RESUMEN
The natural history of infective endocarditis has undergone remarkable changes over the past 100 years as regards both the demographic characteristics of the disease and changes in the incidence of the so-called diagnostic signs. Alongside these changes and the development of new and better diagnostic tools and criteria, we are also facing new problems with the precise definition of cardiovascular infections and calculation of the incidence of the disease. Nosocomial endocarditis presents an emerging problem of diagnosis and treatment after heart valve surgery, with pace-maker catheters, defibrillators and a very large variety of foreign materials used in connection with heart valve surgery. New technological progress including new types of prosthetic valves and use of homografts or the Ross operation will give a greater possibility of choosing the best solution in a particular case. Antimicrobial chemotherapy is mainly based on our understanding of the pathophysiology of the disease and efficacy of the antibiotics achieved in an experimental animal model of endocarditis. Important recommendations of single or combined drug therapy or the dosing regimens of antibiotics are still an expression of expert opinion not always supported by experimental or clinical proof. A typical example is the recommendation of two divided doses of gentamicin for treatment of streptococcal endocarditis. Nevertheless, it is the author's opinion that the development of uncomplicated, easy to handle diagnostic and treatment regimens are justified in order to achieve better compliance with these recommendations.
Asunto(s)
Antibacterianos/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Vasculitis/tratamiento farmacológico , Antibacterianos/historia , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/historia , Infección Hospitalaria/cirugía , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/historia , Endocarditis Bacteriana/cirugía , Historia del Siglo XX , Humanos , Vasculitis/complicaciones , Vasculitis/historia , Vasculitis/cirugíaRESUMEN
A modified rat model of endocarditis with catheterization for 2 days was established in female Lewis rats using different inocula of Enterococcus faecalis (strain no. EF 19) in order to measure IgG antibodies in serum during the course of infection. Increasing the inocula intravenously resulted in an increase in the CFU/g vegetation and the CFU/g spleen, the ID50 being about 10 CFU/ml and the ID90 about 1x10(2) CFU/ml. The lowest bacterial inoculum infecting 100% of the rats was 3x10(3) CFU/ml, and for further investigations we used this inoculum size. Rats were sacrificed on day 2, 5, 7, 9, 11 and 28 after infection. The CFU/g vegetation and the CFU/g spleen increased until day 7 and then decreased. Serum samples were collected from 129 rats at different times after challenge. Three different ELISA systems were established to measure the IgG antibody responses: E. faecalis sonicate ELISA (a pool of four sonicates of strain no. EF 10, EF 11, EF 19 and EF 48), E. faecalis whole cell ELISA (strain no. EF 19) and E. faecalis purified cell wall ELISA (strain no. EF 19). An IgG antibody response was detected already on day 2, and except for a minor decrease on day 6/7 the antibody response continued to increase until day 14 (whole cell ELISA and sonicate ELISA) and day 21 (purified cell wall ELISA) when a plateau was reached. Significant increases in IgG antibody responses (p<0.05) were found between groups of rats from days 0-2, 2-8/9 and 8/9-14 in the E. faecalis whole cell and sonicate ELISAs and from days 0-2, 2-10/11 and 10/11-21 in the E. faecalis purified cell wall ELISA. In conclusion, we established a model of endocarditis in rats with catheterization for 2 days and were able to demonstrate an increase in IgG antibodies during the course of infection.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Enterococcus faecalis/aislamiento & purificación , Infecciones por Bacterias Grampositivas/diagnóstico , Animales , Western Blotting , Fraccionamiento Celular , Pared Celular/química , Pared Celular/inmunología , Reacciones Cruzadas , Modelos Animales de Enfermedad , Electroforesis en Gel de Poliacrilamida , Endocarditis Bacteriana/inmunología , Endocarditis Bacteriana/patología , Enterococcus faecalis/inmunología , Ensayo de Inmunoadsorción Enzimática , Femenino , Infecciones por Bacterias Grampositivas/inmunología , Infecciones por Bacterias Grampositivas/patología , Válvulas Cardíacas/microbiología , Válvulas Cardíacas/patología , Ratas , Ratas Endogámicas LewRESUMEN
Since February 1987 percutaneous CT-guided spine biopsy was performed in 18 patients with spondylodiscitis at the X-ray Department of Bispebjerg Hospital. Eleven cases were spontaneous and seven followed spinal surgery. The infection was located in five cases in the thoracic spine and in 13 cases in the lumbar spine. Only one biopsy was performed during general anaesthesia, the rest under local anaesthesia. No complications were observed. The bioptic material was cultivated immediately beside the patient and incubated for 14 days. The infective organism was isolated in 12 cases (67%). Thus, material obtained through a fine needle was satisfactory for microbiological investigation. A biopsy is crucial for establishing a microbiological diagnosis and thereby enabling prompt adequate treatment.
Asunto(s)
Biopsia con Aguja/métodos , Discitis/patología , Columna Vertebral/patología , Vértebras Torácicas/patología , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Ensayo de Unidades Formadoras de Colonias , Discitis/diagnóstico por imagen , Discitis/microbiología , Discitis/cirugía , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/microbiología , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/microbiologíaRESUMEN
A retrospective study of 23 patients with spondylodiscitis is reported. Sixteen cases were spontaneous. Five of these were seen in the acute phase with S. aureus grown from the blood. Eleven patients were investigated with CT-guided biopsy of the spine with identification of different microorganisms in eight cases. In four of seven cases of spondylodiscitis after operation for disc herniation coagulase-negative staphyloccoci were grown after CT-guided biopsy. In spontaneous cases pain disappeared and CRP was normalized within a few weeks after treatment with antibiotics, but radiological changes might progress for several months. Antibiotics were given for two to six months, with a mean of 5.1 months in purulent bacterial infections, and all patients were considered cured after this.
Asunto(s)
Infecciones Bacterianas/diagnóstico , Discitis/microbiología , Complicaciones Posoperatorias/microbiología , Adolescente , Adulto , Anciano , Antibacterianos/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Biopsia con Aguja/métodos , Discitis/diagnóstico por imagen , Discitis/tratamiento farmacológico , Discitis/patología , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/microbiología , Vértebras Lumbares/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/patología , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/microbiología , Columna Vertebral/patología , Tomografía Computarizada por Rayos XRESUMEN
UNLABELLED: Endocervical sampling for microbiological and pathological screening is laborious and expensive due to different sampling devices and techniques. The purpose of this study was to examine if the routine procedure could be simplified by using a cytobrush for concurrent cytology and sampling for Chlamydia trachomatis detection using the PCR method or cell culture. As a sampling device control we used a conventional rayon swab. RESULTS: Culture: Out of 873 paired endocervical specimens, C. trachomatis was isolated in 68 swab specimens and in 65 cytobrush specimens (overall detection rate 8.4%). The cytobrush proved less suitable than the swab for the isolation of C. trachomatis as 31.5% of the cytobrush samples showed cytotoxicity to the cultured cells vs 0.9% of the swab samples. PCR: In a random sample of 427 paired endocervical specimens, C. trachomatis was detected in 45 pairs without any difference between the two sampling devices. The sensitivity of PCR was 93.8% vs 89.6% and 87.5% in cultured swab and cultured cytobrush specimens, respectively. The cytobrush can therefore be recommended as a cervical sampling device if a PCR assay is used for the detection of C. trachomatis, but not if the cell culture method is used, due to high cytotoxicity. Furthermore, the same cytobrush may be used for cervical cytological sampling and thereafter placed in transport medium for subsequent C. trachomatis detection if the PCR technique is used.
Asunto(s)
Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Cervicitis Uterina/microbiología , Frotis Vaginal/métodos , Adolescente , Adulto , Femenino , Humanos , Reproducibilidad de los ResultadosRESUMEN
A novel gene encoding an antigen from Staphylococcus aureus was isolated from an expression library by screening with antisera from patients with deep Staphylococcus aureus infections. In one positive clone an open reading frame, named ORF-2, was identified. Recombinant ORF-2 protein reacted with human immune serum. ORF-2 was shown to be present in other Staphylococcus aureus strains, but not in related species.
Asunto(s)
Antígenos Bacterianos/genética , Genes Bacterianos , Staphylococcus aureus/genética , Staphylococcus aureus/inmunología , Secuencia de Aminoácidos , Anticuerpos Antibacterianos , Proteínas Bacterianas/genética , Proteínas Bacterianas/inmunología , Secuencia de Bases , Clonación Molecular , Cartilla de ADN/genética , ADN Bacteriano/genética , Expresión Génica , Humanos , Datos de Secuencia Molecular , Sistemas de Lectura Abierta , Proteínas Recombinantes/genética , Proteínas Recombinantes/inmunología , Homología de Secuencia de Aminoácido , Infecciones Estafilocócicas/inmunologíaRESUMEN
A total of 278 streptococci isolated from blood (including 66 strains of Streptococcus pneumoniae) were tested for their MIC to penicillin G, gentamicin, rifampicin, clindamycin, erythromycin, vancomycin and teicoplanin to determine the current state of resistance among streptococci isolated from blood at a University Hospital in Copenhagen, Denmark, and thereby to assess alternative treatment for patients who are infected with a penicillin-resistant streptococcal strain or allergic to penicillin. Danish Blood Sensitivity Agar and the Etest were used. Overall, resistance to penicillin among Streptococcus mitis strains was 44.4% (37% intermediately susceptible and 7.4% resistant). As penicillin resistance in S. mitis may be an early indication of emerging penicillin resistance among other streptococcal species, this finding is a matter of concern. Except for this observation, penicillin remains the best and a safe choice for treatment of streptococcal infection. For alternative treatment when the patient is allergic to penicillin and for prophylaxis, the usual recommendation is macrolide antibiotics or clindamycin. The majority of non-enterococcal groups of streptococci remain sensitive to erthromycin and clindamycin, but the antibiotic susceptibility pattern is unpredictable without testing the isolates, so empirical therapy or prophylaxis may fail.
Asunto(s)
Bacteriemia/microbiología , Streptococcus/efectos de los fármacos , Farmacorresistencia Microbiana , Eritromicina/farmacología , Humanos , Pruebas de Sensibilidad Microbiana , Penicilina G/farmacologíaRESUMEN
OBJECTIVE: To investigate, by use of the Amplicor PCR in a routine setting, the recovery rate of Chlamydia trachomatis in ano-rectal and pharyngeal swab samples obtained from males and females attending an STD clinic in relation to sexual practices, symptoms, and signs. DESIGN: Data regarding sexual practices, and symptoms and signs related to the rectum and pharynx, were obtained from 196 females and 208 males, including 31 homosexuals and eight bisexuals. Swab samples were obtained from the urethra, rectum, and pharynx from all the patients. An additional endocervical swab sample was obtained from the females. METHODS: All samples were analysed by the Amplicor PCR (Roche). SETTING: Rudolph Bergh's Hospital, a clinic for sexually transmitted diseases situated in the centre of Copenhagen, Denmark. RESULTS: The overall prevalence of urogenital C trachomatis infection was 9.2% (37/404). The specificity of the Amplicor PCR was 100% for both ano-rectal and pharyngeal swab samples. In females three (13%) of the 23 infections were detected only by testing an ano-rectal or throat swab sample. In homosexual males two (67%) of three infections were detected only by the anorectal swab sample. Ano-rectal intercourse without use of condom was reported by 44% of females and by 52% of homosexual males. Fellatio without condom use was reported by 91% of females, and 80% of heterosexual males practised cunnilingus. Pharyngeal infection, however, occurred only in females, and the presence of pharyngeal symptoms or signs seemed predictive for pharyngeal C trachomatis infection, for which the time of incubation or colonisation exceeded 3 months. The presence of ano-rectal signs or symptoms was not predictive for an ano-rectal C trachomatis infection. CONCLUSION: The Amplicor PCR can be used on ano-rectal and pharyngeal swab samples. Ano-rectal swab samples should be obtained in females and homosexual males at high risk of being infected. Pharyngeal samples should be taken in females at high risk of being infected, especially when pharyngeal signs or symptoms are present.
Asunto(s)
Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/aislamiento & purificación , Enfermedades Faríngeas/diagnóstico , Enfermedades del Recto/diagnóstico , Adolescente , Adulto , Femenino , Heterosexualidad , Homosexualidad Masculina , Humanos , Masculino , Técnicas Microbiológicas , Persona de Mediana Edad , Enfermedades Faríngeas/microbiología , Reacción en Cadena de la Polimerasa , Enfermedades del Recto/microbiología , Sensibilidad y Especificidad , Enfermedades Uretrales/diagnóstico , Enfermedades del Cuello del Útero/diagnósticoRESUMEN
To gather information on the antibiotic susceptibility of Shigella and Salmonella in the Baltic countries, 98 Shigella and 100 Salmonella isolates collected consecutively in 1994 were examined. All Shigella isolates were resistant to at least two of 12 antibacterial agents: 100% were resistant to oxytetracycline, 92% to trimethoprim/sulfamethoxazole, 64% to chloramphenicol, and 64% to ampicillin. Five different resistance patterns were observed.
Asunto(s)
Antibacterianos/farmacología , Disentería Bacilar/tratamiento farmacológico , Infecciones por Salmonella/tratamiento farmacológico , Salmonella/efectos de los fármacos , Shigella/efectos de los fármacos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Farmacorresistencia Microbiana , Disentería Bacilar/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Lituania/epidemiología , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Salmonella/aislamiento & purificación , Infecciones por Salmonella/epidemiología , Shigella/aislamiento & purificaciónRESUMEN
Using a computed tomography (CT)-guided technique we have been able to obtain fine needle spine biopsies directly from an affected vertebra or disk plate in 14 patients suspected of infectious spondylitis. The bioptic material was cultivated immediately and incubated for 14 days. Cultures from eight patients were positive. No single microbiological agent was predominant though coagulase-negative staphylococci were frequent. In no case were mycobacteria found. Bioptic material from six patients did not give rise to growth of microorganisms. We were able to successfully treat the eight patients with a culture-positive biopsy. We think that biopsies are crucial for establishing a microbiological diagnosis. The whole procedure takes less than one hour; it is performed under local anaesthesia and is thus not very stressful for the patient: The success rate for obtaining a positive spine biopsy was 57%.
Asunto(s)
Biopsia con Aguja/métodos , Espondilitis/diagnóstico , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/aislamiento & purificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/microbiología , Espondilitis/diagnóstico por imagen , Espondilitis/microbiologíaRESUMEN
BACKGROUND: Bacteria have been suggested as a possible cause of hidradenitis. Different species have been found in several small studies, and particularly the presence of Streptococcus milleri has been linked to disease activity. OBJECTIVE: To investigate the possible role of bacteria in hidradenitis. METHODS: Cultures of active lesions and serological analysis of circulating IgG antibodies were studied in 41 patients. RESULTS: Bacteria were found in 49% (20/41) of all lesions: Staphylococcus aureus, 8; S. milleri, 1; Staphylococcus epidermidis, 11; Staphylococcus hominis, 1. Corynebacterium spp., Acinetobacter and Lactobacillus spp. were found once each and considered as contaminants. Patients in whom S. aureus was found had a shorter duration of disease (mean 1.7 vs. 9.7 years for sterile lesions). No other significant correlations were found between location of disease or antibody response and the bacterial species found. CONCLUSION: S. milleri appears to be an unusual pathogen, and bacteria are only found in approximately 50% of all active hidradenitis lesions. It is suggested that S. aureus may play a temporary role in the early phase of the disease, but additional longitudinal studies of cohorts of patients are needed to clarify this point.
Asunto(s)
Hidradenitis Supurativa/microbiología , Infecciones Cutáneas Estafilocócicas , Infecciones Estreptocócicas , Acinetobacter/inmunología , Acinetobacter/aislamiento & purificación , Adulto , Anticuerpos Antibacterianos/sangre , Estudios de Cohortes , Corynebacterium/inmunología , Corynebacterium/aislamiento & purificación , Femenino , Humanos , Inmunoglobulina G/sangre , Lactobacillus/clasificación , Lactobacillus/inmunología , Lactobacillus/aislamiento & purificación , Estudios Longitudinales , Masculino , Infecciones Cutáneas Estafilocócicas/microbiología , Staphylococcus/clasificación , Staphylococcus/inmunología , Staphylococcus/aislamiento & purificación , Staphylococcus aureus/inmunología , Staphylococcus aureus/aislamiento & purificación , Staphylococcus epidermidis/inmunología , Staphylococcus epidermidis/aislamiento & purificación , Infecciones Estreptocócicas/microbiología , Streptococcus/clasificación , Streptococcus/aislamiento & purificación , Factores de TiempoRESUMEN
Admissions of drug abusers with acute soft tissue lesions at the injection site increased in number over the period 1985-1989. There were 146 admissions in 90 patients. The diagnoses were: 58 superficial abscesses, 27 deep abscesses, 57 cellulitis, one tenosynovitis, one purulent arthritis, one not further categorised abscess and one case of arterial spasm. The commonest location was the groin (25%). Serious complications occurred in 17 cases, including four femoral amputations due to arterial lesions. Ultrasonic examination is recommended before surgery if central vessels can be involved, especially in the groin. Sufficient microbiological examination was performed in 78 cases. There was a predominance of polybacterial infections (53% polybacterial, 38% monobacterial, 9% sterile). The most common bacteria were Streptococcus spp. with a preponderance of oropharyngeal bacteria, Staphylococcus aureus, and anaerobes, especially Bacteroides spp. Typical intestinal bacteria were rare. We recommend that aerobic and anaerobic culturing with susceptibility testing always be carried out, that primary antibacterial therapy should be with an antistaphylococcal agent like dicloxacillin plus metronidazole and that free injection paraphernalia with disinfection swabs should be made easily available.
Asunto(s)
Agujas/efectos adversos , Traumatismos de los Tejidos Blandos/etiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Absceso/microbiología , Enfermedad Aguda , Adulto , Amputación Quirúrgica , Arterias/lesiones , Arterias/microbiología , Dinamarca/epidemiología , Femenino , Ingle , Humanos , Masculino , Admisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Factores Socioeconómicos , Traumatismos de los Tejidos Blandos/complicaciones , Traumatismos de los Tejidos Blandos/microbiologíaRESUMEN
The purpose of the investigation was to evaluate two commercially available identification systems: a new modification of the Staph-Zym system (Rosco, Tåstrup, Denmark) and the Staph ID 32 API system (API System, BioMérieux, Paris, France). A local standard method to be used in routine laboratories was also evaluated. A total of 200 staphylococcal isolates, including strains from both the American Type Culture Collection and the Czechoslovak Collection of Microorganisms as well as 89 clinical isolates, were used in tests of all three identification systems. The Staph ID 32 API system identified from 50 to 100% of the reference strains and 82.1% of the clinical isolates correctly. The Staph-Zym system identified from 90 to 100% of the reference strains and 82.1% of the clinical isolates correctly. Most misidentifications were of minor importance, but in both systems major failures appeared (Staphylococcus aureus was identified as a coagulase-negative staphylococcus). Both systems needed backup from a reference laboratory to determine if two isolates were of the same strain.
Asunto(s)
Técnicas Bacteriológicas , Coagulasa/metabolismo , Staphylococcus/clasificación , Staphylococcus/enzimología , Técnicas Bacteriológicas/economía , Técnicas Bacteriológicas/normas , Técnicas Bacteriológicas/estadística & datos numéricos , Costos y Análisis de Costo , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/microbiología , Estudios de Evaluación como Asunto , Humanos , Estándares de Referencia , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Staphylococcus/aislamiento & purificaciónRESUMEN
The purpose of this study was to isolate streptococcal strains from the oral cavities of streptococcal endocarditis patients and compare these strains biochemically and genetically with the corresponding streptococcal blood isolates. Total identity was observed between the blood and oral cavity isolates from the two patients studied.
Asunto(s)
Endocarditis Bacteriana/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus/aislamiento & purificación , Anciano , Bacteriemia/microbiología , Técnicas de Tipificación Bacteriana , ADN Bacteriano/genética , ADN Bacteriano/aislamiento & purificación , Placa Dental/microbiología , Femenino , Humanos , Masculino , Boca/microbiología , Saliva/microbiología , Especificidad de la Especie , Streptococcus/clasificación , Streptococcus/genéticaRESUMEN
Bacterial endocarditis as the consequence of an iatrogenic bacteraemia has been recognized for a long time in the Nordic countries, and national recommendations were issued by groups of experts. It is generally agreed that antibiotic prophylaxis is needed in patients with high-risk conditions and that the maintenance of healthy gums and teeth is of major importance. Investigations, however, reported poor level of compliance, and pointed out that the procedural/practical aspect of interactions between patients, dentists and physicians have largely been neglected. In order to improve the level of compliance an 'endocarditis risk' card has been produced, and there has been a remarkable degree of harmonization of chemotherapeutic regimens recommended by the national organizations. Generally, a single dose of prophylaxis is recommended, because there is little evidence that antibiotic levels in humans must be maintained more than 6-7 h for effective prevention of endocarditis, and because compliance with a multiple dose regimen is highly questionable.
Asunto(s)
Antibacterianos/uso terapéutico , Endocarditis Bacteriana/prevención & control , Endocarditis Bacteriana/epidemiología , Humanos , Cooperación del Paciente , Factores de Riesgo , Países Escandinavos y Nórdicos/epidemiologíaRESUMEN
The prevalence and antibiotic sensitivity patterns of bacteria collected consecutively from medical and surgical intensive care units (ICUs) and from hematology/oncology units in nine hospitals in Denmark were determined and compared to data collected simultaneously in 12 other European countries. Bacterial isolates from 794 Danish patients were tested and compared to 8,625 isolates from European patients. The minimal inhibitory concentrations of eight different antibiotics were determined using a microdilution plate. Similar to findings in European countries, the most common source of bacterial isolates in Danish units was the respiratory tract (49%), followed by blood (18%), urinary tract (14%) and surgical wounds (10%). Staphylococcus aureus was the most prevalent respiratory organism in Danish units, whereas Enterobacteriaceae and Pseudomonas aeruginosa dominated in other countries. In blood, Escherichia coli was most prevalent in Denmark while coagulase-negative staphylococci were predominant in other countries. Urinary tract isolates were dominated by Escherichia coli in both Denmark and the other countries, but Enterococcus faecalis and Pseudomonas aeruginosa were more frequently isolated in the other countries. Staphylococcus aureus was the most frequent wound isolate in Denmark, while Enterobacteriaceae other than Escherichia coli dominated in other European countries. Thus, in Denmark Escherichia coli and Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella spp. (from ICUs) or Enterococcus spp. and Klebsiella spp. (from hematology/oncology units), are the most prominent pathogens in these units today. Indicator organisms of antibiotic consumption (Pseudomonas aeruginosa and methicillin-resistant coagulase-negative staphylococci and Staphylococcus aureus) were more frequent in other European countries than Denmark. In general the Danish isolates were more sensitive to antibiotics than the European isolates.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Bacterianas/epidemiología , Infección Hospitalaria/epidemiología , Farmacorresistencia Microbiana , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Grampositivas/efectos de los fármacos , Antibacterianos/farmacología , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Dinamarca , Utilización de Medicamentos , Europa (Continente) , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/aislamiento & purificación , Hematología , Departamentos de Hospitales/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos , Pruebas de Sensibilidad Microbiana , Servicio de Oncología en Hospital , PrevalenciaRESUMEN
We evaluated clinical and microbiological aspects in 145 hospitalizations of 89 intravenous drug abusers with acute soft tissue infections at the injection site. There were 58 superficial abscesses, 27 deep abscesses, 57 cellulitis with or without concomitant ulcer, 1 purulent arthritis, 1 tenosynovitis and 1 incompletely categorized abscess. The commonest location was the groin. Serious complications occurred in 17 cases, including 4 lower-extremity amputations due to arterial lesions. There was a predominance of polybacterial infections (53 percent polybacterial, 38 percent monobacterial, 9 percent sterile). The commonest bacteria isolates were Streptococcus species with a preponderance of oropharyngeal bacteria, Staphylococcus aureus, and anaerobes, especially Bacteroides species. Typical intestinal bacteria were rare. In addition to surgical treatment we recommend that aerobic and anaerobic culturing with susceptibility tests always are carried out, that primary antibacterial therapy should consist of an antistaphylococcal agent, such as dicloxacillin plus metronidazole, and that free injection paraphernalia with disinfection swabs are easily available.
Asunto(s)
Infecciones Bacterianas/etiología , Infecciones de los Tejidos Blandos/etiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Enfermedad Aguda , Adulto , Infecciones Bacterianas/microbiología , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones de los Tejidos Blandos/microbiologíaRESUMEN
By administering a questionnaire to 253 patients with cardiac-valve prostheses (89.3% responding), and another to 136 of their attending dentists (79% responding), the level of knowledge among both groups of anticoagulant therapy in connection with dental treatment was investigated. The cardiothoracic department monitored all anticoagulation therapies. Of the anticoagulated patients, 96.6% were able to state their medication (94.1% received phenprocoumon); and of 86 dentists with patients on anticoagulation treatment, 94% were aware of their patients' medication. All 20 dentists stating that their patients did not receive anticoagulants were correct. The great majority (98%) of the dentists employed a special measure to reduce the risk of bleeding associated with invasive dental procedures, most commonly (86%) referring patients to their general practitioner or hospital department for adjustment of the anticoagulant therapy. Around 60% of the dentists considered extractions and operations to require measures to reduce the risk of bleeding complications. We recommend referral of patients to the attending physician for adjustment of anticoagulation to a target International Normalized Ratio (INR) of 4.0 or possibly 3.0 before undergoing dental procedures involving the risk of bleeding. Additional reduction of the bleeding risk can be obtained by local application of an inhibitor of fibrinolysis (tranexamic acid).