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Antiseptic negative pressure instillation therapy for the treatment of septic wound healing deficits in oral and maxillofacial surgery.
Eckstein, FM, Pinsel, V, Wurm, MC, Wilkerling, A, Dietrich, EM, Kreißel, S, von WIlmowsky, C, Schlittenbauer, T
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2019;(3):389-393
Abstract
INTRODUCTION Impaired wound healing, chronic wounds and extended soft tissue defects present a crucial problem in reconstructive surgery of the head and neck region, even more after radiation therapy. In such cases the standard is a prolonged open wound treatment. The negative pressure instillation therapy might present an alternative therapy option. MATERIAL AND METHODS In this study the effects of negative pressure instillation therapy on the healing of chronic wounds in 15 patients diagnosed with impaired wound healing were investigated. These based upon infected osteoradionecrosis and osteomyelitis of the jaw. The parameters investigated as markers of the therapeutic success were serum inflammatory parameters i.e. white blood cell counts, wound smear results and wound surface reduction. RESULTS The use of negative pressure instillation therapy lead to a reduction of the bacterial load and formation of a stabile granulation tissue in all but one case. The mean inpatient time of the patients was 13.33 ± 4.62 days. Between 2 and 8 dressing changes were needed to reach clinical sufficient wound healing results. Secondary intention wound healing could be obtained in 14 out of 15 cases. The crucial part for the successful application was a watertight enoral suturing as oro-cutaneous fistulae were present in most cases. CONCLUSION The negative pressure instillation therapy poses a good treatment for wound healing problems and extended size soft tissue defects, even when oro-cutaneous fistulae were present. Especially in cases that contraindicate micro-vascular reconstruction, negative pressure instillation therapy could be a good alternative.
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Vitamin D-binding protein in cervicovaginal fluid as a non-invasive predictor of intra-amniotic infection and impending preterm delivery in women with preterm labor or preterm premature rupture of membranes.
Kook, SY, Park, KH, Jang, JA, Kim, YM, Park, H, Jeon, SJ
PloS one. 2018;(6):e0198842
Abstract
OBJECTIVE To determine whether vitamin D-binding protein (VDBP) in cervicovaginal fluid (CVF) is independently predictive of intra-amniotic infection and imminent spontaneous preterm delivery (SPTD, delivery within 48 hours) in women with preterm labor with intact membranes (PTL) or preterm premature rupture of membranes (PPROM). METHOD This was a single-center retrospective cohort study. CVF samples for VDBP assays were obtained along with serum C-reactive protein (CRP) levels immediately after amniocentesis in consecutive women with PTL (n = 148) or PPROM (n = 103) between 23.0 and 34.0 weeks of gestation. VDBP levels in CVF were determined by enzyme-linked immunosorbent assay kits. The primary outcome measures were intra-amniotic infection [defined as positive amniotic fluid (AF) culture] and SPTD within 48 hours after sampling. RESULTS In the multivariable analysis, elevated VDBP levels in CVF samples of PTL women were significantly associated with intra-amniotic infection and imminent preterm delivery, even after adjusting for potential confounders (e.g., gestational age at sampling, parity, and serum CRP). However, these relationships were not found in women with PPROM. In women with PTL, the areas under receiver operating characteristic curves of CVF VDBP level for predicting intra-amniotic infection and imminent preterm delivery were 0.66 and 0.71, with cut-off values of 1.76 μg/mL (sensitivity of 64.3% and specificity of 78.4%) and 1.37 μg/mL (sensitivity of 65.4% and specificity of 72.6%), respectively. The CVF VDBP levels were significantly higher in women with PPROM than in those with PTL. CONCLUSIONS VDBP in the CVF independently predicts intra-amniotic infection and imminent preterm delivery in women with PTL, whereas in women with PPROM, an elevated VDBP level in CVF is not associated with increased risks of these two outcome variables.
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[Preliminary clinical evaluations of panipenem-betamipron in the treatment of hematological malignancy infections].
Li, JJ, Jia, YQ, Cui, X, Huang, J, He, C
Zhonghua yi xue za zhi. 2012;(7):452-5
Abstract
OBJECTIVE To evaluate the clinical efficacy and safety of intravenous panipenem-betamipron in the treatment of hematological malignancies infections. METHODS From October 2009 to December 2010, a total of 286 hematological malignancy infection patients were recruited into this open-label, perspective and multicenter clinical trial to receive an intravenous daily dose panipenem-betamipron of 0.5 g every 6 or 8 hours for 7 - 14 days. All clinical change and adverse reactions were recorded. RESULTS The total effective rate of panipenem-betamipron in the treatment of hematological malignancy infections was 86.6% (206/238). The effective rates of septicemia, pulmonary infections, urinary tract infections, digestive canal infections, oral infections and other infections were 68.2% (15/22), 89.3% (100/112), 77.8% (14/18), 100% (22/22), 83.3% (10/12) and 86.5% (45/52) respectively. The overall bacterial eradication rate was 85.07% (57/67) and the rate of adverse reactions 5.9% (17/286). CONCLUSION Panipenem-betamipron is both safe and effective in the treatment of hematological malignancy infections.
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[Effect of complex generalized treatment using zinc electrophoresis and electromagnetic field of millimeter range waves on clinical, physiological and bacteriological indices in patients with chronic generalized periodontitis].
Kutateladze, NS
Georgian medical news. 2009;(168):72-5
Abstract
Total of 73 patients with chronic generalized periodontitis have been studied. Among them in 38 patients a light form of this pathology was observed, while in 35 - mean form. It has been established that a complex treatment with the usage of zinc electrophoresis and electromagnetic field of millimeter range waves evokes an improvement of the indices of stomatological status right up to normalization; increases partial pressure of oxygen tension in gums and has a bactericidal action on the microflora of parodontal pockets. This positive process is more expressed at light form of chronic generalized periodontitis.
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Antibiotic prophylaxis for orthognathic surgery: a prospective, comparative, randomized study between amoxicillin-clavulanic acid and penicillin.
Jansisyanont, P, Sessirisombat, S, Sastravaha, P, Bamroong, P
Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2008;(11):1726-31
Abstract
OBJECTIVE The present study was designed to evaluate the prophylactic efficacy after the correction of dentofacial deformities between short- and long-term penicillin and amoxicillin-clavulanic acid. MATERIAL AND METHOD The present study was prospective, randomized, and double blinded. Patients were separated into four groups randomly: short-term and long-term (5 days) penicillin and short-term and long-term (5 days) amoxicillin-clavulanic acid. RESULTS One hundred twenty two patients were assigned randomly into the four groups. Infection developed in a patient in the short-term amoxicillin-clavulanic acid group and in a patient in the long-term penicillin group. CONCLUSION There were no differences in infection between the two groups of antibiotics. Based on the present study, short-term penicillin is still the most appropriate choice for prophylactic antibiotic in orthognathic surgery.
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Randomized controlled trial of moxifloxacin compared with piperacillin-tazobactam and amoxicillin-clavulanate for the treatment of complicated intra-abdominal infections.
Malangoni, MA, Song, J, Herrington, J, Choudhri, S, Pertel, P
Annals of surgery. 2006;(2):204-11
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Abstract
OBJECTIVE To compare the safety and efficacy of sequential intravenous (IV) to oral (PO) moxifloxacin treatment against a standard antimicrobial regimen of IV piperacillin-tazobactam followed by PO amoxicillin-clavulanate for the treatment of adults with complicated intra-abdominal infection (cIAI). SUMMARY BACKGROUND DATA cIAIs are commonly due to mixed aerobic and anaerobic bacteria and require both source control and broad-spectrum antibiotic therapy. METHODS A prospective, double-blind, randomized, phase III comparative trial. Patients with cIAI were stratified by disease severity (APACHE II score) and randomized to either IV/PO moxifloxacin (400 mg q24 hours) or comparator (IV piperacillin-tazobactam [3.0/0.375 g q6 hours] +/- PO amoxicillin-clavulanate [800 mg/114 mg q12 hours]), each for 5 to 14 days. The primary efficacy variable was clinical cure rate at the test-of-cure visit (days 25-50). Bacteriologic outcomes were also determined. RESULTS : Of 656 intent-to-treat patients, 379 (58%) were valid to assess efficacy (183 moxifloxacin, 196 comparator). Demographic and baseline medical characteristics were similar between the 2 groups. Clinical cure rates at test-of-cure were 80% (146 of 183) for moxifloxacin versus 78% (153 of 196) for comparator (95% confidence interval, -7.4%, 9.3%). The clinical cure rate at test-of-cure for hospital-acquired cIAI was higher with moxifloxacin (82%, 22 of 27) versus comparator (55%, 17 of 31; P = 0.05); rates were similar for community-acquired infections (80% [124 of 156] versus 82% [136 of 165], respectively). Bacterial eradication rates were 78% (117 of 150) with moxifloxacin versus 77% (126 of 163) in the comparator group (95% confidence interval, -9.9%, 8.7%). CONCLUSIONS Once daily IV/PO moxifloxacin monotherapy was as least as effective as standard IV piperacillin-tazobactam/PO amoxicillin-clavulanate dosed multiple times daily for the treatment of cIAIs.
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Intravenous iron following cardiac surgery does not increase the infection rate.
Torres, S, Kuo, YH, Morris, K, Neibart, R, Holtz, JB, Davis, JM
Surgical infections. 2006;(4):361-6
Abstract
BACKGROUND Intravenous iron (FeIV) has been used increasingly, alone or in combination with recombinant erythropoietin, to promote red cell production as part of a blood conservation program. Given the important role that iron plays in the growth of bacteria, it has been hypothesized that this use of FeIV may promote surgical site infection. However, this hypothesis has not yet been tested appropriately. To assess this hypothesis, postoperative infection rates in patients undergoing cardiothoracic surgery were analyzed. METHODS Data were collected on 863 patients undergoing cardiopulmonary bypass surgery in 2001. Patients were either enrolled voluntarily in a blood conservation program in which they received either postoperative FeIV and erythropoietin (n=302), as indicated, or blood transfusions and no FeIV (n=561), as indicated, to correct postoperative anemia. Infections were defined according to the U.S. Centers for Disease Control and Prevention guidelines. RESULTS Thirty-nine infections developed. The overall infection rate was 4.52%, with an infection rate of 3.97% in the iron-treated group (n=12) and a rate of 4.81% in the untreated group (n=27). When the impact of gender, age, diabetes mellitus, operating time, type of surgery, and blood transfusions were controlled for, FeIV did not increase the risk of infection (odds ratio of 1.031 for each increment of 125 mg of FeIV; 95% confidence interval 0.908, 1.170; p=0.64). CONCLUSIONS There was no impact of FeIV on the subsequent infection rate in a cardiac surgery patient cohort, indicating its safety for use in the postoperative setting.
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Supply of pre- and probiotics reduces bacterial infection rates after liver transplantation--a randomized, double-blind trial.
Rayes, N, Seehofer, D, Theruvath, T, Schiller, RA, Langrehr, JM, Jonas, S, Bengmark, S, Neuhaus, P
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2005;(1):125-30
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Abstract
Bacterial infections frequently occur early after liver transplantation. We recently reported significant progress with a synbiotic composition, consisting of one lactic acid bacteria (LAB) and one fiber, which reduced the infection rate from 48% (with selective bowel decontamination) to 13%. Now, our aim is to study if a combination of different LAB and fibers would further improve outcome. A prospective randomized double-blind trial was undertaken in 66 liver transplant recipients. All patients received enteral nutrition immediately post-operatively. Comparison was made between one group (A) receiving a composition of four LAB and four fibers and another group (B) receiving the fibers only. The treatment started the day before surgery and continued for 14 days. Thirty-day infection rate, length of hospital stay, duration of antibiotic therapy, non-infectious complications and side effects of enteral nutrition were recorded. The incidence of post-operative bacterial infections was significantly reduced; being 48% with only fibers and 3% with LAB and fibers. In addition, the duration of antibiotic therapy was significantly shorter in the latter group. In both groups, mainly mild or moderate infections occurred. Fibers and LAB were well tolerated. Early enteral nutrition supplemented with a mixture of LAB and fibers reduces bacterial infection rates following liver transplantation. Treatment with only fibers led to a low incidence of severe infections.
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Acute effects of gentamicin on urinary electrolyte excretion in neonates.
Giapros, VI, Cholevas, VI, Andronikou, SK
Pediatric nephrology (Berlin, Germany). 2004;(3):322-5
Abstract
It has recently been shown that a single dose of gentamicin causes immediate and transient calcium and magnesium renal wasting in adults. The aim of this study was to determine the acute effect of gentamicin administration on renal electrolyte handling in preterm and full-term neonates. Twenty-three neonates treated with gentamicin for suspected infection were enrolled in the study. Serum and 3-h urine electrolytes were measured before and immediately after gentamicin infusion on the 1st, 3rd, 4th, and 7th day of treatment. Serum gentamicin levels were monitored. Gentamicin caused a statistically significant post-infusion increase in fractional excretion of sodium and magnesium and in the urine calcium to urine creatinine ratio. Potassium and phosphate fractional excretion remained unchanged. The disturbances in electrolyte excretion were observed in full-term as well as in preterm neonates. Serum electrolyte levels remained unchanged. In conclusion, therapeutic doses of gentamicin result in urinary loss of sodium, calcium, and magnesium in neonates immediately after the infusion of the drug. These electrolyte changes may be of clinical importance, especially for sick preterm neonates.
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Antibiotic therapy for diabetic foot infections: comparison of cephalosporines with chinolones.
Lobmann, R, Ambrosch, A, Seewald, M, Dietlein, M, Zink, K, Kullmann, KH, Lehnert, H
Diabetes, nutrition & metabolism. 2004;(3):156-62
Abstract
Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations and uncontrolled infections represent a major risk factor. This open prospective, multicenter trial compared the efficacy of two antibiotic regimens for treatment of foot infections Wagner stage II or III in diabetic adults. Three hundred diabetic patients with severe, limb-threatening foot infection were consecutively enrolled in a prospective, observational, matched pairs controlled study to test two different antibiotic regimes (ceftriaxone vs chinolones) in addition to standard treatment of foot infection. After matching, 90 patients--each receiving ceftriaxone or chinolones--were analyzed. Our study demonstrated that treatment with a third generation cephalosporine is as effective as a treatment with chinolones. Response (reaching Wagner I or 0) was achieved in 58.0% in the ceftriaxone group and in 51.1% in the chinolone group (NS.). Fourteen days after initiation of treatment, the number of patients with microbiological isolates decreased in both groups (52 to 5 in the ceftriaxone group and 60 to 12 in the chinolone group). At hospital discharge, 66.0% of ceftriaxone and 64.4 of chinolone-treated diabetic ulcers were cured or improved. In summary, both substances proved to be effective in the primary antibiotic treatment of the diabetic foot; an early broad spectrum antibiotic treatment, that covers both gram-positive and gram negative bacteria as well as anerobes is undisputedly an imperative therapeutic intervention for the treatment of diabetic foot infection.