Infection in patients with advanced bladder cancer.
Explore the source record for details and available documents.
Cross Infection↗
Biomedical subjects
S J Childs
Publications and source records attributed to S J Childs.
Antibiotic genitourinary surgical prophylaxis.
Urologists continue to use antibiotics inappropriately. We should rethink the reasons why certain attitudes exist about powerful drugs for prophylaxis and adjust our prescribing habits for therapy as well. Using catheters and urethral instrumentation sparingly and only when necessary, while employing proper infection control techniques and judicious antibiotic prophylaxis can control the nosocomial infections resulting from genitourinary surgery.
Anti-Bacterial Agents↗
Upper and lower urinary tract infections: amikacin's role in managing surgical complications.
Approximately one out of every 40 patients admitted to United States hospitals each year acquires a urinary tract infection while hospitalized. Urologic instrumentation is the precipitating cause in 75 to 80 percent of the cases. Such infections are responsible for a mortality rate among these patients that is three times the rate observed for all other hospitalized patients. When associated with gram-negative bacteremia, nosocomial urinary tract infections can progress rapidly to an irreversible state, resulting in death in 10 percent of those patients affected. Survivors are faced with escalating costs of hospital care and drug therapy. Presumptive administration of antibiotics is routinely recommended in selected types of genitourinary surgery, primarily because of the contaminated nature of the procedures, and especially advised when the surgery is likely to be followed by the placement of an indwelling urinary catheter. Quite often, the regimen for presumptive treatment of urinary tract infections includes aminoglycosides, such as amikacin, alone or in combination. The role of amikacin in empiric management of postoperative urinary tract infections is even more obvious. The fact that it has the broadest spectrum of activity compared with other aminoglycosides reduces the chance of therapeutic failure and results in a shorter hospital stay. In that respect, amikacin may effect an overall decrease in total costs of hospitalization.
Amikacin↗
Treatment of bacterial prostatitis. Comparison of cephalexin and minocycline.
The relative safety and efficacy of minocycline and cephalexin were examined in patients with acute or chronic prostatitis. The multicenter study was of single-blind, parallel-group design. Forty-two men received minocycline (200-mg initial dose followed by 100 mg twice daily) and 44, cephalexin (500 mg four times daily); each antibiotic was administered orally for four weeks. A follow-up period of patient assessment extended for an additional six weeks. Evaluable data were available for 20 minocycline-treated patients and for 24 cephalexin-treated patients. Clinical cure or improvement without recurrence was seen in 65 per cent of the patients who received minocycline and in 46 per cent of those given cephalexin. Bacteriologic cure without relapse or reinfection occurred in 45 per cent of the minocycline-treated men and in 21 per cent of the cephalexin-treated men. Serious adverse clinical experiences were not encountered in either treatment group. Although several factors, mainly the small number of patients, precluded a statistical analysis of comparative efficacy, it was evident that more patients in the minocycline-treated group had both clinical and bacteriologic cures (35%) than did those in the cephalexin-treated group (21%).
Adolescent↗
Appropriate surgical prophylaxis in transurethral genitourinary surgery and potential reduction in nosocomial infections.
Despite the high rate of urinary tract infections seen in hospitals, until recently many surgeons did not advise antibiotic prophylaxis for transurethral genitourinary surgery. This situation has changed with the realization that older trials with questionable results were poorly designed. Several recent well-controlled clinical studies show that appropriate antibiotic prophylaxis greatly reduces the high incidence of infections following transurethral genitourinary surgery. Effective antibiotic prophylaxis for transurethral operations may be a major route to substantial reduction in nosocomial urinary tract infections and bacteremia. To achieve effective prophylaxis, the surgeon must choose a correct antibiotic and use it according to proved principles.
Anti-Bacterial Agents↗
Aztreonam in the treatment of urinary tract infection.
The possible advantages of the monobactam antibiotic aztreonam in the treatment of hospital-acquired urinary tract infection were assessed in a study comparing aztreonam (0.5 to 1 g twice daily or three times daily) to cefamandole (1 g three times daily) in 159 patients. Initial pathogens were eradicated in 91.7 percent of the patients of the aztreonam group who were treated three times daily, in 82.7 percent of the group treated twice daily, and in 78.3 percent of the patients receiving cefamandole. Reinfection and superinfection were most commonly caused by enterococci in the aztreonam groups and by Pseudomonas aeruginosa in the cefamandole group. In a second study, 35 patients infected with organisms resistant to other antibiotics were treated with aztreonam 1 to 6 g per day for eight days. The overall cure rates were 93 percent for Pseudomonas infections, 87.5 percent for Escherichia coli infections, and 100 percent for other pathogens.
Anti-Bacterial Agents↗
Perioperative mezlocillin vs cefotaxime to prevent infections after genitourinary surgery.
This is a report of a randomized, comparative, double-blind study of mezlocillin and cefotaxime given perioperatively to 100 patients undergoing genitourinary surgery. Of 94 evaluable patients, 2 (4.7%) in the mezlocillin group and 2 (3.9%) in the cefotaxime group infections developed in the immediate postoperative period. The difference in these incidences is not statistically significant. One patient with recent bacterial prostatitis and prostatic calculi received cefotaxime and bacteriuria and sepsis developed on the first postoperative day.
Adult↗
Perioperative prevention of infection in genitourinary surgery.
Explore the source record for details and available documents.
Anti-Bacterial Agents↗
Role of piperacillin in surgical prophylaxis of genitourinary infections.
One hundred sixty-five men and women undergoing open or transurethral urologic surgery participated in a study designed to compare the prophylactic efficacy and safety of piperacillin with those of cefotaxime when administered perioperatively. The piperacillin-treated group received 2 Gm one hour before surgery and 2 Gm three hours later, and the cefotaxime-treated group was administered 1 Gm on the same schedule. In 9 per cent of the piperacillin-treated patients and in 11 per cent of the cefotaxime-treated patients postoperative urinary tract infections developed, although no patient in either group had sepsis. The most frequently isolated pathogens were Escherichia coli and Enterococcus sp. As expected, the females in both surgical groups had a greater incidence of postoperative infections than did the males. No significant drug-related clinical reactions or changes in the results of the laboratory tests were encountered in either treatment group. Thus, a two-dose perioperative prophylactic regimen of piperacillin was as safe and as effective as a two-dose regimen of cefotaxime in preventing postoperative urinary tract infections or sepsis in these patients.
Bacterial Infections↗
Ceftriaxone for once-a-day therapy of urinary tract infections.
Ceftriaxone given once-a-day was compared with cefazolin given three times daily as therapy for complicated and uncomplicated urinary tract infections. One hundred ten patients were randomly assigned to receive either 1 g of ceftriaxone every 24 hours or 1 g of cefazolin every eight hours. Standard bacteriologic methods were used to identify the pathogens and their susceptibilities before treatment and at intervals during and after treatment. Clinically, the two regimens were similarly efficacious. Bacteriologic results were significantly better with ceftriaxone in both the proportion of pathogens eradicated and the number of patients cured. The results demonstrate that ceftriaxone compares favorably with cefazolin and is effective when given once-a-day for both complicated and uncomplicated urinary tract infections.
Adult↗
Antibiotic prophylaxis in elective genitourinary tract surgery: a comparison of single-dose pre-operative cefotaxime and multiple-dose cefoxitin.
In a randomized, single-blind study, the efficacy of single-dose cefotaxime was compared with multiple dose cefoxitin in genitourinary surgery prophylaxis. Patients received either 1.0 g cefotaxime before surgery; or 2.0 g cefoxitin pre-operatively and every 8 h for no more than 24 h post-operatively. Of the evaluable patients receiving cefotaxime 3 of 35 (8.6%) became infected post-operatively, compared to 12 of 37 (32.4%) patients receiving cefoxitin (P less than 0.01). It is concluded that single-dose genitourinary surgical prophylaxis with cefotaxime may be more effective than a longer dosing schedule with cefoxitin in the prevention of post-operative urinary tract infections, and that a single-dose regimen may represent significant cost containment advantages for hospitals.
Adolescent↗
Antibiotic therapy in surgical patients.
Explore the source record for details and available documents.
Anti-Bacterial Agents↗
Antibiotic prophylaxis for genitourinary surgery in community hospitals.
For 92 patients who had undergone transurethral and open urologic surgery a prospective, randomized, double-blind study was done that compared the effects of ceftriaxone, a third generation cephalosporin, to placebo. The 2 groups were similar in respect to demographic characteristics. Ceftriaxone reduced significantly the incidence of postoperative infection (p less than 0.01). Of 43 patients who received ceftriaxone 2 (5 per cent) became infected compared to 15 of 49 (30 per cent) who received placebo. Patients in the placebo group who had positive postoperative urine cultures did so approximately 2 days earlier than those in the ceftriaxone group, even though the day of catheter removal averaged about 1 1/2 days later in the ceftriaxone group. There was no correlation between the incidence of fever and infection, and there was no difference between groups with regard to postoperative bleeding, or the incidence of recatheterization or rehospitalization. Average operating time, highest temperature postoperatively and number of hospital days were approximately the same in both groups. Two patients in the placebo group had serious complications and incurred approximately $11,600 in additional expenses as a result of those complications. Of these patients 1 became septic, and 1 had urinary tract and wound infections postoperatively. These data suggest that this method of antibiotic prophylaxis will not only reduce the incidence of postoperative infection in such patients, thereby reducing morbidity, mortality and hospital costs, but also may provide an additional 1 to 2 days of protection from infection for patients who require postoperative catheterization.
Cefotaxime↗
Ceftazidime, an open randomized comparison of 3 dosages for genitourinary infections.
Ceftazidime, a new beta-lactamase resistant aminothiazo-oyl cephalosporin with a broad spectrum of antibacterial activity against gram-positive and gram-negative bacteria, including Pseudomonas species, was evaluated clinically for efficacy and safety at 3 dosage levels in patients with acute genitourinary tract infection. Sixty patients with infections, including cystitis, pyelonephritis, epididymitis and prostatitis, were assigned randomly to 1 of the 3 dosage regimens: 250, 500 or 1,000 mg. administered intramuscularly every 12 hours. Patients were evaluated bacteriologically and clinically during the course of treatment and after treatment. All patients became asymptomatic and showed clinical improvement or cure within 48 to 72 hours regardless of dosage. Bacteriological success, namely eradication of the pathogen during therapy with no recurrence of superinfection during followup, was attained in 95 per cent of the patients with uncomplicated infections and in 61 per cent of those with complicated infections. Superinfections accounted for most of the noncures, particularly with the 250 mg. regimen. The difference in success rates between the 250 mg. dosage, and the 500 mg. and 1 gm. dosages in patients with complicated infections was statistically significant. Injections were well tolerated without significant side effects. No clinically important variations in laboratory tests were observed. The results indicate that ceftazidime is a useful third generation cephalosporin for complicated and uncomplicated genitourinary infections but it is recommended that the 250 mg. dosage not be used in patients with complicated infections.
Ceftazidime↗
Preliminary report on a comparative trial of cefotetan and cefoxitin in the treatment of urinary tract infections.
Cefotetan was compared with cefoxitin in the treatment of hospitalized patients with complicated as well as uncomplicated urinary tract infections. Cefotetan produced high peak and trough plasma and urine concentrations with a twice-daily dosing schedule. The intravenous administration of 1 or 2 g of cefotetan every 12 h was effective in treating urinary tract infections due to susceptible Gram-negative bacteria and compared favourably with the results obtained with 1 or 2 g of cefoxitin every 8 h. Similar types of non-serious adverse reactions occurred with both drugs.
Adolescent↗
A random comparative trial of 0.25, 0.5 and 1.0 g ceftazidime twice daily in urinary tract infection.
One hundred and sixty-six patients with complicated and uncomplicated urinary tract infections were randomized to therapy with either 0.25, 0.50 or 1.00 g of ceftazidime im or iv twice daily for five days. Bacteriological data were complete in 138 patients. Escherichia coli caused 50% of all infections, Klebsiella and Enterobacter spp. caused 10.9%, Pseudomonas spp caused 10.9%, Proteus spp. caused 10.7%, and 8.7% were caused by other Gram-negative bacteria. Staphylococcus and Streptococcus spp. caused 9.4%. Cure rate was lowest in infections caused by Pseudomonas (53.3%) and Proteus spp. (64.3%); however, most of these infections were complicated. No significant dose-related difference in efficacy was observed, but the 0.25 g dose had the lowest cure rate in each category. Nausea was the only side effect. The most common laboratory abnormalities were elevated liver function tests. Minimal changes in haematological and renal function were seen.
Adult↗
Perioperative use of ceftazidime as a prophylactic agent in transurethral surgery.
Sixty-eight patients undergoing transurethral surgery were randomly assigned to receive either a single dose of ceftazidime (31 patients) preoperatively, or three doses of cefotaxime (34 patients) perioperatively, as prophylaxis. In this study, only 1/20 male patients (5%), and none of the female patients, developed an infection. We conclude that single-dose prophylaxis, with a safe, broad-spectrum antimicrobial, provides adequate protection against postoperative infection in genitourinary surgery.
Adult↗