Orofacial space infections, etiology, microbiological susceptibility and surgical management / Infecciones del espacio orofacial, etiología, susceptibilidad microbiológica y manejo quirúrgico

Orofacial infections are considered as one of most common infections and need rapid and adequate treatment as they affect a very delicate region and are associated with serious life-threatening complications. Orofacial infections can be either odontogenic that is with an origin in teeth and associated structures or non-odontogenic, not associated with teeth, can affect facial spaces and spread from one space to another, so a good knowledge about diagnosis and treating these infections is of utmost importance, and can include both non-surgical and surgical treatment. The aim of our study was to determine the most common cause of orofacial infections, the most common bacterial microorganisms and their antibiotic susceptibility. Materials and Methods: A descriptive study was undertaken in the Department of Oral and Maxillofacial Surgery, Al-Shaheed Ghazi Al-Hariry Hospital, Baghdad, Iraq from 1st January to 30th September 2015. This study included 45 patients with different forms of orofacial infections; data regarding age, gender, underlying cause, facial space involvement, presenting signs were collected through history, clinical examination and radiographs, incision and drainage with swab sample for culture and sensitivity test was performed. Results: Patients with orofacial infections showed a female to male ratio of 1.25:1. The mean age was 32.8 years. Most of the patients were in their 4th decade of life (27%). Most infections were odontogenic in origin (62%), the most common facial space involved was submandibular (65%), the most common isolated microorganism was Streptococcus pyogenes (59%), and most patients were treated using an extra-oral surgical approach (78%). Antibiotics to which bacterial isolated showed the most sensitivity were netilmicin, cefoperazone and rifampicin (91%). Pain and limitation of mouth opening gradually decreased in most of patients during the two weeks follow up period. Conclusion: Orofacial infections were more common in females, in the third and fourth decade of life, were odontogenic in origin, were mostly caused by Streptococcus pyogenes, and most isolates were susceptible to netilmicin, cefoperazone and rifampicin. Pain and trismus decreased over two weeks post-treatment.

Las infecciones orofaciales se consideran una de las infecciones más comunes y necesitan un tratamiento rápido y adecuado, ya que afectan una región muy delicada y se asocian con complicaciones graves que amenazan la vida. Las infecciones orofaciales pueden ser odontogénicas que se originan en los dientes y las estructuras asociadas, o no odontogénicas, no asociadas con los dientes, pueden afectar los espacios faciales y propagarse de un espacio a otro, por lo que un buen conocimiento sobre el diagnóstico y el tratamiento de estas infecciones es de suma importancia, y puede incluir tratamiento no quirúrgico y quirúrgico. El objetivo de nuestro estudio fue determinar la causa más común de infecciones orofaciales, los microorganismos bacterianos más comunes y su susceptibilidad a los antibióticos. Material y Métodos: se realizó un estudio descriptivo en el Departamento de Cirugía Oral y Maxilofacial, Hospital Al-Shaheed Ghazi Al-Hariry, Bagdad, Iraq del 1 de enero al 30 de septiembre de 2015. Este estudio incluyó a 45 pacientes con diferentes formas de infecciones orofaciales; Se recopilaron datos sobre edad, sexo, causa subyacente, afectación del espacio facial, signos de presentación a través de la historia, examen clínico y radiografías, incisión y drenaje con muestra de hisopo para cultivo y prueba de sensibilidad. Resultado: Los pacientes con infecciones orofaciales mostraron una relación mujer/hombre de 1.25: 1. La edad media fue de 32,8 años. La mayoría de los pacientes estaban en su cuarta década de vida (27%). La mayoría de las infecciones fueron de origen odontogénico (62%), el espacio facial más común involucrado fue submandibular (65%), el microorganismo aislado más común fue Streptococcus pyogenes (59%), y la mayoría de los pacientes fueron tratados con un abordaje quirúrgico extraoral (78%). Los antibióticos a los que las bacterias aisladas mostraron mayor sensibilidad fueron netilmicina, cefoperazona y rifampicina (91%). El dolor y la limitación de la apertura de la boca disminuyeron gradualmente en la mayoría de los pacientes durante el período de seguimiento de dos semanas. Conclusión:Las infecciones orofaciales fueron más comunes en las mujeres, en la tercera y cuarta década de la vida, fueron de origen odontogénico, fueron causadas principalmente por Streptococcus pyogenes y la mayoría de los aislamientos fueron susceptibles a la netilmicina, cefoperazona y rifampicina. El dolor y el trismo disminuyeron durante las dos semanas posteriores al tratamiento.

Post Marketing Assessment of the Efficacy and Safety of Netromax (Netilmicin) in the Indian Pediatric Population.

Objective: A post-marketing study of Netilmicin (Netromax™) in Indian pediatric patients to assess the safety and efficacy of the drug in various susceptible infections. Method: The study was carried out by 129 pediatricians from across India in 10 states (Maharashtra, Delhi, Uttar Pradesh, Andhra Pradesh, Odisha, Chhattisgarh, Karnataka, Madhya Pradesh, West Bengal, and Bihar) from November 2011 to February 2012. A total number of 542 case report forms were collected and considered eligible for further analysis based upon the completeness of data. The disease profile of patients included bacteremia, septicemia (including neonatal sepsis), severe respiratory tract infections (RTI), intra-abdominal infections (including peritonitis), kidney and genitourinary tract infections, skin and soft tissue infections, burns, bone and joint infections, wounds and perioperative infections. Result: Demographic analysis showed the median age of patients to be 13 months and median duration of therapy was 5 days. Intravenous route (IV) (n= 340) was preferred over intramuscular route (IM) (n=202) by the physicians. Netilmicin was administered in the therapeutic dose range depending upon the age and severity of the condition. The results revealed a favorable clinical efficacy and safety profile of Netilmicin. Clinical Improvement was observed in 98% (n=532) of patients among whom, clinical resolution (Defined as the absence of the infection) was achieved in 63% (n=343) patients. Whereas, partial improvement (defined as partial disappearance of original symptoms and no further requirement of antibiotics) was observed in 35% (n=189) of patients. Adverse events were reported in 11% of the entire study population and were mild in nature. There was no serious adverse event reported during the study period. Conclusion: The present post-marketing study confirmed that at the given doses and duration of therapy, NetromaxTM exhibited remarkable antibacterial efficacy with no serious incidences of toxicity. Thereby giving evidence that NetromaxTM treatment is safe and effective among the Indian pediatric population.

Distribution of Genes Encoding Aminoglycoside Modifying Enzymes and Type Staphylococcal Chromosomal Cassette mec in Methicillin-resistant Staphylococcus aureus from Non-tertiary Hospitals / 감염과화학요법

BACKGROUND: Many genes encoding aminoglycoside modifying enzymes (AMEs) on transposon or plasmid were transferred from one strain to another strain and inserted into a staphylococcal chromosomal cassette mec (SCCmec). There are very diverse subtypes in SCCmec type to the insertion of resistant genes. Therefore, we researched the resistance rates of antibiotics and distribution of AME genes according to SCCmec type in MRSA strains. MATERIALS AND METHODS: We isolated 640 Staphylococcus aureus from non-tertiary hospitals in 2004, detected mecA, aac(6')-aph(2"), aph(3')-IIIa, and ant(4')-Ia using the multiplex PCR method, tested antibacterial susceptibility disk diffusion and minimal inhibitory concentration, and determined SCCmec type. RESULTS: Of 640 S. aureus isolates, MRSA rate was 39.7% and all MRSA isolates carried mecA gene. Among 214 MRSA selected, aminoglycoside-resistant rates were 98.1% in kanamycin and tobramycin, 68.7% in gentamicin, 30.8% in amikacin, and 2.8% in netilmicin. The detection rates for aac(6')-aph(2"), aph(3')-IIIa, and ant(4')-Ia were 77.1%, 13.1%, and 53.3%, respectively. Also, SCCmec type was 50.9% in SCCmec type II, 16.4% in type III, and 32.7% in type IV. The genes encoding AMEs were distributed aac(6')-aph(2") (49.5%) and aac(6')-aph(2")/ant(4')-Ia (36.7%) in SCCmec type II, aph(3')-IIIa/aac(6')-aph(2") (60%) and aac(6')-aph(2") (31.4%) in type III, and aac(6')-aph(2")/ant(4')-Ia (41.4%) and ant(4')-Ia (50%) in type IV. CONCLUSION: 39.7% of S. aureus isolated from non-tertiary hospitals was resistant to methicillin. More than 90% of MRSA isolates were detected aac(6')-aph(2") in SCCmec type II and III, and ant(4')-Ia in type IV. With these results, the genes encoding AMEs may be closed related to SCCmec type.

Distribution of Genes Encoding Aminoglycoside Modifying Enzymes and Type Staphylococcal Chromosomal Cassette mec in Methicillin-resistant Staphylococcus aureus from Non-tertiary Hospitals / 감염과화학요법

BACKGROUND: Many genes encoding aminoglycoside modifying enzymes (AMEs) on transposon or plasmid were transferred from one strain to another strain and inserted into a staphylococcal chromosomal cassette mec (SCCmec). There are very diverse subtypes in SCCmec type to the insertion of resistant genes. Therefore, we researched the resistance rates of antibiotics and distribution of AME genes according to SCCmec type in MRSA strains. MATERIALS AND METHODS: We isolated 640 Staphylococcus aureus from non-tertiary hospitals in 2004, detected mecA, aac(6')-aph(2"), aph(3')-IIIa, and ant(4')-Ia using the multiplex PCR method, tested antibacterial susceptibility disk diffusion and minimal inhibitory concentration, and determined SCCmec type. RESULTS: Of 640 S. aureus isolates, MRSA rate was 39.7% and all MRSA isolates carried mecA gene. Among 214 MRSA selected, aminoglycoside-resistant rates were 98.1% in kanamycin and tobramycin, 68.7% in gentamicin, 30.8% in amikacin, and 2.8% in netilmicin. The detection rates for aac(6')-aph(2"), aph(3')-IIIa, and ant(4')-Ia were 77.1%, 13.1%, and 53.3%, respectively. Also, SCCmec type was 50.9% in SCCmec type II, 16.4% in type III, and 32.7% in type IV. The genes encoding AMEs were distributed aac(6')-aph(2") (49.5%) and aac(6')-aph(2")/ant(4')-Ia (36.7%) in SCCmec type II, aph(3')-IIIa/aac(6')-aph(2") (60%) and aac(6')-aph(2") (31.4%) in type III, and aac(6')-aph(2")/ant(4')-Ia (41.4%) and ant(4')-Ia (50%) in type IV. CONCLUSION: 39.7% of S. aureus isolated from non-tertiary hospitals was resistant to methicillin. More than 90% of MRSA isolates were detected aac(6')-aph(2") in SCCmec type II and III, and ant(4')-Ia in type IV. With these results, the genes encoding AMEs may be closed related to SCCmec type.

Aeromonas spp em diferentes pontos do fluxograma de beneficiamento do leite tipo A e susceptibilidade a antimicrobianos / Aeromonas spp in the line production of pasteurized type A milk and their antimicrobial susceptibility

Com o objetivo de verificar os possíveis pontos de contaminação e disseminação de bactérias do gênero Aeromonas em diferentes pontos do fluxograma de beneficiamento do leite tipo A, foram analisadas 120 amostras. Foi verificada a presença de Aeromonas spp. em 38 amostras, sendo identificadas as espécies A. sobria (40 por cento), A hydrophila (22 por cento), A. cavie (26 por cento), A. veronii (19 por cento) e A.schubertii (3 por cento). Das 37 amostras de espécies bacterianas avaliadas quanto à susceptibilidade aos antimicrobianos, foi observada múltipla resistência a drogas em 94 por cento das cepas testadas. As maiores sensibilidades foram observadas frente ao cloranfenicol, netilmicina, amicacina e gentamicina (80 por cento). A presença no leite das espécies deste gênero, comumente associadas com gastrenterites e as altas resistências observadas frente a múltiplos princípios ativos, devem ser levadas em consideração, pois podem representar um sério risco para a saúde dos consumidores, na eventual necessidade da instituição de um regime terapêutico em casos de infecção por Aeromonas spp.

Brucella isolated from bone marrow.

A 40 year patient presented with pyrexia of one month duration. Routine work up for fever of unknown origin (FUO) was negative. Bone marrow aspiration and culture done yielded Brucella. Bone marrow cultures are recommended for patients for FUO for whom the routine workup turns out to be negative. Serological tests for brucellosis can be false-negative in some cases of brucellosis due to prozone phenomena.

Antimicrobial-induced endotoxaemia in patients with sepsis in the field of acute pyelonephritis.

BACKGROUND: In vitro results have shown that antimicrobial agents may induce the Gram-negative bacteria to release endotoxins (LPS), which in turn, could trigger the secretion of cytokines from monocytes. AIMS: To compare the effect of cefuroxime, netilmicin or ciprofloxacin on serum levels of LPS and tumour necrosis factor-alpha (TNFalpha). METHODS: Seventy-four patients with acute pyelonephritis caused by Gram-negative bacteria and signs of sepsis were randomly assigned to receive one of three intravenous regimens of cefuroxime, netilmicin or ciprofloxacin. Blood samples were collected before therapy and at specified time intervals for 96 hours after the initiation of treatment for the determination of serum levels of LPS and of TNFalpha. RESULTS: Patients treated with cefuroxime presented an early peak of LPS and of TNFalpha in serum two hours after the initiation of treatment compared to the other study groups. After that time interval, concentrations of LPS and TNFalpha were similar in all the study groups. Fever accompanied by endotoxaemia was still detected for 48 hours after the start of therapy in 36, 37.5 and 36% of patients treated with cefuroxime, netilmicin and ciprofloxacin respectively. The corresponding figures for these agents at 72 hours were 28, 12.5 and 24%, respective and 12, 4.2 and 4% at 96 hours (P value not significant). CONCLUSIONS: With the exception of an early peak in the serum levels of LPS and TNFalpha in patients treated with cefuroxime, no significant difference could be detected amongst the study groups as far as their effect on serum levels of LPS and TNFalpha were concerned. This suggests that these three antimicrobial agents may be administered safely at the early stages of sepsis.

Comparative Vestibulotoxicity of Different Aminoglycosides in the Guinea Pigs

The histopathological alterations in the vestibule due to aminoglycosides are well defined. Although there are reports comparing the vestibulotoxic effects of the many aminoglycosides, this is the first study to compare the effects of the most commonly used aminoglycosides i.e., streptomycin, gentamicin, amikacin and netilmicin administered both transtympanically and systemically. The transtympanic and systemic administration of each aminoglycoside caused similar histopathological alterations in the vestibule. The most severe degeneration in the cristae ampullaris, utriculus and sacculus was observed after streptomycine administration. The severity of the vestibular damage in terms of magnitude was in the order of streptomycine, gentamicin, amikacin, and netilmicin.

Invitro comparative evaluation of aminoglycosides at a cancer centre.

A comparative study of in vitro activity of amikacin, gentamicin, netilmicin, tobramycin and isepamicin was done. A total of 200 clinical isolates of Gram negative organisms from various clinical sources were tested. E.Coli was the most frequently isolated organism followed by Pseudomonas spp., Klebsiella spp., Proteus spp., Acinetobacter spp. and Enterobacter spp. Of the 5 aminoglycosides tested, isepamicin showed the highest numbers of susceptible isolates followed by amikacin, netilmicin, gentamicin and tobramycin. MIC 90 value of isepamicin was lower as compared to amikacin.

Frequency of Resistance to Aminog lycoside Antibiotics in Staphy lococcus aureus Isolated from Tertiary Hospitals / 감염

BACKGROUND: Staphylococcus aureus is one of the most important pathogens, causing severe morbidity and fatal infections. To date rapid evolution of antibiotic resistance in S. aureus, including recent emergence of vancomycin-resistant S. aureus (VRSA), has been a serious concern and an obstacle to the effective treatment. The purpose of this study is to update the resistance patterns against aminoglycoside antibiotics which play an important role in the therapy of serious staphylococcal infections. METHODS: Clinical isolates were collected from 8 university-affiliated hospitals during the period of June 1999 to January 2001. Susceptibility tests against 9 antibiotics were performed by disk diffusion method. Minimum inhibitory concentrations (MICs) of arbekacin against non-susceptible strains were determined by microbroth dilution method RESULTS: Among total 682 isolates exclusive of consecutive ones from the same patients, 199 (29%) were from pus, 152 (22%) from respiratory specimens, 137 (20%) from blood, 38 (6%) from urine. Of 682 isolates, 588 (87%) isolates were resistant to at least one of the aminoglycosides tested. Overall prevalence of MRSA was 64% (439/682), and resistance rates of MRSA were summarized as follows; kanamycin (KM) 98%, tobramycin (TOB) 98%, gentamicin (GM) 95%, amikacin (AMK) 90%, neomycin (NEO) 63%, streptomycin (SM) 31%, netilmicin (NET) 18%, arbekacin (ABK) 13%. MRSA isolates were resistant to multiple aminoglycosides, and 88% of them were resistant to all four aminoglycosides of KM, TOB, GM, and AMK. MICs of ABK against 58 non-susceptible strains ranged from 2 to 128 microgram/mL. CONCLUSION: More than 90% of MRSA isolates were resistant against kanamycin, tobramycin, gentamicin, and amikacin. Moreover, most of MRSA isolates were multi-drug resistant to all these four aminoglycosides. Resistance rates against arbekacin and netilmicin were less than 20%. Arbekacin was the most susceptible antibiotic of the aminoglycosides tested.

Prevalence and Risk Factors of Candida Sepsis in Neonatal Intensive Care Unit

PURPOSE: With the development of neonatal intensive care and the increased use of systemic antibiotics, candida sepsis has become one of the most important causes of neonatal morbidity and mortality. The purpose of this study was to investigate the prevalence rate and its associated risk factors. METHODS: We retrospectively reviewed medical records of 28 cases with candida sepsis who were admitted in the neonatal intensive care unit(NICU) of Chonnam University Hospital from July 1995 to June 2001. Twenty-nine patients without candida sepsis were enrolled for the control group to verify the risk factors. RESULTS: The overall incidence of candida sepsis was 0.61% for all NICU admissions and 3.68% for all very low birth weight infants with the gradual increase of the annual prevalance rate over time. The endotracheal intubation, percutaneous central vein catheter(PCVC), umbilical vein catheter, total parenteral nutrition, intralipid and dopamine were more applied than the control group (P<0.01 for all). The durations of mechanical ventilator care, central catheter appliance, nothing per os, and admission were also significantly longer than the control group(P<0.01 for all). Ampicillin/sulbactam, ceftazidime, amikacin, netilmicin, teicoplanin and imipenem/cilastatin were significantly more used than the control group(P<0.05). The durations of ampicillin/sulbactam, ceftazidime, netilmicin and imipenem/cilastatin administration were also proved to be significant as the risk factors(P<0.01). CONCLUSION: The average annual prevalence rate of candida sepsis in NICU for six years was 0.61% with gradual increasing tendency over time. The elimination of the above risk factors is important in decreasing neonatal morbidity and mortality associated with candida sepsis.

Postpneumonic empyema in childhood.

Fifty-six patients with postpneumonic empyema were treated by sulbactam/ampicillin or cephalothin and netilmicin. Dose of sulbactam/ampicillin was 200 mg/kg per day and of cephalothin was 200 mg/kg per day, and of netilmicin was 5 mg/kg per day. Sulbactam/ampicillin alone was used in 27 patients. Twenty-nine patients were treated with cephalothin plus netilmicin. Days on intravenous antibiotics, days with chest tube, decortication rate, and duration of hospitalization were significantly shorter in sulbactam/ampicillin treatment group compared to cephalothin plus netilmicin group. This study shows that sulbactam/ampicillin is a safe and effective agent in the treatment of postpneumonic empyema in childhood.

Evaluating the Necessity of Routine Monitoring of Netilmicin Serum Concentrations in Korean Pediatric Patients with Normal Renal Function / 감염

BACKGROUND: When pediatric patients with normal renal function were given the recommended keep-up amount of aminoglicocide for the use, they showed a better clinical symptom not indicating the poisonous without checking serum concentrations. We studied this subject against the patients who used Netimilcin in order to know if the blood creatinine significantly increases in a clinic and if it reaches the maximum and minimum concentrations without adjusting the amount and the symptom of infection and the result get better. METHODS: We picked the maximum concentration of drugstuffs 30 minutes after injection and its minimum just prior to the next injection within 24~32 hours with a vein injection of 2 mg/kg/dose Netilmicin with the 8 hours difference against 16 patients at the age between 3 months and 14 years. We measured the blood creatinine at the beginning of the treatment and at the closing, and we decided the medicine serum concentration with TDX system and we counted the result of Pharmaco-kinetic parameter with Simkin PC clinical Database system. To check the patients' result of better clinical conditions, leukocyte values and the temperature were measured 72 hours after the treatment. The analysis of statistics was performed with the use of paired t-test. RESULTS: The average age of 16 patients shows 3.5+/-3.2, average weight 15.2+/-8.5 kg, the leukocyte value first 14.9+/-6.6X10X10X10/mm3, and 72 hours after the treatment it shows 6.6+/-1.9X10X10X10/mm3, average temperature fell from 37.7+/-1 celsius into 36.3+/-0.4 celsius. The average drug amount taken in case of patients showed 2.06+/-0.4, the average treatment period was 7.6+/-2.3 days, the maximum serum concentration shows 5.5+/-1.1 mg/mL, the minimum concentration shows 0.5+/-0.3 mg/mL. The average blood creatinine was first 0.52+/-0.19 mg/mL, and at closing 0.46+/-0.11 mg/dL (P=0.209). The minimum concentration didn't show more than 2 mcg/mL, the blood creatinine didn't increase showing 0.5 mg/mL(P=0.201). CONCLUSION: At the result of checking the medicine concentration of Netilmicin in pediatric patients in our clinic, there is no detecting the betterment of the clinical symptom owing to the decrease of the values of leukocyte. There was no necessity to adjust the amount of medicine from the beginning to the end as there was no sign of change of blood creatinine. In view of this result, we can understand that we don't need the regular examination of the medicine concentration about the aminoglicocide from Korean pediatric patients with normal renal function.

Growing problem of methicillin resistant staphylococci--Indian scenario.

In the present study MRSA prevalence increased from 12% in 1992 to 80.83% in 1999. Indian literature shows that MRSA incidence was as low as 6.9% in 1988 and reached to 24% and 32.6% in Vellore and Lucknow in 1994 and was of the same order in Mumbai, Delhi and Bangalore in 1996 and in Rohtak and Mangalore in 1999. However, in some of the centres it was as high as 87%. All the MRSA isolates in India including in the present study were sensitive to vancomycin and resistance to netilmycin appears to be low among MRSA isolates in India. All the MRSA isolates were also found to be sensitive to teicoplanin in the present study. Like in other Indian studies, resistance to cotrimoxazole, erythromycin, gentamicin, other penicillins and cephalosporins appeared to be a common feature for MRSA isolates in the present study.

Comparación de sensibilidad bacteriana in vitro: amikacina versus netilmicina / Comparation of bacterial sensitivity in vitro: amikacin and netilmicin

Desde su introducción, los aminoglucósidos se han convertido en una parte importante del arsenal antimicrobiano empleado en el ámbito hospitalario. El propósito de este estudio fue comparar la sensibilidad in vitro de diferentes microorganismos frente a amikacina y netilmicina en el Hospital Universitario Dr. Manuel Núñez Tovar, durante 1996 y 1997. De manera general, la sensibilidad a ambos fármacos fue comparable, a excepción de ciertas variaciones para enterobacter sp. y serratia sp

Study of human dermal microvasculature after retrograde intravenous pressure infusion [RIPI]

The morphological changes in human dermal microvasculature induced by retrograde intravenous pressure infusion [RIPI] under arterial occlusion of the lower leg [Bier's block] were studied in 18 male subjects, 12 cases with minor foot laceration subjected to RIPI of the antibiotic netilmicin and six served as healthy control volunteers. The ultrastructural study showed a marked dilatation, especially venous capillaries and postcapillary venules with prominent multilayered basal lamina compared with the controls and the pre- technique samples. Lymphatic capillaries were also dilated. The tight junctions between endothelial cells of both dilated blood and lymphatic capillaries were loosened with the appearance of gaps between them. The investigation showed that RIPI of antibiotic into arterially blocked lower limb enhanced the diffusion of molecules into dermis through dermal blood vessels due to a rise of venous blood pressure without any signs of endothelial cell damage which allowed a high local tissue concentration of the antibiotic at the site of injury

Aminoglycoside Nephrotoxicity Using 99mTc-DTPA Renal Scan / 대한신장학회잡지

Aminoglycoside has a broad-spectrum bactericidal activity and especially excellent effect on gram negative bacteria. But, its harmful effect is existed about kidney and ear. Among these, many studies were done about aminoglycoside nephrotoxicity. Until now, many authors have been reported its incidence was 4.45-45%. We needed parameters monitoring about nephrotoxicity. So, our study was done using 99mTc-DTPA renal scan to evaluate nephrotoxicity. We enrolled forty patients who admitted due to infection. 32 patients received Netilmicin and 8 patients Isepamicin. Mean duration and dosage were 8 days, 200mg daily. We accomplished 99mTc-DTPA renal scan, 24hr urine study and blood sampling before starting antibiotics. After mean 8 days, same procedure was repeated. Aminoglycoside nephrotoxicity(defined as 50% GFR reduction) was presented in only one patient. She didn't have risky factor, such as hepatic dysfunction, hypotension, previous renal problem. However, duration was longer than other patients(13 days). GFR was fallen by 25-50% in 6 patients. This finding represent nephrotoxic effects of aminoglycoside indirectly. Above 6 patients had not any characteristics compared to other 33 patients. In addition to renal scan, sodium excretion was increased compared to pre-antibiotics, and glomerular filtration rate using 99mTc-DTPA renal scan was positively correlated with 24hr urine creatinine clearance, GFR by Cockcroft & Gault equation. I conclude that aminoglycoside has nephrotoxic effect when used for longer period. Thus, I suggest that DTPA renal scan including other many renal monitoring method has usefulness in revealing aminoglycoside nephrotoxicity.

The Trend of Species and Microbial Susceptibility of Bacteria Isolated from the Anophthalmic Socket and Fellow Normal Conjunctiva

In 189 consecutive non-inflamed anophthalmic patients wearing uniocular prosthesis, the conjunctival flora was evaluated and compared to that of the opposite healthy eye. And this results were compared with that of department of clinical pathology studied from January 1997 to July 1998. The incidence of bacterial isolation on the anophthalmic side (63.5%) was significantly higher than that on the healthy side (28.0%). Especially, the incidence of potential pathogenic bacterial isolation. (S.aureus, streptococci spp. and gram-negative bacilli grouped together) on the anophthalmic side (42.3%) was very significantly higher (p90%) in all bacterial isolate from the both anophthalmic socket and fellow normal conjunctiva. The bacteria isolated from the anophthalmic socket and fellow normal conjunctiva were similarly sensitive to vancomycin,clindamycin, gentamicin, imipenem, tobramycin, amikacin, netilmicin, colistin and were resistant to penicillin, ampicillin and tetracycline. No significant difference in the anophthalmic conjunctival flora between our study and the previous report but the antimicrobial susceptibility to clindamycin in coagulase-negative staphlyococcus (CNS) and S.aureus from the anophthalmic socket is higher than that of the previous report. The antimicrobial susceptibility to erythromycin in gram-positive bacteria except coagulase-negative staphlyococcus (CNS) and S.aureus from the anophthalmic socket is lower than that of the previous report. The species isolated from our study were more sensitive to the majority of antimicrobial agents than that of the microbial laboratory report. But,the antimicrobial susceptibilities of our study to chloramphenicol and colistin were very significantly lower than that of the microbial laboratory report (p<0.001).