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L Köhler

Publications and source records attributed to L Köhler.

168 records · Page 10Linked to original sources
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Perioperative infection prophylaxis and risk factor impact in colon surgery.

BACKGROUND: A prospective observational study was undertaken in 2, 481 patients undergoing elective colon resection in 114 German centers to identify optimal drug and dosing modalities and risk factors for postoperative infection. METHODS: Patients were pair matched using six risk factors and divided into 672 pairs (ceftriaxone vs. other cephalosporins, group A) and 400 pairs (ceftriaxone vs. penicillins, group B). End points were local and systemic postoperative infection and cost effectiveness. RESULTS: Local infection rates were 6.0 versus 6.5% (group A) and 4.0 versus 10.5% (group B); systemic infection rates in groups A and B were 4.9 versus 6.3% and 3.3 versus 10.5%, respectively. Ceftriaxone was more effective than penicillins overall (6.8 vs. 17.8%, p < 0.001). Length of postoperative hospital stay was 16.2 versus 16.9 days (group A) and 15.8 versus 17.6 days (group B). Of the six risk factors, age and concomitant disease were significant for systemic infection, and blood loss, rectum resection and immunosuppressive therapy were significant for local infection. Penicillin was a risk factor compared to ceftriaxone (p < 0.0001). Ceftriaxone saved 160.7 EUR versus other cephalosporins and 416.2 EUR versus penicillins. CONCLUSION: Clinical and microbiological efficacy are responsible for the cost effectiveness of ceftriaxone for perioperative prophylaxis in colorectal surgery.

Aged↗
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Evaluation of amplicor chlamydia PCR and LCX chlamydia LCR to detect Chlamydia trachomatis in synovial fluid.

OBJECTIVES: PCR has been successfully used in research for the detection of C. trachomatis DNA in synovial samples. However, each research laboratory has developed its own PCR, making inter-laboratory comparisons difficult. To allow for standardization we evaluated two commercially available amplification systems originally designed for the examination of urogenital samples (Roche Amplicor Chlamydia PCR and Abbott LCX Chlamydia LCR), using them to analyse spiked and clinical synovial fluid (SF) samples from reactive arthritis (ReA), undifferentiated arthritis (UA), and rheumatoid arthritis (RA) patients. We compared their sensitivity in assays of clinical SF samples with our in-house developed C. trachomatis specific nested PCR. METHODS: SF was spiked with purified C. trachomatis elementary bodies (EB) and analyzed by the commercial assays. Clinical SF samplesfrom ReA (n=21), UA (n=79) and RA (n=50) patients were examined by the two commercial assays and our in-house PCR. RESULTS: Using SF samples spiked with defined numbers of C. trachomatis EB, the sensitivity of the commercial tests was high and similar to published PCR sensitivity. In clinical SF specimens the commercial assays was also able to detect CT; however, the in-house PCR was more sensitive. Out of 10 PCR-positive SF samples Amplicor tested positive in only 4/10 and LCX in only 3/10. The in-house PCR detected chlamydial DNA in synovialfluidfrom 5/21 ReA (24%), 5/79 UA (6%) and in none of the 50 RA patients. CONCLUSION: Commercial amplification assays allow the detection of C. trachomatis in clinical specimens, although with a lower sensitivity than optimized PCR. Potential explanations are discussed.

Adult↗
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Evaluation of ELISA to detect Chlamydia trachomatis antigen in urine samples from arthritis patients.

OBJECTIVE: To determine whether examination of urine samples using ELISA allows the detection of asymptomatic C. trachomatis infection in arthritis patients. METHODS: The in vitro sensitivity of IDEIA Chlamydia ELISA to detect C. trachomatis in urine samples was determined by the investigation of serial dilutions of chlamydial elementary bodies. In a clinical study, urine samples from 402 consecutive arthritis patients (182 men and 220 women) in a tertiary care rheumatology clinic were examined for asymptomatic chlamydial infection by ELISA and the results were compared to culture and direct immunofluorescence assay (DFA, MicroTrak) of urogenital swabs. RESULTS: The in vitro sensitivity of ELISA for detecting purified elementary bodies of C. trachomatis serovar K in urine was 60 infection forming units. Twenty-three of 402 arthritis patients (6%) had asymptomatic chlamydial infection as shown by DFA and culture from urogenital smears. The ELISA method identified only 3 of 17 swab-positive patients among 271 patients when urine specimens were collected during the clinical visit, while the assay detected all 6 swab-positive patients among 131 patients when first-voided early morning urine specimens were used (p < 0.001). CONCLUSION: It is mandatory to examine only first voided early morning urine samples if ELISA is used instead of DFA or culture from urogenital swabs to detect asymptomatic chlamydial infection in arthritis patients.

Adolescent↗