The efficacy and safety of imipenem/cilastatin was evaluated in a multicenter study. For 49 of the 78 patients with 79 infections entered into the study, the clinical and bacteriologic efficacy of ...therapy could be evaluated. Toxicity data were analyzed for all 79 infections. Overall, 35 of 49 infections were cured or improved: 10 of 11 cases of pneumonia; 8 of 15 cases of pyelonephritis; 4 of 5 cases of osteomyelitis; 3 of 4 intravascular infections; 6 of 9 soft tissue infections; and 4 of 5 miscellaneous infections. There were 13 bacteriologic failures; superinfections with resistant organisms (i.e., Candida albicans, methicillin-resistant Staphylococcus epidermidis, and Pseudomonas maltophilia) occurred in three patients; reinfection with sensitive pathogens complicated one urinary tract infection; relapses developed of five urinary tract infections and of one case of endarteritis; and bacteriologic persistence occurred in three soft tissue infections. Infections with Pseudomonas aeruginosa were the most difficult to treat. In only six of 11 P. aeruginosa infections was both bacteriologic and clinical cure achieved. Adverse effects were minimal; no serious hematologic or hepatic toxicity and no adverse renal effects were noted.
We studied asymptomatic bacteriuria in elderly ambulatory women residents without indwelling catheters in self-contained apartment houses at the Philadelphia Geriatric Center (PGC), in the nursing ...home at PGC, and in several life-care communities (LCC). Subjects were studied every 6 months from January 1983 through January 1989, and since enrollment was continuous some participated in more surveys than others. PGC residents were middle class and lived either in a self care apartment house (CL) or nursing home (NH); LCC residents were middle or upper class. Antimicrobial therapy for asymptomatic bacteriuria was not given by the study team. The ages of the 865 women studied averaged 80.3, 82.8, and 83.3 years in LCC, CL, and NH, respectively. On each survey about 11% at LCC, 18% at CL, and 25% at NH sites had positive cultures. Turnover was high. The conversion rate from a negative to a positive culture was 5% at LCC, 11% at CL, and 8% at NH. The reversion rate from a positive to a negative culture was 33% at LCC, 34% at CL and 31% at NH (P greater than 0.05). Persistent infection with the same organism was uncommon. Infection risk was associated with residence, which was partially explained by a factor evaluating mobility, but was unrelated to age or scores evaluating activities of daily living or mental status. Besides mobility, other more complex factors play a role in the acquisition of infection.
Concentrations of cephalexin (an orally absorbed derivative of cephalosporin C) in serum and urine were determined in normal volunteers and patients. The in vitro antibacterial activity was also ...studied. All strains of group A β-hemolytic streptococci and
Diplococcus pneumoniae
were inhibited by 3.1 μg/ml. Of the
Staphylococcus aureus
strains, 88% were inhibited by 6.3 μg/ml, and 12.5 μg/ml was inhibitory for all
S. aureus
, 80% of
Escherichia coli
, 72% of
Klebsiella-Aerobacter
, and 56% of
Proteus mirabilis
strains. About 90 to 96% of
E. coli, Klebsiella Aerobacter
, and
P. mirabilis
strains were inhibited by 25 μg of cephalexin per ml.
Pseudomonas
and indole-positive
Proteus
strains proved to be quite resistant to cephalexin. Cephalexin was well absorbed after oral administration. A peak serum concentration of cephalexin of at least 5 μg/ml was achieved in each volunteer with 250 and 500-mg doses. A mean peak serum concentration of 7.7 μg/ml was achieved with 250-mg doses; 12.3μg/ml was achieved with 500-mg doses of antibiotic. Food did not interfere with absorption. Probenecid enhanced both the peak serum concentration and the duration of antibiotic activity in the serum. Over 90% of the administered dose was excreted in the urine within 6 hr. The mean peak serum concentration of cephalexin after an oral dose of 500 mg was adequate to inhibit all group A streptococci,
D. pneumoniae
, and
S. aureus
, 85% of
E. coli
, and about 40 to 75% of
Klebsiella-Aerobacter
and
P. mirabilis
strains. Levels of cephalexin in urine were adequate to inhibit over 90% of
E. coli
, and
P. mirabilis
and 80 to 96% of
Klebsiella-Aerobacter
strains.
BACKGROUND Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in ...recent years.
METHODS This study was a prospectively conducted multicenter trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma.
RESULTS There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of > or = to30 minutes (p=0.01) to be associated with development of postoperative paraplegia.
CONCLUSIONS Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.
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