A prospective, randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation: clinical efficacy, absorption of trimethoprim-sulfamethoxazole, effects on the microflora, and the cost-benefit of prophylaxis
Article Abstract:
Due to advances in many areas, kidney transplants have become an effective treatment for end-stage kidney disease. However, infection continues to be a major cause of illness and death in kidney transplant recipients. This is related to the use of urethral catheters and intravenous lines following surgery, along with drugs which suppress the immune system and prevent graft rejection. Preventative (prophylactic) therapy with trimethoprim-sulfamethoxazole (TMP-SMZ) has been adopted by many transplant programs reduce bacterial infections. However, TMP-SMZ therapy in transplantation protocols has seldom been studied. The effectiveness, absorption, and other characteristics of TMP-SMZ therapy was studied in 132 adults who received kidney transplants. Although there was no difference in infection rate while catheters were in place, patients treated with TMP-SMZ had a two-fold lower rate of urinary tract infections while in the hospital following catheter removal, and a three-fold reduction following hospital discharge. Bloodstream infections were significantly reduced; there was also a trend toward fewer infections of the surgical incision, but this was not statistically significant. The type of bacteria involved in infections was different in TMP-SMZ-treated patients; there were fewer intestinal gram-negative bacteria and Staphylococcus, among others. TMP-SMZ treatment did not encourage the growth of TMP-SMZ-resistant bacteria, but more of the patients treated with this antibiotic developed infections with TMP-SMZ-resistant bacteria. Antibiotic treatment generally tends to increase the frequency of infections with fungi like Candida, but patients treated with TMP-SMZ had fewer Candida infections. The treated patients required half the hospitalization time due to fever and needed antibiotic treatment approximately half as often as patients who did not receive preventive therapy. When the daily doses of TMP and SMZ were 160 milligrams (mg) and 800 mg, respectively, inadequate blood levels were obtained during the post-surgical period and the treatment was significantly less effective against infection, while doses of 320 and 1600 mg daily were effective on both counts. The study indicates that TMP-SMZ prophylaxis effectively prevents infection with few side effects in kidney transplant recipients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
User Contributions:
Comment about this article or add new information about this topic:
Nosocomial infections from contaminated endoscopes: a flawed automated endoscope washer; an investigation using molecular epidemiology
Article Abstract:
Many epidemics of nosocomial infections (acquired in the hospital) have resulted from the improper disinfection of contaminated medical equipment and instruments. Mechanical ventilators (breathing machines), bronchoscopes (used for examining the lungs), dialysis machines, and endoscopes (used for examining the stomach and intestines) have been reported to cause lung infections, blood infections and gastrointestinal infections, respectively. Many epidemics have been linked to contaminated endoscopes. Endoscopy is an essential diagnostic procedure that is performed on over 500,000 patients each year. Special washing machines are used in hospitals to clean and disinfect endoscopes. However, several different hospitals have reported that the commonly used washers (Olympus EW-10 and EW-20 models) are not effective in disinfecting endoscopes. This article describes the experience of a hospital that noticed a 36 percent increase in the rate of nosocomial infections in patients undergoing endoscopy within the first 19 months of using the Olympus EW-10 washer. The bacterial organism responsible for causing the infections was identified as Pseudomonas aeruginosa. The same bacteria were found in the endoscopes and in the washer after the washer had been disinfected with glutaraldehyde according to the manufacturer's instructions. It was found that the endoscopes could be disinfected, after washing in the machine, using 70 percent alcohol. Disinfecting the endoscopes with alcohol decreased the number of patient infections threefold. It is concluded that proper disinfection of medical equipment is essential for preventing nosocomial infections, and this emphasizes the importance of proper engineering design to prevent contamination. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
User Contributions:
Comment about this article or add new information about this topic:
The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping
Article Abstract:
A Swan-Ganz catheter is a device that is used to monitor the condition of critically ill patients. It is a thin tube that is inserted into a major vein in the chest and is passed through the heart into the pulmonary artery, which carries blood to the lungs. Studies have reported that bacteremia (bacteria in the blood) occurs in up to 5 percent of the patients with Swan-Ganz catheters, and that 28 percent of these patients who develop bacteremia die. In order to determine the rate of infection, how infections occur and factors that increase the risk of infection, 297 patients with Swan-Ganz catheters were studied. Catheter-related infections were found in 22 percent of the cases, but only two patients developed bacteremia. Staphylococci caused most of the infections. In 80 percent of the infections, the same type of bacteria that was found in the catheter was present on the surface of the skin at the insertion site of the catheter. Factors that increased the risk of infection included excessive amounts of bacteria on the surface of the skin, leaving the catheter in place for more than four days, inserting the catheter into the jugular vein, and inserting the catheter while in the operating room instead of in the intensive care unit (ICU). The results of this study indicate that bacteria on the surface of the patient's skin are responsible for most of the infections. To reduce the risk of catheter-related infections, the skin at the catheter insertion site should be cleaned with antiseptic, sterile gloves and gowns should be worn by the medical staff, the catheter should be inserted into the subclavian vein, and it should be removed within four days. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
User Contributions:
Comment about this article or add new information about this topic:
- Abstracts: The Potential of Hospital Website Marketing. Understanding the Effects of Nurses, Patients' Hospital rooms, and Patients' Perception of Control on the Perceived Quality of a Hospital
- Abstracts: Creating a research base for nursing education: an interpretive review of conventional, critical, feminist, postmodern, and phenomenologic pedagogies
- Abstracts: Drug discovery and diagnostic targets in synergy. Amgen, Biogen, Chiron: early biotechs now in the top 50 Rx
- Abstracts: Hand-arm vibration syndrome: clinical evaluation and prevention. Effect of dust exposure in Ontario cotton textile mills
- Abstracts: Ergonomic deficiencies: I. pain at work. Ergonomic deficiencies: III. Root causes and their correction. Predictors of stress-related illness in city bus drivers