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A more cost-effective use of medical air evacuation personnel
The Joumai of Emergency Medicine activity in middle ear aspirates from children with acute otitis media (AOM) who had failed amoxicillin therapy. Failure of therapy was defined as persistence of clinical signs of infection despite a five day or longer course of amoxicillin. Compliance was assessed by examination of unused medication. Twelve children with bilateral AOM were examined. Aspirates were taken from both ears for a total of twentyfour. Twenty-eight isolates were obtained from the twentyfour aspirates: I 1 non-type b H. injluenza, 9 M. catarrhalis, 5 S. pneumoniae, I Staph. aureus, 1 Strep. pyogenes, and 1 Peptostreptococcus magnus. Five aspirates had no bacterial growth. Nine of the aspirates contained two organisms. All 19 culture-positive aspirates contained at least one BLPB. All nine M. rutcvrhalis, the S. aureus, and 10 of the 11 H. irzfluenza were found to be beta-lactamase producing. In 17 of the 19 culture-positive aspirates, BLPB were isolated but no beta-lactamase activity was detected. This was attributed to low numbers of organisms. In eight of the nine aspirates containing two organisms, the second organism was not betalactamase producing. Amoxicillin concentrations were measured in all 24 aspirates. In the five aspirates with no bacterial growth, amoxicillin concentrations ranged from 4.2 to 10.4 mcg/ml. Two aspirates contained a single BLPB but had no detectable beta-lactamase activity. The amoxicillin concentrations in these two aspirates were 1.8 and 1.5 mcg/ml. Of the remaining 17 aspirates, 12 had no detectable amoxicillin and 5 had amoxicillin present in concentrations of 1.1 to 2.1 mcg/ml. The authors conclude that BLPB may account for failure of amoxicillin therapy. Because eight aspirates that contained a BLPB plus another organism demonstrated betalactamase activity and lower or nondetectable levels of nmoxicillin, the study also suggests that BLPB may “shield” susceptible organisms from the activity of amoxicillin and other penicillins. The authors encourage a change to a betalactamase-resistant antibiotic in acute otitis media failing amoxicillin therapy. [Brad Post, MD]
C PENICILLIN-RESISTANT STREPTOCOCCUS PNEUMONIAE IN ACUTE OTITIS MEDIA: RISK FACTORS, SUSCEPTIBILITY PATTERNS AND ANTIMICROBIAL MANAGEMENT. Block L, Harrison CJ, Hedrick JA, et al. Pediatric Infectious Dis J. 1995: 14:7Sl-759. This is a prospective study of penicillin-resistant streptococcus pneumonia (PRSP) in acute otitis media. The study population was healthy children from 2 months to 1.5 years
403 old in 3 counties of rural Kentucky during the period from January 1992 to January 1994. Cultures were taken from spontaneously ruptured tympanic membranes or from tympanocentesis performed on children with bulging, fun, immobile, opaque, red or yellow tympanic membranes and symptoms of acute otitis media or recurrent otitis media which had been unresponsive to antibiotic therapy. PRSP was identified in 48 (3 1%) of pneumococcal isolates with 25 (16%) relatively PRSP and 23 ( 15%) highly PRSP. Highly PRSP accounted for 30% of 63 isolates from patients recently treated with antibiotics versus 2% of 220 isolates from patients not recently treated with antibiotics. This 3 1% incidence of PRSP in acute otitis media is between the 17% incidence reported in the United States in 1985 and the 42%~ incidence reported in Israel in 1992. Otitis-prone conditions and increasing number of antibiotic courses before culture were independently predictive risk factors for patients with PRSP. Day care attendence and younger age, although statistically associated with PRSP by univariate analysis, were not associated by multivariate analysis. [Cathy ~LlStah’N. MI> 1 Editor’s Comment: Knowledge of these aspirates may lead to a change in antibiotic strategies in the future.
0 A MORE COST-EFFECTIVE USE OF MEDICAL AIR EVACUATION PERSONNEL. Gurland BH. Asensio JA, Kerstein D. American Surgeon. 199.5;6 I :773-777. This is a self-study of the on-duty time of personnel of a hospital based aeromedical transport service. The study found that only 33% of personnel duty time was flight related. This was broken down to include transport, compiling flight records, daily preparation, public relatious or demonstration flights, training, and miscellaneous duties. The remaining 67% of available hours was unaccountable time. The purpose of the study was to evaluate whether aeromedical personnel could work in the Emergency Department during idle times of the day and not affect the speed of response to flights. Crews were assigned to the Emergency Department to work during their non-flight hours. and yet were able to respond quickly for flights. Advantages discovered were an overlap of skills and the ability of MedEvac personnel to triage patients. There was also a financial advantage by decreasing the number of nurses in the emergency department. Disadvantages cited were that this group of specially trained individuals with independent thought processes were forced to take an auxiliary role in the emergency department.
C PENICILLIN-RESISTANT STREPTOCOCCUS PNEUMONIAE IN ACUTE OTITIS MEDIA: RISK FACTORS, SUSCEPTIBILITY PATTERNS AND ANTIMICROBIAL MANAGEMENT. Block L, Harrison CJ, Hedrick JA, et al. Pediatric Infectious Dis J. 1995: 14:7Sl-759. This is a prospective study of penicillin-resistant streptococcus pneumonia (PRSP) in acute otitis media. The study population was healthy children from 2 months to 1.5 years
403 old in 3 counties of rural Kentucky during the period from January 1992 to January 1994. Cultures were taken from spontaneously ruptured tympanic membranes or from tympanocentesis performed on children with bulging, fun, immobile, opaque, red or yellow tympanic membranes and symptoms of acute otitis media or recurrent otitis media which had been unresponsive to antibiotic therapy. PRSP was identified in 48 (3 1%) of pneumococcal isolates with 25 (16%) relatively PRSP and 23 ( 15%) highly PRSP. Highly PRSP accounted for 30% of 63 isolates from patients recently treated with antibiotics versus 2% of 220 isolates from patients not recently treated with antibiotics. This 3 1% incidence of PRSP in acute otitis media is between the 17% incidence reported in the United States in 1985 and the 42%~ incidence reported in Israel in 1992. Otitis-prone conditions and increasing number of antibiotic courses before culture were independently predictive risk factors for patients with PRSP. Day care attendence and younger age, although statistically associated with PRSP by univariate analysis, were not associated by multivariate analysis. [Cathy ~LlStah’N. MI> 1 Editor’s Comment: Knowledge of these aspirates may lead to a change in antibiotic strategies in the future.
0 A MORE COST-EFFECTIVE USE OF MEDICAL AIR EVACUATION PERSONNEL. Gurland BH. Asensio JA, Kerstein D. American Surgeon. 199.5;6 I :773-777. This is a self-study of the on-duty time of personnel of a hospital based aeromedical transport service. The study found that only 33% of personnel duty time was flight related. This was broken down to include transport, compiling flight records, daily preparation, public relatious or demonstration flights, training, and miscellaneous duties. The remaining 67% of available hours was unaccountable time. The purpose of the study was to evaluate whether aeromedical personnel could work in the Emergency Department during idle times of the day and not affect the speed of response to flights. Crews were assigned to the Emergency Department to work during their non-flight hours. and yet were able to respond quickly for flights. Advantages discovered were an overlap of skills and the ability of MedEvac personnel to triage patients. There was also a financial advantage by decreasing the number of nurses in the emergency department. Disadvantages cited were that this group of specially trained individuals with independent thought processes were forced to take an auxiliary role in the emergency department.