Ophthal Plast Reconstr Surg. 2002 Sep;18(5):331-5; discussion 335.
Selective antibiotic use to prevent postoperative wound infection after external dacryocystorhinostomy.

Yazici B, Meyer DR.

Lions Eye Institute, Department of Opthalmology, Albany Medical College, Albany, New York 12208, USA.

PURPOSE: The use of systemic antibiotic prophylaxis in lacrimal drainage surgery is controversial. Some studies have reported high rates of postoperative infection and surgical failure after lacrimal drainage surgery when systemic antibiotic prophylaxis was not routinely administered. Many ophthalmologists have traditionally used antibiotics only in selected patients undergoing dacryocystorhinostomy (DCR), and this study evaluates the success of this strategy. METHODS: This was a retrospective interventional case series of 138 consecutive patients who underwent 163 external DCR procedures. Antibiotics were given only when inflammatory signs were present in the medial canthal region or when purulent material was noted during surgery. Patients with persistent external medial canthal inflammatory signs received amoxicillin/clavulanate or cephalexin orally 3 to 7 days before and 1 week after surgery. Patients in whom purulent lacrimal sac material was noted during surgery received cefazolin intravenously. RESULTS: Postoperative results were evaluated in terms of wound infection and related complications and surgical success. Systemic antibiotics were given in 15 of 163 (9%) cases. Nine (6%) cases received intraoperative (intravenous) antibiotics; 5 (3%) cases received perioperative (oral) antibiotics; and 1 (1%) case received both. None of the patients had postoperative deep soft tissue infection (cellulitis). Skin changes compatible with superficial wound infection occurred in 2 (1%) cases and responded well to topical treatment. Surgery was successful in 157 of 163 (96%) cases. Of 6 failures, none were associated with postoperative wound infection. CONCLUSIONS: Selective use of antibiotics limited to patients with signs of lacrimal sac inflammation appears sufficient to prevent soft tissue infection after DCR.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12352818&dopt=Abstract antibiotic, antibiotics



Clin Orthop. 2002 Oct;(403):54-7.
The effect of sampling method on the elution of tobramycin from calcium sulfate.

McLaren AC, McLaren SG, Nelson CL, Wassell DL, Olsen KM.

Department of Orthopaedic Surgery, University of Arkansas Medical Sciences, Little Rock, AR, USA.

Release rate is a critical property of all drug delivery vehicles, including antibiotic-laden bioerodibles. In vitro elution studies, used to evaluate release rates, use different sampling methods, including changing the entire amount of buffer and partial exchanges each day. Two groups of 10% calcium sulfate-tobramycin pellets were eluted in 20 mL of buffer for 30 days. Group I had 5 mL of buffer withdrawn and replaced daily whereas Group II had the entire 20 mL of buffer changed daily. The results show that the complete exchange method caused a significantly faster release of antibiotic than the partial exchange method. In the complete exchange group, greater than 50% of the tobramycin was released by 24 hours, whereas in the partial exchange group, 50% of the antibiotic was not released until Day 6. The two methods of sampling used to evaluate this bioerodible material provide data that allow the user to anticipate how the material will function in relatively inert and volatile environments. The method used to sample the elution of antibiotics from bioerodible materials affects the amount of antibiotic eluted. It therefore is important to know the method of sampling when making a decision to use a bioerodible material to deliver antibiotics locally.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12360008&dopt=Abstract antibiotic, antibiotics



Berl Munch Tierarztl Wochenschr. 1999 Feb;112(2):41-3.
Antibiotic resistance pattern of foodborne Salmonella isolates in Addis Ababa (Ethiopia).

Molla B, Kleer J, Sinell HJ.

Department of Microbiology, Infectious Diseases and Veterinary Public Health, Faculty of Veterinary Medicine, Addis Ababa University, Ethiopia.

A total of 39 Salmonella cultures isolated from raw minced beef and chicken (gizzard, liver, and heart) samples in Addis Ababa were examined for susceptibility to a group of 10 selected antimicrobials. 34 isolates (87.2%) were resistant to one or more antibiotics. The antibiotics to which isolated Salmonella strains were most often fully resistant included nitrofurantoin (48.7%), furazolidone (48.7%) and streptomycin (46.2%). Only 4 antimicrobials (gentamycin, kanamycin, rifampicin and sulphamethoxazole-trimethoprim) were effective against all Salmonella isolates with the exception of 2 which were intermediate in resistance to kanamycin (1) and sulphamethoxazole-trimethoprim (1). 77.8% of the S. Enteritidis strains showed multiple resistance to up to four antibiotics followed by S. Typhimurium (60.0%) and S. Dublin (33.3%). The high level of antibiotic resistance of foodborne Salmonella isolates in the study area is an indication of indiscriminate and continuous use of subtherapeutic doses of antibiotics in animals.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10189719&dopt=Abstract antibiotic, antibiotics



Tidsskr Nor Laegeforen. 2002 Aug 20;122(19):1864-6.
[Is antibiotic prophylaxis in Cesarean section necessary?]

[Article in Norwegian]

Olsen IP, Augensen K, Jensen A, Njolstad I.

Hammerfest sykehus 9600 Hammerfest. ingrid.petrikke.olseammerfest-sykehus.no

BACKGROUND: A Cochrane Review from October 1998 recommends prophylactic antibiotics for all women undergoing elective and non-elective caesarean section. This is expected to reduce the frequency of postoperative endometritis by two thirds to three quarters. In this study we evaluate the infection rate after caesarean section in a hospital where prophylactic antibiotics are given only to high-risk groups. METHODS: Case records of 344 patient delivered by caesarean section were studied. 30 days after the operation, 83% answered a questionnaire about wound infection. RESULTS: In all, 39% received prophylactic antibiotics. 33 patients (9.6%) developed post-cesarean infections; only 17 were given antibiotic treatment. One patient had endometritis. There were no significant differences with regard to infections between the elective and the non-elective groups (p = 0.63), or between those receiving and those not receiving antibiotic prophylaxis (p = 0.84). CONCLUSION: The policy of selective use of prophylactic antibiotics for caesarean sections has been successful in our hospital. This study does not permit conclusions as to whether selective prophylactics is a better alternative than routine prophylactics, but the results question whether the recommendation in the Cochrane Review is the best choice for all delivery units.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12362707&dopt=Abstract antibiotic, antibiotics



Acta Anaesthesiol Scand. 2002 Oct;46(9):1075-81.
Antibiotic prescription practices, consumption and bacterial resistance in a cross section of Swedish intensive care units.

Walther SM, Erlandsson M, Burman LG, Cars O, Gill H, Hoffman M, Isaksson B, Kahlmeter G, Lindgren S, Nilsson L, Olsson-Liljequist B, Hanberger H; Icustrama Study Group.

Departments of Cardiothoracic Anesthesia and Intensive Care, Clinical Microbiology and Hygiene and the Pharmacy at Universitetssjukhuset, Linkoping, Sweden. sten.waltheio.se

BACKGROUND: The purpose of this work was to study usage of antibiotics, its possible determinants, and patterns of bacterial resistance in Swedish intensive care units (ICUs). METHODS: Prospectively collected data on species and antibiotic resistance of clinical isolates and antibiotic consumption specific to each ICU in 1999 were analyzed together with answers to a questionnaire. Antibiotic usage was measured as defined daily doses per 1000 occupied bed days (DDD1000). RESULTS: Data were obtained for 38 ICUs providing services to a population of approximately 6 million. The median antibiotic consumption was 1257 DDD1000 (range 584-2415) and correlated with the length of stay but not with the illness severity score or the ICU category. Antibiotic consumption was higher in the ICUs lacking bedside devices for hand disinfection (2193 vs. 1214 DDD1000, p=0.05). In the ICUs with a specialist in infectious diseases responsible for antibiotic treatment the consumption pattern was different only for use of glycopeptides (58% lower usage than in other ICUs: 26 vs. 11 DDD1000,P=0.02). Only 21% of the ICUs had a written guideline on the use of antibiotics, 57% received information on antibiotic usage at least every 3 months and 22% received aggregated resistance data annually. Clinically significant antimicrobial resistance was found among Enterbacter spp. to cephalosporins and among Enterococcus spp. to ampicillin. CONCLUSIONS: Availability of hand disinfection equipment at each bed and a specialist in infectious diseases responsible for antibiotic treatment were factors that correlated with lower antibiotic consumption in Swedish ICUs, whereas patient-related factors were not associated with antibiotic usage.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12366501&dopt=Abstract antibiotic, antibiotics



J Am Geriatr Soc. 2002 Oct;50(10):1681-8.
Pneumonia: the demented patient's best friend? Discomfort after starting or withholding antibiotic treatment.

van der Steen JT, Ooms ME, van der Wal G, Ribbe MW.

Institute for Research in Extramural Medicine, Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, The Netherlands. jt.van_der_steen.emged.vu.nl.or

OBJECTIVES: To assess suffering in demented nursing home patients with pneumonia treated with antibiotics or without antibiotics. This study should provide the first empirical data on whether pneumonia is a "friend" or an "enemy" of demented patients and promote a debate on appropriate palliative care. DESIGN: Prospective cohort study. SETTING: Psychogeriatric wards of 61 nursing homes in the Netherlands. PARTICIPANTS: Six hundred sixty-two demented patients with pneumonia treated with (77%) or without (23%) antibiotics. MEASUREMENTS: Using an observational scale (Discomfort Scale-Dementia of Alzheimer Type), discomfort was assessed at the time of the pneumonia treatment decision and periodically thereafter for 3 months or until death. (Thirty-nine percent of patients treated with antibiotics and 93% of patients treated without antibiotics died within 3 months.) Physicians also offered a retrospective judgment of discomfort 2 weeks before the treatment decision. In addition, pneumonia symptoms were assessed at baseline and on follow-up. Linear regression was performed with discomfort shortly before death as an outcome. RESULTS: A peak in discomfort was observed at baseline. Compared with surviving patients treated with antibiotics, the level of discomfort was generally higher in patients in whom antibiotic treatment was withheld and in nonsurvivors. However, these same patients had more discomfort before the pneumonia. Breathing problems were most prominent. Shortly before death from pneumonia, discomfort increased. Discomfort was higher shortly before death when pneumonia was the final cause of death than with death from other causes. CONCLUSION: Irrespective of antibiotic treatment, pneumonia causes substantial suffering in demented patients. Adequate symptomatic treatment deserves priority attention.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12366622&dopt=Abstract antibiotic, antibiotics



Laryngoscope. 2002 Oct;112(10):1758-61.
Outpatient intravenous antibiotics for chronic rhinosinusitis.

Gross ND, McInnes RJ, Hwang PH.

Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 97201, USA.

OBJECTIVE/HYPOTHESIS: Peripherally inserted central catheter (PICC) lines have greatly facilitated the use of intravenous antibiotics in outpatient medical practice. Otolaryngologic applications for home intravenous therapy through PICC lines have not been well characterized to date. The purpose of the study is to describe indications and complications related to outpatient intravenous antibiotic therapy in patients with chronic rhinosinusitis. STUDY DESIGN: Retrospective cohort study. METHODS: Chart review of patients with chronic rhinosinusitis who were treated at an academic rhinology practice with outpatient intravenous antibiotics over a 3-year period.RESULTS Fourteen patients receiving, in all, 16 courses of intravenous antibiotic therapy through PICC line were identified. The average patient age was 51 years (age range, 36-74 y). The primary indication for intravenous antibiotic use was the treatment of resistant pathogens (50%). The most common organisms treated were, and. Other indications included gastrointestinal intolerance of oral antibiotics and extranasal complications of sinusitis. Eighty-eight percent of patients (14 of 16) were able to complete the entire prescribed course of therapy. Three (19%) catheter-related complications occurred, including thrombophlebitis and deep venous thrombosis. All three complications required removal of the PICC line; one of these patients underwent successful reinsertion of a second catheter and completion of treatment. CONCLUSIONS: Peripherally inserted central catheter line delivery of home intravenous antibiotics can be a well-tolerated adjunct to surgery in the outpatient treatment of chronic rhinosinusitis. Resistant infections, intolerance to oral antimicrobials, and extranasal complications of sinusitis are indications for PICC line therapy. Catheter-related complications can be significant and must be considered in patient selection.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12368610&dopt=Abstract antibiotic, antibiotics