RESUMO
We have incorporated bisphosphonates and antibiotics simultaneously into a biomimetic hydroxyapatite implant coating aiming to use the interaction between drug-molecules and hydroxyapatite to enable local release of the two different substances to obtain a dual biological effect. A sustained release over for 43 h of antibiotics (cephalothin) was achieved without negative interference from the presence of the bisphosphonate (clodronate) which, in turn, successfully bonded to the coating surface. To our knowledge, this is the first study that indicates the possibility to simultaneously incorporate both antibiotics and bisphosphonates to an implant coating, a strategy that is believed to improve implant stability and reduce implant-related infections.
Assuntos
Antibacterianos/administração & dosagem , Materiais Biomiméticos/química , Materiais Revestidos Biocompatíveis/química , Difosfonatos/administração & dosagem , Durapatita/química , Biomimética , Biotecnologia , Cefalotina/administração & dosagem , Ácido Clodrônico/administração & dosagem , Preparações de Ação Retardada , Implantes de Medicamento/química , Humanos , Teste de Materiais , Infecções Relacionadas à Prótese/prevenção & controle , Propriedades de SuperfícieRESUMO
Between November 1996 and December 2006, two cases of early-onset and one case of late-onset neonatal listeriosis were reported in San Luis, Argentina. This article describes clinical and laboratory findings as well as treatment and outcome for newborns treated for Listeria monocytogenes meningitis or septicaemia. In one of the newborns with early-onset listeriosis, meningitis led to important complications including hydrocephalus. The two other newborns showed complete recovery following adequate treatment. The L. monocytogenes isolates from two patients belonged to PCR group IVb (including serovar 4b strains) and to PCR group IIb (including serovar 1/2b strains) in the third patient. Listeriosis, especially the maternal-fetal presentation, is still rare in Argentina for unknown reasons. Our data can be used in the future as an epidemiological survey.
Assuntos
Doenças do Prematuro/epidemiologia , Meningite por Listeria/epidemiologia , Adulto , Ampicilina/administração & dosagem , Ampicilina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Argentina/epidemiologia , Ceftriaxona/uso terapêutico , Cefalotina/administração & dosagem , Cefalotina/uso terapêutico , Derivações do Líquido Cefalorraquidiano , DNA Bacteriano/análise , Quimioterapia Combinada , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/microbiologia , Listeria monocytogenes/classificação , Listeria monocytogenes/isolamento & purificação , Masculino , Meningite por Listeria/complicações , Meningite por Listeria/microbiologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/complicaçõesRESUMO
This prospective study was conducted to assess the influence of antibiotics use on surgical site infections (SSI) rates after reduction mammaplasty. Patients undergoing reduction mammaplasty were assigned to group 1 (n = 50), which received intravenous cephalotin pre- and postoperatively, besides oral cephalexin for 6 days after discharge, or to group 2 (n = 50), which received no antibiotics. Patients were followed up weekly for 30 days, regarding to SSI, by a blinded surgeon. The Centers for Disease Control and Prevention definitions and classification of SSI were adopted. There was no statistical difference between the groups in regard to age, body mass index, duration of operation, and total resection weight. SSI rates were 2% and 14% in groups 1 and 2, respectively (P = 0.03). In group 2, older patients and those with higher resection weight had significant higher SSI rates (P = 0.02 and P = 0.04, respectively). We observed that antibiotics use decreased SSI rates after reduction mammaplasty.
Assuntos
Antibioticoprofilaxia , Mamoplastia/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Oral , Adolescente , Adulto , Idoso , Cefalexina/administração & dosagem , Cefalotina/administração & dosagem , Distribuição de Qui-Quadrado , Feminino , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
The possibility to fast-load biomimetic hydroxyapatite coatings on surgical implant with the antibiotics Amoxicillin, Gentamicin sulfate, Tobramycin and Cephalothin has been investigated in order to develop a multifunctional implant device offering sustained local anti-bacterial treatment and giving the surgeon the possibility to choose which antibiotics to incorporate in the implant at the site of surgery. Physical vapor deposition was used to coat titanium surfaces with an adhesion enhancing gradient layer of titanium oxide having an amorphous oxygen poor composition at the interface and a crystalline bioactive anatase TiO(2) composition at the surface. Hydroxyapatite (HA) was biomimetically grown on the bioactive TiO(2) to serve as a combined bone in-growth promoter and drug delivery vehicle. The coating was characterized using scanning and transmission electron microscopy, X-ray diffraction and X-ray photoelectron spectroscopy. The antibiotics were loaded into the HA coatings via soaking and the subsequent release and antibacterial effect were analyzed using UV spectroscopy and examination of inhibition zones in a Staphylococcus aureus containing agar. It was found that a short drug loading time of 15 min ensured antibacterial effects after 24 h for all antibiotics under study. It was further found that the release processes of Cephalothin and Amoxicillin consisted of an initial rapid drug release that varied unpredictably in amount followed by a reproducible and sustained release process with a release rate independent of the drug loading times under study. Thus, implants that have been fast-loaded with drugs could be stored for ~10 min in a simulated body fluid after loading to ensure reproducibility in the subsequent release process. Calculated release rates and measurements of drug amounts remaining in the samples after 22 h of release indicated that a therapeutically relevant dose could be achieved close to the implant surface for about 2 days. Concluding, the present study provides an outline for the development of a fast-loading slow-release surgical implant kit where the implant and the drug are separated when delivered to the surgeon, thus constituting a flexible solution for the surgeon by offering the choice of quick addition of antibiotics to the implant coating based on the patient need.
Assuntos
Antibacterianos/administração & dosagem , Materiais Revestidos Biocompatíveis/química , Sistemas de Liberação de Medicamentos , Ágar/química , Amoxicilina/administração & dosagem , Biomimética , Cefalotina/administração & dosagem , Durapatita/química , Gentamicinas/administração & dosagem , Humanos , Testes de Sensibilidade Microbiana , Staphylococcus aureus/metabolismo , Fatores de Tempo , Titânio/química , Tobramicina/administração & dosagemRESUMO
BACKGROUND: The antibiotics used for prophylaxis during surgery may influence the rate of surgical site infections. Tetracyclines are attractive having a long half-life and few side effects when used in a single dose regimen. We studied the rate of surgical site infections during changing regimens of antibiotic prophylaxis in medium and major size surgery. METHODS: Prospective registration of surgical site infection following intestinal resections and hysterectomies was performed. Possible confounding procedure and patient related factors were registered. The study included 1541 procedures and 1489 controls. The registration included time periods when the regimen was changed from doxycycline to cephalothin and back again. RESULTS: The SSI in the colorectal department increased from 19% to 30% (p=0.002) when doxycycline was substituted with cephalothin and decreased to 17% when we changed back to doxycycline (p=0.005). In the gynaecology department the surgical site infection rate did not increase significantly. Subgroup analysis showed major changes in infections in rectal resections from 20% to 35% (p=0.02) and back to 12% (p=0.003). CONCLUSION: Doxycycline combined with metronidazole, is an attractive candidate for antibiotic prophylaxis in medium and major size intestinal surgery.
Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Cefalotina/administração & dosagem , Doxiciclina/administração & dosagem , Intestinos/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso , Cesárea , Feminino , Humanos , Histerectomia , Masculino , Metronidazol/administração & dosagemRESUMO
A castração química é utilizada para castrar cães machos a um custo mais baixo que o procedimento cirúrgico, que é o método mais aplicado para castrar cães e gatos. A castração química é um procedimento mais simples que a castração cirúrgica e pode ser realizada a nível ambulatorial, sem necessidade de anestesia geral. Entretanto, devido ao estresse pela manipulação e ao desconforto produzido pela injeção de uma substância no interior dos testículos, faz-se necessária uma sedação para que a castração química seja efetuada de um modo que proporcione o bem-estar do animal. Assim, este artigo tem como objetivo propor um protocolo inovador para sedação de cães submetidos à castração química. Para isso, foram utilizados 12 cães submetidos à administração de xilazina em subdose no acuponto yin tang. Após o estabelecimento da sedação, os cães foram castrados quimicamente. O protocolo proposto permitiu que a castração química fosse realizada com conforto para o paciente e para a equipe de médicos veterinários. Desta forma, concluiu-se que o protocolo de sedação é seguro e pode ser empregado em cães para procedimentos não invasivos, como exames, coleta de material e outros processos ou técnicas semelhantes.
Chemical castration is used to spay male dogs at a lower cost than the surgical procedure, which is the most applied method to spay dogs and cats. Chemical castration is a simpler procedure than surgical castration and can be performed on an outpatient basis, without the need for general anesthesia. However, due to the stress caused by manipulation and the discomfort produced by the injection of a substance into the testicles, sedation is necessary so that chemical castration is to be carried out in a way that provides the animal's welfare. Thus, this article aims to propose an innovative protocol for sedation of dogs submitted to chemical castration. For this purpose, twelve dogs submitted to the administration of xylazine in subdosis in the yin-tang acupoint were used. After the establishment of sedation, the dogs were chemically neutered. The proposed protocol allowed chemical castration to be performed with comfort for the patient and the team of veterinarians. Therefore, it is concluded that the sedation protocol is safe and can be used in dogs for non-invasive procedures such as exams, material collection, and other similar processes or techniques.
Assuntos
Animais , Masculino , Cães , Xilazina/administração & dosagem , Analgesia por Acupuntura/veterinária , Cefalotina/administração & dosagem , Acupuntura/métodos , Meloxicam/administração & dosagem , Orquiectomia/métodos , Orquiectomia/veterináriaRESUMO
The present study aimed to evaluate the influence of local administration of gentamicin or cephalothin on the healing of surgical wounds in dogs. Thirty healthy dogs were submitted to surgical castration. They were divided into 2 groups of 15 animals. After the surgical procedure, two 0.6 cm circular cutaneous wounds were made in the abdominal region. Group 1 received 0.1 ml of 0.9% saline in one wound and 0.1 ml of gentamicin (40 mg / ml) in the other wound; and group 2 received 0.1 ml of 0.9% saline and 0.1 ml of cephalothin (200 mg / ml); respectively. All wounds were sutured and assessed macroscopically 1, 3 and 10 days after the operation. On day 10, an incisional biopsy was performed for histopathological evaluation. All analyzes of macroscopic variables did not show significant differences between groups (P <0.05). There were no significant differences between groups for microscopic evaluation of collagenization, vascularization, edema and inflammatory cells (P <0.05). Thus, the topical use of the tested antibiotics does not influence skin healing in dogs.
O presente estudo teve como objetivo avaliar a influência da administração local de gentamicina ou cefalotina na cicatrização de feridas cirúrgicas em cães. Trinta cães saudáveis foram submetidos à cirurgia de castração. Eles foram divididos em 2 grupos de 15 animais. Após o procedimento cirúrgico, foram feitas duas feridas cutâneas circulares de 0,6 cm na região abdominal. O grupo 1 recebeu 0,1 ml de soro fisiológico 0,9% em uma ferida e 0,1 ml de gentamicina (40 mg/ml) na outra ferida; e o grupo 2 recebeu 0,1 ml de soro fisiológico 0,9% e 0,1 ml de cefalotina (200 mg/ml); respectivamente. Todas as feridas foram suturadas e avaliadas macroscopicamente 1, 3 e 10 dias após a operação. No dia 10, foi realizada biópsia incisional para avaliação histopatológica. Todas as análises das variáveis macroscópicas não mostraram diferenças significativas entre os grupos (P<0,05). Não houve diferenças significativas entre os grupos para avaliação microscópica da colagenização, vascularização, edema e células inflamatórias (P<0,05). Assim, o uso tópico dos antibióticos testados não influencia na cicatrização da pele em cães.
Assuntos
Animais , Cães , Cicatrização/efeitos dos fármacos , Gentamicinas/administração & dosagem , Cefalotina/administração & dosagem , Complicações Pós-Operatórias/veterinária , Antibacterianos/administração & dosagemRESUMO
UNLABELLED: ⦠BACKGROUND: The standard treatment of peritoneal dialysis (PD)-associated peritonitis (PD-peritonitis) is intraperitoneal (IP) administration of antibiotics. Only limited data on the pharmacokinetics and appropriateness of contemporary dose recommendations of IP cefalothin and cefazolin exist. The aim of this study was to describe the pharmacokinetics of IP cefalothin and cefazolin in patients treated for PD-peritonitis. ⦠METHODS: As per international guidelines, IP cefalothin or cefazolin 15 mg/kg once daily was dosed with gentamicin in a 6-hour dwell to patients with PD-peritonitis during routine care. Serial plasma and PD effluent samples were collected over the first 24 hours of therapy. Antibiotic concentrations were quantified using a validated chromatographic method with pharmacokinetic analysis performed using a non-compartmental approach. ⦠RESULTS: Nineteen patients were included (cefalothin n = 8, cefazolin n = 11). The median bioavailability for both antibiotics exceeded 92%, but other pharmacokinetic parameters varied markedly between antibiotics. Both antibiotics achieved high PD effluent concentrations throughout the antibiotic dwell. Cefazolin had a smaller volume of distribution compared with cefalothin (14 vs 40 L, p = 0.003). The median trough total plasma antibiotic concentration for cefazolin and cefalothin during the dwell differed (plasma 56 vs 13 mg/L, p < 0.0001) despite a similar concentration in PD effluent (37 vs 38 mg/L, p = 0.58). Lower antibiotic concentrations were noted during PD dwells not containing antibiotic, particularly cefalothin, which was frequently undetectable in plasma and PD effluent. The median duration that the unbound antibiotic concentration was above the minimum inhibitory concentration (MIC) was approximately 13% (plasma) and 25% (IP) for cefalothin, and 100% (plasma and IP) for cefazolin, of the dosing interval. ⦠CONCLUSIONS: When IP cefalothin or cefazolin is allowed to dwell for 6 hours, sufficient PD effluent concentrations are present for common pathogens during this time. However, with once-daily IP dosing, in contrast to cefazolin, there is a risk of subtherapeutic plasma and PD effluent cefalothin concentrations, so more frequent dosing may be required.
Assuntos
Antibacterianos/farmacocinética , Cefazolina/farmacocinética , Cefalotina/farmacocinética , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Peritonite/tratamento farmacológico , Adulto , Idoso , Antibacterianos/administração & dosagem , Disponibilidade Biológica , Cefazolina/administração & dosagem , Cefalotina/administração & dosagem , Feminino , Gentamicinas/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Estudos ProspectivosRESUMO
A combination of amikacin sulfate given by continuous infusion (800 mg/sq m/24 hr) plus cephalothin sodium (2 g every four hours) was used as initial empiric therapy for the treatment of 65 evaluable febrile (greater than 38.5 degrees C) episodes in 54 granulcoytopenic (neutrophils, less than 1,000/microliter) adult cancer patients. Carbenicillin disodium (5 g every four hours) was substituted for cephalothin in patients with Pseudomonas infections and in patients in whom the initial regimen was unsuccessful. Thirty-two of the 38(84%) identifiable infections responded to therapy, including all of the eight septicemias and eight of 11 pneumonias. Three additional infections responded to the substitution of carbenicillin for cephalothin, for a total response rate of 92% (35/38). Nephrotoxicity occurred in five patients (7.1%), most commonly in patients over 60 years of age. Ototoxicity, highly correlated with a duration of greater than 19 days and a total dosage of greater than 25 g of amikacin sulfate, occurred in four patients (5.6%). Amikacin given by continuous infusion plus cephalothin is a safe and efficacious empiric therapy for infections in granulocytopenic cancer patients.
Assuntos
Amicacina/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Cefalotina/administração & dosagem , Doença de Hodgkin/complicações , Canamicina/análogos & derivados , Leucemia/complicações , Doença Aguda , Amicacina/uso terapêutico , Infecções Bacterianas/etiologia , Cefalotina/uso terapêutico , Quimioterapia Combinada , Bactérias Aeróbias Gram-Negativas/isolamento & purificação , Bactérias Anaeróbias Gram-Negativas/isolamento & purificação , Humanos , Infusões ParenteraisRESUMO
Variable degrees of acute renal failure developed in three patients receiving therapy with cephalothin sodium. The course and findings were consistent with acute tubular necrosis of the oliguric and nonoliguric types. One patient had protracted oliguria, a second experienced transient oliguria, and one had normal urine output. All had urinary sediment changes consistent with tubular necrosis, and the two oliguric patients had elevated urine sodium concentrations. No other causes for renal failure could be detected, and all recovered after discontinuation of cephalothin therapy, although peritoneal dialysis was required in one patient. These observations indicate that cephalothin is capable of inducing renal damage in man.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Cefalotina/efeitos adversos , Injúria Renal Aguda/diagnóstico , Adulto , Idoso , Nitrogênio da Ureia Sanguínea , Celulite (Flegmão)/tratamento farmacológico , Cefalotina/administração & dosagem , Cefalotina/uso terapêutico , Creatinina/sangue , Empiema/tratamento farmacológico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Injeções Intravenosas , Túbulos Renais/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Oligúria/induzido quimicamente , Infecções Estafilocócicas/tratamento farmacológicoRESUMO
Two patients developed acute tubular necrosis, characterized clinically by acute oliguric renal failure, while they were receiving a combination of cephalothin sodium and gentamicin sulfate therapy. Patients who are given this drug regimen should be observed very carefully for early signs of nephrotoxicity. High doses of this antibiotic combination should be avoided especially in elderly patients. Patients with renal insufficiency should not be given this regimen.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Cefalotina/efeitos adversos , Gentamicinas/efeitos adversos , Necrose Tubular Aguda/induzido quimicamente , Idoso , Nitrogênio da Ureia Sanguínea , Broncopneumonia/tratamento farmacológico , Cefalotina/administração & dosagem , Cefalotina/uso terapêutico , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Humanos , Túbulos Renais/patologia , Pessoa de Meia-Idade , Infecções por Proteus/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológicoRESUMO
Antibiotic combination-associated nephrotoxicity was reviewed in 491 granulocytopenic patients with cancer and fever. Nephrotoxicity was defined as a rise in the serum creatinine level of more than 0.4 mg/dL. The different aminoglycosides, when combined with ticarcillin disodium, were found to have an equivalent nephrotoxic potential and, for the purpose of analysis, were combined and termed "aminoglycoside plus ticarcillin" (Ags + ticarcillin). Groups treated with gentamicin or amikacin plus cephalothin sodium were combined and termed "aminoglycoside plus cephalothin" (Ags + cephalothin). The rate of nephrotoxicity was statistically less for the Ags + ticarcillin group, eight (3.1%) of 262 patients, than for the Ags + cephalothin group, 23 (18.3%) of 126 patients. Age greater than 50 years was a potentiating factor for the occurrence of nephrotoxicity in the Ags + cephalothin group. We have concluded that for granulocytopenic patients with cancer and fever, the antibiotic combination of the Ags + cephalothin should not be used as empiric antibiotic therapy.
Assuntos
Agranulocitose/complicações , Antibacterianos/efeitos adversos , Nefropatias/induzido quimicamente , Neoplasias/complicações , Adolescente , Adulto , Idoso , Aminoglicosídeos/administração & dosagem , Aminoglicosídeos/efeitos adversos , Cefalotina/administração & dosagem , Cefalotina/efeitos adversos , Ensaios Clínicos como Assunto , Creatinina/sangue , Quimioterapia Combinada , Humanos , Controle de Infecções , Nefropatias/complicações , Pessoa de Meia-Idade , Distribuição Aleatória , Ticarcilina/administração & dosagem , Ticarcilina/efeitos adversosRESUMO
BACKGROUND: Closed suction drainage after joint arthroplasty is common practice in many institutions. The purpose of this study was to determine the correlation between routine drain tip culture and the diagnosis of superficial or deep postoperative wound infection after primary knee and hip replacement. METHODS: Over a 12-month period, drain tips were retrieved and cultured in all patients who underwent unilateral primary total knee or hip replacement with the use of closed suction drainage. A total of 393 cultures was performed in 387 patients (145 hip replacements, 242 knee replacements). Patients were followed for an average of 8.9 months after surgery to assess for postoperative wound infection. RESULTS: Three patients had a positive drain tip culture, none of which were diagnosed with superficial or deep infection. Four patients (1%) were diagnosed with deep infection, 16 (4.1%) with superficial infection. No patient with either superficial or deep infection had a positive drain tip culture after their index procedure. The sensitivity of routine drain tip culture for the diagnosis of postoperative infection in primary joint replacement was 0% and specificity was 99.2%. CONCLUSIONS: These data do not support the practice of routine drain tip culture after primary hip or knee replacement for the diagnosis of postoperative infection.
Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Infecção da Ferida Cirúrgica/microbiologia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Cefalotina/administração & dosagem , Cefalotina/uso terapêutico , Seguimentos , Humanos , Técnicas Microbiológicas , Estudos Retrospectivos , Sucção/instrumentação , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de TempoRESUMO
PURPOSE: The aim of this study was to determine the rate of complications after routine syndesmotic screw removal. MATERIALS AND METHODS: All patients who underwent syndesmotic screw removal at our hospital between 2007 and 2012 were included in the study. Patient demographics, surgical characteristics, radiographic evaluation and complications were recorded from the patients' charts. Questionnaires were sent by postal mail to all patients, to measure patient satisfaction and pain (VAS scales). RESULTS: 161 patients were included in the trial. A wound infection was found in 8 (5%) patients. 3 were regarded as serious infections requiring hospitalisation and intravenous antibiotics, 2 of those required surgical revisions. 5 patients were treated by oral antibiotics. Staphylococcus aureus was identified as the causing organism in all (6/8) cases with a positive culture. The patients with postoperative infection reported more pain (5.3 vs. 2.3; p=0.02) and were less satisfied (4.7 vs. 7.6; p=0.014) with their ankle compared to those without infection (T-test for independent samples). CONCLUSION: There were 5% wound infections after routine syndesmotic screw removal. Routine antibiotic prophylaxis effective against S. aureus should be administered when removing syndesmotic screws. In our institution we now use one single dose Cefalotin of 2g intravenously 30-60min before screw removal.
Assuntos
Traumatismos do Tornozelo/cirurgia , Antibioticoprofilaxia , Parafusos Ósseos/microbiologia , Remoção de Dispositivo/métodos , Fraturas Ósseas/cirurgia , Complicações Pós-Operatórias/microbiologia , Infecções Estafilocócicas/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cefalotina/administração & dosagem , Remoção de Dispositivo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Satisfação do Paciente , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Recuperação de Função Fisiológica , Estudos Retrospectivos , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/isolamento & purificação , Inquéritos e Questionários , Resultado do TratamentoRESUMO
One recognized complication of trabeculectomy with visually devastating potential is blebitis. We present a case of a 74-year-old woman with a culture and polymerase chain reaction-positive Abiotrophia defectiva bleb-associated endophthalmitis. Abiotrophia defectiva is a rare but possible cause of endophthalmitis secondary to blebitis and should be considered in culture-negative cases. Prompt identification, hence directed eradication, of the causative organism in such visually threatening cases may be facilitated by requesting polymerase chain reaction and 16S ribosomal RNA sequencing.
Assuntos
Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Estruturas Criadas Cirurgicamente/microbiologia , Abiotrophia , Idoso , Antibacterianos/uso terapêutico , Atropina/administração & dosagem , Ceftazidima/uso terapêutico , Cefalotina/administração & dosagem , Quimioterapia Combinada , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Injeções Intravítreas , Implante de Lente Intraocular , Midriáticos/administração & dosagem , Facoemulsificação , Reação em Cadeia da Polimerase , RNA Bacteriano/genética , RNA Ribossômico 16S , Trabeculectomia , Vancomicina/uso terapêutico , Corpo Vítreo/microbiologiaRESUMO
The results of empiric antibiotic therapy in 126 hospitalized patients with fever during 192 episodes of granulocytopenia were studied. Febrile granulocytopenic patients were randomly allocated to receive either carbenicillin, methicillin and gentamicin, or carbenicillin and cephalothin. The response rate for the two antibiotic regimens was similar, 49 (60 per cent) of 81 responded to the former and 42 (54 per cent) of 78 to the latter. The response rate in patients receiving other antibiotics because of specific indications or counterindications was 19 (58 per cent) of 33. Thirty-nine (35 per cent) of 110 patients who responded to initial antibiotic therapy had an increase in circulating granulocytes of one log10 or more compared to only 10 (12 per cent) of 79 nonresponders with such an increase. The mortality rate in adult patients receiving carbenicillin, methicillin and gentamicin was eight (16 per cent) of 51, compared to 18 (37 per cent) of 49 in those receiving cephalothin and carbenicillin (P less than 0.05). The significance of this difference in the initial response rate or mortality rate between patients treated with the two antibiotic regimens when only patients with documented bacterial infection were considered. Patients who responded to their initial antibiotic regimen, and patients for whose fever no explanation was found, had the best prognosis.
Assuntos
Agranulocitose/complicações , Carbenicilina/administração & dosagem , Cefalotina/administração & dosagem , Febre/tratamento farmacológico , Gentamicinas/administração & dosagem , Meticilina/administração & dosagem , Adolescente , Agranulocitose/mortalidade , Carbenicilina/uso terapêutico , Cefalotina/uso terapêutico , Criança , Pré-Escolar , Quimioterapia Combinada , Febre/mortalidade , Febre de Causa Desconhecida/tratamento farmacológico , Gentamicinas/uso terapêutico , Granulócitos , Humanos , Contagem de Leucócitos , Meticilina/uso terapêutico , Estudos ProspectivosRESUMO
Peritonitis caused by Staphylococcus aureus in four patients undergoing continuous ambulatory peritoneal dialysis failed to respond to, or relapsed immediately after cessation of, intraperitoneal antibiotic therapy with vancomycin or cephalothin and tobramycin. Sequestration of viable staphylococci within polymorphonuclear leukocytes in the peritoneal fluid was suspected for two reasons: (1) staphylococci could still be grown after treatment of the dialysate cell fraction with lysostaphin, a procedure that kills only extracellular staphylococci, and (2) diminished polymorphonuclear leukocyte bactericidal activity was demonstrated in peritoneal dialysis effluent. Addition of rifampin, which readily penetrates polymorphonuclear leukocytes, to the treatment regimen of all patients led to prompt resolution of peritonitis without relapse.
Assuntos
Atividade Bactericida do Sangue , Neutrófilos/microbiologia , Diálise Peritoneal Ambulatorial Contínua , Diálise Peritoneal , Peritonite/etiologia , Infecções Estafilocócicas/etiologia , Adulto , Cefalotina/administração & dosagem , Criança , Feminino , Humanos , Lisostafina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Neutrófilos/fisiologia , Cavidade Peritoneal/microbiologia , Peritonite/tratamento farmacológico , Peritonite/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/crescimento & desenvolvimento , Tobramicina/administração & dosagem , Vancomicina/administração & dosagemRESUMO
A prospective randomized study was conducted in 200 patients undergoing coronary artery bypass surgery. All patients received intravenous (IV) cephalothin prophylaxis for 48 hours beginning with anesthetic induction. Group A (99 eligible patients) received cephalexin 500 mg po, qid for three extra days. Group B (94 eligible patients) received no oral therapy. The overall infection rate was 9.3 percent (18 patients). Six patients had multiple sites of involvement. There was no difference between group A (9.0 percent, nine patients) vs B (9.5 percent, nine patients) (p greater than 0.5). The median sternotomy infection rate, superficial or deep, was 2.6% (five patients). The surgical wound infection rate was 4.7 percent (nine patients). The overall infection rate compares favorably with that of high risk groups for clean surgical procedures defined in SENIC study. There was no advantage to prolonged oral cephalexin prophylaxis following coronary artery bypass (CAB) surgery.
Assuntos
Cefalexina/uso terapêutico , Cefalotina/uso terapêutico , Ponte de Artéria Coronária , Pneumonia/prevenção & controle , Pré-Medicação , Infecção da Ferida Cirúrgica/prevenção & controle , Infecções Urinárias/prevenção & controle , Cefalexina/administração & dosagem , Cefalotina/administração & dosagem , Ensaios Clínicos como Assunto , Esquema de Medicação , Humanos , Estudos Prospectivos , Distribuição Aleatória , Fatores de Risco , Fatores de TempoRESUMO
Efficient use of prophylactic antibiotics in surgery demands their presence in adequate serum concentration at the time of maximal potential contamination. This cover should extend from the moment of incision until at least the time of removal of large tubes and intravenous connulas. Critical cardiac contamination may occur during the bypass procedure while the operation within the cardiac chambers is being done. This is a special danger in valve replacement with prostheses. The antibiotic regimen of the Cardiothoracic Unit was studied in 12 consecutive patients and was generally found to provide adequate antibiotic coverage throughout the surgical procedure, including the bypass procedure. In all patients, a reinforcing cephalothin dose on completion of bypass ensured adequate circulating cephalothin levels for the completion of surgery. Clearance of the cephalothin from the blood of patients was found to decrease markedly during cardiopulmonary bypass.
Assuntos
Ponte Cardiopulmonar , Cefalotina/uso terapêutico , Circulação Extracorpórea , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Cefalotina/administração & dosagem , Cefalotina/metabolismo , Criança , Esquema de Medicação , Endocardite Bacteriana/prevenção & controle , Feminino , Humanos , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-IdadeRESUMO
A prospective, double-blind study comparing a 6 day with a 2 day regimen of cephalothin prophylaxis was conducted among 200 patients undergoing prosthetic valve replacement. No cases of endocarditis occurred during the 2 month follow-up. Sternal wound infection developed in 2.8 per cent of the 6 day group and 2.1 per cent of the 2 day group. Pneumonia developed in 8.5 per cent of the 6 day and 5.3 per cent of the 2 day group; most of the bacteria isolated were susceptible to cephalothin. Urinary tract infection developed more frequently in the 2 day group (17.0 versus 8.5 per cent), particularly during the first 6 postoperative days. Three of 11 patients with no detectable cephalothin in their sera at the close of operation developed staphylococcal wound infections, compared with 2 of 175 patients whose sera contained cephalothin at the close of surgery (p = 0.002, Fisher's exact test). A short course of prophylactic antibiotics is prudent, but there is no justification for prolonging their administration.