RESUMEN
In modern health care systems nosocomial infection is a major cause of patient suffering and leads to high financial costs. Overall nursing care that is part of nursing staff's daily routine is not brought under scrutiny often enough. The goal of this research project is to look at a small part only of optimal intravenous drip care. The focus of the paper is the influence that the use of two different kinds of dressings and two different types of cleansing methods have on the general appearance, as well as the microbiological results at the point of entry of the i.v. drip into the central veins. In order to examine this, test patients from different types of intensive care units were used for an experiment under highly controlled conditions. The results show that a variation in nursing care of the i.v. drip leads to a variation in germ development and in the general appearance at the point of entry.
Asunto(s)
Vendajes/normas , Cateterismo Venoso Central/instrumentación , Cateterismo Venoso Central/enfermería , Infección Hospitalaria/etiología , Infección Hospitalaria/prevención & control , Control de Infecciones/métodos , Infusiones Intravenosas/instrumentación , Infusiones Intravenosas/enfermería , Cuidados de la Piel/métodos , Cuidados de la Piel/enfermería , Vendajes/efectos adversos , Vendajes/provisión & distribución , Humanos , Investigación en Evaluación de EnfermeríaRESUMEN
This study describes the antibiotic resistance of 1961 staphylococcal strains that were isolated at the University Hospital of Vienna from July to December 1991. Staphylococcus aureus (SA) represented 43.2%; coagulase-negative (CNS) staphylococci 56.8%, three quarters of which were Staphylococcus epidermidis. Excepting netilmicin, the proportion of resistant strains to all antibiotics was higher with CNS than SA. Methicillin resistance (M(r)) was found in 11.8% of SA and 30.3% of CNS. Borderline oxacillin resistance (BOR) was noted in 7.4% of SA and 32.5% of CNS. It is important to note that severe or generalized infections due to M(r) staphylococci should be treated with glycopeptide antibiotics such as vancomycin or teicoplanin from the very beginning, whereas chemotherapy of those with BOR strains may also be carried out with beta lactamase-stable beta lactam antibiotics. Comparing the results of this study with those of the first half of 1991, the respective proportion of M(r) staphylococci was significantly lower than 23.6% for SA and 47.6% for CNS recorded then. As compared with the foregoing period, however, these strains demonstrated increased resistance frequencies to gentamicin (from 81.3 to 90%), amikacin (from 35.4 to 69%), netilmicin (35.4 to 55%), and ciprofloxacin (56.2 to 64%). This is taken as an indication for the epidemic spread of a clone of resistant strains.
Asunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus/efectos de los fármacos , Austria , Infección Hospitalaria/microbiología , Farmacorresistencia Microbiana , Hospitales Generales , Humanos , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus epidermidis/efectos de los fármacosRESUMEN
The present study compares the uptake and metabolism of 17 beta-estradiol, 17 beta-estradiol 3-glucoside, and 17 beta-estradiol 3-glucuronide by a highly purified preparation of rabbit liver nuclei. The uptake of the three estrogens was rapid and equilibration was reached within 60 s. The order of uptake was 17 beta-estradiol (64 fmol X mg protein -1) greater than 17 beta-estradiol 3-glucoside (10 fmol X mg protein -1) greater than 17 beta-estradiol 3-glucuronide (6.5 fmol X mg protein -1). Thin-layer chromatography of the estrogens taken up by rabbit liver nuclei indicated the presence of a beta-glucosidase activity associated with the nuclear preparation. The apparent Km value of this enzyme for 17 beta-estradiol 3-glucoside (3.5 microM) was about 10-fold higher when compared with the cytosolic enzyme. The uptake of the three estrogens was linearly proportional to the substrate concentration from 1 to 100 nM. No competition for uptake was observed among the steroids and the presence of diethylstilbestrol did not reduce the uptake of the steroids. These findings suggest that 17 beta-estradiol, 17 beta-estradiol 3-glucoside, and 17 beta-estradiol 3-glucuronide are taken up by nuclei by a nonsaturable diffusion process. The effect of cytosol on the uptake of estrogens by purified nuclei was also investigated. It was observed that cytosol reduced the uptake o 17 beta-estradiol but had little effect on that of its conjugates.