- Email: [email protected]
Postoperative pneumonia in the intensive care unit
352
Ciiaiions from the literature/ Int. J. Gynecol. Obstet. 46 (1994) 351-358
anaerobic organisms and leaving the surgical incision open decrease the incidence of postoperative wound infection. Despite such preventive measures, major infection remains a problem. Postoperativepneumoniain the intensive care unit Fry D.E. USA
SURG GYNECOL OBSTET 1993/177/SUPPL. (41-49) Postoperative pneumonia in the surgical patient may occur from atelectasis and inadequate postoperative TV, from ventilator-associated pathophysiology and from aspiration. Each process ultimately elicits the proinflammatory responses from the lung in the effort to eradicate the infectious pathogens. Postoperative pneumonia is best prevented by maintaining a clear understanding of the biologic basis for infection in the lung. Therapy requires aggressive tracheobronchial drainage strategies and antibiotic therapy directed toward the pathogens that are producing the pulmonary inflammatory response. A raadomized study of cefepime versus the combination of geotamicia and mezlocillin as an adjuact to surgical treatment in path& with acute cbolecystitis Yellin A.E.; Beme T.V.; Appleman M.D.; Heseltine P.N.R.; Gill M.A.; Okamoto M.P.; Baker F.J.; Holcomb C. USA
SURG GYNECOL OBSTET 1993/177/SUPPL. (23-29) In patients with acute cholecystitis, antibiotics are used as an adjunct to cholecystectomy to reduce the incidence of postoperative septic complications thought to be related to bactibilia. Combinations of penicillins, or cephalosporins or aminoglycosides, or both, are often used. Cefepime is a fourthgeneration cephalosporin with excellent activity against grampositive and gram-negative bacteria, including Pseudomonas species. It has a prolonged serum half-life, allowing twice-daily dosing, and is not nephrotoxic. This study was undertaken to determine whether or not cefepime was as effective as the combination of gentamicin and mezlocillin in patients with acute cholecystitis. One hundred and forty-nine patients were randomized, two to one, to receive cefepime or gentamicin and mezlocillin. Cefepime was given intravenously at 2 grams every I2 h; gentamicin, I .O to I.5 milligrams per kilograms every eight hours, and mezlocillin, 3 to 4 grams every four to six hours. All patients underwent cholecystectomy. Bile cultures were obtained, and concentrations of cefepime in blood, bile, peritoneal fluid and gallbladder were determined in a subset of patients. There were 56 evaluable cefepime-treated and 34 evaluable gentamicin and mezlocillin-treated patients. Bactibilia was present in I7 of 56 cefepime-treated patients (30.4%) and ten of 34 gentamicin and mezlocillin-treated patients (29.4%). Enterococci were recovered in six cefepime-treated patients. Clinical and bacteriologic responses were similar for the cefepime-treated and gentamicin and mezlocillin-treated groups, with one failure in each group, a wound infection in a patient receiving cefepime and a subhepatic abscess in a patients receiving gentamicin and mezlocillin. Other measures of outcome, such as the number of days of fever, days nothing by mouth, days of hospitalization and days of antibiotic therapy were similar in both groups.
Cefepime, with every I2 h dosing, achieved extremely high concentrations in all tissues assayed at the time of the operation, a mean of eight hours after administration. Adverse clinical events were similar in both treatment groups. Cefepime is as effective as gentamicin and mezlocillin in preventing septic complications after cholecystectomy for acute cholecystitis. Cefepime requires fewer doses, does not require drug monitoring, is not associated with nephrotoxicity and may therefore prove to be a cost-effective alternative to combination therapy that uses an aminoglycoside. A clinical comparisonof cefepime aad metronidazoleversus gentan&in aad cliadamycio in the antibiotic maaagement of surgically treated advanced appendicitis Beme T.V.; Yellin A.E.; Appleman M.D.; Heseltine P.N.R.; Gill M.A. USA
SURG GYNECOL OBSTET 1993/177/SUPPL. (18-22) Many antibiotics and antibiotic combinations are used for the treatment of peritonitis because of advanced (gangrenous or perforated) appendicitis. An aminoglycoside combined with an antianaerobe antibiotic is one standard treatment, but there is concern about the potential nephrotoxicity of the aminoglycoside and the necessity for monitoring aminoglycoside blood levels. Cefepime, a new broad-spectrum cephalosporin with a prolonged serum half-life, has excellent activity against gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa. Its spectrum of activity is similar to the aminoglycosides, but it has less potential for inducing renal injury. A double-blind, randomized study compared cefepime, 2 grams every I2 h IVPB plus metronidazole 0.5 grams every eight hours IVPB (C/M) with gentamicin 1.5 milligrams per kilograms of IVPB plus clindamycin 0.9 grams q eight hours IVPB (G/C), administered up to I4 days, in 96 surgically treated patients with gangrenous or perforated appendicitis. Fifty patients had advanced appendicitis (nine gangrenous and 41 perforated) in the C/M group and 46 patients (six gangrenous and 40 perforated) in the G/C group. The mean number of days of postoperative fever (C/M, 4.4 f 2.7 vs. G/C, 5.0 * 2.2), postoperative hospitalization (C/M, 2.0 f 1.9 vs. G/C, 2.0 * 2. I) and antibiotic therapy (C/M, 6.3 f 1.9 vs. G/C, 6.9 f 1.9) was similar in the two treatment groups. There were I I treatment failures (C/M, three; G/C, eight; P = 0.13), six of which were probably a result of enterococci. No deaths occurred. Our study results show that the eflicacy of cefepime plus metronidazole is equivalent to that of clindamycin plus gentamicin.
FERTILITY, STERILITY Infertilitytreatment:From cookery to science. The epidemiology of raadomizedcontrolled trials Vandekerckhove P.; O’Donovan P.A.; Lilford R.J.; Harada T.W. JPN
BR J OBSTET GYNAECOL 1993/100/l I (1005-1036) Objectives: To review the epidemiology of published randomized controlled trials in infertility treatment over the last 25
Ciiaiions from the literature/ Int. J. Gynecol. Obstet. 46 (1994) 351-358
anaerobic organisms and leaving the surgical incision open decrease the incidence of postoperative wound infection. Despite such preventive measures, major infection remains a problem. Postoperativepneumoniain the intensive care unit Fry D.E. USA
SURG GYNECOL OBSTET 1993/177/SUPPL. (41-49) Postoperative pneumonia in the surgical patient may occur from atelectasis and inadequate postoperative TV, from ventilator-associated pathophysiology and from aspiration. Each process ultimately elicits the proinflammatory responses from the lung in the effort to eradicate the infectious pathogens. Postoperative pneumonia is best prevented by maintaining a clear understanding of the biologic basis for infection in the lung. Therapy requires aggressive tracheobronchial drainage strategies and antibiotic therapy directed toward the pathogens that are producing the pulmonary inflammatory response. A raadomized study of cefepime versus the combination of geotamicia and mezlocillin as an adjuact to surgical treatment in path& with acute cbolecystitis Yellin A.E.; Beme T.V.; Appleman M.D.; Heseltine P.N.R.; Gill M.A.; Okamoto M.P.; Baker F.J.; Holcomb C. USA
SURG GYNECOL OBSTET 1993/177/SUPPL. (23-29) In patients with acute cholecystitis, antibiotics are used as an adjunct to cholecystectomy to reduce the incidence of postoperative septic complications thought to be related to bactibilia. Combinations of penicillins, or cephalosporins or aminoglycosides, or both, are often used. Cefepime is a fourthgeneration cephalosporin with excellent activity against grampositive and gram-negative bacteria, including Pseudomonas species. It has a prolonged serum half-life, allowing twice-daily dosing, and is not nephrotoxic. This study was undertaken to determine whether or not cefepime was as effective as the combination of gentamicin and mezlocillin in patients with acute cholecystitis. One hundred and forty-nine patients were randomized, two to one, to receive cefepime or gentamicin and mezlocillin. Cefepime was given intravenously at 2 grams every I2 h; gentamicin, I .O to I.5 milligrams per kilograms every eight hours, and mezlocillin, 3 to 4 grams every four to six hours. All patients underwent cholecystectomy. Bile cultures were obtained, and concentrations of cefepime in blood, bile, peritoneal fluid and gallbladder were determined in a subset of patients. There were 56 evaluable cefepime-treated and 34 evaluable gentamicin and mezlocillin-treated patients. Bactibilia was present in I7 of 56 cefepime-treated patients (30.4%) and ten of 34 gentamicin and mezlocillin-treated patients (29.4%). Enterococci were recovered in six cefepime-treated patients. Clinical and bacteriologic responses were similar for the cefepime-treated and gentamicin and mezlocillin-treated groups, with one failure in each group, a wound infection in a patient receiving cefepime and a subhepatic abscess in a patients receiving gentamicin and mezlocillin. Other measures of outcome, such as the number of days of fever, days nothing by mouth, days of hospitalization and days of antibiotic therapy were similar in both groups.
Cefepime, with every I2 h dosing, achieved extremely high concentrations in all tissues assayed at the time of the operation, a mean of eight hours after administration. Adverse clinical events were similar in both treatment groups. Cefepime is as effective as gentamicin and mezlocillin in preventing septic complications after cholecystectomy for acute cholecystitis. Cefepime requires fewer doses, does not require drug monitoring, is not associated with nephrotoxicity and may therefore prove to be a cost-effective alternative to combination therapy that uses an aminoglycoside. A clinical comparisonof cefepime aad metronidazoleversus gentan&in aad cliadamycio in the antibiotic maaagement of surgically treated advanced appendicitis Beme T.V.; Yellin A.E.; Appleman M.D.; Heseltine P.N.R.; Gill M.A. USA
SURG GYNECOL OBSTET 1993/177/SUPPL. (18-22) Many antibiotics and antibiotic combinations are used for the treatment of peritonitis because of advanced (gangrenous or perforated) appendicitis. An aminoglycoside combined with an antianaerobe antibiotic is one standard treatment, but there is concern about the potential nephrotoxicity of the aminoglycoside and the necessity for monitoring aminoglycoside blood levels. Cefepime, a new broad-spectrum cephalosporin with a prolonged serum half-life, has excellent activity against gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa. Its spectrum of activity is similar to the aminoglycosides, but it has less potential for inducing renal injury. A double-blind, randomized study compared cefepime, 2 grams every I2 h IVPB plus metronidazole 0.5 grams every eight hours IVPB (C/M) with gentamicin 1.5 milligrams per kilograms of IVPB plus clindamycin 0.9 grams q eight hours IVPB (G/C), administered up to I4 days, in 96 surgically treated patients with gangrenous or perforated appendicitis. Fifty patients had advanced appendicitis (nine gangrenous and 41 perforated) in the C/M group and 46 patients (six gangrenous and 40 perforated) in the G/C group. The mean number of days of postoperative fever (C/M, 4.4 f 2.7 vs. G/C, 5.0 * 2.2), postoperative hospitalization (C/M, 2.0 f 1.9 vs. G/C, 2.0 * 2. I) and antibiotic therapy (C/M, 6.3 f 1.9 vs. G/C, 6.9 f 1.9) was similar in the two treatment groups. There were I I treatment failures (C/M, three; G/C, eight; P = 0.13), six of which were probably a result of enterococci. No deaths occurred. Our study results show that the eflicacy of cefepime plus metronidazole is equivalent to that of clindamycin plus gentamicin.
FERTILITY, STERILITY Infertilitytreatment:From cookery to science. The epidemiology of raadomizedcontrolled trials Vandekerckhove P.; O’Donovan P.A.; Lilford R.J.; Harada T.W. JPN
BR J OBSTET GYNAECOL 1993/100/l I (1005-1036) Objectives: To review the epidemiology of published randomized controlled trials in infertility treatment over the last 25