[Staphylococcal infection in a surgical clinic (review of foreign literature)].
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We describe a case of Henoch-Schoenlein purpura, associated with oliguric acute renal failure due to acute interstitial nephritis histologically proven, in a patient with a staphylococcal chest infection. The clinical syndrome appeared twice after vancomycin administration and yielded on the withdrawal of the drug. As pathogenetic mechanism we propose an anaphylactoid reaction either to vancomycin or to a staphylococcal glycoprotein released after breakdown of the microbial cells caused by vancomycin.
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The immunogenicity, immunological and epidemiological effectiveness of the subcutaneous, enteral and combined immunizations of the workers at a steel plant with staphylococcal toxoid has been studied. The subcutaneous injection of the adsorbed toxoid in a dose of 0.2 ml by means of the jet injector, model, was accompanied by moderate reactogenicity (the frequency of local reactions was 26.8%, and the frequency of systemic reaction 18%) and produced 4-fold increase in antitoxin titers and 12-fold decrease in the morbidity rate of staphyloccal infection. Enteral immunization in 3 administrations proved to be nonreactogenic and only slightly effective (antitoxin titers increased more than 2-fold, morbidity rate fell 2-fold). Combined immunization (subcutaneous and enteral) with the toxoid, preceded by the injection of gamma globulin, reduced the frequency of reaction 2- to 3-fold and stimulated antitoxin production (the titer increased 8-fold), thus decreasing the morbidity rate of staphylococcal infection 3.1-fold.
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A continuous infusion of vancomycin (CIV) may provide an alternative mode of infusion in severe hospital-acquired methicillin-resistant staphylococcal (MRS) infections. A multicenter, prospective, randomized study was designed to compare CIV (targeted plateau drug serum concentrations of 20 to 25 mg/liter) and intermittent infusions of vancomycin (IIV; targeted trough drug serum concentrations of 10 to 15 mg/liter) in 119 critically ill patients with MRS infections (bacteremic infections, 35%; pneumonia, 45%). Microbiological and clinical outcomes, safety, pharmacokinetics, ease of treatment adjustment, and cost were compared. Microbiological and clinical outcomes and safety were similar. CIV patients reached the targeted concentrations faster (36 +/- 31 versus 51 +/- 39 h, P = 0.029) and fewer samples were required for treatment monitoring than with IIV patients (7.7 +/- 2.2 versus 11.8 +/- 3.9 per treatment, P < 0.0001). The variability between patients in both the area under the serum concentration-time curve (AUC(24h)) and the daily dose given over 10 days of treatment was lower with CIV than with IIV (variances, 14,621 versus 53,975 mg(2)/liter(2)/h(2) [P = 0.026] and 414 versus 818 g(2) [P = 0.057], respectively). The 10-day treatment cost per patient was $454 +/- 137 in the IIV group and was 23% lower in the CIV group ($321 +/- 81: P < 0.0001). In summary, for comparable efficacy and tolerance, CIV may be a cost-effective alternative to IIV.