Changes of the serum antibiotic levels during open heart surgery (ceftazidim, ciprofloxacin, clindamycin).

BACKGROUND: Wound, mediastinal and intracardiac infections are still very serious complications of open-heart surgery. The incidence of it is still in the range of 0.4%-5%. The aims of our study were to assess the adequacy of regimen using ceftazidim (CTZ), ciprofloxacin (CPF) and clindamycin (CLIN) as prophylactic antibiotics and to verify whether cardiopulmonary bypass (CPB) can modify the time of antibiotic serum concentrations. That is why the serum levels of them were measured during open heart procedures. METHODS: The prospective study comprised 75 consequent coronary patients randomized in to three groups receiving 1 g of CTZ or 400 mg of CPF or 900 mg of CLIN i.v. with anesthesia induction. Routine coronary surgery with left internal mammary artery harvesting, moderate body hypothermic (30 degrees C) CPB with crystaloid cardioplegia was performed. Serum antibiotic levels were determined before application, with skin incision, prior CPB induction, after cardioplegia infusion, every 20 minutes of CPB, prior end of CPB, in time of chest closure. Conventional cylinder-plate microbiological assay was used for antibiotic level measurement. RESULTS: All serum antibiotic concentrations showed a sharp decrease immediately after starting CPB and lasted until CPB ended. After initiating of CPB after cardioplegia administration serum concentrations of CTZ (105 min after initial dose) decreased by, on average 55%, CPF (97 min) by 42% and CLIN (116 min) by 78%. CONCLUSION: CPB can modify the time course of antibiotic serum concentrations. The serum levels of CTZ at the end of the longest procedures were found to be below the MICs for some of the suspected pathogens. We recommend to use higher antibiotic doses for prophylaxis and to administer the second dose with protamin sulphate to obtain maximum concentration in newly formed blood clots.

[Kinetics of ceftazidime in prophylactic administration during cardiopulmonary bypass]. / Kinetika ceftazidimu pri profylaktické aplikaci u kardiopulmonálního bypassu.

Serum ceftazidime levels were followed in 21 patients in which routine coronary bypass surgery with cardiopulmonary bypass was performed. Each patient received one gram of ceftazidime intravenously with anesthesia induction. Antibiotic concentrations were estimated using the microbiologic assay diffusion plate method. The average operation time was 220 +/- 41 minutes (range 130-310). The start of cardiopulmonary bypass was 86 +/- 21 minutes and the full flow time was 104 +/- 21 minutes after starting of ceftazidime application. It can be stated that the decline of ceftazidime serum levels after starting of cardiopulmonary bypass was faster in comparison with standard serum curves of this antibiotic. The concentrations of ceftazidime at the end of some operations were under the supposed minimal inhibitory concentrations for some microorganisms possibly implicated. No infection was recorded.

[Development of resistance and utilization of fluoroquinolones in a university hospital]. / Vývoj spotreby a rezistence u fluorochinolonu ve fakultní nemocnici.

The results of a retrospective study in the Faculty Hospital, Hradec Králové (FHHK) show a steep increase in the consumption of fluoroquinolones in the course of six years. Since 1989, when 360 defined daily doses (DDD) were administered, the consumption increased to 2,825 DDDs in 1992 and 52,162 DDDs in 1995. At the same time, resistance to ofloxacine and ciprofloxacine was increased many times in some bacterial species isolated from patients admitted to FHHK. In the strains Pseudomonas aeruginosa, resistance to ofloxacine increased from 3% to 38% in 1995, in Serratia marcescens from 13% in 1992 to 30% in 1995. A marked increase was observed also in Acinetobacter calcoaceticus. In the naturally highly sensitive species E. coli and Klebsiella pneumoniae no increase in resistance has been observed yet, in Enterobacter cloaceae resistance slightly increased (from 0% in 1992 to 7% in 1995). Due to the fact that in FHHK fluoroquinolones take the first place in the consumption of antibiotics at present, an increase in resistance can be expected also in these bacteria in the future. Investigation of changes in resistance due to the consumption of fluoro-quinolones is a suitable model of a pharmacoepidemiological study (DUE-Drug Utilisation Evaluation) as the relationship of the consumption of a drug and its effect can be observed practically since the introduction of fluoroquinolones into the market.

[Antimicrobial activity of composite filling materials]. / Sledování antimikrobiálního úcinku nekterých kompozitních výplnových materiálu.

Antimicrobial effects of several composite fillers are monitored in response to a mixed aerobic and anaerobic microbial flora of the oral cavity. None of observed both self-polymerizing and photopolymerizing composites showed antimicrobial effects.

[Cooperation between the urologist and microbiologist in the diagnosis and treatment of sepsis. I. Predisposing factors and sources of sepsis in patients with urologic diseases]. / Spolupráce urologa a mikrobiologa v diagnostice a lécení sepse. I--predisponující faktory a zdroje sepse u urologických nemocných.

The most important source of septicemia caused by Gram-negative microorganisms, which has an ever rising trend, is the urogenital tract. The majority of these sepsis is of nosocomial origin (74%). At the Urological Clinic of the Faculty Hospital in Hradec Králové during 1984-1987 sepsis, based on a positive haemoculture, was diagnosed in 52 patients. During the investigation period the number of sepsis almost trebled. The most frequent predisposing factor was obstruction of the urinary pathways concomitant infection (41X) and instrumental procedures (25X). In the majority several factors were involved simultaneously. Septic disease occurred in particular in patients with the basic diagnosis of a malignant disease (36%) and in obstructive pyelonephritis (23%). Its incidence was significantly more frequent in more advanced age groups. In 63% it was urosepsis, in 8% the source was a cannula in the subclavian vein and in the remainder it did not prove possible to reveal the source of septicaemia.

[Cooperation between the urologist and microbiologist in the diagnosis and treatment of sepsis. II. The most common microbial species and their sensitivity to antimicrobial drugs in sepsis at the Urologic Clinic of the Medical School Hospital]. / Spolupráce urologa a mikrobiologa v diagnostice a lécení sepse. II--Nejcastejsí mikrobiální druhy a jejich citlivost na antimikrobiální látky u sepsí na urologické klinice FN.

The authors investigated the spectrum of aetiological agents and their sensitivity to antimicrobial substances in 52 patients with septicaemia at the Urological Clinic in Hradec Králové during 1984-1987. They found a predominating number of Gram-negative bacteria (82%). The most frequent agent producing sepsis was Klebsiella pneumoniae (19X), its source were in 52% the urinary pathways and 16% the cannula in the subclavian vein. In nine instances the aetiological agent was Escherichia coli and 5 times Proteus mirabilis. The above microorganisms are the most important pathogenic organisms of the urinary pathways. In all cases of bacteriaemia urosepsis was involved. The source of sepsis caused by Pseudomonas aeruginosa (7X) was in 43% the urinary tract, in particular in conjunction with instrumental procedures and in 14% a cannula in the subclavian vein. The most effective antimicrobial substance in Gram-negative bacteraemia in the investigated group was amicacin (100%); high sensitivity was recorded also in colistin. In Gram-positive bacteriaemia, where most frequently enterococci were isolated (6X), ampicillin and vancomycin were most effective.

[Bacteriological findings in bronchial secretions of the lower respiratory tract in resected lungs]. / Bakteriologické nálezy v bronchiálním sekretu dolních dýchacích cest resekovaných plic.

The authors investigated during operation the bacteriological findings in the bronchial secretion of the respiratory pathways of resected lungs. Of 100 patients whom they included in the group they detected a positive finding in 42. Wound in 27 patients. Twenty of them had a positive bacteriological finding in the lower respiratory pathways. The authors discuss the problem of prophylactic use of antibiotics in pulmonary surgery. Based on data in the literature and their own observations, the authors recommend preventive administration of antibiotics in pulmonary surgery.

[Serum levels of oxacillin and cephalothin in patients with extracorporeal circulation during surgery]. / Sérové hladiny oxacilinu a cefalotinu u nemocných operovaných v mimotelním obehu.

The authors investigated the oxacillin and cephalotine serum levels in patients operated under conditions of extracorporeal circulation. They found that the time for which the patients are adequately protected against staphylococcal infection is in oxacillin cca 180 mins. and in cephalotine 150 mins. after administration of the first dose of antibiotic. They recommend to administer a second dose of the antibiotic along with protamine sulphate after removal of the aortal cannula to obtain a maximum concentration of the antibiotic in the newly formed blood clots. If the surgical operation lasts longer, they recommend to administer the antibiotic in the given time interval regardless of the operation and to administer a third dose when removing the cannula. The authors investigated a total of 30 patients. In one case they encountered an early and in another case a urinary infection.

[Mediastinal inflammation as a complication of heart surgery under extracorporeal circulation]. / Zánet mezihrudí jako komplikace srdecních operací v mimotelním obehu.

The authors describe mediastinitis in two patients operated on account of ischaemic heart disease. In both patients they used the closed approach which involved suture of the sternum and surgical wound, perfect drainage and the administration of antibiotics (general and local). They describe the applied method of fixation of the sternum. In both patients the sternum and surgical wound healed.

Transferable resistance to cephalosporins, ureidopenicillins and trimethoprim.

Transferable resistance to classical Cephalosporins emerged three years ago among Enterobacteriaceae simultaneously in several hospitals and was associated with resistance to other betalactam drugs, i.e. with a transmissible TEM-like betalactamase. A systematic survey of incidence of R plasmids in Proteus sp. lead, in two district PHLs, to demonstration of transferable Azlocillin resistance. This resistance was most frequently associated with that for Carbenicillin, but also strains susceptible to CAR but resistant to AZL have been isolated. Trimethoprim resistance was in this country first described by Schon, but, since then, it is now frequently found transferable in polyresistant strains from hospitals, resistant also to betalactam antibiotics, Gentamicin and other drugs.

Health problems of windowless henhouses.

The working, health and zoohygiene problems of keeping chickens (45,000) in TEROZ type windowless houses on deep litter with controlled light regimen and hens (75,000) in cages were the subject of study for 3 years. The poultry was fed on factory-produced feedstuffs with the then permitted addition of CTC in amounts of 20 g/l tonne. Except for the low intensity of illumination in the chicken house (10-1.1 1x) and with the observation of the prescribed technology, the working environment is favourable. The state of health of the employees did not differ essentially from that of other groups of workers in aggriculture. The use of CTC resulted in a growing number of resistant microbial strains (Staphylococcus aureus, Proteus mirabilis, E. coli, etc) which led to the banning of its use and replacement by other biostimulants. Every type of large-scale poultry farm should be designed as a whole including the chicken incubator, the egg sorting station, the slaughter house, the use of waste matter and sewage disposal and should be previously tried out experimentally by a group of experts concerned with the given problems, before being introduced into wider use.