RESUMEN
This study explores the role of procalcitonin (PCT) in predicting the outcome of sepsis. In a prospective multicentre observational investigation, blood was sampled within 24 h of onset of sepsis in 1156 hospitalised patients; 234 were in the intensive care unit (ICU) at the point of presentation of sepsis while 922 were not. PCT was estimated in serum by the ultrasensitive Kryptor assay in a double-blinded fashion. Among patients outside the ICU, mortality was 8% in those with PCT ≤0.12 ng/mL but 19.9% in those with PCT >0.12 ng/mL [P<0.0001, odds ratio (OR) for death: 2.606; 95% confidence interval (CI): 1.553-4.371]. Among patients whose sepsis presented in ICU, mortality was 25.6% in those with PCT ≤0.85 ng/mL but 45.3% in those with PCT >0.85 ng/mL (P=0.002; OR for death: 2.404; 95% CI: 1.385-4.171). It is concluded that PCT cut-off concentrations can contribute to predicting the outcome of sepsis and might be of particular value in identifying patients who would benefit from ICU admission.
Asunto(s)
Calcitonina/sangre , Técnicas de Laboratorio Clínico/métodos , Precursores de Proteínas/sangre , Sepsis/diagnóstico , Sepsis/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Péptido Relacionado con Gen de Calcitonina , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Resultado del TratamientoRESUMEN
We studied the effects of antimicrobial prophylaxis and possible predictors of failure in multiple sclerosis patients with bacteriuria and bladder dysfunction. patients were categorized into 3 groups, according to post-voided residual urine volume (PVR): patients with indications for self-intermittent catheterization (SIC) who elected (Group A, n=39) or not (Group B, n=53) to use SIC and patients with no indication for SIC (Group C, n=75). In group A, 90% of patients developed bacteriuria after SIC. Rates of bacteriuria in groups B and C were significantly lower (34% and 24%, respectively, all p<0.001). Prophylaxis failed in 31% and 22% of patients in groups A and b, respectively whereas all group C patients responded to prophylaxis. Symptomatic urinary tract infection was observed only in 14% of group A patients. Significant predictors of prophylaxis failure were an expanded disability status scale (EDSS) score >6 (p<0.05), a high pVR (p<0.075) and resistance to prophylaxis regimen (p<0.007). SIC did not have a significant association with prophylaxis failure. In multivariate analysis only a higher eDSS score (>6) predicted prophylaxis failure (p=0.019).
Asunto(s)
Profilaxis Antibiótica , Bacteriuria/prevención & control , Esclerosis Múltiple/complicaciones , Adulto , Bacteriuria/microbiología , Escherichia coli/aislamiento & purificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia del Tratamiento , Cateterismo Urinario , Infecciones Urinarias/prevención & controlRESUMEN
OBJECTIVE: To evaluate Infecton scintigraphy, with technetium-99m-radiolabeled ciprofloxacin, as a means to detect bone infection, in comparison with other conventional scintigraphic and radiologic methods. METHODS: Forty-five patients with known or suspected bone infection underwent 50 scans with Infecton. Almost all were also subjected to a three-phase 99mTc-methylene diphosphonate bone scan and most of them to a 99mTc-human polyclonal immunoglobulin scan as well as to a gallium-67-citrate scan, plus computerized tomography or magnetic resonance imaging or both. Clinical laboratory criteria for the presence of osteomyelitis were based on the definitions of the Centers for Disease Control and Prevention. RESULTS: Staphylococcus aureus and Pseudomonas aeruginosa were the most frequently isolated pathogens. Based on the CDC clinical laboratory criteria as well as on conventional scan results, Infecton was characterized in 35 studies as 'true positive', in eight as 'true negative', in two as 'false positive', in one as 'false negative', and in four as 'indeterminate'. The sensitivity and specificity of Infecton scintigraphy were found to be 97.2% and 80%, respectively, with positive and negative predictive values of 94.6% and 88.9%. CONCLUSIONS: It is concluded that Infecton is a very sensitive and quite specific marker of bone infection, but care must be taken in cases of excessive new bone formation and primary bone tumors, where false-positive results may be obtained.
Asunto(s)
Ciprofloxacina/análogos & derivados , Compuestos de Organotecnecio , Osteomielitis/diagnóstico por imagen , Radiofármacos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Citratos , Difosfonatos , Femenino , Galio , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteomielitis/microbiología , Valor Predictivo de las Pruebas , Infecciones por Pseudomonas/diagnóstico por imagen , Cintigrafía/métodos , Sensibilidad y Especificidad , Infecciones Estafilocócicas/diagnóstico por imagen , Tecnecio , Tomografía Computarizada por Rayos XRESUMEN
In an attempt to define whether intravenously administered pefloxacin might be appropriate for surgical prophylaxis in prostatectomy, 50 patients undergoing transvesical prostatectomy for benign prostate hyperplasia were given a single intravenous dose of 800 mg; surgery was then performed after 2, 4, 6, 8 or 10 h. Concentrations of pefloxacin were determined in serum and in both the centre and periphery of the prostate adenoma using a microbiological plate assay. Elevated concentrations of pefloxacin were found in the adenoma from 2 h onwards. The central and peripheral concentrations were similar and had a mean value of 4.39 microg/g of tissue. These concentrations were similar to those achieved in serum. Although concentrations of pefloxacin were not determined separately in the intercellular, interstitial or excreted fluid, the tissue levels found were well above the MICs of pefloxacin for the bacteria commonly causing acute and chronic prostatitis. These data suggest the intravenous administration of pefloxacin to be a satisfactory alternative for the surgical prophylaxis before prostatectomy as well as in the therapy of acute prostatitis.
Asunto(s)
Antiinfecciosos/farmacocinética , Pefloxacina/farmacocinética , Premedicación , Próstata/metabolismo , Hiperplasia Prostática/tratamiento farmacológico , Anciano , Antiinfecciosos/administración & dosificación , Antiinfecciosos/uso terapéutico , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Pefloxacina/administración & dosificación , Pefloxacina/uso terapéutico , Próstata/irrigación sanguínea , Prostatectomía , Hiperplasia Prostática/sangre , Hiperplasia Prostática/cirugía , Prostatitis/prevención & controlRESUMEN
PURPOSE: We studied the pharmacokinetics of orally administered clarithromycin in prostatic tissue to define its role in the treatment of chronic abacterial prostatitis caused by intracellular pathogens. MATERIALS AND METHODS: A total of 45 men receiving 3 oral doses of 750 mg. clarithromycin at 12-hour intervals underwent suprapubic prostatectomy for benign prostate hyperplasia 4, 5, 6 and 7 hours after the last drug dose in 13, 12, 10 and 10 patients, respectively. Concentrations were determined in the prostate tissue and in plasma by an agar diffusion assay. RESULTS: A mean peak level of clarithromycin of 3.22 and 3.08 microg./gm. of tissue was achieved 4 hours after the third drug dose at the center and periphery of the adenoma, respectively. Tissue levels remained statistically superior to plasma levels at all intervals. CONCLUSIONS: The oral administration of clarithromycin achieved a prostate level much higher than the minimal inhibitory concentration of clarithromycin for the intracellular pathogens of chronic prostatitis. Thus, clarithromycin may be considered for treating chronic abacterial prostatitis.
Asunto(s)
Antibacterianos/farmacocinética , Claritromicina/farmacocinética , Prostatitis/tratamiento farmacológico , Administración Oral , Anciano , Antibacterianos/uso terapéutico , Enfermedad Crónica , Claritromicina/uso terapéutico , Humanos , Masculino , Próstata/metabolismo , Prostatectomía , Hiperplasia Prostática/cirugía , Factores de Tiempo , Distribución TisularRESUMEN
In order to investigate the frequency of the emergence of resistance during treatment, 1,403 episodes of lower respiratory infection were studied in a General Hospital with three departments of Chest Medicine in a period of four years. In 650 episodes the pathogen was isolated and in 82 of those failure of therapy was accompanied by emergence of resistance to the agent used. Factors associated with this phenomenon were: intensive care, tracheostomy, involvement of Pseudomonas aeruginosa, Enterobacter spp., Serratia marcescens, Staphylococcus aureus or Acinetobacter calcoaceticus, use of antipseudomonas penicillins, cefotaxime (especially when used in P. aeruginosa infections) and co-trimoxazole and monotherapy as opposed to appropriate combination therapy in patients with nosocomial pneumonia.
Asunto(s)
Antibacterianos/uso terapéutico , Bacterias/efectos de los fármacos , Resistencia a las Penicilinas , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Acinetobacter/efectos de los fármacos , Antibacterianos/farmacología , Cefotaxima/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Combinación de Medicamentos/uso terapéutico , Quimioterapia Combinada , Utilización de Medicamentos , Enterobacteriaceae/efectos de los fármacos , Humanos , Unidades de Cuidados Intensivos , Penicilinas/uso terapéutico , Neumonía/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Infecciones del Sistema Respiratorio/microbiología , Estudios Retrospectivos , Staphylococcus aureus/efectos de los fármacos , Sulfametoxazol/uso terapéutico , Traqueotomía , Trimetoprim/uso terapéutico , Combinación Trimetoprim y SulfametoxazolRESUMEN
In 1979, seven years after introduction of gentamicin into the greek market, resistance in Pseudomonas aeruginosa rose in Laiko General Hospital to an incidence of 55% of the isolates. Gentamicin then was the first line antibiotic. In 1983, three years after amikacin was brought onto the market and while it represented 3/5 of all aminoglycoside consumption, resistance against it in strains of Pseudomonas rose suddenly to 23%. However, amikacin prescription was not restricted and, in 1985, resistance rate, including all aminoglycosides and the 3rd generation cephalosporins, exceeded 50%. By analysing all available data, it was evident that: Urine predominates in the isolation of multiresistant strains, while in 1/2 of bacteraemias amikacin-resistant strains are implicated. The ICU is the most common source of isolation and similar strains are spread in all hospital wards. Multiresistant strains are virulent since they were incriminated for a 11% death rate. In 60% of amikacin resistant strains AAC (6') I was detected. Among multiresistant strains serotype O:12 predominated. From the hospital pharmacy data, it was evident that antibiotic consumption refers to greater than 60% of hospital admissions, and amikacin, netilmicin and newer cephalosporins are the first line antibiotics. It is evident that urgent changes are needed in the antibiotic policies in the Laiko General Hospital.
Asunto(s)
Amicacina/farmacología , Infección Hospitalaria/tratamiento farmacológico , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Amicacina/uso terapéutico , Bacteriuria , Infección Hospitalaria/microbiología , Farmacorresistencia Microbiana , Utilización de Medicamentos , Gentamicinas/farmacología , Gentamicinas/uso terapéutico , Grecia , Hospitales Generales , Humanos , Infecciones por Pseudomonas/microbiología , Estudios RetrospectivosRESUMEN
In 1983 an increase in the resistance rate of cefotaxime against Enterobacter cloacae strains was observed in "Laikos General" hospital, that reached 59.3% in the 2nd half of the same year. All strains resistant to cefotaxime were found resistant to cefamandole, moxalactam and ceftriaxone while 61.8% were also resistant to amikacin. Urine represented the main source of isolation, particularly from the catheterized patient of the Renal Transplantation Unit in whom cefuroxime was mostly over used. Multiresistant strains were virulent since 5 patients died of septicemia. Mechanisms of resistance to cefotaxime are speculated upon because resistance work-up has not yet been completed. SHV, was exclusively isolated in the limited number of strains which have been studied up to now.
Asunto(s)
Cefalosporinas/farmacología , Enterobacter/efectos de los fármacos , Enterobacteriaceae/efectos de los fármacos , Farmacorresistencia Microbiana , HumanosRESUMEN
The in vivo efficacy and safety of aztreonam compared to that of cefamandole was randomly and prospectively studied in the treatment of 30 patients suffering from recurrent urinary tract infections with a patient ratio of 2 aztreonam to 1 cefamandole. The mean age was 51.6 +/- 15.4 and 59.8 +/- 13 years respectively. Both antibiotics were given at a dose of 1 g, 8 hourly i.m. for 7-13 days. Sixty-seven percent versus 70% of the patients given aztreonam and cefamandole respectively were suffering from upper urinary tract infections. X ray abnormalities predisposing to relapse or reinfections were present in 88% vs 80% of the patients, while all patients had typical symptoms of urinary tract infections, with high fever (greater than or equal to 38.5 degrees C) reported in 70% and 60% of the patients in the two treatment groups respectively. Escherichia coli and Proteus mirabilis were the predominant isolates in urine cultures. During treatment all patients responded favourably both clinically and bacteriologically, while after a 6-week follow-up 20% versus 30% relapsed clinically with 15% vs 30% bacteriologic relapses in the two groups, but only in patients suffering from upper urinary tract infections. No development of bacterial resistance was observed in the relapses, while mainly Enterococcus spp was implicated in reinfections. No appreciable side effects of toxicity were observed. It was concluded that aztreonam is a promising new antibiotic that deserves further clinical trials in systemic infections.