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Comparison of Escherichia Coli Strains Recovered From Human Cystitis and Pyelonephritis Infections in Transurethrally Challenged Mice
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URINARY TRACT INFECTION
Acetaminophen as an Adjunct to Morphine by Patient-ControlledAnalgesia in the Management of Acute Postoperative Pain S. A. SCHUC, D. A. SIDEBOTHAM, M. MCGUINNETY, J. THOW AND L. Fox, Department of Pharmacology, Section of Anaesthetics, School of Medicine, University of Auckland, Auckland, New Zealand Anesth. Analg., 87: 368-372, 1998 Opioids play a fundamental role in the management of postoperative pain, but their use is associated with a number of side effects, including nausea and vomiting, sedation, and respiratory depression. COadministration of a nonopioid has been proposed as a method of reducing opioid intake and minimizing side effects. Sixty-one ASA physical status I and 11 patients were enrolled in a double-blind, randomized, placebo-controlled, parallel study to investigate the effect of a combination of acetaminophen and morphine after open reduction and internal fixation of acute limb fractures. Patients were randomized to receive either oral acetaminophen (1 g every 4 h) or placebo as an adjuvant to morphine by patient-controlled analgesia (PCA) postoperatively. They were assessed daily for 72 h or until the PCA was discontinued according to standardized guidelines. The outcome variables collected were pain scores ( 11-point scale), amount of morphine self-administered, duration of PCA use, compliance with study design, incidence of nausea and sedation, and overall patient satisfaction. The acetaminophen group had lower pain scores on Day 1 (2.1 vs 3.3; P = 0.03) and a shorter average duration of PCA use (35.8 vs 45.5 h; P = 0.03). Overall patient satisfaction was also significantly greater in the acetaminophen group (8.7 vs 7.9; P = 0.04). These data suggest that acetaminophen is a useful adjunct to morphine PCA. Implications: This study assesses the benefit of combining two analgesics for the treatment of postoperative pain. Such a combination improves the quality of pain relief and patient satisfaction. Reprinted with permission from International Anesthesia Research Society. Editorial Comment: Nonsteroidal anti-inflammatory drugs are often used to potentiate the effect of narcotics. The authors compared nonsteroidal anti-inflammatorydrugs and acetaminophen as an adjunct to morphine for postoperative pain control. Interestingly, acetaminophen was more effective in this trial. There was a statistically significant difference between the 2 treatments but the number of patients studied was small. Undoubtedly,there will be continued evaluation of the best drug combination for pain control after surgery, especially considering the emergence of new analgesics. Joseph A. Smith, Jr., M.D.
URINARY TRACT INFECTION Comparison of Escherichia Coli Strains Recovered From Human Cystitis and Pyelonephritis Infections in Transurethrally Challenged Mice
D. E. JOHNSON,C . V. LOCKATELL, R. G. RUSSELL, J. R. HEBEL, M. D. ISLAND,A. STAPLETON, W. E. STATVIM AND J. W. WARREN, Department of Medicine, Division of Infectious Diseases, Program of Comparative Medicine, Departments of Pathology and Epidemiology, University of Maryland School of Medicine, and Research Service, Department of Veterans w a i r s , Baltimore, Maryland, and Department of Medicine, University of Washington School of Medicine, Seattle, Washington Infect. Immun., 66:3059-3065, 1998 Urinary tract infection, most frequently caused by Escherichia coli, is one of the most common bacterial infections in humans. A vast amount of literature regarding the mechanisms through which E. coli induces pyelonephritis has accumulated. Although cystitis accounts for 95%of visits to physicians for symptoms of urinary tract infections, few in vivo studies have investigated possible differences between E. coli recovered from patients with clinical symptoms of cystitis and that from patients with symptoms of pyelonephritis. Epidemiological studies indicate that cystitis-associated strains appear to differ from pyelonephritis-associated strains in elaboration of some putative virulence factors. With transurethrally challenged mice we studied possible differences using three each of the most virulent pyelonephritis and cystitis E. coli strains in our collection. The results indicate that cystitis strains colonize the bladder more rapidly than do pyelonephritis strains, while the rates of kidney colonization are similar. Cystitis strains colonize the bladder in higher numbers, induce more pronounced histologic changes in the bladder, and are more rapidly eliminated from the mouse urinary tract than pyelonephritis strains.These results provide evidence that cystitis strains differ from pyelonephritis strains in t h i s model, that this model is useful for the study of the uropathogenicity of cystitis strains, and that it would be unwise to use pyelonephritis strains to study putative virulence factors important in the development of cystitis.
URINARY TRACT INFECTION
Acetaminophen as an Adjunct to Morphine by Patient-ControlledAnalgesia in the Management of Acute Postoperative Pain S. A. SCHUC, D. A. SIDEBOTHAM, M. MCGUINNETY, J. THOW AND L. Fox, Department of Pharmacology, Section of Anaesthetics, School of Medicine, University of Auckland, Auckland, New Zealand Anesth. Analg., 87: 368-372, 1998 Opioids play a fundamental role in the management of postoperative pain, but their use is associated with a number of side effects, including nausea and vomiting, sedation, and respiratory depression. COadministration of a nonopioid has been proposed as a method of reducing opioid intake and minimizing side effects. Sixty-one ASA physical status I and 11 patients were enrolled in a double-blind, randomized, placebo-controlled, parallel study to investigate the effect of a combination of acetaminophen and morphine after open reduction and internal fixation of acute limb fractures. Patients were randomized to receive either oral acetaminophen (1 g every 4 h) or placebo as an adjuvant to morphine by patient-controlled analgesia (PCA) postoperatively. They were assessed daily for 72 h or until the PCA was discontinued according to standardized guidelines. The outcome variables collected were pain scores ( 11-point scale), amount of morphine self-administered, duration of PCA use, compliance with study design, incidence of nausea and sedation, and overall patient satisfaction. The acetaminophen group had lower pain scores on Day 1 (2.1 vs 3.3; P = 0.03) and a shorter average duration of PCA use (35.8 vs 45.5 h; P = 0.03). Overall patient satisfaction was also significantly greater in the acetaminophen group (8.7 vs 7.9; P = 0.04). These data suggest that acetaminophen is a useful adjunct to morphine PCA. Implications: This study assesses the benefit of combining two analgesics for the treatment of postoperative pain. Such a combination improves the quality of pain relief and patient satisfaction. Reprinted with permission from International Anesthesia Research Society. Editorial Comment: Nonsteroidal anti-inflammatory drugs are often used to potentiate the effect of narcotics. The authors compared nonsteroidal anti-inflammatorydrugs and acetaminophen as an adjunct to morphine for postoperative pain control. Interestingly, acetaminophen was more effective in this trial. There was a statistically significant difference between the 2 treatments but the number of patients studied was small. Undoubtedly,there will be continued evaluation of the best drug combination for pain control after surgery, especially considering the emergence of new analgesics. Joseph A. Smith, Jr., M.D.
URINARY TRACT INFECTION Comparison of Escherichia Coli Strains Recovered From Human Cystitis and Pyelonephritis Infections in Transurethrally Challenged Mice
D. E. JOHNSON,C . V. LOCKATELL, R. G. RUSSELL, J. R. HEBEL, M. D. ISLAND,A. STAPLETON, W. E. STATVIM AND J. W. WARREN, Department of Medicine, Division of Infectious Diseases, Program of Comparative Medicine, Departments of Pathology and Epidemiology, University of Maryland School of Medicine, and Research Service, Department of Veterans w a i r s , Baltimore, Maryland, and Department of Medicine, University of Washington School of Medicine, Seattle, Washington Infect. Immun., 66:3059-3065, 1998 Urinary tract infection, most frequently caused by Escherichia coli, is one of the most common bacterial infections in humans. A vast amount of literature regarding the mechanisms through which E. coli induces pyelonephritis has accumulated. Although cystitis accounts for 95%of visits to physicians for symptoms of urinary tract infections, few in vivo studies have investigated possible differences between E. coli recovered from patients with clinical symptoms of cystitis and that from patients with symptoms of pyelonephritis. Epidemiological studies indicate that cystitis-associated strains appear to differ from pyelonephritis-associated strains in elaboration of some putative virulence factors. With transurethrally challenged mice we studied possible differences using three each of the most virulent pyelonephritis and cystitis E. coli strains in our collection. The results indicate that cystitis strains colonize the bladder more rapidly than do pyelonephritis strains, while the rates of kidney colonization are similar. Cystitis strains colonize the bladder in higher numbers, induce more pronounced histologic changes in the bladder, and are more rapidly eliminated from the mouse urinary tract than pyelonephritis strains.These results provide evidence that cystitis strains differ from pyelonephritis strains in t h i s model, that this model is useful for the study of the uropathogenicity of cystitis strains, and that it would be unwise to use pyelonephritis strains to study putative virulence factors important in the development of cystitis.