Biomedical subjects

A Trampuz

Publications and source records attributed to A Trampuz.

8 recordsLinked to original sources

PubMed2005

Treatment of infected retained implants.

We have prospectively studied the outcome of infections associated with implants which were retained and treated using a standardised antimicrobial protocol. Over a period of four years, we studied 24 consecutive patients who had symptoms of infection for less than one year, a stable implant, no sinus tract and a known pathogen which was susceptible to recommended antimicrobial agents. The infections involved hip prostheses (14), knee prostheses (5), an internal fixation device (4), and an ankle prosthesis (1). Twenty patients had a successful outcome at a median follow-up of 3.7 years (1.8 to 4.7); four had failure of the implant after a median follow-up of 1.2 years (0.3 to 2.5). The probability of survival without failure of treatment was 96% at one year (95% confidence interval (CI) 88 to 100), 92% at two years (95% CI 80 to 100) and 86% at three years (95% CI 72 to 100). Patients with a short-term infection but with a stable implant, no sinus tract and a known pathogen may be successfully treated by retention of the implant and the use of a standardised regimen of antimicrobial treatment.

Adult↗

PubMed2001

[Pneumococcal pneumonia].

Pneumococci remain the most important cause of bacterial pneumonia with a considerable morbidity and mortality. The characteristic features of pneumococcal pneumonia are fever, shivering, productive cough, and radiographic detection of an infiltrate. Penicillin is still the cornerstone of therapy for pneumococcal infections. With the HIV-epidemic and worldwide emergence of resistant strains particularly the invasive pneumococcal infections became a growing therapeutic problem.

Humans↗

PubMed2001

[Pneumonia in the immune compromised host].

The term "immunocompromised host" is generally applied to a variety of patients with different host defense defects. Pulmonary disease in the immunocompromised host remains a major cause of morbidity and has a high mortality. During the initial evaluation of the patient, it is helpful to define which of the three arms of the host defense system is most likely to be affected. Impaired granulocyte function, as seen after chemotherapy, predisposes to bacterial and fungal infections. Deficiencies in the humoral immune system predisposes to infection with encapsulated organisms, such as Streptococcus pneumoniae and Haemophilus influenzae. Impairment of the cellular immunity is a special problem of the transplant patient. Besides bacteria, a number of unusual microorganisms, such as viruses (cytomegalovirus, varicella-zoster virus, herpes simplex virus), protozoa (Toxoplasma gondii) and fungi (Pneumocystis carinii, Aspergillus, Cryptococcus neoformans) have to be considered in this group of patients. The work-up usually requires an invasive technique, such as a bronchoalveolar lavage or lung biopsy to establish the diagnosis. The initial therapy of a patient with a pulmonary infiltrate often involves an empiric broad-spectrum antibiotic therapy. Whether an additional treatment against atypical bacterial pathogens, fungi or viruses should be started, depends on the clinical presentation, the underlying type and duration of immunosuppression and the radiographic evolution of the infiltrate.

Anti-Bacterial Agents↗

PubMed2000

Spondylodiscitis associated with bacteraemia due to coagulase-negative staphylococci.

Three cases are reported of spondylodiscitis caused by coagulase-negative staphylococci in patients without osteosynthetic material. All three patients had bacteraemia associated with an infected intravascular device left in place. On the basis of this observation, it is concluded that such devices should be removed promptly in cases of prolonged or relapsing bacteraemia. Furthermore, spondylodiscitis should be suspected in patients with back pain after bacteraemia caused by coagulase-negative staphylococci.

Aged↗

PubMed2000

Pharmacokinetics and pharmacodynamics of levofloxacin against Streptococcus pneumoniae and Staphylococcus aureus in human skin blister fluid.

The pharmacokinetics of levofloxacin in serum and in skin blister fluid (SBF) was determined for 20 volunteers after a single 500-mg oral dose of levofloxacin. In addition, ex vivo bactericidal activity of SBF against Streptococcus pneumoniae and Staphylococcus aureus was studied. SBF containing levofloxacin and granulocytes killed 5.2 log of Streptococcus pneumoniae bacteria and 2.0 log of Staphylococcus aureus bacteria during a 6-h incubation.

Anti-Infective Agents↗

PubMed1999

Meropenem (1.5 g/day) is as effective as imipenem/cilastatin (2 g/day) for the treatment of moderately severe intra-abdominal infections.

This multicentre, open-label, randomised trial compared meropenem (0.5 g/8 h) and imipenem/cilastatin (at the commonly used dosage of 0.5 g/6 h) in monotherapy in patients with moderately severe intra-abdominal infections (IAIs). In total, 161 patients were randomised (82 meropenem, 79 imipenem/cilastatin). The mean APACHE II scores in the two groups were 5.8 and 6.4, respectively. At the end of therapy, 65/71 (91.6%) evaluable meropenem recipients were clinically cured or improved, compared to 60/64 (93.8%) imipenem/cilastatin recipients. This difference and that in an intention-to-treat analysis (82.1 vs 86.1%, respectively), were not statistically significant. Both drugs were generally well tolerated. Thus, meropenem 0.5 g/8 h is as clinically effective and well tolerated as imipenem/cilastatin 0.5 g/6 h in moderately severe IAIs.

APACHE↗

PubMed1999

Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland.

OBJECTIVE: To determine the prevalence and risk factors for nosocomial infections (NIs) in four Swiss university hospitals. DESIGN AND SETTING: A 1-week period-prevalence survey conducted in May 1996 in medical, surgical, and intensive-care wards of four Swiss university hospitals (900-1,500 beds). Centers for Disease Control and Prevention definitions were used, except that asymptomatic bacteriuria was not categorized as NI. Study variables included patient demographics, primary diagnosis, comorbidities, exposure to medical and surgical risk factors, and use of antimicrobials. Risk factors for NIs were determined using logistic regression with adjustment for length of hospital stay, study center, device use, and patients' comorbidities. RESULTS: 176 NI were recorded in 156 of 1,349 screened patients (11.6%; interhospital range, 9.8%-13.5%). The most frequent NI was surgical-site infection (53; 30%), followed by urinary tract infection (39; 22%), lower respiratory tract infection (27; 15%), and bloodstream infection (23; 13%). Prevalence of NI was higher in critical-care units (25%) than in medical (9%) and surgical wards (12%). Overall, 65% of NIs were culture-proven; the leading pathogens were Enterobacteriaceae (44; 28%), Staphylococcus aureus (20; 13%), Pseudomonas aeruginosa (17; 11%), and Candida species (16; 10%). Independent risk factors for NI were central venous catheter (CVC) use (odds ratio [OR], 3.35; 95% confidence interval [CI95], 2.91-3.80), admission to intensive care (OR, 1.75; CI95, 1.30-2.21), emergency admission (OR, 1.57; CI95, 1.15-2.00), impaired functional status (Karnofsky index 1-4: OR, 2.56; CI95, 1.953.17), and McCabe classification of ultimately fatal (OR, 2.50; CI95, 2.04-2.96) or rapidly fatal (OR, 2.25; CI95, 1.52-2.98) underlying condition. CONCLUSIONS: According to the results of this survey, NIs are frequent in Swiss university hospitals. This investigation confirms the importance of CVCs as a major risk factor for NI. Patient comorbidities must be taken into account to adjust for case mix in any study comparing interhospital or intrahospital infection rates.

Adolescent↗

PubMed1997

[HIV-associated lung diseases].

Over two-thirds of all HIV-infected individuals have an associated pulmonary disease. The following causes are frequently observed: bacterial infection (Streptococcus pneumoniae, Haemophilus influenzae and mycobacteria), protozoal infection (Pneumocystis carinii), fungal infection (Cryptococcus neoformans and Histoplasma capsulatum), viral infection (cytomegalovirus), tumors (Kaposi's sarcoma) and pneumonitis. For diagnosis and patients' immune status, imaging techniques, and microbiological, cytological and histological examination of respiratory secretions and biopsy material are important. Infection with Pneumocystis carinii remains common as a cause of respiratory disease in HIV-infected patients, mainly those without prophylaxis. The clinical presentation of pulmonary tuberculosis varies with the state of immunity. Kaposi's sarcoma is the commonest HIV-associated malignancy, and may affect the lungs in addition to the skin.

AIDS-Related Opportunistic Infections↗