RESUMEN
Wound bacterial colonization in 118 patients treated with chlorhexidine digluconate 0.2% in silver sulfadiazine 1% applied daily to the burn wounds was compared to that of 135 comparable patients similarly treated with silver sulfadiazine 1%. With chlorhexidine digluconate 0.2% in silver sulfadiazine 1%, colonization by Staphylococcus aureus was less frequent (38%) than with silver sulfadiazine (54%, p = 0.016). No statistical difference was found for colonization by Enterococcus faecalis, Pseudomonas aeruginosa, or Enterobacter cloacae. Washing of the wounds of 65 patients with chlorhexidine gluconate 4% during daily dressing changes was associated with reduced wound colonization by S. aureus (35% versus 51%, p = 0.03) and P. aeruginosa (8% versus 16%, p = 0.08) when compared to the 188 washed with nonantibacterial soap. Chlorhexidine, whether added to the topical agent silver sulfadiazine (chlorhexidine digluconate 0.2%) or in the bath soap (chlorhexidine gluconate 4%), decreased colonization by S. aureus.
Asunto(s)
Bacterias/crecimiento & desarrollo , Quemaduras/microbiología , Clorhexidina/análogos & derivados , Sulfadiazina de Plata/uso terapéutico , Administración Tópica , Adolescente , Adulto , Aerosoles , Análisis de Varianza , Bacterias/efectos de los fármacos , Niño , Clorhexidina/uso terapéutico , Recuento de Colonia Microbiana , Quimioterapia Combinada , Humanos , Persona de Mediana Edad , Nariz/microbiología , Faringe/microbiología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/crecimiento & desarrollo , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Patients with fresh full-thickness burn wounds were randomly assigned to receive wound treatment with daily applications of either 1 per cent silver sulfadiazine plus 0.2 per cent chlorhexidine digluconate cream (Silvazine) or 1 per cent silver sulfadiazine (Flamazine). Fifty-four patients treated with Silvazine were comparable to 67 treated with Flamazine with respect to extent and distribution of burn, age and all aspects of wound and associated treatment. Overall incidence of wound bacterial colonization was less in the Silvazine treated patients (65 per cent versus 88 per cent; P = 0.002). With Silvazine, wound colonization by Staphylococcus aureus was less (41 per cent versus 64 per cent; P = 0.01). Clinical wound infection with Staph, aureus developed in one Silvazine treated patient and five Flamazine treated patients (P = 0.16). Colonization by and infection due to all other organisms did not differ in the two groups. The incidence of graft failure was similar with both agents. In future increasing the concentration of chlorhexidine digluconate above 0.2 per cent might produce an improved prophylactic effect against Gram negative bacteria reported by other authors using the combined agent in in vitro and clinical trials. Silvazine was effective in reducing the incidence of Staph. aureus burn wound colonization without fostering supervening opportunistic infection.
Asunto(s)
Quemaduras/tratamiento farmacológico , Clorhexidina/análogos & derivados , Sulfadiazina de Plata/uso terapéutico , Sulfadiazina/uso terapéutico , Infección de Heridas/prevención & control , Adolescente , Adulto , Bacterias/efectos de los fármacos , Niño , Clorhexidina/uso terapéutico , Ensayos Clínicos como Asunto , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Seventy-four patients with soft tissue sarcomas received the initial diagnosis in Vancouver General Hospital between 1974 and 1979. The patients ranged in age from birth to 92 years, and all common types of sarcoma were encountered. All but 4 patients were treated surgically, and 30 received radiotherapy and 22 chemotherapy as well. The overall recurrence rate was 70 percent; a large majority or recurrences were local, suggesting inadequate excision. The average time to the first recurrence was 11.5 months and to the fourth recurrence, 30 months. The need for large, multicenter prospective studies combining various methods of treatment is stressed.