Sir Thomas Sydenham revisited.
Explore the source record for details and available documents.
History, 17th Century↗
Biomedical subjects
P C Carling
Publications and source records attributed to P C Carling.
Parenteral antibiotic use in acute-care hospitals: A standardized analysis of fourteen institutions.
Despite increasing concerns regarding the need to optimize appropriate antibiotic use in hospitals, a standardized method for evaluating interinstitutional antibiotic use has not been developed. To address this issue, antibiotic use was analyzed by means of a uniform methodology among 14 acute-care hospitals. Data were standardized by use of a defined daily dose for each antibiotic while adjusting for patient volume by calculating use per 1000 patient-days. Within the group, there was a 68% range in total parenteral antibiotic expenditures and wide variability in the use of individual agents. Analysis of these differences indicated that only the use of active antibiotic-management programs clearly correlated with antibiotic cost per 1000 patient-days (P<.001). Given these results, we believe that wider comparative analysis of antibiotic use with a standardized methodology in conjunction with standardized analysis of nosocomial infection rates and antibiotic resistance data may enhance the stewardship of antibiotics in acute-care hospitals.
Anti-Bacterial Agents↗
Part-time residency training in internal medicine: analysis of a ten-year experience.
PURPOSE: To evaluate a ten-year experience (1983-1993) with a part-time residency curriculum. METHOD: In 1994, the authors analyzed the curriculum through interviews with graduates of a part-time residency track, surveys of faculty and graduates of a full-time residency program, and a quantitative comparison of faculty evaluations of those part-time and full-time residents. RESULTS: Both participants and full-time residents supported the part-time track and reported no adverse effect on the residency program as a whole. Analysis of faculty evaluations found that part-time residents scored significantly higher with respect to clinical skills (p = .0005) and humanistic skills (p = .0001), while there was no difference between the groups in leadership or teaching skills. CONCLUSIONS: This part-time residency curriculum provided a highly useful program track for a group of internal medicine residents with concomitant obligations, allowing them to complete their training in an uninterrupted fashion. The part-time structure did not adversely affect clinical competence and may have fostered humanistic attributes. The authors believe that this form of curriculum deserves wider consideration in residency training.
Adult↗
Fournier's gangrene: an approach to its management.
Treatment of Fournier's gangrene (necrotizing fasciitis of the male genitalia) traditionally has involved extensive débridement in concert with broad-spectrum antibiotic administration. However, our management of 4 patients with Fournier's gangrene indicates that limited débridement with placement of through-and-through drains may provide a good result, with far less tissue loss. After surgery and prompt, individualized antibiotic treatment the patients showed rapid improvement in their over-all condition with a brisk defervescence and normalization of leukocytosis. Granulation of the wounds progressed rapidly without secondary infection. In 2 of the 4 patients some skin grafting was required but the areas involved were quite small.
Aged↗
Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients.
Evaluation of 612 episodes of gram-negative bacteremia over a 10-year period demonstrated its progressively increasing frequency. This increase was associated with an increasing proportion of patients with more severe underlying disease, increasing patient age, increasing frequency of cardiac surgery and manipulative procedures, and increasing frequency of treatment with antibiotics, corticosteroids and antimetabolites in patients with bacteremia. Fatality rates paralleled the severity of the host's underlying disease as noted in previous reports. The urinary tract was the most frequent source of bacteremia, but in 30 per cent of the patients, predominantly those with more severe underlying disease, the original source could not be identified. Of all blood cultures obtained in these patients, 72 per cent were positive. Bacteremia was of low magnitude with 77 per cent of the patients have quantitative blood cultures with less than 10 gram-negative bacilli per milliliter of blood. Escherichia coli was the most frequent etiologic agent followed in frequency by Klebsiella-Enterobacter-Serratia species, Pseudomonas aeruginosa, Proteus and Providencia species, and species of Bacteroides. Sixteen per cent of the bacteremias were polymicrobic. K and O-antigen typing of Escherichia coli and capsular typing of K. pneumoniae demonstrated that a large number of serologic types of these strains were responsible for bacteremia. Over-all, bacteremia caused by multiple species of bacteria was associated with higher fatality rates, but no significant differences in fatality rates could be demonstrated for bacteremias caused by individual species of gram-negative bacilli when comparisons were made between patients with underlying diseases of similar severity. The presence or type of K-antigen did not influence the lethality of Esch. coli infections. Although some O-antigen types, 0:4, 0:6 and 0:8, were associated with higher fatality rates than other O-antigen types, "rough" or autoagglutinable Esch. coli were as lethal as smooth strains. These findings indicate that bacterial factors, other than antibiotic resistance, have little influence on the outcome of gram-negative bacteremia and that gram-negative bacilli function primarily as "opportunistic" pathogens.
Adolescent↗
The relation of K-antigen to virulence of Escherichia coli.
The content of K-antigen was determined for 100 strains of Escherichia coli isolated from the blood of patients with bacteremia. 30 strains isolated from urine cultures, and 30 strains isolated from the feces of patients recently admitted to the hospital. The K-antigen content of urinary isolates of E. coli was significantly greater than that of strains isolated from feces, as noted by other workers. In contrast, the amount of K-antigen of blood culture isolates was not significantly greater than that of fecal isolates and was significantly lower than that of urinary E. coli isolates. No correlation could be detected between the K-antigen content of blood culture isolates and the severity and outcome of the bacteremia.
Animals↗
Nephrotoxicity associated with cephalothin administration.
Variable degrees of acute renal failure developed in three patients receiving therapy with cephalothin sodium. The course and findings were consistent with acute tubular necrosis of the oliguric and nonoliguric types. One patient had protracted oliguria, a second experienced transient oliguria, and one had normal urine output. All had urinary sediment changes consistent with tubular necrosis, and the two oliguric patients had elevated urine sodium concentrations. No other causes for renal failure could be detected, and all recovered after discontinuation of cephalothin therapy, although peritoneal dialysis was required in one patient. These observations indicate that cephalothin is capable of inducing renal damage in man.
Acute Kidney Injury↗