Anti-inflammatory properties of alkyl-pseudothioureas with antibacterial and antifungal activity.
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The occurrence of C. albicans in association with opportunistic microorganisms (Staphylococcus aureus and Klebsiella) in intestinal dysbiosis in patents of different age groups (from 6 days to 31 years) was analyzed. The data on the comparative evaluation of the results of the bacteriological examination of patients with intestinal dysbiosis, carried out during the periods of 2000-2001 and 2001-2002 (388 and 467 patients respectively), are presented. During the period of 2000-2001 the detection rate of C. albicans in monoculture was 6-33% of cases (in the examined group). A higher detection rate was registered with respect to the association of C. albicans with staphylococci (42-65% of cases). The associations of C. albicans with staphylococci and Klebsiella were observed in 13-46% of cases. Similar results were registered during the period of 2001-2002, but during this period a reliable decrease in the detection rate of the association of C. albicans with staphylococci (practically by 20% in the group of infants) and the 1 1/2-fold increase of the detection rate of C. albicans in monooulture (in all age groups) were observed.
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From January 1991 to July 1993, 58 patients with MRSA infections in our clinic at Wakayama Medical College and six affiliated hospitals were administered with arbekacin (ABK). The clinical results were as follows: 1. The clinical efficacy rates of ABK were 84% in pneumonia, 100% in both wound infections and hepatobiliary tract infections, and 85% in total. The bacteriological efficacy rate was 83%. 2. Regarding the administration route, the clinical efficacy rates were 60-79% by the intravenous treatment and inhalation therapy. Especially by the local administration with ABK, MRSA was eradicated in all cases. 3. The sufficient efficacy was obtained by the treatment of ABK alone (89%) and by the combined treatment with ABK (82%) and another antibiotics. From these results, it is concluded that ABK is useful for the treatment of MRSA infections after gastrointestinal surgery.
Over 25 years experience with fusidic acid in the treatment of bone and joint infections is reviewed. Fusidic acid, usually given concurrently with another antibiotic, has proved effective in a wide variety of staphylococcal infections, including acute osteomyelitis and septic arthritis. It is a valuable adjunct to surgery in patients with chronic osteomyelitis. Oral therapy is generally well tolerated, apart from gastrointestinal side effects in a small proportion of cases. Use of fusidic acid in other orthopaedic situations is considered in the light of recent information.
Percutaneous endoscopic gastrostomy (PEG) has become a widely practised procedure to maintain long-term nutrition in patients with a variety of medical conditions. Incidence of infection and the usage of prophylactic antibiotic continue to remain an area of debate. Guidelines in gastroenterology on antibiotic prophylaxis published by the British Society of Gastroenterology recommend the use of prophylactic antibiotic prior to placement of PEG tube (1). There has been an alarming rise in the incidence of MRSA, which has jumped from a reported 2% in 1992 to about 42% in 2001 in England & Wales. Use of antibiotic may lead to emergence of MRSA in debilitated patients requiring PEG feeding. This audit addresses some of the problems encountered in a small district general hospital.
We present an unusual case of empyema of the gallbladder associated with a pyogenic liver abscess in a patient with Crohn's disease on Infliximab. It manifested by weakness, weight loss, and vague abdominal pain, which eventually localized to the right upper quadrant 4 days prior to admission. Diagnostic evaluation, which included ultrasonography and computed tomography, revealed cholelithiasis, gallbladder wall thickening, and a low-attenuation, complex mass in the left hepatic lobe. Cholecystectomy and open drainage of the liver abscess were successfully performed. There are few reports of intrahepatic abscess associated with Crohn's disease. The relationship between acute cholecystitis and Crohn's disease has also been documented. However, this report documents the unusual complication of pyogenic liver abscess secondary to acute cholecystitis in the unique population of Crohn's disease patients on Infliximab.
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During the last twenty years there have been considerable advances in the antimicrobial management of the immunosuppressed host. These include the development of antibiotics with broad-spectrum and high bactericidal activity along with the appreciation of the importance of promptly initiating empiric antibiotic therapy when the granulocytopenic patient becomes febrile and continuing them (in some cases with empiric antifungal therapy) until the resolution of granulocytopenia. Nonetheless, infection still remains a major cause of death in compromised hosts and a number of limitations of therapy persist. Included are a limited repertoire of drugs active against fungi (particularly Aspergillus) as well as certain viruses (for example, cytomegalovirus) and the inability to eradicate certain sites of infection (for example, Pseudomonas pneumonia) even with effective agents. Current investigations are focused on developing new antimicrobial agents as well as methods to improve the altered host defenses of immunosuppressed patients, both as adjuvants to therapy and, eventually, as a means to prevent infectious complications.
INTRODUCTION: The intensive care unit is burdened with a high frequency of nosocomial infections often caused by multiresistant nosocomial pathogens. Coagulase-negative staphylococci (CoNS) are reported to be the third causative agent of nosocomial infections and the most frequent cause of nosocomial bloodstream infections. CoNS are a part of the normal microflora of skin but can also colonize the nasal mucosa, the lower airways and invasive devices. The main aim of the present study was to investigate colonization and the rate of cross-transmissions of CoNS between intubated patients in a multidisciplinary intensive care unit. MATERIALS AND METHODS: Twenty consecutive patients, ventilated for at least 3 days, were included. Samples were collected from the upper and lower airways. All samples were cultured quantitatively and CoNS were identified by morphology and biochemical tests. A total of 199 CoNS isolates from 17 patients were genetically fingerprinted by pulsed-field gel electrophoresis in order to identify clones and to monitor dissemination within and between patients. RESULTS: An unexpected high number of transmission events were detected. Five genotypes were each isolated from two or more patients, and 14/20 patients were involved in at least one and up to eight probable transmission events. CONCLUSIONS: A frequent transmission of CoNS was found between patients in the intensive care unit. Although transmission of bacteria does not necessarily lead to infection, it is nevertheless an indication that infection control measures can be improved.
Six patients with aortointestinal fistula have been treated at Royal Prince Alfred Hospital (RPAH) over the last decade. Four had their initial vascular reconstruction at RPAH and two were referred. This represents an incidence of 0.8% following aortic reconstruction at this hospital. All presented with gastrointestinal bleeding (GIT) and two also had infective complications. Preoperative investigations were helpful in only half the patients. Three died as a direct result of the aortointestinal fistula. Later complications occurred in two of three patients where the graft was not removed. The most important aspect of management is suspicion of aortointestinal fistula as a cause for GIT bleeding in a patient with previous aortic surgery. Effective surgical management requires removal of the graft and early revascularization.
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