Activity of third generation cephalosporins against Pseudomonas aeruginosa in high risk hospital units.

Ceftazidime and Cefoperazone are the two third generation cephalosporins with anti-pseudomonal activity. They have been frequently used in the I.C.U.s. in the developed countries but their use in the Indian hospitals has begun relatively recently. We studied the in-vitro susceptibility of 139 Pseudomonas aeruginosa isolates that were multiple drug resistant from the Resuscitation Unit/I.C.U. (61 strains), Burns Unit (48 strains), Surgical Post-operative unit (24 strains), Nephrology unit (6 strains) of our hospital to these two cephalosporine over a period of about 18 months. Antibiotic susceptibility was studied using Kirby Bauer's disc dibusion method. Out of a total of 139 strains of multiple drug resistant Pseudomonas aeruginosa tested, 17.9% were found resistant each to Ceftazidime and Cefoperazone separately and 10% were found resistant to both antibiotics.

A prospective clinico-bacteriological study of internal jugular cannulation in a critical care unit.

The results of 125 consecutive central venous catheterizations during a six-month period in the critical care unit were prospectively studied. All the catheters were inserted percutaneously by internal jugular approach and the placement of catheters was confirmed by chest roentgenography while injecting Conray 420. The safety of the technique was evaluated in terms of success and complication rates. Failure rate was only 0.8 per cent, while overall complication rate was 17.6 per cent. Arterial puncture and hematoma were the commonest complications encountered in 8 and 4 per cent of the patients respectively. Pneumothorax occurred in two patients (1.6%), while misplacement of catheter tip and thrombophlebitis was encountered in 0.8 per cent of all cannulations. No microorganisms were isolated from catheters inserted for less than 5 days. Positive catheter-tip cultures, by quantitative method, were obtained in 41 cases (P < 0.001) of which infected intravenous insert growing > 10(3) colony forming units, was encountered in 36 (P < 0.001) and colonization of the catheter (< 10(3) colony forming units) was seen in 5 cases. Catheter related bacteremia (recovery of the same organism from the catheter tip and peripheral blood cultures) occurred in 31 of these 41 patients (P < 0.01). The study reveals that internal jugular approach is a safe technique for central vein catheterization with very high success rate and fewer complications. However, catheter-related bacteremia is a potential threat which is directly related to the number of days the catheter is in central circulation and is totally preventable.