RESUMO
OBJECTIVE: To describe the serum concentrations of continuous infusion of cefuroxime for postsurgical prophylaxis of sternal wound infection in patients undergoing coronary artery bypass graft (CABG), and to assess the incidence of sternal wound infection in this population. METHODS: This was a prospective, noncomparative trial involving 54 patients undergoing elective CABG surgery. All patients enrolled in the study received cefuroxime 1.5 g as a single intravenous dose 30 minutes preoperatively, followed by a continuous infusion of 3 g every 24 hours until removal of all central venous catheters. RESULTS: Of the 53 evaluable patients, the mean steady-state cefuroxime serum concentration was 21.6 +/- 14.2 microg/mL (range 6.56-59.5). No patient developed a sternal wound infection. The mean treatment duration was 2.58 +/- 2.13 days (range 1-13). The median hospital and intensive care unit lengths of stay were six days and 46 hours, respectively. The average antibiotic cost per day was $32.76. CONCLUSIONS: These preliminary results of continuous infusion of cefuroxime 3 g/d for prophylaxis of sternal wound infections in CABG patients indicate that serum concentrations are highly variable, but reliably above the minimum inhibitory concentration for the common anticipated pathogens in this setting. Further comparative trials in a larger number of patients are necessary before this mode of administration can be routinely advocated for prophylaxis.
Assuntos
Cefuroxima/sangue , Cefalosporinas/sangue , Ponte de Artéria Coronária , Adulto , Idoso , Idoso de 80 Anos ou mais , Cefuroxima/administração & dosagem , Cefuroxima/economia , Cefalosporinas/administração & dosagem , Cefalosporinas/economia , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/economia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
Of the many causes of serous detachment of the macula, toxoplasmic retinochoroiditis is one of the least common. A case presented which responded to only medical treatment. The clinical picture of this case is consistent with the theory that the organisms may in some instances reach the retina from the optic nerve through an embryologic extension of the ventricular system of the brain. Early diagnosis and treatment can prevent significant permanent visual loss as well as unnecessary retinal photocoagulation.
