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Biomedical subjects

I Kappstein

Publications and source records attributed to I Kappstein.

36 records · Page 2Linked to original sources
PubMed1991

[Prevention of stress ulcer and pneumonia: sucralfate].

Pneumonia in ventilated intensive care patients is one of the most serious nosocomial infections with a frequently fatal outcome. Retrograde colonization of the oropharynx originating from the stomach is a recently described phenomenon associated with increased pH values of gastric fluid. Microaspiration of gastric fluid colonized with great numbers of pathogens can lead to ventilator-associated pneumonia. Since the degree of microbial growth is dependent upon the pH of gastric fluid, pH values of gastric aspirates should not exceed pH 4 if stress ulcer prophylaxis is required. It is now known from several clinical studies that the mean pH values of gastric fluid under sucralfate prophylaxis are considerably lower than under conventional stress ulcer prophylaxis. This is at least partly due to the inherent antibacterial activity of the substance. Finally, the most important result is the markedly reduced frequency of pneumonia in ventilated patients compared with conventional prophylaxis regimens.

Critical Care↗
PubMed1989

Influence of architectural design on nosocomial infections in intensive care units--a prospective 2-year analysis.

Nosocomial infection rates in an old intensive care ward constructed in 1924 were compared with those in a new one constructed in 1986. The nosocomial infection rate in the old unit was 34.2% and that in the new unit 31.9%, with an average of 33%. The most frequent infections were: pneumonia, urinary tract infection, septicaemia and wound infection. After transfer of the intensive care unit (ICU) the incidence and profile of nosocomial infections remained the same. These findings suggest that the influence of architectural design has little impact on the incidence of nosocomial infections.

Cohort Studies↗
PubMed1989

Nasal carriage of Staphylococcus aureus treated with topical mupirocin (pseudomonic acid) in a children's hospital.

2% mupirocin ointment applied intra-nasally for 5 days was assessed for elimination of nasal carriage of Staphylococcus aureus in 31 staff members in a children's hospital. Three volunteers failed to complete the trial because of side effects, i.e. buccal reddening and swelling, and unpleasant taste. During treatment staphylococcal nasal carriage was not found in any case; of the 24 post-treatment nasal swabs taken 4 days after treatment 22 were still negative. Re-colonization with S. aureus of different phage types occurred in the remaining two cases.

Administration, Intranasal↗
PubMed1988

Influence of disposable ('Conchapak') and reusable humidifying systems on the incidence of ventilation pneumonia.

The contamination of disposable ('Conchapak') and reusable humidifying systems and their influence on the incidence of pneumonia was studied in 116 patients requiring continuous mechanical ventilation therapy. The water reservoirs of 11 (15.9%) of the 69 disposable systems became colonized, but all reusable systems were found to be sterile. In four of the 11 samples, the organisms isolated corresponded with those cultured from tracheal secretions several days before. Ventilator-associated pneumonia occurred in 36 (31.0%) of the patients, but there was no statistically significant difference in the incidence of pneumonia between the patients treated with the disposable or the reusable humidifying systems. Gram-negative bacteria were the predominant organisms isolated from tracheal aspirates of patients who developed ventilator-associated pneumonia. These results suggest that disposable humidifying systems do not influence the rate of ventilator-associated pneumonia in mechanically ventilated patients.

Adult↗
PubMed1988

Stress ulcer prophylaxis and ventilation pneumonia: prevention by antibacterial cytoprotective agents?

The gastric and tracheal flora of 142 consecutive patients receiving stress ulcer prophylaxis were investigated, identifying identical isolates by typing. Furthermore, the growth pattern of normal respiratory bacteria and organisms causing ventilation pneumonia at different pH values and the in vitro effect of sucralfate and bismuth subsalicylate on these bacteria in simulated gastric fluid were studied. The results obtained were as follows: (1) with rising gastric pH bacterial counts in gastric aspirates, especially gram-negatives, increased significantly; (2) in 45 (31.7%) of the patients identical organisms were first isolated in gastric samples and one to two days later in tracheal secretions; (3) ventilation pneumonia was significantly more frequent in patients with high gastric pH; (4) pathogens causing ventilation pneumonia grew well in simulated gastric fluid at higher pH values, unlike normal respiratory organisms; and (5) sucralfate and bismuth subsalicylate showed antibacterial activity against frequent causative organisms of ventilation pneumonia.

Anti-Bacterial Agents↗
PubMed1988

[Hygienic and organizational precautions to prevent transmission of selected viral infections in hospitals].

Only a few data exist about epidemiology, transmission and prevention of hospital-acquired viral infections. In viral infections, all secretions and excretions can be considered contagious in which viruses can multiply or which transport them in the body (i.e. faeces in hepatitis A and infections caused by enteroviruses, serum in hepatitis B, respiratory secretions in respiratory viral infections). Like bacterial infections, viral infections in the hospital are most commonly transferred by hands. Several recently published studies are demonstrated. In addition, guidelines for isolation procedures and disinfection are made.

Cross Infection↗
PubMed1988

[Risk of infection due to catheter reuse].

Cardiac catheters assigned for reprocessing revealed only minor bacterial contamination. Random samples taken from reprocessed catheters were sterile and free from pyrogens. Among a total of 461 prospectively surveyed patients, in 16 cases a short increase of temperature up to 37.5 degrees C was observed, which appeared independent from the application of reprocessed catheters. None of the patients developed fever or symptoms of catheter-related infection.

Bacterial Infections↗
PubMed1987

Penetration of ceftazidime into heart valves and subcutaneous and muscle tissue of patients undergoing open-heart surgery.

Patients undergoing open-heart surgery were given an intravenous bolus injection of 2 g of ceftazidime as a single dose over a period of 5 min. Within 12 h, ceftazidime concentrations in serum declined from 55.8 to 3.9 mg/liter. Subcutaneous tissue concentrations of the drug decreased from 21.0 to 2.7 micrograms/g, and muscle concentrations decreased from 34.5 to 2.5 micrograms/g. Ceftazidime concentrations in cardiac valvular tissue were even higher than those in muscle or fat, declining from 37.4 to 6.3 micrograms/g within 10 h.

Adipose Tissue↗
PubMed1987

[The effect of stress ulcer prevention on the incidence of pneumonia in artificial respiration].

The role of stress ulcer prophylaxis in increasing the risk of pneumonia in ventilator patients was analyzed prospectively in 142 artificially ventilated patients at a medical and surgical intensive care unit (104 males, 38 females, mean time of ventilation 7.9 days, mean age 46.5 years). The pH of gastric aspirate and bacterial counts in gastric fluid and tracheal secretions were investigated daily. Identical isolates from gastric aspirates and tracheal secretions were typed by agglutination, bacteriocin, or phage typing. An average of 2.1 bacterial species were isolated in 80.5% of all gastric aspirates. Bacterial counts increased with rising gastric aspirate pH, which was especially true for Gram-negative and less so for Gram-positive organisms; colony counts of Candida sp. decreased slightly. In 31.6% of patients identical bacterial species were first isolated from gastric aspirates and 1 to 2 days later from tracheal secretions. Of these microbes that were first isolated from gastric aspirate and later from tracheal secretions, 50.3% were Gram-negative, 37.5% Gram-positive, and only 4.2% Candida sp. One-half of all bacterial aspirations occurred between the 2nd and 7th day of ventilation; 80% occurred within 11 days of ventilation. Only 20% of all migrations of Gram-positive organisms from stomach to respiratory tract lead to pneumonia, as compared with 60% of Gram-negatives. At a gastric pH below 3.4 the incidence of ventilation pneumonia was 40.6%; above pH 5.0 the incidence was 69.2% (P less than or equal to 0.05). As pH increased, the organism causing pneumonia was significantly more often isolated first from the gastric aspirate and 1 to 2 days later from the tracheal secretion of the same patient.

Anesthesia↗
PubMedDate not supplied

Concentrations of mezlocillin in the serum, heart valves, muscle and subcutaneous tissue of patients undergoing open-heart surgery.

4 g mezlocillin as a five-minute intravenous bolus were given preoperatively to 31 adult patients undergoing open-heart surgery. Mezlocillin serum levels declined from 42.8 mg/l at 1-2 h after injection to less than 1 mg/l at 6-8 h after application. Concentrations in muscle and subcutaneous tissue varied between 18 micrograms/g and less than 1 microgram/g. Mezlocillin levels in heart valves were higher than those in muscle and subcutaneous tissue, thus suggesting rapid diffusion of mezlocillin.

Adipose Tissue↗
PubMedDate not supplied

Antibiotic usage in community-acquired pneumonia: results of a survey in 288 departments of internal medicine in German hospitals.

In 1989 a survey was conducted in 800 medical departments of university hospitals and large to small teaching and non-teaching hospitals in the Federal Republic of Germany and West Berlin to gather information on the usage of antibiotics for the treatment of community-acquired pneumonia. A total of 288 (36%) questionnaires could be evaluated. In cases of non-life-threatening pneumonia, the therapy specified was mostly correct, although macrolides as the treatment of choice were stated only rarely (11%). However, patients with life-threatening pneumonia were most often (50%) treated with new beta-lactam antibiotics or beta-lactam antibiotics in combination with aminoglycosides (43%). Thus, atypical pathogens causing pneumonia were not covered by most therapeutic regimens.

Administration, Oral↗
PubMedDate not supplied

Use of perioperative antibiotic prophylaxis in selected surgical procedures--results of a survey in 889 surgical departments in German hospitals.

In 1989, a survey on perioperative antibiotic prophylaxis was conducted in 2,739 surgical (general surgical, orthopedic, traumatologic, and cardiothoracic) departments of German hospitals. In all, 889 (32.5%) questionnaries were returned. Regarding the choice of antibiotic and the duration of prophylaxis the respective rates of correct statements were as follows: 32.6% and 55.0% in gastric surgery, 29.5% and 42.9% in colorectal surgery, 38.3% and 50.5% in biliary tract surgery, 81.0% and 41.0% in total hip replacement, 91.3% and 0% in heart valve replacement, and 95.7% and 0% in coronary artery bypass graft. Altogether, the choice of antibiotic and the duration of prophylaxis were correct in only 49.1% and 43.3%, respectively.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Prevention of infection: facts and myths].

Postoperative wound infection in orthopaedic surgery following implantation of foreign bodies is a possibly disastrous event since this complication can result in serious consequences for the affected patient. To recommend effective hygienic measures for the prevention of postoperative infectious complications the available literature was examined for scientific evidence.

Bone Diseases↗