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  • 1
    ISSN: 1432-1041
    Keywords: Key wordsGentamicin; aminoglycoside antibiotics ; administration and dosage ; serum assays
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Gentamicin continues to have an important role in the treatment of serious bacterial infections. There is increasing interest in once-daily administration, which is more convenient than multiple-dose regimens. Animal studies and clinical trials suggest that once-daily administration is as efficacious and no more toxic for a variety of infections, but there is still some reluctance to use once-daily regimens routinely in neutropenic patients, because of the potential risk of breakthrough bacteraemia. A number of aspects of the serum concentration monitoring of once-daily gentamicin remain unresolved. The most commonly used assay systems are not sensitive enough, without some modification in technique, to detect the very small pre-dose concentrations seen with once-daily dosing, and it is not clear what constitutes an acceptable pre-dose concentration. Until the results from further studies become available, it is prudent to maintain a pre-dose concentration below 1 mg ⋅l−1, and local arrangements are necessary to address the frequency and timing of assays. It seems likely that once-daily administration will become the norm, because of its many advantages.
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  • 2
    ISSN: 1432-1238
    Keywords: Intensive care units ; Streptococcus ; Antibiotics ; Antibiotic resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The effect of selective decontamination of the digestive tract (SDD) on Intensive Therapy Unit (ITU)-acquired enterococcal infection and colonization was studied. Changes in the predominant species isolated and resistance patterns to antimicrobial agents were also studied. Design Three groups were investigated: historical control (HC), contemporaneous control (CC) and patients receiving SDD (topical polymyxin, amphoterecin B and tobramycin throughout ITU stay with intravenous ceftazidime for the first 3 days only). Setting Adult general ITU with 7 beds. Patients Patients with a nasogastric tube in situ and who were likely to remain in ITU for 48 h or longer were recruited. Results Enterococcal infections occured in 3 of 84 HC patients and 2 of 91 CC patients. There were no unit-acquired enterococcal infections in the SDD group. There were 140 episodes of enterococcal colonization occurring in 112 patients, with significantly more in the SDD and CC groups (p〈0.05. There were no significant differences in antibiotic sensitivities between the three groups.Enterococcus faecalis was the most frequently isolated species. Conclusion SDD does not predispose to enterococcal infection but does encourage colonization in patients receiving the regimen and other patients in ITU at the same. There is a complex interaction of factors which influence faecal flora and the likelihood of patients becoming colonized or infected with enterococci.
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  • 3
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between January and April 1993, culture forClostridium difficile and a faecal cytotoxin assay were performed on 500 selected specimens. Isolates from culture-positive patients from whom faecal samples were cytotoxin negative were also examined in vitro for cytotoxin production. The significance of a positive culture result in the absence of faecal cytotoxin was assessed. Forty-one of the 500 specimens were toxin positive. In only 25 of these wasClostridium difficile examination specifically requested. Six of nine culture-positive cytotoxin-negative patients (11 specimens) had recently received antibiotics. In four of these,Clostridium difficile was considered to be of possible clinical significance. Culture and in vitro determination of toxin production of isolates may aid in the diagnosis of some additional cases, but cytotoxin detection remains the single optimal routine laboratory method for diagnosis.
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  • 4
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 5
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Sporadic infections with Acinetobacter spp., punctuated with prolonged outbreaks of infection involving larger numbers of patients and a particular epidemic strain of Acinetobacter baumannii, have occurred in the adult intensive care unit (ICU) of Nottingham University Hospital since 1985. The aim of this study was to screen patients admitted to the ICU for three or more days during a non-outbreak period in 1994–1995 and to use DNA fingerprinting techniques to compare any isolates of Acinetobacter spp. with isolates obtained from the same ICU during the previous ten years. In the present study, almost 20% of the ICU patients screened during 1994–1995 became colonized with Acinetobacter spp. The commonest species isolated from patients was Acinetobacter baumannii; five different strains were identified by random amplified polymorphic DNA fingerprinting, including the epidemic strain responsible for outbreaks of infection in 1985–1986 and 1992–1993. Environmental sampling yielded Acinetobacter spp. from one or more samples on four occasions;Acinetobacter radioresistens was the commonest species isolated, and Acinetobacter baumannii (not the epidemic strain) was isolated on only one occasion from the environment. The long-term persistence of a potentially epidemic strain in the ICU, even during a non-outbreak period, indicates a need for continued vigilance. Consequently, periodic patient and environmental surveillance, combined with typing of isolates, is recommended for ICUs where significant outbreaks of Acinetobacter infection have occurred in the past.
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  • 6
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sporadic infections withAcinetobacter spp., punctuated with prolonged outbreaks of infection involving larger numbers of patients and a particular epidemic strain ofAcinetobacter baumannii, have occurred in the adult intensive care unit (ICU) of Nottingham University Hospital since 1985. The aim of this study was to screen patients admitted to the ICU for three or more days during a non-outbreak period in 1994–1995 and to use DNA fingerprinting techniques to compare any isolates ofAcinetobacter spp. with isolates obtained from the same ICU during the previous ten years. In the present study, almost 20% of the ICU patients screened during 1994–1995 became colonized withAcinetobacter spp. The commonest species isolated from patients wasAcinetobacter baumannii; five different strains were identified by random amplified polymorphic DNA fingerprinting, including the epidemic strain responsible for outbreaks of infection in 1985–1986 and 1992–1993. Environmental sampling yieldedAcinetobacter spp. from one or more samples on four occasions;Acinetobacter radioresistens was the commonest species isolated, andAcinetobacter baumannii (not the epidemic strain) was isolated on only one occasion from the environment. The long-term persistence of a potentially epidemic strain in the ICU, even during a non-outbreak period, indicates a need for continued vigilance. Consequently, periodic patient and environmental surveillance, combined with typing of isolates, is recommended for ICUs where significant outbreaks ofAcinetobacter infection have occurred in the past.
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  • 7
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The aim of this study was to compare the molecular relationships and antibiograms of nosocomial isolates of Acinetobacter spp. from two acute-care hospitals in Nottingham, UK, and Soweto, South Africa, with different hospital infection control problems and procedures. In contrast to Nottingham, where randomly amplified polymorphic DNA fingerprinting demonstrated that a single multiresistant strain of Acinetobacter baumannii has predominated in the hospital intensive care unit over an 11-year period, the Soweto isolates formed a heterogeneous group of unrelated molecular clusters of different antibiograms, with numerous different strains of Acinetobacter baumannii, Acinetobacter sp. 3 and Acinetobacter sp. 13TU apparently being endemic throughout the Soweto hospital. The contrasting results illustrate the need to maintain exemplary infection control procedures in hospitals where high standards have been achieved and warn of what might result if such measures are diminished.
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  • 8
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 9
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Bacteraemia is an important cause of morbidity and mortality in the intensive care unit. In this study the distribution of organisms causing bacteraemic episodes in patients in the adult intensive care unit of a large teaching hospital was determined. Particular emphasis was placed on the type of organisms isolated from community- and hospital-acquired bacteraemia, the suspected source of infection, the possible risk factors associated with bacteraemia, and outcome. The incidence of bacteraemia and fungaemia increased from 17.7 per 1000 admissions in 1985 to 80.3 in 1996. A total of 315 episodes of bacteraemia and fungaemia were documented over a 12-year period, of which 18% were considered community-acquired and 82% hospital-acquired. Gram-positive and gram-negative bacteria accounted for 46.9% and 31.5% of the episodes, respectively. Polymicrobial infection accounted for 17.8% and fungi for 3.8% of the episodes. Staphylococcus aureus (22.5%), Staphylococcus epidermidis (7.6%), and Streptococcus pneumoniae (7.9%) were the predominant gram-positive bacteria implicated, whereas Escherichia coli (6%), Enterobacter cloacae (7%), Klebsiella aerogenes (3.8%), Pseudomonas aeruginosa (5.1%), and Acinetobacter spp. (3.8%) were the predominant gram-negative bacteria isolated. The two most common sources of infection were the respiratory tract (39.7%) and an intravascular line (24.5%), but in 8.9% of episodes the focus of infection remained unknown. Bacteraemic patients stayed in the unit for a longer period (12 days) than did non-bacteraemic patients (3 days). The overall mortality related to bacteraemia and candidaemia was 44.4%. Surveillance of bacteraemia in the intensive care unit is important in detecting major changes in aetiology, e.g., the increasing incidence of gram-positive bacteraemia, the emergence of methicillin-resistant Staphylococcus aureus in 1995, and the emergence of Enterobacter cloacae. It is of value in determining empirical antimicrobial therapy to treat presumed infection pending a microbiological diagnosis and in directing the development of guidelines for infection prevention, e.g., guidelines for central venous catheter care.
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  • 10
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Bacteraemia is an important cause of morbidity and mortality in the intensive care unit. In this study the distribution of organisms causing bacteraemic episodes in patients in the adult intensive care unit of a large teaching hospital was determined. Particular emphasis was placed on the type of organisms isolated from community- and hospital-acquired bacteraemia, the suspected source of infection, the possible risk factors associated with bacteraemia, and outcome. The incidence of bacteraemia and fungaemia increased from 17.7 per 1000 admissions in 1985 to 80.3 in 1996. A total of 315 episodes of bacteraemia and fungaemia were documented over a 12-year period, of which 18% were considered community-acquired and 82% hospital-acquired. Gram-positive and gram-negative bacteria accounted for 46.9% and 31.5% of the episodes, respectively. Polymicrobial infection accounted for 17.8% and fungi for 3.8% of the episodes.Staphylococcus aureus (22.5%),Staphylococcus epidermidis (7.6%), andStreptococcus pneumoniae (7.9%) were the predominant gram-positive bacteria implicated, whereasEscherichia coli (6%),Enterobacter cloacae (7%),Klebsiella aerogenes (3.8%),Pseudomonas aeruginosa (5.1%), andAcinetobacter spp. (3.8%) were the predominant gram-negative bacteria isolated. The two most common sources of infection were the respiratory tract (39.7%) and an intravascular line (24.5%), but in 8.9% of episodes the focus of infection remained unknown. Bacteraemic patients stayed in the unit for a longer period (12 days) than did non-bacteraemic patients (3 days). The overall mortality related to bacteraemia and candidaemia was 44.4%. Surveillance of bacteraemia in the intensive care unit is important in detecting major changes in aetiology, e.g., the increasing incidence of gram-positive bacteraemia, the emergence of methicillin-resistantStaphylococcus aureus in 1995, and the emergence ofEnterobacter cloacae. It is of value in determining empirical antimicrobial therapy to treat presumed infection pending a microbiological diagnosis and in directing the development of guidelines for infection prevention, e.g., guidelines for central venous catheter care.
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