Utilidad de la procalcitonina y la proteína c reactiva en las meningitis agudas en urgencias / Usefulness of procalcitonin and C-reactive protein in the acute meningitis in the emergency department

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[Gas gangrene due to Clostridium septicum in a patient with an occult colonic neoplasm. A case report and review of the literature]. / Gangrena gaseosa por Clostridium septicum en un paciente con neoplasia de colon oculta. Presentación de un caso y revisión de la literatura.

A case of gaseous gangrene by Clostridium septicum associated with colorectal cancer is presented. The patient evolved rapidly towards septic shock and death. Autopsy showed occult neoplasm and pelvic and retroperitoneal myonecrosis. An exceptional finding was that of myocarditis in which thick gram-positive bacilli were identified. A review of the literature was carried out regarding the pathogenesis and clinical manifestations of this disease. The association of colonic neoplasm and Clostridium septicum may be related with the sensitivity of the cells of this neoplasm to the toxins of the microorganisms. The usefulness of this cytotoxicity is being tested in the therapeutic reduction of tumoral mass. With respect to clinical attitude, all the authors agree on the need for clinical suspicion as to the possible existence of occult colon neoplasm in individuals with septic shock by gaseous gangrene with no obvious entry site. Diagnosis is performed by imaging techniques with barium enema and if this is normal colonoscopy is carried out. Emergency treatment consists in laparotomy with resection of the neoplasm and debridement of the area accompanied by hyperbaric oxygen and antibiotics.

[The effect of surgical antibiotic prophylaxis and the timing of its administration on the risk of surgical wound infection]. / Efecto de la profilaxis quirúrgica antibiótica y su tiempo de administración sobre el riesgo de infección de herida quirúrgica.

BACKGROUND: Clinical trials have demonstrated the efficacy of surgical prophylaxis (SP). Nevertheless, how the timing of antibiotic administration influences the risk of infection in clinical praxis has scarcely been studied. In this study an assessment was made of whether the non administration of antibiotic, or its administration longer than 2 hours preoperatively, or only postoperatively, are associated with a higher rate of infection of the surgical wound (SWI) compared with antibiotic administration within the two hours prior to surgery in our setting. METHODS: Observational, longitudinal, pseudoretrospective study. It included 2,483 patients undergoing surgery in 1992, with clean-contaminated, contaminated and clean with prophylaxis indication, and without previous infection surgeries. Information on variables potentially associated with SWI and incidence of infection was monitored. A multivariate analysis was made by means of the logistic regression method to evaluate the association of prophylaxis and time of administration, controlling for the remaining variables. RESULTS: 754 patients received appropriate prophylaxis (within 2 hours prior to surgery); 28 of these patients (3.7%) developed SWI. Twenty-four of the 107 who received prophylaxis longer than 2 hours prior to surgery developed infection (22.4%; p < 0.001 compared with the first group; OD: 7.5, 95% CI: 3.94-14.1); in the group of patients non receiving preintervention doses 94 patients developed infection (7.7%; p = 0.001; OR: 2.16, 95% IC: 1.38-3.41). Among patients who did not receive prophylaxis 24 infections were detected (6%; p = 0.10; OR: 1.66, 95% CI: 0.91-2.99). In the multivariate analysis the administration of prophylaxis longer than 2 hours prior to surgery or postoperatively was confirmed to be associated with a higher SWI rate, as in the non-administration situation, controlling for the remaining variables (OR for longer than 2 hours: 5.82; for postoperative administration: 3.23, and for non-administration: 2.68). CONCLUSIONS: The administration of SP is inappropriate in a high percentage of cases. The administration of SP within the 2 hours prior to surgery reduces the risk of SWI, compared with the administration 2 hours or longer prior to intervention or only postoperatively.