JAMA : the journal of the American Medical Association
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A spectrum of IgE-mediated allergic responses to latex is presented in this report of 14 patients, including health care workers, sensitized by exposure to latex gloves. Symptoms often occurred immediately after exposure to latex, and manifestations varied according to the route of latex antigen presentation. Skin exposure usually caused contact urticaria. ⋯ Physicians should be aware that latex allergy can present as anaphylaxis during surgery, barium enema, or dental work. Latex skin tests are a satisfactory method of diagnosis. Nonlatex gloves are available and are tolerated by affected people.
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Randomized Controlled Trial Clinical Trial
Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial.
Secondary pneumonia in patients requiring mechanical ventilation has a high morbidity and mortality. Diagnosis is difficult and treatment failure common; therefore, preventive measures are important. In a double-blind, placebo-controlled trial, we evaluated selective decontamination of the oropharynx with polymyxin B sulfate, neomycin sulfate, and vancomycin hydrochloride (PNV) in 52 patients requiring mechanical ventilation during a 3- to 34-day period (mean, 10 days). ⋯ During the first 12 days of intubation, tracheobronchial colonization by gram-negative bacteria and Staphylococcus aureus, as well as pneumonia, occurred less frequently in the PNV than in the placebo group (16% vs 78%; P less than .0001). Hospital mortality was not different, but systemic antibiotics were prescribed less often in the PNV group and no resistant microorganism emerged. In these critically ill patients, topical oropharyngeal antibiotic application lowered the rate of ventilator-associated pneumonia by a factor of 5, probably by interrupting the stomach-to-trachea route of infection, and decreased the requirement for intravenous antibiotics.