Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · May 1997
Review[Systemic inflammatory reactions to extracorporeal therapy measures (II): Cardiopulmonary bypass].
About 65,000 cardiac patients undergo surgery annually in Germany with the assistance of cardiopulmonary bypass. The "post pump inflammatory response" (the systemic and myocardial inflammatory response syndrome post cardiac surgery), triggered at least in part by the cardiopulmonary bypass, contributes substantially towards morbidity (e.g., myocardial depression) and mortality in these patients. ⋯ Scoring systems and measurements of tumor necrosis factor-alpha, as well as soluble tumor necrosis factor receptors, allow the early detection of an "escalating inflammatory response" in 2-10% of all patients, which is associated with a worse prognosis. Therapeutic attempts to suppress these systemic and myocardial inflammatory reactions focus on blockade of the complement system, coating of CPB membranes with heparin, leucocyte depletion and attenuation of leucocyte function, elimination of toxins and mediators by means of hemofiltration, as well as on the administration of antiproteases, antioxidants, oxygen radical scavengers and also of immune globulins.
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This study reports pheno- and genotypical analysis of 9 isolates of vancomycin-resistant enterococci (VRE) and 5 vancomycin-sensitive enterococci (VSE) in Austria: 5 E, faecium isolates of 4 patients (the sole patients demonstrating VRE at the University Hospital of Innsbruck in 1994 and 1995), 3 glycopeptide-sensitive isolates collected in Innsbruck in February 1996 for epidemiological analysis, and 6 enterococcus isolates from the University Hospitals of Vienna and Graz. The pheno- and genotypical analyses of all glycopeptide highly resistant E. faecium and E. faecalis isolates indicated the presence of VanA type resistance. One E. casseliflavus strain with intrinsic VanC-1 resistance showed a characteristic constitutive low-level resistance to vancomycin and susceptibility to teicoplanin. ⋯ The results of our study indicate that oral vancomycin administration to humans is a primary cause of VRE in Austrian hospitals. In Austria approximately 66 kg vancomycin, 20% of it given orally, are administered to patients per year. Approx. 18-20 tons Avotan (active ingredient Avoparcin-10%)/year were used in Austria; as of April 1, 1997 the use of this animal foodstuff supplement is prohibited by the European Commission.