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Biomedical subjects

L G Donowitz

Publications and source records attributed to L G Donowitz.

49 records · Page 3Linked to original sources
PubMed1985

The efficacy of antibiotic prophylaxis in the prevention of post-cesarean section endometritis.

Endometritis is an infectious complication in 9% to 65% of patients delivered by cesarean section. The risk of developing endometritis is greater in the high-risk emergent patient as compared to routine repeat abdominal deliveries. This study describes the incidence of endometritis following cesarean section delivery in different patient groups at the University of Virginia Hospital during a 1-year period and reviews the literature on the efficacy and risks of prophylactic antibiotics in this setting. Of patients not receiving antibiotic prophylaxis, 11 (less than 1%) of 1,461 normal spontaneous vaginal delivery patients, 7 (16.7%) of 42 repeat and 39 (29.8%) of 131 emergent cesarean section patients developed endometritis. This contrasts to none of the 24 emergent patients who received antibiotic prophylaxis. The literature review shows multiple prospective well-designed and executed studies that demonstrate reliable decreases in the incidence of endometritis with short course antibiotic prophylaxis. Our conclusion is that short course antibiotic prophylaxis is a safe, reproducible, cost-effective and indicated method of reducing the incidence of this costly and serious postoperative infection.

Anti-Bacterial Agents↗
PubMed1984

Endotracheal administration of emergency medications.

When vascular access is delayed or unreliable in emergency situations, an endotracheal tube provides a rapid and reliable route for administration of medication. Epinephrine, lidocaine, and atropine have shown clinical efficacy when given by the endotracheal route. There is evidence that other medications including naloxone and diazepam may also be suitable for endotracheal use, but clear-cut recommendations await further studies of pharmacokinetics and toxicity.

Adult↗
PubMed1982

High risk of hospital-acquired infection in the ICU patient.

Patients admitted to the ICU have a higher risk of nosocomial infection than other hospitalized patients. Whereas general medical/surgical ward patients have a 6% overall risk of acquiring an infection during their hospital stay, critically ill patients in the ICU have an 18% risk (P greater than 0.001). During this 2-year study, 440 of 2441 patients admitted to an ICU developed nosocomial infections. Patients who had prolonged ICU stays and those on the obstetrics and gynecology, orthopedics, and general surgery services were more likely to become infected. The most common bloodstream pathogens were Staphylococcus epidemidis, Staphylococcus aureus, and Serratia and Pseudomonas species.

Cross Infection↗
PubMed1980

Endometritis following cesarean section. A controlled study of the increased duration of hospital stay and direct cost of hospitalization.

The increased hospital stay and direct costs of hospitalization as a result of postcesarean section endometritis were evaluated in a case-matched and controlled study (N = 20 in each group). Endometritis increased postcesarean section hospital stay by 3 days and increased hospital cost by $850. Fifteen to 20% of women delivered by cesarean section develop postpartum endometritis. The success of future antibiotic or surgical intervention studies in reducing this high complication rate can be more accurately evaluated by comparison with these now established parameters of morbidity and cost.

Adult↗
PubMed1979

Serratia marcescens bacteremia from contaminated pressure transducers.

Primary Serratia marcescens bacteremia developed in 17 patients in an intensive care unit after exposure to pressure monitoring devices. A study showed that all of the transducer heads were contaminated with S marcescens, and prospective culturing of 110 pressure monitoring lines disclosed a 24% rate of contamination with the same organism. Hand contamination occurs at the time the equipment is initially assembled; in five of eight trials, transmission was shown experimentally to occur by direct inoculation of open ports. Routine disinfection of the transducer heads with glutaraldehyde not only effectively decontaminated all pressure monitoring lines in use, but also controlled the outbreak.

Enterobacteriaceae Infections↗
PubMedDate not supplied

Contaminated breast milk: A source of Klebsiella bacteremia in a newborn intensive care unit.

Five patients in a newborn intensive care unit (NICU) developed primary bacteremia due to Klebsiella during a 12-day period, May 2 through June 2, 1979, after feeding for 24-96 hr with contaminated breast milk. All patients had been fed via nasoduodenal tube with milk obtained from a single donor. The donor milk collected via electric suction pump was positive by gram stain for gram-negative rods and by culture for Klebsiella pneumoniae. A culture of hand-expressed milk was negative for gram-negative rods. The breast-pump tubing and safety trap were grossly contaminated with K. pneumoniae. Institution of proper sterilization to the pump equipment controlled the outbreak. This outbreak is the first documentation of nosocomial bacteremia as a major infectious complication of feedings of premature infants with contaminated breast milk.

Cross Infection↗
PubMedDate not supplied

Changing the needle when inoculating blood cultures. A no-benefit and high-risk procedure.

Although the Centers for Disease Control recommends that needles should never be recapped, many phlebotomists routinely recap and change needles before blood culture inoculation. This study compared the extrinsic contamination rate in blood cultures when the needle was and was not changed. One hundred eight medical students obtained 182 blood specimens from each other by means of standard methods. Each specimen was inoculated into two culture bottles. The first bottle was inoculated with the needle used for phlebotomy, and the second was inoculated after needle change. Four (2.2%) of 182 bottles were contaminated when the needle was not changed, compared with one (0.6%) when the needle was changed. This small difference was not statistically significant, and the likelihood of having failed to detect a 5% difference in contamination rate was small. The risk of needle-stick injury incurred by changing the needle before inoculation of blood culture bottles seems to be unjustified.

Accidents, Occupational↗
PubMedDate not supplied

Alteration of normal gastric flora in neonates receiving ranitidine.

OBJECTIVES: To determine if the administration of ranitidine to neonates leads to an increase in gastric pH to > or = 4 and if this increase in gastric pH correlates with gastric colonization. STUDY DESIGN: 628 pH measurements and 276 gastric cultures were obtained from 86 neonates. Twenty-three patients received ranitidine and 63 patients served as controls. RESULTS: Treated patients had a mean gastric pH of 5.6 compared with a control mean pH of 4.4 (p < 0.0001). Gastric pH was significantly affected by feeding and postnatal age. 54 patients were colonized with pathogenic bacteria and/or yeast (n = 20 treated, n = 34 control). Length of hospitalization (p < 0.0001), increase in gastric pH (p < 0.01), days of antibiotics before culture (p < 0.0001), and ranitidine use (p < 0.0001) were associated with an increased rate of colonization. CONCLUSIONS: The use of ranitidine did lead to a significant increase in gastric pH and with this increase in gastric pH gastric colonization rates increased. No increased frequency of infection was found in ranitidine-treated infants.

Anti-Bacterial Agents↗