ABSTRACT
One hundred twenty-three patients undergoing elective colon surgery were prospectively and randomly assigned to receive either three 1-g perioperative doses of intramuscular cephaloridine or three 1-g preoperative doses of both oral erythromycin base and neomycin sulfate. All patients had their bowels thoroughly cleansed mechanically. The groups were comparable in age and nutritional status. Eight wound infections occurred in the 65 patients receiving cephaloridine (12.3%) v one in the 58 receiving erythromycin and neomycin (1.7%). The difference was statistically significant. Eight of nine infected patients had only wound infections; the majority of cultures yielded Bacteroides fragilis. Serum and tissue antimicrobial concentrations were determined in the first 70 randomized patients at operation. Mean (+/- SD) cephaloridine levels were 14.7 +/- 10.2 and 10.5 +/- 10.0 mg/L in serum and tissue, respectively, compared with 1.98 +/- 1.58 and 0.699 +/- 1.146 mg/L for serum and tissue erythromycin levels.
Subject(s)
Cephaloridine/therapeutic use , Colon/surgery , Erythromycin/therapeutic use , Neomycin/therapeutic use , Premedication , Bacteroides Infections/complications , Bacteroides fragilis/isolation & purification , Cephaloridine/administration & dosage , Clinical Trials as Topic , Drug Therapy, Combination , Erythromycin/administration & dosage , Humans , Injections, Intramuscular , Neomycin/administration & dosage , Prospective Studies , Random Allocation , Surgical Wound Infection/etiologyABSTRACT
During a period of 13 months, 28 serious infections caused by Bacteroides were seen in 27 patients. Sixteen patients yielded Bacteroides fragilis; sera from 13 (81%) of these 16 had increased levels of IgG specific for B. fragilis lipopolysaccharide (LPS) antigens by enzyme-linked immunosorbent assay (ELISA). Sera from 20 normal controls did not have increased specific IgG. Sera from 22 of 23 patients with bacteremia caused by other gram-negative rods also failed to yield increased levels of specific antibody (P less than 0.0012). Analysis of sera from patients with B. fragilis infections disclosed a significant correlation between the levels of specific IgG to B. fragilis LPS measured by ELISA and the IgG antibody to the infecting B. fragilis by indirect immunofluorescence (r = 0.84, P less than 0.012). Two of the remaining 12 infections caused by Bacteroides not apparently due to B. fragilis organisms were also associated with increased levels of specific IgG to B. fragilis LPS antigens. Specific IgG antibody response may be an important adjunct in diagnosis of common B. fragilis infections and may allow better management of antimicrobial agents.
Subject(s)
Antibody Specificity , Bacteroides Infections/diagnosis , Immunoglobulin G , Abscess/diagnosis , Appendix/pathology , Bacteroides fragilis , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique , Humans , Immunoglobulin G/biosynthesis , Pneumonia/diagnosisABSTRACT
The combination of clindamycin phosphate and gentamicin sulfate in treating 53 patients with a variety of serious infections was studied. Initial cultures of specimens from 31 patients yielded both anaerobic and aerobic pathogens. Eleven cultures showed only anaerobic organisms and 11 showed only aerobes. Of patients treated with clindamycin and gentamicin and surgical intervention, 87.8% had bacteriologic cure. Clinical response was poor in only two cases. Two patients developed rash and one had diarrhea, but no reactions suggestive of pseudomembranous colitis were seen.
