[Initial empirical antimicrobial therapy with piperacillin/tazobactam in intra-abdominal infections due to perforation of the large intestine and rectum and in postoperative complications after resection of the large intestine and rectum]. / Iniciální empirická antimikrobní lécba piperacilinem/tazobaktamem u nitrobrisních infekcí z perforace tlustého streva a konecníku a u pooperacních komplikací po resekci tlustého streva a konecníku.

One of the basic therapeutic procedures in surgical intraabdominal infections is early administration of antimicrobial drugs. The basic requirement for the selection of antimicrobial drugs is a broad-spectum bactericide action with low toxicity. Within the framework of a retrospective non-comparative investigation the action of the betalactam antibiotic piperacillin combined with the betalactamase inhibitor tazobactam was tested which was used in the initial empirical antimicrobial treatment of 33 patients with intraabdominal infectious complications caused by perforation of the large bowel or dehiscence of the anastomosis on the large intestine or rectum. Twenty-eight patients developed diffuse inflammation of the peritoneum (caused by perforation of a diverticulum in 17, by dehiscence of the anastomosis on the large intestine and rectum after resection on account of carcinoma in 7, by a penetrating injury of the large bowel and rectum in 3 and by postirradiation necrosis of the rectum in one female patient). Five patients developed an intraabdominal abscess as a complication of diverticulitis of the large intestine or as a postoperative infectious complication after resection of the large bowel and rectum. All patients were operated (resection of the large bowel according to Hartmann, or stoma above the site of injury or dehiscence of the intestinal anastomosis or drainage of the abscess). After surgery administration of piperacillin/tazobactam (4.5 g, subsequently after 8 hours). The period of administration was on average 8 days (5 to 11 days). After surgery the contents of the peritoneal cavity were collected for bacteriological examination incl. evaluation of the sensitivity of the isolated bacteria to piperacillin/tazebactam. From the isolated pathogens 58% were Gram-negative aerobic bacteria, in 24% anaerobic bacteria and in 18% enterococci. In 3 patients antimicrobial treatment was because of resistance of isolated bacteria to piperacillin/tazobactam (Klebsiella species, Pseudomonas aeruginosa) combined with aminoglycosides (amikacin, netilmicin). Postoperative complications developed in 9 patients (27%), incl. 3 who died (9%). In patients with intraabdominal infection caused by perforation of the large bowel and rectum or dehiscence of the anastomosis after resection of the large bowel and rectum piperacillin/tazobactam is the antibiotic of choice for the initial empirical antimicrobial treatment on account of its great efficacy against the majority of isolated bacteria, its safety and low toxicity.

Pseudomembraneous clostridium after autologous bone marrow transplantation.

Clostridium difficile (C. difficile) pseudomembraneous colitis was diagnosed in a 13-year-old boy with Hodgkin's disease 3 months after autologous bone marrow transplantation. Hematopoiesis was fully reconstituted at the time. C. difficile infection occurred after gall bladder empyema had been treated conservatively with i.v. antibiotics and prophylactic 4-week administration of oral amoxicillin. C. difficile colitis was diagnosed early and intensive supportive therapy combined with administration of i.v. and subsequently oral vancomycin therapy failed. It is a phenomenon rarely seen and successful eradication of the clostridium infection was only achieved by a combination of higher dose vancomycin with metronidazole. During the post-colitis recovery the patient experienced a relapse of Hodgkin's disease and died following further surgical intervention 137 days post-transplantation.

[Preparation, storage, transportation and use of heart valves for allotransplantation]. / Príprava, skladování, transport a pouzití allotransplantátu srdecních chlopní.

UNLABELLED: Thanks to the co-operation with Czech and Slovak Transplant Centres and with some of the Departments of Pathology and Forensic Medicine 274 hearts were collected for allograft heart valves (AHV) processing during 1992-1995. The Cardiac surgeon dissected the aortic valve with the root and the pulmonary artery trunk with the valve. Tissues were antibiotically (ATB) sterilised in cultivation medium E 199 (24 hours at 37 degrees C). ATB concentrations (mg/ml): Cepharin 0.2, Azlocilin 0.2, Tobramycin 0.08 and Amphotericin B 0.1 for harvesting at post-mortem (P) or Miconazol 0.05 for sterile retrieval during multiorgan harvesting (MOH). After sterilisation AHV were stored at 4 degrees C. 49 AHV were infected even after ATB treatment-15 of 35 collected at P (43%) and 35 of 218 procured during MOH (16%)-(p < 0.01-ch2 test). After serological screening of the donor and microbiological testing the AHV were released for clinical use. Most AHV were programmed cooled to the temperature of liquid nitrogen (-196 degrees C), in which they were stored at the Allograft Heart Valves Cryobank. Cryoprotection was achieved by 10% dimethylsulphidoxide. CONCLUSION: A technology of harvesting, processing, storage and transportation of AHV, was introduced. It enabled the routine use in many cardiac surgical units. The AHV Cryobank was established. 131 AHV were used clinically between 1992 and 1995 (transportation as far as 1300 km). 108 AHV (82.4%) were used for repair of complex congenital heart defects, while 23 (17.6%) were used for aortic valve and/or root replacement.

[The present status and future perspectives of fluorinated quinolones from the aspect of clinical microbiology]. / Soucasnost a perspektiva fluorovaných chinolonu z pohledu klinického mikrobiologa.

The author presents a review on the contemporary position of fluoroquinolones from the microbiological and clinical aspect. He submits basic data on the mechanism of action of these drugs and development of resistance displayed by infectious agents. Favourable pharmacokinetics make wide clinical use of these drugs possible. Indiscriminate administration could debase these drugs possible. Indiscriminate administration could debase these very valuable antimicrobial drugs. This is why the author presents in his paper the main clinical indications for their therapeutic use. To complete the problem the author makes suggestions of suitable combinations and draws attention to possible therapeutic interactions and undesirable effects, incl. contraindications.

[Immunotherapy as part of comprehensive therapy in abdominal reoperations with septic complications]. / Imunoterapie jako soucást komplexní lécby u nitrobrisních reoperací pro septické komplikace.

On the base of literature and clinical experience indications of human immunoglobulins in the treatment of infections in surgical patients are presented. Besides prophylactic using in elective operations immunoglobulins were administered as a part of treatment in septic complications, postinjured infections, hospital acquired infections in ICU and immunosuppression. Application of immunoglobulins are regularly part of adjuvant therapy of sepsis in surgical patients. Intravenous immunoglobulins--Pentaglobin and Endobulin were administered postoperatively in patients with reoperations for postoperative peritonitis. For evaluation of effects of immunoglobulins there are presented some clinical and laboratory parameters of sepsis.

[Treatment of infectious complications affecting the skin and soft tissues with cefpodoxime proxetil]. / Lécení infekcních komplikací kuze a mekkých tkání cefpodoxim proxetilem.

The authors present their experience with antimicrobial treatment with cephalosporin of the third generation, cefpodoxime proxetil, in skin and soft tissue infections in a group of patients treated at the ambulatory department of the Surgical Clinic in Prague 10 in 1995. From the total number antimicrobial treatment was administered to 6 patients with a phlegmon, 5 patients with panaritium, 4 patients with an early infection after laparotomy, 3 with an abscess in the subcutaneous layer, and with cheilitis and bursitis of the olecranon in the remaining two patients. In addition to surgical treatment (incision, evacuation and drainage) cefpodoxime proxetil-200 mg after 12-hour intervals for 6-9 days-was administered to the patients. For microbiological examination a smear from the inflammatory focus and from the nasopharynx was used. The cefpodoxime proxetil serum level was assessed during the 1st-11th hour after administration of the antibiotic. All 20 patients recovered.

[Fluoroquinolones in antimicrobial therapy and prophylaxis in surgery]. / Postavení fluorochinolonu v antimikrobní terapii a profylaxi v chirurgii.

The authors evaluate, based on laboratory and clinical experiments, the importance of quinolones in the antimicrobial prophylaxis and therapy in surgery. In the laboratory investigations they assessed the present state of resistance of some Gram-negative and Gram-positive bacteria to fluoroquinolones-pefloxacine, ofloxacine and ciprofloxacine. In the clinical part the authors made a comparative study of pefloxacine and a cephalosporin of the third generation, ceftazidime, in the treatment of nosocomial postoperative and posttraumatic inflammatory affestions of the lower airways in 20 patients in both groups. The patients were hospitalized at the intensive care unit in 1993-1994. The action of the two chemotherapeutic agents was comparable, in 18 patients of both groups the infections disappeared and regression of the inflammatory pulmonary affection was recorded.

[Tactics in antimicrobial prophylaxis in surgery]. / Taktika antimikrobní profylaxe v chirurgii.

Based on data in the literature and the authors' own experience, the authors recommend antimicrobial prophylaxis in abdominal and thoracic surgery. They give the reasons for antimicrobial prophylaxis, risks of developing postoperative infection, risks of the patient as well as risks depending on the surgeon and hospital environment. The authors discuss factors which limit the selection of a preparation for antimicrobial prophylaxis and finally they submit suggestions for optimal selection of drugs in antimicrobial prophylaxis.

[New approaches in the use of antibiotics in the treatment of postoperative intra-abdominal infections]. / Nové postupy vyuzití antibiotik v terapii pooperacních nitrobrisních infekcí.

The authors present the results of a clinical investigation on the therapeutic use of carbapenem, imipenem/cilastatin in 20 patients operated on account of intraabdominal inflammatory affections, hospitalized at the intensive care unit of the Surgical Clinic of the Third Medical Faculty, Charles University, Prague in 1993. Imipenem/cilastatin was administered to patients during surgery--500 mg i.v.--and subsequently after 8--hour intervals for 5-8 days. During comprehensive treatment no superinfection developed and the patients recovered.

[Augmentin and Tiberal in elective colorectal surgery (comparison of serum and tissue levels and clinical results]. / Augmentin a Tiberal v elektivní kolorektální chirurgii (Srovnání sérových a tkánových hladin a klinických výsledku).

In a group of 340 patients subjected to colorectal surgery for antimicrobial prophylaxis amoxicillin clavulanate (Augmentin) or ornidazole (Tiberal) was used, in both instances as short-term monoprophylaxis. To test the effectiveness of prophylaxis, the clinical results were evaluated, expressed by the number of infectious complications, as well as serum and tissue levels of the two preparations used for prophylaxis. In serum and tissue they reached the MIC level of the tested microbial spectrum; an inadequate level was found in all probands in subcutaneous adipose tissue. The clinical result of 4.8% infectious complications when using ornidazole and 3.2% when using amoxicillin clavulante resp. is considered as evidence of the effectiveness and correct selection of preparations and also of sufficient short-term prophylaxis.

[Short-term prophylaxis with ceftriaxone in planned intrathoracic operations]. / Krátkodobá profylaxe ceftriaxonem u plánovaných nitrohrudních operací.

The purpose of the investigation was to evaluate the effect of short-term prophylaxis with a cephalosporin of the IIIrd generation, ceftriaxone, in 20 patients with an elective intrathoracic operation. The investigation comprised patients operated on account of bronchogenic carcinoma, metastases in the lungs, relapsing spontaneous pneumothorax and carcinoma of the distal cesophagus. ceftriaxone - 1 g was administered before the introduction to anaesthesia. The second 1 g dose was administered after 12 hours. In addition to the microbiological examination of the bronchial secretion and evaluation of the minimal inhibitory concentration of ceftriaxone to the isolated bacteria the ceftriaxone serum level was assessed in the patients and its concentration in the pulmonary parenchyma. Postoperative inflammatory complications/pneumonia/ were detected in two patients. With regard to the long serum half-life/longer than surgery/ ceftriaxone is suitable for short-term prophylaxis in thoracic surgery. The serum level and ceftriaxone penetration into the pulmonary parenchyma is higher than the minimal inhibitory concentration in the majority of isolated bacteria.

[Use of 3rd generation cephalosporins in antimicrobial prophylaxis in surgery]. / Aktuální pohled na pouzití cefalosporinu. III. generace v antimikrobní profylaxi v chirurgii.

In a general and special review the authors discuss contemporary possibilities of antimicrobial prophylaxis in surgery focused on cephalosporins of the third generation. According to available data on the incidence of resistance, pharmacokinetics and others the most suitable preparations seem to be cefotaxime and ceftriaxone. They are used in particular in thoracic surgery, hepatobiliary surgery, colorectal surgery and urology.

[Actinomyces viscosus in subdural empyema]. / Actinomyces viscosus v subdurálním empyému.

The authors describe the finding of Actinomyces viscosus in pus from a subdural empyema in a child patient. When searching for the probable primary source of this uncommon infection of the central nervous system the authors identified by cultivation the same bacterial strain in a periapical dental granuloma. Bacterial diagnosis and radical surgical and antimicrobial therapy led to normalization of a clinical condition with an initially unfavourable prognosis.

[In vitro activity of chemotherapeutic agents on the most common bacterial agents causing urinary infections]. / Soucasná aktivita chemoterapeutik in vitro u nejcastejsích bakteriálních agens vyvolávajících mocové infekce.

The authors made an investigation of the contemporary position as regards the effectiveness of chemotherapeutic agents used for treatment of infections of the urinary pathways caused by the most frequently found infectious agents in out-patients, small Prague hospitals and the University hospital in Prague-Motol. The dominating infectious agent causing urinary infections remains E. coli. A serious feature is the increase of enterococcal infections in hospitals. As to the antibacterial effect, a dominant position is held by furantoin, in enterococcal infections in hospitals. high antibacterial activity of fluoroquinolones is, however, also associated with the responsibility to use them rationally.

[Antimicrobial prophylaxis with cefamandole in biliary tract surgery]. / Cefamandol v antimikrobní profylaxi v biliární chirurgii.

The authors present their experience with antimicrobial prophylaxis using cephalosporin of the second generation--cefamandole--in biliary surgery. Cefamandole was administered to 28 patients operated for a biliary affection and hospitalized at the Surgical Clinic of the Third Medical Faculty in Prague. Cefamandole was administered after 8-hour intervals in 1 g doses up to 48 hours after the first dose. For antimicrobial prophylaxis patients were selected, included after previous investigations in the high risk group. In the patients in addition to microbiological examination of bile the cefamandole levels in bile and serum were compared. The presented results proved that cefamandole administration is justified in the prevention of infectious complications after operations of the gallbladder and biliary pathways because of its antibacterial and pharmacokinetic properties.

[Intensive care in patients with intra-abdominal septic complications]. / Intenzívní péce o nemocné s nitrobrisními septickými komplikacemi.

The authors investigated diagnostic and therapeutic possibilities of intensive care units when treating septic conditions in intraabdominal surgery. The authors emphasize the comprehensive and systematic character of the follow up of patients who are threatened by sepsis. Care involves in particular aimed antimicrobial therapy, immunotherapy, normalization of haemodynamics and the acid-base balance and rational parenteral nutrition. Only a thus conceived therapeutic regime makes it possible to control such serious conditions as sepsis.

[Isolation of Nocardia asteroides using hemoculture (clinical report)]. / Izolace Nocardia asteroides z hemokultury (sdelení z praxe).

The authors describe the finding of Nocardia asteroides from a haemoculture in a patient with right-sided pneumonia and several predisposing factors (TB, chronic bronchitis, anamnestic hepatitis, chronic hepatopathy, anaemia, ethylism and a neoplasm revealed in the final stage). Early bacteriological diagnosis and aimed antimicrobial therapy led to radical improvement of the very dramatic clinical condition. The authors discuss the possible higher incidence of the infectious agent, which previously was detected only very rarely.

[Present possibilities of therapy of septic shock in surgical patients]. / Soucasné moznosti v terapii septického soku u chirurgických nemocných.

The authors present a review of contemporary possibilities of septic shock in surgical patients. As mentioned by the authors, the most frequent cause of Gram-negative sepsis in surgery are intraabdominal inflammatory diseases or septic complications after planned surgery. Based on an experimental study on acute endotoxin shock in dogs and treatment with hydrocortisone, dopamine and antihypertensive drugs (mepamil and metazosine), the authors present some principles of the therapeutic procedure in endotoxin shock under clinical conditions. They emphasize in particular administration of antibodies against endotoxin and cytokines. In the clinical part they submit results of comprehensive therapy of intraabdominal sepsis in patients hospitalized at the intensive care unit of the Surgical Clinic at the Third Medical Faculty in Prague. They give an account of the principles of peroperative and postoperative treatment within the framework of differentiated care. During the postoperative period it is important to ensure prevention and treatment of septic complications such as septic shock and the syndrome of multiorgan systemic failure as well as rational antimicrobial therapy, immunotherapy and adequate nutrition. The authors emphasize that it is essential that specific antibodies are available and indications of their administration must be defined. The expected effect of immunotherapy is limited by the period of administration in relation to early stages of sepsis.

[Immunologic cross reactivity of beta-lactam antibiotics]. / K otázce zkrízené imunologické reaktivity betalaktamových antibiotik.

The authors investigated the antibody response against beta-lactam antibiotics (penicillins, cephalosporins, monolactams, carbapenes) in conjugation with allergic reactions after penicillin administration. The results revealed a high percentage of positive antibody responses against penicillin and high percentage of crossed immunological reactivity between penicillin and the other investigated preparations.