cefotaxime and Gangrene

Over a 6-month period 124 patients submitted to aortic or infra-inguinal arterial reconstruction were alternately allocated to receive cloxacillin plus gentamicin (CX/GM) for 48 hours or cefotaxime (CTX) for 24 hours perioperatively. Evaluations during during the first month were performed by a blinded independent observer and patients were followed for between 6 and 20 months. 63 patients received CX/GM and 61 CTX; the groups were matched for sepsis risk factors. Sepsis rates were: groin and abdominal wounds, CX/GM 5.4% (7 of 129), CTX 6.2% (8 of 127); graft, CX/GM 1.5% (1 of 63), CTX 3.3% (2 of 61). The differences were not statistically significant (p greater than 0.05). Virtually all wound infections were superficial (class I) and no late infections have emerged. 56 patients had infected extremity lesions and 68 had no lesion. There was no significant difference in wound or graft sepsis rates between the 2 groups. Positive cultures of groin lymph nodes and/or aortic clot or atheroma did not predispose patients to postoperative sepsis. The organisms cultured from the extremity lesions were not found in infected wounds of abdominal surgery patients. However, species type and antibiotic susceptibility patterns suggest that the same pathogens were present in wound infections as were isolated from the extremity lesions of patients who underwent infra-inguinal surgery. Thus direct, rather than lymphatic, contamination may be the major aetiological factor. Most infecting organisms were susceptible to the antibiotic used.

Topics: Adult; Aged; Aged, 80 and over; Arterial Occlusive Diseases; Cefotaxime; Cloxacillin; Drug Therapy, Combination; Female; Follow-Up Studies; Gangrene; Gentamicins; Humans; Leg Ulcer; Middle Aged; Prospective Studies; Surgical Wound Infection

Topics: Adult; Amputation Stumps; Amputation, Surgical; Amputation, Traumatic; Anti-Bacterial Agents; Arm; Cefotaxime; Gangrene; Humans; Leg; Male; Metronidazole; Middle Aged; Retrospective Studies; Young Adult

Topics: Cefotaxime; Combined Modality Therapy; Debridement; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Fever; Foot; Gangrene; Hand; Humans; IgA Vasculitis; Immunocompetence; Infant; Ischemia; Male; Physical Therapy Modalities; Plasma; Plastic Surgery Procedures; Pneumococcal Infections; Pneumonia, Pneumococcal; Sepsis; Skin Transplantation; Vancomycin

Twenty-eight patients, 20 females and eight males (age 45-85 years) were treated for diabetic gangrene of the foot using a combination of surgery and intraarterial administration of prostaglandin F and cefotaxime. In 64% of the patients treated it was possible for the leg in question to be saved. We therefore consider intraarterial administration of cefotaxime in conjunction with prostaglandin E, and with simultaneous local surgery of the focal infection, to be a promising concept. Further studies, however, are necessary in order to establish whether the initial success can be consistently reproduced.

Topics: Aged; Aged, 80 and over; Alprostadil; Amputation, Surgical; Cefotaxime; Combined Modality Therapy; Diabetes Complications; Female; Foot; Gangrene; Humans; Infusions, Intra-Arterial; Male; Middle Aged

15 patients with severe diabetic gangrene were treated with a combined intra-arterial PGE1/Cefotaxime infusion therapy. There was no indication for vascular reconstructive surgery. The average treatment took 24.7 days. 11 of the 15 patients were responsive to the therapy. Nevertheless 5 of these 11 patients had to be amputated below-knee in the further course of treatment. In 6 cases we succeeded in preserving the affected extremity in a state of acceptable use. One patient died during the study. No complications due to the therapy were seen. Considering that all patients were near to amputation when entering the study the result to have saved the extremities in 40% of the cases must be regarded as a success.

Topics: Alprostadil; Cefotaxime; Diabetic Angiopathies; Foot; Foot Diseases; Gangrene; Humans; Infusions, Intra-Arterial

Topics: Bacterial Infections; Cefotaxime; Diabetic Angiopathies; Gangrene; Humans; Injections, Intra-Arterial; Osteomyelitis; Sepsis