Biomedical subjects

B Marien

Publications and source records attributed to B Marien.

12 recordsLinked to original sources

PubMed1991

Efficacy and distribution of single-dose preoperative antibiotic prophylaxis in high-risk gastroduodenal surgery.

Although a single preoperative dose of antibiotic is now the accepted means of preventing postoperative surgical infection, the method has not been investigated adequately. In patients at high risk of infection who underwent gastroduodenal operations, the authors compared single-dose prophylaxis by intravenous cefotaxime (26 patients) with short-course perioperative prophylaxis (27 patients). No wound infection occurred, but in one patient in each group a subphrenic abscess developed after leakage at the anastomosis. The half-life of cefotaxime (1.23 +/- 0.12 hours) and its apparent volume of distribution (16.7 +/- 2.6 L/1.73 m2 resulted in perioperative levels of the antibiotic in blood (34.76 +/- 4.21 micrograms/mL), gastric mucosa (32.04 +/- 5.22 micrograms/mL) and subcutaneous fat (24.98 +/- 5.89 micrograms/mL) more than twice the usual minimal inhibitory concentration of the drug for organisms grown from the stomach contents and wound fat. These clinical and pharmacologic findings validate the efficacy of a single preoperative intravenous dose of the antibiotic in preventing postoperative infection in high-risk patients who undergo gastroduodenal surgery.

Adult↗

PubMed1990

Simple elective cholecystectomy: to drain or not.

We performed a large single-center prospective randomized controlled study to assess the role of peritoneal drainage in simple elective cholecystectomy. In 248 patients, drains were omitted; 122 patients had closed suction drains and 124 had Penrose drains. There were no deaths, and no patient required reoperation or drainage of a subhepatic collection. Wound infections occurred in eight patients with drains and in six patients without. Most infections were staphylococcal. Postoperative pulmonary complications and hospital stays were similar in patients with and without drains. Statistical analysis of the 10 available prospective controlled randomized studies (1,920 patients) by the method of odds ratios supported our findings. Simple elective cholecystectomy is safe without peritoneal drainage, but short-term drains do not increase morbidity.

Cholecystectomy↗

PubMed1989

Is neomycin necessary for bowel preparation in surgery of the colon? Oral neomycin plus erythromycin versus erythromycin-metronidazole.

In 132 patients who underwent elective surgery of the colon, the value of bowel preparation with a conventional oral antibiotic preparation of neomycin-erythromycin (N-E) was compared with erythromycin-metronidazole (E-M). Of 125 patients who were available for assessment, 61 received N-E and 64 E-M. The two groups were evenly matched. Two wound infections occurred in patients receiving E-M, neither due to anaerobic bacteria, but seven wound infections developed in patients given N-E (p = 0.057), five of them caused by anaerobic bacteria. Anaerobic bacteria of the colon are the dominant cause of postoperative wound infection in elective surgery of the colon. Adequate antibiotic preparation directed against these bacteria makes the use of neomycin unnecessary.

Administration, Oral↗

PubMed1987

Biliary bacteria, antibiotic use, and wound infection in surgery of the gallbladder and common bile duct.

That clinical risk groups predict postoperative infection in biliary operations has recently been challenged. To reevaluate the risk of infection, we studied 215 patients stratified by clinical risk factors. Of 100 patients having simple "low-risk" cholecystectomy, 11 had positive bile cultures (90% pure), and one with sterile bile got a staphylococcal wound infection (WI). Among 92 "high-risk" patients with acute cholecystitis, obstructive jaundice, or choledochal stones, 42 had positive bile cultures (44% pure, 12% anaerobes). One of 52 patients who received preoperative cefazolin got a staphylococcal WI, but ten of 40 patients without antibiotic therapy developed WIs, nine caused by organisms that also grew from the bile. Of 23 patients with obstructive cholangitis, 22 had positive bile cultures (88% mixed, 23% anaerobes). Despite antibiotic therapy, four developed WIs caused by these organisms. The concept of clinical risk factors is validated.

Adult↗

PubMed1987

The Hartmann procedure.

In 1923, Hartmann described an operation for cancer of the rectosigmoid area in high-risk patients not amenable to abdominoperineal resection. In the period 1972 to 1984 at the Queen Elizabeth Hospital in Montreal interest in the Hartmann procedure, with resection, end-colostomy and suture closure of the distal colon intraperitoneally, was renewed. The main indication for the procedure was diverticulitis, with cancer second. The author reviews the experience with 64 patients (average age 80 years) who underwent the Hartmann procedure. Obstruction, perforation and abscesses were the commoner indications. The mortality was 17%, but this included several patients who died from 1 to 6 months postoperatively of multiple-organ failure not necessarily related to the operation. A 30-day death rate was 8%. The complication rate was 35%. Restoration of bowel continuity (second stage) was done 2 to 3 months later in 28 cases with no deaths.

Abscess↗

PubMed1984

A single preoperative dose of cefazolin prevents postoperative sepsis in high-risk biliary surgery.

To test the ability of cefazolin, given in a single dose preoperatively, to prevent infection in high-risk patients after biliary tract surgery, the authors conducted a double-blind, prospective, randomized, controlled study. Of 92 patients operated on for acute cholecystitis or bile-duct disease, 46 were given 2 g of cefazolin intravenously before operation. Bile was contaminated with bacteria in 36% to 50% of patients with acute cholecystitis, obstructive jaundice, bile-duct disease without jaundice, or over 50 years old compared with only 5% of patients with chronic cholecystitis or under 50 years of age. Postoperative sepsis was eight times more frequent in patients with contaminated bile than in those without. Only 1 patient who received cefazolin had a wound infection, but 9 of the 46 patients in the control group did. The bacteria causing wound sepsis were similar to those in the contaminated bile. The authors conclude that a single dose of cefazolin given intravenously before operation provides effective prophylaxis against infection in high-risk biliary tract surgery.

Abdomen↗

PubMed1983

Are first-generation cephalosporins effective for antibiotic prophylaxis in elective surgery of the colon?

First-generation cephalosporins have recently declined in popularity as antibiotics for prophylaxis in elective surgery of the colon, but their efficacy has not been defined precisely. In a prospective randomized study, 44 patients who underwent elective colonic operations received, preoperatively, cefazolin in a parenteral dose adequate to kill aerobic coliforms. Six had wound infections; Bacteroides fragilis was grown, along with other organisms, from all these wounds. In contrast, only 1 of 57 similar patients had a wound infection after receiving, preoperatively, erythromycin base and metronidazole orally--directed at anaerobic bacteria. Local contamination, predominantly by anaerobic bacteria, is the main cause of wound infection after elective surgery of the colon. Even in what seems to be adequate dosage, first-generation cephalosporins are not antibiotics of first choice for preventing wound infections after these operations.

Aged↗

PubMed1982

Cefamandole in gastroduodenal surgery: a controlled, prospective, randomized, double-blind study.

Acceptance of the value of antibiotic prophylaxis in gastroduodenal surgery is growing, but only one controlled, double-blind study justifying this is available. In this second, controlled, randomized, double-blind study 60 patients underwent urgent and elective gastroduodenal operations. Among 32 patients receiving cefamandole perioperatively for prophylaxis, only 1 subsequently had a wound infection, but wound infections occurred in 8 of the 28 patients who received a placebo (P less than 0.01). Infection rates were higher in contaminated wounds and in urgent operations than in clean-contaminated wounds and elective surgery. The results confirm the value of antibiotic prophylaxis in this setting.

Cefamandole↗

PubMed1982

The conduct of cholecystectomy: incision, drainage, bacteriology and postoperative complications.

The benefits of some ancillary techniques of cholecystectomy are exaggerated by retrospective study of selected patients. Therefore, the authors performed a prospective, randomized study of 100 consecutive patients who underwent simple elective cholecystectomy for chronic cholecystitis and cholelithiasis. No patient was excluded because of incomplete hemostasis or fear of bile leakage. The frequency of pulmonary complications and wound infections was independent of the type of incision--vertical or subcostal. Peritoneal drainage was found to be unnecessary. Short-term drainage may increase the frequency of postoperative fever, but did not increase pulmonary complications or wound infections. In these patients, intra-abdominal sepsis is rare; wound infections were uncommon and the gallbladder bile was usually sterile and not the cause of postoperative infection.

Bile↗

PubMed1981

Preventing anaerobic infection in surgery of the colon.

A randomized prospective study of antibiotic prophylaxis was carried out in patients who underwent elective surgery of the colon. The wound infection rate in 70 patients who received cephradine intravenously in the perioperative period (group 1) was 25%, compared with 8% in 60 patients who received metronidazole and erythromycin base orally before operation (group 2). Both Bacteroides fragilis and Escherichia coli were cultured from the majority of wound infections in group 1, but B. fragilis was not found in any group 2 patients. Wound contamination indicated by wound class or by culture of the subcutaneous tissue of the wound before closure was the best predictor of subsequent wound infections. These results suggest a dominant role for intestinal anaerobes in the genesis of wound infections after colonic surgery and show that antibiotics specifically directed against these organisms can substantially reduce the rate of wound infection.

Administration, Oral↗

PubMed1979

Discriminate use of antibiotic prophylaxis in gastroduodenal surgery.

In a prospective study of 107 patients undergoing surgery for gastroduodenal disease, antibiotics were withheld from a group of 24 patients defined preoperatively to be at low risk of developing postoperative infections; no wound infection occurred in this group. Perioperative cephaloridine was randomized among the remaining patients (high risk). Wound infections developed in 11 of 42 patients who did not receive cephaloridine, but in none of the 41 patients who were given cephaloridine (p less than 0.02). Coliform bacteria were grown only from swabs of the stomach mucosa of patients in the high risk group and were the main cause of wound infections. Severe preoperative lymphocytopenia was frequently associated with the development of serious postoperative sepsis. The results validate a policy of restricting antibiotic prophylaxis in gastroduodenal operations to patients at high risk of postoperative infection and suggest a new risk factor--the preoperative blood lymphocyte count.

Adult↗

PubMed1978

Antibiotics in surgery of the colon.

In a randomized prospective study of patients undergoing elective colonic surgery the postoperative wound infection rate was 13% (early, 10%) in patients receiving systemic cephaloridine perioperatively and 12% (early, 7.3%) in those given oral neomycin and erythromycin base preoperatively. Wound infections were more frequent in patients with severe lymphopenia or hypoalbuminemia preoperatively, but the potential degree of wound contamination was the main determinant of postoperative infection.

Aged↗