Biomedical subjects
Publications and source records attributed to J A T Sandoe.
These guidelines have been produced following a literature review of the requirement for prophylaxis to prevent bacterial endocarditis following dental and surgical interventions. Recommendations are made based on the quality of available evidence and the consequent risk of morbidity and mortality for "at risk" patients.
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The BSAC Guidelines on Endocarditis were last published in 1998. The Guidelines presented here have been updated and extended to reflect changes in both the antibiotic resistance characteristics of causative organisms and the availability of new antibiotics. Randomized, controlled trials suitable for the development of evidenced-based guidelines in this area are still lacking, and therefore a consensus approach has again been adopted. The Guidelines cover diagnosis and laboratory testing, suitable antibiotic regimens and causative organisms. Special emphasis is placed on common causes of endocarditis, such as streptococci and staphylococci, however, other bacterial causes (such as enterococci, HACEK organisms, Coxiella and Bartonella) and fungi are considered. The special circumstances of prosthetic endocarditis are discussed.
Intravascular catheter-related infections (CRI) account for one third of nosocomial bloodstream infections in England. UK Department of Health guidelines state that antibiotic prophylaxis is not required during placement, or use of, central venous catheters, to prevent CRI. However, some clinicians continue to use antibiotics in an attempt to prevent CRI. We investigated the effect of extended routine perioperative antibiotic prophylaxis in cardiothoracic patients on rates of intravascular catheter (IVC) colonization and infection. Investigations were undertaken in patients undergoing uncomplicated cardiothoracic surgery during July 2001-February 2002. Patients who received three doses of cefuroxime as perioperative prophylaxis were compared with those who received extended cefuroxime prophylaxis until the IVC was removed. Patients were not randomized into groups, but received the different prophylaxis regimens according to the usual practice of the consultant cardiothoracic surgeon. A roll tip method was used to determine IVC colonization. Of 191 patients who fulfilled the inclusion criteria, 12 were excluded because data were incomplete. One hundred and forty-six patients received routine prophylaxis, and 33 prophylaxis until the IVC was removed. Twenty-three out of 146 (16%) IVCs in the 'routine' group and four out of 33 (12%) in the 'extended' group became colonized; no IVC-related bloodstream infections occurred during the survey. The duration of IVC placement and the types of operation performed in the two groups were not significantly different (P > 0.05). In routine cardiothoracic surgery patients, extending routine perioperative antibiotic prophylaxis until all IVCs have been removed does not influence rates of IVC colonization.
This study describes an outbreak of penicillin-resistant Streptococcus pneumoniae among patients on an ear, nose and throat (ENT) ward. Over a period of 10 days, S. pneumoniae [penicillin minimum inhibitory concentration (MIC) 0.75] was isolated from a total of seven patients with symptoms and signs of lower respiratory tract infection. Standard source isolation was implemented and the ward was closed to admissions and discharges. Screening of nasopharyngeal secretions was undertaken on all patients and staff contacts. Three patients (of eight possible contacts) and none of the staff (47 screened) were identified as colonized with the same strain. Nasal mupirocin and oral rifampicin were administered to carriers. Confirmation of the outbreak was achieved rapidly using a contemporary molecular typing method (pulsed-field gel electrophoresis) and timely introduction of infection control measures successfully contained the outbreak. Implications for pneumococcal vaccination are discussed.