cefamandole and Bacteremia

A controlled randomized trial was carried out in 324 patients with inguinal hernia. Efficacy was evaluated of a single injection of cefamandole (n = 162) administered at operative site during local anesthesia, using an untreated group as control (n = 162), as prophylaxis against post-operative local infection. Seven patients in the control group developed abscesses at the operative site after discharge, 6 of the 7 during one-month follow up, compared with none in the treated group (n = 0.07). No side effects were reported due to the antibiotic therapy. The cost of the antibiotic treatment was 10 times less than that for treating the suppurations in the control group.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia, Local; Bacteremia; Cefamandole; Child; Drug Evaluation; Escherichia coli Infections; Female; Hernia, Inguinal; Humans; Male; Middle Aged; Postoperative Complications; Staphylococcal Infections; Streptococcal Infections

We report the results of a randomized, prospective study devised to assess the effectiveness of perioperative cefamandole prophylaxis on the remote infections rate in neurosurgery. Only two kinds of neurosurgical procedures were studied: shunt placement and craniotomy for brain tumour. In the treated patients cefamandole 1.5 g was given one hour before surgery, then repeated twice eight hourly. When the surgical procedure lasted more than three hours cefamandole 1.5 g was administered throughout the operation. No case of local infection was observed in either group, and the percentage of patients with remote infections was the same in both groups. Leucocytosis and temperature were measured during 15 days following the surgical procedure, and there were no differences between the treated and untreated groups in the evolution of these parameters. This study does not suggest that routine perioperative antibiotic prophylaxis is mandatory in neurosurgery.

Topics: Adolescent; Adult; Aged; Bacteremia; Brain Neoplasms; Cefamandole; Female; Humans; Lung Diseases; Male; Middle Aged; Postoperative Care; Postoperative Complications; Preoperative Care; Prospective Studies; Urinary Tract Infections; Wound Infection

Methicillin (meticillin)-susceptible Staphylococcus aureus (MSSA) strains producing large amounts of type A beta-lactamase (Bla) have been associated with cefazolin failures, but the frequency and impact of these strains have not been well studied. Here we examined 98 MSSA clinical isolates and found that 26% produced type A Bla, 15% type B, 46% type C, and none type D and that 13% lacked blaZ. The cefazolin MIC(90) was 2 microg/ml for a standard inoculum and 32 microg/ml for a high inoculum, with 19% of isolates displaying a pronounced inoculum effect (MICs of >or=16 microg/ml with 10(7) CFU/ml) (9 type A and 10 type C Bla producers). At the high inoculum, type A producers displayed higher cefazolin MICs than type B or C producers, while type B and C producers displayed higher cefamandole MICs. Among isolates from hemodialysis patients with MSSA bacteremia, three from the six patients who experienced cefazolin failure showed a cefazolin inoculum effect, while none from the six patients successfully treated with cefazolin showed an inoculum effect, suggesting an association between these strains and cefazolin failure (P = 0.09 by Fisher's exact test). In summary, 19% of MSSA clinical isolates showed a pronounced inoculum effect with cefazolin, a phenomenon that could explain the cases of cefazolin failure previously reported for hemodialysis patients with MSSA bacteremia. These results suggest that for serious MSSA infections, the presence of a significant inoculum effect with cefazolin could be associated with clinical failure in patients treated with this cephalosporin, particularly when it is used at low doses.

Topics: Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Cefamandole; Cefazolin; Humans; Methicillin; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus aureus; Treatment Failure

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Aortic Aneurysm, Abdominal; Bacteremia; Cefamandole; Cephalosporin Resistance; Cephalosporins; Drug Resistance, Multiple; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Male; Pneumonia, Bacterial; Postoperative Complications

Eight hundred and twenty two uncemented primary total hip arthroplasties (THAs) were performed between September 1980 and December 1992. The population that underwent uncemented THA can be divided into two groups based on the perioperative antibiotic prophylaxis: group 1 contains 439 primary THAs from September 1980 to September 1987 without antibiotic prophylaxis; group 2 contains 383 primary THAs who received short-term cefamandole prophylaxis from October 1987 to December 1992. Laminar air-flow and whole-body exhaust suits were used during the whole period of this study. Both groups consisted of relatively young patients with a mean age of 53.8 years in group 1, and 54.3 years in group 2. Using Kaplan-Meier survivorship analysis, the estimated survival rate of sepsis-free hips in group 1 was 97.9% at one year, 97.6% at two years, and 97.4% at three and up to eleven years. In group 2 with antibiotic prophylaxis no deep infection occurred; the rate of sepsis-free hips at five years is 100%. Under clean air conditions, antibiotic prophylaxis significantly decreased the incidence of deep sepsis (p log-rank 0.004).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibiotic Prophylaxis; Bacteremia; Cefamandole; Cephalosporins; Evaluation Studies as Topic; Female; Hip Prosthesis; Humans; Incidence; Male; Middle Aged; Prognosis; Prosthesis-Related Infections; Treatment Outcome

The susceptibility of clinical isolates of methicillin-susceptible and -resistant staphylococci from cancer patients with central venous catheter bacteremia to quinupristin/dalfopristin, a semisynthetic streptogramin, was determined in vitro. Susceptibility of these isolates to nine other antistaphylococcal antibiotics was also determined for comparison. A total of 197 staphylococcal strains were tested from 1983 to 1992. Quinupristin/dalfopristin was bactericidal against all isolates, independent of their resistance to methicillin. Its activity was similar to that of vancomycin but superior to that of teicoplanin. Quinupristin/dalfopristin may prove to be an important addition to our armamentarium against catheter-related staphylococcal infections.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Bacteremia; Catheterization, Central Venous; Cefamandole; Cephalosporins; Ciprofloxacin; Clindamycin; Daptomycin; Humans; Methicillin; Methicillin Resistance; Microbial Sensitivity Tests; Neoplasms; Novobiocin; Oxacillin; Penicillins; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Teicoplanin; Vancomycin; Virginiamycin

Topics: Animals; Anti-Bacterial Agents; Bacteremia; Cefamandole; Imipenem; Male; Methicillin Resistance; Mice; Mice, Inbred ICR; Staphylococcal Infections; Staphylococcus aureus