Susceptibility in vitro of 179 staphylococcal strains from 107 cystic fibrosis patients against 31 antibiotics indicates that only teicoplanin, vancomycin and netilmicin were active against all strains. The use of betalactam antibiotics is impaired by 11.7% of methicillin-resistant strains. The bactericidal kinetics of cephalexin and flucloxacillin as determined in a pharmacodynamic model demonstrates the killing of strains resistant to cephalexin (MIC 8 mg/l to 32 mg/l) by flucloxacillin. For the rational selection of antistaphylococcal antibiotics for cystic fibrosis patients, both the MIC of the isolates and the concentration of the antibiotics in cystic fibrosis patients have to be considered.

Adolescent↗

PubMedDate not supplied

Qualitative and quantitative microbiological analysis of sputa of 102 patients with cystic fibrosis.

A microbiological analysis of 102 patients suffering from cystic fibrosis was conducted over a 22 month period. 20 microbial species with the following incidence were identified: Pseudomonas aeruginosa: 83.4%; Candida albicans: 29.4%; Staphylococcus aureus: 24.5%; Staphylococcus epidermidis: 11.8%; Haemophilus influenzae: 11.8%; Streptococcus pneumoniae; 6.9%; Pseudomonas maltophilia: 6.8%; Aspergillus fumigatus: 5.9%. Other species were present in less than 5% of the patients. In the majority of specimens with P. aeruginosa, more than one type (up to six) was detectable. These strains were identical in colony appearance, O-serotype and pyocin-type. Quantitative analysis revealed concentrations of colony-forming units of 10(7) to 10(9) for P. aeruginosa, 10(6) to 10(8) for P. maltophilia, 10(4) to 10(7) for S. aureus, 10(4) to 10(6) for S. epidermidis and 10(4) to 10(7) for C. albicans in the majority of specimens. Significant differences were observed in the time periods during which the pathogens persisted in the patients. Maximum persistence was observed for P. aeruginosa. P. maltophilia and A. fumigatus had about similar persistence rates, which were lower than those for P. aeruginosa but above those for S. aureus and H. influenzae. S. epidermidis was eliminated within shorter periods than S. aureus. C. albicans, although the second most frequent microorganism identified, showed a very low persistence rate. The microbiological analysis confirms results from other research centers (high incidence of P. aeruginosa), but reveals significant regional differences as well (Pseudomonas cepacia not detectable, higher incidence of P. maltophilia and C. albicans). This underlines the necessity for detailed qualitative and quantitative microbiological analysis of sputa from cystic fibrosis patients as a prerequisite for rational analysis of etiological, epidemiological and therapeutical aspects of cystic fibrosis.

Adolescent↗

PubMedDate not supplied

[Advantages of water filtered over conventional infrared irradiation in neonatology].

BACKGROUND: When infrared (IR) radiation is conducted through water, its long-wave parts (called IR-B and IR-C) are filtered out in favour of the short-wave IR-A band. Since the former are normally absorbed in the outer layers of skin, water-filtering results in a reduced risk of superficial burns and a better penetration into tissues. This effect which in solar radiation results from its passing through the water vapour of the earth's atmosphere, has now been successfully imitated in radiant heaters. In this study, the potential benefits of water-filtered as compared to conventional infrared radiation in obstetrics and neonatology were examined. MATERIALS AND METHODS: To this end, three methodological approaches were made, namely: 1. Comparative physical measurements of radiant power density in several clinically used IR-sources, 2. physiological simulation experiments on the surface and depth effects of either type of radiation (performed on human adults and an artificial tissue phantom), and 3. clinical observations on the protective effects of the novel IR-A-radiators in incubator nursing and primary care of preterm neonates. RESULTS AND DISCUSSION: Although the absolute radiant power density was equivalent in a conventional and a novel heating device, the IR-A radiation proved to result in a markedly reduced superficial overheating of tissues. In addition, it exceeded conventional IR radiation in its ability to pass through incubator walls, thus lowering the risk of cooling in preterm neonates during nursing procedures. Moreover, when used as a complementary source of heat in the delivery room, IR-A radiation exerted a preventive effect against hypothermia during the subsequent transport of patients to the neonatal intensive care unit, probably due to the rapid build-up of heat deposits in peripheral tissues. CONCLUSIONS: In view of these benefits which are reinforced by a greatly diminished evaporation effect, water-filtered IR-radiation seems to make a promising contribution to the thermal protection of preterm neonates.

Adult↗

PubMedDate not supplied

Outbreak of systemic aspergillosis in a neonatal intensive care unit.

Small pre-term neonates are susceptible to cutaneous aspergillosis because of their immature immune system and because of the vulnerability of their skin. In addition, the common therapy with broad-spectrum antibiotic drugs and corticoids creates a favourable milieu for fungal superinfections. We present four pre-term neonates who succumbed to cutaneous aspergillosis that subsequently developed into a systemic infection. The source of the infection proved to be contaminated latex finger stalls. Three of the four patients died. The poor prognosis for systemic aspergillosis can only be improved by an early therapy with amphotericin B, possibly in liposomal form.

Aspergillosis↗

PubMedDate not supplied

[Possibilities of therapy of respiratory distress syndrome in premature infants using natural surfactant].

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Humans↗

PubMedDate not supplied

[Obstetric aspects of maternal hepatitis C infection].

The present study discusses problems of maternal infection with hepatitis C virus in pregnancy with respect to the recent publications on this subject. In particular, questions of vertical transmission during pregnancy and fetal infection sub partu are discussed using three cases as an example. It was shown that recently few informations on the risk of transmission of the hepatitis C virus from the mother to the infant in utero or sub partu are existing, but the actual studies provide some evidence for this risk to be relatively low. The actual knowledge concerning the mode of delivery of hepatitis C positive women as well as recommendations concerning the diagnostic and therapeutic procedures are comprehensively shown on the basis of the recent scientific results.

Adult↗

PubMedDate not supplied

[Importance of pre- and perinatal risk factors in respiratory distress syndrome of premature infants. A logical regression analysis of 1100 cases].

BACKGROUND: Respiratory distress syndrome (RDS) due to surfactant deficiency remains a cause of considerable mortality in the neonatal period. METHODS: In a retrospective study we analysed the records of 1109 premature newborns with a birth weight below 1500 g that were treated on our unit. RDS was assumed if the infants needed mechanical ventilation with oxygen supplementation and the typical radiological signs were present on chest x-ray. RESULTS: No changes in the incidence of RDS were found during the period of observation. Below 29 weeks gestational age 90% of infants suffered from RDS (55% severe RDS grade III or IV). The incidence was 75% (grade III or IV: 32%) for infants born at 29 and 30 weeks, 48% (grade III or IV: 15%) at 31 and 32 weeks and 33% (grade III or IV: 6%) for neonates born at 33 weeks of gestation. Using a logistic regression analysis model the following parameters were found to increase the risk for RDS significantly (p < 0.05): no prenatal steroid treatment, Cesarean section, male gender, APGAR at 5 min < 7, metabolic acidosis (base excess < or = -6 mval) and rectal temperature < 36 degrees C on admission. Following gestosis, insufficiency of the placenta and premature rupture of membranes a decrease in the incidence of RDS was observed. CONCLUSION: We conclude that although some risk factors for RDS will be difficult to exclude (e.g. maternal disease, gender) the incidence and severity of RDS can be reduced by measures like maternal antenatal steroid treatment. Perinatal asphyxia (low APGAR values and/or acidosis) and hypothermia should be avoided, as these conditions increase the relative risk for developing RDS.

Acidosis↗