brl-28500 and Postoperative-Complications

The purpose of this study was to assess the value of tracheal aspirate as a predictor of pneumonia after coronary artery bypass grafting and to evaluate the efficacy of prolonged perioperative antibiotic prophylaxis.. Tracheal aspirates of 500 patients undergoing coronary artery bypass grafting were taken immediately after intubation and analyzed for microorganisms by Gram stain and semiquantitative microbiologic cultures. All patients received 2 g ceftriaxone as a single-dose perioperative antibiotic prophylaxis before operation. Results of Gram stains were available before the patients were transferred to the intensive care unit. After the results were known, both groups of patients (positive Gram stain, group 1; negative Gram stain, group 2) were randomly assigned to either conventional antibiotic prophylaxis (A), consisting of ceftriaxone 2 g on postoperative day 1, or prolonged antibiotic prophylaxis (B), with ticarcillin + clavulanic acid 3 x 5.2 g during 72 hours.. From 500 patients, 91 had a positive Gram stain whereas 409 had a negative one. The incidence of pneumonia was significantly higher in patients with preoperative positive tracheal aspirates (15.3%) than in patients with a negative one (3.6%; p < 0.01). However, prolonged prophylaxis did not reduce the rate of postoperative pneumonia, which was as high as 13% in untreated positive patients versus 17% in treated positive patients, and 2% in untreated negative patients versus 4% in treated patients. In patients who had pneumonia, there was a high correlation between the microorganisms found in preoperative aspirates and those observed when aspirates were repeated (100% correlation in patients with conventional antibiotic prophylaxis and 87% in those with prolonged prophylaxis).. Early postoperative pneumonia (<7 days) is most likely caused by microorganisms that colonize the respiratory tract before operation. The risk of pulmonary infection after coronary artery bypass grafting can be predicted from the preoperative tracheal aspirates. Prolonged perioperative antibiotic prophylaxis has no efficacy in reducing the incidence of pulmonary infections.

Topics: Aged; Antibiotic Prophylaxis; Bacteriological Techniques; Ceftriaxone; Clavulanic Acids; Coronary Artery Bypass; Double-Blind Method; Drug Administration Schedule; Female; Humans; Intubation, Intratracheal; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Postoperative Complications; Prospective Studies; Ticarcillin; Trachea

Systemic antibiotics given during the first week after tonsillectomy appear to be effective in reducing postoperative morbidity. We assessed the effectiveness of perioperative topical antibiotic rinses in reducing posttonsillectomy morbidity.. A randomized, double-blinded, placebo-controlled pilot study of 36 patients undergoing tonsillectomy was used to evaluate the effects of a standard 7-day systemic regimen of perioperative intravenous ampicillin/oral amoxicillin and 2 single-day topical antibiotic regimens: (1) clindamycin (Cleocin) and (2) amoxicillin/clavulanate (Augmentin) and ticarcillin/clavulanate (Timentin).. Mean aerobic and anaerobic oral bacterial counts were decreased in both topical treatment groups compared with the placebo group on the first postoperative day, achieving statistical significance with Augmentin/Timentin (aerobic and anaerobic bacterial counts) and Cleocin (aerobic counts). Significantly less postoperative pain and mouth odor were reported for both Cleocin (P = 0.014 and P = 0.005, respectively) and Augmentin/Timentin (P = 0.026 and P = 0.05, respectively) topical treatment groups when compared with the placebo group.. Preliminary results indicate a reduction in oral bacterial counts and postoperative morbidity in adult patients receiving topical antibiotics compared with patients receiving placebo; further investigation is warranted.

Topics: Administration, Topical; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteria; Clavulanic Acids; Clindamycin; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Mouth; Mouthwashes; Pilot Projects; Postoperative Complications; Surgical Wound Infection; Ticarcillin; Tonsillectomy

One hundred and one adult patients undergoing tonsillectomy for chronic/recurrent tonsillitis completed a prospective, randomized, double-blind, placebo-controlled study in which ticarcillin disodium and clavulanate potassium (Timentin) or placebo was administered intravenously at the time of surgery and for 12 hours postoperatively. The patients than received oral amoxicillin and clavulanate potassium (Augmentin) therapy or placebo for an additional seven days. Each patient kept a daily log to assess the incidence and severity of postoperative symptoms. Tonsillar core tissue at the time of surgery, as well as tonsillar fossa cultures after 7 days of treatment, were obtained. Those patients who received antibiotics fared consistently better in the immediate postoperative period compared with the placebo group. Specifically, patients in the antibiotic group experienced significantly less mouth odor, were able to tolerate a regular diet sooner, and resumed their normal activities earlier than did patients who received placebo. Patients who received antibiotics experienced fewer days with mouth odor (p = 0.004). In addition, on postoperative days 3 to 5, the antibiotic group was eating a regular diet (p = 0.05) and had returned to their routine activities earlier (p = 0.045) when compared with the placebo group. Perioperative antibiotic therapy was well tolerated and was effective in minimizing symptoms after tonsillectomy.

Topics: Adolescent; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Child; Clavulanic Acids; Double-Blind Method; Drug Therapy, Combination; Female; Halitosis; Humans; Male; Postoperative Complications; Postoperative Period; Premedication; Prospective Studies; Ticarcillin; Tonsillectomy

To describe the microbiologic etiology of post-cesarean endometritis developing after perioperative cephalosporin prophylaxis, endometrial samples were obtained from 27 women with a triple-lumen catheter. The women were assigned in a double-blind, randomized fashion to receive either ticarcillin/clavulanate, 3.1 g, or cefoxitin, 2 g, administered every six hours, until the clinical signs of infection resolved. A total of 149 microorganisms (84 facultative and 65 obligate anaerobes) were recovered from 26 women, for a mean of 5.5 isolates per specimen. One endometrial specimen was sterile. Bacteroides and Peptostreptococcus species were the most frequent isolates, followed by Gardnerella vaginalis, Enterococcus, facultative gram-negative rods and Mycoplasma hominis. Each of the isolates was tested for beta-lactamase activity. At least one beta-lactamase-producing isolate was recovered from 56% of the specimens. Susceptibility testing of endometrial isolates demonstrated that 96% of 118 potential pathogens (Gardnerella, Bacteroides, Peptostreptococcus, enterococci and streptococci) were susceptible to ticarcillin/clavulanate. By comparison, 86% of these isolates were susceptible to cefoxitin in vitro. Women who were treated with ticarcillin/clavulanate were less likely to have a temperature greater than 38 degrees C for two or more days (8% vs. 57%, P = .01). Also, there was a trend toward a decreased duration of uterine tenderness in the ticarcillin/clavulanate group, but it did not attain statistical significance (60% vs. 86%, P = .4). However, the overall clinical success rate with these single-agent treatments was not different for the two groups (77% vs. 79%, P = 1.0).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Bacteroides; Cefoxitin; Cephalosporins; Cesarean Section; Clavulanic Acids; Double-Blind Method; Drug Evaluation; Drug Therapy, Combination; Endometritis; Female; Humans; Penicillins; Peptostreptococcus; Postoperative Complications; Pregnancy; Randomized Controlled Trials as Topic; Ticarcillin

Topics: Adult; Aged; Aged, 80 and over; Aminoglycosides; Anastomotic Leak; Anti-Bacterial Agents; Ascitic Fluid; Clavulanic Acids; Cohort Studies; Culture Techniques; Digestive System Surgical Procedures; Disk Diffusion Antimicrobial Tests; Drug Resistance, Multiple, Bacterial; Female; Fluoroquinolones; Hospital Mortality; Humans; Imipenem; Male; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Peritonitis; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Prognosis; Retrospective Studies; Surgical Wound Infection; Ticarcillin; Treatment Outcome; Vancomycin

We report a case of Alcaligenes xylosoxidans keratitis following penetrating keratoplasty in a rigid gas permeable (RGP) lens wearer.. A 61 year old RGP lens wearer with a history of nonresponsive keratitis of the right eye which involved the graft margin was referred to us for treatment. Corneal cultures revealed growth of a gram-negative rod on the fifth day and the organism was subsequently identified as Alcaligenes xylosoxidans, which was resistant to most antibiotics and sensitive only to Bactrim, Timentin, and imipenem.. Clinical improvement was observed within 24 hours after treatment with the use of topical i.v. Bactrim and topical i.v. Timentin 2% alternating every 30 minutes. Complete resolution of the infection with mild scarring was observed 6 weeks after treatment.. Alcaligenes xylosoxidans is a potential cause of bacterial keratitis which should be considered in cases of nonresponsive gram-negative keratitis. The addition of topical Bactrim or Timentin may need to be considered in such cases.

Topics: Administration, Topical; Alcaligenes; Anti-Bacterial Agents; Bacterial Infections; Clavulanic Acids; Contact Lenses; Cornea; Drug Therapy, Combination; Gases; Humans; Keratitis; Keratoplasty, Penetrating; Male; Middle Aged; Permeability; Postoperative Complications; Ticarcillin; Trimethoprim, Sulfamethoxazole Drug Combination

A prospective study was performed on 50 consecutive patients with secondary peritonitis. All patients received ticarcillin/clavulanate 5.2 g three times daily as initial antibiotic therapy. In 30 patients a primary perforation was found in the gastro-intestinal tract and 20 had post-operative peritonitis. In two thirds of the patients a diffuse peritonitis was found which affected the whole abdomen. Thirty-six patients underwent one or two laparotomies and 11 patients had more than three laparotomies. Subsequently, 17 patients died. The cause of death was a therapeutic failure as a result of the surgical procedure in ten patients (nine patients with persisting intestinal fistulae, one patient with bleeding), whereas in seven cases antibiotic therapy failed. Micro-organisms found in the latter patients were producers of type 1 beta-lactamase (Pseudomonas aeruginosa, Enterobacter sp., Citrobacter sp., Serratia marcescens) and enterococci. Ticarcillin/clavulanate is characterized by its broad antimicrobial spectrum against anaerobic and aerobic bacteria and seems, therefore, to be well suited for initial chemotherapy in patients with diffuse peritonitis.

Topics: Adult; Aged; Aged, 80 and over; Clavulanic Acids; Drug Resistance, Microbial; Drug Therapy, Combination; Escherichia coli; Female; Humans; Male; Middle Aged; Penicillins; Peritonitis; Postoperative Complications; Ticarcillin

Topics: beta-Lactamase Inhibitors; Clavulanic Acids; Drug Combinations; Drug Resistance, Microbial; Humans; Male; Middle Aged; Penicillins; Postoperative Complications; Pseudomonas aeruginosa; Pseudomonas Infections; Ticarcillin

In an open study 50 patients were treated for a variety of infections with 3.2 g Timentin 6, 8- or 12-hourly for a mean period of six days. Timentin was clinically successful in 87% of patients assessed at the end of treatment of whom 95% remained cured or improved at a later follow-up. Bacteriologically Timentin was successful against 92% of organisms, including all 11 which were ticarcillin or ampicillin resistant. Side effects were reported in seven patients, the majority of which were minor local reactions at the site of infusion. This open study shows Timentin to be a safe and effective antibiotic for the treatment of infection.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Clavulanic Acids; Drug Combinations; Drug Evaluation; Female; Humans; Kinetics; Male; Middle Aged; Penicillin Resistance; Penicillins; Postoperative Complications; Ticarcillin