Potentiating effect of EDTA-Tris on the activity of antibiotics against resistant bacteria associated with otitis, dermatitis and cystitis.

Possible synergistic effects of the combination of EDTA-tromethamine (EDTA-Tris) and three antimicrobial agents (cephaloridine, kanendomycin and enrofloxacin) against resistant Gram-positive and Gram-negative bacteria are reported. Bacteria were isolated from eight cases of chronic otitis externa, five cases of chronic dermatitis and four cases of recurrent cystitis in dogs which had previously been treated with one of the three antibiotics without success. Animals exposed to EDTA-tromethamine plus the antibiotic recovered completely within 10 days, and were controlled clinically and bacteriologically for 180 days. Local irrigation with EDTA-tromethamine solution was well tolerated and no side effects were recorded.

Prevention of infection in children with acute leukaemia. No major difference between total and selective bowel decontamination.

To evaluate the effect of total bowel decontamination (TD) and selective bowel decontamination (SD) in a non-protective environment clinical and laboratory data of children treated for acute leukaemia between 1983 and 1991 were analysed retrospectively. From 1983 until 1989 34 patients [18 acute non-lymphoblastic leukaemia (ANLL) patients, 16 acute lymphoblastic leukaemia (ALL) patients] received TD and 31 patients (8 ANLL patients, 23 ALL patients) received SD from 1987 until 1991. TD consisted of colistin sulphate, neomycin, cephaloridine and amphotericin B orally as well as Orabase and sterilized food, while the patients were nursed in a single room. SD consisted of oral colistin sulphate, neomycin and amphotericin B. Those patients with ANLL were nursed in a single room; patients with ALL were nursed in a single room during remission induction therapy only. All patients except those with ANLL receiving TD received Pneumocystis carinii pneumonia prophylaxis with cotrimoxazole. Because the two groups were heterogeneous for diagnosis and chemotherapy the occurrence of fever (central body temperature at least 38.5 degrees C) and major infections (septicaemia of infections of the deep tissues or organs) were registered during periods of neutropenia (neutrophilic granulocytes < or = 500/mm3 for at least 8 days). Patients on TD had 55 periods of neutropenia, patients on SD 80. Patients on TD had 89.1 periods of fever/100 periods of neutropenia whereas patients on SD had 56.3. Also patients on TD had 27.3 major infections/100 periods of neutropenia whereas patients on SD had 11.3. Major infections predominantly consisted of septicaemia caused by gram-positive bacteria. We conclude that, in this study, TD in a non-protective environment does not offer better protection against major infections that SD in patients with ALL or ANLL.

Prophylactic antibiotics in colon surgery.

One hundred twenty-three patients undergoing elective colon surgery were prospectively and randomly assigned to receive either three 1-g perioperative doses of intramuscular cephaloridine or three 1-g preoperative doses of both oral erythromycin base and neomycin sulfate. All patients had their bowels thoroughly cleansed mechanically. The groups were comparable in age and nutritional status. Eight wound infections occurred in the 65 patients receiving cephaloridine (12.3%) v one in the 58 receiving erythromycin and neomycin (1.7%). The difference was statistically significant. Eight of nine infected patients had only wound infections; the majority of cultures yielded Bacteroides fragilis. Serum and tissue antimicrobial concentrations were determined in the first 70 randomized patients at operation. Mean (+/- SD) cephaloridine levels were 14.7 +/- 10.2 and 10.5 +/- 10.0 mg/L in serum and tissue, respectively, compared with 1.98 +/- 1.58 and 0.699 +/- 1.146 mg/L for serum and tissue erythromycin levels.

Antibiotic prophylaxis in cystic fibrosis: inhaled cephaloridine as an adjunct to oral cloxacillin.

The effect of prophylactic antibiotics on bacterial colonization of the respiratory tract and on general progression of cystic fibrosis was studied in a two-year prospective study of 47 mildly to moderately affected patients. One group of patients received inhaled cephaloridine and the other received no inhaled antibiotic; both groups received cloxacillin orally. Carriage of Haemophilus influenzae was greater in the group not receiving inhaled antibiotic (55% vs 20%). Rates of carriage of Staphylococcus aureus (23%). Pseudomonas aeruginosa (greater than 90%). Pseudomonas cepacia (45%), and other organisms were similar in both groups. There were no significant differences between the two groups in incidence of respiratory tract infections or hospital admissions, clinical scores, radiologic scores, or rate of change of pulmonary function. Although continuous antistaphylococcal antibiotic prophylaxis may be successful in suppressing colonization with S. aureus, it may also contribute to the high rates of carriage of Ps. aeruginosa and Ps. cepacia observed in patients with cystic fibrosis.

[Antibiotic prophylaxis in general surgery. Clinical evaluation of 3 different therapeutic regimens]. / Antibioticoprofilassi in chirurgia generale. Valutazione clinica di tre differenti schemi terapeutici.

Between April 1977 and April 1981, three schedules of prophylactic antibiotic therapy using four different antibiotics -- Cefaloridine, an association of Tobramycin-Lincomycin, and Ribostamycin -- have been employed in the surgical treatment of a series of patients. clinical experiments were carried out administering the dose of chosen antibiotic one hour before and a few hours after surgery, without prior selection of patients and without considering what type of surgery they were to undertake. The clinical series presented was submitted to statistical analysis for the purpose of monitoring the effectiveness of the therapeutic programmes adopted to prevent postoperative infections of the surgical focus and of the skin wound, comparisons also being made of the different types of drug. The high number and variability of the factors affecting this type of experiment are attributed equally to the patient's physiological and metabolic features and to the types of lesions and surgical intervention carried out. The rationality of these therapeutic solutions are assessed by comparison with traditional programmes of antibiotic administration carried out solely in the postoperative period for a prolonged time. Practicality, cost and incidence of side effects (infrequent) and the absence of serious toxic consequences are also discussed.

Antibiotic prophylaxis in general surgery: a comparison of single-dose intravenous and single-dose intra-incisional cephaloridine.

Four hundred and five consecutive patients undergoing emergency or elective abdominal operations were randomly allocated to receive prophylaxis against wound sepsis by means of a single dose of 1 g cephaloridine either injected intravenously at the start of, or instilled into the incision at the end of, operations. Ten patients died within two weeks without wound sepsis and in the remaining 395 patients there were no significant differences between the two groups in the rates of major (3.5% and 2.1%) or minor (12.4% and 15.5%) wound sepsis. Nutrient broth culture of visceral and parietal swabs during operations enabled a microbiological classification of abdominal operations to be made, the rates of wound sepsis being significantly different among "clean" (1.0%), "potentially contaminated" (8.1%), "lightly contaminated" (19.4%) and "heavily contaminated" (44.6%) operations. This classification by extent of operative contamination makes it possible to standardize the audit of sepsis rates both among surgeons and among hospitals.

Discriminate use of antibiotic prophylaxis in gastroduodenal surgery.

In a prospective study of 107 patients undergoing surgery for gastroduodenal disease, antibiotics were withheld from a group of 24 patients defined preoperatively to be at low risk of developing postoperative infections; no wound infection occurred in this group. Perioperative cephaloridine was randomized among the remaining patients (high risk). Wound infections developed in 11 of 42 patients who did not receive cephaloridine, but in none of the 41 patients who were given cephaloridine (p less than 0.02). Coliform bacteria were grown only from swabs of the stomach mucosa of patients in the high risk group and were the main cause of wound infections. Severe preoperative lymphocytopenia was frequently associated with the development of serious postoperative sepsis. The results validate a policy of restricting antibiotic prophylaxis in gastroduodenal operations to patients at high risk of postoperative infection and suggest a new risk factor--the preoperative blood lymphocyte count.

Cephaloridine prophylaxis in resection of the large intestine.

A controlled prospective clinical trial of cephaloridine chemoprophylaxis in resection of the large intestine was undertaken between 1974 and 1978. Data were available on 159 of 177 unselected patients. All were operated on by one surgeon. Three groups were studied: intraabdominal resection and anastomosis (102 patients); pullthrough resection and anastomosis (30 patients): and resection, with colostomy or ileostomy, without anastomosis (27 patients). In the total patient series cephaloridine reduced wound infection from 38.3% to 15.4% (P less than 0.003). There was no significant decrease in intraabdominal infection. In the group of patients undergoing intraabdominal resection and anastomosis the would infection rate was reduced from 40.0% to 14.9% (P less than 0.01). Cephaloridine reduced wound infection from 50.0% to 21.4% (P = 0.05) in those patients in whom drainage tubes were inserted. A decrease in the incidence of faecal fistula from 10.9% to 4.3% was not significant. Wound infections were not reduced significantly after pullthrough excisions or resections without anastomosis. The results support the routine prophylactic use of cephalosporins in patients undergoing intraabdominal resection of the large intestine with anastomosis.

[Preventive therapy in stomatological and maxillofacial surgery. Clinical considerations on the administration of cephaloridine, using a new technic (short-term prophylaxis)]. / La profilassi antibiotica nella chirurgia stomatologica e maxillo-facciale. Considerazioni cliniche sulla somministrazione di cefaloridina secondo una nuova tecnica (Short term Prophylaxis).

The "Short term prophylaxis" technique was used in 100 patients who had undergone Stomatologic surgery and Maxillo-facial surgery for post-operative prophylaxis of surgical infections according to analogous researches conducted in other surgical branches by various authors. The results obtained can be summarized as following: 1) a marked reduction in administered antibiotics (cefaloridina); 2) a marked reduction of post-operative fever; 3) a maintainment of average febrile levels at 37,8 degrees-38 degrees. The above tecnique thus allowed a more rapid mobilization of patients who had undergone surgical intervention, a reduction of the recovery period and the therapeutic costs.

Prophylactic and preventive antibiotic therapy: timing, duration and economics.

Previous studies have demonstrated that administered antibiotics must be active against major anticipated pathogens and must have reached sufficient concentrations in the tissue or body fluid at risk by the time of bacterial challenge if prophylactic therapy is to be maximally effective in reducing the infection rate of potentially contaminated surgery. The need for continuing antibiotic prophylaxis beyond the day of operation, however, has been uncertain. In a prospective, randomized, double-blind study of 220 patients undergoing elective gastric, biliary or colonic surgery, perioperative administration of cefamandole plus five days of placebo was compared to perioperative plus five days of postoperative antibiotic therapy; no significant difference was found between the groups in the rate of infection of wound (6 and 5%, respectively), peritoneum (2% each) and elsewhere (6% and 5%). In another prospective, randomized, nonblind study of 451 determinant cases of 1,624 patients undergoing emergency laparotomy, cephalothin was instituted preoperatively but after peritoneal contamination had occurred (i.e., abdominal trauma, etc.); continued postoperative antibiotic again failed to reduce further the wound and peritoneal infection rates, as noted on comparing perioperative therapy alone (infection rates 8 and 4%, respectively) with perioperative plus 5-7 days of postoperative treatment (10% and 5%, respectively). Analysis of these data, as well as of the extra expenses incurred by 463 patients because of infection in a previous prophylactic antibiotic study, revealed an average additional expenditure of $2,686.00 for each instance of postoperative infection of the wound and/or peritoneum; whereas savings of $300.00 per patient at risk were obtained whenever appropriate prophylactic antibiotic had been given.

Antibiotic prophylaxis in total hip replacement.

A controlled prospective trial to compare the efficacy of the antibiotics cephaloridine and flucloxacillin in preventing infection after total hip replacement was conducted at three hospitals. The antibiotic regimens began before surgery, cephaloridine being continued for 12 hours and flucloxacillin for 14 days afterwards. Over an 18-month period 297 patients undergoing a total of 310 hip replacements were entered into the trial and randomly allocated to one of the regimens. The follow-up period ranged from one to two and a half years. All operations were performed in conventional operating theatres; at two of the hospitals these were also used by various other surgical disciplines. Four patients developed deep infection, two having received the cephaloridine and two the flucloxacillin regimen. The overall rate of deep infection was therefore 1.3%. Thus three doses of cephaloridine proved to be as effective as a two-week regimen of flucloxacillin. Giving a prophylactic systemic antibiotic reduced the incidence of infection to a level comparable with that obtained in ultra-clean-air operating enclosures.

The role of antibacterial preparation of the intestine in the reduction of primary wound sepsis after operations on the colon and rectum.

A consecutive series of 320 patients undergoing operations on the colon and rectum, under the care of one surgeon, was studied to determine the influence of oral antibacterial preparation of the intestine on the incidence of postoperative wound sepsis. Thirty patients were excluded from the analysis, and the rates of major wound sepsis in the remaining 290 patients were 21.7 per cent when no antibacterial preparation was used; 18.6 per cent when the intestine was prepared with phthalylsulfathiazole and neomycin, and 1.6 per cent when the intestine was prepared with phthalysulfathiazole, neomycin and tetracycline. Other important determinants of the rate of wound sepsis were obesity and the use of cephaloridine prophylaxis. Results of bacteriologic studies showed the effectiveness of triple antimicrobial preparation of intestine against gram-negative aerobes and Bacteriodes species.

Antibiotics in surgery of the colon.

In a randomized prospective study of patients undergoing elective colonic surgery the postoperative wound infection rate was 13% (early, 10%) in patients receiving systemic cephaloridine perioperatively and 12% (early, 7.3%) in those given oral neomycin and erythromycin base preoperatively. Wound infections were more frequent in patients with severe lymphopenia or hypoalbuminemia preoperatively, but the potential degree of wound contamination was the main determinant of postoperative infection.

A randomized controlled trial of a short course of cephaloridine in the prevention of infection after abdominal hysterectomy.

One hundred patients took part in a randomized controlled trial to test the efficacy of three 1 g doses of cephaloridine in preventing infection after abdominal hysterectomy. The first dose was given as an intravenous bolus at the commencement of surgery and the second and third as intramuscular injections 6 and 12 hours later. Given in this way, cephaloridine was found to be very effective in preventing febrile morbidity, abdominal wound infection and urinary tract infection. It was less effective in preventing pelvic wound infection and postoperative colonization of the vagina with Escherichia coli.