ABSTRACT
A comparative randomized study was designed to evaluate the prophylactic effect of two different combinations of antimicrobials, i.e. metronidazole-fosfomycin (n = 30) and metronidazole-cephalothin (n = 28), in elective colorectal surgery. The study was strictly consecutive and the treatment groups comparable. The total rate of surgical septic complications was low (10%) in both treatment groups. No anaerobic infections could be demonstrated and the clinical course was mild in all patients developing septic complications. No other antimicrobial therapy was given. Peroperative bacteriological sampling yielded aerobes and anaerobes in 51 and 32, respectively, of 58 patients. A high percentage of the isolated aerobes and anaerobes were cephalothin-resistant, whereas most aerobes were sensitive to fosfomycin. Only aerobes were isolated from surgical septic sites. The absence of anaerobic sepsis must be ascribed to the metronidazole prophylaxis; the probable reason for the low rate of surgical aerobic septic complications is that antimicrobials, active against aerobes, were included in the prophylactic regimens. The combination, metronidazole-fosfomycin, seems adequate and safe for continued evaluation.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Bacterial Infections/prevention & control , Cephalothin/administration & dosage , Colon/surgery , Fosfomycin/administration & dosage , Metronidazole/administration & dosage , Rectum/surgery , Bacteroides , Clinical Trials as Topic , Colonic Diseases/surgery , Drug Therapy, Combination , Escherichia coli , Humans , Microbial Sensitivity Tests , Postoperative Complications , Random Allocation , Rectal Diseases/surgery , Sepsis/prevention & controlABSTRACT
In view of the high incidence of thromboembolic complications after the insertion of cardiac valve prostheses, platelet adhesiveness and aggregation was measured in whole blood before, during, and for several days after this operation in 10 patients. Cardiopulmonary bypass resulted in a profound decrease in the platelet count, in the number of adhesive platelets, and in platelet aggregation. These changes returned to near preoperative levels by the sixth postoperative day. Thereafter a consistent and sustained increase in platelet count, in the number of adhesive platelets, and in platelet aggregation was observed. The results suggest that the prevalence of thromboembolism after valve replacement may be due partly to changes in platelet behaviour.
