Diagnosis and management of urinary tract infections in the emergency department.

Urinary tract infections are a heterogeneous group of disorders, involving infection of all or part of the urinary tract, and are defined by bacteria in the urine with clinical symptoms that may be acute or chronic. Approximately 1 million urinary tract infections are treated every year in United States emergency departments. The female-to-male ratio is 6:1. Urinary tract infections are categorized as upper versus lower tract involvement and as uncomplicated versus complicated. The emergency clinician must carefully categorize the infection and take into account patient host factors to optimally treat and disposition patients. A working knowledge of local or at least national susceptibility patterns of the most likely pathogens is essential. A variety of special populations exist that require special management, including pregnant females, patients with anatomic abnormalities, and instrumented patients.

Preoperative carriage and postoperative same-species sternal wound infection after cardiac surgery.

Sternal wound infection (SWI) after cardiac surgery remains an important problem. Prediction of pathogens involved in such infection could guide antibiotics. From April 1, 2006 to December 31, 2008, retrospectively, we evaluated the diagnostic value of preoperative methicillin-sensible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA) or multi-drug resistant Gram-negative bacillus (MDRGNB) carriage to predict same-pathogens involved in postoperative SWI. All patients referred for elective cardiac surgery were screened using multisite (nares, axillae, rectal) sampling at admission to detect MSSA, MRSA, and MDRGNB. Of the 1895 patients addressed, 425 patients (22.4%) were colonized at admission. Preoperative carriers more frequently developed SWI than non-carriers, respectively, 11% vs. 5.5% (P<0.05). Because of the small sample, MDRGNB carriers could not be analyzed. For prediction of MSSA SWI with preoperative MSSA carriage, the area under the receiver operating characteristic (ROC) curve was 0.720 (95% confidence interval (CI), 0.364-0.796) and 0.710 (95% CI, 0.623-0.787) for prediction of MRSA SWI with preoperative MRSA carriage. Preoperative MSSA carriage is frequent but preoperative MRSA or MDRGNB carriage remains infrequent. The ability of preoperative carriage to predict a same-pathogen-postoperative SWI was low and should not be used to guide empirical antibiotherapy.

Perineal swabs reveal effect of super shedders on the transmission of Escherichia coli O157:H7 in commercial feedlots.

Cattle that shed more than 10(4) cfu/g of Escherichia coli O157 in feces have been described as super shedders (SS) and are thought to have major impacts on prevalence and transmission of this organism. Two Southern Alberta commercial feedlots (feedlot X, 7 pens averaging 183 steers; feedlot Y, 5 pens averaging 153 steers) were sampled from May 2007 to January 2008. Background samples [fecal pat (FP) water, ropes] were taken weekly from each pen for 2 wk before collection of samples from individuals [fecal grab (FG); perineal swab] at 2 different times [during spring and summer (S1); immediately before slaughter during fall and winter (S2)]. Immunomagnetic separation and selective media were used for detecting E. coli O157:H7. Positive FG and FP were enumerated by direct plating onto sorbitol MacConkey agar supplemented with 2.5 mg/L of potassium tellurite and 0.05 mg/L of cefixime. Five sorbitol-negative colonies were agglutinated using an anti-O157 latex kit, and the proportion of positive colonies was adjusted for non-E. coli O157:H7. Overall, there were 153 (7.16%) and 10 (0.45%) SS at S1 and S2, respectively. In feedlot X, SS and penmates of SS during S1 were more likely (P < 0.01) to shed E. coli O157:H7 in their feces and have this organism on their perineum than cattle in a pen where no SS were identified. In feedlot Y, SS and penmates of SS during S1 were more likely (P < 0.01) to have E. coli O157:H7 on their perineum than those from a pen where only 1 SS was identified, but steers in only 1 pen with multiple SS were more likely (P < 0.01) to shed this organism in feces. Overall, E. coli O157:H7 was 1.85 times more likely (P < 0.01) to be detected in perineal swabs compared with FG and E. coli O157:H7 was more likely (P < 0.01) to be detected at S1 compared with S2 for all sample types. Super shedders were a larger proportion of shedding cattle in S1 than in S2, but the presence of SS increased (P < 0.01) prevalence of this organism on the perineum of cattle throughout the year. Even when SS did not increase fecal shedding of E. coli O157:H7, their presence increased contamination of hides, an outcome that could have important implications for contamination of carcasses at the abattoir.

[Clinical trial of aromatherapy on postpartum mother's perineal healing].

PURPOSE: This study was designed to verify the effect of aromatherapy on a postpartum mother's perineal healing. METHOD: The research design was a clinical trial. The methods of aromatherapy were applied sitz bath or soap application using essential oils with Lavender, Myrrh, Neroli, Rose, Grapefruit, Mandarin, Orange, and Roman Chamomile. The subjects of this experiment were postpartum mothers who delivered vaginally with an episiotomy. They were allocated to one of three groups; the aroma-sitz bath group, aroma-soap application group or control group. To evaluate the effect of aromatherapy, the perineal healing status was measured using the REEDA scale and smears of episiotomy wound were obtained. The data were analyzed by repeated measures of ANOVA, ANCOVA, chi2-test, and multiple response analysis via SPSS program. RESULT: The REEDA scale was significantly low in the experimental group at postpartum 5th and 7th days (P=.009, P=.003), respectively. Most were observed 'few'(5-10 bacteria per field) bacteria in the smears of episiotomy wound. The one bacteria was identified in the 50.8% of subjects in pretest and two bacteria in the 60.3% in posttest. Most frequently identified bacteria were Escherichia coli and Enterococcus faecalis. CONCLUSION: In conclusion, these findings indicate that postpartum aromatherapy for perineal care could be effective in healing the perineum perineal care could be effective in healing the perineum.

Clinical trial of Aromatherapy on Postpartum Mother's Perineal Healing / 간호학회지

PURPOSE: This study was designed to verify the effect of aromatherapy on a postpartum mother's perineal healing. METHOD: The research design was a clinical trial. The methods of aromatherapy were applied sitz bath or soap application using essential oils with Lavender, Myrrh, Neroli, Rose, Grapefruit, Mandarin, Orange, and Roman Chamomile. The subjects of this experiment were postpartum mothers who delivered vaginally with an episiotomy. They were allocated to one of three groups; the aroma-sitz bath group, aroma-soap application group or control group. To evaluate the effect of aromatherapy, the perineal healing status was measured using the REEDA scale and smears of episiotomy wound were obtained. The data were analyzed by repeated measures of ANOVA, ANCOVA, x2-test, and multiple response analysis via SPSS program. RESULT: The REEDA scale was significantly low in the experimental group at postpartum 5th and 7th days (P=.009, P=.003), respectively. Most were observed 'few'(5-10 bacteria per field) bacteria in the smears of episiotomy wound. The one bacteria was identified in the 50.8% of subjects in pretest and two bacteria in the 60.3% in posttest. Most frequently identified bacteria were Escherichia coli and Enterococcus faecalis. CONCLUSION: In conclusion, these findings indicate that postpartum aromatherapy for perineal care could be effective in healing the perineum perineal care could be effective in healing the perineum.

Necrotizing soft-tissue infections.

In the realm of clinical practice, this disease entity defies applicability to any classification scheme. Of paramount importance is the early identification of all necrotizing soft-tissue infections. This requires a high index of suspicion, aided by recognition of various risk factors and organ system dysfunction out of proportion to the extent of local signs and symptoms. Expedient, aggressive surgical therapy is imperative: resuscitation, wide débridement, and antibiotic therapy. Once the infection has been controlled, continued supportive care, reconstruction, and rehabilitation can proceed.

Monoplace hyperbaric oxygen therapy for gas gangrene.

Untreated gas gangrene is a fulminating infection that can lead to extensive tissue necrosis and death. Hyperbaric oxygen, when used with antibiotics and surgical debridement, can lead to decreased mortality. Nine patients with gas gangrene proven by positive clostridial cultures have been treated at St Luke's Hospital of Kansas City with a mortality of 11.1%. A case of gas gangrene developing from a perirectal abscess is presented.