Subject(s)
Death Certificates , Ethics, Medical , Euthanasia, Active , Suicide, Assisted/legislation & jurisprudence , Adolescent , Adult , Aged , Aged, 80 and over , Euthanasia/legislation & jurisprudence , Female , Humans , Male , Middle Aged , Patient Participation/legislation & jurisprudence , UtahABSTRACT
Bacterial conjunctivitis appears to resolve more rapidly when treated with appropriate topical antimicrobial agents. In this multicenter, randomized, double-blind study of efficacy and safety, patients with presumed bacterial external eye infections were assigned to topical therapy with 0.3% norfloxacin or 0.3% tobramycin. A total of 120 patients were enrolled. Of the total, 65 had documented bacterial infections and were evaluable; 59 of these patients had bacterial conjunctivitis. All of the patients with documented infections were cured or improved regardless of the drug treatment regimen or in vitro susceptibility testing results. The most common bacteria isolated were Haemophilus influenzae, Streptococcus pneumoniae, alpha-hemolytic streptococci, Staphylococcus aureus, and Staphylococcus sp. No patients had serious adverse reactions attributed to their therapy. Norfloxacin ophthalmic solution seems to be a safe, effective, and appropriate agent for the treatment of bacterial external eye infections.
Subject(s)
Blepharitis/drug therapy , Conjunctivitis, Bacterial/drug therapy , Eyelid Diseases/drug therapy , Norfloxacin/therapeutic use , Tobramycin/therapeutic use , Administration, Topical , Adolescent , Adult , Aged , Aged, 80 and over , Blepharitis/microbiology , Child , Child, Preschool , Clinical Trials as Topic , Conjunctiva/microbiology , Conjunctivitis, Bacterial/microbiology , Double-Blind Method , Eyelids/microbiology , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Multicenter Studies as Topic , Ophthalmic Solutions , Random AllocationABSTRACT
Otolaryngologists have increased their use of parenteral prophylactic antibiotics to prevent toxic shock syndrome following nasal surgery. This rare but potentially serious postoperative complication presumably requires nasal carriage of a toxigenic strain of Staphylococcus aureus by a susceptible patient. We investigated the effect of a single preoperative dose of intravenous cefazolin on nasal carriage of S aureus. Thirty patients were studied; 15 were S aureus carriers initially and 12 (80%) remained culture positive after prophylaxis and at the time surgery was completed. We conclude that this particular regimen is unlikely to have a major effect on the incidence of toxic shock syndrome following nasal surgery.
Subject(s)
Cefazolin/administration & dosage , Shock, Septic/prevention & control , Drug Administration Schedule , Evaluation Studies as Topic , Humans , Injections, Intravenous , Nose/microbiology , Nose/surgery , Premedication , Prospective Studies , Staphylococcus aureus/isolation & purificationABSTRACT
Children have frequent staphylococcal infections, and many lack antibody to TSST-1, a toxin associated with the toxic shock syndrome (TSS). To determine why there have been no nonmenstrual cases of TSS reported in children in Utah, the authors tested S. aureus isolated from children for TSST-1 by radial immunodiffusion and sera from other hospitalized children by radioimmunoassay for antibody to TSST-1. TSST-1 was produced by 25% of S. aureus. Fifty-two children had infections with toxin producing strains. None had TSS. The prevalence of presumably protective levels of antibody (greater than or equal to 1:100) was high in newborns (80%), declined until age 2 years and then gradually increased with age. Therefore, there may have been about 20 children with toxigenic infection who lacked protective antibody but did not show the usual features of TSS. We conclude that the rarity of TSS in children is not caused by misdiagnosis, underreporting, or the absence of toxigenic strains or susceptible patients. Additional factors, such as local conditions or duration of carriage, may influence the clinical presentation of infection with TSST-1 producing staphylococci.
Subject(s)
Antibodies, Bacterial/analysis , Bacterial Toxins , Enterotoxins/immunology , Shock, Septic/epidemiology , Staphylococcal Infections/immunology , Staphylococcus aureus/immunology , Superantigens , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Retrospective Studies , Shock, Septic/immunology , Shock, Septic/microbiologyABSTRACT
Toxic shock syndrome (TSS) occurs most often in menstruating women who use tampons. It also occurs following surgical procedures. The occurrence of three cases after nasal surgery prompted us to determine the incidence of this complication and to evaluate possible risk factors. Our cases showed that onset of TSS after surgery is rapid. Early symptoms include nausea, vomiting, diarrhea, erythroderma, and hypotension. The wound does not appear grossly infected. Incidence of TSS after nasal surgery during 1980 through 1983 was 16.5 per 100,000, higher than the incidence in women of menstrual age. Splints were used more frequently in patients who developed TSS than in patients who did not. Nasal packing was used in all patients with TSS and in 98% of all patients. Topical or systemic antibiotics did not have a demonstrable protective effect.
Subject(s)
Nasal Septum/surgery , Nose/surgery , Postoperative Complications , Shock, Septic/etiology , Adult , Female , Humans , Male , Occlusive Dressings/adverse effects , Rhinoplasty/adverse effects , Shock, Septic/epidemiology , Splints/adverse effects , Staphylococcal Infections/etiology , Surveys and Questionnaires , Turbinates/surgery , UtahSubject(s)
Antibodies, Bacterial/analysis , Bacterial Toxins , Carrier State/epidemiology , Enterotoxins/immunology , Nasal Mucosa/microbiology , Staphylococcus aureus/isolation & purification , Superantigens , Adolescent , Adult , Aged , Child , Enterotoxins/biosynthesis , Female , Humans , Male , Middle Aged , Staphylococcal Infections/epidemiology , Staphylococcus aureus/metabolism , UtahABSTRACT
The sustained high incidence of staphylococcal toxic shock syndrome (TSS) in Utah provided an opportunity to examine changes in the epidemiology of this disease during a period of greater media attention to the syndrome and increased scientific understanding of its etiology and pathogenesis. An apparent peak in the statewide incidence of TSS in 1980 appears in part attributable to self-reporting of outpatient cases. The incidence of the syndrome in patients having a nasal operation appears equal to or greater than the incidence in menstrual-age women. The case-fatality ratio and recurrence rate of TSS have declined since widespread recognition of the syndrome, possibly related to earlier diagnosis and initiation of antistaphylococcal therapy. Identifying milder cases has also contributed to a lower mortality.
