Diagnostic microbiology and infectious disease
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Diagn. Microbiol. Infect. Dis. · Sep 2002
Comparative StudyPharmacodynamic profiling of continuously infused piperacillin/tazobactam against Pseudomonas aeruginosa using Monte Carlo analysis.
Standard doses of piperacillin/tazobactam (9-13.5 g over 24 h) administered by continuous infusion (CI) routinely provide serum concentrations in excess of the susceptibility breakpoint (< or =16/4 micro g/ml) for most Enterobacteriaceae. Since the breakpoint of this agent for Pseudomonas aeruginosa is considerably higher (< or=64/4 micro g/ml), the likelihood of obtaining adequate drug exposures with these doses against this bacterium is currently unknown. Monte Carlo simulation was utilized to determine the probability of obtaining adequate piperacillin concentrations above its MICs for P. aeruginosa in patients receiving CI. ⋯ The simulation resulted in a median level of exposure 12.62 times the MIC. The level of certainty of obtaining concentrations at the MIC, 2 x MIC, 4 x MIC, 5 x MIC, and 6 x MIC for piperacillin administered by CI was 97, 93, 85, 81, and 77%, respectively. Despite concern for the place of CI piperacillin/tazobactam in the management of P. aeruginosa infections due to the higher established breakpoint, these data suggest a high probability of achieving adequate drug exposure against susceptible isolates with this dosing regimen.
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Diagn. Microbiol. Infect. Dis. · Jun 2002
Culturing bronchial washings obtained during bronchoscopy fails to add diagnostic utility to culturing the bronchoalveolar lavage fluid alone.
A retrospective analysis was performed to determine whether cultures of bronchial washings (BW) obtained during bronchoscopy added to the diagnostic efficiency of cultures of bronchoalveolar lavage fluid (BAL) alone. Results of BW and BAL cultures submitted from 268 patients over a 7-month period were compared. ⋯ Culturing the BAL specimen alone would have resulted in an efficiency of 97.0% (95% confidence interval 94.2-98.7%) for the isolation of clinically relevant pathogens identified from bronchoscopic specimens. These results suggest that the submission of BW obtained during the BAL procedure for culture evaluation not only fails to add diagnostic value, but may also result in unnecessary laboratory evaluations and provide misleading information to clinicians.
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Diagn. Microbiol. Infect. Dis. · Sep 2000
Randomized Controlled Trial Clinical TrialEvaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients.
Central venous catheterization represents a significant medical advancement, particularly in the treatment of critical ill. However, there is a high risk of central venous catheters-related infection. A novel antiseptic central venous catheter, made of polyurethane and impregnated with chlorhexidine and silver sulfadiazine, was developed to reduce the risk of catheters-related infection. ⋯ Two of our cases in the control group died directly due to catheter-related candidemia. No adverse reactions such as hypersensitivity or leukopenia were found in the antiseptic catheter group. Our study showed that central venous catheters with antiseptic coating were safe and had less risk of colonization of bacteria and fungi than standard catheters in the critically ill patients.
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Diagn. Microbiol. Infect. Dis. · May 2000
Review Case ReportsBacteremic cellulitis caused by Non-01, Non-0139 Vibrio cholerae: report of a case in a patient with hemochromatosis.
We report a case of bacteremia associated with hemorrhagic bullous skin lesions on the leg caused by non-01, non-0139 Vibrio cholerae in a 66-year-old man with hemochromatosis developed in an inland region. The organism was isolated from blood and bullae fluid. The patient was treated successfully with cefotaxime and doxycycline. This report emphasizes the potential of this organism to produce bacteremic cellulitis in people with underlying illness in the absence of usual epidemiological risk factors.