Biomedical subjects
Publications and source records attributed to N Hoyt.
A case is described of fulminant meningococcal meningitis occurring 1 day after serious head and facial trauma. Although meningococcus is one of the most common causes of bacterial meningitis in general, it is distinctly rare as a cause of posttraumatic meningitis. A review of the literature is included.
The necessary duration of antibiotic administration after open fracture has not been established. In a double-blind prospective trial we randomized 248 patients with open fractures to receive one or five days of cefonicid sodium therapy or five days of cefamandole nafate therapy as part of the initial treatment. Rates of fracture-associated infections in the three groups were ten (13%) of 79, ten (12%) of 85, and 11 (13%) of 84, respectively. The 95% confidence limit for the difference in infection rates between the one-day group and the combined five-day groups was 0% to 8.3%. The actual difference was 0.2%. A brief course of antibiotic administration is not inferior to a prolonged course of antibiotics for prevention of postoperative fracture-site infections.
Among severely traumatized patients, infection is second only to head trauma as the leading cause of death. Few studies have defined the infections that occur, the risk factors involved, or the appropriate means of evaluating these patients. In our trauma unit, daily infection surveillance included clinical evaluation of every patient and all microbiologic data. In addition, prophylactic and therapeutic antibiotics were directly under our control. Over a two period 2,368 patients were admitted, most arriving directly from the scene by patients were admitted, most arriving directly from the scene by helicopter. The over-all mortality was 20 percent. In this setting, 639 nosocomial infections occurred in 381 patients of whom 14 percent died of their infection. Sites of infection in percent of total and of bacteremia (given in parentheses) were urinary tract 18 (3), pneumonia 15 (19), empyema 11 (11), phlebitis 12 (17), primary bacteremia 10 (21), surgical wound 19 (8), intraabdominal 8 (11), CNS 7 (5), sinusitis 5 (0), arterial lines 2 (4) and other 3 (1). Over-all 44 percent of infections were bacteremia. Organisms involved in nosocomial infections as percent of total and in bacteremias given in parentheses) were coagulase-positive Staphylococcus 24 (39), other gram-positive cocci 13 (8), Escherichia coli 13 (9), Proteus 4 (5), anaerobes 3 (1) and other organisms 12 (8). Most infections were directly related to an invasive procedure.
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