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PubMed1982

Comparison of a direct radioimmunoassay with virus isolation in cell culture for detection of pseudorabies virus in tissues of infected swine.

A direct radioimmunoassay (DRIA) was developed for detection of pseudorabies virus (PRV) in tissues of pigs with clinical disease. Homogenates of tissues prepared from 289 swine were tested for PRV with the DRIA and virus-isolation technique (VIT). The virus was detected in 53 (18%) of the homogenates by both DRIA and VIT. Fifteen (5%) others were positive for PRV by VIT, but negative by DRIA. There were no samples negative by VIT and positive by DRIA. A total of 221 (77%) pigs with clinical PRV infection were negative in both DRIA and VIT. Although the VIT is more sensitive than DRIA, the DRIA possesses certain advantages which include reduced requirement for aseptic procedures and cell cultures, rapidity, and increased objectivity. Moreover, high levels of confidence could be attributed to DRIA-positive results, since DRIA-positive/VIT-negative results were not obtained.

Animals↗
PubMed1997

Cerebrospinal fluid gamma-aminobutyric acid and glutamate values in dogs with epilepsy.

OBJECTIVES: To investigate changes in CSF concentrations of inhibitory and excitatory neurotransmitters in dogs with confirmed idiopathic epilepsy, and to evaluate them with regard to the clinical characteristics of the sample population and of the seizures. ANIMALS: 13 (8 male and 5 female) drug-naive dogs with an initial generalized seizure, 6 (4 male and 2 female) drug-naive dogs with an initial partial seizure, and 10 clinically normal (5 male and 5 female) control dogs. PROCEDURE: At least 24 hours after the last observed seizure, CSF was collected aseptically from the cisterna cerebellomedullaris, and a portion was immediately aliquoted into vials, placed on dry ice, then stored at -80 C. The CSF glutamate (GLU) and gamma-aminobutyric acid (GABA) concentrations were estimated by use of HPLC with electrochemical detection. Cerebellomedullary cisternal CSF glutamate and GABA values were analyzed in dogs with noninduced idiopathic epilepsy. Comparisons were determined for differences attributable to weight, sex, age at first seizure, seizure type, and total time of past seizure history. RESULTS: Mean (range) age at onset of the first seizure was 3.33 (0.1 to 11), 3.5 (0.1 to 11), and 3.25 (0.5 to 9) years for all dogs, dogs with initial partial seizure, and dogs with initial generalized seizure, respectively. Low GABA and high GLU values were found in the CSF of epileptic dogs, and were independent of time elapsed between the first observed seizure and CSF sample collection. The GABA value was inversely related to body weight in epileptic dogs, independent of age. Changes in GABA and GLU concentrations were not related to seizure type. CONCLUSIONS: Altered GABA and GLU values in CSF might be indicative of a state of chronic overexcitation in the brain of dogs with primary or idiopathic epilepsy. CLINICAL RELEVANCE: CSF GABA and GLU may serve as important markers in epileptic dogs for potential response to antiepileptic drugs.

Aging↗
PubMed2006

[Molecular identification and genetic analysis of an echovirus 19-associated epidemic of aseptic encephalitis].

OBJECTIVE: To ascertain the pathogen of aseptic encephalitis epidemic in Long-Yan city in Fujian, and to find out the genetic characteristics of the virus. METHODS: Rapid detection of enteroviral RNA by reverse transcription polymerasechain reaction (RT-PCR) was directly carried out in cerebrospinal fluid(CSF) to isolate and identify the viruses from CSF at the same time, and to detect the neutralization antibody in two serum specimens collected in acute and convalescence phase. Nucleotides of VP1 region was also analyzed by constructing phylogenetic tree. RESULTS: ECHO 19 infection was rapidly diagnosed and sequence analysed by RT-PCR, and then echovirus type 19 from 16 of 30 CSF samples (53.33%) was isolated and detected using RD and Hep-2 cells simultaneity. The titer of ECHO 19 neutralization antibody became positive or increased by 4 times from acute to convalescence phase in 4 of the 5 patients. Phylogenetic analyses of the VP1 genes of these isolates showed that their nucleotides identity were 98.9% -100.0% which were different from those ECHO 19 from GeneBank database by 13.0%-22.4%. CONCLUSION: The etiology of the epidemic of aseptic encephalitis was attributed to ECHO 19. The method of molecular identification not only provided rapid diagnosis of enterovirus infections, but also information about the genetic character of the viruses.

Antibodies, Neutralizing↗
PubMed1999

Polyethylene particle morphology in synovial fluid of failed knee arthroplasty.

Synovial fluid from the knees of 16 patients undergoing revision knee arthroplasty for aseptic failure was subjected to base digestion and ultrafiltration. Filtered particles were scanned using scanning electron microscopy and analyzed with an image program. Polyethylene particles were identified visually and confirmed with the use of electron diffraction spectroscopy. Averaging more than 1500 particles per patient sample, 25,148 particles were analyzed. This corresponded to a concentration of 3000 polyethylene particles per milliliter of synovial fluid. Three populations of wear debris were identified in the fluid. Small globular particles with a mean area of 75 mu 2 represented 94% of all particles observed. The particles averaged 10 mu in diameter and often were seen in clumps. Long fibrous particles with a mean area of 1164 mu 2 made up 4% of the particle population. Large rhomboidal particles with an area of 557 mu 2 were observed least commonly and comprised the remainder of the particles visualized. All three particle types were observed in each fluid sample regardless of the wear pattern of the retrieved polyethylene liner. There were no differences in absolute particle counts, particle morphologic characteristics, or particle size between patients with and without gross polyethylene wear.

Aged↗
PubMed1981

A reliable method for repetitively bleeding rabbits from the central artery of the ear.

A method is presented for repeatedly bleeding rabbits from the central ear artery. The use of hypodermic needle with the hub removed provides a smooth flow of blood and avoids the problem of clot formation in the hub. Blood can be obtained aseptically and free of hemolysis with little risk to the animal. Volumes of 35 ml can be obtained from an initial bleed, increasing to 100 ml from subsequent bleeds. Advantages of the method include reliability, minimal trauma to the animal, and little contamination of the sample.

Animals↗
PubMed1983

A comparison of tunnelled and nontunnelled subclavian vein catheters: a prospective study of complications during parenteral feeding.

Forty-four silastic catheters in 38 surgical patients, nursed in general surgical wards, were inserted under aseptic conditions by the infraclavicular subclavian route. The catheters were randomly allocated to non-tunnelled (NT) (n = 24) or tunnelled (T) (n = 20) groups. Catheters were removed on completion of intravenous feeding or clinical suspicion of catheter infection, and the catheter tip and blood samples taken through the catheter and from the peripheral vein were cultured. There was no significant difference between the two groups in terms of bacteriological infection (defined as two or more cultures of the same organism), clinical infection (defined by elevated temperature returning to normal after catheter removal) and combined infection (when both bacteriological and clinical infection co-existed). When the number of infected catheters was related to the duration of catheter insertion, the incidence of combined catheter related sepsis was reduced with tunnelling (NT: one infected catheter per 35 catheter days, T: one infected catheter per 89 catheter days). This study highlights the risks of subclavian vein catheterisation and emphasises the difficulties in defining catheter sepsis but suggests that its incidence may be reduced if skin tunnelling is employed.

Journal Article↗
PubMed1995

Antibiotics in the preservation of allograft and xenograft skin.

The application of antibiotics in the preservation of allograft and xenograft skin is controversial. The penicillin-streptomycin combination that is commonly used in reports in the literature was ineffective in our practice. Our Tissue Bank has tested different antibiotic combinations and found a more effective and suitable combination. After aseptic retrieval of pig and cadaver split skin, the skin strips were incubated in Eagle's MEM containing different antibiotic combinations. From frozen and fresh allogeneic and xenegeneic skin, 1-cm2 pieces were incubated in bacterial growth media, then tested. The antibiotic effect on skin samples of the highest antibiotic concentrations was assessed by growth inhibition around the skin discs. We followed up the clinical results after skin transplantation. The best results were obtained using the following antibiotic combination: 1000 mg/l ceftazidime, 1000 mg/l ampicillin and 80 mg/l amphotericin. The skin retained its antimicrobial effect after freezing and thawing. In 1992, 5 m2 cadaver and 50 m2 pig split skin were supplied to the Hungarian burn centres to cover deep partial and full skin thickness burned patients. There has not been a graft-originated infection during this period.

Amphotericin B↗
PubMed1992

A prospective study of the polymerase chain reaction for detection of herpes simplex virus in cerebrospinal fluid submitted to the clinical virology laboratory.

Polymerase chain reaction (PCR) was prospectively performed with cerebrospinal fluid (CSF) from 51 patients whose CSF was available for analysis and was submitted for viral culture and/or herpes simplex virus (HSV) serology and 20 patients whose CSF was submitted exclusively to the Clinical Biochemistry Laboratory. Primers were used that flanked a 92 bp segment of the HSV DNA polymerase gene (35 cycles). Amplified products were electrophoresed on agarose gel, blotted onto nylon membrane, and probed with a 32P-labelled sequence internal to the primers. For nested PCR, 1 microliter of PCR product was amplified for an additional 35 cycles before electrophoresis and Southern blot analysis. Review of the clinical records revealed that 15 patients had central nervous system (CNS) infections. Specific HSV DNA sequences were detected in CSF specimens of three of the individuals [PCR(2), nested PCR(1)]. Two of these patients had disseminated HSV infection including encephalitis and one patient had aseptic meningitis. The diagnoses of the 12 patients with CNS infection who did not have HSV DNA detected in CSF included encephalitis [varicella-zoster virus (1), cytomegalovirus (1), Mycoplasma pneumoniae (1)], meningitis [Neisseria meningitidis (1), Coccidioides immitis (1), Enterovirus (1), aseptic meningitis (1)], varicella-zoster radiculitis (2), human immunodeficiency virus dementia (2), and transverse myelitis due to Epstein-Barr virus (1). Importantly, HSV DNA was also not detected in the CSF of the 36 patients who did not have CNS infection and 20 samples submitted exclusively to the Clinical Biochemistry Laboratory. Our findings demonstrate the utility of PCR as a rapid, non-invasive method for the routine laboratory diagnosis of CNS infection due to HSV.

Adult↗
PubMed2005

Development and evaluation of a real-time RT-PCR assay on the LightCycler for the rapid detection of enterovirus in cerebrospinal fluid specimens.

BACKGROUND: Detection of enteroviral nucleic acid in cerebrospinal fluid (CSF) specimens has been demonstrated to improve the management of patients with aseptic meningitis. OBJECTIVE: To develop on the LightCycler (LC) instrument a real-time RT-PCR assay based on TaqMan technology for the detection of enteroviruses (EV) in cerebrospinal fluid (CSF) specimens. STUDY DESIGN: After evaluation of the analytical performances, seventy-four CSF samples collected prospectively from patients who have been suspected for a clinical diagnosis of meningitis were evaluated by two LC real-time RT-PCR assays and one conventional RT-PCR assay. RESULTS: Our assay detected all 30 different EV species tested, whereas no reactivity was observed with other neurotropic viruses. The analytical sensitivity of both LC RT-PCR real-time assays was 1 TCID50 for LC one-step and two-step RT-PCR assays. Results for LC one-step and LC two-step RT-PCR were compared to results of the conventional RT-PCR: of the 74 CSF specimens tested, 11 were positive and 56 were negative by all methods. Four other specimens were positive for EV by at least two of the methods (including the LC two-step RT-PCR and the conventional RT-PCR), two other CSF specimens were positive by the LC two-step RT-PCR assay only, and another one CSF specimen was positive by the LC one-step RT-PCR assay only. No CSF specimens were negative by the LC two-step RT-PCR assay and positive by the conventional RT-PCR assay. The sensitivity, specificity, positive and negative predictive values of both LC RT-PCR assays by using conventional RT-PCR as the "gold standard" were, respectively, 73.3, 98.3, 91.7, 93.5% for the LC one-step RT-PCR and 100, 96.6, 88.2, 100% for the LC two-step RT-PCR. There was substantial agreement between the three assays (k=0.80). CONCLUSIONS: The LC two-step RT-PCR assay is a rapid, sensitive and reliable method which can be routinely performed with CSF samples for diagnosis of EV infection and is an important improvement for optimal patient management.

Cerebrospinal Fluid↗
PubMed1999

Parenteral infusions bacterial contamination in a multi-institutional survey in Mexico: considerations for nosocomial mortality.

BACKGROUND: Parenteral infusions can be contaminated during administration (extrinsic contamination). A previous survey found that extrinsic contamination was not uncommon in a hospital in Mexico with lapses in aseptic techniques. To determine whether this problem exists in other similar institutions, we undertook a multi-institutional study. METHODS: We surveyed 6 hospitals (A to F) lacking an infection control committee to determine the level of extrinsic contamination. We visited each hospital and obtained samples of all the parenteral infusions in use, drawing 0.5-1 mL from the tubing injection port. Quantitative and qualitative bacterial cultures were performed. Chlorine levels of the tap water were measured. Visits were repeated until the survey was completed. RESULTS: A total of 751 infusions were cultured, of which 16 (2.13%) were contaminated. Hospital contamination rates varied from zero to 5.56%. Klebsiella pneumoniae was the most common isolate (10 cases). During the first sampling day in hospital C, the 7 infusions from the pediatric ward were found to be contaminated with a similar K pneumoniae strain. In-service education was started in this hospital. Infusion contamination was eliminated followed by a reduction in mortality rate. Overall, a higher risk for infusion contamination was noted for pediatric patients (P =.01, odds ratio = 3.28, 95% CI, 1.10-9.91) and in wards with inadequate water chlorine levels (P =. 02, odds ratio = 3.64, 95% CI, 1.08-13.51). CONCLUSIONS: If the hospitals surveyed are representative of others in developing countries, an endemic level of parenteral infusion contamination could exist in many hospitals throughout the world.

Adult↗
PubMed1998

No evidence for persistent enterovirus infection in patients with end-stage idiopathic dilated cardiomyopathy.

Persistence of enteroviruses in heart tissue has been implicated in the etiology of idiopathic dilated cardiomyopathy (IDC). Therefore, we determined the prevalence of enterovirus RNA in heart tissue from patients with end-stage IDC. During heart transplantation, 287 transmural biopsy specimens were aseptically collected from the explanted hearts of 38 patients with IDC and of 39 patients with cardiac failure of known cause. A nested polymerase chain reaction with general specificity for enteroviruses was used to screen for the presence of enterovirus RNA in the heart tissue samples. No enterovirus RNA was detected in any of the 287 heart biopsy specimens. These findings lead to a conclusion that enteroviruses do not persist in heart tissue from patients with end-stage IDC, nor with other heart diseases of known cause.

Adolescent↗
PubMed1997

The fate of intraperitoneally retained gallstones with different morphologic and microbiologic characteristics: an experimental study.

Management of intraperitoneally retained gallstones after laparoscopic cholecystectomy (LC) is controversial, as their natural course is not known. This study was undertaken to assess the probable effects of stone morphology and clinically obvious infection on the outcome of retained gallstones in a mouse model. Forty albino mice were divided into four groups. Group I served as the control group (simple laparotomy, n = 10). Groups II, III, and IV (n = 10 in each group) were study groups. "Intact-sterile-cholesterol" (group II), "crushed-sterile-cholesterol" (group III), and "intact" (n = 5) [group IVa] and "crushed" (n = 5) [group IVb] "infected-cholesterol" gallstones aseptically retrieved from three different human patients were implanted to the peritoneal cavity of the animals. Group IV animals were implanted with stones retrieved from an acutely inflamed gallbladder with proven infection. Animals were sacrificed 6 and 12 weeks after the operations. Cultures and tissue samples were obtained. No animal was lost, no microscopic or macroscopic abnormality was observed in groups I and II, and cultures remained negative. In group III, adhesions surrounding the fragmented stones were evident at the 12th week, and no mortality was encountered. The histopathology revealed a fibroblastic reaction, and cultures remained negative in group III. In group IV, three animals from group IVb and one animal from group IVa died because of intra-abdominal sepsis before their sacrifice. All remaining mice showed severe adhesions with localized abscesses at the 12th week. In conclusion, intraperitoneally retained cholesterol gallstones remain inert and do not cause serious peritoneal reaction unless they are crushed into fragments or are from an acutely inflamed gallbladder. It is for this group of patients that laparotomy for total stone clearance is probably not justifiable. Better stone retrieval techniques or even laparotomy may be worthwhile considering in patients with crushed and particularly infected retained stones.

Animals↗
PubMed2002

Molecular epidemiology of echovirus 30: temporal circulation and prevalence of single lineages.

Echovirus 30 (EV30) is one of the most frequently isolated EVs, causing extensive outbreaks of EV30 aseptic meningitis in temperate climates. EV30 is antigenically heterogeneous, and three major antigenic groups have been defined, although the basis for the antigenic differences is unknown. A reverse transcription-nested PCR which amplifies the 3'-terminal region of the VP1 gene directly from clinical samples was selected for studying EV30 molecular epidemiology, since the major antigenic sites in this region reflect the serotypic pattern of this virus. The different previous approaches to the genetic classification of EV30 were analyzed. A complete study of the EV30 strains was performed by analyzing the sequences from the 112 EV30 strains amplified in this work and the complete set of EV30 strains previously published. A total of 318 strains of EV30 were divided into two broad genotypes (I and II). This classification was supported by the phylogenetic trees obtained from amino acid sequences, and it correlated with the antigenic heterogeneity of the reference strains described in earlier studies. The genotypes could be further divided into subgroups, and these subgroups could be divided into lineages based on their nucleotide distances and levels of bootstrapping. On the other hand, the subgroups and lineages did not result in the same correlation between amino acid and nucleotide differentiation. The molecular epidemiology of EV30 can be compared to influenza virus epidemiology, where prevailing lineages displace the less established lineages on the basis of immune escape. This pattern of evolution is clearly different from that of other enteroviruses. A single lineage at a time appears to be circulating worldwide. This behavior may be related to the epidemic activity of EV30.

Argentina↗
PubMed1986

Hormonal responses associated with early hyperglycemia after graded hemorrhage in dogs.

Trained, awake, splenectomized dogs (n = 17) were studied to examine potential mechanisms for early hyperglycemia after hemorrhage (H). Animals were surgically prepared under halothane-nitrous oxide 3 days before the experiment. Chronic catheters were placed aseptically in the portal vein (PV), femoral vein, and femoral artery. Electromagnetic flow probes were placed around the PV and hepatic artery. After an overnight fast, dogs were hemorrhaged 10, 20, or 30% of their estimated blood volume in 3 min. Flow measurements and blood samples for glucose (G), immunoreactive insulin (IRI), immunoreactive glucagon (IRG), catecholamines (C), and cortisol (F) were taken prior to H and from 5 min to 8 h post-H. Plasma IRI, IRG, and F were measured by radioimmunoassay, plasma C by high-pressure liquid chromatography, and G by a glucose oxidase method. Peripheral G did not change after 10% H but increased significantly after 20 and 30% H from 10 min to 2 h. Similarly, peripheral C did not change after 10% H but increased significantly from 10 min to 2 h after 20 and 30% H. In contrast, the portal venous delivery of IRG did not increase significantly until at least 1 h after any magnitude of H. Peripheral IRI did not change after any magnitude of H. However, portal venous delivery of IRI decreased significantly from 20 min to 6 h after 10% H. Plasma F increased significantly in peripheral blood after all magnitudes of H. These results indicate that an increase in the release of IRG occurs too late to account for the early hyperglycemia that occurs during the 1st h following H.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Involvement of dogs in plague epidemiology in Tanzania. Serological observations in domestic animals in Lushoto District.

Venous blood was collected aseptically from clinically healthy domestic dogs, goats, sheep, cats and fowl in various plague-infected villages of Lushoto District, Tanzania, at the time when the disease was actively prevalent in the area. Flea ectoparasites were collected from the animals, processed, identified and counted. Serum samples were tested for specific plague antibodies, using the passive haemagglutination technique and checked by passive haemagglutination inhibition tests. Altogether 389 animals, of which 201 were domestic dogs, were involved. 11 (5.5%) dogs had significantly elevated specific plague antibodies at titres ranging from 20 to 1280. All the dogs were also heavily infested with fleas at a mean index of 7.7 fleas per animal. Of 1,871 fleas collected from the dogs, 93.8% were Ctenocephalides felis and 6.2% were C. canis. All the other animals examined were negative for plague. It was concluded that domestic dogs could play an important role as plague carriers in the area and that the animals could serve as sentinel animals for the detection of plague in villages where human plague outbreaks have not previously occurred.

Animals↗
PubMedDate not supplied

Distribution of fibronectins and their integrin receptors in interface tissue from aseptic loosening of hip prostheses.

OBJECTIVES: To assess the distribution of fibronectins (FNs) and their integrin (Int) receptors in synovial membrane-like interface tissue (SMLIT) from aseptic loosening of total hip replacement (THR), and potential role of FN-Int interaction in the loosening process. METHODS: The alkaline phosphatase anti-alkaline phosphatase (APAAP) method was used to detect the distribution of FNs and their Int receptors in SMLIT and control samples. Double immunofluorescence labeling was used to reveal the different co-localizations. RESULTS: Intensive FN staining appeared in the lining layers, sublining area, and vascular endothelium, while immunoreactivities for Int alpha 4, alpha 5, beta 1 subunits were detected in the lining and endothelial cells of SMLIT. Immunofluorescence labeling revealed Int alpha 5 and collagenase-1/collagenase-3 double positive cells in lining layers and sublining area of SMLIT. CONCLUSION: Increased expression of FNs, Int alpha 4 beta 1 and alpha 5 beta 1 appeared in SMLIT compared with that in OA synovial membrane. FN-Int interactions may play a role in local collagenase production.

Arthroplasty, Replacement, Hip↗
PubMed2002

Patient-to-patient transmission of nosocomial malaria in Italy.

OBJECTIVE: To describe nosocomial transmission of malaria from patient to patient via blood exposure. PATIENTS: A 56-year-old man was admitted to an Italian hospital with fever and Plasmodium falciparum parasitemia, but with no risk factors for malaria. Twenty days earlier, he had been admitted for bronchopulmonary disease to the hospital's intensive care unit, where a woman with P. falciparum malaria acquired abroad was present. METHODS: We reviewed both patients' medical records and searched for mosquitoes in the hospital and on the grounds. We interviewed the staff about patient care practices potentially involving contact with blood. The genetic identities of strains were determined by genotyping of the DNA extracted from blood. RESULTS: Molecular genotyping showed that the two strains were identical. The only invasive procedures performed on both patients by the same staff on the same shift were capillary blood sampling by finger stick, intravenous drug administration, and substitution of total parenteral nutrition bags and intravenous sets. The fingerstick device used was designed to prevent person-to-person transmission of blood-borne infections, and the staff interviews did not reveal any incorrect use of aseptic techniques. The likely source of infection was identified during a training course 6 months later: a nurse reported that, when collecting blood, she placed patients' fingers directly on the blood glucose meter, a practice she had learned from a poster advertising the device. CONCLUSIONS: A nosocomial case of malaria was ascertained, which was likely due to patient-to-patient transmission via a contaminated blood glucose meter. Incomplete instructions for the meter seem to have played a role in this case.

Cross Infection↗
PubMed2006

[Antibiotic treatment for prevention of infectious complications in joint replacement].

Prophylactic antibiotic treatment is mandatory in every operation involving an orthopedic implant. Carefully selected and correctly administered antibiotics can provide effective protection of the implant from bacterial colonization. The prevention of deep wound infection in joint replacement includes several procedures and measures which constitute three basic groups: 1) Promotion of patient's ability to resist infection (careful pre-operative preparation, elimination of potential infectious loci, good nutritional status, etc). 2) Optimal conditions for the operative wound (surgical technique, prophylactic antibiotics). 3) Reduction of the number of bacteria brought in the wound (control measures, super-sterile operating theatres). Clear rules for the system of prophylactic antibiotic treatment should be adopted. A program in which responsibility for antibiotic administration was shifted from the nursing staff to the anesthesiologist in the operating theatre showed improved outcomes and reduced costs. Poor timing of prophylactic antibiotic administration is one of the basic mistakes. If the wound happened to be contaminated during surgery, the first three post-operative hours would be most decisive for the development of infection. An effective bactericidal concentration of antibiotic should be present in tissues and serum immediately after surgery has begun. Therefore the appropriate time for antibiotic application is before a skin incision is made, and not after the operation has started; the highest serum and bone tissue levels appear 20 to 30 min. after intravenous antibiotic injection. To allow antibiotics to reach target tissues, they should be introduced at least 10 min. before tourniquet application. For long surgical procedures or when blood loss is high, an additional dose of antibiotics is recommended during the operation. If a sample for bacterial cultivation is required, antibiotic administration is postponed until during surgery. However, this is used only in indicated cases when deep infection is suspected and no assessment of the causative agent is available. Otherwise this approach carries a high risk of infectious complications in aseptic revision arthroplasty. Long-term, unjustified administration of antibiotics leads to an increase in resistance to the antibiotic involved. Some studies show that a day's course is as effective as a seven-day one. A shorter antibiotic course decreases the costs, reduces side-effects and minimizes the development of resistance. An optimal duration of antibiotic treatment has not been defined yet, and is still a hot issue for discussion. Many authors recommend one pre-operative antibiotic dose and, according to the kind of antibiotic, agree to its 24-hour administration in order to lower the toxic effect of antibiotic and to prevent selection of resistant microorganisms. The choice of suitable antibiotics for prophylactic treatment should be based on the range of agents causing joint replacement infections and the pharmacological properties of the drug. This should have minimal toxicity, should be well tolerated by the patient and, from the epidemiological point of view, should have a low risk of inducing resistance because of frequent use. Naturally, it is not possible to include all antibiotics against all causative agents and therefore attention should be paid, in the first place, to Gram-positive bacteria, i. e., staphylococci and streptococci, which are the most common causes of infectious complications associated with joint replacement. Because of difficulties related to the right choice of antibiotic, it is recommended to keep a record of complications in each patient in order to provide feedback and to facilitate the establishment of reliable antibiotic-based prevention. The prevention of infection in orthopedics is a comprehensive issue. It cannot be expected that prophylactic antibiotic treatment will compensate for mistakes made in operative protocols, for inadequate operative techniques, for shortcomings in operating theatre equipment or insufficient preparation of patients.

Antibiotic Prophylaxis↗