ro13-9904 and Wounds--Penetrating

Penetrating cranionasal injuries are relatively rare, usually occur in young children, and can be caused by a variety of unusual objects. The mortality and disability rates are high without appropriate treatment. We report a penetrating cranionasal injury caused by a bicycle spoke. Some fundamental principles in the diagnosis and treatment of penetration injuries are emphasized from this case and the surrounding literature reviewed.

Topics: Anti-Bacterial Agents; Bed Rest; Bicycling; Ceftriaxone; Child, Preschool; Craniocerebral Trauma; Female; GABA Agents; Humans; Nose; Tomography, X-Ray Computed; Valproic Acid; Wounds, Penetrating

We wanted to determine the value of single-versus multiple-antibiotic treatment in cases of penetrating abdominal trauma. Of 357 patients entered into a prospective, randomized, examiner-blinded study, 291 met all protocol criteria; 101 of these patients received cefoperazone alone, 95 were given ceftriaxone with metronidazole, and 95 were placed on metronidazole, gentamicin, and ampicillin. Aerobic and anaerobic bacterial cultures were obtained upon opening and closing the peritoneum. The three groups were found to be similar upon evaluation of key parameters, such as the median number of febrile days, morbidity, incisional wound infection, intra-abdominal abscess, septicemia, other infections, hospital stay, and death. Fifteen of 291 (5%) patients had infectious complications, and 12 (4.1%) developed noninfectious complications. There were six (2.1%) deaths, two in each antibiotic group. Noninfectious complications occurred more frequently in the triple-antibiotic group, which was statistically significant (P = 0.013). There were no therapeutic failures, and therefore, the routine usage of additional antibiotics to cover for enterococcus needs justification.

Topics: Abdominal Injuries; Adolescent; Adult; Antibiotic Prophylaxis; Cefoperazone; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Metronidazole; Middle Aged; Prospective Studies; Single-Blind Method; Treatment Outcome; Wound Infection; Wounds, Penetrating

This was a prospective, randomized study of 123 patients with penetrating abdominal injuries. The patients received ceftriaxone or cefoxitin for 24 h (in the presence of colonic injury, 48 h). The overall incidence of abdominal sepsis was 7.3 per cent (ceftriaxone 5 per cent, cefoxitin 9.5 per cent, P greater than 0.05). Colonic injury was the most important risk factor for the development of septic complications. Other factors, such as the weapon used, a prehospital time longer than 4 h, shock on admission, multiple organ injuries, and small bowel perforation, did not influence the incidence of sepsis.

Topics: Abdominal Injuries; Adult; Bacterial Infections; Cefoxitin; Ceftriaxone; Colon; Female; Humans; Male; Multiple Trauma; Postoperative Complications; Premedication; Prospective Studies; Risk Factors; Wounds, Penetrating

Necrotizing soft tissue infections are rapidly progressive infections with a high rate of mortality. One type of necrotizing soft tissue infection is caused by marine gram-negative bacteria and commonly occurs in immunocompromised hosts. These types of infections are more common in patients with chronic liver disease, possibly because of impaired iron metabolism. We present the case of a rapidly progressive necrotizing soft tissue infection caused by Edwardsiella tarda, a marine gram-negative pathogen common in catfish. Few extraintestinal infections of E tarda have been described previously. Our patient had hepatitis C and was exposed to the bacteria by a puncture injury from a wild catfish. His infection required multiple debridements and ultimately required a transhumeral amputation for local control of the infection.

Topics: Amputation, Surgical; Animals; Anti-Bacterial Agents; Catfishes; Ceftriaxone; Comorbidity; Debridement; Disease Progression; Edwardsiella tarda; Enterobacteriaceae Infections; Fascia; Hand Injuries; Hepatitis C; Humans; Male; Middle Aged; Muscle, Skeletal; Necrosis; Soft Tissue Infections; Upper Extremity; Wounds, Penetrating

"Empty" liposomes and ceftriaxone (CT)-entrapped liposomes were developed. Lipids of natural origin, i. e. soybean phosphatidyl choline (PhCh) and cholesterol were used for the design. The conditions for production of the CT-entrapped liposomes were optimized to provide the maximum content of the antibiotic in the liposomes. The effect of the "empty" liposomes and the antibiotic-entrapped liposomes on healing of skin wounds was studied on rats. The wound on the skin surface of the rat back was purulent due to contamination with E. coli (10(9) cells/ml). The treatment with the antibiotic solution, "empty" liposomes or CT-entrapped liposomes was started in 48 hours. The use of the PhCh "empty" liposomes promoted more rapid healing of the wound vs. the control or the treatment with CT aqueous solution. The treatmen of the wound with the CT-entrapped PhCh liposomes provided 2 times more rapid healing vs. the control or the use of the CT aqueous solution.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Escherichia coli; Escherichia coli Infections; Liposomes; Rats; Skin; Wound Healing; Wound Infection; Wounds, Penetrating

In the pediatric literature, only 1 case of cervical spondylodiscitis from an ingested foreign body is reported and this was caused by a blunt radiolucent foreign body. The authors now describe a unique case of a 13-year-old teenaged boy who presented with neck pain 6 days after accidental ingestion of a sewing pin. Uncomplicated removal of this pin was followed in 36 days by the development of cervical spondylodiscitis that failed conservative management and required surgical debridement and arthrodesis. Physicians should be aware of the possibility of this complication in any patient that presents with neck pain after foreign body ingestion.

Topics: Accidents; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bone Plates; Ceftriaxone; Cervical Vertebrae; Clindamycin; Combined Modality Therapy; Deglutition Disorders; Discitis; Diskectomy; Emergencies; Equipment Contamination; Follow-Up Studies; Foreign Bodies; Humans; Laryngoscopy; Larynx; Male; Neck Pain; Oxacillin; Paresthesia; Penicillanic Acid; Pharynx; Piperacillin; Piperacillin, Tazobactam Drug Combination; Radiography; Recurrence; Retropharyngeal Abscess; Spinal Fusion; Vancomycin; Wounds, Penetrating

The incidence and mortality of sepsis increase with age, consequently, 80% of the clinical mortality from sepsis occurs in patients over age 65. Despite this aged clinical population, most research models of sepsis use 6- to 16-week-old mice as patient surrogates. This age range of mice corresponds to human ages 10 to 17 years. To assess the influence of age on rodent CLP and on antibiotic therapy, we studied young (4 month), mature (12 month), and aged (24 month) mice. Male C57BL/6 mice (n = 27-30 in each age group) were subjected to cecal ligation and puncture (CLP), two punctures with a 25-gauge needle. Mice were observed untreated for 10 days. Young mice had 20% mortality, mature mice had 70% mortality (P = 0.0013 vs. young), and aged mice had 75% mortality (P = 0.0001 vs. young). To assess the effects of age on antibiotic therapy, mice were subjected to CLP as above (n = 38-40 in each age group). Mice were then randomized to treatment with intraperitoneal injections of ceftriaxone and metronidazole or normal saline. Therapy was initiated 12 h after CLP, and injections were repeated every 12 h for 7 days. Young mice saw a 56% decrease in mortality from CLP with antibiotic therapy (P = 0.001), and mature mice had a 30% decrease in mortality (P = 0.06). Aged mice saw no benefit from antibiotic therapy. We also compared plasma cytokine levels between young and aged mice after CLP. When compared with young mice, aged mice had higher levels of IL-6 and TNF-alpha 24 h after CLP. However, high IL-6 was predictive of mortality at any age. Mice appear to have age-dependent responses to intra-abdominal sepsis and to appropriate therapy.

Topics: Age Factors; Aging; Animals; Cecum; Ceftriaxone; Disease Susceptibility; Drug Therapy, Combination; Intestinal Perforation; Ligation; Male; Metronidazole; Mice; Mice, Inbred C57BL; Models, Animal; Sepsis; Tumor Necrosis Factor-alpha; Wounds, Penetrating

A prospective study was undertaken to evaluate the use of ceftriaxone in patients with abdominal trauma admitted to our hospital over a period of 6 months. Because of the large trauma load and an unacceptable waiting period before surgery combined with the fact that many patients on 6-hourly antibiotic regimes often did not receive their second and third doses, it was decided to use ceftriaxone because of its long half-life with maintenance of fluid and tissue concentrations for 24-48 hours. Because ceftriaxone is not reliably effective against anaerobic organisms such as Bacteroides fragilis, it was decided to add metronidazole as a combined initial dose. Two hundred ninety patients were entered in this trial, of which there were 259 stab wounds (89.3%), 20 missile injuries (6.9%), and 11 blunt injuries (3.8%). It was found that the mean delay between injury and initial dosage of ceftriaxone was 9.1 hours, with a range of 1-126 hours, and the mean delay between antibiotic therapy and operation 6.3 hours, with a range of 0-39 hours. The organs most frequently injured were the small bowel, the large bowel, the stomach, and the liver. Wound infection developed in only 4 patients (1.4%); intra-abdominal sepsis did not occur; and 35 patients (12%) developed respiratory infections. There were no deaths. We conclude that ceftriaxone, because of its 24-hour dosage was not only convenient but also adequate to prevent intra-abdominal sepsis and there was no difference in cost between this product and our previous protocol of 6-hourly antibiotic regime.

Topics: Abdominal Injuries; Adolescent; Adult; Aged; Ceftriaxone; Humans; Male; Middle Aged; Premedication; Preoperative Care; Prospective Studies; Time Factors; Wound Infection; Wounds, Penetrating

Topics: Abdominal Injuries; Cefoxitin; Ceftriaxone; Humans; Prospective Studies; Wound Infection; Wounds, Penetrating