Bivalirudin as an adjunctive anticoagulant to heparin in the treatment of heparin resistance during cardiopulmonary bypass-assisted cardiac surgery.

Heparin resistance (unresponsiveness to heparin) is characterized by the inability to reach acceptable activated clotting time values following a calculated dose of heparin. Up to 20% of the patients undergoing cardiothoracic surgery with cardiopulmonary bypass using unfractionated heparin (UFH) for anticoagulation experience heparin resistance. Although UFH has been the "gold standard" for anticoagulation, it is not without its limitations. It is contraindicated in patients with confirmed heparin-induced thrombocytopenia (HIT) and heparin or protamine allergy. The safety and efficacy of the use of the direct thrombin inhibitor bivalirudin for anticoagulation during cardiac surgery has been reported. However, there have been no reports on the treatment of heparin resistance with bivalirudin during CPB. In this review, we report the favorable outcome of our single-center experience with the alternative use of bivalirudin in the management of anticoagulation of heparin unresponsive patients undergoing coronary artery bypass graft surgery.

[Not Available]. / Listériose humaine : Expériences cliniques avec cette zoonose chez 12 patients en Estrie, Québec sur une période de 19 ans (1976 à 1995).

To review the epidemiology, risk factors, clinical features and outcomes of Listeria monocytogenes infection in the Eastern Townships of Quebec, a retrospective study was completed over the period 1976 to 1995. Cases were identified from positive cultures and diagnosis given by the infectious diseases service of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec. A total of 12 cases were in the study. Septicemia not related to pregnancy (four of 12) and meningitis (six of 12) were the major clinical presentations. There was one case of listeriosis associated with pregnancy and one case of granulomatosis infanti septica. Ten patients had at least one predisposing underlying condition. Only one death was related to L monocytogenes infection. Neurological sequelae were observed in half of the cases of meningitis, whereas no sequelae were noted in cases of septicemia. In conclusion, listeriosis is predominantly a disease of elderly and immunosuppressed patients. The clinical presentation and outcome are not different from those reported in other industrialized countries.

Staphylococcus aureus mediastinitis: prognostic usefulness of an early medicosurgical therapy.

Six cases of acute Staphylococcus aureus mediastinitis after median sternotomy were reported. Five resulted from an asymptomatic disseminator of S aureus present in the operating room. Each case was characterized by an acute bacteremic phase, occurring after a mean interval of 8.2 +/- 1.7 days after the surgical procedure; within 24 to 36 hours all patients had a temperature above 39 degrees C, toxic appearance, and marked leukocytosis. Pericicatricial inflammation was moderate, instability of the sternum was present in only two patients, and chest roentgenogram was not helpful in making an early diagnosis. No risk factor for mediasinitis in connection with the perioperative or postoperative periods was noted in cases compared with a control group of 103 patients. All strains of S aureus were susceptible in vitro to the antibiotic regimen used in prophylaxis. All patients underwent early surgical reopening of the mediastinum within 47 +/- 15 hours after the first sign of acute mediastinitis. Mediastinal debridement and continuous irrigation-suction with dilute povidone-iodine solution were associated with intravenous antistaphylococcal therapy for a period of four to six weeks. All patients survived and no recurrence was observed, a finding we think due to early diagnosis and aggressive medicosurgical therapy.

[Actinobacillus actinomycetemcomitans infectious endocarditis. Apropos of 2 cases and review of the literature]. / Endocardite infectieuse à Actinobacillus actinomycetemcomitans. A propos de 2 cas et revue de la littérature.

This work reports two cases of endocarditis caused by Actinobacillus actinomycetemcomitans. As noted in the medical literature, the mean clinical features are a subacute infection without know source of bacteremia, in a male patient aged 40 years or older and who is suffering from a heart disease. In our two presentations, the good response to single antibiotic treatment, although the optimal therapeutic approach is not yet defined, and the lack of embolism phenomena are of special interest. Spectrum of bacteria which can be responsible of infective endocarditis is widening rapidly; this study is an example of this trend.

Protection of indwelling vascular catheters: incidence of bacterial contamination and catheter-related sepsis.

We compared the incidence of catheter contamination and catheter-related sepsis in 200 noninfected patients admitted postoperatively to the surgical ICU. Four methods of catheter fixation were used: (a) povidone-iodine ointment (Betadine) with a sterile gauze and adhesive dressing (Elastoplast); (b) Op-Site film; (c) Op-Site spray followed by Op-Site film; and (d) Beta-dine and Op-Site film. Of 708 catheters used for 200 patients, 516 (72.8%) were cultured. There was no catheter-related septicemia but 13 (2.52%) catheters were contaminated. However, these were evenly distributed among the four groups. We, therefore, conclude that aseptic insertion of catheters, daily inspection of puncture site, and replacement of tubing are the determining factors in preventing catheter-related sepsis.

Infective endocarditis due to Leptotrichia buccalis: a case report.

A patient with Down's syndrome presented with infective endocarditis due to Leptotrichia buccalis. The source of the infection was not detected, but the predisposing factor was a complex cardiac malformation. The disease followed a subacute course, had a number of immunologic manifestations and was successfully treated with a 28-day course of penicillin G, given intravenously. L. buccalis has never been reported before as a cause of endocarditis.

Pitfalls in identification of methicillin-resistant Staphylococcus aureus.

Media and techniques for in vitro testing with respect to screening for methicillin-resistant Staphylococcus aureus are discussed.