RESUMO
The majority of surgical infections are due to multiple bacterial pathogens, usually represented by mixtures of both aerobic and anaerobic species. Contamination from endogenous sources accounts for the majority of these infections. The most virulent of all such sepsis appears to arise from a symbiosis between aerobic gram-negative rods and various anaerobes. Antibiotics have proved efficacy in both the treatment as well as the prevention of surgical infection. The choice of antimicrobial agent(s) should be based upon the drug's spectrum of activity against known or anticipated pathogens, the biologic half-life of the agent, which serves as a guide to the frequency of administration, and the drug's safety. The third-generation cephalosporins have been shown to be especially useful because of their broad spectrum of activity, prolonged half-life, and limited toxicity. Sepsis that persists or is uncontrolled despite antibiotic administration often leads to failure of multiple organ systems. Only energetic surgical measures offer any real chance for patient survival when such a stage has been reached.
Assuntos
Infecções , Complicações Pós-Operatórias , Antibacterianos/uso terapêutico , Humanos , Infecções/diagnóstico , Infecções/tratamento farmacológico , Infecções/microbiologia , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Insuficiência de Múltiplos Órgãos/fisiopatologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
A technique for transduodenal sphincteroplasty is presented. T-tube decompression of the common bile duct and subphrenic space drainage are routinely avoided. To date, results in 123 consecutive patients have been excellent. The single most troublesome wound complication, duodenal fistula, had been avoided in the most recent 68 patients by colonic or omental onlay of serosa.
Assuntos
Ampola Hepatopancreática/cirurgia , Duodeno/cirurgia , Cálculos Biliares/cirurgia , Pancreatite/cirurgia , Esfíncter da Ampola Hepatopancreática/cirurgia , Ducto Colédoco/cirurgia , Humanos , Mucosa Intestinal/cirurgia , MétodosRESUMO
Although acute pancreatitis is relatively common, factors useful in predicting immediate outcome or likelihood of recurrence have seldom been studied in greater detail. A ten-year experience with 389 patients hospitalized for 821 separate episodes of acute pancreatitis was reviewed. The overall mortality was 6.7%, being highest on the first admission and considerably greater for white males. Respiratory complications accounting for 27% of the fatalities were the most common causes of death. The incidence of considerable morbidity was 19.5%. Clinical diagnoses of "shock" and "respiratory distress" were associated with mortalities of 88% and 71%, respectively. The overall recurrence rate was 50.1%, with little variation regardless as to the number of previous bouts. Recurrence was more likely if the patient was black, male, older than 30 years of age, and had experienced a second episode of acute pancreatitis. Admission data aid considerably in identifying high-risk patients in whom major complications develop, who die during the present episode, or who have a future recurrent bout of acute pancreatitis.
Assuntos
Pancreatite/mortalidade , Doença Aguda , Adolescente , Adulto , Idoso , Amilases/sangue , Temperatura Corporal , Cálcio/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/epidemiologia , Prognóstico , Recidiva , Estudos RetrospectivosRESUMO
A prospective study was conducted to determine the incidence of "silent" gastric regurgitation and aspiration during general anesthesia in 146 patients randomized with respect to presence of a nasogastric tube. A bland dye was instilled in the stomach to serve as the determinant marker. The overall incidence of regugitation was 8.9% and of aspiration, 2.1% in spite of the uniform use of an endotracheal tube. The incidence of regurgitation was twice as high when anesthesia was given by an inexperienced anesthetist (11% vs 5.6%) and in patients without nasogastric tubes (12% vs 6%), although such differences were not statistically significant. The primary agent used, difficulty of endotracheal intubation, location of surgical incision, and duration of anesthesia did not alter the incidence of regurgitation or aspiration. No correlation was found between the detection of subclinical aspiration and the development of postoperative pulmonary complications.
Assuntos
Refluxo Gastroesofágico , Intubação Gastrointestinal , Procedimentos Cirúrgicos Operatórios , Adolescente , Adulto , Idoso , Anestesia Endotraqueal , Anestesia Geral , Suco Gástrico , Refluxo Gastroesofágico/epidemiologia , Georgia , Humanos , Concentração de Íons de Hidrogênio , Inalação , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
We reviewed the charts of 2,567 patients from 11 prospective clinical trials of antibiotic therapy for surgical infection to identify reliable predictors of sepsis eradication. Particular attention was paid to temperature, blood cell counts, renal and hepatic function tests, arterial gases, and clotting factors, both at the termination of parenteral antibiotic administration as well as at patient discharge from the hospital. On the discontinuation of antibiotic therapy, sepsis recurred in 19% of the patients who had a normal rectal temperature, in 3% of the patients if the rectal temperature and WBC count were normal, but in no patient when both the temperature and WBC count were normal and the differential blood smear contained less than 73% granulocytes and less than 3% immature forms. Rates for recurrent sepsis, once antibiotic therapy was discontinued for more than 48 hours, were 8%, 2%, and 0%, respectively, for the same criteria at hospital discharge.
Assuntos
Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Peritonite/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Abscesso/etiologia , Antibacterianos/administração & dosagem , Temperatura Corporal , Granulócitos , Humanos , Contagem de Leucócitos , Alta do Paciente , Peritonite/etiologia , Contagem de Plaquetas , Complicações Pós-Operatórias , Probabilidade , Recidiva , RiscoRESUMO
During 31 months of study, 808 patients with polymicrobial surgical infection were randomized for antibiotic therapy between a third-generation cephalosporin (moxalactam disodium [149], cefotaxime sodium [125], and cefoperazone sodium [141]) and the combination of gentamicin sulfate plus clindamycin (393). Results based on antibiotic therapy included the following: cure in 83% given cephalosporin, 73% with antibiotic combination; control but recurrent sepsis in 7% and 15%; and failure in 4% and 8%, respectively. Such data support the tenet that third-generation cephalosporins are at least equal, if not superior, to the combination of gentamicin plus clindamycin for treatment of polymicrobial surgical sepsis.
Assuntos
Infecções Bacterianas/tratamento farmacológico , Cefalosporinas/uso terapêutico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Abscesso/tratamento farmacológico , Abscesso/etiologia , Adolescente , Adulto , Idoso , Bactérias/efeitos dos fármacos , Infecções Bacterianas/complicações , Cefoperazona , Cefotaxima/uso terapêutico , Cefamicinas/uso terapêutico , Criança , Clindamicina/efeitos adversos , Clindamicina/uso terapêutico , Ensaios Clínicos como Assunto , Feminino , Gentamicinas/efeitos adversos , Gentamicinas/uso terapêutico , Humanos , Nefropatias/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Moxalactam , Doenças Peritoneais/tratamento farmacológico , Doenças Peritoneais/etiologia , Peritonite/tratamento farmacológico , Peritonite/etiologia , Complicações Pós-Operatórias , Distribuição Aleatória , Infecção da Ferida Cirúrgica/etiologiaRESUMO
This prospective, open, consecutive, nonrandomized trial examined management techniques and outcome in severe peritonitis. A total of 239 patients with surgical infection in the abdomen and an APACHE (acute physiology and chronic health evaluation) II score greater than 10 were studied. Seventy-seven patients (32%) died. Reoperation had a 42% mortality rate (35 of 83 patients died) compared with a 27% mortality rate (42 of 156 died) in patients who did not undergo reoperation. Forty-six patients underwent one reoperation; 15, two reoperations; 10, three reoperations; five, four reoperations; and seven, five reoperations, with mortality rates of 43%, 40%, 30%, 40%, and 57%, respectively. There was no significant difference in mortality between patients treated with a "closed-abdomen technique" (31% mortality) and those treated with variations of the "open-abdomen" technique (44% mortality). Logistic regression analysis showed that a high APACHE II score, low serum albumin level, and high New York Heart Association cardiac function status were significantly and independently associated with death. Low serum albumin level, youth, and high APACHE II score were significantly and independently associated with reoperation.
Assuntos
Infecções Bacterianas/cirurgia , Peritonite/microbiologia , Peritonite/cirurgia , Abdome/cirurgia , Dor Abdominal/cirurgia , Abscesso/cirurgia , Fatores Etários , Idoso , Transfusão de Sangue , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reoperação , Albumina Sérica/análise , Índice de Gravidade de Doença , Infecção da Ferida Cirúrgica/etiologia , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
The first reported case of traumatic rupture of a horseshoe kidney with partial ureteral duplication and an associated supernumerary kidney is presented. A review of the incidence, hypothesis of embryogenesis, associated anomalous development, and acute surgical management of this unique renal anomaly is provided.
Assuntos
Rim/anormalidades , Ureter/anormalidades , Adulto , Humanos , Rim/cirurgia , Masculino , Ruptura/cirurgiaRESUMO
Information concerning the efficacy of prophylactic antibiotics in patients sustaining penetrating abdominal trauma is limited. Duration of such therapy is also uncertain. Thus a prospective, randomized, double-blind study was performed at Grady Memorial and City of Memphis Hospitals. A total of 360 patients sustaining penetrating abdominal trauma were randomized to one of three groups: group 1, cefotaxime perioperatively only; group 2, cefotaxime perioperatively plus postoperative doses every six hours for 24 hours; and group 3, cefazolin perioperatively plus postoperative doses every six hours for 24 hours. Postoperative infection of the incision or peritoneal cavity occurred in 20 (17%) of the patients in group 1, 13 (10%) in group 2, and 11 (9%) in group 3. Differences were not statistically significant. The occurrence of higher infection rates in group 1 may be explained by the greater number of patients sustaining shotgun wounds and rectal injuries. This study lends support to the practice of discontinuing antibiotic therapy on termination of the operative procedure. Cefotaxime has been found to be a reliable, effective agent for prophylaxis against infection in patients who have sustained penetrating abdominal trauma.
Assuntos
Traumatismos Abdominais/cirurgia , Antibacterianos/uso terapêutico , Pré-Medicação , Ferimentos Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Ensaios Clínicos como Assunto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos por Arma de Fogo/cirurgiaRESUMO
One hundred fifty-one patients with presumed aerobic-anaerobic mixed peritoneal infections were treated in a prospective, randomized trial with either cefotaxime alone (76) or the combination of gentamicin-clindamycin (75). Primary and complicating foci of sepsis were cultured for both aerobic and anaerobic pathogen identification and antibiotic susceptibility. In vitro aerobic disk sensitivities (114 isolates) to cefotaxime were 82% and to gentamicin, 88%; anaerobic agar-diffusion sensitivities (227 isolates) to cefotaxime were 87% and to clindamycin, 98%. Only enterococci and Pseudomonas sp were consistently resistant to cefotaxime. Infection was eliminated in 82% of those treated with cefotaxime and in 87% of those treated with the gentamicin-clindamycin combination, yet sepsis recurred in 11% of those treated with cefotaxime and in 13% for those given gentamicin-clindamycin. Five patients (7%) demonstrated nephrotoxicity for gentamicin. (Serum creatinine increased greater than 1.5 mg/100 ml over pretreatment levels.) Otherwise, incidence and severity of adverse reactions were identical for the two groups and consisted primarily of phlebitis and diarrhea. One patient in each treatment group died of uncontrolled sepsis. Although results suggested a laboratory superiority of gentamicin-clindamycin, there was a clinical equality in therapeutic benefit and a greater safety following the use of cefotaxime alone.
Assuntos
Infecções Bacterianas/tratamento farmacológico , Cefotaxima/uso terapêutico , Clindamicina/uso terapêutico , Gentamicinas/uso terapêutico , Peritonite/tratamento farmacológico , Adolescente , Adulto , Idoso , Infecções Bacterianas/microbiologia , Cefotaxima/efeitos adversos , Clindamicina/efeitos adversos , Quimioterapia Combinada , Feminino , Gentamicinas/efeitos adversos , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-IdadeRESUMO
The safety and efficacy of cefotaxime versus a combination of gentamicin and clindamycin were compared in a prospective, randomized study of 98 surgical patients with polymicrobial soft-tissue infection or septicemia. Forty-nine patients received cefotaxime (20 mg/kg every six hours), and 49 received gentamicin (1 mg/kg every eight hours) plus clindamycin (5 mg/kg every six hours); all drugs were given intravenously. Overall, there was no statistical difference in clinical response to the two regimens, infection being eliminated in 73% of the patients treated with cefotaxime and 71% of those given gentamicin plus clindamycin. Adverse effects were mild and self-limited in both treatment groups, although three patients treated with gentamicin plus clindamycin experienced some loss of renal function. Most aerobic gram-negative rods were sensitive to both cefotaxime and gentamicin, but anaerobes were slightly more sensitive to clindamycin than to cefotaxime. Cefotaxime appeared to be at least as effective as gentamicin plus clindamycin in the treatment of polymicrobial soft-tissue infections and septicemia, and, in light of the loss of renal function associated with the gentamicin-clindamycin regimen, somewhat safer. The high failure rate among patients on both regimens with septicemia of unknown origin (five of the nine treated with cefotaxime and two of the four treated with gentamicin and clindamycin), however, indicates the critical role of surgical management in the treatment of polymicrobial soft-tissue sepsis.
Assuntos
Cefotaxima/uso terapêutico , Clindamicina/uso terapêutico , Gentamicinas/uso terapêutico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Adolescente , Adulto , Idoso , Cefotaxima/efeitos adversos , Clindamicina/efeitos adversos , Ensaios Clínicos como Assunto , Quimioterapia Combinada , Feminino , Gentamicinas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Infecção da Ferida Cirúrgica/microbiologiaRESUMO
Reports in the surgical literature are conflicting as to whether appendectomy "in passing" during laparotomy for trauma or for some other disease state does or does not significantly increase patient morbidity or mortality. A chart survey of all appendectomies (342 for acute appendicitis and 146 as incidental procedures) performed on the trauma service of Grady Memorial Hospital over a 40 month period appeared to indicate that the wound infection rate (6.8 percent) was the same as that for acute simple or suppurative appendicitis (6.7 percent), whereas the intraabdominal sepsis rate (17.5 percent) paralleled that for more advanced gangrenous or perforative appendicitis (18.6 percent). Since the validity of a retrospective review is always open to question, a prospective, randomized trial was carried out only on patients with a negative abdominal exploration for trauma over a 22 month interval at the same trauma service. An odd second from the last digit hospital number dictated appendectomy, provided the appendix was readily accessible; an even digit in the same locus dictated retention of the appendix. In no patient did intraperitoneal sepsis develop, regardless of the procedure chosen. Wound infection rates were 1.8 percent for appendectomy (1 of 56), if local anatomic considerations precluded an easy appendectomy (0 of 45), and 3.6 percent for the control subjects without appendectomy (3 of 83). There were no deaths. These data cast considerable doubt on the reliability of retrospective reviews and support the generally accepted dictum that incidental appendectomy, especially in the trauma patient, can be a relatively innocuous procedure.
Assuntos
Apendicectomia , Infecção da Ferida Cirúrgica/etiologia , Traumatismos Abdominais , Doença Aguda , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Humanos , Laparotomia/efeitos adversos , Tempo de Internação , Estudos Prospectivos , Distribuição Aleatória , Estudos Retrospectivos , Ferimentos Penetrantes/complicaçõesRESUMO
During a 32 year period, 164 patients with 165 popliteal artery injuries were treated. One hundred twenty-five injuries were due to penetrating trauma, and 40 to blunt force. During the first decade reviewed, with ligation the main method of management, the amputation rate was 74 percent. Almost routine attempts at vascular repair over the ensuing 10 years reduced the amputation rate to 28 percent. During the final 12 years, six amputations were required for 81 injuries, thereby producing an amputation rate of only 6 percent. From this experience, the following principles of management have evolved: (1) early diagnosis is best accomplished by a careful history and detailed physical examination, not by arteriography; (2) thrombectomy followed by distal heparinization before repair is the best method for guaranteeing an adequate arterial outflow tract and thus successful revascularization; (3) resection of all injured vessels with reconstitution of continuity by the use of an interposed saphenous vein graft is often warranted to avoid tension; (4) popliteal vein repair should be performed when practical; and (5) subperiosteal fibulectomy-fasciotomy should be done routinely immediately after vascular repair.
Assuntos
Artéria Poplítea/lesões , Adolescente , Adulto , Idoso , Amputação Cirúrgica , Criança , Pré-Escolar , Fraturas Ósseas/complicações , Humanos , Lactente , Luxações Articulares/complicações , Traumatismos do Joelho/complicações , Ligadura , Métodos , Pessoa de Meia-Idade , Artéria Poplítea/cirurgia , Veia Poplítea/cirurgia , Veias/transplante , Ferimentos por Arma de Fogo , Ferimentos não Penetrantes , Ferimentos PerfurantesRESUMO
During a 7 month trial for therapy of polymicrobial surgical sepsis, intravenous antibiotic treatment was randomized between gentamicin (1 mg/kg every 8 hours) plus clindamycin (8 mg/kg every 6 hours), and the cephalosporin, ceftriaxone (1 g every 12 hours) in 197 patients, of whom 99 were being treated for peritonitis, 93 for soft tissue sepsis, and 5 for other forms of infection. No significant differences were noted in patient demographics, type of sepsis, associated disease states, surgical procedure, or causative aerobic or anaerobic pathogens. Results demonstrated approximately equivalent efficacy, although cure rates obtained with ceftriaxone in patients with soft tissue sepsis or intraabdominal abscess were superior to those achieved with combination gentamicin and clindamycin. There were no significant side effects with ceftriaxone therapy, such as the renal failure noted in six of the patients treated with gentamicin and clindamycin. We conclude that single agent treatment with ceftriaxone is preferable because of the greater safety and the longer dosing intervals.
Assuntos
Infecções Bacterianas/tratamento farmacológico , Cefotaxima/análogos & derivados , Clindamicina/administração & dosagem , Gentamicinas/administração & dosagem , Complicações Pós-Operatórias/tratamento farmacológico , Abdome/cirurgia , Abscesso/tratamento farmacológico , Adolescente , Adulto , Idoso , Cefotaxima/uso terapêutico , Ceftriaxona , Clindamicina/efeitos adversos , Ensaios Clínicos como Assunto , Quimioterapia Combinada , Feminino , Gentamicinas/efeitos adversos , Humanos , Nefropatias/induzido quimicamente , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Peritonite/tratamento farmacológico , Distribuição Aleatória , RecidivaRESUMO
The safety and effectiveness of a single 2 g preoperative dose of cefotetan to reduce postoperative infectious complications after colorectal surgery was compared with multiple 2 g perioperative doses of cefoxitin in 289 patients enrolled in a multicenter trial; of the 239 evaluable patients, 164 received cefotetan and 75, cefoxitin. No statistically significant difference was detected in the successful clinical response rates for cefotetan and cefoxitin (88 percent and 92 percent, respectively). The difference in median increase in oral body temperature before and after the study (2.5 degrees F for cefotetan and 2 degrees F for cefoxitin) was statistically but not clinically significant (p = 0.03). Although nearly four times as many cefotetan patients as cefoxitin patients had surgery lasting 4 hours or more, the satisfactory bacteriologic response rates for cefotetan and cefoxitin were similar (88 percent and 93 percent, respectively). Nonobese patients and patients whose surgical procedures lasted less than 4 hours treated with either drug had significantly higher success rates (p less than 0.01). The incidence of major wound infection was approximately 8 percent for both treatment groups. Mean concentrations of cefotetan in plasma, specimens of colon, and subcutaneous fat were 128 +/- 61.8 micrograms/ml, 57.2 +/- 40.4 micrograms/g, and 26.8 +/- 19.4 micrograms/g, respectively. The incidence of adverse reactions was 12 percent for each group, and no reaction was considered treatment-related, including changes in results of clinical laboratory tests. A single 2 g preoperative dose of cefotetan was as safe and effective as multiple doses of cefoxitin in the reduction of postoperative wound infections after colorectal surgery.
Assuntos
Cefoxitina/administração & dosagem , Cefamicinas/administração & dosagem , Colo/cirurgia , Pré-Medicação , Reto/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Cefotetan , Cefoxitina/uso terapêutico , Cefamicinas/uso terapêutico , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Distribuição AleatóriaRESUMO
Soft tissue infections are almost routinely the product of direct microbe inoculation through a bridged protective skin. Day of onset and clinical presentation reflect the causative pathogen(s) and course that should be taken in treatment. Exclusive of chronic states, only in the most fulminating cases are culture and antimicrobial drugs of any real value.
Assuntos
Infecções dos Tecidos Moles , Infecção da Ferida Cirúrgica , Infecções Bacterianas , Humanos , Fatores de TempoRESUMO
The treatment of 77 patients with wounds of the inferior vena cava admitted to Grady Hospital, Atlanta, Georgia, from January 1972 through December 1983, was reviewed. All injuries were identified by laporotomy and/or thoracotomy. Trauma resulted from gunshot wounds in 79 per cent of patients, stab wounds in 18 per cent, and blunt trauma in 3 per cent, with an overall mortality of 30 per cent. The chief determinates of survival were preoperative hypotension, location of the injury and the presence of other major vascular injuries. Of the 49 patients admitted in shock, 22 (45%) died, all of complications related to organ ischemia. Only one patient not hypotensive on admission succumbed. Of the 29 patients with at least one additional injury to a major vascular structure, 45 per cent died. The mortality of infrarenal and suprarenal injuries was relatively low (22% and 33% respectively), compared with retrohepatic and supradiaphragmatic injuries, both of which were fatal in 67 per cent of the cases. Despite advances in the care of the trauma patient, significant improvement in survival has not occurred, and the patient mortality has remained at 30 per cent.
Assuntos
Veia Cava Inferior/lesões , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Ferimentos por Arma de Fogo/mortalidade , Ferimentos por Arma de Fogo/cirurgia , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Ferimentos Perfurantes/mortalidade , Ferimentos Perfurantes/cirurgiaRESUMO
Bowel anastomoses, as performed on 181 dogs, were studied: (1) by interposing segments of colon into small bowel and vice versa, (2) by comparing clean anastomoses to those contaminated by feces before and after suturing, (3) with and without parenteral preoperative antibiotic, and (4) with and without coaptation of an inverted serosa. All animals with a timed sacrifice as well as an unexplained death had careful autopsy. Results demonstrated no difference in the healing capacity of large (91%) versus small (92%) intestine under identical circumstances. Intraluminal bacteria were of importance only if spillage caused contamination during operation and thereby subsequent infection of the peritoneal surface of the suture line. Peritonitis preceded all 28 leaks, yet the converse never occurred. Likelihood of a complicating peritonitis (67%) and thus an anastomotic leak (24%) was significantly reduced through the preoperative administration of prophylactic cefazolin (19 and 4%, respectively). A "serosal seal" also appeared important in obviating suture line disruption. Our data emphasize the value of an inverted and serosal lined anastomosis, bowel preparatory measures, prophylactic antibiotic, and the disruptive action of local bacterial peritonitis.
Assuntos
Intestino Grosso/cirurgia , Intestino Delgado/cirurgia , Deiscência da Ferida Operatória/etiologia , Animais , Cefazolina/administração & dosagem , Colo/transplante , Cães , Mucosa Intestinal/microbiologia , Jejuno/transplante , Peritonite/prevenção & controle , Deiscência da Ferida Operatória/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de Sutura , Transplante AutólogoRESUMO
A survey of the safety and effectiveness of tobramycin, a newly developed aminoglycoside antibiotic, was assessed in 116 septic surgical patients. For comparison, the final 52 cases were randomized with 51 similarly infected patients who were treated with gentamicin. The two antibiotics gave equally good results when evaluated bacteriologically and clinically. Nevertheless, gram-negative infections appeared more likely to be susceptible to tobramycin than to gentamicin. No toxicity to the liver or bone marrow was observed. Although there were 13 cases of nephrotoxicity and 4 of ototoxicity, only one instance of such an adverse drug reaction could be attributed to parenterally administered aminoglycoside alone. In fact, topical neomycin and established renal damage caused by prior episodes of shock or dehydration appeared to be significantly more responsible for such adverse effects.
Assuntos
Antibacterianos/uso terapêutico , Infecções/tratamento farmacológico , Procedimentos Cirúrgicos Operatórios , Infecção da Ferida Cirúrgica/tratamento farmacológico , Tobramicina/uso terapêutico , Adolescente , Adulto , Idoso , Bactérias/efeitos dos fármacos , Queimaduras/tratamento farmacológico , Criança , Pré-Escolar , Avaliação de Medicamentos , Resistência Microbiana a Medicamentos , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Humanos , Lactente , Injeções Intramusculares , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Peritonite/tratamento farmacológico , Fatores de Tempo , Tobramicina/administração & dosagem , Tobramicina/farmacologiaRESUMO
Aerobic and anaerobic cultures were taken immediately upon operative entry to the peritoneal cavity of 114 consecutive children undergoing appendectomy. Stage of appendicitis and clinical presentation could be closely correlated to specific patterns of peritoneal bacterial flora. It was found that appendiceal gangrene and perforation uniformly produce a polymicrobial peritonitis that is based on the symbiosis of aerobes with anaerobes. Ensuing wound and intra-abdominal septic complications were likewise mixed infections. Based on these findings, refinements in the diagnosis of appendiceal gangrene and perforation as well as rationales in the treatment of appendicitis have been discussed.