 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Infectious disease clinics of North America 13,2 Infections bactériennes Sepsie Bacterial Sepsis Bacterial diseases Septic shock Sepsis (DE-588)4181014-4 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Sepsis (DE-588)4181014-4 s DE-604 Opal, Steven M. Sonstige oth Infectious disease clinics of North America 13,2 (DE-604)BV000841738 13,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008573595&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Bacterial sepsis and septic shock Infectious disease clinics of North America Infections bactériennes Sepsie Bacterial Sepsis Bacterial diseases Septic shock Sepsis (DE-588)4181014-4 gnd |
| subject_GND | (DE-588)4181014-4 (DE-588)4143413-4 |
| title | Bacterial sepsis and septic shock |
| title_auth | Bacterial sepsis and septic shock |
| title_exact_search | Bacterial sepsis and septic shock |
| title_full | Bacterial sepsis and septic shock Steven M. Opal, ... guest ed. |
| title_fullStr | Bacterial sepsis and septic shock Steven M. Opal, ... guest ed. |
| title_full_unstemmed | Bacterial sepsis and septic shock Steven M. Opal, ... guest ed. |
| title_short | Bacterial sepsis and septic shock |
| title_sort | bacterial sepsis and septic shock |
| topic | Infections bactériennes Sepsie Bacterial Sepsis Bacterial diseases Septic shock Sepsis (DE-588)4181014-4 gnd |
| topic_facet | Infections bactériennes Sepsie Bacterial Sepsis Bacterial diseases Septic shock Sepsis Aufsatzsammlung |
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