Reviews of infectious diseases
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Comparative Study
Mediastinitis complicating cardiac operations: evidence of postoperative causation.
An excess rate of mediastinitis complicating cardiac operations occurred in one of two hospitals served by the same surgeons. The rates were 4% at hospital A and 0.48% at hospital B for the same period (P = .002). At hospital A five patients who underwent a thoracic reoperation experienced postoperative pneumonia or bacteremia prior to onset of mediastinitis; these infections were caused by the same bacterial species. ⋯ At hospital A regular and temporary critical care nursing personnel, who took care of both infected and uninfected patients, did not antisepticize their hands before manipulation of percutaneous catheters. After cohorts of nurses were formed and antisepsis of the hands with alcohol was strictly enforced (no diminution in the number of temporary personnel was instituted), the frequency of mediastinitis decreased significantly among patients who underwent reoperations at hospital A (P = .002), but no concurrent change was noted at hospital B. Preventable postoperative remote-site infection may lead to mediastinitis.
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Review Clinical Trial
Antibiotic prophylaxis in trauma: penetrating abdominal injuries and open fractures.
Infection is an important cause of late morbidity and mortality following traumatic injury. As part of a coordinated treatment effort for the injured patient, preventive antibiotic use can reduce subsequent infectious complications. Available evidence supports the use of antibiotic(s) with activity against both aerobic and anaerobic enteric pathogens for patients with penetrating abdominal injuries and bowel penetration. ⋯ Data on the ideal dose and duration of antibiotic administration in these situations are incomplete. It is likely that the best results will be obtained with early parenteral administration of large doses of the chosen antibiotic continuing for less than or equal to 24 hours. For injuries other than penetrating abdominal wounds and open fractures, definitive information is not available.
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Streptococcus agalactiae, a group B streptococcus, has been a well-known cause of postpartum and postabortion endocarditis since the preantibiotic era. Streptococcus agalactiae is capable of infecting normal valves and usually produces left-sided disease. We describe a 30-year-old woman who developed tricuspid valve endocarditis due to S. agalactiae. Excision of the valve and a 4-week course of therapy with vancomycin resulted in cure.
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Postpartum endometritis continues to be the leading cause of morbidity following cesarean section. This infection is commonly polymicrobial, involving aerobic, facultative, and obligate anaerobic gram-negative bacteria as well as gram-positive bacteria. ⋯ The combination ticarcillin/clavulanate has a spectrum of activity resembling that of clindamycin and gentamicin. In the data reported, cure rates among patients treated with ticarcillin/clavulanate were similar to the rates for those treated with clindamycin plus gentamicin as well as those for cefoxitin.
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Review Clinical Trial
Pneumococcal vaccine trials in Papua New Guinea: relationships between epidemiology of pneumococcal infection and efficacy of vaccine.
Field trials in Papua New Guinea have shown that pneumococcal capsular polysaccharide vaccine protects children less than 2 years of age from death due to acute lower respiratory infections (ALRI). The vaccine appears to reduce mortality by preventing bacteremia. ⋯ The evaluation of pneumococcal vaccines in areas where mortality is high should have the highest priority. For such trials investigators should, at minimum, define epidemiologic circumstances in terms of (1) the invasive serotypes of pneumococci, (2) the protective levels of antibody, (3) the antibody response to vaccination, and (4) the general immune status of the population.